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Occipito-Frontal Sharp Waves—An Under-Recognized Electroencephalogram Pattern in Self-Limited Idiopathic Childhood Focal Epilepsy

Wyllie, Elaine; Moosa, Ahsan N. V.

Journal of Clinical Neurophysiology: May 2017 - Volume 34 - Issue 3 - p e9–e14
doi: 10.1097/WNP.0000000000000345
Case Report

Summary: We report four children who highlight the potentially under-recognized electroencephalogram pattern of bilaterally synchronous occipito-frontal sharp waves, which may occur in children with Panayiotopoulos type self-limited childhood epilepsy but may be easily confused with the patterns of symptomatic generalized epilepsy. Our patients were young, healthy children who had infrequent, predominantly nocturnal, fairly prolonged seizures characterized by altered consciousness, vomiting, and autonomic features, or in one case nocturnal secondary generalized tonic-clonic convulsion. Their electroencephalograms showed stereotyped abundant sleep-activated sharp waves with maximum negativity in bilateral occipital and frontal greater than centro-temporo-parietal regions. On a “double-banana” bipolar montage, the sharp waves had upward deflections in frontal electrodes, downward deflections at occipital electrodes, and a positive phase reversal in the middle of each chain. The lower-amplitude occipital discharges slightly preceded the frontal discharges, consistent with posterior-to-anterior propagation likely originating from mesial occipital regions. In the proper clinical context, recognizing the electroencephalogram pattern of bilateral occipito-frontal sharp waves affords confidence in a favorable prognosis, presents the option to possibly defer daily treatment with antiepileptic medication, and shifts the emphasis to rescue medication for isolated seizures.

Section of Pediatric Epilepsy, Epilepsy Center, Department of Neurology, Cleveland Clinic, Cleveland, Ohio, U.S.A.

Address correspondence and reprint requests to Elaine Wyllie, MD, Cleveland Clinic Lerner College of Medicine, Epilepsy Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk S50, Cleveland, OH 44195, U.S.A.; e-mail:

The authors have no funding or conflicts of interest to disclose.

Presented at American Clinical Neurophysiological Society Annual Meeting, Orlando, FL, February 12, 2016.

© 2017 by the American Clinical Neurophysiology Society