Isolated Paroxysmal Right Upward Eye Deviation as the Sole Semiology of Childhood Occipital Epilepsy: An Electroclinical Case Report.

Abstract

BackgroundIsolated paroxysmal eye deviation in children is often considered a benign nonepileptic phenomenon. When epileptic in origin, gaze deviation is usually accompanied by visual symptoms, autonomic features, impaired awareness, or additional motor manifestations.CaseWe report a 6-year-old boy with frequent daily episodes of brief right upward eye deviation without impaired awareness, visual symptoms, head version, or other ictal features. Neurological and ophthalmological examinations, routine laboratory investigations, and brain magnetic resonance imaging were unremarkable. Video-electroencephalography demonstrated repetitive spike-wave discharges over the left occipital region, supporting an epileptic origin.ResultsCarbamazepine treatment markedly reduced episode frequency, and the spells resolved completely after dose adjustment during follow-up. Next-generation sequencing analysis of calcium channelopathy-related genes revealed no pathogenic variants.ConclusionsThis case highlights that isolated paroxysmal right upward eye deviation, even in the absence of other ictal features, may represent a focal preserved consciousness seizure rather than a benign ocular phenomenon. Early electroencephalographic evaluation is essential in children with frequent or atypical paroxysmal eye movements to avoid misdiagnosis and delayed treatment.