Benign epilepsy of childhood with occipital paroxysms (BECOP)

Epilepsy Action is indebted to Dr Richard Appleton, a Consultant Paediatric Neurologist who specialises in children’s epilepsy, and to Dr Rachel Kneen, Consultant Paediatric Neurologist and Dr Stewart Macleod, Specialist Registrar in paediatric neurology, at Alder Hey at Alder Hey Children’s Hospital, Liverpool, who have kindly prepared the information on this page.

BECOP can start at any age from 15 months to 17 years, but usually begins in middle childhood between seven and 11 years of age.

This epilepsy syndrome is often called ‘late-onset occipital epilepsy’ to separate it from ‘early-onset occipital epilepsy’ (also known as Panayiotopoulos syndrome).

About one third of children have a family history of epilepsy and some children have had seizures with feverish illnesses (febrile convulsions) before starting to have BECOP.

Most children with this condition have normal neurological and learning abilities. Brain scans are normal.

Diagnosis

In the electroencephalogram (EEG), which records the electrical activity in the brain, abnormalities are seen in the occipital region (the very back part of the brain).

As a result some children may have seizures as they go from a dark area into a brighter one, or from a well lit area into a dark one.

Symptoms

The seizures usually affect vision. Complete or partial visual loss occurs in about half the children who have this type of epilepsy. Some may experience a sensation of flashing lights, often multicoloured spots. Visual hallucinations (seeing things) are rare but occur in some children.

About half have jerking of one side of the body. Semi-purposeful movements and behaviour is rarer and generalised tonic clonic seizures may also occur.

Headaches are a very common feature of this epilepsy syndrome. These headaches may occur during or after the seizure.

Treatment

The seizures respond readily to anti-epileptic drugs such as sodium valproate (Epilim), or carbamazepine (Tegretol).

There is currently no information as to whether the newer anti-epileptic drugs may also be helpful in this syndrome (eg: lamotrigine (Lamictal), levetiracetam (Keppra) or topiramate (Topamax).

Prognosis (outlook)

The outlook is good for neurological development. There are educational problems only in rare cases. The seizures usually get better by puberty but in five to 10 out of 100 cases, they persist into adulthood.

Support organisations

Contact a Family,
209-211 City Road,
London, EC1V 1JN,
telephone 0808 808 3555,
http://www.cafamily.org.uk/

9 March 2007