Aim: This study aimed to evaluate the clinical, electroencephalography, neuroimaging, and treatment characteristics of childhood occipital epilepsy spectrum disorders and to compare self-limited and symptomatic cases. Materials and Methods: Sixty-four pediatric patients followed between October 2015 and January 2026 were retrospectively evaluated. The patients were classified into three groups according to clinical, developmental, and radiological findings: self-limited, symptomatic, and unclassified. Results: Sixty-four patients were included, comprising 25 (39.1%) self-limited, 36 (56.3%) symptomatic/determinable, and 3 (4.7%) unclassified cases. The mean seizure onset age was 4.77±3.77 years and this was significantly earlier in the symptomatic group (p<0.001). Magnetic resonance imaging abnormalities were identified in 31 patients (48.4%). Autonomic symptoms (54.7%) and nocturnal seizures (37.5%) were common, with nocturnal seizures occurring more frequently in the self-limited group (p=0.014). Occipital epileptiform activity was observed in 55 patients (85.9%), including 24 out of the 25 (96.0%) patients in the self-limited group and 29 out of the 36 (80.6%) in the symptomatic/determinable group. The remaining nine patients (14.1%) demonstrated multifocal epileptiform activity with occipital involvement. Extra-occipital spread of occipital epileptiform discharges was observed in 56.3% of the patients, and generalized spike-wave discharges (31.3%) and spike-wave activation in sleep (9 patients) were identified in both groups. Initial antiseizure medication failure and polytherapy requirement were significantly more frequent in the symptomatic/determinable group. Conclusion: Childhood occipital epilepsies represent a heterogeneous and dynamic electroclinical spectrum rather than sharply separated syndromes. The presence of extra-occipital epileptiform activity, generalized spike-wave discharges, and sleep-activated epileptiform activity supports the concept that childhood occipital epilepsies represent a dynamic electroclinical spectrum. Therefore, long-term neurocognitive and electroencephalographic follow-up remains important, particularly in those children with self-limited occipital epilepsy syndromes as electroclinical evolution may continue despite clinical seizure remission.
