Unmasking the role of the occipital lobe in epilepsy with eyelid myoclonia

ABSTRACT Epilepsy with eyelid myoclonia (EEM) is classified within the spectrum of genetic generalized epilepsies. However, the involvement of the occipital lobe in seizure generation in EEM remains a topic of debate. This study aims to investigate the role of the occipital lobe in the pathophysiology of EEM. We reviewed the medical charts and video–electroencephalography (EEG) recordings of patients diagnosed with EEM at the Danish Epilepsy Centre from 2019 to 2024. We included 21 consecutive patients with clinically and video‐EEG‐confirmed EEM. In addition to visual analysis, EEG recordings were assessed using integrated quantitative methods, including amplitude mapping, power spectrum frequency analysis, and source localization. Interictal and ictal epileptiform discharges with onset in the posterior brain regions were consistently observed. Quantitative EEG analysis documented occipital onset within the network involved in eyelid myoclonia, both with and without absence seizures. Furthermore, a focal‐onset occipital seizure was recorded in one patient. These findings support the involvement of the occipital lobe in initiating seizures in EEM and better define the underlying pathophysiological mechanisms of this condition.