Occipital Needle-Like Spikes in a Visually Intact Child with Dystonia: Insights from Ambulatory EEG

Needle-shaped occipital spikes are most often described in children with cortical visual impairment or congenital blindness. We report the case of a 5-year-old child with developmental delay, microcephaly based on an occipitofrontal circumference below the 3rd percentile, and recurrent dystonic movements. Despite the reduced head size, MRI of the brain and spine showed no additional structural abnormalities beyond the microcephaly, and her vision was clinically normal. She underwent ambulatory EEG for episodes of abnormal posturing. The study showed low-voltage, surface-negative spikes maximal at O2 that persisted throughout the recording without associated clinical events, while background activity remained normal. Although these discharges have features that may resemble benign EEG variants, their interpretation should be cautious given the patient's developmental and neurological background. Recognizing such patterns and interpreting them in the full clinical context is essential to prevent misdiagnosis and unnecessary antiepileptic therapy.