Childhood occipital visual epilepsy (COVE) is a type of epilepsy that usually begins in later childhood and causes brief visual seizures, such as seeing colored circles or flashing lights. Some children also experience temporary blindness, eye, head, or body movements, or migraine-like headaches. It is considered a self-limited condition, meaning the seizures are likely to stop as the child grows older. Children usually develop and learn normally, and many become seizure-free by puberty.

COVE is a type of epilepsy marked by brief visual seizures that usually occur while a child is awake. It was previously called late-onset benign occipital epilepsy or Gastaut syndrome.

COVE usually begins around ages 8 or 9, although it can begin during adolescence. Seizures beginning before age 6 or after age 14 are unusual and may lead doctors to consider other conditions.

The seizures begin in the occipital lobe, the area at the back of the brain that processes vision. They usually cause simple visual symptoms, such as small, multicolored circles in the child’s vision. The circles may move across the field of vision. During this part of the seizure, the child usually remains aware and later may be able to describe what they saw. Visual symptoms may evolve, and the child will fall and have full-body shaking movements (bilateral tonic-clonic seizure).

Most seizures last seconds or a few minutes. Without treatment, they may happen frequently. Migraine-like headaches are common after seizures and may occur with nausea or vomiting.

The exact cause of COVE is unknown. Researchers think variations in several genes may combine to make seizures more likely, but no specific gene has been identified.

Up to one-third of children with COVE have a family history of epilepsy or seizures with fever. However, it is difficult to predict whether another family member will develop COVE.

Symptoms of COVE usually begin suddenly with brief changes in vision. Other symptoms may follow if the seizure moves beyond the areas of the brain that process vision.

Symptoms may include:

• The child may suddenly see colored circles, lights, or shapes, often in their peripheral vision.
• Visual effects may grow or move across the child’s field of vision.
• Temporary partial or complete loss of vision may occur during a seizure.
• The eyes or head may turn after the visual symptoms begin.
• The child may become less aware or responsive during part of the seizure.
• Jerking may occur on one or both sides if the seizure reaches parts of the brain that control movement.
• The child may have a headache after the seizure.
• Nausea or vomiting may occur with a headache after the seizure.

Visual seizures occur mainly while the child is awake. Some children also have seizures during sleep. These seizures usually last a few seconds, and most last less than three minutes, although they can last longer.

COVE can initially be mistaken for migraine because both can cause changes in vision and headaches. Migraines can also cause changes in vision, such as seeing lines or zigzag patterns. These changes usually develop more slowly and last longer than the visual changes caused by COVE. Visual seizures caused by COVE usually begin suddenly and often involve colored circles or moving lights.

Visual seizures that are consistently triggered by flashing lights may suggest a different type of epilepsy and should be discussed with the child’s doctor.

To diagnose COVE, doctors review the child’s medical and seizure history and perform a neurological examination. Diagnosis also involves tests that measure the brain’s electrical activity and produce images of the brain.

A detailed history focuses on what the child sees, how quickly the symptoms begin, and how long they last. The doctor will ask whether the child remains aware during seizures and whether eye movements, head turning, jerking, headache, nausea, or vomiting follow the visual symptoms.

The doctor will ask when seizures first began and whether seizures occur while the child is awake or asleep. The doctor may also ask whether epilepsy, seizures with fever, or migraines run in the family.

The doctor will perform a neurological examination that checks the child’s vision, movement, balance, and reflexes. Results are usually normal in children with COVE.

Tests used to diagnose COVE include:

• Electroencephalogram (EEG), which records the brain’s electrical activity and checks for unusual activity in the area that processes vision.
• Magnetic resonance imaging (MRI), which is required for diagnosis and produces detailed images that doctors use to check for changes in brain structure that could be causing seizures.

Genetic testing is not needed because no specific gene is known to cause COVE. Doctors may order other tests if the medical history, examination, EEG, or MRI points to another condition.

Treatment for COVE focuses on controlling seizures and monitoring the child’s development and learning.

Treatment may include:

• Anti-seizure medicine can reduce or stop seizures, and most children respond well to it.
• Doctors usually begin with one medicine.
• If seizures continue, the doctor may try a different medicine or prescribe more than one medicine.
• Regular follow-up helps the care team monitor seizures, medicine effects, development, and learning.

The choice of medicine depends on the child’s seizures and individual needs.

Some children may eventually stop taking medicine after remaining seizure-free for at least two years. The care team will review the child’s seizure history before deciding whether to stop treatment.

Potential complications of COVE may include:

• Ongoing seizures that interrupt school, activities, and daily routines.
• Migraine-like headaches after seizures, sometimes with nausea or vomiting.
• Mild learning difficulties in some children.

The outlook for COVE is generally favorable. Most children continue to develop normally, and most children with COVE become seizure-free by puberty. Some children continue to have seizures beyond puberty or into adulthood.

This article was medically reviewed in August 2026.