AIWS is a visuo-perceptual phenomenon that has been associated with paroxysmal neurologic disorders like epilepsy and migraine. Literature on the electrophysiological correlates of this syndrome is limited. However, parieto-occipital slowing on EEG has been reported. fMRIs and SPECT scans have demonstrated aberrations in the same region.

An eleven-year-old boy with a history of frontal lobe epilepsy, presented with concerns of episodes of binocular visual changes for two years. He describes objects appearing larger or smaller without any impairment in consciousness lasting minutes to hours. Over time, the frequency increased from once every few weeks to multiple times a day. Initially, they were associated with bifrontal headaches, but soon headaches resolved and the visual phenomena persisted. Extended EEG monitoring and some episodes were captured with no epileptiform correlate and no other inter-ictal abnormalities were noted. Neuropsychological testing revealed a non-lateralizing temporo-parieto-occipital lobe dysfunction. This increased the suspicion for a potential deep focal epileptogenic dysfunction in the parieto-occipital region that could explain these episodes. Magnetoencephalography was done to investigate for the same and it detected left occipital lobe spikes. With supportive evidence for left occipital lobe epilepsy, patient was started on daily lacosamide and there was marked reduction in his symptoms. Of note, he had prior epilepsy surgery for resection of a symptomatic left frontal cavernoma. Since then, his seizures were mostly well controlled and only had rare subtle head drops, despite being off anti-seizure medications.