Occipital lobe epilepsy in children can present as an idiopathic form (i.e., childhood epilepsy with occipital paroxysms) or as a symptomatic form. Forty-three children (18 boys, 25 girls) were divided into the idiopathic group or symptomatic group, according to the classification for epileptic seizures of the International League Against Epilepsy. Patients in the idiopathic group were further subdivided into the Panayiotopoulos or Gastaut type, according to clinical presentation. The idiopathic group consisted of 15 children (5 boys, 10 girls), of whom 11 were of the Panayiotopoulos type and 4 of the Gastaut type. The symptomatic group consisted of 28 children (13 boys, 15 girls). The average age of seizure onset in the idiopathic group was younger than in the symptomatic group (6.5 +/- 2.4 vs 8.5 +/- 3.0 years). Ictal vomiting was more common in the idiopathic group, and positive visual symptoms were more common in the symptomatic group. Mean epilepsy duration in the idiopathic group was shorter (5.7 +/- 5.3 vs 20.1 +/- 16.0 months), and the response to treatment was better. The average age of seizure onset was much younger in the Panayiotopoulos than in the Gastaut type (5.4 +/- 1.5 vs 9.5 +/- 1.5 years), and mean epilepsy duration was also shorter (3.9 +/- 4.2 vs 10.5 +/- 4.9 months). Seizure semiology can distinguish between idiopathic occipital lobe epilepsy and the symptomatic form with ictal vomiting and positive visual symptoms. In idiopathic occipital lobe epilepsy, the Panayiotopoulos type has better prognosis than the Gastaut type.