Q. My daughter, age 15, has been having episodes of (I call them (though they are not)) bi-temporal-hemianopsia 1-2 times per day for 2 years. Four doctors (primary care (Hmmm?"), cardiologist ("These usually go away."), ophthalmologist ("I don't see anything"), neurologist ("We'll call it migraine if it's nothing else."), GTT, EKG, MRI, EEG... no results. Neurologist suspects this is a migraine manifestation. However.. no headache and definitely bilateral.

To wit: Usually while standing, not while arising, these occur. Recently she had two episodes while kneeling. She says from the outside in she "blacks out", meaning she loses vision starting with ears side of the eyes toward center of eye. The sight loss is progressive as it moves inward. In other words as the vision is becoming reduced closer to the center of the eye, the ear side of the vision is going black and then the vision "blacks out" closer to the center, too. Sometimes it is accompanied by nose to central. Always in both eyes at the same time. Ninety-nine percent of the time she adjusts position or sits and it goes away. Infrequently, it goes totally black before she can control it. She says it occurs about 15 times per week (range 0-10 per day) and each episode lasts on average 8 seconds. Even while it is occurring she says she can continue what she is doing but must concentrate on what she is doing plus the episode (She might have to slow down what she is doing, though, for more concentration on the episode.). It goes away the same way by vision gradually coming back central to earside of eyes.

A. The description sounds like a migraine without any pain. These are not as rare as you might think. Nonetheless, without a good work-up, this is just an educated guess. If you treat them like migraines, and prophylax with anti-migraine agents (e.g., Depakote, high dose antidepressants, beta blockers, calcium channel blockers, etc.) she should get less of them or they might just go away. Failure to respond does not mean they are not migraines. It just means they did not respond to the particular treatment.

I would ask the neurologist about medications. If he puts her on something that works, her life is easier. If it does not work, she's no worse off than she is now.