Parietal lobe epilepsy: the semiology, yield of diagnostic workup, and surgical outcome.
OBJECTIVE
To characterize the clinical features, the prognostic value, and diagnostic sensitivities of various presurgical evaluations and the surgical outcomes in parietal lobe epilepsy (PLE), we describe 40 patients who were diagnosed as having PLE, including 27 surgically treated patients.


METHODS
The diagnosis was established by means of a standard presurgical evaluation, including magnetic resonance imaging (MRI), fluorodeoxyglucose-positron emission tomography (FDG-PET), ictal single-photon emission tomography (SPECT), and scalp video-electroencephalography (EEG) monitoring, with additional intracranial EEG monitoring in selected cases.


RESULTS
Among the 40 patients, 27 experienced at least one type of aura. The most common auras were somatosensory (13 patients), followed by affective, vertiginous, and visual auras. The patients had diverse manifestations. Eighteen patients showed simple motor seizure, followed by automotor seizure, and dialeptic seizure. Two patients manifested generalized tonic-clonic seizures only, and 19 patients experienced more than one type of seizure. The surgical outcome was favorable in 22 of 26 patients including 14 who were seizure free. Patients with localized MRI abnormality had a higher probability to be seizure free, with marginal significance (p = 0.062), whereas other diagnostic modalities failed to predict the surgical outcome. In the seizure-free group, localization sensitivity was 64.3% by MRI, 50% by PET, 45.5% by ictal SPECT, and 35.7% by ictal EEG. The concordance rate of the various diagnostic modalities was higher in the seizure-free group than in the non-seizure-free group, although it did not reach statistical significance.


CONCLUSIONS
Seizures, in the case of PLE, can manifest themselves in a wider variety of ways than was previously thought. Surgical outcome was favorable in most of the patients. MRI abnormality and concordance of different diagnostic modalities were associated with high seizure-free rate.
Kim
Dong Wook
DW
Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
Lee
Sang Kun
SK
Yun
Chang-Ho
CH
Kim
Kwang-Ki
KK
Lee
Dong Soo
DS
Chung
Chun-Kee
CK
Chang
Kee-Hyun
KH
D000293:Adolescent; D000328:Adult; D001931:Brain Mapping; D002648:Child; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019579:Neocortex / Q000000981:diagnostic imaging / Q000601:surgery; D010296:Parietal Lobe / Q000000981:diagnostic imaging / Q000601:surgery*; D011300:Preoperative Care; D011379:Prognosis; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
D019788:Fluorodeoxyglucose F18