Intractable occipital lobe epilepsy: clinical characteristics and surgical treatment.
Intractable occipital lobe epilepsy remains a surgical challenge. Clinical characteristics of 14 patients were analyzed. Twelve patients had surgery, seven patients had visual auras (50%) and only eight patients (57%) had posterior scalp EEG changes. Ictal single-proton emission computed tomography (SPECT) incorrectly localized in 7 of 10 patients. Six patients (50%) had Engel's class I outcome. Patients with inferior occipital seizure onset appeared to fare better (three of four class I) than patients with lateral or medial occipital seizure onset (three of eight class I). Patients who had all three occipital surfaces covered with electrodes had a better outcome (four of five class I) than patients who had limited electroencephalography (EEG) coverage (two of seven class I). Magnetic resonance imaging (MRI) lesions did not guarantee a seizure free outcome. In conclusion, visual auras, scalp EEG, and imaging findings are not reliable for correct identification of occipital onset. Occipital seizure onset can be easily missed in nonlesional epilepsy. Comprehensive intracranial EEG coverage of all three occipital surfaces leads to better outcomes.
Jobst
Barbara C
BC
Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA. Barbara.C.Jobst@Hitchcock.org
Williamson
Peter D
PD
Thadani
Vijay M
VM
Gilbert
Karen L
KL
Holmes
Gregory L
GL
Morse
Richard P
RP
Darcey
Terrance M
TM
Duhaime
Ann-Christine
AC
Bujarski
Krysztof A
KA
Roberts
David W
DW
D000293:Adolescent; D000328:Adult; D000654:Amobarbital; D001931:Brain Mapping / Q000379:methods; D004567:Electrodes, Implanted; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009778:Occipital Lobe / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D012815:Signal Processing, Computer-Assisted; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D014794:Visual Fields / Q000502:physiology; D055815:Young Adult
D000654:Amobarbital