title: Occipital lobe epilepsy with fear as leading ictal symptom.
abstract: Ictal fear is a semiological feature which is commonly associated with mesial temporal lobe epilepsy. Here, we describe fear as a leading symptom in cryptogenic occipital lobe epilepsy. In a patient with negative MRI findings, intracranial EEG recordings documented a strict correlation between habitual ictal anxiety attacks and both spontaneous and stimulation-induced epileptic activity in a right occipital epileptogenic area with subsequent spreading to the symptomatogenic zone in the amygdala. Circumscribed occipital topectomy led to seizure freedom. Episodes of non-epileptic fear ceased shortly afterwards. This report provides insight into pathways of propagation of epileptic activity, illustrates different etiologies of pathologic fear and underlines the importance of ictal EEG recordings.
authors.affiliation: Epilepsy Center, University Hospital Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany. bernhard.oehl@uniklinik-freiburg.de
authors.forename: Bernhard
authors.initials: B
authors.lastname: Oehl
authors.forename: Andreas
authors.initials: A
authors.lastname: Schulze-Bonhage
authors.forename: Michael
authors.initials: M
authors.lastname: Lanz
authors.forename: Armin
authors.initials: A
authors.lastname: Brandt
authors.forename: Dirk-Matthias
authors.initials: DM
authors.lastname: Altenmüller
mesh_terms: D001931:Brain Mapping; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000473:pathology / Q000503:physiopathology*; D005239:Fear; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009778:Occipital Lobe / Q000503:physiopathology