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Intractable occipital lobe epilepsy: Clinical characteristics and surgical treatment
Author(s) -
Jobst Barbara C.,
Williamson Peter D.,
Thadani Vijay M.,
Gilbert Karen L.,
Holmes Gregory L.,
Morse Richard P.,
Darcey Terrance M.,
Duhaime AnnChristine,
Bujarski Krysztof A.,
Roberts David W.
Publication year - 2010
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/j.1528-1167.2010.02673.x
Subject(s) - occipital lobe , ictal , electroencephalography , epilepsy , scalp , epilepsy surgery , magnetic resonance imaging , medicine , temporal lobe , surgery , psychology , radiology , psychiatry
Summary 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.