BACKGROUND Neurosurgical treatment of severe bilateral occipital lobe epilepsy usually involves two operations several mos apart.AIM To evaluate surgical resection of bilateral occipital lobe lesions during a single o...BACKGROUND Neurosurgical treatment of severe bilateral occipital lobe epilepsy usually involves two operations several mos apart.AIM To evaluate surgical resection of bilateral occipital lobe lesions during a single operation as a treatment for bilateral occipital lobe epilepsy.METHODS This retrospective case series included patients with drug-refractory bilateral occipital lobe epilepsy treated surgically between March 2006 and November 2015.RESULTS Preoperative evaluation included scalp video-electroencephalography(EEG),magnetic resonance imaging,and PET-CT.During surgery(bilateral occipital craniotomy),epileptic foci and important functional areas were identified by EEG(intracranial cortical electrodes)and cortical functional mapping,respectively.Patients were followed up for at least 5 years to evaluate treatment outcome(Engel grade)and visual function.The 20 patients(12 males)were aged 4-30 years(median age,12 years).Time since onset was 3-20 years(median,8 years),and episode frequency was 4-270/mo(median,15/mo).Common manifestations were elementary visual hallucinations(65.0%),flashing lights(30.0%),blurred vision(20.0%)and visual field defects(20.0%).Most patients were free of disabling seizures(Engel grade I)postoperatively(18/20,90.0%)and at 1 year(18/20,90.0%),3 years(17/20,85.0%)and≥5 years(17/20,85.0%).No patients were classified Engel grade IV(no worthwhile improvement).After surgery,there was no change in visual function in 13/20(65.0%),development of a new visual field defect in 3/20(15.0%),and worsening of a preexisting defect in 4/20(20.0%).CONCLUSION Resection of bilateral occipital lobe lesions during a single operation may be applicable in bilateral occipital lobe epilepsy.展开更多
Background:For seizures emerging from the posterior cortex it can be a challenge to differentiate if they belong to temporal,parietal or occipital epilepsies.Sensoric auras like visual phenomena may occur in all of th...Background:For seizures emerging from the posterior cortex it can be a challenge to differentiate if they belong to temporal,parietal or occipital epilepsies.Sensoric auras like visual phenomena may occur in all of these focal epilepsies.Ictal signs may mimic non-epileptic seizures.Case presentations:Case 1:Patient suffering from a pharmacoresistent focal epilepsy.Focal seizures with sudden visual disturbance,later during the seizure epigastric aura,vertigo-nausea,involvement to bilateral tonic-clonic seizures.MEG detected interictal spikes,source localization indicated focal epileptic activity parietal right.Case 2:Patient with focal pharmacoresistent epilepsy,semiology with focal unaware seizures,feeling that something like a coat is imposed from behind on him,then feeling cold over the whole body,goose bumbs from both arms to head,then block of motoric activity,later focal unaware seizures with stare gaze,blinking of eyes,clouding of consciousness,elevation of arms and legs,sometimes tonic-clonic convulsions.EEG/MEG source localization and MRI detected an epileptogenic lesion parietal left.Case 3:Patient with pharmacoresistent focal epilepsy,focal aware seizures,a dark spot occurring in the left visual field,sometimes anxiety during seizures(leading to the suspicion of non-epileptic psychogenic pseudo seizures).MRI demonstrated an atrophy occipito-temporal right after sinus vein thrombosis.Ictal video-EEG showed a focal seizure onset occipital right.Conclusion:Contribution of noninvasive and/or invasive confirmation of the localization of the underlying focal epileptic activity in posterior cortex is illustrated.Characteristics of posterior cortex epilepsies are ventilated.展开更多
文摘BACKGROUND Neurosurgical treatment of severe bilateral occipital lobe epilepsy usually involves two operations several mos apart.AIM To evaluate surgical resection of bilateral occipital lobe lesions during a single operation as a treatment for bilateral occipital lobe epilepsy.METHODS This retrospective case series included patients with drug-refractory bilateral occipital lobe epilepsy treated surgically between March 2006 and November 2015.RESULTS Preoperative evaluation included scalp video-electroencephalography(EEG),magnetic resonance imaging,and PET-CT.During surgery(bilateral occipital craniotomy),epileptic foci and important functional areas were identified by EEG(intracranial cortical electrodes)and cortical functional mapping,respectively.Patients were followed up for at least 5 years to evaluate treatment outcome(Engel grade)and visual function.The 20 patients(12 males)were aged 4-30 years(median age,12 years).Time since onset was 3-20 years(median,8 years),and episode frequency was 4-270/mo(median,15/mo).Common manifestations were elementary visual hallucinations(65.0%),flashing lights(30.0%),blurred vision(20.0%)and visual field defects(20.0%).Most patients were free of disabling seizures(Engel grade I)postoperatively(18/20,90.0%)and at 1 year(18/20,90.0%),3 years(17/20,85.0%)and≥5 years(17/20,85.0%).No patients were classified Engel grade IV(no worthwhile improvement).After surgery,there was no change in visual function in 13/20(65.0%),development of a new visual field defect in 3/20(15.0%),and worsening of a preexisting defect in 4/20(20.0%).CONCLUSION Resection of bilateral occipital lobe lesions during a single operation may be applicable in bilateral occipital lobe epilepsy.
文摘Background:For seizures emerging from the posterior cortex it can be a challenge to differentiate if they belong to temporal,parietal or occipital epilepsies.Sensoric auras like visual phenomena may occur in all of these focal epilepsies.Ictal signs may mimic non-epileptic seizures.Case presentations:Case 1:Patient suffering from a pharmacoresistent focal epilepsy.Focal seizures with sudden visual disturbance,later during the seizure epigastric aura,vertigo-nausea,involvement to bilateral tonic-clonic seizures.MEG detected interictal spikes,source localization indicated focal epileptic activity parietal right.Case 2:Patient with focal pharmacoresistent epilepsy,semiology with focal unaware seizures,feeling that something like a coat is imposed from behind on him,then feeling cold over the whole body,goose bumbs from both arms to head,then block of motoric activity,later focal unaware seizures with stare gaze,blinking of eyes,clouding of consciousness,elevation of arms and legs,sometimes tonic-clonic convulsions.EEG/MEG source localization and MRI detected an epileptogenic lesion parietal left.Case 3:Patient with pharmacoresistent focal epilepsy,focal aware seizures,a dark spot occurring in the left visual field,sometimes anxiety during seizures(leading to the suspicion of non-epileptic psychogenic pseudo seizures).MRI demonstrated an atrophy occipito-temporal right after sinus vein thrombosis.Ictal video-EEG showed a focal seizure onset occipital right.Conclusion:Contribution of noninvasive and/or invasive confirmation of the localization of the underlying focal epileptic activity in posterior cortex is illustrated.Characteristics of posterior cortex epilepsies are ventilated.
