Occipital lobe epilepsy: The semiology, yield of diagnostic work up, and surgical outcome Sang Kun Lee, Seo Young Lee, Dong Soo Lee, and. Chun-Kee Chung Department of Neurology, Nuclear Medicine and Neurosurgery, Seoul National University College of Medicine, Seoul, Korea Objectives In order to find out the diagnostic role of various diagnostic modalities and surgical prognostic factors including concordance of presurgical evaluations, and to characterize the clinical features in occipital lobe epilepsy (OLE), we described 26 patients who were diagnosed as OLE and underwent epilepsy surgery. ·There was no significant relationship between the diagnostic accuracy of each modality and surgical outcome. The localization of epileptogenic zone by different diagnostic methods was complementary. Concordance of three or more modalities was significantly observed in seizure free patients (P=0. 042). There was no definite relationship between the presence of lateralizing seizure manifestation and the surgical outcome (p=0. 108). Methods We included 26 consecutive patients who were diagnosed as OLE at Seoul National University Hospital from September 1994 to August 2001. The diagnostic criteria for OLE was the presence of either a discrete lesion in the occipital lobe on MRI with compatible intracranial ictal EEG, or of an exclusive ictal onset zone in the occipital lobe confirmed by intracranial EEG. Surgery was performed in all patients. The postoperative follow-up duration was more than two years at least. Surgical outcome was analyzed in terms of Engel classification and ‘seizure-free’ or ‘nonseizure-free’. We analyzed the prognostic value of each diagnostic modality by comparison between the seizure-free group and the non-seizure-free group. We also analyzed the diagnostic sensitivity of each diagnostic modality in seizure-free patients. We also tried to find out the characteristics of semiology of OLE, and the prognostic value of the lateralizing semiology. Results ·Sixteen (61. 5%) became seizure free, and another 8 patients had a favorable outcome. Sixteen patients had at least a type of aura related with vision such as visual hallucination, visual illusion, and blindness or field defect. Nine patients had both automotor seizure and secondary generalized tonic-clonic seizure at a different time. Interictal EEG showed correctly localizing spikes in 10 of 16 patients with seizure-free, and in three of 10 with non-seizure-free patients. MRI correctly localized the lesion in seven of the 16 patients with seizure-free, and in three of the 10 patients with non-seizure-free which was not significant. FDGPET correctly localized the lesion in eight of 16 patients with seizure-free, and in three of the nine patients with non-seizure-free. Ictal SPECT was performed in 19 patients, and correctly localized the lesion in only three out of 12 patients with seizure-free, in four of seven patients with nonseizure-free. Ictal EEG correctly localized the. L lesion in 13 of the 16 patients with seizure-free, and in five of the 10 patients with non-seizure-free. MRI and FDG-PET of the right OLE patient MRI and ictal SPECT of the left OLE patient Conclusions Some specific auras indicated the occipital onset of epilepsy. Various diagnostic methods can be useful in the diagnosis of OLE. More concordant results of presurgical evaluation indicated good surgical outcome.
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