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Ruben Kuzniecky - One of the best experts on this subject based on the ideXlab platform.
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symptomatic Occipital Lobe epilepsy
Epilepsia, 1998Co-Authors: Ruben KuznieckyAbstract:Summary: Symptomatic Occipital Lobe epilepsy is increasingly recognized among patients with partial-onset seizures. Although traditional clinical and electroencephalographic criteria had defined Occipital Lobe epilepsy in the past, new neuroimaging techniques and the recognition of specific syndromes associated with Occipital Lobe epilepsy have improved the diagnosis and management of these patients. These syndromes include, among others, lesional Occipital Lobe epilepsy (congenital vs. acquired), MELAS, and epilepsy with bilateral Occipital calcifications. The diagnosis of symptomatic Occipital Lobe epilepsy is improving as functional and structural neuroimaging techniques enable the detection of subtle abnormalities in such patients. This has had a direct impact on the correct classification of patients with benign Occipital Lobe epilepsy, basilar migraine, and symptomatic Occipital Lobe epilepsy. The common clinical symptoms, EEG patterns, and neuroimaging findings of these patients are discussed. Key Words: Occipital Lobe epilepsy-congenital vs. acquired syndromes-EEG patterns-Neuroimaging. Advances in the diagnosis of epilepsy have led to refinements in the classification of the epilepsies. This has been primarily possible because of recent major advances in neuroimaging techniques, which are now able to detect pathology in many patients with temporal Lobe epilepsy, particularly in those with mesial temporal Lobe sclerosis. This capability, in addition to the wealth of new noninvasive imaging techniques, has directed efforts toward the better definition of extratemporal Lobe epilepsies. This article describes the clinical features associated with symptomatic Occipital Lobe epilepsy and reviews the etiologic factors, imaging and electrographic characteristics, and outcome.
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Occipital Lobe developmental malformations and epilepsy clinical spectrum treatment and outcome
Epilepsia, 1997Co-Authors: Ruben Kuzniecky, Frank Gilliam, Richard B Morawetz, Edward Faught, Cheryl A Palmer, Lorie BlackAbstract:Summary: Purpose: Cortical developmental malformations (CDM) are increasingly recognized in association with epilepsy. We describe 10 patients (age range 14–35 years) with symptomatic Occipital Lobe epilepsy and CDM. Methods: Neurologic, neuroophthalmologic and electro-physiologic studies were performed. Patients had MRI, SPECT, and in some cases intracranial EEG investigators. Results: Mean age of seizure onset was 8 years. We noted strong correlations between the presence of visual auras, the scalp EEG pattern, and the subtype of underlying pathology. Magnetic resonance imaging (MRI) showed CDM in all patients, with polymicrogyria and focal dysplasia being the most frequent malformations. Despite the presence of Occipital Lobe structural malformations in all patients, visual field deficits were present in only 2. Those who underwent cortical resections were seizure–free or showed major improvement at a mean follow–up of 3.5 years. Conclusions: Intracranial stimulation studies and the low frequency of pre- and postoperative deficits suggest that some degree of cortical visual reorganization may occur in patients with Occipital Lobe malformations. Occipital Lobe CDM should be sought as a cause of symptomatic Occipital Lobe epilepsy even though they may become symptomatic after childhood.
Patrick Chauvel - One of the best experts on this subject based on the ideXlab platform.
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Ictal Single Photon Emission Computed Tomography Occipital Lobe Seizures in
1997Co-Authors: Roderick Duncan, Sarnaud Biraben, James Patterson, Donald M. Hadley, A. M. Bernard, Jean-pierre Vignal, Patrick ChauvelAbstract:Summary: Purpose: Ictal single photon emission computed tomography (SPECT) has been evaluated as an adjunctive lo- calizing technique in temporal Lobe epilepsies and, to a lesser degree, in some extratemporal epilepsies. The purpose of this study was to determine whether Occipital Lobe seizures are as- sociated with distinctive ictal cerebral blood perfusion (rCP) patterns. Methods: SPECT was used with the tracer 99mTc HMPAO to image ictal rCP in 6 patients in whom clinical, EEG, and im- aging data indicated Occipital Lobe seizures. Results: Two patterns of rCP were seen. Four patients had hyperperfusion that was restricted to the Occipital Lobe, and two patients had hyperperfusion of the Occipital Lobe and the ipsi- lateral mesial temporal Lobe, with hypoperfusion of the lateral temporal Lobe. The latter 2 patients had clinical and surface EEG evidence of temporal Lobe involvement in the seizure discharge. Conclusions: Ictal rCP patterns in Occipital Lobe seizures
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ictal single photon emission computed tomography in Occipital Lobe seizures
Epilepsia, 1997Co-Authors: Roderick Duncan, James Patterson, Donald M. Hadley, A. M. Bernard, Jean-pierre Vignal, Amaud Biraben, Joseph Lecloirec, Patrick ChauvelAbstract:Summary: Purpose: Ictal single photon emission computed tomography (SPECT) has been evaluated as an adjunctive localizing technique in temporal Lobe epilepsies and, to a lesser degree, in some extratemporal epilepsies. The purpose of this study was to determine whether Occipital Lobe seizures are associated with distinctive ictal cerebral blood perfusion (rCP) patterns. Methods: SPECT was used with the tracer 99mTc HMPAO to image ictal rCP in 6 patients in whom clinical, EEG, and imaging data indicated Occipital Lobe seizures. Results: Two patterns of rCP were seen. Four patients had hyperperfusion that was restricted to the Occipital Lobe, and two patients had hyperperfusion of the Occipital Lobe and the ipsilateral mesial temporal Lobe, with hypoperfusion of the lateral temporal Lobe. The latter 2 patients had clinical and surface EEG evidence of temporal Lobe involvement in the seizure discharge. Conclusions: Ictal rCP patterns in Occipital Lobe seizures are distinct from those in temporal Lobe seizures and may vary according to whether or not ipsilateral temporal Lobe structures are involved in the ictal discharge.
Roderick Duncan - One of the best experts on this subject based on the ideXlab platform.
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Ictal Single Photon Emission Computed Tomography Occipital Lobe Seizures in
1997Co-Authors: Roderick Duncan, Sarnaud Biraben, James Patterson, Donald M. Hadley, A. M. Bernard, Jean-pierre Vignal, Patrick ChauvelAbstract:Summary: Purpose: Ictal single photon emission computed tomography (SPECT) has been evaluated as an adjunctive lo- calizing technique in temporal Lobe epilepsies and, to a lesser degree, in some extratemporal epilepsies. The purpose of this study was to determine whether Occipital Lobe seizures are as- sociated with distinctive ictal cerebral blood perfusion (rCP) patterns. Methods: SPECT was used with the tracer 99mTc HMPAO to image ictal rCP in 6 patients in whom clinical, EEG, and im- aging data indicated Occipital Lobe seizures. Results: Two patterns of rCP were seen. Four patients had hyperperfusion that was restricted to the Occipital Lobe, and two patients had hyperperfusion of the Occipital Lobe and the ipsi- lateral mesial temporal Lobe, with hypoperfusion of the lateral temporal Lobe. The latter 2 patients had clinical and surface EEG evidence of temporal Lobe involvement in the seizure discharge. Conclusions: Ictal rCP patterns in Occipital Lobe seizures
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ictal single photon emission computed tomography in Occipital Lobe seizures
Epilepsia, 1997Co-Authors: Roderick Duncan, James Patterson, Donald M. Hadley, A. M. Bernard, Jean-pierre Vignal, Amaud Biraben, Joseph Lecloirec, Patrick ChauvelAbstract:Summary: Purpose: Ictal single photon emission computed tomography (SPECT) has been evaluated as an adjunctive localizing technique in temporal Lobe epilepsies and, to a lesser degree, in some extratemporal epilepsies. The purpose of this study was to determine whether Occipital Lobe seizures are associated with distinctive ictal cerebral blood perfusion (rCP) patterns. Methods: SPECT was used with the tracer 99mTc HMPAO to image ictal rCP in 6 patients in whom clinical, EEG, and imaging data indicated Occipital Lobe seizures. Results: Two patterns of rCP were seen. Four patients had hyperperfusion that was restricted to the Occipital Lobe, and two patients had hyperperfusion of the Occipital Lobe and the ipsilateral mesial temporal Lobe, with hypoperfusion of the lateral temporal Lobe. The latter 2 patients had clinical and surface EEG evidence of temporal Lobe involvement in the seizure discharge. Conclusions: Ictal rCP patterns in Occipital Lobe seizures are distinct from those in temporal Lobe seizures and may vary according to whether or not ipsilateral temporal Lobe structures are involved in the ictal discharge.
Hans Clusmann - One of the best experts on this subject based on the ideXlab platform.
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surgical treatment of Occipital Lobe epilepsy
Journal of Neurosurgery, 2008Co-Authors: Devin K Binder, Marec Von Lehe, Thomas Kral, Christian G Bien, Horst Urbach, Johannes Schramm, Hans ClusmannAbstract:OBJECT: Occipital Lobe epilepsy (OLE) accounts for a small percentage of extratemporal epilepsies and only few and mostly small patient series have been reported. Preoperative findings, surgical strategies, histopathological bases, and postoperative outcomes for OLE remain to be elucidated. METHODS: A group of 54 patients with Occipital Lobe involvement were identified from a prospective epilepsy surgery database established in 1989. Medical charts, surgical reports, MR imaging, and histopathology data were reviewed, and patients with additional temporal and/or parietal involvement were categorized separately. Seizure outcome was classified according to the Engel classification scheme (Classes I-IV). Two patients were excluded due to incomplete data sets. Fifty-two patients with intractable epilepsy involving predominantly the Occipital Lobe were included in the study, comprising 17.8% of 292 patients undergoing operations for extratemporal epilepsies. RESULTS: In nearly all cases (50 [96.2%] of 52), a structural lesion was visible on preoperative MR imaging. Of these cases, 29 (55.8%) had "pure" OLE with no temporal or parietal Lobe involvement. Most patients (83%) had complex partial seizures, and 60% also had generalized seizures. All patients underwent Occipital lesionectomies or topectomies; 9 patients (17.3%) underwent additional multiple subpial transections. Histopathology results revealed 9 cortical dysplasias (17.3%), 9 gangliogliomas (17.3%), 6 other tumors (11.5%), 13 vascular malformations (25%), and 15 glial scars (28.8%). Visual field deficits were present in 36.4% of patients preoperatively, and 42.4% had new or aggravated visual field deficits after surgery. After a mean follow-up of 80 months, 36 patients were seizure free (69.2% Engel Class I), 4 rarely had seizures (7.7% Engel Class II), 8 improved more than 75% (15.4% Engel Class III), and 4 had no significant improvement (7.7% Engel Class IV). Multifactorial logistic regression analysis revealed that early age at epilepsy manifestation (p = 0.031) and shorter epilepsy duration (p = 0.004) were predictive of better seizure control. All other clinical and surgical factors were not significant in predicting outcome. CONCLUSIONS: Occipital Lobe epilepsy is an infrequent but significant cause of extratemporal epilepsy. Satisfactory results (Engel Class I or II) were obtained in 77% of patients in our series. Postoperative visual field deficits occurred in a significant proportion of patients. In the modern MR imaging era, lesions should be investigated in patients with OLE and lesionectomies should be performed early for a better outcome.
Susan S Spencer - One of the best experts on this subject based on the ideXlab platform.
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surgical outcome in Occipital Lobe epilepsy implications for pathophysiology
Annals of Neurology, 1998Co-Authors: Canan Aykutbingol, Richard A Bronen, Dennis D Spencer, Susan S SpencerAbstract:: Medically refractory Occipital Lobe epilepsies are increasingly treated with surgery, but outcome and its relationship to etiology, pathological substrate, Occipital Lobe location, surgical approach, and electroclinical features have not been systematically investigated in a substantial group of patients. Thirty-five patients who underwent surgery for intractable Occipital Lobe seizures were retrospectively evaluated. Outcome and Occipital Lobe location were analyzed with respect to surgical procedure, pathology, clinical seizure characteristics, seizure onset and termination locations, and localization of interictal spikes. Most patients had developmental abnormalities (14) or tumors (13, all gliomas). Developmental abnormalities consisted of focal cortical dysplasia (5), heterotopia (2), hamartoma (3), cortical duplication (1), polymicrogyria (1), Sturge-Weber syndrome (1), and tuberous sclerosis (1). There was 1 patient with a vascular abnormality, 1 with chronic inflammatory changes, 4 with gliosis, 1 with cerebral ossification, and 1 with normal pathology. Developmental abnormalities had significantly worse outcome (45% excellent/good) than tumors (85% excellent/good). In the developmental group, low-grade focal cortical dysplasias had better outcome than heterotopia and hamartoma regardless of type of surgical procedure. Pathological groups did not significantly differ with respect to location within the Occipital Lobe (overall medial [50%] or lateral [38%]); clinical seizure characteristics referable to specific Lobe (Occipital [14%], temporal [34%], frontal [23%], more than one type [29%]); electroencephalographic localization (to Occipital [17%], temporal [27%], or other/multifocal locations [56%]); or intracranial ictal onset or termination location. Electroclinical variables were also unrelated to the Occipital Lobe location of abnormality. Surgical outcome was not predicted by surgical approach (lesion excision with margins or Lobectomy). The main pathological substrates of uncontrolled Occipital Lobe epilepsy are gliomas and developmental abnormalities. Whereas resection of Occipital Lobe tumors associated with chronic epilepsy produces nearly uniform seizure control, outcome after resection of Occipital Lobe developmental abnormalities is less uniform.
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Occipital Lobe epilepsy clinical characteristics seizure spread patterns and results of surgery
Annals of Neurology, 1992Co-Authors: Peter D Williamson, Dennis D Spencer, Susan S Spencer, V M Thadani, Terrance M Darcey, Richard H MattsonAbstract:Twenty-five patients with Occipital Lobe seizure origin were retrospectively evaluated to determine clinical seizure characteristics and electroencephalographic manifestations. Certain symptoms and signs served to identify Occipital Lobe origin in 22 (88%). These included elementary visual hallucinations, ictal amaurosis, eye movement sensations, early forced blinking or eyelid flutter, and visual field deficits. Eye or head deviation, or both, was observed frequently and was contralateral to the side of seizure origin in 13, but 3 patients exhibited ipsilateral deviation in some or all their seizures. After the initial signs and symptoms, clinical seizure characteristics resembled those of seizures originating elsewhere. Seizures typical of temporal Lobe origin with loss of contact and various types of automatic, semipurposeful activity occurred in 11 patients. Seizures in 3 patients exhibited asymmetrical tonic or focal clonic motor patterns characteristic of frontal Lobe seizures. Eleven of the 25 patients had, on two occasions, two or more distinctly different seizure types. Scalp electroencephalographic findings were seldom helpful for Occipital Lobe localization and were frequently misleading. Intracranial electroencephalographic recording correctly identified Occipital Lobe seizure origin in most, but not all, patients who had such studies. Intracranial electroencephalic recording also proved the variability in clinical seizure characteristics was related to different seizure spread patterns, medially or laterally above and below the sylvian fissure, both ipsilateral and contralateral to the Occipital Lobe of seizure origin. Eighteen patients had Occipital Lobe lesions detected with computed tomographic or magnetic resonance imaging scans or both. Resection of the lesions in 16 patients produced excellent results in 14 (88%). Five patients had temporal Lobectomies, with good results in 3, but poor results in 2. Two patients with unlocalized seizures had complete section of the corpus callosum, 1 with a good result and the other with a poor result.
