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Parietal Lobe Epilepsy (parietal + lobe_epilepsy)

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Medical Sciences100%

Selected Abstracts

Parietal Lobe Epilepsy: The Semiology, Yield of Diagnostic Workup, and Surgical Outcome

EPILEPSIA, Issue 6 2004
Dong Wook Kim
Summary: Purpose: To characterize the clinical features, the prognostic value, and diagnostic sensitivities of various presurgical evaluations and the surgical outcomes in parietal lobe epilepsy (PLE), we describe 40 patients who were diagnosed as having PLE, including 27 surgically treated patients. Methods: The diagnosis was established by means of a standard presurgical evaluation, including magnetic resonance imaging (MRI), fluorodeoxyglucose,positron emission tomography (FDG-PET), ictal single-photon emission tomography (SPECT), and scalp video-electroencephalography (EEG) monitoring, with additional intracranial EEG monitoring in selected cases. Results: Among the 40 patients, 27 experienced at least one type of aura. The most common auras were somatosensory (13 patients), followed by affective, vertiginous, and visual auras. The patients had diverse manifestations. Eighteen patients showed simple motor seizure, followed by automotor seizure, and dialeptic seizure. Two patients manifested generalized tonic,clonic seizures only, and 19 patients experienced more than one type of seizure. The surgical outcome was favorable in 22 of 26 patients including 14 who were seizure free. Patients with localized MRI abnormality had a higher probability to be seizure free, with marginal significance (p = 0.062), whereas other diagnostic modalities failed to predict the surgical outcome. In the seizure-free group, localization sensitivity was 64.3% by MRI, 50% by PET, 45.5% by ictal SPECT, and 35.7% by ictal EEG. The concordance rate of the various diagnostic modalities was higher in the seizure-free group than in the non,seizure-free group, although it did not reach statistical significance. Conclusions: Seizures, in the case of PLE, can manifest themselves in a wider variety of ways than was previously thought. Surgical outcome was favorable in most of the patients. MRI abnormality and concordance of different diagnostic modalities were associated with high seizure-free rate. [source]

Revisiting the role of the insula in refractory partial epilepsy

EPILEPSIA, Issue 3 2009
Dang Khoa Nguyen
Summary Purpose:, Recent evidence suggesting that some epilepsy surgery failures could be related to unrecognized insular epilepsy have led us to lower our threshold to sample the insula with intracerebral electrodes. In this study, we report our experience resulting from this change in strategy. Methods:, During the period extending from October 2004 to June 2007, 18 patients had an intracranial study including 10 with insular coverage. The decision to sample the insula with intracerebral electrodes was made in the context of (1) nonlesional parietal lobe-like epilepsy; (2) nonlesional frontal lobe-like epilepsy; (3) nonlesional temporal lobe-like epilepsy; and (4) atypical temporal lobe-like epilepsy. Results:, Intracerebral recordings confirmed the presence of insular lobe seizures in four patients. Cortical stimulation performed in 9 of 10 patients with insular electrodes elicited, in decreasing order of frequency, somatosensory, viscerosensory, motor, auditory, vestibular, and speech symptoms. Discussion:, Our results suggest that insular cortex epilepsy may mimic temporal, frontal, and parietal lobe epilepsies and that a nonnegligeable proportion of surgical candidates with drug-resistant epilepsy have an epileptogenic zone that involves the insula. [source]

Parietal Lobe Epilepsy: The Semiology, Yield of Diagnostic Workup, and Surgical Outcome

EPILEPSIA, Issue 6 2004
Dong Wook Kim
Summary: Purpose: To characterize the clinical features, the prognostic value, and diagnostic sensitivities of various presurgical evaluations and the surgical outcomes in parietal lobe epilepsy (PLE), we describe 40 patients who were diagnosed as having PLE, including 27 surgically treated patients. Methods: The diagnosis was established by means of a standard presurgical evaluation, including magnetic resonance imaging (MRI), fluorodeoxyglucose,positron emission tomography (FDG-PET), ictal single-photon emission tomography (SPECT), and scalp video-electroencephalography (EEG) monitoring, with additional intracranial EEG monitoring in selected cases. Results: Among the 40 patients, 27 experienced at least one type of aura. The most common auras were somatosensory (13 patients), followed by affective, vertiginous, and visual auras. The patients had diverse manifestations. Eighteen patients showed simple motor seizure, followed by automotor seizure, and dialeptic seizure. Two patients manifested generalized tonic,clonic seizures only, and 19 patients experienced more than one type of seizure. The surgical outcome was favorable in 22 of 26 patients including 14 who were seizure free. Patients with localized MRI abnormality had a higher probability to be seizure free, with marginal significance (p = 0.062), whereas other diagnostic modalities failed to predict the surgical outcome. In the seizure-free group, localization sensitivity was 64.3% by MRI, 50% by PET, 45.5% by ictal SPECT, and 35.7% by ictal EEG. The concordance rate of the various diagnostic modalities was higher in the seizure-free group than in the non,seizure-free group, although it did not reach statistical significance. Conclusions: Seizures, in the case of PLE, can manifest themselves in a wider variety of ways than was previously thought. Surgical outcome was favorable in most of the patients. MRI abnormality and concordance of different diagnostic modalities were associated with high seizure-free rate. [source]

Withdrawal of antiepileptic drugs after neocortical epilepsy surgery

ANNALS OF NEUROLOGY, Issue 2 2010
Kyung-Il Park MD
Objective This study investigated the prevalence of successful antiepileptic drug withdrawal and identified predictors of seizure recurrence after antiepileptic drug reduction following resectional operation for intractable neocortical epilepsy. Methods We retrospectively assessed 223 patients (100 with neocortical temporal lobe epilepsy, 69 with frontal lobe epilepsy, 23 with parietal lobe epilepsy, 25 with occipital lobe epilepsy, and 6 with multifocal epilepsy) who underwent surgery. The mean period of observation was 84.4 months (range, 24,152 months) after surgery and 72.6 months (range, 12,138 months) after initial reduction. Clinical characteristics, magnetic resonance imaging, and surgical parameters were evaluated for their potential to predict recurrence associated with antiepileptic drug withdrawal. Results Antiepileptic drug reduction was attempted in 147 patients (65.9%), 78 (53.1%) of whom had seizure recurrence after initial reduction. Discontinuation was achieved in 73 patients (32.7%), and 59 (80.8%) of these remained seizure free until final assessment. Multivariate analysis revealed that early drug tapering, normal magnetic resonance imaging results, seizure before reduction, and longer epilepsy duration were associated with recurrence. Finally, 27.4% of patients were seizure free without drugs, and 26.9% were seizure free with drugs. Compared with preoperative status, the number of antiepileptic drugs needed decreased in 50.7% of patients, did not change in 19.3%, and increased in 30.0% after surgery. Interpretation The complete-cure rate of intractable neocortical epilepsy by resectional surgery was 27.4%. When patients undertake early tapering, and have normal magnetic resonance imaging results, seizure before reduction, and longer disease duration, further withdrawal should be done cautiously because of the high risk of relapse. ANN NEUROL 2010;67:230,238 [source]