Epilepsy classification and additional definitions in occipital lobe epilepsy

Abstract

Aim. To evaluate epileptic children with occipital lobe epilepsy (OLE) in the light of the characteristics of Panayiotopoulos syndrome and late-onset occipital lobe epilepsy of Gastaut (OLE-G). Methods. Patients were categorized into six groups: primary OLE with autonomic symptoms (Panayiotopoulos syndrome), primary OLE with visual symptoms (OLE-G), secondary OLE with autonomic symptoms (P-type sOLE), secondary OLE with visual symptoms (G-type sOLE), and noncategorized primary OLE and non-categorized secondary OLE according to characteristic ictal symptoms of both Panayiotopoulos syndrome and OLE-G, as well as aetiology (primary or secondary). Patients were compared with regards to seizure symptoms, aetiology, cranial imaging, EEG, treatment and outcome. Results. Of 108 patients with OLE (6.4±3.9 years of age), 60 patients constituted primary groups (32 with Panayiotopoulos syndrome, 11 with OLE-G, and 17 with non-categorized primary OLE); the other 48 patients constituted secondary groups (eight with P-type sOLE, three with G-type sOLE, and 37 with non-categorized sOLE). Epileptiform activity was restricted to the occipital area in half of the patients. Generalized epileptiform activity was observed in three patients, including a patient with Panayiotopoulos syndrome (PS). Only one patient had refractory epilepsy in the primary groups while such patients made up 29% in the secondary groups. Conclusion. In OLE, typical autonomic or visual ictal symptoms of Panayiotopoulos syndrome and OLE-G do not necessarily indicate primary (i.e. genetic or idiopathic) aetiology. Moreover, primary OLE may not present with these symptoms. Since there are many patients with OLE who do not exhibit the characteristics of Panayiotopoulos syndrome or OLE-G, additional definitions and terminology appear to be necessary to differentiate between such patients in both clinical practice and studies.

Seizure Outcomes in Occipital Lobe and Posterior Quadrant Epilepsy Surgery: A Systematic Review and Meta-Analysis

“…4–6 However, OLE can also manifest with altered mental status and generalized tonic-clonic activity, suggesting electrical spread to neighboring cortical regions, and complicating accurate diagnosis and seizure localization. 7 Overall, OLE is often a severely debilitating disorder with significant impact on patient quality of life.…”

Seizures in Childhood: Aetiology, Diagnosis, Treatment, and What the Future May Hold

“…6 Self-limited occipital epilepsy is another childhood epilepsy syndrome and accounts for 5-10% of epilepsies. 4,7 There are two types, early onset which is known as Panayiotopoulos syndrome and late onset, which is known as Gastaut type. In Panayiotopoulos syndrome, the age of onset is between the age of 1 and 6, and seizures typically resolve within 3 years.…”

Childhood Occipital Epilepsy: Clinical Evaluation of 19 Patients

“…They mostly demonstrate visual symptoms like visual hallucinations and sometimes ictal blindness. Impairment of consciousness is infrequent but visual symptoms with eyelid blinking may advance into hemiconvulsions and focal to bilateral tonic-clonic seizures (4,6,7).…”

“…Early-onset benign childhood occipital epilepsy (Panayiotopoulos syndrome) presents by ictal vomiting, tonic eye deviation with infrequent and nocturnal seizures (4,6). The seizures commonly start at the age of 1-14 years (mean of 4.7 years) and also may complete with hemiclonic or generalized.…”

“…The seizures commonly start at the age of 1-14 years (mean of 4.7 years) and also may complete with hemiclonic or generalized. Moreover, two-thirds of seizures occur during sleep (6).…”