Tailored resections in occipital lobe epilepsy surgery guided by monitoring with subdural electrodes: Characteristics and outcome

Caicoya, Anne Gomez; Macarrón, Jesús; Albisua, Julio; Serratosa, Joan

doi:10.1016/j.eplepsyres.2007.07.004

Cited by 27 publications

(25 citation statements)

References 20 publications

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“…Previous studies reported a successful outcome in occipital lobe epilepsy of between 22 and 85% of cases (Williamson et al., 1992; Aykut‐Bingol et al., 1998; Dalmagro et al., 2005; Kun Lee et al., 2005; Caicoya et al., 2007; Urbach et al., 2007; Binder et al., 2008; Tandon et al., 2009); 50% of our patients became seizure free. Outcome studies are difficult to compare given the variable outcome scales or surgical approaches.…”

Section: Discussionsupporting

confidence: 47%

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Intractable occipital lobe epilepsy: Clinical characteristics and surgical treatment

et al. 2010

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Summary Intractable occipital lobe epilepsy remains a surgical challenge. Clinical characteristics of 14 patients were analyzed. Twelve patients had surgery, seven patients had visual auras (50%) and only eight patients (57%) had posterior scalp EEG changes. Ictal single‐proton emission computed tomography (SPECT) incorrectly localized in 7 of 10 patients. Six patients (50%) had Engel’s class I outcome. Patients with inferior occipital seizure onset appeared to fare better (three of four class I) than patients with lateral or medial occipital seizure onset (three of eight class I). Patients who had all three occipital surfaces covered with electrodes had a better outcome (four of five class I) than patients who had limited electroencephalography (EEG) coverage (two of seven class I). Magnetic resonance imaging (MRI) lesions did not guarantee a seizure free outcome. In conclusion, visual auras, scalp EEG, and imaging findings are not reliable for correct identification of occipital onset. Occipital seizure onset can be easily missed in nonlesional epilepsy. Comprehensive intracranial EEG coverage of all three occipital surfaces leads to better outcomes.

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Section: Discussionsupporting

confidence: 47%

“…Patients with normal MRI undergoing occipital epilepsy surgery are few (Caicoya et al., 2007; Urbach et al., 2007; Binder et al., 2008). Lesional epilepsy has generally a better surgical outcome than nonlesional epilepsy.…”

Section: Discussionmentioning

confidence: 99%

Intractable occipital lobe epilepsy: Clinical characteristics and surgical treatment

et al. 2010

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“…This concurs with previous studies showing a tendency for favorable outcomes in lesional MCDs (Kuzniecky et al., 1997; Dalmagro et al., 2005; Urbach et al., 2007), and more so in tumors (Aykut‐Bingol et al., 1998; Boesebeck et al., 2002). This also suggests that similar to low‐grade neoplasms, high‐grade MRI‐visible MCDs (types IIA and IIB) are amenable to successful surgical treatment (Kuzniecky et al., 1997; Hamiwka et al., 2005; Yun et al., 2006; Caicoya et al., 2007; Urbach et al., 2007).…”

Section: Predictors Of Seizure Recurrencementioning

confidence: 94%

A longitudinal study of surgical outcome and its determinants following posterior cortex epilepsy surgery

Jehi¹,

O’Dwyer²,

Najm³

et al. 2009

Epilepsia

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SUMMARYPurpose: To investigate the longitudinal seizure outcome and identify potential prognostic indicators following posterior cortex epilepsy (PCE) surgery. Methods: We reviewed patients who underwent a parietal, occipital, or parietooccipital resections between 1994 and 2006, using survival analysis and multivariate regression with Cox proportional hazard modeling. A favorable outcome was defined as Engel Class I at last follow-up. Results: Fifty-seven patients were identified with a mean follow-up of 3.3 years (range 1-12 years). The estimated chance of seizure freedom (SF) was 73.1% % at 6 postoperative months, 68.5% % at 1 year, 65.8% % at between 2 and 5 years, and 54.8% % at 6 years and beyond. Most recurrences (75% %) occurred within the first 6 postoperative months. Parietal resections had a worse outcome than occipital or parietooccipital resections (52% % SF vs. 89% % and 93% %, respectively, at 5 years). Independent predictors of recurrence included an epilepsy etiology other than tumor or dysplasia [risk ratio (RR) 2.29], limiting resection to a lesionectomy (RR 2.10), having ipsilateral temporal spiking on preoperative scalp electroencephalography (EEG) (RR 2.06), or any ipsilateral spiking on postoperative EEG (RR 2.70) (Log likelihood-ratio test p < 0.0001). Only 40-50% % of patients with a poor outcome predictor were SF at 5 postoperative years as opposed to about 80% % otherwise. In surgical failures, recurrent seizure frequency was related directly to baseline seizure frequency and to the presence of ipsilateral spiking on postoperative EEG. Discussion: These data highlight favorable longterm outcomes following PCE surgery. Limited surgical resection and diffuse baseline epileptogenicity may be important predictors of seizure recurrence.

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“…Ulegyria is a relatively common consequence of hypoxic-ischaemic encephalopathy. Rapid ictal spread is not unique to ulegyria and has been demonstrated in cases of occipital lobe epilepsy due to underlying cortical dysplasia and neoplasms (Caicoya et al, 2007). Thus, ischaemic injury typically involves tissue in the frontoparietal, occipital, and peisylvian areas.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, ischaemic injury typically involves tissue in the frontoparietal, occipital, and peisylvian areas. Multifocal interictal spikes and early ictal depolarisation of the medial temporal lobes have been recorded in cases of surgically responsive occipital lobe epilepsy (Caicoya et al, 2007). Previous series investigating the impact of neonatal hypoglycaemia have demonstrated a posterior predilection of cortical injury, suggesting that there is a high metabolic rate in the occipital lobes during the perinatal period (Burns et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

Occipital ulegyria causing epilepsy and visual impairment: an easily overlooked epilepsy syndrome

O’Connor

Costello

2017

Epileptic Disorders

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Ulegyria refers to scarring of the cerebral cortex usually arising from perinatal ischaemia. The scarring has a specific configuration in which small atrophic circumvolutions at the bottom of a sulcus underlie an intact spared gyral apex. This disconnection of overlying cortex may allow an “epileptogenic” island of cortex to generate seizures. Ulegyria is often associated with epilepsy and developmental delay, however, the syndromic association of visual impairment with epilepsy due to occipital ulegyria may not be recognised as a specific entity. Here, we report a series of five patients with occipital ulegyria who presented with widely variable seizure semiology and an array of visual deficits. In some patients, the link between the epilepsy and the visual impairment was not appreciated until they attended an epilepsy clinic.

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Tailored resections in occipital lobe epilepsy surgery guided by monitoring with subdural electrodes: Characteristics and outcome

Cited by 27 publications

References 20 publications

Intractable occipital lobe epilepsy: Clinical characteristics and surgical treatment

Intractable occipital lobe epilepsy: Clinical characteristics and surgical treatment

A longitudinal study of surgical outcome and its determinants following posterior cortex epilepsy surgery

Occipital ulegyria causing epilepsy and visual impairment: an easily overlooked epilepsy syndrome

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