Clinical Characteristics and Surgical Outcome in Patients with Intractable Seizure of Posterior Quadrant
Abstract number :
H.03
Submission category :
Year :
2000
Submission ID :
745
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
Yong D Park, Don W King, Edward Hartmann, Ki H Lee, David W Loring, Kimford J Meador, Anthony M Murro, Joseph R Smith, Mark R Lee, Medical Coll of Georgia, Augusta, GA.
RATIONALE: To determine the clinical phenomena and surgical outcome in patients with intractable seizures of posterior cortical onset. METHODS: Between 1988 and 1999, twenty-five patients (mean age=24; range 1.8-years) underwent cortical resection: occipital lobe (OL)=11, temporo-occipital (TO)=9, parieto-occipital (PO)=3, parieto-occipito-temporal (POT)=2. All underwent MRI, continuous video/EEG monitoring, and 20 patients underwent intracarotid amytal testing. Fifteen underwent invasive monitoring. The mean number of seizures was 6.8 and 9.6 per patient during scalp EEG recording and invasive monitoring respectively. All outcome data were acquired at one year postoperative. RESULTS: Fourteen patients were seizure free. Elementary visual auras were present in 12 patients. Auras suggestive of temporal lobe onset were present in 6 patients. Contralateral eye and/or head deviation observed in 10 cases. Complex partial seizures suggesting temporal lobe involvement (TLE) were noted in 14 cases. Interictal epileptiform discharges from the posterior temporal or occipital regions were noted in 11 patients. Anterior temporal lobe spikes were noted in 6 patients. Four patients had occipital ictal onset. Temporal lobe onset was noted in 2 patients. Unlocalized or multifocal EEG onset was noted in 14 patients. During invasive monitoring focal ictal EEG onset was found in 8 patients. Diffuse onset was found in 5 patients. Significant Wada memory differences were noted in 12 patients (OL=3, TO=8, and PO=1). Neuropathological examination revealed cortical dysplasia in 11, tumor in 6 . Presence of visual aura correlated with good surgical outcome (p=0.023). The age of seizure onset, age at surgery, seizure duration, both scalp and invasive EEG findings, pathology, and the location of resection did not affect surgical outcome. CONCLUSIONS: Our results showed: a) comparable surgical outcome is achieved in posterior cortical resection for intractable epilepsy, b) presence of visual aura may be a favorable prognostic indicator, c) invasive monitoring may be required in posterior cortical onset epilepsy.