Visual phenomena and anatomo-electro-clinical correlations in occipital lobe seizures |
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| Institution: | 1. Department of Neurology, University Hospital of Nancy, Nancy, France;2. Neurosciences of Systems and Cognition Project, BioSIS Department (Département Biologie, Signaux et Systèmes en Cancérologie et Neurosciences), Research Center for Automatic Control of Nancy (CRAN), Lorraine University, CNRS, UMR 7039, Vandoeuvre, France;1. Department of Neurology, CHU de Nîmes, université de Montpellier, Nîmes, France;2. Institut de cancérologie du Gard, CHU de Nîmes, université de Montpellier, Nîmes, France;1. Neurological department, groupe hospitalier Paris Saint-Joseph, Paris, France;2. Université Paris Cité, Paris, France;3. Intensive care unit, groupe hospitalier Paris Saint-Joseph, Paris, France;1. Neurology Department, Hôpitaux Civils de Colmar, Colmar, France;2. INSERM U-1118, University of Strasbourg, Strasbourg, France;1. Department of Nuclear Medicine, Public Assistance Hospitals of Marseille, Timone University Hospital, Marseille, France;2. Centre Européen de Recherche en Imagerie Médicale, Aix-Marseille University, Marseille, France;3. Department of Neurology and Movement Disorders, AP–HM, Timone University Hospital, Marseille, France;4. CRMBM, CEMEREM, CNRS, Aix Marseille Univ, Marseille, France;5. LNC, CNRS, Aix Marseille Univ, Marseille, France;6. CNRS, Central School of Marseille, Fresnel Institute, Aix-Marseille University, Marseille, France;1. Interventional Neuroradiology Department, Besançon University Hospital, Besançon, France;2. Neurology Department, Besançon University Hospital, Besançon, France;3. UR 481 Neurosciences laboratory, Bourgogne Franche-Comté University, Besançon, France;4. Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, Dijon, France;5. CIC-1431 Inserm, Besançon, France |
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| Abstract: | BackgroundOccipital lobe seizure are underrepresented in epilepsy surgery cases series. This may reflect the fear for post-surgical functional deficits but also the doubt about the ability of anatomo-electro-clinical correlations to localize precisely the epileptogenic zone in occipital lobe seizure.MethodsIn this expert opinion paper, we review first the general clinical characteristics of occipital lobe seizures, describe the repertoire of visual phenomena and oculo-motor signes in occipital seizures, describe inter-ictal and ictal EEG and finally the possible schemes of epileptogenic zone organization.ResultsVisual and oculo-motor semiology points towards occipital onset seizures but is neither pathognomonic nor constant. Eyes version and unilateral ictal discharge have a strong lateralizing value but inter-ictal spikes as well as eyes version can be falsely lateralizing.ConclusionAlthough visual and oculo-motor phenomena are characteristic of occipital lobe seizures, they may be discrete, overlooked and should therefore be carefully assessed. There are no clear electro-clinical correlations of a sublobar organization of occipital seizures but the clinical pattern of propagation might help to differentiate complex occipito-temporal from occipito-parietal initial epileptogenic network. |
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| Keywords: | Drug resistant epilepsy Epilepsy surgery Visual phenomena Occipital lobe seizures Video-EEG Stereo-electroencephalography (SEEG) |
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