Abstract
BackgroundFor seizures emerging from the posterior cortex it can be a challenge to differentiate if they belong to temporal, parietal or occipital epilepsies. Sensoric auras like visual phenomena may occur in all of these focal epilepsies. Ictal signs may mimic non- epileptic seizures.Case presentationsCase 1: Patient suffering from a pharmacoresistent focal epilepsy. Focal seizures with sudden visual disturbance, later during the seizure epigastric aura, vertigo-nausea, involvement to bilateral tonic-clonic seizures. MEG detected interictal spikes, source localization indicated focal epileptic activity parietal right.Case 2: Patient with focal pharmacoresistent epilepsy, semiology with focal unaware seizures, feeling that something like a coat is imposed from behind on him, then feeling cold over the whole body, goose bumbs from both arms to head, then block of motoric activity, later focal unaware seizures with stare gaze, blinking of eyes, clouding of consciousness, elevation of arms and legs, sometimes tonic-clonic convulsions. EEG/MEG source localization and MRI detected an epileptogenic lesion parietal left.Case 3: Patient with pharmacoresistent focal epilepsy, focal aware seizures, a dark spot occurring in the left visual field, sometimes anxiety during seizures (leading to the suspicion of non-epileptic psychogenic pseudo seizures). MRI demonstrated an atrophy occipito-temporal right after sinus vein thrombosis. Ictal video-EEG showed a focal seizure onset occipital right.ConclusionContribution of noninvasive and/or invasive confirmation of the localization of the underlying focal epileptic activity in posterior cortex is illustrated. Characteristics of posterior cortex epilepsies are ventilated.
Highlights
For seizures emerging from the posterior cortex it can be a challenge to differentiate whether they belong to temporal, parietal or occipital epilepsies
Focal aware seizures with sudden visual disturbance, semiology later during the seizure epigastric aura, vertigo-nausea, headache temple right, duration 1–4 min, frequency 12 times per month, focal unaware seizures with or without stare gaze, oral automatisms, no reaction, memory impairment, in 50% of these seizures involvement to bilateral tonic-clonic seizures occurred
Semiology: focal unaware seizures: feeling that something like a coat is imposed from behind on him, feeling of cold over the whole body, goose bumbs from both arms to head, block of motoric activity, later focal unaware seizures with stare gaze, blinking of eyes, clouding of consciousness, elevation of arms and legs, duration 15–30 s, frequency 3–6 times per month, sometimes tonic-clonic convulsions
Summary
After describing the clinical findings concerning semiology, electrophysiology and imaging of these patients the differentiation from non-epileptic attacks and the localization of the posterior cortex for the seizure onset region is discussed. The contribution of noninvasive and/or invasive confirmation of the localization of the underlying focal epileptic activity is illustrated. Characteristics of posterior cortex epilepsies are ventilated. Parietal and occipital lobe epilepsies represent a challenge for diagnosis and treatment. The combined view to ictal semiology, imaging, noninvasive source imaging and invasive recordings provide improved chances for correct diagnosis. Abbreviations DNT/ DNET: Dysembrioplastic neuroectodermal tumor; EEG: Electroencephalography; FCD: Focal cortical dysplasia; FDG-PET: Positron emission tomography; MAP: Morphometric analysis program; MEG: Magnetoencephalography; MRI/MSI: Magnetic resonance imaging; NOS: Not otherwise specified; OLE: Occipital lobe epilepsy; PLO: Parietal lob epilepsy; SPECT: Single photon emission computed tomography
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