PARIETAL LOBE EPILEPSY-THE SEMIOLOGY, YIELD OF DIAGNOSTIC WORK UP AND SURGICAL OUTCOME
Abstract number :
1.444
Submission category :
Year :
2003
Submission ID :
2518
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Dong Wook Kim, Chang-Ho Yun, Sang Kun Lee, Dong Soo Lee, Chun-Kee Chung Neurology, Seoul National University Hospital, Seoul, Korea; Neurology, Inha University Hospital, Incheon, Korea; Nuclear Medicine, Seoul National University Hospital, Seoul, Korea; N
Reports about intractable parietal lobe epilepsy (PLE) were limited due to unsatisfactory surgical result and difficulty for defining ictal origin. To characterize clinical features, diagnostic sensitivities of various presurgical evaluations and surgical outcome in PLE, we described 40 patients who were diagnosed as PLE including 27 surgically treated patients.
We included 40 consecutive patients (age; 27.0 [plusmn] 6.9 years, 21 male) who were diagnosed as PLE. The diagnosis was established by standard presurgical evaluations including magnetic resonance imaging (MRI), fluorodeoxyglucose-positron emission tomography (FDG-PET), ictal single photon emission tomography (SPECT), and scalp video[ndash]electroencephalography (EEG) monitoring with additional intracranial EEG monitoring in selected cases. We evaluated the clinical seizure characteristics, surgical prognosis and value of each evaluation method.
Among 40 patients, 27 patients experienced at least one type of aura. The most common auras were somatosensory (13/40, 32.5%), followed by affective, vertiginous, and visual auras. Patients presented with diverse manifestations. Eighteen patients showed simple motor seizure (18/40, 45%), 14 showed automotor seizure (14/40, 35%), and seven showed dialeptic seizure (7/40, 17.5%). Two patients presented with generalized tonic clonic seizure only, and 19 of 40 patients (47.5%) experienced more than one seizure type. The surgical outcome was favorable (seizure reduction more than 90%) in 22/26 (84.6%) patients. In favorable outcome group, localization sensitivity was 50% (11/22) by MRI, 50% (9/18) by ictal SPECT, 36.4% (8/22) by FDG-PET, 36.4% (8/22) by scalp ictal EEG, and 13.6% (3/22) by interictal EEG. The diagnostic sensitivity of each modality was not statistically significant (chi-square, p[gt]0.05). Concordance rate of various diagnostic modalities was higher in the favorable outcome group, though it did not reach statistical significance.
Seizures of PLE can manifest in wide diversity than previously appreciated. Surgical outcome was favorable in most of patients. Various presurgical evaluations showed similar modest localizing value in detecting the epileptogenic foci except interictal EEG.