Abstracts

Rationale: Patients with occipital lobe epilepsy may have isolated, simple partial seizures or following associated spread of the electrical discharge to neighboring temporal regions, complex partial seizures with or without secondary generalization. Affective disorders are prevalent in patients with epilepsy and adversely impact quality of life, though limited data is available on psychiatric disease in patients with occipital onset seizures. The purpose of this study was to determine whether the semiology of seizures in this group of patients is correlated with psychiatric co-morbidity. Methods: We retrospectively identified consecutive, adult patients (>17 years of age) with partial seizures of occipital lobe origin confirmed by video-EEG monitoring at the Strong Epilepsy Center between 2000 and the present. Of 20 patients identified, 16 patients participated in a formal interview by a neuropsychologist or psychiatrist as part of their seizure work-up to evaluate for co-morbid psychiatric disease. The other 4 patients had been diagnosed with dementia or developmental delay in addition to complex partial seizures. Twelve patients were female and 4 were male. The mean age at EEG monitoring was 36.1 years (18-69 years). Seven patients had left and 7 had right occipital seizures. One patient had independent left and right occipital seizures, and one had bilateral, simultaneous, occipital onset. Results: Patients with simple partial seizures only (5 patients) as determined by clinical history and video-EEG monitoring did not have co-morbid psychiatric diagnoses or report psychiatric symptoms of concern. Ten of 11 patients with complex partial semiology of seizures with or without secondarily generalized tonic-clonic seizures had co-morbid psychiatric disease or endorsed symptoms warranting further psychiatric follow-up (p=0.001). Six patients had a history of affective disorders (depression/dysthymia), 3 had anxiety, and 2 were diagnosed with psychogenic, non-epileptic attacks distinct from their epileptic seizures. Conclusions: This analysis confirms that affective disorders are also prevalent in patients with occipital lobe epilepsy though within this sample, only in patients with complex partial semiology. The involvement of temporal lobe structures with seizures in these individuals may predispose to underlying affective symptoms. Alternatively these symptoms may represent a reactive component to the social restrictions that are placed on patients with consciousness impairing events.