Clinical Features of Patients with Posterior Cortex Epilepsies and Predictors of Surgical Outcome

Abstract

Summary:Purpose: Posterior cortex epilepsies (PCEs) encompass a group of epilepsies originating from the occipital, parietal, or occipital border of the temporal lobe, or from any combination of these regions. When their seizures are refractory to pharmacologic treatment, these patients are usually referred for surgery. The aim of our study was to analyze clinical characteristics of all PCE patients referred for surgery from 1994 to 2003, and to search for predictors of surgical outcome.Methods: We performed a retrospective analysis of clinical and laboratory data from 81 consecutive refractory PCE patients referred for surgery. Surgical and nonsurgical groups of patients were compared, and detailed analyses of all variables of the surgical cases were performed in the search for predictors of seizure outcome.Results: Risk factors for PCEs included gliosis (34.56%), malformations of cortical development (33.33%), tumors (8.64%), brain trauma (3.70%), Sturge-Weber disease (4.93%), vascular malformations (3.70%), family history of epilepsy (3.70%), history of CNS infections (2.46%), and low IQ (2.46%). Of the 81 patients, 44 were submitted to surgery at the time of the completion of this study. Surgical treatment was highly effective in improving seizures (p < 0.001) when compared with previous pharmacologic treatment alone. Twenty-eight (65.11%) patients became seizure free after surgery versus none in the nonsurgical group. Regarding outcome predictors, patients with shorter duration of epilepsy and those without neurologic abnormalities on clinical examination had higher chances of favorable evolution.Conclusions: Surgical treatment is effective for the treatment of PCEs and superior to pharmacologic therapy alone. In our series, shorter duration of epilepsy and normal neurologic examination were the only independent variables that predicted better surgical outcome.

Individually tailored extratemporal epilepsy surgery in children: Anatomo-electro-clinical features and outcome predictors in a population of 53 cases

“…Our results are in line with previous studies [19,20] showing that individuals with longer duration of focal epilepsy had significantly worse seizure prognosis after resective surgery, independently from age at seizure onset and at surgery, and this could constitute a strong argument for early surgical referral.…”

Magnetic Source Imaging in Posterior Cortex Epilepsies

“…PCE are challenging in the context of epilepsy surgery, being characterized by less satisfying postoperative results than temporal lobe epilepsies. The long-term favourable outcome after PCE surgery ranges from 17 to 74 % (Blume et al 1991;Boesebeck et al 2002;Dalmagro et al 2005;Elsharkawy et al 2009;Jehi et al 2009;Bartolomei et al 2011). Surface EEG interictal spikes are present in 80-90 % of PCE.…”

“…The term posterior cortex epilepsy (PCE) encompasses a group of epilepsies originating from the occipital or parietal lobe or the posterior part of the temporal lobe, or from any combination of these regions (Blume et al 1991;Sveinbjornsdottir and Duncan 1993;Dalmagro et al 2005). PCE are challenging in the context of epilepsy surgery, being characterized by less satisfying postoperative results than temporal lobe epilepsies.…”

Long-term outcome of lesional posterior cortical epilepsy surgery in adults

“…Previous reports of PCEs included a small number of surgical patients,2 only a subgroup of PCEs was studied,7 and they included only occipital lobe5 8 or parietal lobe 9. Some previous studies merely focused on the surgical technique in PCEs,10 and most of them included only short-term follow-up results 1…”