Seizure Outcomes in Occipital Lobe and Posterior Quadrant Epilepsy Surgery: A Systematic Review and Meta-Analysis

Harward, Stephen C.; Chen, William; Rolston, John D.; Haglund, Michael M.; Englot, Dario J.

doi:10.1093/neuros/nyx158

Cited by 35 publications

(40 citation statements)

References 54 publications

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“…69 Resection had an average Engel I outcome in 65% (range 5 20-100%). 70 A discrete MRI lesion and age < 18 years were predictive of successful surgical outcome. Occipital lobe epilepsy surgery carries significant risk of postoperative visual dysfunction.…”

Section: Scope Of Surgical Treatmentmentioning

confidence: 95%

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Getting the best outcomes from epilepsy surgery

Vakharia

Duncan

Witt

et al. 2018

Annals of Neurology

178

139

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Neurosurgery is an underutilized treatment that can potentially cure drug‐refractory epilepsy. Careful, multidisciplinary presurgical evaluation is vital for selecting patients and to ensure optimal outcomes. Advances in neuroimaging have improved diagnosis and guided surgical intervention. Invasive electroencephalography allows the evaluation of complex patients who would otherwise not be candidates for neurosurgery. We review the current state of the assessment and selection of patients and consider established and novel surgical procedures and associated outcome data. We aim to dispel myths that may inhibit physicians from referring and patients from considering neurosurgical intervention for drug‐refractory focal epilepsies. Ann Neurol 2018;83:676–690

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Section: Scope Of Surgical Treatmentmentioning

confidence: 95%

“…Resection had an average Engel I outcome in 65% (range = 20–100%) 70. A discrete MRI lesion and age < 18 years were predictive of successful surgical outcome.…”

Section: Scope Of Surgical Treatmentmentioning

confidence: 98%

Getting the best outcomes from epilepsy surgery

Vakharia

Duncan

Witt

et al. 2018

Annals of Neurology

178

139

View full text Add to dashboard Cite

show abstract

“…Its etiology is attributed to a wide spectrum of causes, including metabolic, structural, neoplastic, traumatic, infectious, and idiopathic processes. [ 8 ] Typically, this type of epilepsy has been associated with the appearance of visual symptoms (e.g., visual hallucinations, campimetric defects, transient amaurosis or eye movement sensation, among others) and occipital abnormalities in the electroencephalogram (EEG), although these findings are not present in all patients and their absence does not rule out the diagnosis. [ 1 ] In certain cases, this pathology can be manifested by altered level of consciousness and/or generalized tonic-clonic activity.…”

Section: Introductionmentioning

confidence: 99%

“…[ 16 ] Some studies attribute the low localization values of the surface EEG to the high prevalence of extensive (79%) and bilateral (29%) epileptogenic foci in this pathology, as well as to the anatomical position of the occipital lobe at the base of the brain and its multiple connections with other brain areas. [ 8 , 13 ] The limitations associated with surface electrodes highlight the importance of using more invasive monitoring methods (such as subdural and/or depth electrodes) and neuroimaging tests when diagnosing and characterizing this type of epilepsy anatomically.…”

Section: Introductionmentioning

confidence: 99%

Evolution of patients with surgically treated drug-resistant occipital lobe epilepsy

Aznarez

Cabeza

Quintana

et al. 2020

Surgical Neurology International

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Background: This study was to describe the evolution of patients who underwent surgical treatment of drug- resistant occipital lobe epilepsy (OLE) at our institution. Methods: We performed a retrospective analysis of data collected from electronic and paper clinical records of 20 patients who were diagnosed of OLE and underwent epilepsy surgery at our institution between 1998 and 2018. We also contacted patients by telephone and asked them to fill out a questionnaire about quality of life in epilepsy (QOLIE-10). Assembled data were analyzed using descriptive statistics. Results: The age at surgery ranged between 19 and 55 years. The period encompassing epilepsy onset and the date of surgery was variable. Semiology of seizures included visual symptoms in 75% of patients. In 90% of cases subdural grids, depth electrodes or a combination of both were used to plan the surgery. The most frequent neuroimaging and histopathological finding was cortical dysplasia (55%). The postoperative follow-up period was up to 15 years. The most common score on the Engel scale was I (70%). Visual deficits increased after surgery. Median score on QOLIE-10 questionnaire was 82.5 (interquartile range: 32.5). Conclusion: Surgical treatment of drug-resistant OLE offers hopeful results to those patients who have run out of pharmacological options and leads to postoperative deficits that are deemed expectable and occasionally acceptable.

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“…3 However, OE is amenable to resective surgery, with reported long-term seizure freedom in 46%-65% of the cases. 6,17 The visual status of the patient and whether or to what degree a postoperative visual field deficit is acceptable is a pivotal discussion between the patient and surgeon prior to surgery. 5 To minimize the likelihood for or extent of postoperative visual impairment, mapping techniques by means of electrocortical stimulation under awake conditions have been applied since the beginning of epilepsy surgery.…”

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confidence: 99%

Awake perimetry testing for occipital epilepsy surgery

Joswig

Girvin

Blume

et al. 2018

Journal of Neurosurgery

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In the literature, there are few reports that provide a detailed account on the technique of visual electrocortical stimulation in the setting of resective surgery for occipital epilepsy. In this technical note, the authors describe how a 26-year-old male with long-standing occipital epilepsy underwent resective surgery under awake conditions, using electrocortical stimulation of the occipital lobe, with the aid of a laser pointer and a perimetry chart on a stand within his visual field. The eloquent primary visual cortex was found to overlap with the seizure onset zone that was previously determined with subdural electrodes. A maximum functionally safe resection was performed, rendering the patient seizure free as of his last follow-up at 20 months, with no visual field impairment.

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Seizure Outcomes in Occipital Lobe and Posterior Quadrant Epilepsy Surgery: A Systematic Review and Meta-Analysis

Abstract: Surgical resection for OLE is associated with favorable outcomes with nearly two-thirds of patients achieving postoperative seizure freedom. However, patients must be counseled regarding the risk of visual decline following surgery.

Cited by 35 publications

References 54 publications

Getting the best outcomes from epilepsy surgery

Getting the best outcomes from epilepsy surgery

Evolution of patients with surgically treated drug-resistant occipital lobe epilepsy

Awake perimetry testing for occipital epilepsy surgery

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