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Epilepsy classification and additional definitions in occipital lobe epilepsy Volume 17, issue 3, September 2015

TEST YOURSELF

(1) What are the electroclinical epilepsy syndromes related to the occipital lobe?


(2) Most of the children with occipital lobe epilepsy have autonomic or visual ictal symptoms; is this correct?


(3) An occipital epilepsy patient whose seizures begin with autonomic or visual ictal symptoms has either Panayiotopoulos syndrome or late-onset occipital lobe epilepsy of Gastaut. Is this correct?


(4) Are all cases with occipital lobe epilepsy classified under the two epilepsy syndromes related to the occipital lobe (e.g. Panayiotopoulos syndrome or late-onset occipital lobe epilepsy of Gastaut)?

 

 

 

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Answers

(1) There are two: Panayiotopoulos syndrome and late-onset occipital lobe epilepsy of Gastaut.

(2) No, it is not. Half of the children with OLE had autonomic or visual ictal symptoms. If OLE is idiopathic (e.g. genetic), these presentations are more likely (three quarters of primary cases), but it may take time to confirm whether a patient is primary (e.g. genetic) or not.

(3) Both Panayiotopoulos syndrome and late-onset occipital lobe epilepsy of Gastaut are idiopathic (e.g. genetic) syndromes. Structural/metabolic or unknown aetiology in our study was identified in nearly half of the children with OLE, and 20% patients had autonomic or visual ictal symptoms. In other words, 20% of such patients are likely to have symptomatic occipital epilepsy despite the fact that they have autonomic or visual ictal symptoms. It should be noted that many patients with autonomic or visual ictal symptoms cannot be classified as Panayiotopoulos syndrome or late-onset occipital lobe epilepsy of Gastaut.

(4) These two syndromes constituted of 40% of all the occipital epilepsy patients and 71% of idiopathic (e.g. genetic) occipital epilepsy patients in our study, and 28% of the patients with primary OLE, 20% of the patients with the typical autonomic symptoms of Panayiotopoulos syndrome, and 21% of the patients with the typical visual symptoms could not be classified as either Panayiotopoulos syndrome or late-onset occipital lobe epilepsy of Gastaut. These findings demonstrate that the cases which cannot be classified as these syndromes require additional definitions to be differentiated in clinical practice and research. Since many patients with OLE, 60% of patients with OLE and 28% of those with primary OLE in our study, could not be classified according to electroclinical syndrome classification, we formed new definitions and terms for patients with occipital epilepsy who can be defined as either Panayiotopoulos syndrome or late-onset occipital lobe epilepsy of Gastaut.

 

 

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