Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct;268(10):3926-3934.
doi: 10.1007/s00415-021-10557-y. Epub 2021 Apr 26.

Adult occipital lobe epilepsy: 12-years on

Heather Angus-Leppan  1   2 , Thomas A Clay  3
Affiliations

Adult occipital lobe epilepsy: 12-years on

Heather Angus-Leppan et al. J Neurol. 2021 Oct.

Abstract

Objective: Occipital lobe epilepsies (OLE) comprise 5-10% of focal epilepsies in surgical and paediatric series; with little data from adult medical cohorts. This longitudinal study examined OLE patients, to characterise prevalence, semiology, co-morbidity and prognosis in a neurology outpatient setting.

Methods: 24 adult OLE patients identified over 12 months from 1548 patients in a neurologist's service were followed over 12 years.

Results: 92% of these OLE patients had simple visual hallucinations, misdiagnosed in 40% of cases. 75% had co-morbid interictal migraine and 38% had visual field defects. Only 33% achieved long-term remission, and only 2 /10 (20%) of OLE patients with a structural aetiology were seizure-free. The two patients with migralepsy achieved remission.

Conclusion: Adult OLE accounted for 7.7% of focal epilepsies in this cohort, misdiagnosed or misclassified in 40%. Most patients had co-existing migraine. A minority had migralepsy characterised by a longer aura and good prognosis. Remission rates were lower than that of childhood OLE and general adult epilepsy populations, strengthening the argument for considering epilepsy surgery in drug-resistant OLE patients with a structural cause. Precision medicine will potentially refine diagnosis and management in those OLE patients without an identified cause but is predicated on accurate clinical phenotyping.

Keywords: Focal epilepsy; Migraine; Migralepsy; Occipital epilepsy; Occipital seizures; Visual aura; Visual hallucinations.

PubMed Disclaimer

References

    1. Caraballo R, Cersosimo R, Fejerman N (2007) Panayiotopoulos syndrome: a prospective study of 192 patients. Epilepsia 48(6):1054–1061 - DOI
    1. Taylor I et al (2008) Benign occipital epilepsies of childhood: clinical features and genetics. Brain 131(Pt 9):2287–2294 - DOI
    1. Sveinbjornsdottir S, Duncan JS (1993) Parietal and occipital lobe epilepsy: a review. Epilepsia 34(3):493–521 - DOI
    1. Manford, M., et al., The National General Practice Study of Epilepsy. The syndromic classification of the International League Against Epilepsy applied to epilepsy in a general population. Arch Neurol, 1992. 49(8): p. 801–8.
    1. Kennedy DN et al (1998) Gyri of the human neocortex: an MRI-based analysis of volume and variance. Cereb Cortex 8(4):372–384 - DOI