Cases with parietal and occipital lobe epilepsies

Background:For seizures emerging from the posterior cortex it can be a challenge to differentiate if they belong to temporal,parietal or occipital epilepsies.Sensoric auras like visual phenomena may occur in all of these focal epilepsies.Ictal signs may mimic non-epileptic seizures.Case presentations:Case 1:Patient suffering from a pharmacoresistent focal epilepsy.Focal seizures with sudden visual disturbance,later during the seizure epigastric aura,vertigo-nausea,involvement to bilateral tonic-clonic seizures.MEG detected interictal spikes,source localization indicated focal epileptic activity parietal right.Case 2:Patient with focal pharmacoresistent epilepsy,semiology with focal unaware seizures,feeling that something like a coat is imposed from behind on him,then feeling cold over the whole body,goose bumbs from both arms to head,then block of motoric activity,later focal unaware seizures with stare gaze,blinking of eyes,clouding of consciousness,elevation of arms and legs,sometimes tonic-clonic convulsions.EEG/MEG source localization and MRI detected an epileptogenic lesion parietal left.Case 3:Patient with pharmacoresistent focal epilepsy,focal aware seizures,a dark spot occurring in the left visual field,sometimes anxiety during seizures(leading to the suspicion of non-epileptic psychogenic pseudo seizures).MRI demonstrated an atrophy occipito-temporal right after sinus vein thrombosis.Ictal video-EEG showed a focal seizure onset occipital right.Conclusion:Contribution of noninvasive and/or invasive confirmation of the localization of the underlying focal epileptic activity in posterior cortex is illustrated.Characteristics of posterior cortex epilepsies are ventilated.

Interictal and Ictal MEG in presurgical evaluation for epilepsy surgery

Although presurgical evaluation of patients with pharamacoresistent focal epilepsies provides essential information for successful epilepsy surgery,there is still a need for further improvement.Developments of noninvasive electrophysiological recording and analysis techniques offer additional information based on interictal and ictal epileptic activities.In this review,we provide an overview on the application of ictal magnetoencephalography(MEG).The results of a literature research for published interictal/ictal MEG findings and experiences with own cases are demonstrated and discussed.Ictal MEG may provide added value in comparison to interictal recordings.The results may be more focal and closer to the invasively determined seizure onset zone.In some patients without clear interictal findings,ictal MEG could provide correct localization.Novel recording and analysis techniques facilitate ictal recordings.However,extended recording durations,movement and artifacts still represent practical limitations.Ictal MEG may provide added value regarding the localization of the seizure onset zone but depends on the selection of patients and the application of optimal analysis techniques.