CHILDHOOD OCCIPITAL EPILEPSY: CLINICAL EVALUATION OF 19 PATIENTS

Yıl 2021, , 168 - 172, 17.05.2021

Dilek Çavuşoğlu

https://doi.org/10.18229/kocatepetip.716277

Öz

OBJECTIVE: Childhood occipital epilepsy (COE) can mainly be divided into idiopathic (IOLE) or symptomatic occipital lobe epilepsy (SOLE). Idiopathic occipital lobe epilepsy consists of Panayiotopoulos (PS) and Gastaut syndromes (GS). In this study, we aimed to classify COE and investigate the segregations between the groups according to clinical features.
MATERIAL AND METHODS: Nineteen patients with COE were enrolled. Medical records of the patients were evaluated. Demographic data, ictal symptoms, neurological examination, brain magnetic resonance imaging (MRI) and electroencephalography (EEG) findings, family history, febrile seizure, and treatment response were analyzed.
RESULTS: There were 6 patients diagnosed with idiopathic occipital lobe epilepsy and 13 patients diagnosed with SOLE. Compared to the SOLE, all patients of the IOLE had a normal neurological examination and MRI findings (p=0.044 and p=0.009). The most frequent ictal symptom was generalized seizures in all groups (100% IOLE, 75% SOLE). However, ictal vomiting was the most frequent autonomic seizure in IOLE and PS (2/6, 2/4; 33%, 50%). Nocturnal seizures were observed more frequently in IOLE than SOLE (1/13, 3/6; 8%, 50%). The rate of family history (1 patient, 25%) and febrile seizures (1 patient, 25%) were found in only PS group. Psychomotor/mental retardation was more common in SOLE than IOLE (8/13, 2/6; 62%, 33%). According to treatment outcomes, the seizures were controlled with one antiepileptic drug (AED) in all patients of PS and two AEDs in all patients of GS. On the other hand, 38% of patients in SOLE were treated with three or more AEDs.
CONCLUSIONS: Normal neurologic examination and neuroimaging are substantial features due to discrimination between IOLE and SOLE. Ictal vomiting is a remarkable autonomic seizure in IOLE and PS. Although psychomotor/mental retardation is observed higher in SOLE than IOLE, the patients of COE should be followed up carefully. IOLE has better treatment outcomes than SOLE and PS has better than GS.

Anahtar Kelimeler

Occipital epilepsy, Child, Panayiotopoulos

ÇOCUKLUK ÇAĞI OKSİPİTAL EPİLEPSİ: 19 HASTANIN KLİNİK DEĞERLENDİRİLMESİ

Öz

AMAÇ: Çocukluk çağı oksipital epilepsi (ÇOE) başlıca idiyopatik (İOLE) ve semptomatik oksipital lob epilepsisi (SOLE) olarak ayrılabilir. İOLE, Panayiotopoulos (PS) ve Gastaut sendromundan (GS) oluşmaktadır. Bu çalışmada çocukluk çağı oksipital epilepsisini sınıflandırmak ve klinik özelliklerine göre gruplar arasındaki farklılıkları araştırmak amaçlandı.
GEREÇ VE YÖNTEM: Çocukluk çağı oksipital epilepsi tanılı 19 hasta çalışmaya dahil edildi. Hastaların tıbbi kayıtları değerlendirildi. Demografik verileri, iktal semptomları, nörolojik muayeneleri, elektroensefalografi ve manyetik rezonans görüntüleme(MRG) bulguları, aile öyküleri, febril nöbet ve tedavi yanıtları açısından analiz edildi.
BULGULAR: İdiyopatik oksipital lob epilepsi tanılı 6 hasta ve SOLE tanılı 13 hasta mevcuttu. SOLE ile karşılaştırıldığında, IOLE tanılı tüm olguların nörolojik muayeneleri ve beyin MRG’leri normal saptandı (p=0.044 ve p=0.009). Tüm gruplarda en sık iktal semptom jeneralize nöbetti (%100 IOLE, %75 SOLE). Ancak, IOLE ve PS grubunda en sık izlenen otonomik nöbet iktal kusma idi (2/6, 2/4; %33, %50). Nokturnal nöbetler, SOLE’den daha sık IOLE’de gözlendi (1/13, 3/6; %8, %50). Aile öyküsü (1 olgu, %25) ve febril nöbet (1 olgu, %25) sadece PS’de saptandı. Psikomotor/ mental retardasyon, SOLE’de IOLE’den daha sık saptandı (8/13, 2/6; %62, %33). Tedavi yanıtlarına göre nöbetler tek bir antiepileptik ilaç ile tüm PS tanılı olgularda ve iki antiepileptik ilaç ile tüm GS tanılı olgularda kontrol altına alındı. Diğer taraftan, SOLE tanılı olguların %38’i üç veya daha fazla antiepileptik ilaç ile tedavi edildi.
SONUÇ: Normal nörolojik muayene ve nörogörüntüleme IOLE’ni SOLE’den ayırmada esas özelliklerdir. İktal kusma IOLE ve PS içinde en dikkat çekici otonomik nöbettir. Psikomotor/mental retardasyon SOLE’de IOLE’den daha sık gözlenmesine rağmen ÇOE tanılı hastalar dikkatlice izlenmelidir. İdiyopatik oksipital lob epilepsisi SOLE’den ve PS de GS’den daha iyi tedavi cevabına sahiptir.

Anahtar Kelimeler

Oksipital epilepsi, Çocuk, Panayiotopoulos

Kaynakça

• 1. Gastaut H. A new type of epilepsy: benign epilepsy of childhood with occipital spike-waves. Clin Electroencephalogr 1982; 13: 13-23.
• 2. Jackson Hughlings J. Unilateral epileptiform seizures attended by temporary deficit of sight. Med Times Gaz 1863; 1: 588-9.
• 3. Du JC, Chien YH, Weng WC, et al. Clinical analysis of childhood occipital lobe epilepsy in 42 Taiwanese patients. Pediatr Neurol 2007; 36: 387-92.
• 4. Polat M, Gokben S, Tosun A, et al. Neurocognitive evaluation in children with occipital lobe epilepsy. Seizure 2012; 21: 241-4.
• 5. Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017; 58:512-21.
• 6. Yilmaz K, Karatoprak EY. Epilepsy classification and additional definitions in occipital lobe epilepsy. Epileptic Disord 2015;17: 299-307.
• 7. Taylor I, Berkovic SF, Kivity S, et al. Benign occipital epilepsies of childhood: clinical features and genetics. Brain 2008; 131:2287-94.
• 8. Van den Hout BM, van der Meij W, Wieneke GH, et al. Seizure semiology of occipital lobe epilepsy in children. Epilepsia 1997; 38: 1188-91.
• 9. Panayiotopoulos CP. Benign nocturnal childhood epilepsy: a new syndrome with nocturnal seizures, tonic deviation of eyes, and vomiting. J Child Neurol 1989; 4:43-8.
• 10. Tata G, Guveli BT, Dortcan N, et al. Panayiotopoulos syndrome and symptomatic occipital lobe epilepsy of childhood: a clinical and EEG study. Epileptic Disord 2014;16: 197-202.
• 11. Pal DK, Ferrie C, Addis L, et al. Idiopathic focal epilepsies: the "lost tribe". Epileptic Disord 2016;18: 252-88.
• 12. Ludwig BI, Ajmone-Marsan C. Clinical ictal patterns in epileptic patients with occipital electroencephalographic foci. Neurology 1975; 25: 463–71.
• 13. Williamson PD, Spencer SS. Clinical and EEG features of complex partial seizures of extratemporal origin. Epilepsia 1986; 27: S46–63.
• 14. Barkovich AJ, Kuzniecky RI, Jackson GD, et al. A developmental and genetic classification for malformations of cortical development. Neurology 2005; 65: 1873–87.
• 15. KF Swaiman. Swaiman's Pediatric Neurology. In: Tenney JR and Glauser T. Electroclinical Syndromes: Childhood Onset. Sixth Edition, Elsevier, 2018: e1346-58