Adult occipital lobe epilepsy: 12-years on

• Published in: Journal of neurology Vol. 268; no. 10; pp. 3926 - 3934
• Main Authors: Angus-Leppan, Heather, Clay, Thomas A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2021; Springer Nature B.V
• Subjects: Children; Drug resistance; Epilepsy; Hallucinations; Headache; Medicine; Medicine & Public Health; Migraine; Morbidity; Neurological Update; Neurology; Neuroradiology; Neurosciences; Occipital lobe; Patients; Phenotyping; Precision medicine; Prognosis; Remission; Seizures; Visual field; Visual aura; Occipital epilepsy; Focal epilepsy; Migraine; Occipital seizures; Migralepsy; Visual hallucinations
• ISSN: 0340-5354; 1432-1459; 1432-1459
• DOI: 10.1007/s00415-021-10557-y

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.