Surgical Outcome of Parietal Lobe Epilepsy (P7.278)

Objective: This study reviews semiology, electroclinical features, neuroimaging, and surgical outcomes of a group of Parietal Lobe Epilepsy (PLE) patients Background: PLE accounts for approximately 10% of epilepsy patients, but it is underecognized due atypical semiologies and false electoencephalographic (EEG) localization. Correlation of semiological features, EEG and neuroimaging findings, and surgical outcomes of PLE can provide improved diagnostic markers. Methods: Retrospective chart review of clinical histories, video-EEG and neuroimaging, surgical pathology was performed in 16 patients (6M/9F) with suspected medically refractory PLE. The mean age of the patients at surgery was 22 (range 1.5 to 51) years old, and had epilepsy for a mean 11(range 0.5 to 30) years. Results: Seizures included simple, complex and secondary generalized tonic-clonic seizures. Auras were identified in 13 (81%) patients, most commonly paresthesias, visual or auditory auras. Supplementary motor area (SMA) and hypermotor seizures originated from the superior parietal lobe and parietal operculum, hypo- or automotor seizures from the inferior and mesial parietal regions. Five patients also had suspected psychogenic-nonepileptic seizures (PNES). EEG demonstrated multiregional discharges interictally, but ictal onsets tended to be ipsilateral to the seizure onset zone. Ten (62.5%) patients had visible lesions on magnetic resonance imaging (MRI). Eleven patients were implanted for Phase II intracranial monitoring due to planned resections near eloquent cortex, lack of structural abnormality, large irritative zone or poorly localized seizure onset. Pathological changes were found on all samples, including neoplasms, cortical dysplasia and cerebrovascular malformations in 8 patients. Eleven (68.7%) patients had Engel Class I or II outcomes. Conclusions: The surgical success in this patient group is due to the high percentage of lesional patients. Although most patients exhibited auras, they were localizing only in a few cases. Semiology differed between patients with a superior versus inferior or mesial parietal onset, while EEG was more often lateralizing than localizing. Disclosure: Dr. Moise has nothing to disclose. Dr. Jordan has nothing to disclose. Dr. Morgan has nothing to disclose. Dr. Leary has nothing to disclose. Dr. Karkar has nothing to disclose. Dr. Lie has nothing to disclose. Dr. Cavazos has received personal compensation for activities with GXC Global, Inc. as a consultant. Dr. Caron has nothing to disclose. Dr. Papanastassiou has nothing to disclose. Dr. Szabo has received personal compensation for activities with UCB Pharma, GlaxoSmithKline Inc., and Pfizer Inc. as a speaker.