Clinical features of epilepsy in patients with cerebellar structural abnormalities in a referral center

The objective of this study was to describe epilepsy localization, clinical features and surgery outcome in patients with epilepsy and cerebellar structural abnormalities.

We identified 10 patients with cerebellar lesions and epilepsy from our epilepsy database. Patients with only cerebellar atrophy were excluded. Medical records were reviewed for demographic data, seizure history, examination findings, EEG findings, epilepsy treatment and course. We reviewed imaging data for cerebellar structural findings, as well as cerebral abnormalities.

Out of 2288 epilepsy patients in the database, 10 had epilepsy and cerebellar structural abnormalities other than atrophy. Their ages ranged from 26 to 52 years. The most common cerebellar malformations included Dandy-Walker malformation, cerebellar tumors and posterior fossa arachnoid cyst. Epilepsy was classified as generalized in one patient. Nine patients had focal epilepsy: the localization was temporal in five, frontal in one, occipital in one, and unclassified in two. A cerebral structural abnormality considered responsible for epilepsy was identified in six patients; four had hippocampal sclerosis, one had a hippocampal malformation, and one had a temporal pole cortical malformation. Presurgical evaluation was done in six patients. Surgery was performed in five, with excellent outcome in four.

In this small series, epilepsy associated with cerebellar malformations was usually focal, most often with a temporal lobe focus. The cerebellar lesions did not adversely affect surgical success.