Versive seizures in occipital lobe epilepsy: lateralizing value and pathophysiology

Area of Science:

• Neurology
• Epileptology
• Neurosurgery

Background:

• Occipital lobe epilepsy (OLE) presents diagnostic challenges for precisely locating the epileptogenic zone.
• Versive seizures, characterized by head and eye deviation, are potential indicators of seizure origin.
• Understanding the lateralizing value of versive seizures is crucial for effective surgical planning in OLE.

Purpose of the Study:

• To determine the accuracy of versive seizures in lateralizing and localizing the epileptogenic zone in OLE.
• To investigate the association between versive seizure direction and surgical resection side.
• To analyze accompanying motor symptoms during versive seizures in OLE.

Main Methods:

• Retrospective analysis of 13 OLE patients with documented versive seizures during video-electroencephalography (EEG) monitoring.
• Surgical resection of the occipital lobe.
• Postoperative follow-up exceeding 2 years with Engel's class I outcome assessment.
• Detailed analysis of 49 videotaped versive seizures, comparing version direction with resection side.
• Examination of associated motor symptoms, including somatomotor manifestations, automatisms, and eyelid blinking.

Main Results:

• The direction of versive seizures was consistently contralateral to the side of surgical resection in 12 out of 13 patients.
• Partial somatomotor manifestations were observed in only five patients during versive seizures.
• The low incidence of accompanying motor symptoms suggests a distinct mechanism for versive seizures in OLE compared to frontal lobe epilepsy.

Conclusions:

• Versive seizures serve as a reliable lateralizing sign for the epileptogenic zone in occipital lobe epilepsy.
• The findings support the utility of versive seizure analysis in preoperative localization for OLE.
• The distinct pattern of associated symptoms implies a unique pathophysiology of versive seizures in OLE.