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Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients
Published on: December 18, 2016
Drug-resistant parietal epilepsy: polymorphic ictal semiology does not preclude good post-surgical outcome
Stefano Francione1, Alexandra Liava2, Roberto Mai1
1"Claudio Munari" Epilepsy Surgery Centre, Niguarda Ca' Granda Hospital.
Insights
Parietal lobe epilepsy surgery in children and adults shows 75% success, with pediatric patients achieving better outcomes and drug discontinuation. Complete resection of the seizure focus is key for successful surgical treatment.
Area of Science:
- Neurosurgery
- Epileptology
- Clinical Neurology
Background:
- Pharmacoresistant epilepsy often necessitates surgical intervention.
- Parietal lobe epilepsy presents unique diagnostic and therapeutic challenges.
- Understanding the specific features of parietal lobe seizures is crucial for surgical planning.
Purpose of the Study:
- To analyze the anatomo-electro-clinical features and surgical outcomes of parietal lobe resections.
- To compare outcomes between pediatric and adult patients undergoing parietal lobe surgery.
- To identify predictors of successful surgical treatment for pharmacoresistant parietal lobe epilepsy.
Main Methods:
- Retrospective analysis of 40 consecutive patients with pharmacoresistant seizures undergoing parietal lobe resection.
- Subgroup analysis of pediatric (n=11) and adult (n=29) populations.
- Evaluation of clinical outcomes using Engel classification and seizure recurrence rates.
- Correlation analysis of pre-operative factors, surgical techniques, and post-operative results.
Main Results:
- Overall, 75% of patients achieved Engel Class I outcome after a mean follow-up of 9.4 years.
- Pediatric patients exhibited more comorbidities but had significantly better surgical outcomes and higher rates of drug discontinuation.
- Total resection of the epileptogenic zone and localizing interictal electroencephalography (EEG) were significant predictors of favorable outcomes.
- Parietal lobe seizures are characterized by diverse auras and secondary generalization, which did not negatively impact surgical results.
Conclusions:
- Surgical resection confined to the parietal lobe is an effective treatment for pharmacoresistant epilepsy, with high success rates.
- Pediatric patients with parietal lobe epilepsy benefit significantly from surgery, often achieving better seizure control and medication independence.
- Complete resection of the epileptogenic zone, guided by EEG, is paramount for optimizing surgical outcomes in parietal lobe epilepsy.
Abstract:
We investigated the anatomo-electro-clinical features and clinical outcome of surgical resections strictly confined to the parietal lobe in 40 consecutive patients who received surgery for pharmacoresistant seizures. The population was subcategorized into a paediatric (11 subjects; mean age at surgery: 7.2+/-3.7 years) and an adult group (29 patients; mean age at surgery: 30+/-10.8 years). The paediatric group more frequently exhibited personal antecedents, neurological impairment, high seizure frequency, and dysplastic lesions. Nonetheless, compared with adults, children had better outcome and more frequently reached definitive drug discontinuation after surgery. After a mean follow-up of 9.4 years (range: 3.1-16.7), 30 subjects (75%) were classified as Engel Class I. The presence of multiple types of aura in the same patient, as well as a high incidence of secondary generalization, represented a characteristic feature of parietal seizures and did not correlate negatively with surgical outcome. A total resection of the epileptogenic zone and a localizing/regional interictal EEG were statistically significant predictive factors of outcome. Intracerebral investigation, performed in 55% of cases, contributed to complete tailored resections of the epileptogenic area and determination of prognosis. Frequent subjective manifestations of parietal lobe seizures, such as vertiginous, cephalic and visual-moving sensations, underscore their potential misdiagnosis as non-epileptic events.
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