POSTERIOR CORTEX SEIZURES 
- PEDIATRIC CHALLENGES

Area of Science:

• Neurology
• Pediatric Epilepsy
• Neurophysiology

Background:

• Posterior cortex seizures present complex semiology, particularly challenging in pediatric populations.
• Clinical presentation alone is insufficient for localizing ictal activity in children, leading to under-recognition of this epilepsy type.
• Subjective ictal symptoms can be overshadowed by adjacent cortical involvement, masking posterior cortex epilepsy.

Purpose of the Study:

• To highlight the diagnostic challenges of posterior cortex seizures in pediatric epilepsy.
• To emphasize the need for advanced diagnostic methods beyond clinical presentation and scalp EEG.
• To discuss the implications for surgical management of pharmacoresistant epilepsies originating in the posterior cortex.

Main Methods:

• Review of clinical semiology in pediatric posterior cortex seizures.
• Analysis of electroencephalography (EEG) findings, including scalp and direct cortical recordings.
• Discussion of surgical outcomes and challenges in posterior quadrant epilepsy surgery.

Main Results:

• Posterior cortex seizures exhibit misleading semiology and often present with scattered interictal discharges and uninformative ictal EEG recordings.
• Scalp EEG can provide inaccurate localization due to the parietal lobe's extensive synaptic network and imitator characteristics.
• Direct cortical recordings may aid localization but are subject to misinterpretation, even by experienced epileptologists.

Conclusions:

• Posterior cortex epilepsy, especially in children, remains under-recognized due to diagnostic complexities.
• Current diagnostic tools, including clinical presentation and scalp EEG, are often insufficient for accurate localization.
• Epilepsy surgery in the posterior quadrant is infrequent and less successful, particularly in non-lesional cases, necessitating further research into underlying mechanisms.