ÇOCUKLUK ÇAĞI OKSİPİTAL EPİLEPSİ: 19 HASTANIN KLİNİK DEĞERLENDİRİLMESİ

AMAÇ: Çocukluk çağı oksipital epilepsi (ÇOE) başlıca idiyopatik (İOLE) ve semptomatik oksipital lob epilepsisi (SOLE) olarak ayrılabilir. İOLE, Panayiotopoulos (PS) ve Gastaut sendromundan (GS) oluşmaktadır. Bu çalışmada çocukluk çağı oksipital epilepsisini sınıflandırmak ve klinik özelliklerine göre gruplar arasındaki farklılıkları araştırmak amaçlandı.GEREÇ VE YÖNTEM: Çocukluk çağı oksipital epilepsi tanılı 19 hasta çalışmaya dahil edildi. Hastaların tıbbi kayıtları değerlendirildi. Demografik verileri, iktal semptomları, nörolojik muayeneleri, elektroensefalografi ve manyetik rezonans görüntüleme(MRG) bulguları, aile öyküleri, febril nöbet ve tedavi yanıtları açısından analiz edildi.BULGULAR: İdiyopatik oksipital lob epilepsi tanılı 6 hasta ve SOLE tanılı 13 hasta mevcuttu. SOLE ile karşılaştırıldığında, IOLE tanılı tüm olguların nörolojik muayeneleri ve beyin MRG’leri normal saptandı (p=0.044 ve p=0.009). Tüm gruplarda en sık iktal semptom jeneralize nöbetti (%100 IOLE, %75 SOLE). Ancak, IOLE ve PS grubunda en sık izlenen otonomik nöbet iktal kusma idi (2/6, 2/4; %33, %50). Nokturnal nöbetler, SOLE’den daha sık IOLE’de gözlendi (1/13, 3/6; %8, %50). Aile öyküsü (1 olgu, %25) ve febril nöbet (1 olgu, %25) sadece PS’de saptandı. Psikomotor/ mental retardasyon, SOLE’de IOLE’den daha sık saptandı (8/13, 2/6; %62, %33). Tedavi yanıtlarına göre nöbetler tek bir antiepileptik ilaç ile tüm PS tanılı olgularda ve iki antiepileptik ilaç ile tüm GS tanılı olgularda kontrol altına alındı. Diğer taraftan, SOLE tanılı olguların %38’i üç veya daha fazla antiepileptik ilaç ile tedavi edildi.SONUÇ: Normal nörolojik muayene ve nörogörüntüleme IOLE’ni SOLE’den ayırmada esas özelliklerdir. İktal kusma IOLE ve PS içinde en dikkat çekici otonomik nöbettir. Psikomotor/mental retardasyon SOLE’de IOLE’den daha sık gözlenmesine rağmen ÇOE tanılı hastalar dikkatlice izlenmelidir. İdiyopatik oksipital lob epilepsisi SOLE’den ve PS de GS’den daha iyi tedavi cevabına sahiptir.

Anahtar Kelimeler:

Oksipital epilepsi, Çocuk, Panayiotopoulos

CHILDHOOD OCCIPITAL EPILEPSY: CLINICAL EVALUATION OF 19 PATIENTS

OBJECTIVE: Childhood occipital epilepsy (COE) can mainly be divided into idiopathic (IOLE) or symptomatic occipital lobe epilepsy (SOLE). Idiopathic occipital lobe epilepsy consists of Panayiotopoulos (PS) and Gastaut syndromes (GS). In this study, we aimed to classify COE and investigate the segregations between the groups according to clinical features.MATERIAL AND METHODS: Nineteen patients with COE were enrolled. Medical records of the patients were evaluated. Demographic data, ictal symptoms, neurological examination, brain magnetic resonance imaging (MRI) and electroencephalography (EEG) findings, family history, febrile seizure, and treatment response were analyzed.RESULTS: There were 6 patients diagnosed with idiopathic occipital lobe epilepsy and 13 patients diagnosed with SOLE. Compared to the SOLE, all patients of the IOLE had a normal neurological examination and MRI findings (p=0.044 and p=0.009). The most frequent ictal symptom was generalized seizures in all groups (100% IOLE, 75% SOLE). However, ictal vomiting was the most frequent autonomic seizure in IOLE and PS (2/6, 2/4; 33%, 50%). Nocturnal seizures were observed more frequently in IOLE than SOLE (1/13, 3/6; 8%, 50%). The rate of family history (1 patient, 25%) and febrile seizures (1 patient, 25%) were found in only PS group. Psychomotor/mental retardation was more common in SOLE than IOLE (8/13, 2/6; 62%, 33%). According to treatment outcomes, the seizures were controlled with one antiepileptic drug (AED) in all patients of PS and two AEDs in all patients of GS. On the other hand, 38% of patients in SOLE were treated with three or more AEDs.CONCLUSIONS: Normal neurologic examination and neuroimaging are substantial features due to discrimination between IOLE and SOLE. Ictal vomiting is a remarkable autonomic seizure in IOLE and PS. Although psychomotor/mental retardation is observed higher in SOLE than IOLE, the patients of COE should be followed up carefully. IOLE has better treatment outcomes than SOLE and PS has better than GS.

Keywords:

Occipital epilepsy, Child, Panayiotopoulos,

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