Objectives To compare the clinical features and the effects on cognition, emotion, and prognosis of antiepileptic drugs (AEDs) between occipital lobe epilepsy (OLE) and temporal lobe epilepsy (TLE).Methods We collected the clinical data of the patients with OLE and TLE from the Department of Neurology, the First Hospital of Jilin University from January 2016 to May 2018. We measured the patients with Mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), digital span, Auditory verbal memory test (AVMT), Generalized anxiety disorder (GAD-7), Patient health questionnaire-9 (PHQ-9) and Chinese version of the Neurological Disorders Depression Inventory for Epilepsy (c-NDDI-E) and followed up for 1 year.Results ① After 1 year’s follow-up, the frequency of the two groups decreased compared with the first visit (Z=3.734, P=0.000) and the extent was similar (Z=−0.290, P=0.772). In group OLE, occipital aura was 45.9% (17 cases) and temporal aura was 37.8% (14 cases). In TLE group, temporal aura was 49.3% (33 cases) and occipital aura 7.5% (5 cases). In OLE group, post-seizure headache was found in 17 cases (45.9%), which was more than the 15 cases (22.4%) in TLE group (χ²=6.210, P=0.013). ② 30 cases (81.1%) in OLE group interictal discharge involved lobes outside occipitotemporal lobe, 4 of which had a wide-lead-involved discharge, and 19 cases (28.4%) in TLE group involved lobes outside temporal lobe, and there was a significant difference between the two groups (χ²=26.592, P=0.000). ③ There was no significant difference in the score of MOCA and AVMT in the group of OLE-A and OLE-B, either the group of TLE-A and TLE-B. The score of AVMT in group OLE-A was higher than that in group TLE-A (t=3.193, P=0.002), and that in group OLE-B was higher than that in group TLE-B (t=2.264, P=0.029). There was no significant difference in GAD-7, PHQ-9, and c-NDDI-E (P>0.05). After follow-up for 1 year, the scores were compared with its initial scales. The score of GAD-7 (Z=−2.561, P=0.010), PHQ-9 (Z=−2.053, P=0.040) and c-NDDI-E (Z=−2.493, P=0.013) all decreased. The score of GAD-7 (r=0.281, P=0.021) and c-NDDI-E (r=0.456, P=0.000) have a positive correlation with the frequency of seizure. Therapeutic effect: In OLE group, the efficiency of carbamazepine or oxcarbazepine group was 58.82% and of levetiracetam group was 83.33%. in TLE group, the efficiency of carbamazepine or oxcarbazepine was 72.50% and of levetiracetam group was 70.00%. There was no significant difference between group OLE and group TLE in the curative effect of carbamazepine or oxcarbazepine group (χ²=1.033, P=0.310) or levetiracetam group (χ²=0.356, P=0.551). After 1 year’s follow-up, the frequency of OLE group was 0.00 (0.000, 2.750) times per month, and the TLE group was 0.00 (0.000, 1.500) times per month. There was no significant difference between the two groups (Z=−0.226, P=0.822). At the follow-up, the frequency of seizure in the two groups was lower than that at the first visit (P=0.000). The frequency of seizure in TLE group was similar to that in OLE group (=−0.648, P=0.517). After 1 year, 5 patients (13.51%) in OLE group were newly diagnosed as refractory epilepsy and 6 patients (9.00%) in TLE group There was no significant difference in the rate of the newly diagnosed refractory epilepsy between the two groups (2=0.524, P=0.469).Conclusion Occipital aura and post-seizure headache are specific to OLE, which can be used as one of the basis for diagnosis of OLE. Epileptiform discharge in OLE is more likely to spread out in multiple cerebral lobes, while epileptiform discharge in TLE is confined to temporal lobe and the area near it. The cognitive impairment in OLE or TLE is not related to the duration of the disease. The degree of depression is positively correlated with the frequency of seizure. The responses to AEDs of OLE and TLE are similar.

Citation： LI Nan, LIN Weihong. Comparison of clinical manifestation between occipital lobe epilepsy and temporal lobe epilepsy and their influences on emotion and cognition in adults. Journal of Epilepsy, 2019, 5(6): 424-430. doi: 10.7507/2096-0247.20190068 Copy