Objective To explore the clinical electrophysiology, seizure symptomatology, multimodal imaging characteristics and epileptogenic zone location of the temporal -parietal -occipital junction (TPOJ) epilepsy.Methods The seizure symptomatology, head MRI, PET-CT and their fusion manifestations, long-range scalp video EEG monitoring results of 6 cases of TPOJ epilepsy patients from March 2015 to August 2018 were analyzed retrospectively in the Second Hospital of Lanzhou University, and the value of localization of epileptogenic zone was analyzed, and the role of multi-modal evaluation based on SEEG in localization of epileptogenic zone was discussed.Results The first symptoms: 2 of 6 patients were complicated visual hallucination; 3 were head eye deflection (2 were opposite to epileptogenic focus, 1 was ipsilateral); 1 was excessive movement. EEG of scalp: the epileptogenic potentials in intermittent period were all multi -brain regions, but could be lateralized; in seizure period, the electroencephalogram was diffuse in 4 cases, without lateralization, and could be lateralized in 2 cases (1 case was the beginning of one hemisphere, 1 case was the beginning of one posterior head). Imaging findings: MRI was negative in 2 cases, post-traumatic soft focus in 2 cases, and FCD in 2 cases; after fusion of MRI and PET-CT, low metabolic areas in a large area including TPOJ could be found. Six patients were implanted with stereotactic electrodes, and the epileptogenic focus could be identified by EEG monitoring after implantation.Conclusion For TPOJ epilepsy, the manifestations of premonitory and multimodal images at the onset of seizure can provide important clues for the lateralition of epileptogenic zone; scalp EEG and the first symptoms except premonitory can only provide reference clues; multimodal evaluation based on stereoelectroencephalogram can accurately locate the onset of seizure.
Citation：
HAN Yanming, SHEN Yunjuan, SHI Zhe, LAN Zhenbo, LIU Yali, HE Wenbin, WANG Xiaoqiang, YANG Wenzhen, SHI Xuefeng, YANG Bohui, WANG Tiancheng, MENG Xiaoxu, ZHANG Xinding. To study the clinical characteristics of epilepsy and the lateralition of epileptogenic zone in the tempor-parietal -occipital junction. Journal of Epilepsy, 2020, 6(6): 492-497. doi: 10.7507/2096-0247.20200081
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Alessandro De Benedictis, Hugues Duffau, Beatrice Paradiso, et al. Anatomo-functional study of the temporo-parieto-occipital region: dissection, tractographic and brain mapping evidence from a neurosurgical perspective. J Anat, 2014, 225(2): 132-151.
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- 1. F Marossero, GP Cabrini, G Ettorre, et al. Stereo-EEG and surgery in partial epilepsy with temporo-parieto-occipital foci. Acta Neurochirurgica, 1980, 30: 113-116.
- 2. Alessandro De Benedictis, Hugues Duffau, Beatrice Paradiso, et al. Anatomo-functional study of the temporo-parieto-occipital region: dissection, tractographic and brain mapping evidence from a neurosurgical perspective. J Anat, 2014, 225(2): 132-151.
- 3. Davide Tiziano Di Carlo, Nicola Benedetto1, Hugues Duffau, et al. Microsurgical anatomy of the sagittal stratum. Acta Neurochirurgica, 2019, 161(11): 2319-2327.
- 4. Gloor P, Olivier A, Quesney LF, et al. The role of the limbic system in experiential phenomena of temporal lobe epilepsy. Ann Neurnl, 1982, 12(2): 129-144.
- 5. Bien CG, Berminger FO, Urbaeh H, et al. Localizing value of epileptic visual auras. Brain, 2000, 123(Pt2): 244-253.
- 6. 张冰清, 周文静, 王海祥, 等. 起源于颞后-枕交界区癫痫的电-临床研究. 中华神经外科杂志, 2015, 12(3): 176-120.
- 7. 吴英, 陈述花, 张玮, 等. 颞-枕叶交界区癫痫的致痫区定位研究. 中华神经外科杂志, 2012, 29(1): 3-6.
- 8. Chong H. Wong, Armin Mohamed, George Larcos, et al Brain activation patterns of versive, hypermotor, and bilateral asymmetric tonic seizures. Epilepsia, 2010, 51(10): 2131-2139.
- 9. 张玮, 龙琦婷, 郭强, 等. 后头部癫痫发作中的痫性眼球运动. 癫痫杂志, 2016, 2(5): 406-413.
- 10. SP Dukelow, JF DeSouza, JC Culham, et al. Distinguishing subregions of the human MT+complex using visual fields and pursuit eye movements. J Neurophysiol, 2001, 86(4): 1991-2000.
- 11. Ali H Palejwala, Kyle PO Connor, Panayiotis Pelargos, et al. Anatomy and white matter connections of the lateral occipital cortex. Surgical and Radiologic Anatomy, 2019, 42(3): 315-328.
- 12. Conzalez-Martinez JA. The Stereo-electroencephalography: the epileptogenic zone. J Neurophysiology, 2016, 33(6): 522.
