Comparison Of Clinical Manifestation Between Occipital Lobe Epilepsy And Temporal Lobe Epilepsy And Their Influences On Emotion And Cognition In Adult

Objectives:Compare the clinical features and the effects on cognition,emotion,and prognosis of antiepileptic drugs(AEDs)of 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.According to the course of epilepsy,the patients with OLE and TLE were divided into group OLE-A and TLE-A(course<3 years),group OLE-B and TLE-B(course ?3 years).We measure the patients with Mini-mental state examination(MMSE),Montreal cognitive assessment(Mo CA),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.General data: 104 cases were involved,including 37 cases in OLE group(M 20,F17)and 67 cases in TLE group(M 38,F 29).There was no significant difference in the ratio of male to female between the two groups(c2=0.068,p =0.794).The average onset age was 17.00(10.50,28.00)years old of OLE and 34.07 ±18.29 years old of TLE.The former group was lower than the latter one.The mean course was 39.00(8.00,164.00)months of OLE group and 22.00(7.00,83.00)months of TLE group.There was no significant difference in the course of epilepsy between the two groups(Z=-0.791,p=0.429).2.Clinical manifestation: The initial-visit seizure frequency of OLE group and TLE group were 0.67(0.17,1.75)and 1.50(0.40,8.00)times per month and the former was lower than the latter(Z=-2.728,p=0.006).After 1 year's follow-up,the frequency of OLE group and TLE group were 0.00(0.000,2.875)and 0.00(0.000,1.500)times per month.There was no significant difference between the two groups(Z=-0.350,p=0.727).Both of them decreased compared with the first visit(Z=3.734,p=0.000)and the extent was similar(Z=-0.290,p=0.772).There were 18 cases(48.6%)of the OLE group and 25 cases(37.3%)of the TLE group had seizure inducements.In OLE group,the occipital aura was found in 7 cases,the temporal aura in 4 cases,other aura in 6 cases,occipital and other aura in 2 cases,temporal and other aura in 2 cases,the occipital and the temporal aura in 5 cases,and all above in 3 cases.The incidence of aura in OLE group was 78.4%,and the incidence of occipital aura was 45.9%(17cases).In the TLE group,the occipital aura was found in 3 cases,the temporal aura in21 cases,other aura in 6 cases,temporal and other aura in 10 cases,occipital and temporal aura in 2 cases.The incidence of aura in TLE group was 62.7%,and the incidence of temporal aura was 49.3%(33 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(?2=6.210,p=0.013).3.EEG and head MRI: In the OLE group,there were 14 cases of unilateral origin of interictal discharge and 23 cases of bilateral origin,and there were 36 cases of unilateral origin of interictal discharge and 31 cases of bilateral origin in the TLE group.There was no significant difference(?2=2.412,p=0.120).30 cases'(81.1%)interictal discharge in group OLE involved lobes outside occipital lobe and posterior temporal lobe,4 of which had a wide-lead-in-type discharge,and 19 cases'(28.4%)in TLE group involved lobes outside temporal lobe,and there was a significant difference between the two groups(?2 = 26.592,p = 0.000).Abnormal discharge originated from occipital lobe in ictal period was monitored in 2 cases in OLE group,and temporal lobe originated abnormal discharge in ictal period was found in 18 cases in TLE group.Hippocampal sclerosis was found in 6 cases(16.2%)in OLE group and in 34 cases(50.7%)in TLE group.There was a significant difference between the two groups(?2=12.008,p=0.001).4.Test score: There was no significant difference in the score of MMSE between group OLE-A and group TLE-A(Z=-0.641,p=0.522),and group OLE-B and TLE-B(Z=-0.173,p=0.863).The score of Mo CA in group OLE-A was higher than that of group TLE-A(Z=-1.972,p=0.049),but there was no significant difference between group OLE-B and TLE-B(Z=-1.434,p=0.151).There was no significant difference in the digital span among the groups(Z=-1.770,p=0.077).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 the 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.5.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(?2=1.033,p=0.310)or levetiracetam group(?2=0.356,p=0.551).After 1 year's follow-up,the frequency of the group OLE was 0.00(0.000,2.750)times per month,and the group TLE 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 the group TLE was similar to that in the group OLE(=-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 were newly diagnosed as refractory epilepsy.There was no significant difference in the rate of the newly diagnosed refractory epilepsy between the two groups(c2=0.524,p=0.469).Conclusion:1.Occipital aura and post-seizure headache are specific to OLE,which can be used as one of the basis for diagnosis of OLE.2.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.3.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.4.The responses to AEDs of OLE and TLE are similar.