Non-dominant, Lesional Parieto-occipital Lobe Epilepsy

This chapter describes a patient with non-dominant parieto-occipital cortical dysplasia who developed pharmacoresistant epilepsy and required resective surgery. We review the neuroimaging characteristics of patients with focal cortical dysplasia and the differential diagnoses of supratentorial cystic lesions. We analyze the underlying mechanisms of epileptogenesis and ictogenesis in focal cortical dysplasia. We discuss semiologies pertaining to the occipital and parietal lobes and their diverse ictal propagation pathways. In addition, we examine the expected ictal and interictal epileptiform activity in this patient population. We summarize the post-operative outcomes and predictors of outcome following parietal and posterior quadrant surgical interventions. We examine the mapping of the occipital lobe utilizing visual evoked potentials. In addition, we provide a concise description of somatosensory evoked potentials and highlight their utility in demarcating sensorimotor cortices. Finally, we address the withdrawal of anti-seizure medications following neocortical epilepsy surgery.