Epilepsy Secondary to Occipital Ulegyria

Our patient is a 47-year-old woman. She suffered from prolonged labour at birth which was further complicated by meconial aspiration. Neurological exploration was normal. At age 11, she started experiencing partial complex seizures, consisting on sudden lapses of consciousness with motor automatisms (chewing, sucking, bimanual movements). Afterwards she would stare blankly and remain arreactive for a minute, later showing poscritic confusion. Frequency of these episodes was high, even happening several times a day. 3-Tesla Magnetic Resonance Imaging (MRI) of the brain showed an area of focal atrophy in the left occipital pole with ulegyric pattern criteria. Video-EEG monitoring found no anomalies. Currently she is under treatment with levetiracetam (3 g/day), lamotrigine (500 mg/ day) and clonazepam (2 mg/day), with partial control of the seizures.

Occipital Ulegyria
Occipital Ulegyria

Ulegyria is a cortical injury that mostly affects posterior regions. Its pathophysiology is based on diminished vascular flow. It is an important cause of occipital epilepsy. Seizures are usually limited to the occipital region. Unlike what has been reported in the literature, our patient did not show localising symptoms, but her seizures’ semiology suggested a temporal origin (infrasylvian propagation).

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