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Behavioural Neurology
Volume 2015 (2015), Article ID 872645, 10 pages
http://dx.doi.org/10.1155/2015/872645
Research Article

The Classical Pathways of Occipital Lobe Epileptic Propagation Revised in the Light of White Matter Dissection

1Department of Neuroscience, Section of Neurosurgery, Uppsala University Hospital, 75185 Uppsala, Sweden
2Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
3Department of Neuroscience, Regenerative Neurobiology, Uppsala University, Uppsala, Sweden

Received 12 March 2015; Accepted 20 April 2015

Academic Editor: Francesco Pisani

Copyright © 2015 Francesco Latini et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The clinical evidences of variable epileptic propagation in occipital lobe epilepsy (OLE) have been demonstrated by several studies. However the exact localization of the epileptic focus sometimes represents a problem because of the rapid propagation to frontal, parietal, or temporal regions. Each white matter pathway close to the supposed initial focus can lead the propagation towards a specific direction, explaining the variable semiology of these rare epilepsy syndromes. Some new insights in occipital white matter anatomy are herein described by means of white matter dissection and compared to the classical epileptic patterns, mostly based on the central position of the primary visual cortex. The dissections showed a complex white matter architecture composed by vertical and longitudinal bundles, which are closely interconnected and segregated and are able to support specific high order functions with parallel bidirectional propagation of the electric signal. The same sublobar lesions may hyperactivate different white matter bundles reemphasizing the importance of the ictal semiology as a specific clinical demonstration of the subcortical networks recruited. Merging semiology, white matter anatomy, and electrophysiology may lead us to a better understanding of these complex syndromes and tailored therapeutic options based on individual white matter connectivity.