Pdf frontal lobe function in temporal lobe epilepsy. Frontal lobe epilepsy fle probably represents 2030% of partial seizures. Unfortunately, scalp eeg and mri are often unsatisfactory. We sought to better characterize frontal lobe epilepsy in childhood. Pdf topiramate in frontal lobe epilepsy paola iannetti. Versive seizures appear earlier in seizures of frontal lobe origin as opposed to temporal lobe origin and can be the first sign of frontal lobe seizures. The frontal lobe and epilepsy relatively unexplored. Some of these seizure types, such as focal clonic motor seizures, are readily identifiable, others are more difficult to recognize. Eyes look to rightspread of seizure to left frontal eye field. Nov 12, 2019 the frontal lobe is a relatively large lobe of the brain, extending from the front of the brain almost halfway towards the back of the brain. Frontal lobe epilepsy is the term for recurring seizures beginning in the frontal lobe the area of the brain behind the forehead. Frontal lobe epilepsy is probably the largest subgroup of extratemporal partial epilepsy, representing 2030% of partial epilepsies bhatia and kollevold, 1976.
This is located at the front of the brain, behind your childs forehead. Although fle is typically associated with tonic or clonic hd contralateral to seizure. Frontal lobe epilepsy can be difficult to diagnose because its symptoms can be mistaken for psychiatric problems or sleep disorders, such as night terrors. As expected, frontal lobe epilepsy fle has also been associated with frequent impairments of attention and executive functioning, although of highly variable severity. Frontal lobe epilepsy in childhood pediatric neurology.
Another study evaluated 16 children with frontal lobe epilepsy via an extensive neuropsychological test battery and continuous performance testing. Concepts, classification, and approach frontal lobe seizures localization of electrographic discharges in frontal lobe seizures and epilepsies cognitive neurophysiology and neuropsychology of. Uw health s comprehensive epilepsy program at uw hospital and clinics in madison, wisconsin, offers stateoftheart care for patients with epilepsy or those suspected of having seizures. Seizures usually occur during sleep, tends to cluster, brief, and frequently secondarily generalize. Some people with adnfle also have seizures during the day. Frontal lobe epilepsy fle is a neurological disorder that is characterized by brief, recurring seizures that arise in the frontal lobes of the brain, often while the patient is sleeping. A variety of conditions can damage the frontal lobe, including stroke, head trauma, and dementia. The typical seizure semiology for fle includes unilateral clonic, tonic asymmetric or hypermotor seizures. Frontal lobe seizure characteristics can include aggressive behavior, agitation, screaming and exhibiting physical.
Frontal lobe seizures symptoms and causes mayo clinic. About onequarter of patients with refractory focal epilepsies have frontal lobe epilepsy fle. Jun 25, 2019 frontal lobe seizures are a common form of epilepsy, a neurological disorder in which clusters of brain cells send abnormal signals and cause seizures. Frontal lobe seizures diagnosis and treatment mayo clinic. Treatment includes medication, and sometimes surgery. Know the causes, symptoms, treatment, recovery and prevention of frontal lobe seizures.
These seizures may be startling, including screaming. In these cases, an ictal correlate may be observed only if there is propagation to the temporal lobe. Frontal lobe epilepsy is a common cause of focal seizures. Because the frontal lobe is responsible for planning and executing movement and personality, frontal lobe epilepsy can have a dramatic effect on a patients quality of life. For epileptologists today, frontal lobe epilepsy fle remains the most challenging of all the epilepsies, both in terms of understanding how seizures are organized and how they should be treated. Frontal lobe seizures in children what you need to know. Several regions have been described as being associated with gelastic seizures within the frontal lobe. It is the second most common type of epilepsy after temporal lobe epilepsy tle, and is related to the temporal form by the fact that both forms are characterized by the occurrence of partial focal seizures. A region of particular importance in adults with epilepsy, but less so in children, is the mesial, or middle, part of the temporal lobe. On completion of this article, the reader should be able to make a distinction between nocturnal seizures and other normal and abnormal sleep phenomena. The findings in these patients clearly overlapped presumably reflecting the interconnections between functionally related frontal zones. So far, only two studies evaluated the lateralizing value of clinical seizure semiology in fle in a systematic manner jobst et al. Frontal lobe epilepsy an overview sciencedirect topics.
An analysis of clinical seizure patterns and their localizing value in. Frontal lobe, epileptic seizures, semiology, stereoelectroencephalog raphy, stereotypies. Autosomal dominant nocturnal frontal lobe epilepsy is a familial partial epilepsy syndrome and the first human idiopathic epilepsy known to be related to specific gene defects. Compared to typical partial complex seizures, their manifestations more often consist of abrupt, aura. A nocturnal frontal lobe seizure is an epileptic disorder that leads to violent seizures that occurs while sleeping. Seizures are typically brief, and can have prominent vocalization, bizarre behavior, urinary incontinence, and head and eye deviation. February 1st 5th, 2011 lyon france course directors philippe kahane grenoble philippe ryvlin lyon dear colleagues and friends, the epilepsy centers of grenoble and lyon, idee institute for children and adolescents with epilepsy and the epilepsy journal epileptic disorders, are delighted to welcome you to. Seizure onset at a young age has been the most consistent factor for poor outcome. Cognitive effects of epilepsy jeffrey bigelow, md, mph. Seizures can be focal partial, with or without secondary generalisation. A number of families have been described across the world. Dorsolateral frontal lobe seizures often present as a diagnostic challenge. There is, therefore, a need to establish the reliability of historical features in distinguishing nocturnal frontal lobe seizures from parasomnias in those situations in which video eeg and psg are impractical or unhelpful.
Frontal lobe lope epilepsy frequently is marked by partial seizures, and patients often experience seizures during their sleep. X research source this type of seizure can be mistaken for other disorders, such as night terrors or even a psychological disorder. Movement vision sensation speech emotion memory planning. Frontal lobe seizures, or frontal lobe epilepsy, can be caused by abnormalities such as tumors, stroke, infection or traumatic injuries in the brains frontal lobes. Pdf nocturnal hypermotor seizures, suggesting frontal. Focal seizures are the most common form of seizure in adults and one of the most common forms of seizures in children. The international league against epilepsy ilae diagnostic manuals goal is to assist clinicians who look after people with epilepsy to diagnose the epilepsy syndrome and if possible the etiology of the epilepsy. This is very evident in comparison to the now welldefined syndrome of mesial temporal lobe epilepsy tle. Frontal lobe parietal lobe temporal lobe occipital lobe. The semiology of frontal lobe seizures depends on the origin and spread of the epileptogenic focus. A clinical scale has recently been validated and may obviate the need for prolonged monitoring in some cases11. After examination of all ictal clinical data, 14 categories of signs and symptoms were established.
Frontal lobe seizures or epilepsycausessymptomstreatment. We sought to better characterize frontal lobe epilepsy in childhood and help delineate this condition from other nonepileptic events. Frontal lobe epilepsy epileptiform discharges often poorly localized l multifocal, generalized secondary. Role in diagnosis and management focal interictal nonepileptiform.
Gelastic seizures in a child with frontal lobe epilepsy. Surgery for frontal lobe epilepsy the treatment of frontal lobe epilepsy is especially challenging due to the complexity of the seizures, the difficulty of using surface eeg for hidden areas such as the medial frontal lobe, and the risk of motor or language deficit following resection of eloquent cortex. Frontal lobe epilepsy makes up between 20 and 30% of all partial epilepsies and is the biggest subgroup of the extratemporal lobe epilepsies. Seizures in a given patient with frontal lobe epilepsy are generally similar, with stable and reproducible electroencephalography eeg. Ipsilateral head deviation in frontal lobe seizures request pdf. Temporal lobe epilepsy tle is typically associated with longterm memory dysfunction.
The seizures of autosomal dominant sleeprelated hypermotor epilepsy sheformerly known as adnfle for autosomal dominant nocturnal frontal lobe epilepsy, which are mostly originating in the frontal lobe, are clinically characterized by brief, nocturnal motor seizures that often occur in clusters, mainly during nonrem sleep. Eeg findings in frontal lobe epilepsy the frontal lobe is second most common lobe of seizure origin. The frontal lobes support highlevel cognition comprising executive skills and working memory that is vital. Hyperkinetic seizures are considered a typical manifestation of nocturnal frontal lobe epilepsy nfle. A frontal lobe seizure is called a focal seizure because it starts in one part of your childs brain. Pdf the aim of this study is to analyze the seizure semiology consistent with frontal lobe symptomatogenic zone in childhood. The differentiation of frontal lobe epilepsy fle and temporal lobe epilepsy tle is a clinical problem of major theoretical and practical importance. There are other types of seizures which may look like epileptic seizures but they do not start in the brain. Frontal lobe seizures are particularly prone to misdiagnosis as psychogenic nonepileptic seizures, due to their sometimes bizarre or atypical appearance, as well as to the fact that. To clarify the confusing clinical presentation of these different seizure types, we compared the clinical ictal characteristics of 63 flps in 11 patients with 29 ps in 12 patients. When applied to the presurgical evaluation of patients, it has poor specificity.
Nocturnal frontal lobe epilepsy brain oxford academic. Autosomal dominant nocturnal frontal lobe epilepsy adnfle adnfle is a distinctive disorder, with autosomal dominant mendelian inheritance12. Sleep, seizure, epilepsy, juvenile myoclonic epilepsy, frontal lobe, benign rolandic epilepsy, polysomnography objectives. Abnormal brain tissue, infection, injury, stroke, tumors or other conditions can also cause frontal lobe seizures. The frontal lobe is one of the four lobes of the cerebral cortex, which also includes the temporal lobe, the parietal lobe, and the occipital lobe.
Clinical seizure lateralization in frontal lobe epilepsy. Tshw at seizure onset should suggest a neocortical rather than hippocampal seizure onset. A frontal lobe seizure starts in the frontal lobe of the brain. Its also possible that some seizure effects found in the frontal lobe might be the result of seizures that begin in other parts of the brain. Autosomal dominant nocturnal frontal lobe epilepsy adnfle is an uncommon form of epilepsy that runs in families. Barry sinclair, md, matt wheatley, md, phd, and thomas snyder, phd frontal lobe epilepsy is poorly understood and often unrecognized by health care workers caring for children. Of all partial seizures, those of frontal lobe origin flps are most bizarre and are often mistaken for psychogenic seizures ps. To define further the electroclinical manifestations of frontal lobe epilepsy fle, we studied 150 seizures manifested by 24 patients.
After temporal lobe epilepsy, frontal lobe epilepsy is the next most common type of epilepsy featuring focal seizures. There are different types of epileptic seizures, but they all start in the brain. Nocturnal frontal lobe epilepsy nfle is a heterogeneous epileptic seizure disorder that affects all age groups. Frontal lobe epilepsy is the secondmost common type of epilepsy and may have a genetic component. Studies of absence seizures as using eeg with fmri eegfmri show a consistent network with prominent thalamic activation and a variety of cortical changes. We have developed the frontal lobe epilepsy and parasomnias flep scale to achieve this. For epileptologists today, frontal lobe epilepsy fle remains. One retrospective study of 21 children with nonlesional frontal lobe epilepsy demonstrated adhdadd in 23 of the population, while half of the children had cognitive impairments. These types of seizures stem from the front of the brain. Jun 25, 2019 frontal lobe seizures, or frontal lobe epilepsy, can be caused by abnormalities such as tumors, stroke, infection or traumatic injuries in the brains frontal lobes. Front lobe epilepsy may induce seizures of an especially stressful nature, including brief periods of screaming. Seizures may, for example, spread from temporal to orbitofrontal cortex or vice versa within milliseconds, giving substantial overlap between the seizure manifestations documented from these two regions2. Frontal lobe seizures vary greatly because of the size of the frontal lobe and widespread functions it subserves. Feb 03, 2020 a frontal lobe seizure starts in the frontal lobe of the brain.
The typical seizure semiology for fle includes unilateral clonic. Patients with frontal lobe epilepsy will likely also experience issues with learning and education. Fle in general has been less well studied than temporal lobe epilepsy. Epilepsy incidence rates by age 10 100 0 10 20 30 40 50 60 70 80 all epilepsy types age years incidence per 100,000 data from rochester, mn 197584 hauser wa et al. It was often not possible to determine site of seizure onset within the frontal lobe by clinical features of the seizures as suggested in the literature 15. John hughlings jackson reflected that the frontal lobe is the brains most complex and least organized centre jackson 1931 and, despite subsequent advances in neuroscience, even by the late 20th century the frontal lobe was still considered to be. Autosomal dominant nocturnal frontal lobe epilepsy. Interictal electroencephalograms eeg usually reveal interictal epileptiform discharges and rhythmical midline theta, which has localizing value. Sep 25, 2018 frontal lobe epilepsy is characterized by recurrent seizures arising from the frontal lobes. Frontal lobe epilepsy frequently overlaps with sleeprelated hypermotor epilepsy she. Frequently, seizure types are simple partial or complex partial, often with secondary generalization. Patients with ps had significantly later age at onset.
Despite evidence suggesting a role of frontal cortex in seizure generation, group studies have not detected consistent asrelated changes in this region. Frontal lobe seizures, named for the region of the brain where they originate, constitute a distinct, important variety of partial complex seizures. Temporal lobe epilepsy is the type of epilepsy that accounts for the most common form of seizures called focal seizures. The frontal lobe seizures and epilepsies request pdf. Frontal lobe seizures may be exclusively nocturnal and often cluster. Frontal lobe epilepsy is poorly understood and often unrecognized by health care workers caring for children. Frontal lobe seizures are also associated with a rare inherited disorder called autosomal dominant nocturnal frontal lobe epilepsy. Some seizures are caused by conditions such as low blood sugar hypoglycaemia or a change to the way the heart is working. Frontal lobe seizures or epilepsy is a neurological disorder in which the sufferer experiences recurrent seizures in their brains frontal lobes. Frontal lobe seizures also tend to come on suddenly and progress rapidly making it difficult for an employer to control the exposure of the seizure to others.
However it is less common than temporal lobe epilepsy. Focal epileptic seizures vanderbilt university medical. It presents with various clinical manifestations ranging from brief seizures, consisting of stereotypic sudden arousals that recur throughout the night in a periodic pattern, to more elaborate seizures, with complex dystonic and dyskinetic phenomena, or to longer. Most complex partial seizures show a scalp eeg correlate. The validity of the ictal clinical data used was confirmed on the basis of 99 frontal lobe seizures recorded by teleelectroencephalogram or telestereoelectroencephalogram.
We describe ictal clinical manifestations of frontal lobe epileptic seizures in 22 patients. The lateralizing value of ictal head deviation hd in frontal lobe epilepsy fle is a matter of debate. Among the latter, particular attention has been devoted in recent years to those seizures arising from epileptic foci located within the frontal lobe, socalled nocturnal frontal lobe epilepsy nfle. Patients with temporal lobe epilepsy with mainly sleeprelated seizures have been described. Surgery for frontal lobe epilepsy seizure european journal of. Seizures can occur anywhere in the brain, but in children they frequently occur in the temporal and frontal lobes, affecting the functions that these regions control. Temporal lobe epilepsy is a type of epilepsy characterized by the. However, she can occasionally arise from extrafrontal areas. Focal partial seizures that begin in the frontal lobe are briefer, more abrupt in onset and termination, and occur with greater frequency than focal partial temporal lobe seizures that begin in the temporal lobe. Know the causes, symptoms, treatment, recovery and.
Our understanding of the temporal lobes, the nature. Temporal lobe or psychomotor seizures are caused by abnormal electrical activity in one area of the brain. Frontal lobe seizures are a part of a group of seizures called focal or partial seizures because they only affect a part of the brain. Some very young children have febrile convulsions jerking movements. However, a deep eeg generators such as the orbitofrontal region, medial occipital region, the cingulate and the insula may not show an eeg correlate. There are two types of focal seizures, each of which has its own distinct signs and symptoms, as follows. Current electroclinical classification is based on retrospective studies of highly selected patients. Frontal lobe epilepsy is characterized by recurrent seizures arising from the frontal lobes.
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