Frontal Lobe Seizure

Introduction

Frontal Lobe Seizure (frontal lobe epilepsy) as the name implies originate from the frontal lobe area of the brain.

Epilepsy is a more specific or definite term and requires that seizures originate due to some underlying brain pathology and also recurrent in nature.

How does patient present?

There are certain features that are characteristic for frontal lobe epilepsies;

• Preponderance during night
• Brief duration episodes
• Multiple episodes occurring in a short span of time (clustering) etc

However none of these features are diagnostic for frontal lobe epilepsy, also not all frontal lobe epilepsies will strictly conform to these features.

Frontal lobes are large in human beings and are involved in the organization and mediation of innumerable number of motor & cognitive functions. Because of their involvement in multiple brain activities there are multiple types of clinical presentations too.

The exact presentation depends upon what sub part of frontal lobe gives rise to seizure. There could be motor manifestations like tonic (stiffening), clonic (convulsive movements), both tonic and clonic activities, head and/or eye deviation to one side etc. in SMA (supplementary motor cortex) area seizures a characteristic fencing posture may be seen.

Various cognitive & behavioral manifestations may be seen too and sometimes they maybe confused with psychogenic seizures (pseudo seizures). Complex automatism like pelvic thrusting may also be seen. Speech arrest may be seen if frontal speech centers are involved.

Some common causes of frontal lobe epilepsy

• May be part of genetically mediated frontal lobe epilepsies
• Scar tissue
• Tumors
• Vascular malformations
• Cortical dysplasias etc

Diagnosis & Treatment

The diagnosis is accomplished usually in the same lines as any seizure disorder and generally requires imaging study of the brain like CT and/or MRI and EEG (sometimes video EEG) etc. Depth electrodes may be necessary to pick up seizure focus arising from areas deeper & away from the cortex.

Treatment is with antiepileptic drugs as well as the treatment for the underlying pathology that causes the seizure. Medically refractory epilepsy requires surgical procedures like VNS (vagal nerve stimulator) and epilepsy brain surgeries.

For more details on Epilepsy & Seizures click on the link



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