Frontal Lobe Epilepsy: A Primer for Psychiatrists and a Systematic Review of Psychiatric Manifestations

Gold, Jessica A.; Sher, Yelizaveta; Maldonado, José R.

doi:10.1016/j.psym.2016.05.005

Cited by 29 publications

(24 citation statements)

References 67 publications

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“…However, despite vEEG and consults from neurologists, no clinical correlation was observed with abnormal EEG. Nuances of vEEG have been discussed elaborately with its limitations highlighted with FLE, which may contribute to the inconclusiveness [5-7]. It may be argued that owing to the early onset and rapid spread of FLEs, studying the anatomoelectroclinical correlations of stereoelectroencephalography (SEEG) data may be the preferred the diagnostic modality [8].…”

Section: Discussionmentioning

confidence: 99%

Non-epileptic Seizures versus Frontal Lobe Epilepsy in an Adolescent: A Case Report

Gaur

2019

Cureus

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Multiple inpatient psychiatric hospitalizations can be due to system issues, patient complexity, family dynamics, and misdiagnoses to name a few. This study highlights a diagnostically challenging case and how that, in itself, contributed to hospital admissions. Although 18 months elapsed from the time of the initial presentation to the diagnosis of non-epileptic seizures (NES), the suspicion of the diagnosis may have been made earlier by clinicians. The evidence for seizures of post-ictal confusion followed by lethargy, amnesia for the event, and response to an anti-seizure medication only could have provided a higher index of suspicion for NES. Many health care providers will argue that this will create over-diagnoses of NES and usage of anti-epileptic medications. While reviewing the literature on NES, it was noted that frontal lobe epilepsy (FLE) causing psychiatric comorbidities has been poorly studied. Furthermore, this case highlights that within the field of child psychiatry, the same clinical presentation can be interpreted differently. This case helps us understand how eliciting clinical information to enable the timely ordering of imaging could help in diagnoses. This may help set up clinical guidelines for NES for the mental health providers to facilitate improvement in diagnoses and treatment.

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Section: Discussionmentioning

confidence: 99%

Non-epileptic Seizures versus Frontal Lobe Epilepsy in an Adolescent: A Case Report

Gaur

2019

Cureus

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“…Frontal lobe epilepsy can present with behavioural disturbance, psychiatric symptoms including depression or psychosis and cognitive changes (Braakman et al, 2011;Gold et al, 2016); it can be associated with attention deficit hyperactivity disorder (ADHD) in children (Braakman et al, 2011).…”

Section: Seizures Can Present As Symptoms Of Mental Illnessmentioning

confidence: 99%

The neurology–psychiatry interface in epilepsy

Murphy

Hallahan

Connell

et al. 2018

Ir. j. psychol. Med.

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Epilepsy and mental illness have a bidirectional association. Psychiatrists are likely to encounter epilepsy as comorbidity. Seizures may present as mental illness. Equally, the management of psychiatric conditions has the potential to destabilise epilepsy. There is a need for structured epilepsy awareness and training amongst psychiatrists. This paper outlines key considerations around diagnosis, treatment and risk while suggesting practical recommendations.

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“…Several previous studies involving adult patients have described the semiological seizure characteristics of FLE as follows: very short duration, sudden onset and offset, stereotypic form, a tendency for clustering, nocturnal disposition, and rapid secondary generalization [2,[9][10][11][12][13][14][15]. Because the frontal lobe is involved in not only motor function, but also in language and emotional control, the ictal appearance of FLE can present as psychiatric symptoms such as fearful feelings or paranoid delusions [1,7,16]. FLE is often misdiagnosed as pseudoseizures related to psychiatric conditions [7,9,[16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

“…Because the frontal lobe is involved in not only motor function, but also in language and emotional control, the ictal appearance of FLE can present as psychiatric symptoms such as fearful feelings or paranoid delusions [1,7,16]. FLE is often misdiagnosed as pseudoseizures related to psychiatric conditions [7,9,[16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Frontal Lobe Epilepsy in a Pediatric Population: Characterization of Clinical Manifestations and Semiology

Lee

2022

Ann Child Neurol

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Purpose: Frontal lobe epilepsy (FLE) has various clinical presentations depending on the anatomy involved. Seizures are brief and can mimic psychiatric conditions, and patients often cannot describe the aura. Therefore, it is difficult to characterize the semiology, especially in pediatric patients. This study investigated the characteristics of pediatric FLE.Methods: We retrospectively reviewed the data of pediatric patients with FLE who underwent long-term video-electroencephalography (EEG) monitoring between January 2010 and June 2020. Patients’ demographic data, seizure-related clinical presentations, semiology, brain magnetic resonance imaging (MRI), and EEG data were analyzed.Results: Fifty-six patients were included (31 males, 25 females). The age of seizure onset varied from 1 month to 14 years (mean±standard deviation, 6.1±4.4 years). Seizures were classified into nine categories, including focal tonic (30/56), aura (22/56), hypermotor (17/56), focal clonic (15/56), versive (13/56), and bilateral asymmetric tonic (4/56). Seventeen patients (30.4%) had abnormal MRI results, including focal cortical dysplasia, heterotopic gray matter, and neuroepithelial tumors. Ictal EEG changes were commonly observed in the dorsolateral premotor and central cortices. In focal tonic seizures, EEG changes often originated in the premotor cortex. The location of the lesions on MRI and EEG coincided in six cases.Conclusion: In pediatric FLE, various seizure types occur depending on the ictal anatomic origin, and individual patients had multiple semiologies. Brain MRI was normal in two-thirds of patients, and interictal EEG did not reveal epileptiform discharges in approximately 25%. Semiology reported on the basis of home videos and interictal EEG will help localize the ictal onset zone.

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Frontal Lobe Epilepsy: A Primer for Psychiatrists and a Systematic Review of Psychiatric Manifestations

Cited by 29 publications

References 67 publications

Non-epileptic Seizures versus Frontal Lobe Epilepsy in an Adolescent: A Case Report

Non-epileptic Seizures versus Frontal Lobe Epilepsy in an Adolescent: A Case Report

The neurology–psychiatry interface in epilepsy

Frontal Lobe Epilepsy in a Pediatric Population: Characterization of Clinical Manifestations and Semiology

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