Frontal Lobe Seizures: Electroclinical Syndromes

Abstract

To define further the electroclinical manifestations of frontal lobe epilepsy (FLE), we studied 150 seizures manifested by 24 patients; 18 patients had subdural electrode arrays (SEA). The findings in these patients clearly overlapped presumably reflecting the interconnections between functionally related frontal zones; yet the manner in which the symptoms clustered and the sequence in which they occurred generally indicated the anatomic site of the epileptogenic zone. We divided the patients into three major groups: (a) those with supplementary motor seizures, (b) those with focal motor seizures, and (c) those with complex partial seizures (CPS, psychomotor seizures). Supplementary motor seizures began with tonic posturing of the extremities. Focal motor seizures generally began with conscious contralateral version or unilateral clonic focal motor activity; tonic posturing was noted only late in the seizure. CPS (psychomotor) began with unresponsiveness at onset, followed by staring or unconscious contraversion. We compared frontal lobe seizures with temporal lobe seizures reported previously; oral-alimentary automatisms, repetitive hand movements, or looking around, were more common in temporal lobe seizures, whereas tonic posturing and bicycling movements were more common in frontal lobe psychomotor seizures.

Bilateral akinetic seizures: A clinical and electroencephalographic description

“…In line with the four previously reported cases (Meletti et al., 2003; Ikeda et al., 2009), surface EEG recordings provided excellent localization to the central and anterior midline in all our cases; six patients had structural lesions and one had abnormal functional neuroimaging involving the mesial aspect of the frontal lobe. However, in contrast with other mesial frontal epilepsies, characterized by nonlocalizing slowing or attenuation ictal patterns, we found well‐localized anterior mesial discharges (Morris et al., 1988; Salanova et al., 1995; Bautista et al., 1998; Foldvary et al., 2001). These electrical differences may be due to a more superficial ictal dipole, easily detected by midline electrodes.…”

Bilateral akinetic seizures: A clinical and electroencephalographic description

“…In line with the four previously reported cases (Meletti et al., 2003; Ikeda et al., 2009), surface EEG recordings provided excellent localization to the central and anterior midline in all our cases; six patients had structural lesions and one had abnormal functional neuroimaging involving the mesial aspect of the frontal lobe. However, in contrast with other mesial frontal epilepsies, characterized by nonlocalizing slowing or attenuation ictal patterns, we found well‐localized anterior mesial discharges (Morris et al., 1988; Salanova et al., 1995; Bautista et al., 1998; Foldvary et al., 2001). These electrical differences may be due to a more superficial ictal dipole, easily detected by midline electrodes.…”

Metabolic phenotyping of hand automatisms in mesial temporal lobe epilepsy

“…Our findings suggested that the SMA and MCC are the brain regions that might be involved in the production of HA since these regions control movement. Moreover, our findings are consistent with reported data from previous studies concerning the vital role of extratemporal structures, particularly mesial frontal structures, in the development of extremity automatisms [ 13 , 35 , 36 ].…”

Video-EEG Monitoring Differences in Children with Frontal and Temporal Onset Seizures

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Bilateral akinetic seizures: A clinical and electroencephalographic description

“…In line with the four previously reported cases (Meletti et al., 2003; Ikeda et al., 2009), surface EEG recordings provided excellent localization to the central and anterior midline in all our cases; six patients had structural lesions and one had abnormal functional neuroimaging involving the mesial aspect of the frontal lobe. However, in contrast with other mesial frontal epilepsies, characterized by nonlocalizing slowing or attenuation ictal patterns, we found well‐localized anterior mesial discharges (Morris et al., 1988; Salanova et al., 1995; Bautista et al., 1998; Foldvary et al., 2001). These electrical differences may be due to a more superficial ictal dipole, easily detected by midline electrodes.…”

Metabolic phenotyping of hand automatisms in mesial temporal lobe epilepsy

“…Our findings suggested that the SMA and MCC are the brain regions that might be involved in the production of HA since these regions control movement. Moreover, our findings are consistent with reported data from previous studies concerning the vital role of extratemporal structures, particularly mesial frontal structures, in the development of extremity automatisms [ 13 , 35 , 36 ].…”

Video-EEG Monitoring Differences in Children with Frontal and Temporal Onset Seizures

“……”

Bilateral akinetic seizures: A clinical and electroencephalographic description

“…In line with the four previously reported cases (Meletti et al., 2003; Ikeda et al., 2009), surface EEG recordings provided excellent localization to the central and anterior midline in all our cases; six patients had structural lesions and one had abnormal functional neuroimaging involving the mesial aspect of the frontal lobe. However, in contrast with other mesial frontal epilepsies, characterized by nonlocalizing slowing or attenuation ictal patterns, we found well‐localized anterior mesial discharges (Morris et al., 1988; Salanova et al., 1995; Bautista et al., 1998; Foldvary et al., 2001). These electrical differences may be due to a more superficial ictal dipole, easily detected by midline electrodes.…”

Metabolic phenotyping of hand automatisms in mesial temporal lobe epilepsy

“…Our findings suggested that the SMA and MCC are the brain regions that might be involved in the production of HA since these regions control movement. Moreover, our findings are consistent with reported data from previous studies concerning the vital role of extratemporal structures, particularly mesial frontal structures, in the development of extremity automatisms [ 13 , 35 , 36 ].…”

Video-EEG Monitoring Differences in Children with Frontal and Temporal Onset Seizures

“……”