Frontal Lobe Tumoral Epilepsy: Clinical, Neurophysiologic Features and Predictors of Surgical Outcome

Abstract

Summary:Purpose: To review the clinical, neurophysiologic features and surgical outcomes in patients with frontal lobe tumors and chronic intractable seizures.Methods: Medical records of patients with intractable epilepsy who underwent resection or stereotactic biopsy of frontal lobe tumor (confirmed by surgical pathology) seen between 1985 and 1999 at Yale University School of Medicine Epilepsy Center were reviewed for age at diagnosis, age at onset of seizures, delay between seizure onset and tumor diagnosis, types and frequencies of seizures, EEG results, use of anticonvulsants, extent of surgery, pathological diagnosis, and tumor recurrence.Results: Thirty-seven patients were included. Mean age at seizure onset was 31.6 years, and at tumor diagnosis was 36.2 years. Mean duration between onset of seizures and tumor diagnosis was 6.1 years. Seventeen patients had auras. Seizure frequency averaged 7.6 seizures per week, with 58% of patients having more than one seizure type. All patients used anticonvulsants, with 90% eventually using polytherapy. All patients eventually underwent at least one surgical procedure. Only 13 (35.1%) patients were class I. Twelve (32.4%) patients were class II, seven (18.9%) class III, and five (13.5%) class IV. No statistically significant differences were seen between good and poor long-term seizure outcome in relation to specific tumor pathology, seizure types, or type of resection.Conclusions: Long-term surgical outcomes in tumoral frontal lobe epilepsy are more favorable than those in nontumoral intractable frontal lobe epilepsy (65% class I or II) and less favorable than those in other tumoral epilepsy (overall, 70% class I). Frontal location of intracranial neoplasm may predict a less favorable long-term epilepsy prognosis than tumoral epilepsy in general, an observation for which several explanations are proposed.

Presurgical seizure frequency and tumoral etiology predict the outcome after extratemporal epilepsy surgery

“…In addition, the epilepsy onset tended to be later in this study. In contrast, a report of 37 tumoral frontal lobe epilepsies revealed a mild but not statistically significant lower age of epilepsy onset in patients with a Class I and II outcome (follow-up 1-15 years) [14]. However, although both studies used varying follow-up periods of at least 1 year, the definition of favorable outcome in terms of Engels Classification differed.…”

Treatment with direct-current stimulation against cingulate seizure-like activity induced by 4-aminopyridine and bicuculline in an in vitro mouse model

“…Most focal ACC epilepsies are believed to be idiopathic and cryptogenic. Frontal lobe epilepsy and ACC seizures are often drug-resistant (Biraben et al, 2001;Zaatreh et al, 2002) and the evaluation of alternative treatments, such as tDCS, is needed. Seizures that arise from the ACC are difficult to study because this region lies deep within the brain, and the proximity between the right and left ACC increases the difficulty in identifying where seizures actually start (Geier et al, 1977;Mazars, 1970;Nadkarni and Devinsky, 2009).…”

Seizures in patients with low-grade gliomas — incidence, pathogenesis, surgical management, and pharmacotherapy

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