Seizure Semiology of Lesional Frontal Lobe Epilepsies in Children

Abstract

The aim of the study was to analyse the semiology of seizures in children with frontal lobe epilepsy (FLE) and to compare them with other paediatric cohorts described in the literature as well as with adult counterparts. We analysed 174 registered seizures of 18 cases under 12 years with lesional epilepsy whose frontal origin was defined by the concordance of neuroimaging and ictal electrographic findings, and confirmed by surgery in the six cases operated on. Seizures were generally short, with a high daily frequency and usually related to sleep. The most characteristic semiological pattern consisted of complex motor seizures, particularly hypermotor. Often seizures corresponded to a mixture of different semiological patterns (tonic, gelastic, automotor, hypermotor, versive) presenting in the same seizure, often as a unique type in the same patient. With regard to several aspects the semiology of FLE in our cohort looks like that reported in adult series, in particular as to the frequency of complex motor seizures. However, our cohort was also characterised by a more protean array of seizure semiology, stressing the occurrence of seizures typically present in adults (versive and complex motor) and of some seizure patterns more characteristic in children such as epileptic spasms; moreover, the rare occurrence of secondarily generalised tonic clonic seizures (SGTCS) was confirmed.

The seizure semiology consistent with frontal lobe symptomatogenic zone in children

“…The average time of seizures was found to be 29 seconds in a study which investigated frontal lobe semiology in children under 7 years 10 . In our study, the number of seizures per patient was on average 6.8; and the duration was 25.7 sec in accordance with previous reports 11,12 .…”

“…However, semiological studies in children have shown that versive seizures are seen in frontal lobe seizures 12,23,24 . In our study, versive semiology was the second most common seizure type in accordance with this information.…”

“…This ratio varies around 5-30% in children with frontal lobe epilepsy due to maturation 6,12,24,28 . We similarly observed secondarily generalized tonic-clonic seizures in 20% of our patients and 6.3% of the seizures.…”

“…In children, 14-30% of seizures showed focal clonic semiology, lateralizing to the contralateral hemisphere in 90-100% of the seizures 1,12,18 . In our study, clonic semiology was observed in 17.7% of the seizures and mostly consisted of focal clonic seizures (81.4%).…”

Psychogenic non-epileptic seizures: A challenging entity

“…51,52 Believed to signify ES, stereotypy has also been observed in PNES. 38 Bicycling movements may be seen in complex partial seizures (CPS) of the temporal lobe.…”