Frontal lobe epilepsy presenting as paroxysmal psychiatric events: A case report

Abstract

Introduction: Frontal lobe epilepsy is the second most common type of focal epilepsy affecting children and it accounts for 20%–30% of partial epilepsies. The frontal lobes are anatomically represented by the motor areas responsible for basic motor functions, control of language regulation, and also by the prefrontal cortex, responsible for cognitive functioning, emotional drives and social skills, which plays a critical role in the proper integration and implementation of complex behaviors. Thus, patients with frontal lobe epilepsy are having a plurality of clinical symptoms affecting motion, speech transmission and personality disorders with impairment in complex cognitive functions. In clinical practice, it is often difficult to distinguish mainly psychiatric disorders with frontal lobe epilepsy, which incorrectly can be diagnosed as sleep disorders or psychogenic nonepileptic seizures. Objective: We report a childhood case with paroxysmal psychiatric manifestations due to frontal lobe epilepsy. Methods: A 7-year-old girl was admitted to Children's Hospital “P. & A. Kyriakou” for psychiatric assessment because of hyperactivity, change of behavior, social disinhibition, regression and 12–18 episodes per day with stereotyped movements and vocalizations, lasting a few seconds, especially during sleep. Due to the paroxysmal nature of the disease and the frequency of the episodes, which occurred especially at night, she was admitted for neurological assessment and an EEG was performed, which showed frontal epileptic spikes. A subsequent brain MRI was normal. She was started on treatment with levetiracetam, however, due to lack of improvement, oxcarbazepine was added to her treatment regiment, resulting in significant seizure reduction and gradual return to her premorbid personality. Conclusion: It is important to think of underlying neurological disorders in the differential diagnosis of acute psychiatric symptoms, particularly if they are stereotypic and occur during sleep, for prompt diagnosis and treatment of the underlying disease.