Abstract
Behavioral abnormalities have been noted in specific epilepsy syndromes involving the frontal lobe. Epilepsies that involve the frontal lobe, such as frontal lobe epilepsy (FLE), atypical evolution of benign childhood epilepsy with centrotemporal spikes (BCECTS), and epilepsy with continuous spike-waves during slow sleep (CSWS), are characterized by impairment of neuropsychological abilities, frequently associated with behavioral disorders. These manifestations correlate strongly with frontal lobe dysfunction. Accordingly, epilepsies in childhood may affect the prefrontal cortex and leave residual mental and behavioral abnormalities. Brain volumetry has shown that frontal and prefrontal lobe volumes show a growth disturbance in patients with FLE, atypical evolution of BCECTS, and CSWS compared with those of normal subjects. These studies also showed that seizures and the duration of paroxysmal anomalies may be associated with prefrontal lobe growth abnormalities, which are associated with neuropsychological problems. Moreover, these studies also showed that the prefrontal lobe appears more highly vulnerable to repeated seizures than other cortical regions. The urgent suppression of these seizure and EEG abnormalities may be necessary to prevent the progression of neuropsychological impairments. Treatment options to remit seizures and EEG abnormalities as soon as possible may be required to achieve the optimal prognosis in frontal lobe epilepsies. Of the new AEDs, levetiracetam (LEV) may be an important addition to the treatments available for refractory childhood epilepsies with cognitive and behavioral problems.
Highlights
Behavioral changes in patients with frontal lobe seizures can be related to multiple causes
These results suggest that the occurrence of frequent seizures in patients with frontal lobe epilepsy (FLE) might be associated with prefrontal lobe growth retardation, which relates to neuropsychological problems and ultimate neuropsychological outcome
Prefrontal growth showed more rapid recovery in a benign childhood epilepsy with centrotemporal spikes (BCECTS) patient with cognitive/behavioral problems with a shorter active seizure period in that study (Table 1). These findings suggested that clinical symptoms, such as frequent seizures, and clinical investigations, such as paroxysms on EEG, might be associated with prefrontal lobe growth disturbance, which relates to neuropsychological problems in BCECTS children
Summary
Behavioral changes in patients with frontal lobe seizures can be related to multiple causes. Prefrontal functions can show an unusually long period of increased vulnerability, in which neurons and glial cells are readily affected by many factors, including genetic influences, the hormonal milieu, and external insults, such as infections, toxins, and trauma [2] In these investigations, the prefrontal lobe appears more highly vulnerable to repeated seizures than other cortical regions [3]. Children with frontal lobe epilepsies manifest significant psychosocial problems relative to normative standards [8] These studies suggest that treatment may be required to remit seizures as soon as possible to achieve optimal. Brain volumetric analysis has contributed to the search for structural correlates of developmental disorders such as autism [14] and seizure disorders such as temporal lobe epilepsy [15]. The maturation-associated changes detectable during development will be important for comparison with maturational sequences in developmental disorders
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