Abstract
Clinical and electroencephalogram (EEG) features in frontal lobe epilepsy (FLE) vary considerably among patients, making the diagnosis a challenge. The objective of this study was to describe interictal and ictal EEG activity, identifying variables that could help to differentiate and diagnose frontal lobe epilepsy cases. A prospective cross-sectional study from patients with frontal interictal epileptiform discharges (IED) referred to the Vall d’Hebron University Hospital (Barcelona, Spain) after a clinical event compatible with epileptic seizures was designed. The interictal and ictal activity were analyzed to provide a detailed EEG description of the cases, using different statistical analyses. The morphological seizure pattern at the ictal onset remained globally unchanged over time in seizures arising from the frontal lobe for each patient. Isolated sharp waves were the most frequent waveforms in the expression of IED. Frontal lobe seizures are frequently short and sometimes appear grouped in clusters within the same recording. Often the ictal expression of the electrical activity in frontal lobe seizure is subtle and challenging to interpret. A description of the main findings is summarized to identify seizures arising from the frontal lobe and avoid false negatives findings in EEG interpretations.
Highlights
Frontal lobe epilepsy (FLE) is the second most frequent type of focal epilepsy
The symptomatology suggestive of frontal lobe seizure is understood as the presence of one or more of the following manifestations: focal motor manifestations, fencer posture, “sign of four” posture, loud vocalizations, focal atonic features, hypermotor manifestations, “chapeau de gendarme”, unmotivated laugh, axial tonic-clonic movements, forced head or eye deviation, atonia, tonic manifestation, autonomic manifestations, aphasia or dysphasia, automatisms at seizure onset, impaired awareness, olfactory hallucinations and illusions [4]
The number of patients who met the inclusion criteria was 175, contributing to a total of 461 EEG recordings reviewed for this study
Summary
Seizures arising from the frontal lobe can be misdiagnosed due to their very variable clinical manifestations [1,5] They often present during sleep, sometimes in clusters, frequently with early motor symptoms, none of them specific (1), which makes clinical classification more difficult [6,7]. Bilateral paroxysmal EEG discharges appear with an amplitude asymmetry and often preceded by a bilateral electro-decremental activity, representing secondary synchrony rather than actual generalized seizure onset [4]. All these facts make EEG very difficult to read
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