Manifestation Of Frontal Lobe Epilepsy Research Articles

It Was Just a Simple Surgery…

Introduction Frontal lobe lesions are associated with a range of behavioral and cognitive changes that vary according to location, extent, depth and laterality of the lesion. Behavior disturbances are usually divided into positive (related to disinhibition) and negative (related to apathy), while cognitive deficits mainly involve prefrontal functions, including executive functions and social cognition. Case Report In 2009, a 42-year-old man was admitted to the Emergency Department with a cerebrospinal fluid (CSF) rhinorrhea, 2 days after elective endonasal sinus surgery. The fistula was surgically corrected. Three years later, he developed frontal epileptic seizures. A CT scan was performed and revealed multiple right frontobasal cysts and bifrontal inflammation with extensive edema. In 2013, he underwent surgical drainage of the cysts and repair of the anterior cranial fossa. Family members reported that his personality had changed progressively over the 5 years since the endonasal intervention, and he had become reckless, impulsive, sexually disinhibited and aggressive towards his family, showing lack of insight and difficulty in accepting his limitations. He became unable to manage his finances or carry tasks like paying bills, dealing with paperwork and keeping important documents. He also started consuming large amounts of alcohol, which worsened his epilepsy. Because of these behaviors, he was referred to a Psychiatric consultation, where he started medication and underwent a neuropsychological evaluation. Conclusions This case demonstrates the neuropsychiatric changes associated with a frontal lobe syndrome, and the clinical manifestations of frontal lobe epilepsy. Moreover, it encourages the reflection that no surgery is risk-free.

Paroxysmal craniocervical dyskinesia as manifestation of frontal lobe epilepsy

Paroxysmal craniocervical dyskinesia as manifestation of frontal lobe epilepsy

The Sleep Manifestations of Frontal Lobe Epilepsy

Frontal lobe seizures have a tendency to occur from sleep, and in some cases occur exclusively (or almost exclusively) from sleep; these individuals are said to have nocturnal frontal lobe epilepsy (NFLE). NFLE can be difficult to distinguish clinically from various other sleep disorders, particularly parasomnias, which also present with paroxysmal motor activity in sleep. Here, the manifestations of frontal lobe epilepsy are reviewed in detail, with particular reference to the influence of sleep and the characteristics of NFLE. Key aspects of differential diagnosis are also considered, and the underlying mechanisms involved in NFLE discussed.

Psychosis as a manifestation of frontal lobe epilepsy

A 7-year-old girl presented with a cluster of seizures occurring in one day and followed by the development of paranoid delusions. Her electroencephalogram (EEG) revealed a psychomotor variant. Cranial MRI was normal, but the 2-deoxy-2-[ 18F]fluoro-D-glucose (FDG) positron emission tomography (PET) scan showed hypometabolism in the left inferior frontal cortex. Her psychotic symptoms occurred episodically. Three years later, she developed hypermotor seizures associated with a fearful look. Video/EEG monitoring captured seizures of left frontotemporal onset. Her seizures became drug resistant and she underwent epilepsy surgery. Intracranial electrocorticography captured spontaneous and electrically induced seizures with onset in the left inferior frontal region, which was resected. She became seizure-free and her psychosis resolved. This case illustrates that frontal lobe epilepsy can present solely with psychotic symptoms, which may delay the diagnosis of epilepsy. We suggest that these cases may be underdiagnosed. When epilepsy is suspected and if MRI fails to demonstrate an abnormality, FDG PET scanning and video/EEG monitoring should be considered.

A Comparison Between Seizure Manifestations and Outcome in Frontal Lobe Epilepsy of Childhood Onset

Purpose: The seizure manifestations of frontal lobe epilepsy (FLE) vary considerably, and the correlation between the ictal symptoms and seizure prognosis has not yet been fully elucidated. We retrospectively compared seizure manifestations with outcomes of the seizures in FLE of childhood onset. Methods: The subjects were 20 (11 male and nine female) patients diagnosed with FLE based on seizure manifestations, interictal or ictal EEG findings, and neurologic imaging, including magnetic resonance imaging (MRI), computed tomography (CT), or positron emission tomography (PET) or a combination of these. They were followed for 3 years. The age at onset of epilepsy ranged from 3 months to 11 years (mean, 3 years), and that at the last visit from 5 to 23 years (mean, 16 years). Eight patients had mental retardation. The MRI revealed structural abnormalities in six patients. Ten patients were considered to have symptomatic FLE, and the remaining 10, cryptogenic FLE. We examined the presence of the following manifestations: gestural automatism, postural seizures, secondarily generalized seizures (SGSs), vocalizations, facial expressions, eye deviation, motion arrest, staring, generalized tonic seizures, focal tonic seizures, twitching of the face, twitching of eyelids, contraction at the lip corner, abnormal sensations of the limb, swallowing, gustatory signs, atonic seizures, salivation, and other autonomic manifestations. Seizure prognosis was evaluated on the basis of seizure frequency over the last 2 years, according to the following criteria: no seizures without medication (I), no seizures with medication (11), one to several seizures in a year (III), in a month (IV), in a week (V), and in a day (VI). In addition to correlations between seizure prognosis and seizure manifestation, we examined the relation of the ictal symptoms with intelligence, the presence of seizure clustering, and etiology. The Mann‐Whitney U test was used for statistical analysis. Results: Gestural automatisms were found in 14 (70%) patients, including complex gestural automatisms in five (25%), followed by generalized tonic seizures in 10 (50%), vocalizations in nine (45%). SGSs in seven (37%), swallowing in seven (37%), facial expressions in six (30%), and contraction at lip corner in four (20%).Postural seizures were not seen in any of the patients. Fifteen patients had a history of seizure clustering of at least one per patient. Seizure prognosis was generally poor. Only three patients had remained free from seizures for 2 years at their last visit. Seizure outcome was significantly poorer in patients with clustering of seizures or with gestural automatisms (p < 0.05).The presence of other ictal manifestations, mental retardation, or the etiology of epilepsy were not associated with poor control of seizures. Conclusions: The seizure outcome of patients with FLE of childhood onset was generally poor. In particular, seizure clustering or gestural automatisms were predictive factors for poor seizure control.

A case of periodic catatonia, due to frontal lobe epilepsy

A case history is presented in which acute periodic catatonia was caused by frontal lobe epilepsy. This manifestation of frontal lobe epilepsy has not, to the authors' knowledge, been described before. The authors mention the problems of diagnosis and discuss a possible pathogenetic mechanism for the capricious presentation in this patient.