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Frontal Lobe Epilepsy


Presentation

  • Screaming was also present in patients #4,7, vocalizations were also present in patients #1, 3, 5, and prominent tachypnea was also present in patient #1.[sleepscience.org.br]
  • After 6 months post-surgery EDS had disappeared in the 9 patients who presented this complaint pre-operatively.[ncbi.nlm.nih.gov]
  • Published on Mar 1, 2018 A 14-year-old boy presented to the University of Rochester Pediatric Movement Disorder clinic for abnormal movements of 1 year’s duration. He was referred to the Movement Disorder clinic for evaluation of complex tics.[youtube.com]
  • A physician and technicians were present throughout the recordings to assess vigilance and consciousness in case of seizures.[academic.oup.com]
  • This case demonstrates the importance of a careful clinical evaluation and investigation of patients presenting with possible panic attacks, especially if panic attacks are treatment resistent or have atypical features (for example automatisms).[radiopaedia.org]
Noncompliance
  • The researchers excluded patients with abortions, seizure onset during pregnancy, poorly defined preconception seizure frequency, nonepileptic seizures, antiepileptic drug (AED) noncompliance, and pregnancies that were enrolled in other studies.[mdedge.com]
Collapse
Enuresis
  • Personal history Thirty-four patients (34%) presented in their personal history, mostly in infancy, sleep disorders resembling sleep-talking, pavor nocturnus, enuresis, head banging and sleep-walking.[academic.oup.com]
Sleep Apnea
  • Her medical history showed she had been diagnosed with clinical depression and obstructive sleep apnea syndrome, supported by polysomnography. There were no risk factors for epileptic seizures.[mayoclinic.pure.elsevier.com]
  • apnea syndrome, and arousal disorders.[orpha.net]
  • Recordings showing stereotyped polygraphic patterns recurring throughout the night, but without the features of sleep apnoea (apnoea/hypopnoea index Studies in the literature data have shown that the prevalence of obstructive sleep apnea (OSA) in children[scicombinator.com]
  • Channels 20–23 represent the nasal/oral airflow, chest respiratory effort, abdomen respiratory effort and O2 saturation, which do not show any sleep apnea, oxygen desaturation, or tachypnea.[sleepscience.org.br]
Tachypnea
  • Screaming was also present in patients #4,7, vocalizations were also present in patients #1, 3, 5, and prominent tachypnea was also present in patient #1.[sleepscience.org.br]
Flushing
  • Autonomic symptoms such as palpitations, choking, pallor, flushing, salivation and migraine like sensations are also common. Occasionally bizarre behaviour and complex motor activities can sometimes be observed.[epilepsyqueensland.com.au]
Withdrawn
  • In five cases, carbamazepine was withdrawn because it was ineffective, and phenytoin (in two) or clobazam (in three, in one case associated with valproic acid) were instituted, without any significant efficacy.[academic.oup.com]
Social Isolation
  • They report higher levels of anxiety and stress due to social isolation, discrimination, the unpredictability of their seizures and people's reactions to them as well as fear of injury, death and brain damage from their seizures.[en.wikipedia.org]
Addictive Behavior
  • People with frontal lobe epilepsy show decreased cognitive capabilities in the following areas: humor appreciation, recognition of emotional expressions, response selection/initiation and inhibition, hyperactivity, conscientiousness, obsession, addictive[en.wikipedia.org]
Head Banging
  • Personal history Thirty-four patients (34%) presented in their personal history, mostly in infancy, sleep disorders resembling sleep-talking, pavor nocturnus, enuresis, head banging and sleep-walking.[academic.oup.com]
Olfactory Hallucination
  • Orbitofrontal cortex Impaired awareness, initial repetitive automatisms, olfactory hallucinations and illusions and autonomic features may be seen.[epilepsydiagnosis.org]
Facial Grimacing
  • grimacing, vocalization, or speech arrest; seizures are frequently preceded by a somatosensory aura; complex automatisms, such as kicking, laughing, or pelvic thrusting, may be present; responsiveness often preserved Primary motor cortex - Usually focal[emedicine.medscape.com]
  • Motor symptoms : Facial grimacing and complex automatisms like kicking and pelvic thrusting Vocal symptoms : Laughing, yelling, or speech arrest. [5] Primary motor cortex The primary motor cortex has jacksonian seizures that spread to adjacent areas of[en.wikipedia.org]
  • Finally, in only 15% of the episodes was the first movement opening of the eyes, then moving the lower limbs (4%) and the head (5%); in 4%, seizures began with pelvic movements; in 2% of the cases, patients had a facial grimace or swallowed (2%); in only[academic.oup.com]
Atonic Seizures
  • Atonic seizures may occur when there is a rapid spread of discharge from one hemisphere to the other. Please CLICK HERE to download the fact sheet. References: Betts, T. (1998). Epilepsy, Psychiatry and Learning Difficulty.[epilepsyqueensland.com.au]
  • Physiology of atonic seizures. In: Fahn, S, Hallett, M, Lüders, HO, Marsden, CD (eds). Negative Motor Phenomena. Philadelphia : Lippincott-Raven ; 1995 : 173 – 179. Google Scholar 48.[journals.sagepub.com]
Tremulousness
  • The fluttering phase was characterised initially by asymmetric, less rhythmic, and less synchronous tremulous movement and was then followed by the subtle clonic phase. Subtle oral automatism was observed in the postictal phase.[scicombinator.com]
Echolalia
  • While in hospital, he had approximately 15 episodes of catatonia, involving rigidity, negativism, mutism except echolalia and perseveration, automatic obedience and utilisation phenomena, lasting 2-20 min each.[scicombinator.com]
Insomnia
  • […] social relationships, lifestyle, role activities and life fulfillment. [12] A Center for Disease Control study reported that seizure sufferers were more likely to have lower education levels, higher unemployment, higher levels of pain, hypersomnia / insomnia[en.wikipedia.org]
Involuntary Movements
  • Out of the 59 cases interviewed during NPD episodes, 26 (44%) were in contact at the end of the episode and 10 also during the episode (sometimes the patients voluntarily tried to stop the involuntary movements, for instance by holding firm the moving[academic.oup.com]
Urinary Incontinence
  • Seizures are typically brief, and can have prominent vocalization, bizarre behavior, urinary incontinence, and head and eye deviation. Frontal lobe seizures may be exclusively nocturnal and often cluster.[epilepsydiagnosis.org]

Workup

  • […] frontal lobe epilepsy frequently require invasive EEG monitoring On intracranial EEG, Ictal onset most often appears as a low-voltage, high-frequency discharge (ie, buzz), although rhythmic activity at alpha, theta, or delta frequencies may be seen See Workup[emedicine.medscape.com]

Treatment

  • Management and treatment The treatment of choice for ADNFLE includes use of carbamazepine (200-1,000 mg/day). Carbamazepine abolishes seizures in 20% of cases, and gives significant relief (at least 50 % seizure reduction) in another 48%.[orpha.net]
  • Researchers at the clinic studied the effects of surgery on more than 150 patients, all of whom were at different stages in their treatment for epilepsy.[epilepsyresearch.org.uk]
  • Learn more about epilepsy symptoms, treatment and diagnosis at UCLA »[neurosurgery.ucla.edu]
  • Among the patients with drug-resistant NFLE, surgical treatment is considered a potential option.[ncbi.nlm.nih.gov]
  • Treatment effectiveness can vary greatly amongst frontal lobe epilepsy patients. People with brain injuries or malformations often must take medication for the duration of their lives.[uwhealth.org]

Prognosis

  • Engel class I and Engel class II were defined as good prognosis, and Engel class III and Engel class IV were defined as poor prognosis. The ILAE classification system 1, 2 and 3 were defined as good prognosis, 4 and 5 were defined as poor prognosis.[alliedacademies.org]
  • Prognosis ADNFLE is lifelong but not progressive. As an individual reaches middle age, attacks may become milder and less frequent. The documents contained in this web site are presented for information purposes only.[orpha.net]
  • An important feature in prognosis is the early recognition of frontal lobe seizures as an epileptic syndrome rather than as a parasomnia or a psychiatric condition. Patient Education Patient education is important for all patients with epilepsy.[emedicine.medscape.com]
  • This not only requires early seizure control but also the recognition of the poor global prognosis of this nonlesional form of epilepsy, which should help us obtain special help from educational professionals for these children at the time of diagnosis[onlinelibrary.wiley.com]
  • […] impairment within the motor-controlled system including the cerebellum and the caudate/putamen in FLE patients, this therefore suggest that the deficits in GMV at the caudate and putamen as well as their causality would enhance understanding in the prognosis[bmcneurol.biomedcentral.com]

Etiology

  • We believe that in children, FLE, even without a known etiology, can not be considered benign.[onlinelibrary.wiley.com]
  • Etiology ADNFLE results from malfunction in the thalamo-cortical loops. The genes involved are CHRNA4 (20q13.33), CHRNB2 (1q21.3), CHRNA2 (8p21), KCNT1 (9q34.3), DEPDC5 (22q12.3), CRH (8q13), and CABP4 (11q13.2).[orpha.net]
  • Etiology Developmental lesions With improvements in neuroimagine, cortical dysplasias are increasingly being identified as epileptogenic lesions. This is particularly true for patiens who were initially assumed to be nonlesional.[emedicine.medscape.com]
  • ., based on clinical presentation, EEG and MRI findings, presumed to be symptomatic, but with unknown etiology) localization-related epilepsy with an epileptic focus in the frontal lobe, aged between 8 and 13 years, no other disease that could cause cognitive[journals.plos.org]

Epidemiology

  • Summary Epidemiology Over 100 families have been described in the literature to date. Males and females are affected equally. Clinical description The age of onset varies between 3 and 47 years (usually 20 years, with a peak during childhood).[orpha.net]
  • Sex predilection No significant sex-based frequency difference has been reported for frontal lobe epilepsy in epidemiologic studies.[emedicine.medscape.com]
  • Also, in regards to the question of whether any forms of epilepsy are different between Taiwanese and Caucasian populations (viz. epidemiology and clinical characteristics), a PubMed search did not reveal any identified differences.[sleepscience.org.br]
  • Further research in the genetic and epidemiological fields together with elucidation of the motor component of the nocturnal attacks by video-PSG, not only in sleep disorders but also in normal subjects, may help to define the border between these two[touchneurology.com]
  • Enuresis, sleepwalking, and nightmares: an epidemiological survey in the Republic of San Marino. In: Guilleminault C, Lugaresi E, editors. Sleep/wake disorders: natural history, epidemiology, and long-term evolution.[academic.oup.com]
Sex distribution
Age distribution

Pathophysiology

  • An overview of epilepsy: its history, classification, pathophysiology and management. Brain and nerve Shinkei kenkyu no shinpo 65, 509–520 (2013). 33. Yan, C. G., Wang, X. D., Zuo, X. N. & Zang, Y. F.[nature.com]
  • CrossRef Google Scholar Access Volume 18, Issue S4 November 1991, pp. 559-563 Abstract: The first section of this article deals with specific anatomic and pathophysiologic factors which contribute to a poor EEG localization of the interictal epileptic[cambridge.org]
  • Low therapy adherence seems to have a multifactorial origin with some factors being associated with neuropsychological impairments and psychiatric co-morbidities of chronic diseases [ 11 ], and others reflecting pathophysiological changes of neural networks[royalsocietypublishing.org]
  • Pathophysiological conclusions NFLE has a peculiar relationship to the physiology of sleep. Polygraphic recordings show that a mesiofrontal epileptic focus is often activated during NREM sleep.[academic.oup.com]

Prevention

  • Medications [ edit ] Anticonvulsants are the most successful medication in reducing and preventing seizures from reoccurring.[en.wikipedia.org]
  • About the American Epilepsy Society Founded in 1946, the American Epilepsy Society (AES) is a medical and scientific society whose members are dedicated to advancing research and education for preventing, treating and curing epilepsy.[aesnet.org]
  • There is a large range of anticonvulsants which has both types of different abilities to prevent some types of seizures and modes of action.[biomedpharmajournal.org]
  • Both perfusion and agonist solution contained no Cl ions to prevent contamination with endogenous Ca 2 -dependent Cl current. Oocytes were preincubated in Cl -free media for 4–16 hr.[jneurosci.org]
  • What can I do to help my child prevent a seizure? You may not be able to prevent every seizure.[drugs.com]

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