Frontal lobe epilepsy

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 24, 2016
StartDiseasesFrontal lobe epilepsy

Epilepsy is a broad term to describe neurological seizures which are defined by excessive and abnormal nerve activity. Some individuals develop epilepsy due to birth defects, stroke, tumors or a traumatic brain injury, but the majority of cases do not have a definite cause. Frontal lobe epilepsy is the term used for seizures that occur in the frontal lobe of the brain, located directly behind the forehead.

Contents

Definition & Facts

The frontal lobe is primarily responsible for motor functioning. It can be difficult to distinguish between frontal lobe epilepsy and temporal lobe epilepsy because the two lobes share many connections in the brain. Frontal lobe seizures typically occur during sleep. It isn’t uncommon for the seizures to be confused with a mental disorder or sleep disorder due to similar signs and symptoms.

Symptoms & Complaints

Seizures in the frontal lobe are short and typically last less than thirty seconds. They are also characterized by movement of the head and eyes to one side, facial grimacing, moaning and yelling, speaking random words, difficulty speaking, and complete or partial unresponsiveness.

It is also common for repetitive motions to occur, such as thrusting of the pelvis, rocking back and forth or moving the legs as if trying to pedal a bike in the air. Abnormal body poses are also common during a frontal lobe seizure.

Some individuals have an aura before the seizure begins accompanied by fear, vertigo, or feeling like they are going to fall over. After the seizure is over, the individual may also experience confusion. They might also not know or understand what happened or have any memory of the seizure occurring at all.

Every individual is different and someone suffering from these types of seizures may have only a few of the aforementioned symptoms, while another individual could have almost all of these. It depends on the exact location and intensity of the seizure. 

Causes

The causes of frontal lobe seizures are not always evident. In the majority of cases, the cause of the epilepsy is unknown. They can be a result of abnormalities that occur in the brain such as tumors, infections, stroke or suffering from a traumatic brain injury.

It is also possible to have a very rare disorder, autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE), which is an inherited genetic disorder. This disorder is caused by a genetic mutation in the CHRNA4 gene or CHRNB2 gene. Most develop the disorder during childhood, but ADNFLE can surface at any age.

Diagnosis & Tests

Diagnosing frontal lobe seizures depends on the symptoms the individual reports or what others have seen while observing someone while they are experiencing a seizure. Since many individuals don’t remember the seizure occurring, it can be difficult to accurately diagnose the condition.

Diagnosis includes getting a magnetic resonance imaging (MRI) scan. This imaging scan uses a combination of magnets and radio waves to develop pictures of the brain. A major benefit of an MRI is that it does not emit any radiation.

Another type of diagnostic test a neurologist will perform is an electroencephalography or EEG. This test consists of a technician applying various electrodes all over the scalp to measure its electrical activity during certain activities such as looking at flashing lights or sleeping. The test typically lasts for up to an hour, but if the results are inconclusive, a 24-hour EEG can be performed by sending the patient home with a machine to record brain activity for a longer time period.

Some neurologists do a video EEG by recommending the individual visit a sleep clinic to measure activity through the night both visually and with the monitor. Longer tests can be more effective at measuring abnormal brain activity for a more accurate diagnosis. 

Treatment & Therapy

Most seizures can be controlled with certain medications or a combination of medications though it can take a lot of trial-and-error to determine which medication is best for the individual. Anticonvulsant drugs that are used to treat frontal lobe epilepsy include topiramate, carbamazepine, vaproate, and barbituates.

In more severe cases where medication is unable to reduce or eliminate the seizures completely, surgery might be a possibility. After temporal lobectomies, surgery to treat frontal lobe epilepsy is the most common procedure to treat epilepsy that is unresponsive to anticonvulsant medication. The surgery varies but typically involves removing damaged tissue (the lesion) in the brain that is causing the seizures (lesionectomy).

Another option is vagus nerve stimulation in which a surgeon stimulates the vagus nerve with a device that transmits electrical impulses; this is not dissimilar to putting in a artificial cardiac pacemaker for a cardiovascular disease. The device tends to reduce the number of seizures experienced.

A newer method involves implanting a responsive neurostimulation device, which only turns on when the seizure starts and prevents it from occurring. Technology and research is evolving as scientists learn more about how the brain works and the specific causes of each person’s frontal lobe seizures. 

Prevention & Prophylaxis

Seizure prevention mostly consists of taking the prescribed medication, though some people have triggers that can increase the frequency of seizures; these triggers should be avoided for preventative purposes.

Triggers vary from one person to another, but some include not getting enough sleep, drinking too much alcohol, and smoking, skipping meals or watching rapidly flashing lights. Avoiding these triggers may reduce how often seizures occur. Psychological stress is also a trigger and stressing about having a seizure makes it more likely to actually experience a seizure.

Researchers also have evidence that changing to a high-fat and low-carbohydrate diet, also known as a ketogenic diet, can be an effective treatment to reduce seizure frequency, especially in younger children as an alternative or in conjunction with medication. Epilepsy is a life-long condition that doesn’t go away, but it can be managed if properly addressed and diagnosed.