Frontal lobe seizures

This video teaching course presents several patterns of frontal lobe seizures recorded in a number of Italian Epilepsy Centers*. The general features of frontal lobe seizures are outlined in the introduction. Sixteen video-EEG sequences involving 10 different patients are shown. A short presentation of the clinical history precedes each case report. The electroclinical characteristics of seizures implicating the frontal lobe are extremely variable. According to the literature, general characteristics allowing differentiation between seizures of different topography include: appearance of seizures in clusters; seizures predominantly nocturnal or while the patient is falling asleep; short duration of each episode (approximately 30 s); abrupt onset and end; relatively short post-ictal phase, when present; frequent secondary generalization and falls; frequent subjective sensations, usually difficult to describe; impairment of consciousness is not a constant feature; episodes of status are frequent; differentiation from pseudo-seizures may prove to be difficult. When confirmation of the epileptic nature of paroxysmal phenomena is needed, video-EEG recordings may be of some help. Possible subjective manifestations are: cephalic and neuro-vegetative (even epigastric) manifestations, as well as "pensée forcée", fear, olfactory hallucinations, non-lateralized visual disturbances. Motor manifestations include tonic, dystonic, postural, oculocephalic deviations and falls. Verbal and more often gestural automatisms can be complex, very brief and often violent, but elementary automatisms, such as automatic hand and mouth movements, or bimanual and pedaling movements, are also frequent. In this video teaching course, we first present seizures featuring minimal motor signs, followed by seizures with a more complex semiology. The most significant clinical and EEG features are discussed.