Frontal lobe epilepsy

Frontal lobe epilepsy accounts for one to two percent of all the types of epilepsies. If the seizures originate in the frontal lobe of the brain, then the condition is called frontal lobe epilepsy. The frontal lobe is large and has many areas that do not have a known function. So, the symptoms appear when it spreads to other parts of the brain.

Types of seizures

There a different types of seizures. They are categorized into two parts, focal and generalized seizures. Focal seizure is limited to only a part of the brain hemisphere.

Generalized seizures occur when the entire right and left part of the hemispheres of the brain are involved.

  • Absence seizure occurs throughout the entire brain. The person undergoes brief loss of consciousness.
  • Tonic seizure is a rare seizure and it develops during childhood.
  • Grand Mal is also known as generalized tonic-clonic seizure which features loss of consciousness and muscle contractions.

Symptoms

The signs and symptoms of seizures include:

  • Occurrence of seizures during sleep
  • Abrupt onset and relief of seizures
  • Loss of consciousness
  • Movement of head and eye to one side
  • Incoherent
  • Difficulty speaking
  • Explosive screams, laughing or yelling
  • Dystonic motor movements
  • Repetitive movements such as bicycle pedaling, kicking or pelvic thrusting
  • Tonic seizure

Usually, frontal lobe seizures last for 30 seconds. The symptoms vary in every individual depending on the area affected in the brain.

Causes

There are different causes of frontal lobe seizures. You may experience seizures if you have tumors. Tumors account for one-third of frontal lobe epilepsy cases. Birth defects such as arteriovenous malformations cause seizures. During head trauma, seizures occur if the injury is caused to the frontal lobe. Seizures occurring due to head trauma appear in few months to years of time.

Risk factors

Excessive alcohol intake, smoking, and lack of sleep are the risk factors of frontal lobe epilepsy. Individuals with severe stress are also susceptible to seizures.

Complications

Status epilepticus is a complication of frontal lobe seizures. This is a serious medical emergency. In this condition, seizures last more than usual. Due to dystonic motor movements during the occurrence of seizures, there may be a chance of injury. Frontal lobe seizures may also affect motor skills and memory. In few cases, sudden death may also occur due to epilepsy.

Diagnosis

The diagnosis of frontal lobe epilepsy begins with the determination of side of dominance in the frontal lobe as the risks of surgery vary from right side to left side of the brain. The tests used to determine side of dominance are:

  • Brain scan using imaging tests such as magnetic resonance imaging (MRI) or positron emission tomography (PET) – to identify the source of seizures
  • Intracarotid sodium amobarbital test (WADA) - most reliable test. But the procedure is invasive, hence considered to be risky.
  • Video EEG – a video camera and an EEG monitor are made to run all the night to detect the electrical activity in the brain during occurrence of seizures
 

Treatment

In the case of seizures, it is important to determine the site of onset, site of dominance, and the area in the frontal lobe causing seizures (also called as the focal point). Depending on this, surgery is performed to remove the affected part of the frontal lobe. Your doctor prefers surgery when medication doesn’t work.

Your doctor may prescribe a single anti-seizure medication or a combination of drugs depending on the severity of your disease.

Your doctor may advise you to take a ketogenic diet that has high-fat and low-carbohydrates. On limiting the intake of carbohydrates, the body produces ketone bodies that reduce the frequency of seizures. A proper diet for epilepsy should be maintained.

An imaging technique, brain mapping is used to perform the surgery. Brain mapping involves implantation of electrodes into the area of the brain to determine whether that area has an important function by electrical stimulation (determining the focal point). Different procedures of surgery are:

  • Removing the focal point to reduce or eliminate seizures
  • Isolating the focal point to prevent seizures moving into other parts of the brain (performed if it is difficult to remove focal point)
  • Stimulating the vagus nerve by implanting a device to reduce the frequency of seizures
  • Implanting a responsive neurostimulator device that activates when a seizure begins and stops it from occurring

Coping and support

The quality of life is significantly affected if you have seizure disorder. It becomes difficult to travel distant places. Some patients also experience learning and cognitive impairment. The people may experience stress and feel depressed.

You should have a positive outlook to cope with the condition. Undergoing counseling and performing relaxation techniques may help you cope with the condition and treatment. It is important for the family members to support the patients with epilepsy in dealing with the effects of seizures.

Self-management

Avoiding smoking, limiting alcohol intake, and having an adequate sleep may help you to prevent occurrence or recurrence of seizures.