Frontal Lobe Epilepsy

Patient’s Story

"My head starts jerking towards the right side. I try, but I can’t stop it. Then my right hand goes up and my head turns toward the hand. I may just stay in that position for half a minute and it’s over, or it can become a grand mal seizure."

What is Frontal Lobe Epilepsy?

Frontal lobe epilepsy is the next most common form of epilepsy after temporal lobe epilepsy (TLE), and involves the frontal lobes of the brain. As in temporal lobe epilepsy, seizures in frontal lobe epilepsy are partial, though seizure symptoms differ depending on the frontal lobe area involved.

Types of Seizures in Frontal Lobe Epilepsy

Since the frontal lobes are responsible for a wide array of functions including motor function, language, impulse control, memory, judgment, problem solving, and social behavior, to name a few, seizure symptoms in the frontal lobes vary widely. Also, the frontal lobes are large and include many areas that do not have a precisely known function. Therefore, when a seizure begins in these areas, there may be no symptoms until it spreads to other areas or to most of the brain, causing a tonic-clonic seizure. When motor areas (areas that control movement) are affected, abnormal movements occur on the opposite side of the body. Seizures beginning in frontal lobe motor areas can result in weakness or the inability to use certain muscles, such as the muscles that allow someone to speak.

Complex partial seizures of frontal lobe origin are usually quite different from temporal lobe seizures. Frontal lobe seizures tend to be short (less than 1 minute), occur in clusters and during sleep, include strange automatisms such as bicycling movements, screaming, or even sexual activity, followed by confusion or tiredness. Sometimes a person will remain fully aware during a frontal lobe seizure, while at the same time having wild movements of the arms and legs. In fact, a seizure from the frontal lobe may even involve laughing or crying as the only symptom, though both laughing (gelastic) and crying (dacrystic) seizures could come from the temporal lobe as well. The EEG might be the only way to determine which lobe is involved in these cases.

How is Frontal Lobe Epilepsy Treated?

In many cases, frontal lobe seizures can be well controlled with medications for partial seizures. If antiepileptic drugs are not effective, surgery to remove the seizure focus may be an option in selected cases. Those patients with abnormalities on the brain MRI or CT scans limited to one frontal lobe are the best candidates, but even those with normal imaging studies may be successfully treated with surgery. Vagus Nerve Stimulation can also be beneficial in cases where brain surgery is not recommended or fails.