Frontal lobe seizures

 

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Frontal lobe seizures

Overview

Frontal lobe seizures are a common form of epilepsy, a neurological disorder in which clusters of brain cells send abnormal signals and cause seizures. These types of seizures stem from the front of the brain.

Abnormal brain tissue, infection, injury, stroke, tumors or other conditions can also cause frontal lobe seizures.

Because the frontal lobe is large and has important functions, frontal lobe seizures can produce unusual symptoms that can appear to be related to psychiatric problems or a sleep disorder. They often occur during sleep.

Medications usually can control frontal lobe seizures, but surgery or an electrical stimulation device might be options if anti-epileptic drugs aren't effective.

Symptoms

Frontal lobe seizures often last less than 30 seconds. In some cases, recovery is immediate.

Signs and symptoms of frontal lobe seizures might include:

·         Head and eye movement to one side

·         Complete or partial unresponsiveness or difficulty speaking

·         Explosive screams, including profanities, or laughter

·         Abnormal body posturing, such as one arm extending while the other flexes, as if the person is posing like a fencer

·         Repetitive movements, such as rocking, bicycle pedaling or pelvic thrusting

When to see a doctor

See your doctor if you're having signs or symptoms of a seizure. Call 911 or call for emergency medical help if you see someone having a seizure that lasts longer than five minutes.

Causes

Frontal lobe seizures, or frontal lobe epilepsy, can be caused by abnormalities — such as tumors, stroke, infection or traumatic injuries — in the brain's frontal lobes.

Frontal lobe seizures are also associated with a rare inherited disorder called autosomal dominant nocturnal frontal lobe epilepsy. If one of your parents has this form of epilepsy, you have a 50 percent chance of inheriting the abnormal gene that causes this disorder and developing the disease yourself.

For about half the people who have frontal lobe epilepsy, the cause remains unknown.

Complications

·         Status epilepticus. Frontal lobe seizures, which tend to occur in clusters, might provoke this dangerous condition in which seizure activity lasts much longer than usual. Consider seizures that last longer than five minutes a medical emergency, and seek immediate help.

·         Injury. The motions that occur during frontal lobe seizures sometimes result in injury to the person having the seizure. Seizures can also result in accidents and drowning.

·         Sudden unexplained death in epilepsy (SUDEP). For unknown reasons, people who have seizures have a greater than average risk of dying unexpectedly. Possible factors include heart or breathing problems, perhaps related to genetic abnormalities. Controlling seizures as well as possible with medication appears to be the best prevention for SUDEP.

·         Depression and anxiety. Both are common in people with epilepsy. Children also have a higher risk of developing attention-deficit/hyperactivity disorder.

Diagnosis

Frontal lobe epilepsy can be difficult to diagnose because its symptoms can be mistaken for psychiatric problems or sleep disorders, such as night terrors. It's also possible that some seizure effects found in the frontal lobe might be the result of seizures that begin in other parts of the brain.

Your doctor will review your symptoms and medical history and give you a physical exam. You might also have a neurological exam, which will assess:

·         Muscle strength

·         Sensory skills

·         Hearing and speech

·         Vision

·         Coordination and balance

Your doctor might suggest the following tests.

·         Brain scans. Brain imaging, usually MRI, might reveal the source of frontal lobe seizures. An MRI scan uses radio waves and a powerful magnetic field to produce detailed images of soft tissues, which make up the brain.

An MRI scan involves lying on a narrow pallet that slides into a long tube. The test often takes about an hour. Some people feel claustrophobic inside MRI machines, although the test itself is painless.

·         Electroencephalogram (EEG). An EEG monitors the electrical activity in your brain via a series of electrodes attached to your scalp. EEGs are often helpful in diagnosing some types of epilepsy, but results can be normal in frontal lobe epilepsy.

·         Video EEG. Video EEG is usually performed during an overnight stay at a sleep clinic. Both a video camera and an EEG monitor run all night. Doctors can then match what physically occurs when you have a seizure with what appears on the EEG during the seizure.

Treatment

Over the past decade, treatment options have increased for frontal lobe seizures. There are newer types of anti-seizure medications as well as a variety of surgical procedures that might help if medications don't work.

Medications

All anti-seizure drugs seem to work equally well at controlling frontal lobe seizures, but not everyone becomes seizure-free on medication. Your doctor might try different types of anti-seizure drugs or have you take a combination of drugs to control your seizures. Researchers are continuing to look for new and more-effective medications.

Surgery

If your seizures can't be controlled with medications, surgery might be an option. Surgery involves pinpointing the areas of the brain where seizures occur.

Two newer imaging techniques — single-photon emission computerized tomography (SPECT) and subtraction ictal SPECT coregistered to MRI (SISCOM) — can help identify the area generating seizures.

Another imaging technique, known as brain mapping, is commonly used before epilepsy surgery. Brain mapping involves implanting electrodes into an area of the brain and using electrical stimulation to determine whether that area has an important function, which would rule out surgery on that area. In addition, functional MRI (fMRI) is used to map the language area of the brain.

If you have surgery for your frontal lobe seizures, you're likely to continue to need anti-seizure medication after the surgery, although possibly at a lower dose.

Surgery for epilepsy might involve:

·         Removing the focal point. If your seizures always begin in one spot in your brain, removing that small portion of brain tissue might reduce or eliminate your seizures.

·         Isolating the focal point. If the portion of the brain that's causing seizures is too vital to remove, surgeons might make a series of cuts to help isolate that section of the brain. This prevents seizures from moving into other parts of the brain.

·         Stimulating the vagus nerve. This involves implanting a device — similar to a cardiac pacemaker — to stimulate your vagus nerve. This procedure usually reduces the number of seizures.

·         Responding to a seizure. A responsive neurostimulator is a newer type of implanted device. It is activated only when you begin to have a seizure, and it stops the seizure from occurring.

·         Deep brain stimulation (DBS). This newer procedure involves implanting an electrode into your brain that's connected to a stimulating device, similar to a cardiac pacemaker, which is placed under the skin of your chest. The device sends signals to the electrode to stop signals that trigger a seizure.

Lifestyle and home remedies

Some seizures might be triggered by alcohol intake, smoking and, especially, lack of sleep. There is also evidence that severe stress can provoke seizures, and that seizures themselves can cause stress. Avoiding these triggers where possible might help improve seizure control.

Alternative medicine

Some people with common neurological conditions, including seizures, turn to complementary and alternative medicine, such as:

·         Herbal medicines

·         Acupuncture

·         Psychotherapy

·         Mind-body techniques

·         Homeopathy

Researchers are looking into these therapies, hoping to determine their safety and effectiveness, but good evidence is mostly still lacking. There is some evidence that a strict high-fat, low-carbohydrate (ketogenic) diet might be effective, particularly for children.

Many people with epilepsy use herbal remedies. However, there's little evidence for their effectiveness, and some can cause an increased risk of seizures.

Marijuana (cannabis) is one of the most commonly used herbal remedies for treating epilepsy, but most evidence doesn't show that it helps. However, little data are available and research into its usefulness is ongoing. Let your doctor know if you use cannabis.

The Food and Drug Administration does not regulate herbal products, and they can interact with other anti-epileptic drugs you take, putting your health at risk. Talk to your doctor before taking herbal or dietary supplements for your seizures.

Coping and support

Some people who have epilepsy are embarrassed or frustrated by their condition. Frontal lobe seizures can be especially embarrassing if they involve loud utterances or sexual movements.

Parents of children with frontal lobe seizures can find information, resources and emotional connections from support groups to help their children and themselves. Counseling can be helpful as well. Adults with epilepsy also can find support through in-person and online groups.

Preparing for your appointment

You'll probably first see your family doctor, who might refer you to a neurologist.

What you can do

Ask a family member or friend to come with you to the doctor to help you remember the information you receive.

Make a list of:

·         Your symptoms, even those that seem unrelated to the reason you scheduled the appointment, when they began and how often they occur

·         All medications, vitamins and supplements you take, including doses

·         Questions to ask your doctor

Some questions to ask include:

·         What is likely causing my symptoms or condition?

·         Will I likely have more seizures? Will I have different types of seizures?

·         What tests do I need? Do they require any special preparation?

·         What treatments are available, and which do you recommend?

·         I have other medical problems. How can I manage them together?

·         Is surgery a possibility?

·         Will I have restrictions on my activity? Will I be able to drive?

·         Are there brochures or other printed materials I can have? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

·         Did you notice any unusual sensations before the seizures?

·         How often do the seizures occur?

·         Can you describe a typical seizure?

·         How long do the seizures last?

·         Do the seizures occur in clusters?

·         Do they all look the same or are there different seizure behaviors you or others have seen?

·         Have you noticed seizure triggers, such as illness or lack of sleep?

·         Has anyone in your immediate family ever had seizures?