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Frontal lobe seizuresBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/frontal-lobe-seizures/DS00810
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Frontal lobe seizures are seizures that originate in the front of the brain. Epilepsy symptoms can vary depending on what part of the brain is involved. Frontal lobe seizures may produce unusual symptoms that can appear to be related to a psychiatric problem or a sleep disorder.
Frontal lobe seizures often occur during sleep and may feature bicycle pedaling motions and pelvic thrusting. Some people scream profanities or laugh during frontal lobe seizures.
In many cases of frontal lobe seizures, brain wave tests (electroencephalograms) may not show the changes characteristic of epileptic seizures that originate elsewhere in the brain. Medications usually can control frontal lobe seizures, but surgery is an option if anti-epileptic drugs aren't effective.
Frontal lobe seizures usually last less than 30 seconds and often occur during sleep. Signs and symptoms of frontal lobe seizures may 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 observe someone having a seizure that lasts more than five minutes.
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Frontal lobe seizures can result from abnormalities — such as tumors, stroke, infection, or traumatic injuries — in the brain's frontal lobes. An abnormal gene causes a rare inherited disorder called autosomal dominant nocturnal frontal lobe epilepsy. If one of your parents has this form of frontal lobe epilepsy, you have a 50 percent chance of inheriting the gene and developing the disease yourself.
In most cases, however, the cause of frontal lobe epilepsy remains unknown.
- Status epilepticus. Frontal lobe seizures tend to occur in clusters and may provoke a dangerous condition called status epilepticus — in which seizure activity lasts much longer than usual. Seizures that last longer than five minutes should be treated as a medical emergency.
- Injury. The motions that occur during frontal lobe seizures sometimes result in injury to the person experiencing the seizure.
- Other brain functions. Depending on the frequency and duration of seizures, frontal lobe epilepsy may affect memory, motor skills and other brain functions. However, more research is needed.
- 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.
Preparing for your appointment
You'll probably first bring your symptoms to the attention of your family doctor, who may refer you to a neurologist.
What you can do
To prepare for your appointment:
- Write down any symptoms you have experienced. Include any that may seem unrelated to the reason you scheduled the appointment. If you have experienced different kinds of seizures, make a particular note of that. Do they affect different sides of the body? Do some affect speech and others not?
- Make a list of all medications. Include vitamins and supplements you are taking, including dosages. Write down the reasons any were discontinued, whether because of side effects or lack of effectiveness.
- Ask a family member to come with you to the doctor. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who goes with you may remember something you missed or forgot. Also, since memory loss can happen during seizures, many times an observer is able to better describe the seizures than is the person who's had them.
- Write down questions. Preparing a list of questions for your doctor will help you make the most of your time together.
Some basic 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 kind of tests do I need? Do they require any special preparation?
- What treatments are available, and which do you recommend?
- Are you prescribing medication? If so, is there a generic alternative?
- I have other medical problems. How can they be managed together?
- What types of side effects can I expect from treatment?
- Is surgery a possibility?
- Will I have any restrictions on my activity? Will I be able to drive?
- Are there brochures or other printed materials that I can take with me? What websites do you recommend?
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
- When did you begin experiencing symptoms?
- 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?
- What medications have you tried? What doses were used?
- Have you tried any medication combination?
- Have you noticed any seizure triggers, such as illness or lack of sleep?
- Has anyone in your immediate family ever had seizures?
Your physical may include a neurological exam, which will assess:
- Muscle strength
- Sensory skills
- Hearing and speech
- Coordination and balance
Tests and diagnosis
Frontal lobe epilepsy can be difficult to diagnose because its symptoms may be mistaken for psychiatric problems or sleep disorders, such as night terrors. It has not been studied as much as some other types of epilepsy. It's possible that some seizure effects found in the frontal lobe may be the result of seizures that begin in other parts of the brain.
Your doctor may suggest the following tests.
Brain scans. Frontal lobe seizures can be caused by tumors, abnormal blood vessels or injuries. Brain imaging, usually MRI, may reveal the source.
MRI uses radio waves and a powerful magnetic field to produce very detailed images of soft tissues such as the brain. To undergo an MRI scan, you must lie on a narrow pallet that slides into a long tube. The test often takes about an hour to complete. Some people may 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 may be normal in frontal lobe epilepsy.
- Video EEG. Video EEG is usually performed during an overnight stay at a hospital's 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 at the same time.
Treatments and drugs
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|Vagus nerve stimulation|
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 may help if medications don't work.
All anti-seizure drugs seem to work equally well at controlling frontal lobe seizures, but not everyone becomes seizure-free on medication. Your doctor may 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.
If your seizures can't be controlled adequately with medications, your doctor may recommend surgery. 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) — are more accurate at identifying the area, but aren't yet widely available.
Another imaging technique, known as brain mapping, is commonly used before epilepsy surgery. Brain mapping involves implanting electrodes directly 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.
In general, surgery for seizures that aren't well controlled by medication may be quite successful. Surgery for frontal lobe seizures may be less successful than for other types of seizures, but still may provide benefit.
Surgery for epilepsy may involve:
- Removing the focal point. If your seizures always begin in one specific spot in your brain, removing that small portion of brain tissue may 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 may 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. Another surgical option is to implant a device — similar to a cardiac pacemaker — to stimulate your vagus nerve. This procedure usually reduces the number of seizures people experience.
- Responding to a seizure. A responsive neurostimulator (RNS) 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.
Lifestyle and home remedies
Some seizures may 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 may help improve seizure control.
People with common neurological conditions, including seizures, tend to use complementary and alternative medicine more often than those who don't have these conditions. People with seizures may use:
- Herbal medicines
- Mind-body techniques
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 may be effective, particularly for children.
Many people with epilepsy use herbal remedies in particular. However, there is little evidence for their effectiveness and some can cause increased risk of seizures. Some specific remedies include:
- Marijuana (cannabis). Current evidence does not show that cannabis is useful for treating epilepsy. However, little data are available and research into its usefulness is ongoing. It's important to let your doctor know if you are using cannabis.
- Huperzine A. Research shows promise for an herbal remedy called huperzine A, but more studies are needed.
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. Make sure to talk with your doctor before taking any herbal or dietary supplements for your seizures.
Coping and support
People who have epilepsy may be embarrassed or frustrated by their condition. Frontal lobe seizures may be especially embarrassing because they sometimes feature loud vocalizations or sexual movements.
It helps if family members can encourage a positive outlook. Parents 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.
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