Padaczka płata czołowego
Diagnostyka i diagnoza
Padaczka płata czołowego stanowi 20-30% wszystkich padaczek ogniskowych i charakteryzuje się zróżnicowanymi objawami klinicznymi, które często utrudniają diagnostykę, mogąc być mylone z zaburzeniami psychiatrycznymi, parasomniami czy napadami niepadaczkowymi psychogennymi (PNES). Typowe napady trwają krócej niż 2 minuty, występują w skupiskach, często w nocy, i manifestują się stereotypowymi ruchami (np. gwałtowne pchnięcia miednicą, ruchy pedałowania) oraz zachowaniem świadomości. Diagnostyka opiera się na szczegółowym wywiadzie, badaniu neurologicznym, a także na badaniach EEG, z naciskiem na wideo-EEG, które umożliwia korelację objawów klinicznych z zapisem elektrycznym mózgu. Standardowe EEG może być prawidłowe u około 30% pacjentów z tym typem padaczki, co wynika z anatomicznej lokalizacji ogniska i artefaktów mięśniowych. Obrazowanie MRI jest kluczowe w identyfikacji zmian strukturalnych u około 50% chorych, a zaawansowane techniki, takie jak PET, SPECT czy fMRI, wspomagają precyzyjną lokalizację ogniska padaczkowego.
Diagnostyka padaczki płata czołowego
Padaczka płata czołowego to drugi najczęstszy typ padaczki ogniskowej, odpowiadający za 20-30% wszystkich padaczek ogniskowych. Diagnostyka tego schorzenia jest szczególnie trudna ze względu na różnorodność objawów klinicznych, które mogą być mylone z zaburzeniami psychiatrycznymi, zaburzeniami snu (takimi jak parasomnia/” title=”parasomnia” class=”to-tag” data-termid=”61612″>parasomnie czy nocne lęki) lub napadami niepadaczkowymi psychogennymi (PNES).123
Trudności diagnostyczne wynikają również z faktu, że płat czołowy jest największym płatem mózgu, o złożonej anatomii i funkcjach. Napady padaczkowe z płata czołowego mogą charakteryzować się szybkim rozprzestrzenianiem się wyładowań do innych obszarów mózgu, co dodatkowo utrudnia właściwą lokalizację ogniska padaczkowego.45
Wywiad i badanie kliniczne
Właściwa diagnoza padaczki płata czołowego rozpoczyna się od dokładnego wywiadu lekarskiego i badania klinicznego. Istotne elementy procesu diagnostycznego to:67
- Szczegółowy wywiad dotyczący przebiegu napadów, częstotliwości ich występowania, czasu trwania oraz okoliczności im towarzyszących
- Informacje od świadków napadów, którzy mogą opisać zachowanie pacjenta podczas epizodu
- Wywiad rodzinny (ze względu na możliwe podłoże genetyczne niektórych form padaczki płata czołowego)
- Badanie neurologiczne, obejmujące ocenę siły mięśniowej, umiejętności sensorycznych, słuchu i mowy, widzenia, koordynacji i równowagi
- Ocena czynników ryzyka, takich jak urazy głowy, udary, guzy mózgu, infekcje ośrodkowego układu nerwowego
Napady padaczkowe z płata czołowego mają często charakterystyczne cechy, które mogą sugerować ich pochodzenie. Typowe są krótkie napady (zwykle trwające krócej niż 2 minuty), często występujące w skupiskach, szczególnie w nocy lub podczas snu. Mogą im towarzyszyć stereotypowe ruchy, takie jak gwałtowne pchnięcia miednicą, ruchy pedałowania lub ruchy kończyn, a także wokalizacje i zachowanie świadomości podczas epizodu.1011
Badanie elektroencefalograficzne (EEG)
Elektroencefalografia (EEG) jest podstawowym narzędziem diagnostycznym w padaczce, jednak w przypadku padaczki płata czołowego ma pewne ograniczenia. Standardowe EEG może nie wykazać nieprawidłowości, nawet jeśli pacjent cierpi na napady padaczkowe.1213
Trudności w wykrywaniu nieprawidłowości w EEG przy padaczce płata czołowego wynikają z kilku czynników:14
- Duże obszary przyśrodkowej i dolnej kory czołowej nie są dobrze widoczne w standardowym EEG powierzchniowym
- Nawet przy wielokrotnych badaniach EEG, wyładowania padaczkopodobne mogą być widoczne tylko u około 70% pacjentów
- Napady często wiążą się z aktywnością hiperkienetyczną, która powoduje, że EEG jest zaburzone przez artefakty mięśniowe
- Zmiany w EEG podczas napadu mogą być subtelne, trudne do interpretacji lub przejawiać się jako uogólnione zmiany EEG z asymetrią amplitudy
Ze względu na te ograniczenia, w diagnostyce padaczki płata czołowego szczególnie istotne jest zastosowanie wideo-EEG. Badanie to pozwala na jednoczesną rejestrację aktywności elektycznej mózgu oraz obrazu wideo zachowania pacjenta podczas napadu. Jest to niezwykle wartościowe narzędzie diagnostyczne, ponieważ umożliwia lekarzom dopasowanie objawów klinicznych napadu do zmian w zapisie EEG.1617
Badanie wideo-EEG jest często wykonywane podczas nocnego pobytu w klinice snu, ponieważ napady z płata czołowego często występują w czasie snu. Monitorowanie trwa całą noc, a lekarz może porównać objawy fizyczne napadu z jednoczesnym zapisem EEG.1819
Badania neuroobrazowe
Badania obrazowe odgrywają kluczową rolę w diagnostyce padaczki płata czołowego, pomagając w identyfikacji strukturalnych przyczyn napadów, takich jak guzy, malformacje naczyniowe, blizny czy dysplazje korowe.20
Rezonans magnetyczny (MRI) jest preferowaną metodą obrazowania w przypadku padaczki płata czołowego. Badanie to wykorzystuje pole magnetyczne i fale radiowe do uzyskania szczegółowych obrazów tkanek miękkich mózgu. Postępy w technologii MRI poprawiły możliwość identyfikacji zmian strukturalnych, które są obecne u nawet 50% pacjentów z padaczką płata czołowego.2122
Oprócz standardowego MRI, w diagnostyce padaczki płata czołowego stosowane mogą być także bardziej zaawansowane techniki obrazowania:23
- PET (pozytronowa tomografia emisyjna) – wykorzystywana do oceny metabolizmu glukozy w mózgu, co może pomóc w lokalizacji ogniska padaczkowego
- SPECT (tomografia emisyjna pojedynczego fotonu) – badanie to może być wykonane podczas napadu (ictal SPECT) lub pomiędzy napadami (interictal SPECT) i może wykazać obszary zwiększonego lub zmniejszonego przepływu krwi w mózgu
- SISCOM (Subtraction Ictal SPECT Co-registered to MRI) – technika łącząca dane z badania SPECT wykonanego podczas napadu i pomiędzy napadami, co pozwala na dokładniejszą lokalizację ogniska padaczkowego
- Funkcjonalny MRI (fMRI) – szczególnie przydatny w mapowaniu obszarów funkcjonalnych mózgu, takich jak obszary mowy, przed planowanym zabiegiem chirurgicznym
Badania inwazyjne
U pacjentów z podejrzeniem padaczki płata czołowego, u których standardowe badania nieinwazyjne nie dostarczają jednoznacznych wyników, a napady są lekooporne, mogą być konieczne bardziej inwazyjne metody diagnostyczne.25
Najczęściej stosowane inwazyjne metody diagnostyczne to:26
- Stereoelektroencefalografia (SEEG) – minimalnie inwazyjna procedura chirurgiczna, w której elektrody są implantowane do mózgu w celu dokładnego określenia źródła napadów padaczkowych. Jest stosowana do lokalizacji aktywności napadowej, która nie może być wykryta za pomocą standardowego EEG
- Śródoperacyjne monitorowanie EEG – stosowane podczas zabiegów chirurgicznych w celu lokalizacji ogniska padaczkowego
- Mapowanie funkcjonalne mózgu – wykonywane przed zabiegiem chirurgicznym w celu określenia lokalizacji ważnych funkcjonalnie obszarów mózgu (np. związanych z mową czy ruchem), aby zminimalizować ryzyko powikłań pooperacyjnych
Badania laboratoryjne
Badania laboratoryjne są ważnym elementem procesu diagnostycznego padaczki płata czołowego, szczególnie w celu wykluczenia metabolicznych przyczyn napadów lub monitorowania leczenia przeciwpadaczkowego.28
Najczęściej wykonywane badania laboratoryjne obejmują:29
- Podstawowe badania krwi (morfologia, elektrolity, glukoza, funkcja wątroby i nerek)
- Badania metaboliczne (poziom magnezu, wapnia, sodu)
- Badania toksykologiczne
- Poziom leków przeciwpadaczkowych (w przypadku pacjentów już leczonych)
Badania genetyczne
Badania genetyczne powinny być rozważone u pacjentów z padaczką płata czołowego, szczególnie jeśli występuje silna rodzinna historia padaczki. Ze względu na duży rozmiar płatów czołowych, każda dysfunkcja genów o szerokim spektrum ekspresji w mózgu może prowadzić do padaczki płata czołowego.30
Szczególnie istotne są badania genetyczne w przypadku autosomalnie dominującej nocnej padaczki płata czołowego (ADNFLE), która jest najlepiej poznaną formą padaczki płata czołowego, często związaną z mutacjami genów kodujących podjednostki receptorów acetylocholinowych (np. CHRNA4, CHRNB2, CHRNA2).3132
Diagnostyka różnicowa
Diagnostyka różnicowa padaczki płata czołowego jest szczególnie istotna ze względu na możliwość mylenia jej objawów z innymi zaburzeniami. Najważniejsze stany kliniczne, które należy uwzględnić w diagnostyce różnicowej, to:3334
Napady niepadaczkowe psychogenne (PNES)
PNES to epizody przypominające napady padaczkowe, ale bez nieprawidłowej aktywności elektrycznej w mózgu. Rozróżnienie między PNES a napadami z płata czołowego może być szczególnie trudne, ponieważ:3536
- Napady z płata czołowego mogą charakteryzować się zachowaniami, które typowo sugerują napady niepadaczkowe, takimi jak pchnięcia miednicą, pedałowanie czy gwałtowne ruchy
- Aktywność napadowa może nie być wykrywalna w powierzchniowym EEG lub może być zaburzona przez artefakty ruchowe
- Pacjenci mogą zachowywać świadomość podczas napadów z płata czołowego, co może błędnie sugerować PNES
Wideo-EEG jest kluczowym narzędziem w różnicowaniu PNES od napadów z płata czołowego. Nawet jeśli EEG nie wykazuje wyraźnych zmian, charakterystyczne cechy semiologiczne napadu mogą pomóc w rozpoznaniu padaczki płata czołowego, szczególnie jeśli epizody są stereotypowe i krótkotrwałe.38
Zaburzenia snu
Nocne napady z płata czołowego mogą być mylone z parasomnią lub innymi zaburzeniami snu. Kluczowe różnice, które mogą pomóc w diagnostyce różnicowej, to:39
- Napady z płata czołowego są zazwyczaj krótkie (trwają około 2 minut), mają stereotypowe cechy i często zachowana jest świadomość
- Parasomnie zazwyczaj trwają dłużej (około 10 minut), mają zmienne cechy i charakteryzują się stanem splątania, z brakiem pamięci epizodu po jego zakończeniu
- W parasomnii grupowanie epizodów jest rzadkie, a typowe parasomnie fazy NREM występują zwykle 1-2 godziny po zaśnięciu
- Nocne napady z płata czołowego występują zazwyczaj przez całą noc, najczęściej w ciągu pół godziny po zaśnięciu lub przebudzeniu
W różnicowaniu pomocna może być skala FLEP, która składa się z 11 pytań dotyczących charakterystyki nocnych epizodów, w tym wieku wystąpienia, czasu trwania, grupowania i czasu epizodów, objawów, stereotypowości, pamięci i wokalizacji.41
Zaburzenia psychiatryczne
Objawy padaczki płata czołowego mogą być mylone z zaburzeniami psychiatrycznymi, takimi jak napady paniki, psychoza czy zaburzenia zachowania. Kluczowe dla właściwej diagnozy jest:42
- Zwrócenie uwagi na stereotypowość epizodów, która jest charakterystyczna dla napadów padaczkowych
- Krótki czas trwania epizodów (zwykle poniżej 2 minut)
- Występowanie automatyzmów (np. mlaskanie, pociąganie za ubranie)
- Brak odpowiedzi na leczenie psychiatryczne
Warto zauważyć, że psychoza ponapadowa może wystąpić po napadach z płata czołowego, co dodatkowo komplikuje diagnostykę.43
Wyzwania diagnostyczne
Diagnostyka padaczki płata czołowego stanowi wyzwanie z wielu powodów:4445
- Objawy mogą być nietypowe i różnorodne ze względu na złożoność funkcji płata czołowego
- Standardowe EEG może być prawidłowe lub wprowadzające w błąd
- Napady mogą rozpoczynać się w jednej części płata czołowego, ale szybko rozprzestrzeniać się do innych obszarów mózgu
- Może występować fałszywa lokalizacja, szczególnie do ipsilateralnego płata skroniowego
Dodatkowo, napady z płata czołowego mogą być oporne na leczenie farmakologiczne, co wymaga dokładnej diagnostyki w celu rozważenia innych opcji terapeutycznych, takich jak leczenie chirurgiczne.47
Znaczenie interdyscyplinarnego podejścia
Ze względu na złożoność padaczki płata czołowego, najlepsze wyniki diagnostyczne osiąga się dzięki interdyscyplinarnemu podejściu, które może obejmować:48
- Neurologów specjalizujących się w padaczce (epileptologów)
- Neurofizjologów klinicznych
- Neuroradiologów
- Neurochirurgów
- Specjalistów medycyny snu
- Psychiatrów
- Genetyków klinicznych
Takie podejście jest szczególnie ważne w specjalistycznych ośrodkach leczenia padaczki, gdzie pacjenci z oporną na leczenie padaczką płata czołowego mogą być kwalifikowani do leczenia chirurgicznego.49
Nowoczesne trendy w diagnostyce
W ostatnich latach pojawiły się nowe metody i technologie, które mogą poprawić diagnostykę padaczki płata czołowego:50
- Zaawansowane techniki neuroobrazowania – takie jak obrazowanie tensora dyfuzji (DTI), spektroskopia MR czy obrazowanie podatności magnetycznej (SWI), które mogą pomóc w identyfikacji subtelnych zmian strukturalnych
- Elektroencefalografia wysokiej gęstości – wykorzystująca większą liczbę elektrod, co pozwala na lepszą lokalizację źródeł aktywności elektrycznej w mózgu
- Magnetoencefalografia (MEG) – nieinwazyjna technika obrazująca aktywność magnetyczną mózgu, która może pomóc w lokalizacji ogniska padaczkowego
- Testowanie genetyczne nowej generacji – umożliwiające szybszą i dokładniejszą identyfikację mutacji genetycznych związanych z padaczką płata czołowego
Te nowe technologie, w połączeniu z tradycyjnymi metodami diagnostycznymi, mogą znacząco poprawić dokładność diagnostyki padaczki płata czołowego, co z kolei może prowadzić do lepszych wyników leczenia.52
Podsumowanie procesu diagnostycznego
Diagnostyka padaczki płata czołowego wymaga kompleksowego podejścia obejmującego:5354
- Dokładny wywiad medyczny i rodzinny
- Szczegółowy opis napadów, najlepiej z relacją świadków
- Badanie neurologiczne
- Badania elektroencefalograficzne, w tym wideo-EEG
- Badania neuroobrazowe (MRI, PET, SPECT)
- Badania laboratoryjne
- W wybranych przypadkach badania genetyczne
- W razie potrzeby inwazyjne badania elektrofizjologiczne
Ze względu na złożoność objawów i możliwe trudności diagnostyczne, ważne jest, aby pacjenci z podejrzeniem padaczki płata czołowego byli kierowani do specjalistycznych ośrodków leczenia padaczki, gdzie dostępne są zaawansowane techniki diagnostyczne i interdyscyplinarny zespół specjalistów.5556
Wczesna i dokładna diagnoza padaczki płata czołowego jest kluczowa dla wdrożenia odpowiedniego leczenia, które może obejmować farmakoterapię, leczenie chirurgiczne lub neuromodulację, w zależności od indywidualnego przypadku pacjenta.5758
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Materiały źródłowe
- #1 Frontal Lobe Seizures: Causes, Symptoms & Treatmenthttps://my.clevelandclinic.org/health/diseases/17011-frontal-lobe-epilepsy
Frontal lobe epilepsy is a type of seizure disorder affecting your frontal lobes. It causes frontal lobe seizures, which is a pattern of abnormal electrical activity in your brain. […] To diagnose frontal lobe epilepsy, your healthcare provider will review your medical history and perform a physical exam. Testing helps confirm a diagnosis. […] The following tests can help diagnose frontal lobe epilepsy: MRI, Electroencephalography (EEG), Video EEG, Stereoelectroencephalography (SEEG), Magnetoencephalography (MEG). […] Antiseizure medications may help you manage frontal lobe seizures. These medications regulate electrical activity in your brain and may reduce the frequency of seizures. […] A healthcare provider may consider epilepsy surgery if medications aren’t successful at managing frontal lobe seizures. Your healthcare provider may recommend a frontal lobe resection. […] In some cases, surgery may not be a safe option to treat frontal lobe seizures. Your provider may recommend neuromodulation.
- #2 Frontal lobe seizures – Diagnosis and treatment – Mayo Clinichttps://www.mayoclinic.org/diseases-conditions/frontal-lobe-seizures/diagnosis-treatment/drc-20353962
Frontal lobe epilepsy can be hard to diagnose. Its symptoms can be mistaken for mental health problems or sleep disorders such as night terrors. It also is possible that some symptoms of frontal lobe seizures are the result of seizures that begin in other parts of the brain. […] To make a diagnosis, a health care professional reviews your symptoms and medical history. The care professional also conducts a physical exam. You may have blood drawn to test for health conditions or disorders that may be causing the seizures. […] You might need a neurological exam, which will test your muscle strength, sensory skills, hearing and speech, vision, coordination and balance. […] Brain imaging usually an MRI might reveal the source of frontal lobe seizures. An MRI uses radio waves and a powerful magnetic field to produce detailed images of soft tissues, which make up the brain.
- #3 Frontal Lobe Epilepsy Differential Diagnoseshttps://emedicine.medscape.com/article/1184076-differential
Patients with frontal lobe seizures may present with a clear epileptic syndrome or with unusual behavioral or motor manifestations that are not immediately recognizable as seizures. […] As previously mentioned, it can be difficult to distinguish frontal lobe seizures from nonepileptic events based on history alone, and patients with frontal lobe epilepsy may be misdiagnosed as having psychogenic nonepileptic events. Seizures arising from the medial frontal, cingulate gyrus, orbitofrontal, and frontopolar regions can be particularly difficult to recognize as they can present with behaviors that are typically suggestive of nonepileptic events, such as pelvic thrusting, pedaling, or thrashing. Furthermore, PNES and frontal lobe epilepsy are frequently comorbid. […] Even with continuous video EEG, it can be difficult to diagnose frontal lobe seizures as they can be surface negative or obscured by muscle artifact. Rapid propagation of ictal discharges on surface EEG also poses a diagnostic challenge with frontal lobe seizures. In these cases, the semiology and their stereotypical nature are particularly crucial in making the correct diagnosis. In addition, interictal epileptiform discharges may be very rare.
- #4 Localisation in focal epilepsy: a practical guide | Practical Neurologyhttps://pn.bmj.com/content/21/6/481
While certain semiologies, in particular those that involve activation of eloquent brain areas, are pathognomonic (such as focal motor seizures that arise from contralateral primary motor cortex) other signs are of less localising value, for example, automotor seizures that can arise from different brain regions. […] The frontal lobe is the largest lobe of the brain. […] Its high connectivity with other cortical regions can result in rapid, widespread ictal propagation. […] Moreover, some of the semiological features from more rostral areas may result more from disinhibition (removal of higher cortical control) than from direct activation. […] Together, these can make frontal lobe seizure semiology complex and difficult to interpret. […] Nevertheless, seizures have characteristic patterns depending on the area of the frontal lobe involved.
- #5 FRONTAL LOBE SEIZUREhttps://www.epilepsydiagnosis.org/seizure/frontal-lobe-overview.html
The frontal lobe is the largest lobe. Seizures involving frontal lobe network have distinctive features depending on the area of the frontal lobe involved. Motor features are prominent and may be hyperkinetic (e.g. pelvic thrusting, bipedal kicking or pedalling) or asymmetric tonic in nature. The motor feature may not be the initial sign and the seizure may be a focal aware non-motor seizure with the prominent motor phase occurring a brief period after seizure onset. Seizures are typically brief overall, and can have prominent vocalization, bizarre behavior, urinary incontinence, and head and eye deviation. Seizures may be exclusively nocturnal and often cluster. The ictal EEG may not show ictal patterns or may be obscured by movement artifact. […] When awareness is impaired, focal impaired awareness seizures of frontal origin can be difficult to distinguish from absence seizures.
- #6 Frontal lobe seizures – Diagnosis and treatment – Mayo Clinichttps://www.mayoclinic.org/diseases-conditions/frontal-lobe-seizures/diagnosis-treatment/drc-20353962
Frontal lobe epilepsy can be hard to diagnose. Its symptoms can be mistaken for mental health problems or sleep disorders such as night terrors. It also is possible that some symptoms of frontal lobe seizures are the result of seizures that begin in other parts of the brain. […] To make a diagnosis, a health care professional reviews your symptoms and medical history. The care professional also conducts a physical exam. You may have blood drawn to test for health conditions or disorders that may be causing the seizures. […] You might need a neurological exam, which will test your muscle strength, sensory skills, hearing and speech, vision, coordination and balance. […] Brain imaging usually an MRI might reveal the source of frontal lobe seizures. An MRI uses radio waves and a powerful magnetic field to produce detailed images of soft tissues, which make up the brain.
- #7 Frontal lobe seizures // Middlesex Healthhttps://middlesexhealth.org/learning-center/diseases-and-conditions/frontal-lobe-seizures
Frontal lobe epilepsy can be hard to diagnose. Its symptoms can be mistaken for mental health problems or sleep disorders such as night terrors. It also is possible that some symptoms of frontal lobe seizures are the result of seizures that begin in other parts of the brain. […] To make a diagnosis, a health care professional reviews your symptoms and medical history. The care professional also conducts a physical exam. You may have blood drawn to test for health conditions or disorders that may be causing the seizures. […] You might need a neurological exam, which will test your: Muscle strength. Sensory skills. Hearing and speech. Vision. Coordination and balance. […] You also might need the following tests: Brain scans. Brain imaging usually an MRI might reveal the source of frontal lobe seizures. An MRI uses radio waves and a powerful magnetic field to produce detailed images of soft tissues, which make up the brain.
- #8 Frontal lobe seizures | Health Library | Memorial Health Systemhttps://www.mhsystem.org/health-library/con-20197154/
Frontal lobe epilepsy can be hard to diagnose. Its symptoms can be mistaken for mental health problems or sleep disorders such as night terrors. It also is possible that some symptoms of frontal lobe seizures are the result of seizures that begin in other parts of the brain. […] To make a diagnosis, a health care professional reviews your symptoms and medical history. The care professional also conducts a physical exam. You may have blood drawn to test for health conditions or disorders that may be causing the seizures. […] You might need a neurological exam, which will test your: Muscle strength. Sensory skills. Hearing and speech. Vision. Coordination and balance. […] You also might need the following tests: Brain scans. Brain imaging usually an MRI might reveal the source of frontal lobe seizures. An MRI uses radio waves and a powerful magnetic field to produce detailed images of soft tissues, which make up the brain.
- #9 Frontal lobe seizureshttps://www.mymlc.com/health-information/diseases-and-conditions/f/frontal-lobe-seizures/
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: […] 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. […] 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.
- #10 FRONTAL LOBE SEIZUREhttps://www.epilepsydiagnosis.org/seizure/frontal-lobe-overview.html
Nocturnal frontal lobe seizures can be mistaken for parasomnias, however: Frontal lobe seizures are usually brief events ( 2 minutes), with stereotyped features seen from seizure to seizure and preserved awareness. Parasomnias are usually longer in duration ( 10 minutes), have variable features from event to event and are characterized by a confusional state with the patient having no memory of the event afterwards. In parasomnias, clustering is rare and the common non-REM parasomnias typically occur 1-2 hours after falling asleep, in the first cycle of deep slow wave sleep. Nocturnal frontal lobe seizures typically occur throughout the night, and more frequently within half an hour of falling asleep or awakening. […] Frontal lobe seizures may be mis-diagnosed as non-epileptic seizures as there may be bilateral motor phenomena with preserved awareness, and the ictal EEG can be normal.
- #11 Localisation in focal epilepsy: a practical guide | Practical Neurologyhttps://pn.bmj.com/content/21/6/481
In general, frontal lobe seizures are typically brief, may cluster, can have prominent vocalisation and commonly occur from sleep. […] Motor features are prominent and include various different motor phenomena, including simple clonic movements, tonic posturing and eye deviation, or more complex movements such as cycling, rocking and grimacing. […] Seizures can appear bizarre, with bilateral motor phenomena, but with retained awareness. […] Ictal scalp EEG may show no changes if there is a deep source, or may be obscured by movement artefact, and so frontal lobe seizures may be mistaken for dissociative (non-epileptic) attacks. […] The ictal onset patterns during intracranial studies with stereo-EEG show that elementary motor signs (clonic, tonic, versive) arise from precentral and premotor regions, while more complex motor signs arise from more rostral frontal regions.
- #12 Frontal lobe seizures – Diagnosis and treatment – Mayo Clinichttps://www.mayoclinic.org/diseases-conditions/frontal-lobe-seizures/diagnosis-treatment/drc-20353962
An EEG monitors the electrical activity in the brain. This is done by attaching small metal discs called electrodes to the scalp. EEGs often help diagnose some types of epilepsy. However, EEG results might not identify frontal lobe epilepsy. […] Video EEG is recommended for some people with seizures. This test is usually performed during an overnight stay at a sleep clinic. Both a video camera and an EEG monitor run all night. A video EEG allows health care professionals to match what physically occurs during a seizure with what appears on the EEG.
- #13 Frontal lobe seizures – PubMedhttps://pubmed.ncbi.nlm.nih.gov/21532379/
Frontal lobe epilepsy is the second most common localization-related or focal epilepsy. Frontal lobe seizures are challenging to diagnose as the clinical manifestations are diverse due to the complexity and variability of the patterns of epileptic discharges, and the scalp electroencephalograph (EEG) can often be normal or misleading. […] Scalp EEG recording is sometimes helpful in localization but is usually normal or misleading in frontal lobe epilepsy. […] Although this review provides a framework for the understanding of these seizures, one should remain cautious in diagnosing seizure localization based on clinical or EEG description. Only a few patients have well-described syndromes and can be diagnosed with confidence. For most patients, new diagnostic methods and genetic testing may help improve our ability to diagnose and treat the conditions discussed in this study.
- #14 FRONTAL LOBE SEIZUREhttps://www.epilepsydiagnosis.org/seizure/frontal-lobe-eeg.html
FRONTAL LOBE SEIZURE […] Please refer to specific syndromes and etiologies in which this seizure type occurs for specific information. As a general rule, EEG abnormality may be enhanced by sleep deprivation, in drowsiness and in sleep. […] There are large areas of mesial and inferior frontal cortex that are not sampled by scalp EEG. The interictal EEG is frequently normal if the etiology of the epilepsy is a structural brain abnormality in these areas. Even with repeated EEGs, epileptiform discharges may only be seen in up to 70% of such patients. In these patients, discharges are typically midline or bi-frontal. […] Ictal EEG in frontal lobe seizures may be difficult to interpret. Seizures often involve hyperkinetic activity, which causes the EEG to be obscured by muscle artifact. Ictal EEG can demonstrate a localized ictal rhythm in lateral frontal lobe seizures with localized repetitive discharges. Ictal EEG in mesial frontal lobe seizures can often appear as a generalized EEG change, if an EEG change is present. These bilateral discharges often have an amplitude asymmetry, representing secondary bilateral synchrony rather than true generalized seizure onset, and may be preceded by generalized suppression of the EEG. Ictal EEG may also be characterized by diffuse or localized low voltage fast rhythms. […] CAUTION False localization may occur, especially to the ipsilateral temporal lobe. Interpretation of seizure features in conjunction with ictal EEG is important in this situation.
- #15 Frontal Lobe Epilepsy Workup: Approach Considerations, Scalp EEG and Prolonged Video-EEG Monitoring, Intracranial EEGhttps://emedicine.medscape.com/article/1184076-workup
All patients with frontal lobe epilepsy should undergo EEG evaluation. Patients with intractable epilepsy, or in whom the diagnosis is doubtful, should undergo prolonged video-EEG monitoring. […] Patients with suspected frontal lobe epilepsy frequently require invasive EEG monitoring. Intracranial EEG is used for localizing the epileptogenic region and for functional mapping prior to resection when seizures arise close to eloquent cortex (eg, motor or language functional areas).
- #16 Frontal lobe seizures | Health Library | Memorial Health Systemhttps://www.mhsystem.org/health-library/con-20197154/
An MRI involves lying on a narrow table that slides into a long tube. The test often takes about an hour. Some people have a fear of enclosed spaces. They can be given a medicine to feel sleepy and less anxious. The test itself is painless. […] Electroencephalogram, known as an EEG. An EEG monitors the electrical activity in the brain. This is done by attaching small metal discs called electrodes to the scalp. EEGs often help diagnose some types of epilepsy. However, EEG results might not identify frontal lobe epilepsy. […] Video EEG is recommended for some people with seizures. This test is usually performed during an overnight stay at a sleep clinic. Both a video camera and an EEG monitor run all night. A video EEG allows health care professionals to match what physically occurs during a seizure with what appears on the EEG.
- #17 Frontal Lobe Seizures – What You Need to Knowhttps://www.drugs.com/cg/frontal-lobe-seizures.html
What is a frontal lobe seizure? A seizure is an abnormal burst of electrical activity in your brain. A frontal lobe seizure starts in the frontal lobe of the brain. This is located at the front of the brain, behind your forehead. This part of the brain controls many functions. A frontal lobe seizure is called a focal seizure because it starts in one part of your brain. […] How is a frontal lobe seizure diagnosed? Your healthcare provider will ask about your health conditions and what medicines you take. Describe how you felt before and after the seizure. Include details about the side of your body that seemed more affected. Tell the provider how close together the seizures were if you had more than one. Your healthcare provider will ask for a detailed description of each seizure. If possible, bring someone with you who saw you have a seizure. You may also need any of the following: An EEG records the electrical activity of your brain. It is used to find changes in the normal patterns of your brain activity. A frontal lobe seizure may not show up on an EEG. Your healthcare provider may make a video recording while you sleep. The combination of EEG and video recording may help diagnose a frontal lobe seizure. […] A SPECT scan uses radioactive material to find where the seizure started in your brain. This scan may be done if other scans do not show where the seizure started.
- #18https://pmc.ncbi.nlm.nih.gov/articles/PMC4308027/
Moreover, this case illustrates that it is much safer to rely on video-EEG monitoring before decreasing or stopping antiepileptic drugs if a diagnosis of PNES is suspected in a patient with an initial diagnosis of possible epilepsy. […] In our case, video-EEG monitoring established the epileptic nature of the paroxysmal motor behavior based on discrete electroencephalographic ictal correlates. […] In conclusion, this case illustrates that motor and behavioral manifestations with normal interictal EEG encountered in frontal lobe epilepsy may be misdiagnosed as psychogenic nonepileptic seizures. It emphasizes the need for early video-EEG monitoring in ambiguous cases before starting or stopping AED treatment.
- #19https://healthmatch.io/epilepsy/frontal-lobe-epilepsy
Video EEGs are generally performed in sleep clinics where video cameras and EEG monitors are used to study the patients physical activity and brain activity during sleep. A specialist can match seizures up to your EEG results during the seizure. […] Treatment options for frontal lobe seizures have come a long way in the last decade. Several types of antiseizure medication are available, and there are surgeries that may help with frontal lobe seizures. […] If your frontal lobe seizures are unaltered by medication, you may be a good candidate for surgery.
- #20 Frontal Lobe Epilepsy Workup: Approach Considerations, Scalp EEG and Prolonged Video-EEG Monitoring, Intracranial EEGhttps://emedicine.medscape.com/article/1184076-workup
Blood tests should be performed to rule out a metabolic cause of new-onset seizures, eg, hypoglycemia or hypomagnesemia. Once the diagnosis of epilepsy is established, blood testing remains important in the management of patients who are taking antiseizure medications. […] Genetic testing – Should be considered for any patient with frontal lobe epilepsy, especially if there is a strong family history of epilepsy. Testing could also be performed from saliva or oral swabs. Given the large size of the frontal lobes, any dysfunction of genes with widespread brain expression can lead to frontal lobe epilepsy. […] The imaging modality of choice in patients with frontal lobe seizures is MRI. Advances in MRI have improved the identification of underlying lesions, which are reported to be present in up to 50% of patients with frontal lobe epilepsy. […] PET scanning is being increasingly used in the presurgical evaluation of patients with extratemporal epilepsy.
- #21 Frontal lobe seizures – Diagnosis and treatment – Mayo Clinichttps://www.mayoclinic.org/diseases-conditions/frontal-lobe-seizures/diagnosis-treatment/drc-20353962
Frontal lobe epilepsy can be hard to diagnose. Its symptoms can be mistaken for mental health problems or sleep disorders such as night terrors. It also is possible that some symptoms of frontal lobe seizures are the result of seizures that begin in other parts of the brain. […] To make a diagnosis, a health care professional reviews your symptoms and medical history. The care professional also conducts a physical exam. You may have blood drawn to test for health conditions or disorders that may be causing the seizures. […] You might need a neurological exam, which will test your muscle strength, sensory skills, hearing and speech, vision, coordination and balance. […] Brain imaging usually an MRI might reveal the source of frontal lobe seizures. An MRI uses radio waves and a powerful magnetic field to produce detailed images of soft tissues, which make up the brain.
- #22 Mayo Clinic Health Library – Frontal lobe seizures | Swiss Medical Networkhttps://www.swissmedical.net/en/healtcare-library/con-20197154
Frontal lobe epilepsy can be hard to diagnose. Its symptoms can be mistaken for mental health problems or sleep disorders such as night terrors. It also is possible that some symptoms of frontal lobe seizures are the result of seizures that begin in other parts of the brain. […] To make a diagnosis, a health care professional reviews your symptoms and medical history. The care professional also conducts a physical exam. You may have blood drawn to test for health conditions or disorders that may be causing the seizures. […] You might need a neurological exam, which will test your: Muscle strength. Sensory skills. Hearing and speech. Vision. Coordination and balance. […] You also might need the following tests: Brain scans. Brain imaging usually an MRI might reveal the source of frontal lobe seizures. An MRI uses radio waves and a powerful magnetic field to produce detailed images of soft tissues, which make up the brain.
- #23 Frontal lobe epilepsy – Wikipediahttps://en.wikipedia.org/wiki/Frontal_lobe_epilepsy
When both the amount and severity of seizures becomes uncontrollable and seizures remain resistant to the various anticonvulsants, a patient most likely will be considered for epilepsy surgery. […] But, while performing it, there is the need for identifying or pinpointing the exact location of the seizure in the brain. […] This, in recent times have been aided by some of the modern techniques such as, SISCOM i.e., subtraction ictal SPECT co registered to MRI, SPECT i.e. single-photon emission computerized tomography, brain mapping performed before the surgery and functional MRI (fMRI), especially for the language area mapping.
- #24 Nocturnal Familial Frontal Lobe Epilepsy | Pediatric Neurology Briefshttps://pediatricneurologybriefs.com/articles/10.15844/pedneurbriefs-12-3-2
EEGs are frequently non-specific, and video-polysomnographic monitoring is important in the differentiation of ADFLE from parasomnias. A trial of antiepileptic drugs, carbamazepine or clonazepam, is warranted when the diagnosis is suspected, particularly in patients with diurnal symptoms. […] Frontal lobe foci were unilateral and in variable locations in two patients with ADFLE reported from the Department of Neurology, Austin and Repatriation Medical Centre, Heidelberg (Melbourne), Victoria 3084, Australia. One case showed a left frontal onset corroborated by congruent focal hypometabolism on intericatal PET and focal hyperperfusion on ictal SPECT. Another case studied with ictal SPECT showed a right parasagittal, midfrontal focus.
- #25 Frontal Lobe Epilepsy Workup: Approach Considerations, Scalp EEG and Prolonged Video-EEG Monitoring, Intracranial EEGhttps://emedicine.medscape.com/article/1184076-workup
All patients with frontal lobe epilepsy should undergo EEG evaluation. Patients with intractable epilepsy, or in whom the diagnosis is doubtful, should undergo prolonged video-EEG monitoring. […] Patients with suspected frontal lobe epilepsy frequently require invasive EEG monitoring. Intracranial EEG is used for localizing the epileptogenic region and for functional mapping prior to resection when seizures arise close to eloquent cortex (eg, motor or language functional areas).
- #26 Frontal Lobe Epilepsy: Causes & Symptoms – Unique Community Serviceshttps://uniquecs.co.uk/blog/frontal-lobe-epilepsy/
Frontal lobe epilepsy is a form of epilepsy that occurs in the frontal lobes and causes seizures. Diagnosing frontal lobe epilepsy may be challenging as the symptoms may be confused with mental health conditions or sleep problems. […] An accurate assessment is essential in managing seizures effectively and preventing possible risks and complications. […] Your GP will ask for a medical history and general health information to diagnose frontal lobe seizures. Then, they may ask you to do all the necessary analysis, including neurological tests and physical examinations such as: Hearing and speech, Vision, Sensory and cognitive skills, Muscle strength, Balance and coordination. […] Common methods used in diagnosing frontal lobe epilepsy include: Electroencephalography (EEG) measures the electrical activity in your brain with the help of electrodes attached to your scalp, MRI helps identify any changes in the brain structure, such as lesions, scars or tumours, that might be the root cause of a seizure, Stereoelectroencephalography (SEEG) a minimally invasive surgical process in which your doctor will implant electrodes in the brain to accurately identify the source of the seizure. SEEG is used to locate the seizure activity that cannot be detected with EEG, Video EEG helps monitor your behaviour and movements and your brain activity. EEG observation may be held in a hospital where you can stay overnight or undergo a sleep study, as most frontal lobe seizures occur while the person is asleep.
- #27 Frontal Lobe Epilepsy Diagnosis – Acibadem Health Point – ACIBADEM Hospitals – Acibadem Health Grouphttps://www.acibademhealthpoint.com/frontal-lobe-epilepsy-diagnosis/
Doctors often use several tests together. These include tests that go inside the brain and ones that donât. Wada testing and magnetoencephalography (MEG) are also used. Each test helps with the diagnosis, along with EEG and brain scans. […] To diagnose frontal lobe epilepsy, doctors use special tests. These tests help find and understand the seizures. This is key for making treatment plans.
- #28 Frontal Lobe Epilepsy Workup: Approach Considerations, Scalp EEG and Prolonged Video-EEG Monitoring, Intracranial EEGhttps://emedicine.medscape.com/article/1184076-workup
Blood tests should be performed to rule out a metabolic cause of new-onset seizures, eg, hypoglycemia or hypomagnesemia. Once the diagnosis of epilepsy is established, blood testing remains important in the management of patients who are taking antiseizure medications. […] Genetic testing – Should be considered for any patient with frontal lobe epilepsy, especially if there is a strong family history of epilepsy. Testing could also be performed from saliva or oral swabs. Given the large size of the frontal lobes, any dysfunction of genes with widespread brain expression can lead to frontal lobe epilepsy. […] The imaging modality of choice in patients with frontal lobe seizures is MRI. Advances in MRI have improved the identification of underlying lesions, which are reported to be present in up to 50% of patients with frontal lobe epilepsy. […] PET scanning is being increasingly used in the presurgical evaluation of patients with extratemporal epilepsy.
- #29 Frontal lobe seizures – Diagnosis and treatment – Mayo Clinichttps://www.mayoclinic.org/diseases-conditions/frontal-lobe-seizures/diagnosis-treatment/drc-20353962
Frontal lobe epilepsy can be hard to diagnose. Its symptoms can be mistaken for mental health problems or sleep disorders such as night terrors. It also is possible that some symptoms of frontal lobe seizures are the result of seizures that begin in other parts of the brain. […] To make a diagnosis, a health care professional reviews your symptoms and medical history. The care professional also conducts a physical exam. You may have blood drawn to test for health conditions or disorders that may be causing the seizures. […] You might need a neurological exam, which will test your muscle strength, sensory skills, hearing and speech, vision, coordination and balance. […] Brain imaging usually an MRI might reveal the source of frontal lobe seizures. An MRI uses radio waves and a powerful magnetic field to produce detailed images of soft tissues, which make up the brain.
- #30 Frontal Lobe Epilepsy Workup: Approach Considerations, Scalp EEG and Prolonged Video-EEG Monitoring, Intracranial EEGhttps://emedicine.medscape.com/article/1184076-workup
Blood tests should be performed to rule out a metabolic cause of new-onset seizures, eg, hypoglycemia or hypomagnesemia. Once the diagnosis of epilepsy is established, blood testing remains important in the management of patients who are taking antiseizure medications. […] Genetic testing – Should be considered for any patient with frontal lobe epilepsy, especially if there is a strong family history of epilepsy. Testing could also be performed from saliva or oral swabs. Given the large size of the frontal lobes, any dysfunction of genes with widespread brain expression can lead to frontal lobe epilepsy. […] The imaging modality of choice in patients with frontal lobe seizures is MRI. Advances in MRI have improved the identification of underlying lesions, which are reported to be present in up to 50% of patients with frontal lobe epilepsy. […] PET scanning is being increasingly used in the presurgical evaluation of patients with extratemporal epilepsy.
- #31 Frontal lobe epilepsy – Wikipediahttps://en.wikipedia.org/wiki/Frontal_lobe_epilepsy
Unlike most epileptic EEGs, the abnormalities in FLE EEGs precede the physical onset of the seizure and aid in localization of the seizure’s origin. […] Episodes that include complex hyperactivity of the proximal portions of the limbs that lead to increased overall motor activity are called hypermotor seizures. […] Autonomic dominant nocturnal frontal lobe epilepsy (ADNFLE) is the best understood form of frontal lobe epilepsy but is often misdiagnosed as sleep apnea. […] Video surveillance as well as EEG is occasionally needed to differentiate between the two disorders. […] The origins of frontal lobe seizures can be different deviations. […] One of the major reasons for FLE is abnormal cognitive development or sometimes congenital abnormal brain development. […] Other causes are tumors, head trauma, and genetics.
- #32 KCNT1-Related Epilepsy | Children’s Hospital of Philadelphiahttps://www.chop.edu/conditions-diseases/kcnt1-related-epilepsy
Children with frontal lobe epilepsy (ADNFLE) caused by KCNT1 have onset of seizures before adolescence, but later than children with KCNT1-related developmental and epileptic encephalopathy. […] Delays in reaching developmental milestones in infancy and early childhood combined with seizures is not specific but is consistent with a KCNT1-related epilepsy. However, there are no typical signs of a KCNT1-related epilepsy that enable a diagnosis based on clinical features alone. […] Genetic testing is required to diagnose a KCNT1-related epilepsy. […] Electroencephalogram (EEG) to look for evidence of abnormal brain activity and seizures. Evidence of migrating focal seizures may be consistent with a diagnosis of KCNT1-related developmental and epileptic encephalopathy. […] Many children with KCNT1-related epilepsies are diagnosed with specific epilepsy syndromes based on the types of seizures they have experienced and features of their EEG. Some of these epilepsy syndromes include: Nocturnal frontal lobe epilepsy.
- #33 Frontal Lobe Epilepsy Differential Diagnoseshttps://emedicine.medscape.com/article/1184076-differential
Patients with frontal lobe seizures may present with a clear epileptic syndrome or with unusual behavioral or motor manifestations that are not immediately recognizable as seizures. […] As previously mentioned, it can be difficult to distinguish frontal lobe seizures from nonepileptic events based on history alone, and patients with frontal lobe epilepsy may be misdiagnosed as having psychogenic nonepileptic events. Seizures arising from the medial frontal, cingulate gyrus, orbitofrontal, and frontopolar regions can be particularly difficult to recognize as they can present with behaviors that are typically suggestive of nonepileptic events, such as pelvic thrusting, pedaling, or thrashing. Furthermore, PNES and frontal lobe epilepsy are frequently comorbid. […] Even with continuous video EEG, it can be difficult to diagnose frontal lobe seizures as they can be surface negative or obscured by muscle artifact. Rapid propagation of ictal discharges on surface EEG also poses a diagnostic challenge with frontal lobe seizures. In these cases, the semiology and their stereotypical nature are particularly crucial in making the correct diagnosis. In addition, interictal epileptiform discharges may be very rare.
- #34 FRONTAL LOBE SEIZUREhttps://www.epilepsydiagnosis.org/seizure/frontal-lobe-overview.html
Nocturnal frontal lobe seizures can be mistaken for parasomnias, however: Frontal lobe seizures are usually brief events ( 2 minutes), with stereotyped features seen from seizure to seizure and preserved awareness. Parasomnias are usually longer in duration ( 10 minutes), have variable features from event to event and are characterized by a confusional state with the patient having no memory of the event afterwards. In parasomnias, clustering is rare and the common non-REM parasomnias typically occur 1-2 hours after falling asleep, in the first cycle of deep slow wave sleep. Nocturnal frontal lobe seizures typically occur throughout the night, and more frequently within half an hour of falling asleep or awakening. […] Frontal lobe seizures may be mis-diagnosed as non-epileptic seizures as there may be bilateral motor phenomena with preserved awareness, and the ictal EEG can be normal.
- #35https://aesnet.org/abstractslisting/diagnostic-challenges-in-evolving-frontal-lobe-epilepsy-a-case-report
Frontal lobe epilepsy (FLE) is the second most common type of focal epilepsy, accounting for 2030% of focal epilepsy patients. Frontal lobe seizures are known for their perplexing characteristics, making their diagnosis and differentiation from psychogenic non epileptic seizures (PNES) challenging. […] EEGs were abnormal for left frontal or frontotemporal epileptiform discharges. […] Frontal lobe seizures are often misdiagnosed as PNES due to several factors. The ictal EEG findings may not be picked on surface EEG in the mesial and inferior frontal cortex and can sometimes be obscured by movement artifacts especially in hypermotor episodes. […] This case highlights the challenge of differentiating FLE and PNES, especially in a patient with multiple seizure semiologies. Timely and definitive diagnosis with video-EEG monitoring not only helps with the appropriate AED management but also avoids patients stigma with psychogenic seizures and prevents unnecessary referrals to psychiatry for presumed PNES.
- #36https://pmc.ncbi.nlm.nih.gov/articles/PMC4308027/
We reported the case of a young woman who received an antiepileptic drug after a first possible generalized tonic-clonic seizure with no clear inter-ictal epileptic paroxysms in the routine electroencephalogram. […] After antiepileptic drug reduction, seizure frequency and severity gradually increased, and she presented postictal psychotic features that, combined with video-EEG findings, led to the final diagnosis of new-onset prefrontal lobe epilepsy. […] The differential diagnosis between epileptic seizures and PNES is known to be sometimes difficult, especially for frontal lobe seizures. […] This diagnosis has improved over the last 30 years, especially in conjunction with more widespread utilization of video-EEG recordings. […] The present case is reported to increase awareness in physicians that the epileptic nature of paroxysmal motor behaviors with normal interictal EEG may be underrecognized and misdiagnosed as PNES in the absence of video-EEG monitoring.
- #37 Diagnosis and Treatment of Non-Epileptic Seizures (NES)https://www.cureepilepsy.org/webinars/non-epileptic-seizures-diagnosis-treatment-and-management-strategies-for-patients-and-their-families/
An epilepsy diagnosis usually occurs after an individual has suffered several unprovoked seizures. The diagnosis is then confirmed by a test known as an electroencephalogram (an EEG for short). However, there are cases in which individuals experience symptoms similar to those of an epileptic seizure without any of the unusual electrical activity detected in the brain. […] Just because you haven’t had a normal EEG doesn’t mean it’s not epileptic seizures. We’ve got a clue, though, and we use the term semiology, ictal semiology, and all that means is the physical characteristics of the seizure. There are certain ways that frontal lobe epileptic seizures present, characteristically, that differ from psychogenic non-epileptic seizures. […] That’s why you heard me say earlier, the right history, with the right witnessed seizure, with the right EEG, those are the ways that we get the documented non-epileptic seizures. If we have the seizure characteristics, even though it’s a scalp negative EEG we may say, hmm, this looks more like frontal lobe epilepsy than it does psychogenic non-epileptic seizure, just because I’m watching the seizure myself. That’s the importance of the video EEG.
- #38 DIFFERENTIAL DIAGNOSIS OF EPILEPTIC SEIZURES IN CRYPTOGENIC FOCAL FRONTAL LOBE EPILEPSY VERSUS PSYCHOGENIC NON-EPILEPTIC PAROXYSMS (A CASE REPORT) | Chebanenko | Epilepsy and paroxysmal conditionshttps://www.epilepsia.su/jour/article/view/345?locale=en_US
The report addresses the causes and diagnostic problems of cryptogenic focal frontal epilepsy. A clinical case of a patient with cryptogenic focal frontal epilepsy is presented. In this patient, epileptic seizures have long been considered as psychogenic non-epileptic paroxysms. […] Psychogenic non epileptic events and frontal lobe seizures. […] Frontal lobe epilepsy. […] A review of diagnostic techniques in the differential diagnosis of epileptic and nonepileptic seizures.
- #39 FRONTAL LOBE SEIZUREhttps://www.epilepsydiagnosis.org/seizure/frontal-lobe-overview.html
Nocturnal frontal lobe seizures can be mistaken for parasomnias, however: Frontal lobe seizures are usually brief events ( 2 minutes), with stereotyped features seen from seizure to seizure and preserved awareness. Parasomnias are usually longer in duration ( 10 minutes), have variable features from event to event and are characterized by a confusional state with the patient having no memory of the event afterwards. In parasomnias, clustering is rare and the common non-REM parasomnias typically occur 1-2 hours after falling asleep, in the first cycle of deep slow wave sleep. Nocturnal frontal lobe seizures typically occur throughout the night, and more frequently within half an hour of falling asleep or awakening. […] Frontal lobe seizures may be mis-diagnosed as non-epileptic seizures as there may be bilateral motor phenomena with preserved awareness, and the ictal EEG can be normal.
- #40 Nocturnal Frontal Lobe Epilepsy – An Update on Differential Diagnosis with Non-rapid Eye Movement Parasomnia – touchNEUROLOGYhttps://touchneurology.com/epilepsy/journal-articles/nocturnal-frontal-lobe-epilepsy-an-update-on-differential-diagnosis-with-non-rapid-eye-movement-parasomnia/
The different types of NFLE seizures may cause severe sleep disruption affecting both the macrostructure and microstructure of sleep and resulting in poor sleep quality, daytime tiredness and sleepiness. […] Neurological examination is generally normal. […] NFLE should be differentiated from parasomnias, in particular from NREM parasomnias such as arousal disorders. […] The clinical/anamnestic features are quite similar; however, the older age of onset, the high frequency of the episodes and their short duration, the partial preservation of consciousness and the tendency of the syndrome to persist in adulthood differentiate NFLE from arousal disorders. […] Notwithstanding the spread of video-PSG and the wide diffusion of the concept of NFLE, the differential diagnosis between some types of sleep-related seizures and paroxysmal non-epileptic motor events is still a challenge, and no definite guidelines have been approved for this field.
- #41 Nocturnal Frontal Lobe Epilepsy – An Update on Differential Diagnosis with Non-rapid Eye Movement Parasomnia – touchNEUROLOGYhttps://touchneurology.com/epilepsy/journal-articles/nocturnal-frontal-lobe-epilepsy-an-update-on-differential-diagnosis-with-non-rapid-eye-movement-parasomnia/
The FLEP scale consists of 11 questions covering characteristics of the nocturnal attacks including age at onset, duration, clustering and timing of the episodes, symptoms, stereotypy, recall and vocalisation. […] The scale reached a sensitivity of 1 and a specificity of 0.9, with a Cohen k of 0.97 between different interviewers; notwithstanding the retrospective type of the study and the lack of video- PSG confirmation of typical parasomnias, the scale seems promising for the differential diagnosis of NFLE and parasomnias. […] Despite standardised semiological and video-PSG criteria, guidelines to differentiate nocturnal frontal lobe seizures from arousal disorders are lacking, and critical or intercritical EEG are not useful. […] Video-PSG examination, although expensive and not always available in all clinical settings, remains the gold standard for diagnosis.
- #42 Frontal lobe epilepsy mimicking panic attacks | Radiology Case | Radiopaedia.orghttps://radiopaedia.org/cases/frontal-lobe-epilepsy-mimicking-panic-attacks?lang=us
Three year history of episodes initially diagnosed and treated as panic attacks. […] His panic attacks were rediagnosed as complex partial seizures and he was commenced on carbamazepine with resolution of episodes for the next 12 months. […] Frontal or temporal lobe epilepsies can have symptomology that mimics panic attacks. This case demonstrates the importance of a careful clinical evaluation and investigation of patients presenting with possible panic attacks, especially if panic attacks are treatment resistent or have atypical features (for example automatisms).
- #43https://pmc.ncbi.nlm.nih.gov/articles/PMC4308027/
We reported the case of a young woman who received an antiepileptic drug after a first possible generalized tonic-clonic seizure with no clear inter-ictal epileptic paroxysms in the routine electroencephalogram. […] After antiepileptic drug reduction, seizure frequency and severity gradually increased, and she presented postictal psychotic features that, combined with video-EEG findings, led to the final diagnosis of new-onset prefrontal lobe epilepsy. […] The differential diagnosis between epileptic seizures and PNES is known to be sometimes difficult, especially for frontal lobe seizures. […] This diagnosis has improved over the last 30 years, especially in conjunction with more widespread utilization of video-EEG recordings. […] The present case is reported to increase awareness in physicians that the epileptic nature of paroxysmal motor behaviors with normal interictal EEG may be underrecognized and misdiagnosed as PNES in the absence of video-EEG monitoring.
- #44 Frontal lobe seizures – Diagnosis and treatment – Mayo Clinichttps://www.mayoclinic.org/diseases-conditions/frontal-lobe-seizures/diagnosis-treatment/drc-20353962
Frontal lobe epilepsy can be hard to diagnose. Its symptoms can be mistaken for mental health problems or sleep disorders such as night terrors. It also is possible that some symptoms of frontal lobe seizures are the result of seizures that begin in other parts of the brain. […] To make a diagnosis, a health care professional reviews your symptoms and medical history. The care professional also conducts a physical exam. You may have blood drawn to test for health conditions or disorders that may be causing the seizures. […] You might need a neurological exam, which will test your muscle strength, sensory skills, hearing and speech, vision, coordination and balance. […] Brain imaging usually an MRI might reveal the source of frontal lobe seizures. An MRI uses radio waves and a powerful magnetic field to produce detailed images of soft tissues, which make up the brain.
- #45 Frontal lobe seizures – PubMedhttps://pubmed.ncbi.nlm.nih.gov/21532379/
Frontal lobe epilepsy is the second most common localization-related or focal epilepsy. Frontal lobe seizures are challenging to diagnose as the clinical manifestations are diverse due to the complexity and variability of the patterns of epileptic discharges, and the scalp electroencephalograph (EEG) can often be normal or misleading. […] Scalp EEG recording is sometimes helpful in localization but is usually normal or misleading in frontal lobe epilepsy. […] Although this review provides a framework for the understanding of these seizures, one should remain cautious in diagnosing seizure localization based on clinical or EEG description. Only a few patients have well-described syndromes and can be diagnosed with confidence. For most patients, new diagnostic methods and genetic testing may help improve our ability to diagnose and treat the conditions discussed in this study.
- #46 FRONTAL LOBE SEIZUREhttps://www.epilepsydiagnosis.org/seizure/frontal-lobe-eeg.html
FRONTAL LOBE SEIZURE […] Please refer to specific syndromes and etiologies in which this seizure type occurs for specific information. As a general rule, EEG abnormality may be enhanced by sleep deprivation, in drowsiness and in sleep. […] There are large areas of mesial and inferior frontal cortex that are not sampled by scalp EEG. The interictal EEG is frequently normal if the etiology of the epilepsy is a structural brain abnormality in these areas. Even with repeated EEGs, epileptiform discharges may only be seen in up to 70% of such patients. In these patients, discharges are typically midline or bi-frontal. […] Ictal EEG in frontal lobe seizures may be difficult to interpret. Seizures often involve hyperkinetic activity, which causes the EEG to be obscured by muscle artifact. Ictal EEG can demonstrate a localized ictal rhythm in lateral frontal lobe seizures with localized repetitive discharges. Ictal EEG in mesial frontal lobe seizures can often appear as a generalized EEG change, if an EEG change is present. These bilateral discharges often have an amplitude asymmetry, representing secondary bilateral synchrony rather than true generalized seizure onset, and may be preceded by generalized suppression of the EEG. Ictal EEG may also be characterized by diffuse or localized low voltage fast rhythms. […] CAUTION False localization may occur, especially to the ipsilateral temporal lobe. Interpretation of seizure features in conjunction with ictal EEG is important in this situation.
- #47 Frontal Lobe Seizures: Causes, Symptoms & Treatmenthttps://my.clevelandclinic.org/health/diseases/17011-frontal-lobe-epilepsy
Frontal lobe epilepsy is a type of seizure disorder affecting your frontal lobes. It causes frontal lobe seizures, which is a pattern of abnormal electrical activity in your brain. […] To diagnose frontal lobe epilepsy, your healthcare provider will review your medical history and perform a physical exam. Testing helps confirm a diagnosis. […] The following tests can help diagnose frontal lobe epilepsy: MRI, Electroencephalography (EEG), Video EEG, Stereoelectroencephalography (SEEG), Magnetoencephalography (MEG). […] Antiseizure medications may help you manage frontal lobe seizures. These medications regulate electrical activity in your brain and may reduce the frequency of seizures. […] A healthcare provider may consider epilepsy surgery if medications aren’t successful at managing frontal lobe seizures. Your healthcare provider may recommend a frontal lobe resection. […] In some cases, surgery may not be a safe option to treat frontal lobe seizures. Your provider may recommend neuromodulation.
- #48https://link.springer.com/article/10.1007/s101430100174
Frontal lobe epilepsy has been better understood during the past two decades with the advent of technologies with improved localizing capabilities. […] In the following article, we attempt to review the current concepts regarding diagnosis and surgical management of frontal lobe epilepsy.
- #49 Frontal Lobe Epilepsy – Neurosurgery | UCLA Healthhttps://www.uclahealth.org/medical-services/neurosurgery/conditions-treated/frontal-lobe-epilepsy
Seizures with a motor, or movement, component indicate damage or malformation in the area of the brain that controls movement. […] Surgical treatment is difficult because traditional imaging techniques do not identify the source of the seizures. […] At UCLA, doctors use electrodes to locate the seizure focus in the brain and to map essential motor function, allowing surgical removal that eliminates seizures in the majority of cases.
- #50 Frontal lobe seizures – PubMedhttps://pubmed.ncbi.nlm.nih.gov/21532379/
Frontal lobe epilepsy is the second most common localization-related or focal epilepsy. Frontal lobe seizures are challenging to diagnose as the clinical manifestations are diverse due to the complexity and variability of the patterns of epileptic discharges, and the scalp electroencephalograph (EEG) can often be normal or misleading. […] Scalp EEG recording is sometimes helpful in localization but is usually normal or misleading in frontal lobe epilepsy. […] Although this review provides a framework for the understanding of these seizures, one should remain cautious in diagnosing seizure localization based on clinical or EEG description. Only a few patients have well-described syndromes and can be diagnosed with confidence. For most patients, new diagnostic methods and genetic testing may help improve our ability to diagnose and treat the conditions discussed in this study.
- #51 Frontal Lobe Epilepsy Diagnosis – Acibadem Health Point – ACIBADEM Hospitals – Acibadem Health Grouphttps://www.acibademhealthpoint.com/frontal-lobe-epilepsy-diagnosis/?amp=1
An electroencephalogram (EEG) is key for finding frontal lobe epilepsy. It watches the brainâs electrical activity to spot issues others might miss. This test is great for finding where seizures start in the brain. […] Neuroimaging is key in finding and treating epilepsy. It uses special scans to see the brain and find problems. This helps doctors know whatâs going on inside the brain. […] To diagnose frontal lobe epilepsy, doctors use special tests. These tests help find and understand the seizures. This is key for making treatment plans. […] Doctors often use several tests together. These include tests that go inside the brain and ones that donât. Wada testing and magnetoencephalography (MEG) are also used. Each test helps with the diagnosis, along with EEG and brain scans.
- #52 Localisation in focal epilepsy: a practical guide | Practical Neurologyhttps://pn.bmj.com/content/21/6/481
The semiology of epileptic seizures reflects activation, or dysfunction, of areas of brain (often termed the symptomatogenic zone) as a seizure begins and evolves. […] The correct diagnosis of paroxysmal events also depends on the clinician being familiar with the spectrum of semiologies. […] Here, we summarise the current literature on localisation in focal epilepsies using illustrative cases and discussing possible pitfalls in localisation. […] Careful analysis of semiology, using both the patients history and data from videotelemetry, can help to localise seizure onset. […] This is particularly important in presurgical epilepsy assessment, something that should be considered for everyone with medically refractory focal epilepsies. […] Clinicians also need to be familiar with the spectrum of epilepsy semiologies in order to make the correct diagnosis and to differentiate epileptic seizures from dissociative events, syncope and other non-epileptic events.
- #53 Frontal lobe seizures – Diagnosis and treatment – Mayo Clinichttps://www.mayoclinic.org/diseases-conditions/frontal-lobe-seizures/diagnosis-treatment/drc-20353962
Frontal lobe epilepsy can be hard to diagnose. Its symptoms can be mistaken for mental health problems or sleep disorders such as night terrors. It also is possible that some symptoms of frontal lobe seizures are the result of seizures that begin in other parts of the brain. […] To make a diagnosis, a health care professional reviews your symptoms and medical history. The care professional also conducts a physical exam. You may have blood drawn to test for health conditions or disorders that may be causing the seizures. […] You might need a neurological exam, which will test your muscle strength, sensory skills, hearing and speech, vision, coordination and balance. […] Brain imaging usually an MRI might reveal the source of frontal lobe seizures. An MRI uses radio waves and a powerful magnetic field to produce detailed images of soft tissues, which make up the brain.
- #54 Frontal Lobe Seizures: Causes, Symptoms & Treatmenthttps://my.clevelandclinic.org/health/diseases/17011-frontal-lobe-epilepsy
Frontal lobe epilepsy is a type of seizure disorder affecting your frontal lobes. It causes frontal lobe seizures, which is a pattern of abnormal electrical activity in your brain. […] To diagnose frontal lobe epilepsy, your healthcare provider will review your medical history and perform a physical exam. Testing helps confirm a diagnosis. […] The following tests can help diagnose frontal lobe epilepsy: MRI, Electroencephalography (EEG), Video EEG, Stereoelectroencephalography (SEEG), Magnetoencephalography (MEG). […] Antiseizure medications may help you manage frontal lobe seizures. These medications regulate electrical activity in your brain and may reduce the frequency of seizures. […] A healthcare provider may consider epilepsy surgery if medications aren’t successful at managing frontal lobe seizures. Your healthcare provider may recommend a frontal lobe resection. […] In some cases, surgery may not be a safe option to treat frontal lobe seizures. Your provider may recommend neuromodulation.
- #55 Localisation in focal epilepsy: a practical guide | Practical Neurologyhttps://pn.bmj.com/content/21/6/481
The semiology of epileptic seizures reflects activation, or dysfunction, of areas of brain (often termed the symptomatogenic zone) as a seizure begins and evolves. […] The correct diagnosis of paroxysmal events also depends on the clinician being familiar with the spectrum of semiologies. […] Here, we summarise the current literature on localisation in focal epilepsies using illustrative cases and discussing possible pitfalls in localisation. […] Careful analysis of semiology, using both the patients history and data from videotelemetry, can help to localise seizure onset. […] This is particularly important in presurgical epilepsy assessment, something that should be considered for everyone with medically refractory focal epilepsies. […] Clinicians also need to be familiar with the spectrum of epilepsy semiologies in order to make the correct diagnosis and to differentiate epileptic seizures from dissociative events, syncope and other non-epileptic events.
- #56 Mayo Clinic Health Library – Frontal lobe seizures | Swiss Medical Networkhttps://www.swissmedical.net/en/healtcare-library/con-20197154
An MRI involves lying on a narrow table that slides into a long tube. The test often takes about an hour. Some people have a fear of enclosed spaces. They can be given a medicine to feel sleepy and less anxious. The test itself is painless. […] Electroencephalogram, known as an EEG. An EEG monitors the electrical activity in the brain. This is done by attaching small metal discs called electrodes to the scalp. EEGs often help diagnose some types of epilepsy. However, EEG results might not identify frontal lobe epilepsy. […] Video EEG. Video EEG is recommended for some people with seizures. This test is usually performed during an overnight stay at a sleep clinic. Both a video camera and an EEG monitor run all night. A video EEG allows health care professionals to match what physically occurs during a seizure with what appears on the EEG.
- #57https://healthmatch.io/epilepsy/frontal-lobe-epilepsy
Video EEGs are generally performed in sleep clinics where video cameras and EEG monitors are used to study the patients physical activity and brain activity during sleep. A specialist can match seizures up to your EEG results during the seizure. […] Treatment options for frontal lobe seizures have come a long way in the last decade. Several types of antiseizure medication are available, and there are surgeries that may help with frontal lobe seizures. […] If your frontal lobe seizures are unaltered by medication, you may be a good candidate for surgery.
- #58 Frontal lobe epilepsy: Causes, symptoms, treatment, and morehttps://www.medicalnewstoday.com/articles/frontal-lobe-epilepsy
Frontal lobe epilepsy causes seizures that begin in the part of the brain responsible for movement, personality, and planning. […] A frontal lobe seizure is a partial seizure because it starts in one part of the brain the frontal lobe. […] Frontal lobe seizures can significantly impact a persons quality of life. […] Doctors typically treat frontal lobe epilepsy with medication, surgery, and neuromodulation. […] If medication does not work, a doctor may recommend neuromodulation therapy for seizures. […] If medication and neuromodulation have no effect on a persons seizures, a doctor may recommend surgery. […] People with frontal lobe epilepsy may be able to manage or reduce seizures with the right medication, diet, or surgery. […] With the right treatment such as medication, diet, surgery, neuromodulation, or a combination of these a person may be able to manage or reduce their seizures.