Frontal lobe seizures

Diagnosis

Frontal lobe seizure presents a diagnostic challenge due to its symptoms often resembling psychiatric disorders or sleep disorders like night terrors. Additionally, certain seizure effects originating in the frontal lobe can actually stem from seizures originating elsewhere in the brain.

To diagnose frontal lobe seizure, your doctor will carefully evaluate your symptoms and medical history and perform a thorough physical examination. A neurological examination may also be conducted to assess various aspects, including:

• Muscle strength
• Sensory abilities
• Hearing and speech
• Vision
• Coordination and balance

The tests below might be recommended by your doctor.

• Brain scans. Brain imaging, typically performed with an Magnetic Resonance Imaging (MRI), can help identify the origin of frontal lobe seizures. During an MRI scan, radio waves and a strong magnetic field are used to generate detailed images of the brain’s soft tissues. The procedure involves lying on a narrow bed that slides into a lengthy tube. The scan usually lasts approximately one hour. While the test itself is painless, some individuals may experience feelings of claustrophobia when inside the MRI machine.
• Electroencephalogram (EEG). A set of electrodes connected to your scalp during an EEG measures the electrical activity in your brain. EEG readings in frontal lobe seizure can be normal, despite the fact that they are frequently helpful in diagnosing some forms of epilepsy.
• Video EEG. Typically, a video EEG is conducted while the patient stays overnight at the sleep center. During this time, an EEG monitor and a video camera are continuously active. This allows medical professionals to compare the actual events during a seizure with the recorded EEG data.

Treatment

There are now more alternatives for treating frontal lobe seizures than there were ten years ago. If medication does not work, there are a variety of surgical techniques and newer anti-seizure drug kinds that may be helpful.

Medications

Frontal lobe seizures can be effectively controlled by various anti-seizure drugs, although not everyone achieves complete seizure freedom with medication alone. To address this, doctors may explore different drug options or combinations to improve seizure control. Ongoing research aims to develop new and more efficient medications. Typically, the initial treatment for frontal lobe seizures involves anti-seizure drugs like oxcarbazepine, which regulate brain electrical activity to halt or reduce seizure occurrences. However, approximately 30% of individuals do not experience optimal results with medication, leading healthcare providers to consider alternative treatments such as surgical interventions.

Surgery

When medications prove ineffective in controlling seizures, surgery becomes an option to address frontal lobe seizures. Advanced imaging techniques such as single-photon emission computerized tomography (SPECT) and subtraction ictal SPECT coregistered to MRI (SISCOM) assist in pinpointing seizure-generating areas, while brain mapping and functional MRI (fMRI) help identify important brain functions and language areas. Frontal lobe resection surgery involves removing the seizure-causing part of the frontal lobe, with detailed brain mapping and electrode recordings guiding the procedure to minimize damage to critical functions. Although ongoing anti-seizure medication may still be required, surgery offers a targeted approach to address seizures while preserving essential brain functions.

Epilepsy surgery may involve:

• Removing the focal point.  If a certain area of your brain is where your seizures always start, cutting out that area of brain tissue may lessen or stop your seizures altogether.
• Isolating the focal point. Surgeons may do a series of cuts to help isolate the part of the brain producing seizures if it is too important to remove. This stops seizures from spreading to different areas of the brain.
• Vagus nerve stimulation. In order to stimulate your vagus nerve, a device that is akin to a cardiac pacemaker must be implanted. The amount of seizures is typically reduced by this technique.
• Responding to a seizure. A more recent kind of implanted device is a responsive neurostimulator. It only comes on when you start having a seizure, and it prevents the seizure from happening.
• Deep brain stimulation (DBS). In this more recent technique, an electrode is implanted into the brain and attached to a stimulating device—similar to a cardiac pacemaker—that is positioned beneath the skin of the chest. To prevent signals that start a seizure, the device delivers signals to the electrode.