Frontal Lobe Epilepsy: Caused and Treatment
Frontal lobe epilepsy is a bizarre form of epilepsy, which is often misdiagnosed due to its strange presentation. The frontal lobe is an area of the brain, which is important in voluntary movement, expressive language, and performing cognitive skills like planning, initiating self-monitoring, and expression of a personality.
What Causes Frontal Lobe Epilepsy?
Various types of pathologies can cause frontal lobe epilepsy. Trauma or physical injury to the frontal area of the brain can cause epilepsy, as a hard impact will damage the soft tissue of the frontal area, leading to dysfunction which will cause seizures. Another cause is stroke. Strokes take place due to an interference of the vital blood supply to the brain, due to clots blocking blood flow or a bleeding vessel. The death of brain cells that occur in a stroke can be a cause of frontal lobe epilepsy. The cells of the brain are organized in a specific way and various cells are specialized for various functions.
Sometimes brain cells don't form normally, and this may lead to frontal lobe epilepsy. Abnormal cell formation taking place even before birth, such as cortical dysplasia can give rise to frontal lobe epilepsy. Frontal lobe epilepsy can also be caused by infections such as meningitis and encephalitis. It can even be caused when the body's immune system attacks its cells, in a condition known as autoimmune encephalitis. In some cases, abnormal cells may rapidly divide to produce masses which are tumors, and these tumors when associated with the frontal lobe can incite epilepsy.
Frontal lobe epilepsy may even run in families. In particular, a condition known as autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) causes seizures that occur at night.
What does Frontal Lobe Epilepsy Look Like?
This variety of seizures happens most commonly during sleep. When we fall asleep, most areas of the brain calm down leaving the deep brain areas like the thalamus and the frontal lobe still working during sleep. What happens in this condition is that the underlying cause of the condition will sneak into and interfere with the connection between the frontal lobe and the thalamus and cause a sudden, explosive, and bizarre seizure pattern which may involve abnormal movements such as flipping around, shaking arms and leg, vocalizations such as screaming and laughter, cycling movements and even sexual movements like pelvic thrusting. During the seizure, the face may show a grimace.
Due to this pattern of movement, it is often misdiagnosed as psychogenic non-epileptic seizures (PNES), but it's important to realize that nonepileptic seizures are more prolonged and don't usually happen while the patient is sleeping. You may also see abnormal eye movements, including a forced deviation of the eyes to one direction, associated with abnormal body movements. The seizure may start from one area of the body, such as the face, and then progress along to include the arm, hands, and then to legs, and may eventually spread to the whole body. This phenomenon is known as the 'Jacksonian march' and it was observed by Dr. John Hughling Jackson, an English neurologist who observed the phenomenon in his wife.
Some people may even experience sudden urinary incontinence. In one situation a newly engaged patient would suffer sudden urinary incontinence every time she sat next to her fiancé. When it was investigated, it was diagnosed as a seizure and following treatment, her symptoms subsided.
How to Diagnose Frontal Lobe Epilepsy?
To diagnose someone with frontal lobe epilepsy, it is important to take a complete and thorough medical history. Video recording an episode of a seizure is an invaluable record of the seizure pattern. Sleep studies can be used to rule out other factors that may contribute to or mimic a seizure.
Imaging like an MRI scan can be used to get detailed images of the brain to see if there is any scarring of brain tissue or to see if there are any abnormal malformations or tumors. Electroencephalography is also a useful tool to investigate seizures, however at times may turn up falsely negative as frontal lobe epilepsy usually involve deep brain tissue, whereas EEG only detects surface brain activity.
How to Treat Frontal Lobe Epilepsy?
There are about 31 different varieties of antiseizure medications each with its unique risks and benefits. The most important thing to realize is that treatment is patient-specific and should not exacerbate existing conditions the patient may have. 50-70% of the time, seizures are completely controlled through medication, however, 25% of patients may not respond to therapy. Surgery may be a treatment method to treat anatomical anomalies or remove tumors. Implant devices such as deep brain stimulation (DBS) or vagus nerve stimulators (VNS) and responsive neurostimulation (RNS) are also increasing in popularity. Diet changes may aid in treating epilepsy as well.