Frontal lobe seizures

Overview

Frontal lobe seizures are a common form of epilepsy. Epilepsy is a brain disorder in which clusters of brain cells send a burst of electrical signals. This causes movements that can't be controlled, known as seizures. Frontal lobe seizures begin in the front of the brain, the area known as the frontal lobe.

The frontal lobe is large and has important functions. For this reason, frontal lobe seizures can produce symptoms that are unusual and may appear to be related to a mental illness. The seizures also can be mistaken for a sleep disorder because they often occur during sleep. Frontal lobe seizures also are known as frontal lobe epilepsy.

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

Medicines can help control the seizures. Surgery or electrical stimulation might be options if medicines don't reduce or stop the seizures.

Symptoms

Frontal lobe seizures often last less than 30 seconds. Sometimes recovery is immediate.

Symptoms of frontal lobe seizures might include:

• Head and eye movement to one side.
• Not responding to others or having trouble speaking.
• Explosive screams, including profanities or laughter.
• Body posturing. A common posture is extending one arm while the other flexes, as if the person is posing like a fencer.
• Repetitive movements. These may include rocking, bicycle pedaling or pelvic thrusting.

When to see a doctor

See a health care professional if you're having symptoms of a seizure. Call 911 or emergency medical help if you see someone having a seizure that lasts longer than five minutes.

Causes

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

Frontal lobe seizures also are associated with a rare inherited disorder called autosomal dominant nocturnal frontal lobe epilepsy. This form of epilepsy causes brief seizures during sleep. If one of your parents has this form of epilepsy, you have a 50% chance of inheriting the disorder.

For about half of people who have frontal lobe epilepsy, the cause is not known.

Risk factors

Risk factors of frontal lobe seizures include:

• Family history of seizures or brain disorders.
• Head trauma.
• Brain infection.
• Brain tumors.
• Blood vessels or brain tissues that form in an irregular way.
• Stroke.

Complications

Frontal lobe seizures can cause complications that may include:

• Seizures that last dangerously long. Frontal lobe seizures tend to occur in clusters. For this reason, they might provoke a condition in which seizure activity lasts much longer than usual, known as status epilepticus. If these seizures continue, they can cause permanent brain damage or death.

  Seizures that last longer than five minutes are medical emergencies. Call 911 or get medical help right away if you witness someone having a seizure for longer than five minutes.

• Injury. The motions that occur during frontal lobe seizures sometimes result in injury to the person having the seizure. Seizures also can result in accidents and drowning if they occur in certain situations, such as while driving or swimming.
• Sudden unexplained death in epilepsy (SUDEP). People who have seizures have a greater risk than the average person of dying suddenly. The reasons for this are not known. Possible factors include heart or breathing problems, perhaps related to genetic changes. Controlling seizures as well as possible with medicines appears to be the best way to prevent SUDEP.
• Depression and anxiety. Both are common in people with epilepsy. Children also have a higher risk of developing attention-deficit/hyperactivity disorder (ADHD).

Diagnosis

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.

  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.

Treatment

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

Medications

All anti-seizure medicines seem to work equally well at controlling frontal lobe seizures. But not everyone becomes seizure-free on medicine. You may need to try different types of anti-seizure medicines. Or you may need to take a combination of medicines to control your seizures. Researchers are continuing to look for new and more-effective medicines.

Surgery

If your seizures can't be controlled with medicines, surgery might be an option. Before surgery, the goal is to find the areas of the brain where seizures occur.

Imaging techniques can help identify the area generating seizures. These include single-photon emission computerized tomography (SPECT) and subtraction ictal SPECT coregistered to MRI (SISCOM).

Another imaging technique, known as brain mapping, is commonly used before epilepsy surgery. Brain mapping involves implanting electrodes into an area of the brain. Then electrical stimulation is used to determine whether that area has an important function. This helps to rule out surgery on certain areas of the brain. Functional MRI (fMRI), in particular, is used to map the language area of the brain.

If you have surgery for frontal lobe seizures, it's likely you'll need anti-seizure medicine after the surgery. But surgery may allow you to take a lower dose.

Surgery for epilepsy might involve:

• Removing the focal point. If your seizures always begin in one spot in your brain, surgery removes that small portion of brain tissue. This might reduce the number of seizures you have. Or it might stop your seizures.
• Isolating the focal point. Sometimes the portion of the brain that's causing seizures is too vital to remove. When this happens, surgeons might make a series of cuts to help isolate that section of the brain. This prevents seizures from moving into other parts of the brain.
• Stimulating the vagus nerve. This involves implanting a device that's similar to a cardiac pacemaker, but it stimulates your vagus nerve. This procedure usually lowers the number of seizures you have.
• Responding to a seizure. A responsive neurostimulator is a newer type of implanted device. It is activated only when you begin to have a seizure. Once activated, it stops the seizure from occurring.
• Deep brain stimulation (DBS). This newer procedure involves implanting an electrode into your brain. The electrode is connected to a stimulating device under the skin of the chest. The device sends signals to the electrode in the brain to stop the activity that triggers a seizure.

Lifestyle and home remedies

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

Alternative medicine

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

• Herbs.
• Acupuncture.
• Psychotherapy.
• Mind-body techniques.
• Homeopathy.

Researchers are looking into these therapies to determine their safety and effectiveness. However, good evidence that they're effective at reducing seizures is mostly still lacking. There is some evidence that a ketogenic diet might be effective for treating seizures, particularly in children. A ketogenic diet is a strict high-fat, low-carbohydrate diet.

Many people with epilepsy use herbs to try to reduce their seizures. However, there's not enough evidence that most herbs are effective. Some herbs can cause an increased risk of seizures.

Marijuana, also known as cannabis, is one of the most commonly used herbs for treating epilepsy. The Food and Drug Administration (FDA) has approved a medicine that contains the purified marijuana chemical cannabidiol (Epidiolex). The medicine was approved to treat two rare forms of severe childhood epilepsy, Dravet syndrome and Lennox-Gastaut syndrome. Cannabidiol, also known as CBD, hasn't been approved in the United States or for any other types of epilepsy.

Researchers are studying how effective CBD may be for treating other types of seizures. They're also studying its potential risks, including how CBD interacts with anti-seizure medicines. Cannabis products have been reported to make seizures worse.

The FDA doesn't currently regulate herbal products. Herbs can interact with anti-seizure medicines, putting your health at risk. Talk to a health care professional before taking herbal or dietary supplements for your seizures.

Coping and support

Some people who have epilepsy are frustrated by their condition. Frontal lobe seizures can involve loud utterances or sexual movements that may make the person with epilepsy anxious.

Parents of children with frontal lobe seizures can find information, resources and emotional connections from support groups. Support groups also can help children who have epilepsy. Counseling also can be important. Adults with epilepsy can find support through in-person and online groups.

Preparing for an appointment

You're likely to first see a health care professional. This person may refer you to a doctor trained in nervous system conditions, called a neurologist.

What you can do

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

Make a list of:

• Your symptoms. Include even those that seem unrelated to the reason you scheduled the appointment, when they began and how often they occur.
• All medicines, vitamins and supplements you take, including doses.
• Questions to ask the health care professional.

Some questions to ask include:

• What is likely causing my symptoms or condition?
• Will I likely have more seizures? Will I have different types of seizures?
• What tests do I need? Do they require any special preparation?
• What treatments are available, and which do you recommend?
• I have other medical problems. How can I manage them together?
• Is surgery a possibility?
• Will I have restrictions on my activity? Will I be able to drive?
• Are there brochures or other printed materials I can have? What websites do you recommend?

What to expect from your doctor

You're likely to be asked questions, such as:

• Did you notice any unusual sensations before the seizures?
• How often do the seizures occur?
• Can you describe a typical seizure?
• How long do the seizures last?
• Do the seizures occur in clusters?
• Do they all look the same or are there different seizure behaviors you or others have seen?
• Have you noticed seizure triggers, such as illness or lack of sleep?
• Has anyone in your immediate family ever had seizures?