No abstract available.
Brain* ; Epilepsy, Frontal Lobe* ; Frontal Lobe*

Epileptic nystagmus is defined as a quick, repetitive jerky movement of the eyeball associated with seizure activity. In cases of epileptic nystagmus associated with ictal discharge from multiple brain areas, localization of the exact epileptogenic zone could be extremely difficult. In a nine-year-old patient with epileptic nystagmus and vertigo associated with bilateral temporal and frontal lobe epilepsy, we could infer the epileptic focus by interpreting the patient's clinical picture, characteristics of nystagmus, and findings of electroencephalography.
Brain ; Electroencephalography ; Epilepsy ; Epilepsy, Frontal Lobe* ; Frontal Lobe* ; Humans ; Nystagmus, Pathologic ; Seizures ; Vertigo*

PURPOSE: This study was performed to correlate clinical behaviours with either a temporal or frontal site of origin and then to identify behaviours that might have a significant practical value in differentiating a temporal from a frontal focus and thus reduce the need for invasive monitoring. METHODS: We analysed 129 seizures that occured during video-EEG monitoring in 13 patients with temporal lobe epilepsy (TLE) and in 9 patients with frontal lobe epilepsy (FLE) as well as neuroimaging studies. We compared first the clinical behaviours that occurred in frontal lobe seizures to those of temporal lobe seizures (second stage analysis). To eliminate clinical behaviours that could occur as the discharge propagated another lobe, we compared only clinical seizure events in which we had no evidence of spread to other regions, or that spread only to the homologous contralateral lobe (first stage analysis). The Fisher exact test was used for analysis. RESULTS: Although staring, sitting up, leg movement, and tonic-clonic movement, generalization occurred more frequently in FLE, and oral, alimentary and hand automatisms were more frequent in TLE, no statistically significant difference was found between the two groups. In second stage analysis, sitting up, tonic-clonic movement were seen only in FLE and oral, alimentary and hand automatisms only in TLE. Staring, hand posturing occurred more frequently in FLE. CONCLUSION: We therefore conclude that the reliability of clinical behaviour alone to predict the site of origin of an epileptic discharge is limited when the surface EEG is equivocal or neuroradiologic evidence of a focus is not clear.
Child ; Electroencephalography ; Epilepsy, Frontal Lobe ; Epilepsy, Temporal Lobe ; Frontal Lobe* ; Generalization (Psychology) ; Hand ; Humans ; Leg ; Neuroimaging ; Seizures* ; Temporal Lobe

Eye blinking is a rare semiology in frontal lobe epilepsy. However, eye blinking with leg jerking as a manifestation of simple partial seizure has not been reported. We report a patient with frontal oligodendroglioma who showed simple partial seizure presenting with eye blinking and leg jerking.
Blinking* ; Epilepsy* ; Epilepsy, Frontal Lobe ; Humans ; Leg* ; Oligodendroglioma ; Seizures

BACKGROUND: Localizable scalp ictal EEG appears to be rare in neocortical epilepsy. However, there have not been many studies based upon a large number of patients. This study aims to identify the characteristic patterns of variable neocortical epilepsies and to evaluate their clinical usefulness in the localization of epileptogenic foci. METHODS: We retrospectively assessed 394 noninvasive ictal recordings from 86 patients who subsequently underwent invasive study and resective surgery. Ictal EEGs were recorded by video-EEG monitoring systems with electrodes placed according to the international 10-20 system including additional anterior temporal electrodes. Ictal recordings were analyzed accord-ing to the localizing accuracy and frequency characteristics. The durations of discrete or regional ictal rhythms were also measured. RESULTS: The percentage of discrete or regional EEGs were respectively 26, 52, 70, and 10% in frontal lobe epilepsy (FLE), lateral temporal lobe epilepsy, occipital lobe epilepsy (OLE), and parietal lobe epilepsy (PLE). The ictal rhythms in the order of frequency were theta, delta, beta, alpha, and rhythmic spike-and-wave. The duration of discrete or regional ictal rhythms were significantly shorter in FLE and PLE than in other epilepsies. Ictal beta activ-ity was the most common rhythm in discrete-patterned EEGs. There were some tendencies of poor lateralization in the presence of structural lesion. Types of seizure were not related with the degree of localization except for simple partial seizure. CONCLUSIONS: Ictal surface EEG was clinically helpful in the localization of epileptogenic foci especially in particular neocortical epileptic syndromes.
Electrodes ; Electroencephalography* ; Epilepsies, Partial ; Epilepsy* ; Epilepsy, Frontal Lobe ; Epilepsy, Temporal Lobe ; Humans ; Parietal Lobe ; Retrospective Studies ; Scalp ; Seizures

We report a rare case of meningioangiomatosis in a 22 year-old man who has refractory partial seizures. Seven of 11 seizures had ictal onset zone at the perilesional medial and orbitofrontal areas of frontal lobe and 4 seizures arose from the mesial temporal area. After having lesion resection and an anterior temporal lobectomy with amygdalohippocam-pectomy, the patient no longer suffered from seizures. The epileptogenic foci were found not only in the intra-/peri-lesional area but also in remote area.
Anterior Temporal Lobectomy ; Epilepsy* ; Frontal Lobe ; Humans ; Seizures ; Young Adult

PURPOSE: To evaluate the usefulness of functional MR imaging(fMRI) for determination of language dominance compared with Wada test and to assess the lateralization of activated signals according to stimulation task of activated area. MATERIALS AND METHODS: Functional maps were obtained during word generation task and reading task in twenty patients(16 epilepsy, 4tumor; 17 right-handed, 1 left-handed, 2 ambidextrous). MR examinations were performed at 1.5T scanner with EPI BOLD technique during word generation and word reading tasks. We used SPM program for the postprocessing of image. The threshold for significance was set at p<0.0001 or p<0.001. A lateralization index(LI) was calculated from the number of activated pixels in three hemispheric areas(whole hemisphere, frontal lobe, and temporoparietal lobe. The LIs of fMRI and Wada test were compared according to stimulation task and area for calculation of LI. RESULTS: During the Wada test, sixteen patients had the left language dominance and four patients had right dominance. The language dominance determined by LI of fMRI in each hemisphere was concordant with the result of Wada in 19(95%) by word generation task and in 15(75%) by reading task. At word generation task, the concordance rate was higher with LI calculated on whole hemisphere than that on frontal(80%) or temporoparietal lobe(90%). Correlation between the LIs of Wada and fMRI was significant(r=0.74) CONCLUSION: In fMRI word generation task produced stronger activation of language areas and showed more accurate lateralization reading task. The concordance rate of and Wada test was higher with LI calculated on whole hemisphere than on frontal or temporoparietal lobe.
Brain ; Epilepsy ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging*

This review describes the wide spectrum of paroxysmal events during sleep in infancy and childhood. The differential diagnosis between sleep-related non-epileptic paroxysmal events and epileptic seizures is difficult in special occasions. The nocturnal frontal lobe seizure and of the more common non- epileptic paroxysmal events during sleep are described. The main differentiating features characterizing parasomnias are: onset in early childhood, rare episodes of long duration, relatively lower frequency per night, absence of stereotypy, gradual disappearance of older age. Video-polysomnography is the gold standard to diagnosing and differentiating parasomnias from nocturnal frontal lobe seizures.
Diagnosis, Differential ; Epilepsy* ; Frontal Lobe ; Night Terrors ; Parasomnias ; Seizures

PURPOSE: To investigate the origin of frontal lobe dysfunction identified by the Wisconsin Card Sorting Test (WCST) in mesial temporal lobe epilepsy (MTLE). METHODS: We included 85 patients with unilateral MTLE and 34 patients with neocortical temporal lobe epilepsy (NTLE). We included only MTLE patients who postoperatively became seizure free at least for 1 year. Comparisons were made on the WCST performance between MTLE and NTLE and between preoperative and postoperative test in MTLE. Standardized regression based (SRB) methodology was used for correcting test-retest bias. RESULTS: 1) There were no significant differences in frontal lobe dysfunction defined as more than 17 perseverative errors between MTLE (64%) and NTLE (76%). 2) No significant differences in WCST performance between MTLE and NTLE were noted, except in categories completed (p=0.05). NTLE achieved significantly fewer categories than MTLE. 3) The proportions of patients with MTLE who postoperatively showed a clinically meaningful improvement on WCST performance were higher than those who displayed a significant decline. In case of perseverative responses, 52% of patients with MTLE postoperatively showed an improvement whereas 18% displayed a decline. 4) Postoperatively, mean values of perseverative responses and total errors were significantly decreased (p<0.05). 5) Significant negative correlations were found between preoperative WCST performance and postoperative SRB change scores for WCST (r=-0.3~-0.4, p<0.05). CONCLUSIONS: Our results could not be explained by any one of 'neural noise' or 'hippocampal' hypothesis. Our data suggest that poor WCST performance in patients with MTLE might be attributed to dysfunction of neural system including both hippocampus and frontal lobe cortex. Further studies are needed to make new hypothesis.
Bias (Epidemiology) ; Epilepsy, Temporal Lobe* ; Frontal Lobe ; Hippocampus ; Humans ; Seizures ; Temporal Lobe* ; Wisconsin*

PURPOSE: Seizures arising from the frontal area are the second most common type of partial seizure disorder. As many of them showes various clinical manifestations, they are often misdiagnosed in children. This studies was performed to correlate clinical characteristics of children with electroencephalographic abnormal findings in the frontal area. METHODS: The clinical manifestations were analysed in 81 children with seizures showing interictal paroxysmal activities on scalp electroencephalography at frontal lobe area. This clinical manifestation involves type of seizure, frequency and duration of seizure, mental retardation, speech and motor development as well as medication. RESULTS: The abnormal electrical activities of frontal lobe were classified to spike or sharp waves in 56 cases, spike and waves in 16 cases, slow waves in 9 cases. 34 children had generalized tonic clonic seizures, 19 had partial seizure disorders, 8 had absence seizures, and 6 had atonic seizures, 12 had generalized tonic seizures, 2 had myoclonic seizures. Accompanying developmental disorders were mental retardation in 20 cases, speech delay in 27 cases, motor delay in 11 cases. Polytherapy is more common in children with specific etiology and absence seizure. CONCLUSION: Epileptic children with frontal paroxysmal activities in their EEG clinically manifestes partial and generalized seizure, and speech delay is the most frequent in developmental delay. Patents with frontal lobe epilepsy manifest various unpredictable clinical features.
Child* ; Electroencephalography ; Epilepsies, Partial ; Epilepsy, Absence ; Epilepsy, Frontal Lobe ; Frontal Lobe ; Humans ; Intellectual Disability ; Language Development Disorders ; Scalp ; Seizures