Frontal lobe epilepsy (FLE) is a neurological disorder that is characterized by seizures in the frontal lobe of the brain. It is the second-most common type of epilepsy, after temporal lobe epilepsy (TLE). Like TLE, FLE seizures are typically characterized by focal, or partial, seizures. Focal epilepsy is a seizure condition that originates in one part of the brain only. In frontal lobe epilepsy, focal seizures are predominant. They can, however, progress to generalized, tonic-clonic seizures involving both sides of the brain, with characteristic jerking movements and muscle stiffening.
FLE can happen in both children and adults. The cortical (outer layer or cortex) areas of the brain are large, and they have many important functions. Dysfunction in these areas due to seizure activity can cause symptoms of many types of disorders, including psychiatric, neuropsychological, and sleeping disorders. Because these symptoms can be due to a variety of disorders, they can sometimes lead to misdiagnosis and delays in receiving the correct treatment. This is why having an understanding of FLE is so important.
In neurology, FLE is characterized by seizure activity in the brain’s frontal lobe. These seizures usually last less than 30 seconds. They most often occur during sleep, or between the hours of 2 a.m. and noon. Signs and symptoms of frontal lobe seizures might include:
Learn more about seizure types and symptoms of epilepsy.
There are many potential causes of FLE. In the majority of cases, FLE is caused by an abnormality in the frontal lobe of the brain. These abnormalities can include tumors, strokes, hemorrhages, infections, or traumatic brain injuries. An abnormal lesion in the brain can disrupt the brain’s normal processing and pathway of electrical impulses, making it a prime location for seizures to develop.
Genetics may also play a role in FLE. In one study, researchers analyzed tissue from the olfactory bulb, which enables the sense of smell, from deceased people who had FLE in their lifetime. They found higher numbers of genes related to proinflammatory processes, such as interleukin (IL)-1 beta, IL-6, and tumor necrosis factor (TNF)-alpha, in people with FLE than people without.
One rare form of FLE — autosomal dominant nocturnal frontal lobe epilepsy — has a strong genetic component. “Autosomal dominant” means that if one of a person’s parents has the disorder, then that person has a 50 percent chance of inheriting the mutated gene. In this type of FLE, the genetic mutation is found in the CHRNA4 and CHRNB2 genes, which code for nicotinic receptors in the brain. A nicotinic receptor is a special kind of receptor for acetylcholine, an important chemical messenger. Acetylcholine and its receptors act like a key and lock to facilitate brain communication. Mutations on these genes can lead to problems in how that receptor (the lock) functions.
Because the frontal lobe is so large, several subtypes of FLE have emerged. These subtypes are defined by the area of the frontal lobe in which the seizure starts. Frontal lobe seizure locations include the:
The names of these different locations in the brain may sound intimidating, but for FLE they really only differentiate between seizure symptoms and treatment options. Symptoms vary depending on where in the frontal lobe seizures begin.
Learn more about the causes of seizures and epilepsy.
Diagnosing FLE can be challenging. Some of the symptoms of these epileptic seizures can be mistaken for nonepileptic events, such as behavioral disorders, movement disorders, or parasomnias or sleep disorders. One of the most effective ways to diagnose FLE is to use MRI for neuroimaging. An MRI allows a neurologist or neurosurgeon to see if there is an underlying lesion in the brain that could explain the seizure activity. For example, in FLE, an MRI may reveal a tumor or other lesion somewhere in the frontal lobe.
Electroencephalography (EEG) and positron emission tomography (PET) scans are other tools used in the diagnosis of frontal lobe epilepsy. In EEG, electrodes are placed on the scalp to monitor brain wave activations and overall activity. EEGs can help identify ictal (seizure) activity, interictal (in-between seizure) activity, and different seizure types overall. Video EEG may be used to monitor a person’s body movements while brain waves are being analyzed. Blood work can help to rule out other conditions that may be causing seizures. A doctor may also administer a variety of neuropsychiatric tests to diagnose FLE.
Learn more about how epilepsy is diagnosed.
The first-line treatment for epilepsy is usually antiepileptic drugs. Carbamazepine is often prescribed for people who experience seizures during the night with significant motor movement. A variety of other antiepileptic medications are available to treat FLE, and some may be used on their own or in combination with others. Some medications are more effective for certain people than others. Finding the right medication or dose may take time, and how you tolerate the medication’s side effects plays a role in this process.
For example, one small study looked at people living with FLE whose seizures did not respond to three different types of medication. Researchers found that the combination of two anticonvulsants, Depakote (divalproex sodium) and Lamictal (lamotrigine), led to no seizures for one year in nearly half of the study participants. It is important to note that women of child-bearing age should take folate with any antiepileptic medication to prevent birth defects.
Around 30 percent of people will not respond to antiepileptic medication. This is known as refractory FLE. In these cases, epilepsy surgery may be the best option. One issue that neurologists and neurosurgeons face is that it can be difficult to pinpoint the site of seizure origin. The frontal lobe has many critical brain functions, and it is important to keep the surgical resection as small as possible. Early intervention is critical for surgical routes. One study found that the long-term outcomes of frontal lobe surgery or frontal lobe resection during childhood or adolescence were quite positive.
In recent years, newer surgical approaches have been developed, including implanted vagus nerve stimulation and responsive neurostimulation devices. When you meet with your neurosurgeon, it is important to ask them about the possibility of using one of these devices to help reduce seizure frequency.
Besides surgery, dietary changes, such as the ketogenic diet or modified Atkins diet, have been shown to help control seizures in people living with epilepsy. Whenever possible, it is always important to try lifestyle changes to improve your overall condition.
Learn more about treatments for epilepsy.
Around 65 percent to 75 percent of patients with FLE will have a response to antiepileptic medication and will no longer experience seizures. The prognosis or outlook for FLE usually depends on how early the diagnosis can be made from seizure onset. It also depends on where in the frontal lobe the seizures are happening. This, in turn, influences whether surgery can be a treatment option and how likely surgical outcomes are to be successful. If a surgical option is chosen for treatment, research shows that earlier surgery leads to better outcomes for people living with epilepsy — and greater quality of life after surgery.
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