Understanding Frontal Lobe Seizures
An EEG this morning had frontal lobe seizures, which is a type of epileptic seizure that can originate in the frontal lobes of the brain. As EEG techs, you play a vital role in conducting and interpreting EEG tests that can help diagnose and monitor these seizures, so I hope this information will be useful to you throughout your EEG Tech role.
Frontal lobe seizures can be classified into two main categories: focal seizures and generalized seizures. Focal seizures begin in a specific area of the brain and can affect a single part of the body or a specific function, such as speech or vision. Generalized seizures involve both sides of the brain and can cause a loss of consciousness or muscle control. Frontal lobe seizures can also be classified based on their specific location within the frontal lobes.
Some common symptoms of frontal lobe seizures include sudden, brief movements or jerks of one side of the body, abnormal sensations, changes in behavior or emotions, and loss of consciousness or muscle control. THEY OFTEN HAPPEN AT NIGHT, CAUSING SLEEP DISTURBANCES OR BEHAVIOR CHANGES. Diagnosing frontal lobe seizures usually involves a combination of physical exams, medical history, and neurological tests such as EEG.
On an EEG, frontal lobe seizures may be identified by focal slowing, spike or sharp wave activity, and ictal or interictal activity. EEG techs play a vital role in conducting and interpreting these tests, and can help identify the specific type and location of a frontal lobe seizure. An EEG tech could see several patterns of activity that may be indicative of frontal lobe seizures. These include:
Focal slowing: This refers to a slowing of the normal background activity in a specific area of the brain, which can be a sign of a focal or partial seizure originating in the frontal lobe.
Spike or sharp wave activity: These are short, high-frequency bursts of electrical activity that can be seen on an EEG and are often associated with epileptic seizures. In frontal lobe seizures, these spikes or sharp waves may be localized to the frontal lobes.
Ictal activity: This refers to the abnormal electrical activity that occurs during a seizure. On an EEG, ictal activity may appear as rhythmic spikes or waves that are time-locked to the onset of clinical symptoms, such as jerking movements or loss of consciousness.
Interictal activity: This refers to abnormal electrical activity that occurs between seizures. On an EEG, interictal activity may appear as brief bursts of spikes or sharp waves that are not associated with any clinical symptoms.
Treatment for frontal lobe seizures typically involves medications such as antiepileptic drugs (AEDs) to help control seizures, and in some cases, surgery may be recommended to remove the part of the brain where seizures originate.
It is important for EEG techs to be knowledgeable about frontal lobe seizures. Some frontal lobe seizures will be easy to recognize because of the clinical manifestations. At times, the seizure onset on EEG will be contaminated by high-voltage muscle artifact. It best not to confuse arousals during sleep and frontal lobe seizures. Specifically, this patient has gestural motor seizures. Gestural motor seizures are a type of epileptic seizure that involves involuntary or purposeful movements of the limbs, face, or other body parts. These seizures can occur in any part of the brain, but they are often associated with seizures that originate in the frontal lobes or the parietal lobes. Gestural motor seizures can be difficult to diagnose, as the movements may be mistaken for voluntary actions or tics. However, there are several features that can help distinguish these seizures from other types of movement disorders. For example, the movements may be preceded by an aura, or a sense of impending seizure, and they may be followed by confusion or disorientation. Additionally, the movements may be time-locked to abnormal electrical activity in the brain, which can be detected using an EEG.
Frontal Lobe Seizure Onset
Frontal Lobe Seizure Continues
Frontal Lobe Seizure Ends
The Routine EEG report on this patient included the following:
A single gestural motor seizure during non-REM sleep presenting as integrated hyperkinetic body movements of indeterminate onset.
Awake and asleep.
History: This is a 7-year old previously healthy young man who had acute onset of OCD symptoms followed by seizure-like activity.
Medications: Trileptal and Klonopin
EEG Description (portion only): A single clinical seizure was recorded on non-REM sleep at ##:## hours. Clinically, it can be best described as integrated hyperkinetic body movements with acute onset in non-REM sleep. Patient suddenly woke up from non-REM sleep, sat up and started to roll over and try to get out of bed. This seizure lasted approximately 15 seconds. There was an abrupt onset and termination with quick return to baseline. Electrographically, seizure onset was indeterminate.
Clinical Correlation: (portion only): Recorded single gestural motor seizure with indeterminate onset. Clinical presentation of this seizure was very typical of pre motor frontal seizures. Interictal EEG was normal during routine EEG.
The EMU EEG report on this patient included the following:
Numerous gestural motor seizures during non-REM sleep presenting as integrated hyperkinetic body movements of indeterminate onset but probably right frontal.
Spike and wave: A right frontal-sleep activated (interictal).
Intermittent polymorphic delta: Right frontal.
Awake and asleep.
EEG Description (portion only): Intermittent right frontal polymorphic delta theta frequencies were seen during sleep. Right frontal sharps specifically high-voltage from F8 region were present in non-REM sleep. Multiple stereotypical clinical seizures were recorded in non-REM sleep. Clinically, these can be best described as integrated hyperkinetic body movements with acute onset in non-REM sleep. Patient suddenly woke up from non-REM sleep, sat up and started to roll over and try to get out of bed. Each seizure lasted approximately 15 seconds. There was an abrupt onset and termination and quick return to baseline. Electrographically, seizure onset was indeterminate though often it was preceded by right frontal spikes by few seconds.
Clinical Correlation (portion only): Recorded numerous stereotypical gestural motor seizures presenting as integrated hyperkinetic body movements with electrographic onset indeterminate but probably right frontal. Interictally, in non-REM sleep, right frontal spike and wave discharges as well as intermittent polymorphic delta theta frequencies were seen. Patient clinical semiology and EEG finding are both very suggestive of presence of pre motor frontal lobe epilepsy.
Authored by "Sharp and Spike Finder"