The document discusses frontal lobe epilepsy, including its anatomy and functions, aetiology, diagnosis, and treatment. It covers the different classifications of frontal lobe seizures based on their functional anatomy and manifestations. Some key seizure types mentioned are Rolandic epilepsy, which involves characteristic "Jacksonian march" seizures, and ventromedial and dorsolateral prefrontal seizures, which present with different behavioral and autonomic symptoms. Evaluation involves neuroimaging like MRI and EEG to localize the seizure focus. Treatment options include medications, surgery, diet, and management of impairments.

1. Neha Sharma

2. »Anatomy and Functions
»Aetiology
»Clinico-anatomical localization
»Diagnosis
»Neurological evaluation
»Treatment
»Impairments

3. »Largest of all lobes
»Myriad functions
»Divided into 3 aspects
˃Dorsolateral
˃Medial
˃Inferior orbital

4. »Precentral region : Primary motor area (4)
»Premotor : SMA – Lateral & Medial (6) Broca’s area (44)
»Frontal eye fields : (8) cortical & subcortical occulomotor associations
»Prefrontal cortex: Heterogenous connections (limbic, temporal, parietal)
»Sensory processing
»Decision making
»Impulse control
»Motor & Visual Memory

7. »5 Axes (ILAE)
»Axis 1 : Ictal phenomenology
»Axis 2 : Seizure type
»Axis 3 : Syndrome
»Axis 4 : Aetiology
»Axis 5 : Impairment

8. »Variety of seizure patterns
»Lobar manifestations rather than disease per se
»Proposed classifications on functional anatomy
˃Central
˃Premotor
˃Prefrontal
Dorsolateral and Medioventral in each
»Postural & tonic motor activity – Posterior
»Complex motor behaviours, autonomic & emotional
manifestations - Prefrontal

9. »Tumours (1/3rd)
˃Low grade gangliogiomas, low grade gliomas, epidermoid tumours
»Birth defects/ CNS malformations
»Vascular malformations
˃Arteriovenous
˃Cavernous angiomas
»Head trauma
»Encephalitis
»Genetic
˃Autosomal Dominant Nocturnal Frontal Lobe Epilepsy (ADNFLE)
»Syndromes
˃Benign Rolandic Epilepsy/BECTS
˃Aqd. Epileptiform Opercular Syndrome

10. »Sudden onset
»Brief
»Sudden termination
»During sleep
»Clusters
»Rapid 20 generalization
»Minimal postictal confusion
»Motor :Clonic, Asymmetric tonic posturing
»Gestural automatisms
»Adaptability

11. »Broca
˃Loss of an area of brain -> loss of function of that area ( Neurologic deficit)
»Jackson
˃Loss of an area of brain -> emergence of new function suppressed by that part ( Release phenomenon) “ Functional Uncoupling”

14. »Rolandic (Central) Epilepsy
»Characteristic “Jacksonian march”
»Focal clonic seizures (contralateral)
»Associated parietal postcentral (sensory) and frontal precentral (motor) “ reflex epilepsy”
˃Triggers : cutaneous stimulation, movement
˃Manifestations : motor , sensory
»Related Startle seizures : Infantile hemiplegia
»Rare : Epilepsia partialis continua

15. »B/L Proximal asymmetrical tonic posturing
˃“Fencing posture”
»Adversion of Head & Eyes
»Speech arrest/ Vocalization : Palilalia
»Facial symptoms
»Infrequent
˃Aura
˃Secondary generalization

17. »Ventral & Dorsal patterns
»Posterior spread – 2o generalisation
»VENTRO-MEDIAL PREFRONTAL
˃Complex partial seizures of frontal lobe origin
˃Intense subjective behavioural agitation : facial, screaming
˃Apparently purposeful gesticulation
˃Autonomic signs

18. »DORSO-LATERAL PREFRONTAL
˃Adversion of eyes preceding head version
˃Directed , compulsive or semi-purposeful automatisms
˃Complex motor patterns
˃Vocalizations without emotive content
˃Visual hallucinations
˃Compulsive thinking
˃Frontal absence

20. »Pavor nocturnus
»Sleep Apnoea
»Pseudo seizures
»Temporal Lobe Epilepsy
»Psychogenic movement disorders
»Familial paroxysmal dystonic choreoathetosis
»Paroxysmal kinesigenic choreoathetosis/ dyskinesia
»Episodic ataxia type I

21. »Neuroimaging
»Structural : MRI
»Functional : Non – invasive – EEG
˃VEEG
˃High resolution scalp EEG – source localization
»PET : FDG , Flumazenil
»Invasive : SEEG

26. »Medications
˃Oxcarbamazepine, Carbamezepine
˃Phenytoin
˃Levetiracetam
˃Gabapentin
»Surgical
˃Lobectomy
˃Multiple Sub - pial Resection
˃Vagus nerve stimulation
»Diet
˃Ketogenic diet

27. »Intellectual Disability
»Education, learning & cognitive function
»Physical health
»Mental & Emotional health
»Driving & Transportation restricted
»Employment
»Pregnancy

28. »H. Gray.Gray’s Anatomy of the Human Body 1st Edn (1918)
»Kliegman R. M. , Stanton B.F. , Geme J. W. S. , Schor N. F., Behrman R.E. Nelson Textbook of Pediatrics 19th Edn. (2012)
»McGonigal A. , Chauvel P. Frontal lobe epilepsy : seizure semiology and presurgical evaluation Practical Neurology, 2004, 4, 260–273
»Piña-Garza J. E. Fenichel’s Clinical Pediatric Neurology 7th edn. (2013)
»Rudolph’s Pediatrics 20th edn
»Brett E. M., Pediatric Neurology 3rd edn. (1997)
»Forfar and Arnell’s Textbook of Pediatrics 6th Edn.