Frontal lobe epilepsy

Frontal lobe epilepsy is relatively frequent in children. Seizures are usually brief (seconds to tens of seconds) and sleep-related. They are highly stereotyped in the same patient. Arousal from sleep, with opening of the eyes and a frightened expression is often the first ictal manifestation. Consciousness disruption is variable but recovery of awareness is fast. Subjective symptoms are ill defined. Onset of motor phenomena is with tonic asymmetric posturing or repetitive hyperkinetic automatisms. Most children exhibit organised movements of the proximal limbs (hypermotor seizures). Epileptic nocturnal wanderings are longer attacks (2—3 min) with arousal from sleep and an ambulatory behaviour during which a frightened child might scream and attempt to escape. Frontal lobe seizures in the awake child can cause violent drop attacks. Interictal and even ictal EEG is often normal, or shows abnormalities that enable neither lateralisation nor localisation.

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