Psychomotor frontal attacks are accompanied by impaired consciousness, gaze stopping, bilateral tonic tension of the hands, gestural automatism, pedaling, vocalization, tonic turning of the eyes and head. Possible secondary generalization.
The above types of frontal epileptic seizures are schematic. In the clinical picture of PE, the seizure polymorphism is expressed as no other type of epilepsy. This is due to the complexity of the structure and functional organization of the human frontal lobes. Thus, with the involvement of orbitofrontal regions, patients may have olfactory hallucinations and illusions, visceral sensory symptoms (abdominal, cardiac, thoracic, etc.), alimentary disorders (hunger, thirst), vegetative symptoms (pallor, facial redness, increased heart rate). If the epileptic process is localized in the middle parts of the frontal lobe with the involvement of cingular structures, during the attack the patient has an expression of fear on his face,
disturbance of consciousness, vocalization (screaming, swear words), complex gesture automatisms, emotional disturbances in the form of arousal, aggression, involuntary urination.
So, the most characteristic signs of frontal epilepsy (Luders, 1993; Chauvel, Bancaud, 1994) are: – pronounced stereotyped seizures;
- sudden onset of attacks (more often without aura);
- high frequency of attacks with a tendency to seriality;
- short duration of attacks – 30-60 seconds;
-expressed, often unusual movement phenomena (foot pedaling, chaotic
movements, complex gesture automatisms); - absence or minimal post-attack confusion;
- frequent occurrence of attacks in a dream;
- fast secondary localization.
- The diagnostic value of MRI studies with symptomatic frontal epilepsy is significantly lower than with temporal ones. Anomalies are found only in 30-40% of cases.
Treatment and prognosis. Symptomatic frontal epilepsy is often resistant to anticonvulsant therapy, often requires polytherapy (valproate + carbamazepine). The effectiveness of surgical treatment of frontal epilepsy is lower than that of temporal epilepsy.