PEs are ranked second in frequency of occurrence among partial epilepsy (20–30% Manford, 1995).
Etiology. Etiological factors determining the development of PE include traumatic brain injury, tumors, birth trauma, brain dysgenesis, neuroinfection, etc. (Rasmussen,Ush).
Clinic. Frontal epilepsy can manifest at any age and depending on
localization of the epileptogenic zone is characterized by simple, complex (psychomotor) partial or secondary-generalized paroxysms. Psychomotor frontal attacks are most often observed. In comparison with the temporal, frontal psychomotor attacks have a number of fundamental differences. They, unlike the temporal, have a shorter duration, a higher frequency, are characterized by a partial impairment of consciousness and the absence or minimal post-attack confusion. In the clinical picture of an attack of PE, one-sided or bilateral tonic postures, pedaling movements, tonic deviation of the head and eyes, complex gestural automatisms, vocalization are most often observed. Frontal paroxysms are often observed in a dream. In 42.5% of patients with frontal epilepsy seizures occur suddenly, without a prior aura. (So, 1993).
Diagnosis of frontal paroxysms and localization of the epileptogenic zone within the frontal lobe often represent great difficulties. An erroneous diagnosis of “psychogenic paroxysms” or “paroxysmal sleep disorders” is established for many patients with frontal epilepsy. The reasons for such diagnostic errors are mainly the nighttime nature of the frontal paroxysms, unusual motor manifestations, the lack of consciousness in some cases at the time of the attack, the low informative significance of the interictal EEG.
From a practical point of view, the most adequate is the division of frontal epilepsy into three clinical and electrophysiological syndromes:
1) seizures emanating from the additional motor area;
2) focal motor paroxysms;
3) psychomotor frontal attacks Luders et al, 1993; Salanova etal, 1995).
For seizures emanating from the additional motor zone, are characterized by safety
Consciousness or partial violation of it, often a somatosensory aura, postural tonic poses (“fencer posture”) with predominant involvement of the proximal limbs, tonic rotation of the head and eyes, speech stopping or vocalization (shrieks, howling sounds), pedaling with foot movements, mydriasis.
With focal motor paroxysms, consciousness is preserved, mainly in the distal extremities, partial myoclonias (one-sided or bilateral), simple partial motor seizures (with predominant involvement of the upper limbs and face), tonic partial paroxysms, blinking, clonic eye twitching, tonic rotation of the head and eye are recorded. .