Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey; Istanbul University, Graduate School of Health Sciences, Department of Neuroscience, Istanbul, Turkey; University of Health Sciences, Sancaktepe Training and Research Hospital, Department of Neurology, Istanbul, Turkey.
Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey.
Clin Neurol Neurosurg. 2021 Apr;203:106532. doi: 10.1016/j.clineuro.2021.106532. Epub 2021 Feb 8.
Frontal lobe epilepsy (FLE) is the second most common epilepsy among drug-resistant focal epilepsies. Semiologic and electrophysiologic features of FLE present some difficulties because frontal lobe seizures are brief, accompanied by complex motor activities and emotional signs. The rich connectivity of the frontal lobe with other areas leads to the rapid and widespread propagation of seizure activity, which contribute to the difficulty of evaluating the semiologic and EEG patterns of the seizure. In this study, we investigated semiologic, interictal, ictal, and postictal EEG characteristics; the imaging data of patients with FLE and the possible contribution of these data to localization and lateralization of seizures.
The medical records of patients who were diagnosed as having FLE between 2010 and 2019 in our clinic were evaluated retrospectively. The diagnosis of FLE was considered either when patients had a structural lesion in the frontal region or seizure semiology and EEG characteristics were compatible with FLE. Clinical, electrophysiologic, and imaging features were investigated in these patients.
We have evaluated 146 seizures in 36 patients (17 lesional and 19 non-lesional according to MRI). There were 110 focal motor or nonmotor seizures, 18 bilateral tonic-clonic seizures, and 18 subclinical seizures. There were 16 patients with aura. The most common semiologic feature was hyperkinetic movements. Among the interictal EEGs, 30.5 % included focal anomalies. Among the ictal EEGs, 69.1 % were non-localizing or lateralizing. The most common ictal pattern was rhythmic theta activity (21.2 %). In four patients, who had non-localizing or lateralizing EEG, the postictal EEG was informative. Our study showed a low percentage of localized FDG-PET, which, however, involved visual analysis.
Our results support the previously known difficulties in the determination of the epileptogenic zone of FLE. Semiologic and electrophysiologic correlation studies, longer postictal records, and quantitative analysis of FDG-PET may contribute to a better characterization of the disease.
额叶癫痫（FLE）是耐药性局灶性癫痫中第二常见的癫痫类型。FLE 的症状学和电生理学特征存在一些困难，因为额叶发作时间短，伴有复杂的运动活动和情绪迹象。额叶与其他区域的丰富连接导致发作活动的快速广泛传播，这导致评估发作的症状学和 EEG 模式变得困难。在这项研究中，我们研究了 FLE 患者的症状学、发作间期、发作期和发作后 EEG 特征；FLE 患者的影像学数据以及这些数据对定位和偏侧化的可能贡献。
回顾性评估了 2010 年至 2019 年在我们诊所诊断为 FLE 的患者的病历。当患者在额叶区域有结构性病变或发作的症状学和 EEG 特征与 FLE 相符时，考虑诊断为 FLE。对这些患者进行了临床、电生理和影像学特征的研究。
我们评估了 36 名患者的 146 次发作（17 例有结构病变，19 例无结构病变）。有 110 次局灶性运动或非运动性发作，18 次双侧强直阵挛发作，18 次亚临床发作。有 16 名患者有先兆。最常见的症状学特征是多动。在发作间期 EEG 中，30.5%包括局灶性异常。在发作期 EEG 中，69.1%是非定位或偏侧化的。最常见的发作模式是节律性θ活动（21.2%）。在 4 名 EEG 无定位或偏侧化的患者中，发作后 EEG 有信息。我们的研究显示 FDG-PET 的局部化比例较低，但进行了视觉分析。
我们的研究结果支持之前已知的 FLE 致痫区确定的困难。症状学和电生理学相关性研究、更长的发作后记录和 FDG-PET 的定量分析可能有助于更好地描述该疾病。
