What is Frontal Epilepsy in Children?
Frontal epilepsy is a chronic disease of the brain, accompanied by secondary convulsive seizures, loss of consciousness, and personality changes. A form of frontal epilepsy occurs in 15-20% of sick patients. Pathological foci are localized in the frontal lobes due to their primary lesion. The disease can occur at any age. The occurrence may be delayed, or may coincide with the course of the pathological process in the brain.
Causes of Frontal Epilepsy in Children
Frontal lobe epilepsy occurs due to injuries, arteriovenous malformations, focal atrophy, tumors, neuroinfection, and impaired neuronal migration or dysgenesis.
Pathogenesis during Frontal Epilepsy in Children
An epileptic seizure in this form can manifest itself as short attacks or long, in which the child can be unconscious for more than half an hour.
Frontal epilepsy is characterized by simple, complex (psychomotor) partial and secondary-generalized seizures. The most commonly observed psychomotor frontal seizures. Frontal epilepsy is localized in the additional motor zone, opercular, dorsolateral in the motor cortex. However, it is extremely difficult to determine the clear localization of the epileptogenic zone in the frontal lobe clinically and even when using special research methods.
Symptoms of Frontal Epilepsy in Children
Frontal epileptic seizures are characterized by significant variability in clinical manifestations. The disease is characterized by a sudden onset (often without an aura), a series of seizures, an extremely short duration (30-60 s), often consciousness remains (sometimes patients are able to fully describe or demonstrate their seizures), vocalization, pronounced, artsy motor phenomena (pedaling by feet) , chaotic movements, complex gesture automatisms), fast secondary generalization, lack of provoking factors.
Analysis of clinical symptoms can reliably distinguish three types of frontal attacks: simple partial motor paroxysms; psychomotor frontal attacks and attacks coming from the additional motor zone.
Simple partial motor paroxysms are manifested by one-sided convulsive twitching of facial muscles, less often convulsive twitching of the hand, and even less so – limbs. Focal clonic seizures are more often localized in one part of the body (face, hand, foot, arm, leg) or, much less often, extend to other areas of the motor cortex with sequential involvement of various parts of the body – the “epileptic march”. Sometimes, after an attack, Todd’s paralysis is observed (paralysis that occurs in the post-epileptic period after a focal or secondary epileptic seizure. It can persist for up to a day and helps determine localization).
Tonic postural and reverse seizures are characterized by the predominant involvement of the upper limbs (sidetracking and raising the arm up with a clenched fist), tonic rotation of the head and eyes, and often tonic casting of the upper and lower extremities on both sides. In most cases, the head and eyes are diverted to the contralateral side.
Simple motor paroxysms are often accompanied by secondary generalization. In some cases, generalization occurs so quickly that neither the patient nor those around him notice the partial motor onset of the attack, and only video monitoring of the attack allows the partial onset to be highlighted.
Psychomotor seizures (emanating mainly from the middle parts of the frontal lobe) are characterized by a shorter duration (30-60 s), a higher frequency (up to 10 per day – a cluster course), partial impaired consciousness and the absence or minimal post-attack confusion.
Frontal pseudo-absences with short-term impaired consciousness, speech loss, interruption of motor activity, gestural automatisms, and sometimes a tonic turn of the head and eyes are an option for a psychomoric attack.
Seizures originating from the additional motor zone occupy a special place among the frontal paroxysms, they are often mistakenly diagnosed as psychogenic seizures. Attacks are characterized by the preservation of consciousness or its partial violation. An attack may be preceded by a somatosensory aura. The dominant clinical symptoms of the attack are topical motor phenomena and automatisms. Typical localization of tonic motor phenomena in the proximal upper and lower extremities. The limbs accept elaborate protective poses, one-sided or bilateral, there may be a typical “fencer’s pose”, a tonic turn of the head and eyes. Automatisms are manifested by clapping hands, wheel-like rotation of the whole body (rhythmic movements of the pelvis, pedaling movements of the legs). Phonator symptoms are represented by a stop in speech or vocalization (screaming, howling sounds), there may be laughter.