Frontal Lobe Seizure
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Overview
What is a frontal lobe seizure?
A frontal lobe seizure results from a period of abnormal electrical activity in the front section of your brain, behind your forehead. The frontal lobes are the largest of the four lobes in the brain. They’re responsible for:
- Behavior and personality.
- Cognition (thinking, learning and remembering).
- Movement.
- Speech.
Frontal lobe seizures are a type of partial (focal) epilepsy. This means that the seizures start in one area of the brain instead of multiple areas. In addition to seizures, frontal lobe epilepsy can cause personality changes or sleep disturbances. It’s often misdiagnosed as a mental health disorder or sleep disorder.
What is nocturnal frontal lobe epilepsy?
Frontal lobe seizures can affect people while they’re awake or asleep, but are more common at night. Nocturnal frontal lobe epilepsy (NFLE) occurs when people only experience the seizures in their sleep.
Who gets frontal lobe seizures?
Frontal lobe seizures can occur in people of any age or gender. The risk factors are similar to those of epilepsy and include:
- Being born with brain abnormalities.
- Having a developmental disability.
- Having a family history of seizures or epilepsy.
- Having brain injuries or infections.
- Having seizures in infancy or early childhood.
How common is frontal lobe epilepsy?
Frontal lobe epilepsy makes up approximately 20 to 30% of all focal epilepsies.
Symptoms and Causes
What causes frontal lobe seizures?
About half of frontal lobe seizures are the result of brain development problems. Sometimes the cortex, or outermost layer of the brain, doesn’t form properly during fetal development.
Other causes include:
- Brain infections.
- Brain injuries or trauma, such as a stroke.
- Brain tumors or lesions (abnormal growths).
One particular form of nocturnal frontal lobe epilepsy is due to a change in one or more genes. It’s inherited, meaning parents can pass it on to their children. This form, autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE), is very rare.
What are the symptoms of a frontal lobe seizures?
Frontal lobe seizures usually last a short time (less than 20 seconds), but they can happen in clusters. You may or may not lose consciousness or have problems with awareness.
Some people have an “aura”, or warning feelings, at the start of a frontal lobe seizure. An aura might make you feel dizzy or unbalanced, as if you’re falling. It can also cause tingling, numbness, hallucinations or a sense of fear or panic.
Frontal lobe seizures usually happen during sleep and can lead to:
- Abnormal behavior such as screaming, swearing or laughing.
- Head or eyes turning to one side.
- Leg movements such as kicking or pedaling.
- Pelvic thrusting.
- Sleep-walking.
- Thrashing.
- Twitching or jerking.
- Urinary incontinence (uncontrollable urine leakage).
After a frontal lobe seizure, you have memory loss or feel confused and groggy.
What are the potential complications of frontal lobe seizures?
Complications of frontal lobe seizures can include:
- Injuries: Some people get bruises, cuts, bone fractures or other injuries while they’re having a seizure. Tongue and dental injuries are also common.
- Status epilepticus: If a seizure lasts longer than five minutes or you don’t regain consciousness between seizures, it’s a medical emergency. Status epilepticus is a life-threatening condition.
- Sudden unexplained death in epilepsy (SUDEP): About 1 in 1,000 adults with epilepsy will die suddenly, for no clear reason. Experts aren’t sure what causes SUDEP.
Diagnosis and Tests
How is a frontal lobe seizure disorder diagnosed?
Your healthcare provider reviews your medical history and performs a physical exam. They may also do neurological testing. The following tests can help diagnose frontal lobe seizures:
- MRI: An MRI makes detailed pictures of the soft tissues in your brain. This scan can help your healthcare provider see tumors, lesions or other problems that might be causing seizures.
- Electroencephalography (EEG): An EEG records the electrical activity in your brain. Your healthcare provider may do an ictal (during a seizure) or inter-ictal (between two seizures) EEG. The EEG helps determine which part of your brain the seizures start in.
- Stereoelectroencephalography (SEEG): During SEEG, a healthcare provider does surgery to implant electrodes in your brain. These devices can find seizure activity deep in your brain, in areas that an EEG might not detect.
- Video EEG: A video EEG records your movements and behavior alongside your brain’s activity. You may stay overnight in a hospital for video-EEG monitoring or a sleep study, especially since most frontal lobe seizures occur during sleep.
Management and Treatment
How are frontal lobe seizures treated?
Your healthcare provider may treat frontal lobe seizures with:
- Medication.
- Diet.
- Neuromodulation.
- Surgery.
How can medication treat frontal lobe seizures?
Anti-seizure medication, such as oxcarbazepine or other drugs, is usually the first treatment for frontal lobe seizures. It regulates electrical activity in your brain, stopping seizures or reducing their frequency. But for about 30% of people, the medications are not fully effective. In these cases, healthcare providers consider the possibilities for other treatments such as surgery.
How can my diet treat frontal lobe seizures?
Your healthcare provider may recommend a special diet if your seizures don’t improve with medication. The ketogenic diet for epilepsy is a high-fat, low-carbohydrate diet that changes how your cells use energy. About 50% of people who adjust their diet have fewer seizures; 10% are free from seizures. It tends to be more effective for children with epilepsy. Adults have a harder time sticking to the strict diet.
How can surgery treat frontal lobe seizures?
People who have frontal lobe seizures that don’t respond to medication may consider epilepsy surgery. During a frontal lobe resection, a surgeon removes the part of your frontal lobe that is causing seizures.
Before surgery, the surgeon makes detailed maps of your brain using imaging scans. They may also surgically implant electrodes to do a specialized EEG from recording inside your brain. All of this information helps your neurologist and surgeon to:
- Target the specific areas of your brain causing seizures.
- Avoid damaging areas of the frontal lobe that control important functions.
How can neuromodulation treat frontal lobe seizures?
Neuromodulation is a therapy using electrical stimulation to change the way brain cells work. Your healthcare provider may recommend neuromodulation for your seizures if medications don’t work and surgery is not an option. Common types of neuromodulation include:
- Vagus nerve stimulation (VNS): A small device implanted under the skin of your chest connects to a wire. The wire wraps around your vagus nerve and sends mild impulses to the nerve. VNS works like a pacemaker for your brain.
- Responsive neurostimulation (RNS): RNS is similar to VNS, but the stimulators are in your skull. RNS monitors your brain’s activity and only sends electrical impulses when it detects you’re about to have a seizure.
- Deep brain stimulation (DBS): You have surgery to implant the DBS device in your brain. Wires attach it to a neurostimulator, which your healthcare provider programs like a computer. It sends electrical currents to your brain on a set cycle. Some VNS devises also sense changes in your heart rate which indicate that a seizure is starting and send electrical currents to stop it from evolving.
Prevention
How can I prevent frontal lobe seizures?
There’s no way to prevent frontal lobe epilepsy, but you may be able to prevent or limit the number of seizures you have by:
- Avoiding seizure triggers, such as stress, alcohol, drugs, flashing lights or not getting enough sleep.
- Eating a healthy diet, or maintaining a specialized ketogenic diet.
- Taking your anti-seizure medicine as prescribed.
Outlook / Prognosis
What is the outlook for people with frontal lobe seizures?
Some people need medication to manage seizures for the rest of their lives. For others, seizures may stop over time and medication isn’t needed anymore. Never stop your medication or change the amount you take without talking to your healthcare provider.
Living With
What can I do to make living with frontal lobe epilepsy easier?
If you have frontal lobe epilepsy:
- Stay in close communication with your healthcare provider. Contact them right away if there are any changes in your condition.
- Make sure close family and friends are aware of your condition and know what to do if you have a seizure.
- Watch out for any sudden changes in your mood. Some anti-seizure medications can increase the risk of suicidal thoughts or actions.
Contact a healthcare provider right away if you experience thoughts of suicide. You can call the National Suicide Prevention Lifeline at 800.273.8255. This hotline connects you to a national network of local crisis centers for free and confidential emotional support. The centers support people in suicidal crisis or emotional distress 24 hours a day, 7 days a week. In an emergency, call 911.
A note from Cleveland Clinic
Frontal lobe seizures are a form of epilepsy. They start in the front part of your brain and usually occur during sleep. These seizures can affect children or adults. Anti-seizure medication is usually the first line of treatment for frontal lobe epilepsy. Other treatments include surgery, special diets or devices that regulate your brain activity.
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