[Frontal lobe epilepsy--clinical seizure seminology]

The aim of this study was an analysis of the localizing and lateralizing value of clinical symptoms in frontal lobe epilepsy. Nineteen patients with medically refractory seizures originating from the frontal lobe were examined retrospectively, seven of these patients underwent subsequent neurosurgical removal of the epileptogenic zone. The predominant clinical symptoms were clonic (53%) and tonic motor phenomena (89%). Dystonic posturing (32%) and postictal paresis (37%) occurred frequently, indicating a seizure onset in the contralateral hemisphere. Head version contralateral to the seizure onset zone, as demonstrated in 53% of the patients, was a reliable lateralizing sign, whereas early head and eye turning (11%) had no lateralizing significance. 37% of the patients showed ictal vocalisation, another 37% presented with automatisms--so called hypermotor seizures should be considered as a special subtype. An aura was present in 26% of the patients--in most cases as a somatosensory manifestation or a feeling of dizziness, especially with seizures originating from the supplementary motor area (SMA) or the precentral area. Secondary generalization and seizure series occurred frequently. Unilateral automatisms, head version, tonic phenomena, dystonic posturing, unilateral grimacing, postictal paresis and unilateral clonic movements could be identified as reliable lateralizing signs. We conclude that the analysis of clinical symptoms plays an important role in presurgical epilepsy diagnosis.