Drug-resistant frontal lobe epilepsy: A review

Drug-resistant frontal lobe epilepsy is a challenge in epilepsy surgery because it is the second most common epilepsy type after temporal lobe epilepsy. Additionally, the frontal lobe is the largest brain lobe, making the localization of epileptic foci difficult, thereby preventing necessary surgery and improving seizure control. This review discusses the epidemiology and aetiology of drug-resistant frontal lobe epilepsy, demonstrating that cortical developmental manifestations constitute the most common aetiology of epileptic focus. Additionally, we reviewed the anatomy and symptoms of frontal lobe seizures. The review discusses advances in the neurophysiological study, including magnetoencephalography and neuroimaging modalities, such as quantitative PET scans and 7T MRI, for lesion detection and outcome improvement in frontal lobe epilepsy surgery. Although 7T MRI is unavailable in many epilepsy centres, the imaging modality can increase the rate of lesion detection, particularly when its findings are confirmed using depth electrode implantation, along with the utilization of artificial intelligence and machine learning in interpreting the morphometric analysis of MRI and nuclear imaging.