Ictal semiology in fronto-opercular epilepsy: A systematic review

Area of Science:

• Neurology
• Epileptology
• Neurosurgery

Background:

• Fronto-opercular epilepsy is a rare focal epilepsy.
• Understanding its ictal semiology is crucial for pre-surgical evaluation.
• Anatomical-clinical correlations can guide the interpretation of seizure manifestations.

Purpose of the Study:

• To systematically review the ictal semiology of fronto-opercular seizures.
• To assess anatomical-clinical correlations in fronto-opercular epilepsy.
• To aid in the interpretation of ictal semiology during pre-surgical planning.

Main Methods:

• Systematic review of PubMed and Embase databases.
• Keywords included "fronto-opercular" and "epilepsy" or "seizure".
• Included case series and case reports with specific resection or electroencephalogram (EEG) criteria.

Main Results:

• 21 patients from 16 studies were included.
• Auras (non-painful somatosensory sensations) occurred in 67% of patients.
• Ictal signs included motor orofacial/brachial symptoms, speech dysfunction, and respiratory symptoms, with preserved consciousness.

Conclusions:

• Pure fronto-opercular epilepsy is rare.
• Contralateral elementary sensory aura, especially for the Rolandic operculum, is a key feature.
• Motor orofacial and brachial symptoms with preserved consciousness are common ictal signs.