The syndrome of frontal lobe epilepsy: characteristics and surgical management

We reviewed the historical features, preoperative diagnostic evaluation, operative procedure, and surgical outcome in 16 patients with refractory frontal lobe epilepsy. Clinical expression of the epilepsy varied widely, particularly with respect to seizure characteristics, although high monthly seizure frequency and absence of a risk factor for epilepsy before age 5 occurred more often than in reported in temporal lobe epilepsy patients. Seizures often caused early bilateral movements, were brief, and lacked oroalimentary automatisms and a prolonged postictal state. Both the interictal and ictal scalp EEGs had relatively poor sensitivity and specificity and often either contained no epileptiform abnormalities or were misleading. MRI usually identified structural lesions when these were present, although it was negative in two patients with tumors. In the absence of an MRI lesion, intracranial EEG usually identified the area to be resected, although it too provided misleading information in one case. Surgical procedures consisted of focal resections with or without anterior corpus callosotomy, or of corpus callosotomy alone. Nearly all patients improved after surgery, with a majority (67%) becoming seizure-free (average follow-up, 46 months). Preoperative seizure frequency correlated with seizure relief after surgery, as did age of seizure onset, whereas presence of tumor did not. We conclude that frontal lobe epilepsy warrants aggressive investigation and that surgical treatment often can be successful.