THE SYNDROME OF FRONTAL-LOBE EPILEPSY - CHARACTERISTICS AND SURGICAL-MANAGEMENT

We reviewed the historical features, preoperative diagnostic evaluatio n, operative procedure, and surgical outcome in 16 patients with refra ctory frontal lobe epilepsy. Clinical expression of the epilepsy varie d widely, particularly with respect to seizure characteristics, althou gh high monthly seizure frequency and absence of a risk factor for epi lepsy before age 5 occurred more often than is reported in temporal lo be epilepsy patients. Seizures often caused early bilateral movements, were brief, and lacked oroalimentary automatisms and a prolonged post ictal state. Both the interictal and ictal scalp EEGs had relatively p oor sensitivity and specificity and often either contained no epilepti form abnormalities or were misleading. MRI usually identified structur al lesions when these were present, although it was negative in two pa tients with tumors. In the absence of an MRI lesion, intracranial EEG usually identified the area to be resected, although it too provided m isleading information in one case. Surgical procedures consisted of fo cal resections with or without anterior corpus callosotomy, or of corp us 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 no t. We conclude that frontal lobe epilepsy warrants aggressive investig ation and that surgical treatment often can be successful.