A detailed analysis of frontal lobe seizure semiology in children younger than 7 years

Purpose: We sought to analyze semiology of seizure onset and evolution in y oung children with frontal lobe epilepsy (FLE), compare this with adult rep orts, and assess age-related differences. Methods: We analyzed III videotaped seizures from 14 patients with FLE base d on focal cortical dysplasia aged 3-81 months (mean, 30 months). Ictal eve nts were categorized into behavioral, consciousness, autonomic, and sensory features, as well as motor patterns, which included tonic, clonic. epilept ic spasm, and myoclonic seizure components. We developed a time-scaled data sheet to record each epileptic event as onset, very early, early, or late m anifestation. Results: Patients had a high seizure frequency with up to 30 attacks/day; h alf of them showed a cluster tendency. Forty-seven percent of the seizures started in sleep. Mean duration of seizures was short (29 s). Most common s eizure components were motor manifestations, mostly tonic-clonic seizures, and epileptic spasms. Behavioral change was frequent, and hypermotor seizur es were not seen. In five patients, the motor features were contralateral t o the epileptic focus, including two children with asymmetric epileptic spa sms. Secondarily generalized tonic-clonic seizures (SGTCSs) were not record ed, but had been reported in the history of two patients. Complex motor aut omatisms were not seen, whereas oral automatism appealed in three children. Conclusions: Motor features are common in young children with FLE, as repor ted in adults. The characteristics, however, differ. Epileptic spasms and s ubtle behavioral change were frequent. Hypermotor seizures and complex moto r automatisms were not seen, and SGTCSs were unusual. Our results suggest t hat FLE in young children shows age-related features differing from those o f adults.