Frontal lobe seizures
Frontal lobe epilepsy is a type of seizure disorder affecting your frontal lobes. It causes frontal lobe seizures, which is a pattern of abnormal electrical activity in your brain.
The frontal lobes are the largest of the four lobes in your brain. They’re located behind your forehead. There’s a lobe on the left and right side. They’re responsible for your:
- Behavior and personality
- Cognition (thinking, learning and decision-making)
- Movement
- Speech
Frontal lobe seizures are a type of focal (partial) seizure. This means that the seizures start in one area of your brain. Seizures can start on either the left or right frontal lobe.
It’s often misdiagnosed as a mental health disorder or sleep disorder, as these seizures often happen at night. A healthcare provider can help you manage them.
Autosomal dominant sleep-related hypermotor epilepsy (formerly known as autosomal dominant nocturnal frontal lobe epilepsy and nocturnal frontal lobe epilepsy) is a seizure disorder that happens during sleep. This type of frontal lobe epilepsy typically runs in families.
The main symptom of frontal lobe epilepsy is a brief focal seizure (a seizure that starts in one area of your brain).
The features of a frontal lobe seizure can include:
- Abnormal behavior such as screaming, laughing or swearing
- Turning your head or eyes to one side
- Leg kicking or pedaling
- Thrashing or convulsions
- Uncontrolled, repetitive movements (like arm and leg waving)
- Twitching or repetitive jerking
- Loss of consciousness or awareness (staring off into space)
- Urinary or fecal incontinence
- Muscle weakness
- Difficulty speaking
- Personality changes
- Sleep disturbances
These usually occur in clusters (when you have more than two seizures in 24 hours). They often happen while you’re asleep but may happen when you’re awake. They also tend to be short, lasting less than a minute.
You may experience an aura or unusual feelings before a seizure starts. These feelings could include:
- Sudden emotional changes like fear, anxiety, anger, sadness or joy
- Abnormal sensations (like numbness or tingling)
- Altered senses (smell, hearing, sight, taste or touch)
After a frontal lobe seizure, you may have confusion, memory loss or muscle soreness. This is the postictal state.
Abnormal electrical activity in your frontal lobe causes frontal lobe epilepsy. Neurons (nerve cells) usually send signals to other cells in your brain. When a frontal lobe seizure happens, neurons fire signals uncontrollably.
Common reasons why this may happen could include:
- Abnormal formation of your brain during fetal development
- Brain infections
- Stroke
- Traumatic brain injury
- Brain tumor
- Genetic variations
Sometimes, the cause isn’t known.
Can you inherit frontal lobe epilepsy?
Yes, you can inherit one type of frontal lobe epilepsy from your biological parents, although this is rare. A type of sleep-related hypermotor epilepsy is an autosomal dominant condition. This means a child can inherit it if one biological parent passes on the genetic variant to the child.
What are the risk factors for frontal lobe epilepsy?
Frontal lobe epilepsy can affect anyone at any age. You may be more at risk of developing frontal lobe epilepsy if you:
- Have a biological family history of epilepsy
- Had a brain infection at a young age
- Experienced a stroke, traumatic brain injury, or have a tumor or lesion on your frontal lobe
- Have a developmental delay
- Were born with brain abnormalities
What triggers frontal lobe seizures?
Triggers are things that may make seizures more likely to happen. Common triggers may include:
- Stress
- Flashing lights
- Sleep deprivation
- Substance use
These differ for each person. It helps to keep track of what you were doing or how you felt before a seizure started to identify what may be triggering for you.
Are frontal lobe seizures dangerous?
Frequent frontal lobe seizures may lead to the following:
- Increased risk of injuries
- Status epilepticus (seizures that last longer than five minutes), which is a life-threatening emergency
- Sudden unexplained death in epilepsy (this is rare)
Having seizures can often have a significant impact on your mental health and emotional well-being. You may consider talking with a mental health professional in addition to other treatments recommended by a healthcare provider.
Contact a provider right away if you experience thoughts of suicide. You can also call or text the Suicide and Crisis Lifeline at 988 (U.S.). This hotline connects you to a national network of local crisis centers for free and confidential emotional support. The centers support people in suicidal crisis or emotional distress 24 hours a day, seven days a week.
To diagnose frontal lobe epilepsy, your healthcare provider will review your medical history and perform a physical exam. Testing helps confirm a diagnosis.
What tests diagnose frontal lobe epilepsy?
The following tests can help diagnose frontal lobe epilepsy:
- MRI: An MRI makes detailed pictures of your brain. This scan can help your provider see tumors, lesions or other problems that might be causing frontal lobe seizures.
- Electroencephalography (EEG): An EEG records the electrical activity in your brain. The EEG helps determine the starting location of the seizure.
- Video EEG: A video EEG records your movements and behavior alongside your brain’s activity. You may need to stay overnight in a hospital for video-EEG monitoring. Sometimes, a sleep study is done, especially as most frontal lobe seizures occur during sleep.
- Stereoelectroencephalography (SEEG): During SEEG, a surgeon implants electrodes in your brain. These devices detect seizure activity deep in your brain, in areas that an EEG might not find. SEEG is typically done if your seizures aren’t responding to medications and if brain surgery is considered to treat seizures.
- Magnetoencephalography (MEG): An MEG test records magnetic activity produced by brain electrical activity and can help determine the location of the abnormal activity in your brain.
Your provider may also do neuropsychological testing to learn more about whether or not seizures affect brain functioning.
The goal of frontal lobe epilepsy treatment is to reduce how many frontal lobe seizures you experience. Your healthcare provider may recommend the following:
- Antiseizure medications
- Epilepsy surgery
- Neuromodulation
In addition, your provider may recommend changing the foods you eat to a high-fat, low-carbohydrate meal plan (ketogenic diet for epilepsy).
Frontal lobe seizure medication
Antiseizure medications may help you manage frontal lobe seizures. These medications regulate electrical activity in your brain and may reduce the frequency of seizures. These are usually the first line in managing frontal lobe seizures.
Your provider will review your symptoms and prescribe medications to fit your needs. They’ll explain the possible side effects to look out for before you start taking a new drug. Your provider may need to adjust the dosage or type of medication you receive until they find one that works best for you.
Frontal lobe seizure surgery
A healthcare provider may consider epilepsy surgery if medications aren’t successful at managing frontal lobe seizures. Your healthcare provider may recommend a frontal lobe resection. This is where they remove the affected part of your frontal lobe where seizures start. They may also remove a brain tumor or other lesion in this area.
Before the procedure, your surgeon will make detailed maps of your brain using imaging scans. They may also surgically implant electrodes to do a specialized stereo-EEG (SEEG) from recording inside your brain. All of this information helps your surgical team:
- Target the specific areas of your brain causing seizures
- Avoid damaging areas of your frontal lobe that control important brain functions
Neuromodulation for frontal lobe seizures
In some cases, surgery may not be a safe option to treat frontal lobe seizures. Your provider may recommend neuromodulation. This treatment uses an implanted device that sends an electrical impulse, which may stop a seizure before it begins.
Common types of neuromodulation devices include:
- Vagus nerve stimulation (VNS): A surgeon will implant a small device under the skin of your chest. It connects to a wire. The wire wraps around your vagus nerve in your neck and sends impulses to the nerve. Some VNS devices can detect a change in heart rate during a seizure and send additional electric impulses to the vagus nerve.
- Responsive neurostimulation (RNS): RNS is a device implanted in your skull. RNS monitors your brain’s activity and only sends electrical impulses when it detects you’re experiencing a seizure.
- Deep brain stimulation (DBS): A surgeon will implant a DBS device in your chest. The wires are connected to the electrodes implanted in your brain. A healthcare provider programs this device to send electrical currents to your brain.
Your healthcare provider can give you the best information on what your outlook looks like. It varies from person to person based on many factors like your general health and how often you have seizures.
Medications may help you manage seizures long term. But sometimes, medications don’t work well for everyone. Surgery may be another option. While there isn’t a cure for frontal lobe epilepsy, many people report fewer seizures or seizure freedom with the right combination of medications or after surgery.
Your provider will let you know what treatment options they recommend to help you stay safe.
When should I see a healthcare provider?
Visit a healthcare provider if you experience new or worsening symptoms. Stay regular with your follow-up visits so your provider can make sure your treatment is working as expected. Let them know if you have side effects after starting a new medication.
What questions should I ask my healthcare provider?
If you have frontal lobe epilepsy, you should ask your provider:
- What type of treatment do you recommend?
- What are the side effects of treatment?
- Are antiseizure medications safe to take if I want to start a family?
- How do I keep myself safe during a seizure?
- Am I a candidate for surgery?
References
- American Association of Neurological Surgeons. Anatomy of the Brain (https://www.aans.org/patients/conditions-treatments/anatomy-of-the-brain/). Last reviewed 6/14/2024. Accessed 12/2/2024.
- Epilepsy Action (U.K.). Focal Seizures (https://www.epilepsy.org.uk/info/seizures/focal-seizures). Last updated 10/2024. Accessed 12/2/2024.
- Epilepsy and other seizure disorders. In: Ropper AH, Samuels MA, Klein JP, Prasad S, eds. Adams and Victor’s Principles of Neurology. 12th ed. McGraw-Hill Education, 2023.
- Epilepsy Foundation (U.S.). Sleep-related Hypermotor Epilepsy (SHE) (https://www.epilepsy.com/what-is-epilepsy/syndromes/sleep-related-hypermotor-epilepsy-she). Last reviewed 11/19/2019. Accessed 12/2/2024.
- Hirata S, Morino M, Nakae S, et al. Surgical Technique and Outcome of Extensive Frontal Lobectomy for Treatment of Intracable Non-lesional Frontal Lobe Epilepsy (https://pmc.ncbi.nlm.nih.gov/articles/PMC6970070/). Neurol Med Chir (Tokyo). 2020 Dec;60(1):17-25. Accessed 12/2/2024.
- McGonigal A. Frontal lobe seizures: overview and update (https://pubmed.ncbi.nlm.nih.gov/35006387/). J Neurol. 2022 Jun;269(6):3363-3371. Accessed 12/2/2024.
- Merck Manual Professional Version. Seizure Disorders (https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders). Last reviewed 1/2024. Accessed 12/3/2024.
- National Institute of Neurological Disorders and Stroke (U.S.). Epilepsy and Seizures (https://www.ninds.nih.gov/health-information/disorders/epilepsy-and-seizures). Last reviewed 7/19/2024. Accessed 12/2/2024.
- National Library of Medicine (U.S.). Focal Seizure (https://medlineplus.gov/ency/article/000697.htm). Last reviewed 3/31/2024. Accessed 12/2/2024.
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