Frontal lobe seizures

Diagnosis

Frontal lobe epilepsy can be hard to diagnose. Its symptoms can be mistaken for mental health conditions or sleep disorders, such as night terrors. It also is possible that some symptoms of frontal lobe seizures are the result of seizures that begin in other parts of the brain.

To make a diagnosis, a healthcare professional reviews your symptoms and medical history. You may have a physical exam and blood tests to check for other health conditions that could be causing the seizures.

You might need a neurological exam to test your:

• Muscle strength.
• Sensory skills.
• Hearing and speech.
• Vision.
• Coordination and balance.

Several scans and imaging tests can help diagnose frontal lobe seizures:

• An electroencephalogram (EEG) monitors the electrical activity in the brain. This is done by attaching small metal disks called electrodes to the scalp. EEGs often help diagnose some types of epilepsy, but they may not identify frontal lobe epilepsy.

  Video monitoring may be used along with EEG. This is usually done during an overnight stay at a sleep clinic. A video camera and an EEG monitor you through the night. A video EEG allows healthcare professionals to match what physically happens during a seizure with what appears on the EEG.

• CT and MRI scans look for physical issues in the brain that can cause seizures, such as tumors and cysts. A functional MRI (fMRI) shows if there are issues with how different areas of the brain are working.
• Positron emission tomography (PET) scans show chemical activity and metabolism levels in the brain, which can help identify where a seizure started and ended.

Treatment

Over the past decade, treatment options have increased for frontal lobe seizures. There are several types of medicines to treat seizures. There also are a variety of surgical procedures that may help if medicines don't work.

Medications

Most antiseizure medicines work equally well at controlling frontal lobe seizures. But not everyone becomes seizure-free on medicine. You may need to try different medicines. Or you may need to take a combination of medicines to manage your seizures. Researchers continue to look for new and more effective medicines.

Surgery

If medicine does not control your seizures, surgery might be an option. Before surgery, the goal is to find the areas of the brain where your seizures happen.

Imaging tests can help identify the area that causes the seizure. Tests may include:

• Single-photon emission computerized tomography (SPECT). SPECT uses a tracer to find where the seizure starts in the brain. A tracer is a contrast material injected into the blood that shows blood flow during a seizure. Scans are done during and after the seizure, then compared. The seizure area has higher blood flow. This test may require an overnight stay.
• Stereoelectroencephalography (SEEG or stereo EEG). With SEEG, electrodes are surgically implanted into the brain where the seizures are happening. SEEG can help determine if an individual is a candidate for epilepsy surgery.
• Brain mapping. Brain mapping is commonly used before epilepsy surgery. Brain mapping involves implanting electrodes into an area of the brain. Then electrical stimulation is used to determine whether that area has an important function. This helps to rule out surgery on certain areas of the brain. Functional MRI (fMRI) is used to map the brain's language area.

If you have surgery for frontal lobe seizures, it's likely you'll still need antiseizure medicine after the surgery. But surgery may allow you to take a lower dose.

Surgery for epilepsy might involve:

• Removing the focal point. If your seizures always begin in one spot in your brain, this spot is called the focal point. You may have surgery to remove that small area of brain tissue. This might reduce the number of seizures you have. Or it might stop your seizures.
• Isolating the focal point. Sometimes, the area of the brain that causes seizures is too vital to remove. When this happens, surgeons might make a series of cuts to help isolate that section of the brain. This prevents seizures from moving into other parts of the brain.
• Vagus nerve stimulation (VNS). This procedure involves implanting a device similar to a cardiac pacemaker under the skin of the chest. The device sends pulses that stimulate the vagus nerve. This procedure usually lowers the number of seizures.
• Deep brain stimulation (DBS). This procedure involves making small holes in the skull to implant the electrodes into brain tissue. The electrode is connected to a pacemakerlike stimulating device under the skin of the chest. The device sends signals to the electrode in the brain to stop the activity that triggers a seizure.
• Responsive neurostimulation (RNS). This procedure involves implanting an electrode into the brain where the seizures likely start. It is placed within the bones of the skull and hidden under muscles and hair. The electrode is connected to an EEG device. The device detects the start of a seizure and then delivers a signal to that area of the brain to stop the seizure.

Alternative medicine

Some people with neurological conditions, including seizures, turn to complementary and alternative medicine, such as:

• Herbs.
• Acupuncture.
• Psychotherapy.
• Mind-body techniques.
• Homeopathy.

Researchers are looking into these therapies to determine their safety and effectiveness. However, strong evidence that they effectively reduce seizures is limited. There is some evidence that a ketogenic diet might be effective for treating seizures, particularly in children. A ketogenic diet is a strict high-fat, low-carbohydrate diet.

People often use herbs to try to reduce their seizures. But there's not much evidence that herbs are effective. Some herbs can cause an increased risk of seizures.

Marijuana, also known as cannabis, is one of the most commonly used herbs for treating epilepsy. The U.S. Food and Drug Administration has approved Epidiolex, a medicine that contains the purified marijuana chemical cannabidiol (CBD). The medicine was approved to treat two rare forms of severe childhood epilepsy: Dravet syndrome and Lennox-Gastaut syndrome. Epidiolex also was approved to treat seizures caused by tuberous sclerosis complex, a rare condition where tumors that are not cancer grow on the brain. CBD hasn't been approved for any other type of epilepsy.

Researchers are studying how effective CBD may be for treating other types of seizures. They're also studying its potential risks, including how CBD interacts with antiseizure medicines. Cannabis products have been reported to make seizures worse.

The FDA doesn't currently regulate herbal products. Herbs can interact with antiseizure medicines, putting your health at risk. Talk to a healthcare professional before taking herbal or dietary supplements for your seizures.

Lifestyle and home remedies

You may find that certain things trigger seizures. Seizures can be triggered by alcohol intake, smoking and, especially, lack of sleep. There also is evidence that severe stress can provoke seizures and that seizures themselves can cause stress. Avoiding these triggers when possible might help improve seizure control.

Coping and support

Some people who have epilepsy are frustrated by their condition. Frontal lobe seizures can involve loud utterances or body movements that may make the person with epilepsy anxious.

Parents of children with frontal lobe seizures can find information, resources and emotional connections from support groups. Support groups also can help children who have epilepsy. Counseling can be very helpful. Adults with epilepsy can find support through in-person and online groups.

Preparing for your appointment

You're likely to see a primary healthcare professional first. This person may refer you to a healthcare professional in nervous system conditions, called a neurologist.

What you can do

Ask a family member or friend to come with you to the appointment to help you remember the information you receive.

Make a list of:

• Your symptoms. Include even those that seem unrelated to the reason you scheduled the appointment, when they began and how often they happen.
• All medicines, vitamins and supplements you take, including doses.
• Questions to ask the healthcare professional.

Some questions to ask include:

• What is likely causing my symptoms or condition?
• Will I likely have more seizures? Will I have different types of seizures?
• What tests do I need? Do they require any special preparation?
• What treatments are available, and which do you recommend?
• I have other medical concerns. How can I manage them together?
• Is surgery a possibility?
• Will I have restrictions on my activity? Will I be able to drive?
• Are there brochures or other printed materials I can have? What websites do you recommend?

What to expect from your doctor

You're likely to be asked questions, such as:

• Did you notice any unusual sensations before the seizures?
• How often do the seizures happen?
• Can you describe a typical seizure?
• How long do the seizures last?
• Do the seizures happen in clusters?
• Do they all look the same or are there different seizure behaviors you or others have seen?
• Have you noticed seizure triggers, such as illness or lack of sleep?
• Has anyone in your immediate family ever had seizures?

Living with frontal lobe seizures?

Connect with others like you for support and answers to your questions in the Epilepsy & Seizures support group on Mayo Clinic Connect, a patient community.

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