Фронталды лоб эпилепсиясы: психикалық және ұйқы бұзылыстарымен байланысы

Form of epilepsy that may be related to a psychiatric problem or a sleep disorder

Frontal lobe epilepsy (FLE) is a neurological disorder that is characterized by brief, recurring seizures arising in the frontal lobes of the brain, that often occur during sleep. It is the second most common type of epilepsy after temporal lobe epilepsy (TLE), and is related to the temporal form in that both forms are characterized by partial (focal) seizures. Partial seizures occurring in the frontal lobes can occur in one of two different forms: either “focal aware”, the old term was simple partial seizures (that do not affect awareness or memory) “focal unaware” the old term was complex partial seizures (that affect awareness or memory either before, during or after a seizure). The symptoms and clinical manifestations of frontal lobe epilepsy can differ depending on which specific area of the frontal lobe is affected. The onset of a seizure may be hard to detect since the frontal lobes contain and regulate many structures and functions about which relatively little is known. During the onset of a seizure, the patient may exhibit abnormal body posturing, sensorimotor tics, or other abnormalities in motor skills. Medications such as anti epileptic drugs can typically control the onset of seizures, however, if medications are ineffective the patient may undergo surgery to have focal areas of the frontal lobe removed. In most cases, a patient will experience a physical or emotional aura of tingling, numbness or tension prior to a seizure occurring.

Episodes that include complex hyperactivity of the proximal portions of the limbs that lead to increased overall motor activity are called hypermotor seizures. When associated with bizarre movements and vocalizations these seizures are often misdiagnosed as psychogenic or functional sezures or other episodic movement disorders such as psychogenic movement disorders, familial paroxysmal dystonic choreoathetosis, paroxysmal kinesogenic choreoathetosis, or episodic ataxia type 1. One of the major reasons for FLE is abnormal cognitive development or sometimes congenital abnormal brain development.

When both the amount and severity of seizures becomes uncontrollable and seizures remain resistant to the various anticonvulsants, a patient most likely will be considered for epilepsy surgery. But, while performing it, there is the need for identifying or pinpointing the exact location of the seizure in the brain. This procedure involves the removal of focal regions of the frontal lobes that have been identified as being problematic for the patient. It has been found that around 30% to 50% of patients that undergo a frontal lobectomy will forever be free from seizures that cause a loss of consciousness or cause abnormal movements. However, frontal lobectomy and MCD contribute to lower seizure controls. But, in children with conditions like Sturge–Weber syndrome (SWS) or tumors, there is report of greater seizure control rates. If on the other hand, the seizures occur in an area that is too vital to remove (such as areas that control motor, sensory or language functions), then the surgeon will perform a procedure known as a multiple subpial transection. By making cuts surrounding the focal region, the surgeon is able to isolate that specific section of the brain and prevent electrical impulses from being able to travel horizontally to other areas of the brain. When the onset of an aura is felt, the stimulator can be activated which provides stimulation to the left vagus nerve (the left vagus nerve is used because the right nerve plays a role in cardiac function). Deep brain stimulation (DBS) is another procedure that can be used that utilizes a mechanism similar to that of a cardiac pacemaker.

The use of a ketogenic diet is recommended for those with intractable epilepsy. A ketogenic diet is a high fat, low carbohydrate diet recommended to be followed when appropriate, along with prescribed anticonvulsants. This diet was designed in order to mimic many of the effects that starvation has on the metabolic functioning of the body. and frontal lobe epilepsy accounts for about 1–2% of all epilepsies. Patients with medically refractive epilepsy, over a fraction of one fourth have been diagnosed with FLE, only one third of which have been found to get relief from seizures by surgical interventions. The disorder also has no gender or age bias, affecting males and females of all ages. In a recent study, the mean subject age with frontal lobe epilepsy was 28.5 years old, and the average age of epilepsy onset for left frontal epilepsy was 9.3 years old whereas for right frontal epilepsy it was 11.1 years old. In Gamma Knife radiosurgery, intersecting gamma radiation beams are applied directly to the tumor site or vascular malformation site that had been established using neuroimaging. The early success rates in being able to alleviate seizures seem to be similar to those of temporal resective surgery however Gamma Knife radiosurgery has less associated risk factors. Current research on this topic is aimed at improving the technique in order to increase success rates as well as developing non invasive forms of physiologic monitoring in order to determine the epileptogenic focus conclusively. Another way of understanding or studying FLE, highly under study is the network approach. When conventional imaging does not show the structural lesions, high frequency oscillation (HFO) analysis shows the pathophysiology, locally at the neural circuit level. Genetic analysis along with neuroimaging like fMRI, EEG, MEG, and in depth semiological analysis, aids in the network approach study of FLE, both at micro and macro levels, giving it a comprehensive view.