Complex Partial Seizures of Frontal Lobe Origin with Hypermotor Automatisms

Complex partial seizures of frontal lobe origin have complex, behavioral manifestations. These were initially recognized by the French school (15,35), later described by Williamson (13), and shortly thereafter also by Waterman (17). They described behavior that was bizarre and explosive. Because the behavior is so peculiar and emotional, this type of seizure is frequently mistaken as nonepileptic or psychogenic seizures. In childhood, other diagnoses, such as Tourette's syn drome, are frequently considered as differential diagnoses (Table 2.1) (see also Chapter 12).

Complex partial seizures of frontal lobe origin begin suddenly or explosively with bizarre automatisms. Automatisms may consist of stepping, bicycling, jumping out of bed, running around, pounding, or rocking. These automatisms involve the upper and lower extremities and always involve complex movements. This behavior is frequently accompanied by violent yelling and shouting, which gives the seizure an even more bizarre appearance. Vocalization is often understandable and may have emotional contents. It can be formed (swearing, shouting) as well as unformed (production of sounds such as growling or grunting). The patient often has preserved consciousness, which makes these automatisms peculiar, as the patient has no control over his motor behavior, but is fully aware of the seizures. The seizures often have a nocturnal preponderance and occur in clusters. However, behavior throughout these seizures is stereotyped and seizures are very brief, which distinguishes them from nonepileptic events. The patient often returns immediately back to normal without apparent postic-

TABLE 2.2

Diffential Diagnosis of Masticatory Seizures, Vocal Tics, Tardive Dyskinesia, and Syndenham's Chorea

Masticatory

Tardive

Syndenham's

Seizures

Vocal Tics

Dyskinesia

Chorea

Duration

Brief, intermittent,

Brief, intermittent,

Continuous

Continuous, lasting

and frequency

frequent

frequent, worse

several weeks then

with attention

disappearing

Motor

Stereotyped mouth

Vocalization of sounds,

Orolingual and

Chorea of multiple

manifestations

movements

tongue protrusion,

masticatory

muscle groups,

can be variable

movements

including face

in appearance

and extremities

Speech

Speech arrest

Echolalia, production

No major speech

Only impaired if

of sounds

impairment

involvement of

orolingual muscles

Associated

Tonic mouth movement,

Tongue protrusion

Previous intake

Previous

features

salivation, throat

of neuroleptics

streptococcal

constriction

infection

Age of onset

Childhood

Childhood

Adulthood

Between 5-15 years

and adolescence

of age

Spontaneous

Uncommon

Common

Uncommon

Always

remission

EEG changes

Common

Normal

Normal

Normal

tal confusion after this typically brief (15-30 seconds) seizure (16). Ictal EEG may not always be helpful in distinguishing between epileptic and nonepilep-tic events, as scalp EEG recordings can show very little epileptiform activity during these seizures, especially if they originate on the mesial surface of the frontal lobes.

Complex partial seizures of frontal lobe origin were localized to various areas in the prefrontal cortex, namely the dorsolateral cortex, the orbitofrontal region, and the mesial frontal cortex (14,15,17). Currently, no definite localization within these areas of the frontal lobe can be made since large areas of the prefrontal cortex are clinically silent (12). The clinical characteristics represent the overall spread pattern, possibly as a release or disinhibition phenomen. For that reason, it is more difficult to identify the seizure origin unless there is a definite abnormality on imaging studies. Epilepsy surgery can be successful even in the absence of an obvious lesion (12).

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Responses

  • nicola
    Where does compex patial seizures originate?
    6 years ago
  • hyiab
    How to distinguish partial complex seizures from tardative diskensia?
    6 years ago

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