Abstracts

RATIONALE: Since 1990 publications have written about extra-temporal lobe seizures. Frontal lobe seizures have been discussed in Advances in Neurology in vol. 57, 66 and with the neocortical epilepsies in vol. 84. This is the second most common type of partial seizure and some authors beleive it to be more prevelant but often misdiagnosed. The pediatric epilepsy literature does not seem to reflect the recognition of this newly described seizure type. They may be diagnosed as generalized seizures, pseudoseizures or psychiatric illness. Treatments used for these conditions would not be helpful to these children.
METHODS: Five cases of MEG/EEG positive frontal lobe epilepsy are described. Patients presented to pediatric neurologists, developmental/behavioral specialists or child psychiatrists and were diagnosed as either as a generalized seizure, pseudoseizures, language delay, autism or a psychiatric problem. None had typical generalized tonic clonic or complex partial seizures. All had psychiatric issues which seemed to hide any neurologic concerns. Presentations included variable speech, hyperactivity, night terrors, bed wetting,staring spells, behavior problems or unusual episodes. Histories told of learning and/or language skills and behavior which inexplicably were lost or erased periodically.
RESULTS: Case 1 is a 14 year old who appeared to have absence seizures with frequent staring spells and no post ictal state. She also had unilateral headaches and learning disabilities. Case 2 had very unusual right sided episodes involving the right hand and arm follwed by head and eye deviation every morning. Her EEG was read as negative with these episodes and were diagnosed as pseudoseizures. Case 3 is a child who at 17 months was diagnosed as schizophrenic with unconsolable crying and no language. Case 4 was a language delayed child with behavior problems. Case 5 was a hyperactive, non interactive child diagnosed as autistic.
CONCLUSIONS: Frontal lobe seizures have not impacted the pediatric epilepsy literature and may not be recognized by pediatric neurologists, development/behavioral specialists or child psychiatrists. These are the first line doctors who will see these children for an initial diagnosis. It is essential that pediatric neurologist know about this seizure type before these children are misdiagnosed and lost to effective medical help in this Burmuda triangle-like group of subspecialists. Factors besides the EEG, such as a history of fluctuations in learning and language acquisition, might help screening for epilepsy in younger children. A staring spell may be just a staring spell or it could be a frontal absence seizure with a deep frontal focus and no clear epileptiform signature?!
Disclosure: Grant - Grants have been from Abbott, Cephalon, Novartis and Parke Davis/Pfizer. Consulting - Consulting fees have been received from Abbott, Cephalon, Novartis, Parke Davis. Pfizer, Elan, Cyberonics and Ortho MacNeil. Honoraria - Honoraria for speaking from Abbott, Cephalon, Novartis, Parke Davis, Pfizer. Glaxo Wellcome and Shire Richwood.