Children who underwent video-EEG monitoring between 1995 and 2000, and were classified as frontal lobe epilepsy (FLE) (n=39) or mesial temporal lobe epilepsy (MTLE) (n=17), were examined for clinical, EEG, and quantitative MRI differences, in a study at Sydney Children’s Hospital, Australia. Compared to MTLE, seizures in FLE were significantly shorter, more frequent, and occurred predominantly in sleep; EEG abnormalities were often bilateral and of significantly higher frequency; MRI mean frontal cortical volume in FLE was significantly lower than MTLE and controls; and the outcome following surgery was poor. Few were considered optimal surgical candidates because of signs of bilateral disease. Frontal lesions occurred in only 29% compared to a 94% temporal lobe lesion rate in patients with MTLE. Etiology was undetermined in the majority of FLE cases. [1]

COMMENT. Frontal lobe epilepsy accounts for more than 20% of pediatric partial epilepsies in this center. The seizures are of briefer duration, more frequent, and usually nocturnal, compared to temporal lobe epilepsy. Rates of epigastric aura, oral and gestural automatisms, and contralateral limb dystonia are higher, and motor manifestations such as asymmetric tonic, focal clonic, and motor agitation are more prominent. Interictal and ictal EEG abnormalities are not clearly lateralized, and more often synchronous bilateral or independent right or left. MRI detection of a localized lesion is uncommon, and etiology is usually undetermined, although unilateral frontal hypometabolism may be demonstrated by PET and SPECT. Compared to TLE cases, results of surgery for FLE are disappointing.