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Frontal lobe seizures: overview and update

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Abstract

Frontal lobe seizures (FLS) are debilitating for patients, highly diverse and often challenging for clinicians to evaluate. Frontal lobe epilepsy is the second most common localization for focal epilepsy, and if pharmacoresistant, can be amenable to resective surgery. Detailed study of frontal seizure semiology in conjunction with careful anatomical and electrophysiological correlation based on intracerebral recording with stereoelectroencephalography (SEEG) has allowed demonstration that ictal motor semiology reflects a hierarchical rostro-caudal axis of frontal lobe functional organization, thus hel** with presurgical localization. Main semiological features allowing distinction between different frontal sublobar regions include motor signs and emotional signs. Frontal lobe seizure semiology also represents a valuable source of in vivo human behavioral data from a neuroscientific perspective. Advances in defining underlying etiologies of FLE are likely to be crucial for appropriate selection and exploration of potential surgical candidates, which could improve upon current surgical outcomes. Future research on investigating the genetic basis of epilepsies and relation to structural substrate (e.g. focal cortical dysplasia) and seizure organization and expression, could permit a “genotype-phenotype” approach that could be complementary to anatomical electroclinical correlations in better defining the spectrum of FLS. This could help with optimizing patient selection and prognostication with regards to therapeutic choices.

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Fig. 1
Fig. 2

Reproduced with permission from Catani, 2019 [75]

Fig. 3

Reproduced with permission from Fuster 2004 [23]

Fig. 4

reproduced with permission from McGonigal et al. 2021 [28]

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Acknowledgements

I am very grateful to Prof Patrick Chauvel, University of Pittsburgh Medical Center, USA. Many thanks to Prof Fabrice Bartolomei, Dr Francesca Bonini, Dr Bernard Giusiano and colleagues of the Clinical Neurophysiology department, Timone Hospital, Marseille, France. Many thanks to Dr Rinki Singh, Kings College, London. Many thanks to Prof Marco Catani (Kings College, London) and to Prof Joaquin Fuster (UCLA) for kind permission to reproduce figures. Many thanks to Dr Stéphane Dufau, CNRS, with help for preparing figures.

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  1. Clinical Neurophysiology, Timone Hospital, APHM, Marseille, France

    Aileen McGonigal

  2. Inserm, INS, Institut de Neurosciences Des Systèmes, Aix Marseille Univ, Marseille, France

    Aileen McGonigal

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McGonigal, A. Frontal lobe seizures: overview and update. J Neurol 269, 3363–3371 (2022). https://doi.org/10.1007/s00415-021-10949-0

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