frontal lobe epilepsy
Introduction
Introduction to frontal lobe epilepsy Epilepsy called frontal lobe epilepsy with simple partial seizures, complex partial seizures, and secondary systemic seizures or mixed seizures of these episodes originating from the frontal lobe. basic knowledge The proportion of sickness: 0.0020% Susceptible people: no special people Mode of infection: non-infectious Complications: epilepsy
Cause
Frontal lobe epilepsy
Causes
The frontal lobe includes the primary motor cortex, the motor cortex, the prefrontal cortex, and the marginal and marginal cortical areas. These areas may cause epilepsy if they are abnormally discharged due to heredity and some unknown causes.
Prevention
Frontal lobe epilepsy prevention
1 eugenics and superiority, prohibiting close relatives from marrying. During the first trimester of pregnancy, be sure to stay away from radiation and avoid viral and bacterial infections. Regular pregnancy test, avoid fetal hypoxia, asphyxia, birth injury and so on during childbirth.
2 children should be treated promptly when they have fever, to avoid high fever and convulsions, and damage brain tissue. You should also take care of your child and avoid head trauma.
Complication
Frontal lobe epilepsy complications Complications
Frontal lobe epilepsy is characterized by simple partial seizures, complex partial seizures, and secondary systemic seizures or mixed episodes of these episodes, usually occurring several times a day and often during sleep. Partial episodes of the frontal lobe can sometimes be confused with episodes caused by mental factors, which are common comorbidities. The dorsolateral episode is accompanied by the rotation of the eyes and head and the cessation of speech.
Symptom
Frontal lobe epilepsy symptoms Common symptoms Frontal lobe epilepsy island cover episodes of frontal lobe epilepsy...
Frontal lobe epilepsy is characterized by simple partial seizures, complex partial seizures, and secondary systemic seizures or mixed episodes of these episodes. The episodes usually occur several times a day, and often occur during sleep. Partial episodes of the frontal lobe can sometimes be associated with the spirit. The seizures caused by the factors are confused, and the status epilepticus is a common complication.
1. A strong reminder of frontal lobe epilepsy includes:
(1) Usually the attack time is short.
(2) Complex partial seizures from the frontal lobe, usually accompanied by a slight episode of post-seizure confusion or non-occurrence.
(3) quickly caused secondary systemic seizures (frontal lobe epilepsy is more common than temporal lobe epilepsy).
(4) The symptoms of tonic or sporty posture are prominent.
(5) Commonly complicated gesture-type autonomic syndromes at the time of onset.
(6) When the discharge is bilateral, it often falls.
2. Type of seizure : The type of seizure of frontal lobe epilepsy is described below, but the multi-amount area may be rapidly affected, and the type of seizure may not be recognized.
(1) Auxiliary exercise zone seizures: episodes in the auxiliary exercise zone, in the form of postural focal tonics with vocalization, speech pauses, and fencing postures, the patient's head and eyeballs turn to the opposite side of the origin of epilepsy, epilepsy The upper limbs of the contralateral side are abducted, the shoulders are externally rotated, and the elbows are flexed. The appearance is like that the patient is looking at his or her own hand. The upper and lower limbs of the same side are abducted, and the distal end of the upper limb is more obvious than the distal end of the lower extremity. The clinical manifestations of the ipsilateral upper extremity extending to the origin of the epilepsy are described as "fencing postures".
(2) shackle back seizures: the form of seizures is complicated with part of the complex movement gesture autopsy, common autonomic nerve signs, such as mood and emotional changes.
(3) Forehead polar zone episodes: Forehead polar zone episodes include compulsive thinking or loss of initial contact and head and eye steering, possibly accompanied by evolution, including reverse motion and axial clonic tics and falls. Autonomic nerve sign.
(4) Seizures in the forehead area: The form of seizures in the frontal area is a complex part of the seizure accompanied by initial movement and gesture automatism, olfactory hallucinations and illusions, and autonomic signs.
(5) dorsolateral seizures: the form of seizures may be tonic or less common, accompanied by rotation of the eyes and head and speech stop.
(6) Island cover episodes: Characteristics of island cover episodes include chewing, salivation, swallowing, symptoms of the throat, speech stop, abdomen of abdomen, fear and autonomic sympathy. Simple partial seizures, especially partial clonic facial muscle attacks are Very common, and may be unilateral, numbness may be a symptom if secondary sensory changes occur, especially in the hands, and taste illusion is particularly common in this area.
(7) Exercise cortex episodes: The main feature of motor cortex epilepsy is simple partial seizures, which are located according to the local anatomy of the affected side and the affected area. In the lower pre-Rolando area, there may be speech stop, vocalization or Speech disorder, systemic seizures often occur in lateral tonic-clonic movements or swallowing movements. In the lateral fissures, partial seizures are not accompanied by progressive or Jacksonian episodes; especially in the contralateral upper limbs, the central central lobe In the onset, there is an ankylosing movement in the ipsilateral foot, and sometimes a tonic movement in the contralateral leg. Todd is common after the attack. The seizure occurs precisely in the motor cortex. The epileptic threshold in this area is low. Spread to the wider epileptic area.
(8) Kojewnikow syndrome: There are currently two types of Kojewnikow syndrome, one of which is known as Rasmussen syndrome, which is a type of epilepsy syndrome included in childhood symptomatic epilepsy. The types are special types that represent partial seizures in the lateral fissures of adults and children, and are related to different lesions in the sports area. The main features are:
1 motility partial seizure, clear positioning;
2 In the later stage, myoclonus usually occurs in the site where the somatic seizure occurs;
3 On the basis of the normal background activity of the EEG, focal episodes of abnormalities (spine and slow waves) occur;
4 The syndrome can occur at any age in childhood and adulthood;
5 often can find the cause (tumor, vascular disease);
6 The syndrome does not undergo progressive progression (clinical, EEG or psychological, except for those associated with the evolution of pathogenic damage), which can be caused by mitochondrial encephalopathy (MELAS).
It should be noted that the anatomical origin of some patients with epilepsy is difficult to determine in a particular cerebral lobe. This epilepsy includes symptoms associated with the anterior central and posterior central regions (excitation of the peripheral zone of the lateral fissure). Adjacent anatomical sites are also seen in the island cover epilepsy.
The interictal scalp EEG trace of frontal lobe epilepsy can present:
1 no abnormality;
2 Sometimes the background is asymmetrical, and spikes or sharp waves appear in the forehead area;
3 sharp or slow waves (both unilateral or more common on both sides or seen on the unilateral majority of the brain), intracranial tracing can sometimes distinguish between unilateral and bilateral lesions.
Different EEG manifestations of frontal lobe episodes may be associated with initial clinical symptoms. In a few cases, EEG abnormalities occur before clinical episodes, which can provide important localization information, such as:
1 frontal or multi-leaf, usually bilateral, low amplitude, fast activity, mixed spikes, rhythmic spikes, rhythmic slow waves or rhythmic slow waves;
2 bilateral high amplitude single sharp waves followed by diffuse low level waves.
According to the symptomology, intracranial electrode tracing can provide information about the temporal and spatial evolution of the release; positioning is sometimes difficult.
Examine
Frontal lobe epilepsy
1. EEG : Because the frontal lobe epilepsy often causes bilateral frontal lobe synchronous release, scalp EEG is difficult to locate, and often due to artifacts difficult to explain changes in EEG, epilepsy of frontal lobe epilepsy The lesion often presents multifocal or bilateral frontal foci, which also affects the accurate localization of the frontal lobe. In this case, video EEG should be performed to observe changes in EEG and behavioral changes during the episode to help locate It is one of the main methods for preoperative evaluation of patients with intractable epilepsy. It should also be routinely recorded with special scalp recording electrodes (such as dome electrodes), long-term EEG, induced tests, etc., and should be selectively used. The intracranial electrode records the EEG of the attack period, which has high reliability and high accuracy. However, the EEG of the epilepsy originating from the frontal lobe is very diverse and complex. The interictal EEG is a modern neuroimaging and long-range video. An important auxiliary means outside the EEG, compared with temporal lobe epilepsy, the interictal epileptiform discharge is relatively limited in the diagnosis of frontal lobe epilepsy, about 70% of patients with frontal lobe epilepsy have interictal epileptiform discharge, But it is difficult With localization, it is multifocal or generalized, and conventional EEG can only record a part of the frontal cortex, unable to correctly record the potential of the deep frontal lobe, and the discharge of the temporal, cingulate and midline hemisphere cortex. There are some major functional pathways between the frontal and temporal lobes, including the hook bundle and the cingulate gyrus. The presence of these functional networks allows epilepsy to spread inside and outside the frontal lobe and impede the accurate localization of the EEG, but In the preoperative evaluation of frontal lobe epilepsy, EEG is still an important means.
2. Imaging examination : using structural and functional imaging methods, CT, MRI can find some small low-grade glioma, AVM, cavernous hemangioma and cerebral cortex hypoplasia, can also find meningeal brain scar, Brain atrophy, cerebral cystic changes, etc., are conducive to the location of epileptogenic focus.
Diagnosis
Diagnosis and diagnosis of frontal lobe epilepsy
Diagnostic criteria
The presence of one of the following six characteristics can be diagnosed as frontal lobe epilepsy:
1. Systemic tonic - immediate loss of consciousness after the onset of clonic convulsions.
2. At the beginning of seizures, the head and eyes turn to the opposite side, followed by systemic convulsions, loss of consciousness after the onset, often suggesting that the epileptogenic focus is located in the first 1/3 of the frontal lobe.
3. The initial head and eye turn to the contralateral side of the lesion, the consciousness is clear and gradually unconscious, and then the total loss of consciousness and systemic seizures suggest that the epileptogenic focus originates from the middle part of the frontal lobe.
4. The posture is a posture movement of a certain part of the body, such as the contralateral arm is raised and raised, the ipsilateral arm is extended downward and the head is turned to the opposite side of the lesion, suggesting that the epileptogenic focus is located on the inner side of the middle part of the frontal lobe.
5. Often showing no emotions, or short-term movement pauses, confusion, and gaze, followed by generalized seizures.
6. Seizures may have an episode or an episode of autopsy, similar to temporal lobe epilepsy, interictal SPECT and PET can confirm local hypoperfusion or low metabolism, while SPECT often shows frontal cortex High perfusion contributes to the localization of epileptic foci.
At present, a consensus has been reached that 80% to 90% of patients with epilepsy diagnosed by MRI have a good effect after epileptic resection of the lesion, but the non-focal epilepsy with no positive findings on MRI is not satisfactory.
There are no diseases that need special identification.
