The "fencing pose" for frontal lobe epilepsy

Introduction The upper and lower extremities of the same side are abducted, and the distal end of the upper extremity is more pronounced than the distal end of the lower extremity. The clinical manifestation of this ipsilateral upper limb extending to the origin of the epilepsy is described as a "fencing posture." This is a symptom of the clinical manifestations of frontal lobe epilepsy.

Cause

The frontal lobe includes the primary motor cortex, the anterior 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.

an examination

EEG

Because frontal lobe seizures often cause bilateral frontal lobe to be synchronously distributed, scalp EEG is difficult to locate, and it is often difficult to explain EEG changes due to artifacts. The epileptogenic focus of frontal lobe epilepsy often presents multifocal or bilateral frontal foci, which also affects the accurate localization of the frontal lobe. At this time, a video EEG should be taken to observe changes in EEG during episodes and behavioral changes in the episodes to aid in localization. It is one of the main means of preoperative evaluation of patients with intractable epilepsy. Special scalp recording electrodes (such as dome electrodes), long-term EEG, and induced tests should also be routinely performed. The intracranial electrode should also be selectively used to record the EEG during the attack, which is more reliable and accurate. However, the electroencephalogram of epilepsy originating from the frontal lobe is very diverse and complex. Interictal EEG is a very important auxiliary means in addition to modern neuroimaging and long-range video EEG. Compared with temporal lobe epilepsy, interictal period The diagnostic value of epileptiform discharge for frontal lobe epilepsy is relatively limited. About 70% of patients with frontal lobe epilepsy have interictal epileptiform discharges, but they are difficult to locate and are multifocal or generalized. And the 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 cortex between the detour, the cingulate gyrus and the midline hemisphere. 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 within and outside the frontal lobe and impede the accurate localization of EEG. However, in the preoperative evaluation of frontal lobe epilepsy, EEG is still an important means.

2. Imaging examination

Using structural and functional imaging methods, CT and MRI can be found in some small low-grade gliomas, AVM, cavernous hemangioma, and cerebral cortex hypoplasia. Meningeal brain scars, brain atrophy, and cerebral sacs can also be found. Changes, etc., are conducive to the location of epileptogenic foci.

Differential diagnosis

It should be differentiated from the following symptoms:

1. Motor cortex episodes of frontal lobe epilepsy

Motor cortex episodes of frontal lobe epilepsy: The main feature of motor cortex epilepsy is a simple partial seizure, which is based on 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 disorders, often occur in the lateral tonic-clonic movement or swallowing exercise, generalized seizures. In the lateral fissure, partial movement episodes were not accompanied by progressive or Jacksonian episodes, especially in the contralateral upper limbs. When the central lobule is involved, there is a tonic movement in the ipsilateral foot, and sometimes a tonic movement occurs in the contralateral leg. Todd is common after the attack. Seizures originate precisely from the motor cortex, where the threshold for epileptic seizures is low and spreads to a wider area of epileptogenicity.

2. Forehead polar zone episodes of frontal lobe epilepsy

Prefrontal episodes of frontal epilepsy: Prefrontal polar 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.

3. Frontal episodes of frontal lobe epilepsy

Prefrontal episodes of frontal lobe epilepsy: The form of seizures in the anterior region is a complex partial seizure with initial motor and gesture automatism, olfactory hallucinations and illusions, and autonomic stimuli. It is one of the clinical manifestations of frontal lobe epilepsy.

4. The cingulate gyrus of frontal lobe epilepsy

Frontal lobe epilepsy with episodes of seizures: the form of seizures with complex partiality accompanied by complex motorized gesture autopsy, common autonomic signs, such as mood and emotional changes. It is a clinical symptom of frontal lobe epilepsy.

5. Frontal epilepsy island cover episode

The frontal lobe epilepsy is one of the clinical diagnoses of 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.

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