Cingulate seizures in frontal lobe epilepsy

Introduction 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.

Cause

The frontal lobe includes the primary motor cortex, the prefrontal cortical area of the anterior motor cortex, and the marginal and marginal cortical areas, which may cause frontal lobe epilepsy if abnormal discharge occurs due to heredity and some unknown cause.

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

Frontal lobe attacks should be differentiated from other types of seizures:

1 Identification of generalized tonic seizures: frontal lobe attacks are often asymmetrical posture or torsion stiffness, generalized tonic is mainly axial and torso of the neck and trunk, the latter is common in Lennox-Gastaut syndrome. Most occur in sleep, and the EEG is a full-scale 10-20 Hz spike rhythm outbreak. Children are often accompanied by other types of episodes such as atypical loss, tension, or myoclonic episodes.

2 Identification of frontal lobe: Both can be characterized as local seizures, but the duration, frequency, motor symptoms and autonomic symptoms are different. Because the frontal lobe is closely related to the structure and function of the temporal lobe, the seizure process can spread to each other, often leading to overlapping overlapping symptoms. For patients who are ineffective in drug therapy, the origin of the seizure should be accurately located by intracranial or deep electrode recording before surgery.

3 Identification of seizures: The onset of the frontal lobe can sometimes manifest as a simple gaze, similar to a seizure. At this time, EEG is essential for differential diagnosis. The frontal lobe EEG is a spine slow wave originating from one side or bilateral frontal lobe, and the systemic absence is a bilateral symmetric synchronous 3 Hz spine slow wave.

Frontal lobe seizures are particularly susceptible to misinterpretation of certain non-epileptic seizures, such as pediatric night terrors and rickets. There is no cause of seizures, repeated symptoms and stereotypes, short and frequent clusters of episodes, and EEG with evidence of epileptiform discharges contribute to the diagnosis of frontal lobe epilepsy.

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