I’m probably not just crazy – Frontal Lobe Epilepsy

When I was two years old, I was chasing my mom around and smashed forehead-first into the thresh-hold of the door. It’s a story that bears a permanent scar, but I otherwise tend to forget about it. Then it occured to me today to look up the symptoms of epilepsy caused by damage to the frontal lobe. This is what I found out.

Frontal Lobe Epilepsy (FLE)

Seizure types resulting from FLE are very characteristic simple partial and complex seizures with secondary generalization. During simple partial seizures, consciousness is preserved; the person is alert, can respond to questions or commands, and can remember what occurred during the seizure. During complex partial seizures, consciousness is altered or lost; the ability to pay attention or respond to questions or commands is thus impaired or lost. Often, there is no memory of what happened during all or part of the complex partial seizure. Generalized (tonic-clonic) seizures affect both sides of the body, involve loss of consciousness, and convulsions. Frontal Lobe Epilepsy seizures may be simple partial or complex partial, or they may spread into other body parts (Jacksonian) or amplify into generalized (secondarily generalized) seizures. Or a combination of all of those seizure types.

FLE is characterized by seizures that begin in one part of the brain and spread laterally to other parts, causing an array of symptoms. They can range anywhere from asymmetric and abnormal body positioning to repetitive vocal outbursts and repetitive jerking movements. Emotional aura’s (particularly fear) is associated with FLE, and in patients with FLE fear is shown strongly on the face, as opposed to TLE seizures in which the fear is internal and not shown. Dystonia is usually the first symptom of FLE, which is defined as sustained muscle contractions that cause twisting and repetitive movements or abnormal postures; these movements tend to go unnoticed at first because they are quite brief and don’t affect consciousness at all.

Other symptoms partial seizures due to FLE, depending on the part of the brain affected by neurological discharge:

Supplementary Motor Area (SMA)

-facial grimacing
-vocalization
-inability to speak (selective mutism)

-complex automatisms such as kicking, pelvic thrusting, finger rubbing, lip smacking, chewing or swallowing. Others may include speech, which may or may not be coherent or sensible.
-Responsiveness is often preserved, but the patient will regain consciousness, often feeling disoriented and with no memory of the incident

Primary Motor Cortex (PMC)

-“Jacksonian” seizure, which looks like twitching in one part of the body which sortof “catches on” to the other parts and spreads.
-Clonic movements (alternate involuntary muscular contraction and relaxation in rapid succession)

Anterior (frontal) regions: 
-motor and vocal agitation similar to that of the SMA and accompanied by emotional feelings, often leading to misdiagnosis of a psychological disorder

Dorsolateral cortex:

-clonic movements
-head turn in direction of damaged area of brain (ipsilateral)
-ipsilateral eye deviation (looking)

Operculum:
-swallowing, salivation, chewing
-Clonic facial movements
-Inability to speak

-person is fearful and has epigastric aura (pain in the solar plexus)

Other facts:

The majority of frontal lobe seizures occur between 2 am and noon. I think it’s also interesting that electronic Vagal Nerve Stimulators (VNS) are supposed to be effective in treating this disorder. VNS is a technique I discovered as a teenager, when I started having little “breathing-attacks,” misdiagnosed as anxiety. I would press on my vagal nerve in the small depression in my collar bone and the attacks would decrease.

Maybe I’ve got some brain damage. Maybe the fancy MRI-gadget with it’s pants-crapping gadolinium contrast will show me that brain damage. Monday’s the day.

VC

 

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