A Detailed Analysis of Frontal Lobe Seizure Semiology in Children Younger Than 7 Years

Abstract

Summary:  Purpose: We sought to analyze semiology of seizure onset and evolution in young children with frontal lobe epilepsy (FLE), compare this with adult reports, and assess age‐related differences.Methods: We analyzed 111 videotaped seizures from 14 patients with FLE based on focal cortical dysplasia aged 3–81 months (mean, 30 months). Ictal events were categorized into behavioral, consciousness, autonomic, and sensory features, as well as motor patterns, which included tonic, clonic, epileptic spasm, and myoclonic seizure components. We developed a time‐scaled datasheet to record each epileptic event as onset, very early, early, or late manifestation.Results: Patients had a high seizure frequency with up to 40 attacks/day; half of them showed a cluster tendency. Forty‐seven percent of the seizures started in sleep. Mean duration of seizures was short (29 s). Most common seizure components were motor manifestations, mostly tonic–clonic seizures, and epileptic spasms. Behavioral change was frequent, and hypermotor seizures were not seen. In five patients, the motor features were contralateral to the epileptic focus, including two children with asymmetric epileptic spasms. Secondarily generalized tonic–clonic seizures (SGTCSs) were not recorded, but had been reported in the history of two patients. Complex motor automatisms were not seen, whereas oral automatism appeared in three children.Conclusions: Motor features are common in young children with FLE, as reported in adults. The characteristics, however, differ. Epileptic spasms and subtle behavioral change were frequent. Hypermotor seizures and complex motor automatisms were not seen, and SGTCSs were unusual. Our results suggest that FLE in young children shows age‐related features differing from those of adults.