Naslov
Classification of Frontal Lobe Epilepsy

Autori
Petelin Gadže, Željka ; Poljaković, Zdravka ; Nanković, Sibila ; Šulentić, Vlatko

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
Neurologia Croatica / Sporiš, Davor ; Prpić, Igor ; Gjergja Juraški, Romana ; Bašić, Silvio - Zagreb : Denona, 2016, 21-23

Skup
12th Croatian Symposium on Epilepsy

Mjesto i datum
Zadar, Hrvatska, 20.10.2016. - 23.10.2016

Vrsta sudjelovanja
Pozvano predavanje

Vrsta recenzije
Domaća recenzija

Ključne riječi
frontal lobe, epilepsy, classifi cation, semiology, resective neurosurgery

Sažetak
Patients with pharmacoresistant focal epilepsies who are candidates for resective neurosurgical treatment in about one-quarter of cases have frontal lobe epilepsy (FLE). The typical seizure semiology for FLE includes unilateral clonic, tonic asymmetric or hypermotor seizures (HMS). The objective of resective surgery is removal of the entire epileptogenic zone (EZ) without causing permanent neurological deficits. Following the mentioned, presurgical evaluation should include classifi cation of FLE as dorsolateral frontal (further subdivided into central, premotor, and prefrontal lobe epilepsy), mesial frontal or basal (orbital) frontal lobe epilepsy to allow successful minimal cortical resection. Further, the mentioned HMS typical for mesial frontal or orbitofrontal epilepsies can be classified into HMS1 and HMS 2. HMS1 seizures are characterized by violent semipurposeful agitation that either includes body rocking, kicking, or boxing and facial expression of fear, with EZ centered on the ventromesial frontal cortex. HMS2 seizures mainly consist of mild agitation that includes either horizontal movements or rotation of trunk and pelvis while lying on the bed, usually associated with tonic/dystonic posturing, with an EZ localized within the mesial premotor cortex. These findings may help optimize the placement of intracranial electrodes in patients with drug- resistant frontal lobe epilepsy. Recent literature data suggest that meaningful electroclinical categorization of frontal seizures in terms of semiology is possible and correlates with anatomic organization along the rostrocaudal axis, in keeping with current hypotheses on frontal lobe hierarchical organization. Four main groups of patients have been identifi ed.The more anterior the seizure organization, the more likely was the occurrence of integrated behavior during seizures. Distal stereotypies were associated with the most anterior prefrontal localizations, whereas proximal stereotypies occurred in more posterior prefrontal regions. FLE classifi cation and accurate localization of the EZ, as well as recognition of prognostic factors contribute to success in the mentioned clinical entity neurosurgery. Besides antiepileptic drugs, vagal nerve stimulation, ketogenic diet and multiple subpial transections represent other therapeutic possibilities in patients not eligible for resective surgery.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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