Diagnosis of partial epilepsy

  Among partial epilepsies, frontal lobe epilepsy is second only to temporal lobe epilepsy, accounting for about 20-30% of partial epilepsies. Frontal lobe epilepsy is more common than temporal lobe epilepsy in childhood. Due to the complex anatomy and function of the frontal lobe, the manifestations of frontal lobe epilepsy are rich and variable, which makes clinical and localization difficult.  The presentation of frontal lobe seizures is complex and variable from patient to patient, but each seizure in the same patient is usually very stereotypically similar. In general, seizures originating in the frontal lobe have the following characteristics: they are frequent, often occurring in clusters, and can be several or even tens of seizures per day; they start and end abruptly and last for short periods of time, from a few seconds to tens of seconds; there is no or only a short postictal haze, and consciousness usually returns to normal quickly; there are often sleep-phase seizures; and the various seizure forms can be rapidly followed by generalized seizures or by a continuous epileptic The frontal lobe epilepsy is characterized by the presence of a frontal lobe seizure.  In frontal lobe epilepsy, the conventional EEG positivity rate is extremely low and the relationship between clinical symptoms and paroxysmal discharges in the anatomy and physiology is quite complex. A significant proportion of frontal lobe epilepsies have a normal EEG during the interictal period. A variable number of paroxysmal discharges in one or bilateral frontopolar, frontal, central, and anterior temporal region leads are seen in some frontal lobe epilepsies and are easily seen during sleep. Some atypical spikes and sharp waves are easily overlooked. Discharges in the frontal pole or frontal floor produce spike-shaped slow waves issued in the frontal regions bilaterally, but the left and right sides are often asymmetrical.  The EEG during frontal lobe seizures has multiple manifestations of 10-20 low-moderate wave amplitude spike-wave rhythms in one or both frontal regions, or initially as diffuse low-voltage desynchronized fast waves lasting 1-3 seconds, followed by paroxysmal rhythmic activity predominantly in the frontal regions.  In patients with frontal lobe epilepsy who have failed to respond to pharmacological treatment, the origin of the seizure should be accurately localized by preoperative cortical or deep electrode recording to determine the site and method of surgery.