Classifying frontal lobe epileptic seizures

Epileptic seizures originating in the frontal lobe have a wide clinical spectrum. Some seizures may mimic absence seizures, some may have automatisms just like a temporal seizure, and some have spectacular automatisms and may appear as pseudo‐psychiatric seizures. These seizures are usually difficult to describe for the patient and the witnesses. This wide clinical spectrum of ictal motor activity is not only due to the anatomical volume of this lobe, but mainly due to its implication in the movement (preparation, initiation and realisation). The frontal lobe is also involved in emotional processing, and its body manifestations; this may explain the fear expression, the laugh or the autonomic manifestations observed during some seizures. This lobe is implicated in several physiological networks with particular involvement of the basal ganglia. Therefore the seizures originating in a limited area of the frontal lobe have an immediate spreading to the entire lobe, to the contra lateral one and farther. Secondary generalisations are thus frequent. An anatomical classification of such seizures is, for these reasons, restrictive and false; nevertheless, according to our knowledge, it is the most useful and significant as it is based on surgical series of cured patients (ultimate proof of the frontal origin of their seizures). To analyse and classify those seizures, it is necessary to record several seizures and to extract the constant clinical signs in every seizures. This will help to answer different questions: what is the patient‘s consciousness during the fit, is he able to interact with the surrounding objects, what is his facial expression, are there autonomic manifestations, are the movements during the seizures orientated to a goal, or anarchic. Recording several seizures will also help to analyse the ictal EEG as movements artefacts may be delayed in some seizures.