Abstract for presentation at 21st Annual Scientific Meeting of the Epilepsy Society of Australia

Childhood lesional frontal lobe epilepsy - semiology characterisation and outcome

  • Dr Gopinath Musuwadi, Department of Neurology, The Children's Hospital at Westmead, Australia
  • Dr Deepak Gill, Department of Neurology, The Children's Hospital at Westmead, Australia
  • Dr Chong Wong, Department of Neurology, Westmead Hospital, Australia
  • Dr Andrew Bleasel, Department of Neurology, Westmead Hospital, Australia
  • Dr Mark Dexter, Department of Neurosurgery, The Children's Hospital at Westmead, Australia

    • Purpose: To review our centre’s experience of cases of paediatric onset symptomatic lesion related epilepsy of frontal lobe origin.
    Methods: The charts and neuroimaging data were reviewed retrospectively of 17 patients (M:F= 11:6) who had childhood onset (<16 years) frontal lobe epilepsy. Cases were selected as those who either had a well defined lesion on MRI in the frontal lobes or seizure free outcome in the non-lesional cases. Children with multiple lesions or diffuse pathology were excluded. The age of seizure onset, semiology and epilepsy outcome were recorded. Diagnostic video-EEG data was reviewed for all 10 patients who underwent surgery and was available in all but three of the others.
    Results: The mean age of seizure onset was 3.7 years (2mo- 15years) and 65% had seizure onset less than two years of age(n=11). The majority of seizures were characterised into three groups of ictal events: tonic (asymmetric or symmetric), focal clonic or hyper motor seizures. Abnormal findings on MRI were cortical dysplasia (CD) in 13 patients, suspected ganglioglioma in 2 and normal study in 2 patients. The following histological diagnoses were confirmed: FCD in 9 patients (one had coexisting ganglioglioma) and meningioangiomatosis in one patient. Nine of the ten patients who underwent surgery were either completely or almost seizure free (Engel Class 1or 2). The mean interval between seizure onset and surgery was 7.5 years (1-22.5 years). The mean follow up period was 4.1 years (6mo-12 years).
    Conclusion: The seizure semiology characteristics in our series were consistent with well known clinical patterns of tonic, clonic or hyper motor seizures of frontal lobe epilepsy. A distinct hyper motor crawling seizure type was seen in infancy. There was poor correlation between seizure semiology and seizure focus. A beneficial outcome was seen in the majority of patients, although there remains a lengthy time interval between seizure onset and surgery.

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