Frontal Lobe Epilepsy: The Next Frontier

Frontal lobe epilepsy, the great new epileptological challenge, presents enormous difficulties that still preclude a more profound understanding at the present time. The major subdivision of the frontal lobe into a prefrontal and premotor portion is the first step toward a better and yet limited comprehension of the frontal lobe epilepsies. Prefrontal implies higher mental functions (e.g., ictal forced thinking); rapid generalization to full grand mal evolves quite often from prefrontal foci. The frontal accentuation of classical generalized 3/sec spike-wave absences adds to the conceptual difficulties of the frontal lobe epilepsies. The unique type of disturbed consciousness in classical absences is presumed to be based upon ictal suspension of the working memory. Limbic components (via orbitofrontal and cingulate mechanisms) also play an important role. Correlations between ictal semiologies and regional frontal lobe functions are still quite controversial.