Early ictal face wiping in frontal lobe epilepsy

Abstract We describe two patients with medication-resistant nonlesional mesial frontal lobe epilepsy and seizures that manifested with early face wiping prior to other motor phenomena. Ictal scalp monitoring either was nonlocalizing or involved the central regions. Intracranial monitoring demonstrated anterior mesial frontal ictal low-voltage gamma activity during the face wiping activity in both patients. Habitual seizures with the same clinical characteristics were induced during extraoperative functional mapping with stimulation of the same region. Ictal activation of mesial frontal regions can elicit early ictal face wiping activity, and this clinical sign may play a role in presurgical evaluation.