Behavioural Epileptic Seizures: A Clinical and Intracranial EEG Study in 8 Children with Frontal Lobe Epilepsy

Abstract

We report on eight children who underwent prolonged invasive video-EEG recording (IC-EEG) for intractable frontal lobe epilepsy and whose seizures consisted of behaviour changes. Seizures were recorded on a BMSI computer with 128 channels connected to the Gotman software of a stellate system; their identification was made both clinically and by automatic detection of paroxysmal electrical events. Behavioural epileptic seizures (BES) consisted of various clinical signs comprising mood change, sudden agitation, unexpected quietness, and subtle change of awareness or awakening. In 2 patients, seizures consisted in repetitive movements that we referred to as epileptic stereotypes. BES came from the prefrontal areas of the brain. Most of them were overlooked or misdiagnosed as behavioural manifestations, especially in children with mental deficiency and autistic features. Given the improvement of behaviour and mental functions following surgery, we assume that BES may contribute to generate mental and behavioural dysfunction.

Key words

Behavioural epileptic seizures - frontal lobe epilepsy - childhood - epilepsy surgery - intracranial recording - stereotypes

References

• 1 Ajmone-Marsan C, Goldhammer L. Clinical ictal patterns and electrographic data in cases of partial seizures of frontal-central-parietal origin. Brazier AB Epilepsy: Its Phenomena in Man. New York; Academic Press 1973: 236-260
• 2 Bancaud J, Talairach J. Clinical semiology of frontal lobe seizure. Chauvel P, Delgado-Escueta AV et al Advances in Neurology. Vol. 57. New York; Raven Press 1992: 3-34
• 3 Berg A, Levy S, Novotny E, Shinnar S. Predictors of intractable epilepsy in childhood: a case control study.  Epilepsia. 1996;  37 24-30
• 4 Berkson G. Repetitive stereotyped behaviors.  Am J Ment Defic. 1983;  88 239-246
• 5 Deonna T, Fohlen M, Jalin C, Delalande O, Zirgler A L, Roulet E. Epileptic stereotypies in children. Guerrini R, Aicardi J, Andermann F, Hallet M Epilepsy and Movement Disorders. Cambridge; Cambridge University Press 2002: 319-332
• 6 Duchowny M S. Complex partial seizures of infancy.  Arch Neurol. 1987;  40 911-914
• 7 Fogarasi A, Janszky J, Faveret E, Pieper T, Tuxhorn I. A detailed analysis of frontal lobe seizure semiology in children younger than 7 years.  Epilepsia. 2001;  42 80-85
• 8 Foster L G. Nervous habits and stereotyped behaviors in preschool children. J.  Am Acad Psychiatry. 1998;  37 711-717
• 9 Geier S, Bancaud J, Talairach J, Bonis A, Enjelvin M, Hossard-Bouchaud H. Automatisms during frontal lobe epileptic seizures.  Brain. 1976;  99 447-458
• 10 Harvey A S, Hopkins I J, Bowe J M, Cook D J, Shield L K, Berkovic S F. Frontal lobe epilepsy; Clinical seizure characteristcs and localization with ictal 99 mTc-HMPAO SPECT.  Neurology. 1993;  43 1966-1980
• 11 Hernandez M T, Sauerwein H C, Jambaque I, De Guise E, Lussier F, Lortie A, Dulac O, Lassonde M. Attention, memory, and behavioral adjustment in children with frontal lobe epilepsy.  Epilepsy Behav. 2003;  4 522-536
• 12 Jambaque I, Delatollas G, Dulac O, Ponsot G, Signoret J L. Verbal and visual memory impairment in children with epilepsy.  Neuropsychologia. 1993;  31 1321-1337
• 13 Jayakar P, Alvarez L A, Duchowny M S, Resnick T J. A safe and effective paradigm to functionally map the cortex in childhood.  J Clin Neurophysiol. 1992;  9 288-293
• 14 Jobst B C, Siegel A M, Thadani V M, Roberts D W, Rhodes H C, Williamson P D. Intractable seizures of frontal lobe origin: clinical characteristics, localizing signs, and results of surgery:.  Epilepsia. 2000;  41 1139-1152
• 15 Kanner L. Autistic disturbance of affective contact.  Nervous child. 1943;  2 217-250
• 16 Lassonde M, Sauerwein H C, Jambaqué I, Smith M L, Helmtaeder C. Neuropsychology of childhood epilepsy: pre- and postsurgical assessment.  Epileptic Disorders. 2000;  2 3-13
• 17 Lhermitte F. “Utilisation behaviour” and its relation to lesions of the frontal lobes.  Brain. 1983;  106 237-255
• 18 Ludwig B, Ajmone Marsan C, Van Buren J. Cerebral seizures of probable orbitofrontal origin.  Epilepsia. 1975;  16 142-158
• 19 McCarthy A M, Riscman L C, Yarbrough D. Memory attention and school problems in children with seizures disorders.  Dev Neuropsychol. 1995;  11 71-86
• 20 Munari C, Bancaud J. Electroclinical symptomatology of partial seizures of orbital frontal origin. Chauvel P, Delgado-Escueta AV et al Advances in Neurology. New York; Raven Press 1992: 257-265
• 21 Munari C, Tassi, Di Leo M. et al . Video-stereo-electroencephalographic investigation of orbitofrontal cortex. Ictal electroclinical patterns.  Adv Neurol. 1995;  66 273-295
• 22 Morell F, Whisler W W, Bleck T P. Multiple subpial transection: a new approach to the surgical treatment of focal epilepsy.  J Neurosurg. 1989;  71 629-630
• 23 Nordli D R, Bazil C W, Scheuer M L, Pedley T A. Recognition and classification of seizures in infants.  Epilepsia. 1997;  38 553-560
• 24 Penfield W, Kristiansen K. Epileptic seizure patterns. A Study of the Localizing Value of Initial Phenomena in Focal Cortical Seizures. Springfield, IL; Charles C. Thomas 1951
• 25 Penfield W, Jasper H. Epilepsy and the Functional Anatomy of the Human Brain. Boston; Little Brown 1954: 896
• 26 Quesney L F, Constain M, Rasmussen T. Seizures from the dorsolateral frontal lobe. Chauvel P, Delgado-Escueta AV et al Advances in Neurology. New York; Raven Press 1992: 233-308
• 27 Ridley R M. The psychology of perseverative and stereotyped behaviour.  Progress in Neurobiology. 1994;  44 221-231
• 28 Rougier A, Loiseau P. Orbitofrontal epilepsy: a case report.  J Neurol Neurosurg Psychiatry. 1988;  51 146-157
• 29 Roulet Perez E, Davidoff V, Despland P A, Deonna T. Mental and behavioural deterioration of children with epilepsy and CSWS: acquired epileptic frontal syndrome.  Dev Med Child Neurol. 1993;  35 661-674
• 30 Salanova V, Morris H H, Van Ness P, Kotagal P, Wyllie E, Lüders H. Frontal lobe seizures: electroclinical syndromes.  Epilepsia. 1995;  36 16-24
• 31 Tharp B R. Orbito frontal seizures. An unique electroencephalographic and clinical syndrome.  Epilepsia. 1972;  13 627-642
• 32 Williamson P D, Spencer D D, Spencer S S, Novelly R A, Mattson R H. Complex partial seizures of frontal origin.  Ann Neurol. 1985;  18 497-504
• 33 Williamson P D, Spencer S S. Clinical and EEG features of complex partial seizures of extratemporal origin.  Epilepsia. 1986;  27 (Suppl 2) S46-63
• 34 Wyllie E, Bass N E. Supplementary sensorimotor area seizures in children and adolescents. Luders HO Advances in Neurology. Vol 70. Philadelphia; Lippincott Raven Publishers 1996: 301-308
• 35 Wyllie E, Comair Y, Kotagal P, Raja S, Ruggieri P. Epilepsy in infants.  Epilepsia. 1996;  37 625-637