eMedicine Specialties > Neurology > Seizures and Epilepsy

Frontal Lobe Epilepsy: Follow-up

Author: Sheryl Haut, MD, Director, Adult Epilepsy, Associate Professor of Clinical Neurology, Departments of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine
Contributor Information and Disclosures

Updated: May 7, 2009

Follow-up

Further Outpatient Care

  • Patients require frequent office visits during the titration and adjustment phase of anticonvulsants.
    • Examination should include evaluation for excessive nystagmus, tremor, and ataxia.
    • Baseline and follow-up blood testing may be needed.
  • When seizure free on maintenance dose of medication, patients may be asked to come for follow-up 1-3 times a year.
  • Patients who are seizure free for 2-5 years may be considered for a trial of medication withdrawal, depending on the individual case.

Inpatient & Outpatient Medications

Folate should be added to the anticonvulsant regimen of female patients of childbearing age.

Deterrence/Prevention

  • Frontal lobe epilepsy may be an early or late aftermath of head trauma. Measures should be taken to prevent head injury, including mandatory use of seat belts and bicycle helmets.
  • Use of prophylactic anticonvulsants following head trauma has not demonstrated a decrease in the development of epilepsy.

Complications

  • Status epilepticus - This is reported in up to 25% of patients with frontal lobe epilepsy. The episodes may be convulsive, nonconvulsive, or simple partial.
  • Comorbid psychiatric or behavioral disturbance

Prognosis

  • Approximately 65-75% of patients with frontal lobe seizures respond to appropriate anticonvulsants and become seizure free.
  • The proportion of patients with medically refractory frontal lobe epilepsy who become seizure free from additional medications or surgical options is lower than in patients with temporal lobe epilepsy.
  • An important feature in prognosis is the early recognition of frontal lobe seizures as an epileptic syndrome rather than a parasomnia or psychiatric condition.

Patient Education

  • Patient education is important for all patients with epilepsy. Many patients benefit from joining one of the national or regional epilepsy support groups.
  • Quality of life issues
    • "Stigma" of epilepsy
    • Living with restrictions
    • Living with long-term medical therapy

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose the episodes as epilepsy, misdiagnosis as a psychiatric or parasomniac condition
  • Driving restrictions
    • Certain states have mandatory reporting of seizures by physicians to the motor vehicle authorities (eg, Department of Motor Vehicles [DMV]).
    • Even in states that do not have mandatory reporting, physicians must document that the patient is aware of driving restrictions.
  • Patients must be aware of the potential risks of pregnancy and epilepsy/anticonvulsants. Women of childbearing age who are taking anticonvulsants should be given folate supplementation.
 


More on Frontal Lobe Epilepsy

Overview: Frontal Lobe Epilepsy
Differential Diagnoses & Workup: Frontal Lobe Epilepsy
Treatment & Medication: Frontal Lobe Epilepsy
Follow-up: Frontal Lobe Epilepsy
References
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References

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Further Reading

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Keywords

frontal lobe epilepsy, supplementary motor area seizures, primary motor cortex seizures, medial frontal seizures, cingulate gyrus seizures, orbitofrontal seizures, frontopolar seizures, dorsolateral cortex seizures, operculum seizures, seizure treatment, epilepsy treatment

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Contributor Information and Disclosures

Author

Sheryl Haut, MD, Director, Adult Epilepsy, Associate Professor of Clinical Neurology, Departments of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine
Sheryl Haut, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, and American Neurological Association
Disclosure: UCB Honoraria Speaking and teaching; King Consulting fee Consulting; Jazz Consulting fee Consulting; Endo Grant/research funds Research

Medical Editor

Edward B Bromfield, MD, Associate Professor of Neurology, Faculty Member, Division of Sleep Medicine, Harvard Medical School; Chief, Division of EEG, Epilepsy and Sleep Neurology, Consulting Neurologist, Brigham and Women's Hospital
Edward B Bromfield, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, American Neurological Association, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jose E Cavazos, MD, PhD, FAAN, Associate Professor with Tenure, Departments of Neurology, Pharmacology, and Physiology, University of Texas Health Science Center at San Antonio; Co-Director, South Texas Comprehensive Epilepsy Center; Director of the Epilepsy Center, Audie L Murphy Veterans Affairs Medical Center
Jose E Cavazos, MD, PhD, FAAN is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, and Society for Neuroscience
Disclosure: Glaxo-SmithKline Honoraria Consulting; Ortho-McNeil Neurologics Honoraria Consulting; UCB Pharma Honoraria Consulting

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

 
 
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