Frontal lobe epilepsy

A 24-year-old right-handed woman sought a second opinion regarding recurrent spells. They began at 6 months of age and occurred spontaneously without provocation. Her medical history showed she had been diagnosed with clinical depression and obstructive sleep apnea syndrome, supported by polysomnography. There were no risk factors for epileptic seizures. She had only one type of clinical event, which occurred during sleep and upon wakening. The events were approximately 30 s in duration and occurred daily, sometimes up to ten times per night. Brain MRI and routine EEGs were normal. Prolonged video-EEG recorded numerous stereotypic events characterized by arousal from sleep, rolling over into the prone position, right hand hyperflexion posturing, repeatedly sitting up, and then lying down with kicking and body rocking. During this time, the EEG was obscured by movement artifact. However, during some of the events, the EEG showed rhythmic 3-4 Hz activity that appeared to evolve in the midline frontal and central head regions (Fig. 22.1).