What is it like?

Here's a typical story: "My head starts jerking toward the right side. I try, but can't stop it. Then my right hand goes up and my head turns toward the hand. I may just stay in that position for half a minute and it's over, or it can become a grand mal seizure."

And another person's experience: "Usually I don't get any warning, I just have tonic-clonic seizures. Occasionally I get a momentary warning before the seizure—a strange feeling in my head."

Here's what a family member sees: "I spend the night watching Molly sleep sometimes. She will have 5 or 10 seizures in a single night. They are short, usually less than 20 seconds. Her body starts to rock, like she is adjusting her position in the bed, and then she may start to make these kicking movements with her legs, like she is riding a bicycle. She may not have any more seizures for a month or two."

An account by another family member: "Craig has had the same giggles for more than a decade. Now they occur mainly when he is exercising or stressed. He makes a weird smirk and then giggles for a few seconds. He is usually able to cover it up and the kids don't know. If he misses his medications, he can have a bigger seizure."

Who gets it?

After temporal lobe epilepsy, frontal lobe epilepsy is the next most common type of epilepsy featuring partial seizures. Frontal lobe epilepsy may run in families. In a disorder called autosomal dominant frontal lobe epilepsy (ADFLE) individuals typically have seizures occuring during sleep.

Tell me more

The frontal lobes are large and include many areas that do not have a precisely known function. Therefore, when a seizure begins in these areas, there may be no symptoms until it spreads to other areas or to most of the brain, causing a tonic-clonic seizure. When areas that control movement (called motor areas) are affected, abnormal movements occur on the opposite side of the body. Seizures beginning in motor areas can cause weakness or the inability to use certain muscles, such as the muscles that allow someone to speak.

Sometimes a person remains fully aware during a frontal lobe seizure while having wild movements of the arms and legs. Because of their strange nature, frontal lobe seizures can be misdiagnosed as nonepileptic seizures.

The features of seizures may suggest whether they begin in the frontal or temporal lobes, but the only way to be certain about where they start is to obtain an EEG recording during a seizure.

Complex partial seizures (during which the person is not aware) also may begin in the frontal lobes. Complex partial seizures beginning in the frontal lobe tend to be shorter (usually lasting less than 1 minute) than ones that start in the temporal lobe. They also are less likely to be followed by confusion or tiredness, more often occur in a cluster or series, and are more likely to include strange movements such as bicycling motions, screaming, or even sexual activity.

How is it treated?

Frontal lobe seizures often can be well controlled with medications for partial seizures. If seizure medicines are not effective, vagus nerve stimulation or surgery may be helpful.

What's the outlook?

The outlook for people with frontal lobe epilepsy varies greatly, depending on the cause of the seizures. People with brain malformations or acquired lesions such as scar tissue caused by injury or infection are likely to require life-long treatment with seizure medicines. If the causes are genetic, the seizures eventually may stop.

Topic Editor: Gregory L. Holmes, M.D.
Last Reviewed: 10/21/06