Question for those familiar with frontal lobe seizures

[masterjen]

For almost 4 years I have had nocturnal frontal lobe motor seizures predominantly affecting my left upper and lower body. In terms of upper body activity, my left arm is flexed and pulled up to my head, and my head is forced to the left and sometimes my torso strongly tenses and is pulled to the left as well. My right arm extends out to the right. My left leg kind of does a sustained kick out to the left. Based on the direction of my head/body turn, the seizures have been called right frontal lobe.
During the last two seizures, everything about my limbs has been the same and my head and torso started to go left but then suddenly have been forced in the direction of my extended right arm. When I looked this up, the head turning toward the extended arm implies the seizure focus is left sided not right.

I know any change in seizure warrants contacting the neurologist, and I have an appt. next month already for usual follow-up. What I'd like to know is what might be going on to cause this change? What does the change mean?

 

[Nakamova]

The change in your motor activity doesn't necessarily indicate that the focus has shifted from one side of the brain to the other. Seizure activity on one side of the brain can produce different kinds of motor responses depending on the particular area of the frontal cortex that's affected, and tonic activity can manifest differently from clonic activity and from automatisms like kicking and thrusting. Here's a rough breakdown of FLE motor activity by affected area of the frontal cortex:

-- Supplementary Motor Area (SMA) = Tonic activity (muscle tensing) that's one-sided OR on both-sides but asymmetrical. Automatisms such as lower body kicking and thrusting.
-- Medial frontal, cingulate gyrus, orbitofrontal, or frontopolar regions = similar to SMA above.
-- Primary motor cortex = Clonic or myoclonic motor activity on opposite side as focus.
-- Dorsolateral cortex = Opposite-sided tonic or clonic movements. Head-turning can be same-sided OR opposite-sided.

Making things [more] complicated: Seizure activity can spread from one frontal area to another (even while staying on the same side of the brain), and so can produce a variety of motor activity. The timing of the activity is relevant as well: Head-turning early in a seizure tends to indicate a same-sided seizure focus, whereas head-turning late in a seizure (particularly one that generalizes) suggests an opposite-sided focus.

So...it may be hard to draw conclusions about the focus based on changes in your motor activity. But all the same, worth letting your neuro know about when you see him next month. Hope this helps.

 

[masterjen]

Making things [more] complicated: Seizure activity can spread from one frontal area to another (even while staying on the same side of the brain), and so can produce a variety of motor activity. The timing of the activity is relevant as well: Head-turning early in a seizure tends to indicate a same-sided seizure focus, whereas head-turning late in a seizure (particularly one that generalizes) suggests an opposite-sided focus.

Many thanks, Nakamova. Everything you said helps me understand better. I quoted that one part of what you typed because I honestly didn't realize seizure activity could spread without it necessarily becoming a generalized seizure. That is what you are meaning here, right?

 

[Nakamova]

Yes, that's it exactly. Many of the areas in the frontal and temporal lobes are so close to another that activity can quickly spread from one section to another. Additionally, a focus can be narrowly restricted to a single part of a lobe, or it can be broad, involving several areas at once. It can be difficult to definitively pinpoint the originating focus based on the resulting symptoms, but there are some rough correlations between type of aura and origin -- see http://www.coping-with-epilepsy.com...auras-determine-location-seizure-focus-18572/