Orbitofrontal epilepsy: Electroclinical analysis of surgical cases and literature review

Clinical and electrographic data were reviewed on 2 of our patients
with orbitofrontal epilepsy who were seizure free at 5-year
follow-up, and on 2 similar patients from the literature. One of
our patients was lesional, and the other was nonlesional.
Interictal EEG discharges were lateralized to the side of
invasively recorded orbitofrontal seizures in the nonlesional case.
In this case, no clinical manifestations occurred until the
orbitofrontal discharge had spread to the opposite orbitofrontal
and both mesial temporal areas. Unresponsiveness or arrest of
activity were the initial manifestations of complex partial
seizures in both cases. The 2 cases from the literature with
long-term seizure-free follow-up had little impairment of awareness
and displayed vigorous motor automatisms. Interictal epileptiform
activity was bifrontally synchronous in 1 case. Ipsilateral
frontotemporal discharges were seen in both. Invasive ictal
epileptiform activity appeared maximal in the ipsilateral
orbitofrontal region in both patients. No consistent electrographic
or clinical pattern characterized these 4 cases. Seizures of
orbitofrontal origin may be characterized by either
unresponsiveness associated with oroalimentary automatisms or
limited alteration of awareness and associated with vigorous motor
automatisms. Invasive monitoring of the orbitofrontal cortex should
be considered in nonlesional cases with complex partial seizures
that show nonlocalizing ictal patterns and interictal frontal or
frontotemporal epileptiform discharges. Copyright (C) 2004 S.
Karger AG, Basel.