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Frontal Lobe Growth Retardation and Dysfunctions in Children with Epilepsy: A 3-D MRI Volumetric Study

Hideaki Kanemura *,Masao Aihara

Behavioral abnormalities have been noted in specific epilepsy syndromes involving the frontal lobe. Epilepsies that involve the frontal lobe, such as frontal lobe epilepsy (FLE), atypical evolution of benign childhood epilepsy with centrotemporal spikes (BCECTS), and epilepsy with continuous spike-waves during slow sleep (CSWS), are characterized by impairment of neuropsychological abilities, frequently associated with behavioral disorders. These manifestations correlate strongly with frontal lobe dysfunction. Accordingly, epilepsies in childhood may affect the prefrontal cortex and leave residual mental and behavioral abnormalities. Brain volumetry has shown that frontal and prefrontal lobe volumes show a growth disturbance in patients with FLE, atypical evolution of BCECTS, and CSWS
compared with those of normal subjects. These studies also showed that seizures and the duration of paroxysmal anomalies may be associated with prefrontal lobe growth abnormalities, which are associated with neuropsychological problems. Moreover, these studies also showed that the prefrontal lobe appears more highly vulnerable to repeated seizures than other cortical regions. The urgent suppression of these seizure and EEG abnormalities may be necessary to prevent the progression of neuropsychological impairments. Treatment options to remit seizures and EEG abnormalities as soon as possible may be required to achieve the optimal prognosis in frontal lobe epilepsies. Of the new AEDs, levetiracetam (LEV) may be an important addition to the treatments available for refractory childhood epilepsies with cognitive and behavioral problems.