Complex Partial Seizures of Frontal Lobe Origin

Abstract

As early as 400years B.C., Hippocrates [26] recognized the warning signs or symptoms (aura) of epilepsy. In 1677, Thomas Willis [59] gave the first description of a psychomotor attack, and in 1822 Prichard [42] first used the term “partial epilepsy.” However, it was John Hughlings Jackson who developed the conceptual framework and meaning of epileptic symptomatology and signs. Jackson, a true scholar, completely refounded epileptology and collated bedside observations with anatomical facts. By 1889, he [24, 25] had linked the symptoms and signs of psychomotor seizures to the “sphenoidal lobe” or the medial temporal areas of the uncus. Since then, modern studies, notably by Ajmone-Marsan and Abraham [1–3], Bancaud, Talairach and collaborators in Paris [4–12,20,21, 31–33,48, 53], Wieser and Ya§argil [52, 54, 55] in Zurich, the Spencers et al. [45, 46] and Williamson et al. [56–58] in New Haven, Rasmussen [44], Gloor [22, 23], and Quesney et al. [43] in Montreal, and our Comprehensive Epilepsy Program in Los Angeles [12–15, 34], have characterized a wide range of psychomotor automatisms on cine film or closed-circuit television videotape (CCTV) from simple lip smacking, chewing, pursing lips, and, eye blinking, to running, mimicry, gesticulations, and sometimes bizarre complex bilateral hand and leg movements. These clinical signs have been related to epileptiform discharges recorded by scalp and sphenoidal electroencephalography (EEG) and stereoelectroencephalography (SEEG).

Such as are habituated to their disease have a presentiment when an attack is imminent and run away from men, home, if their house be near, if not, to the most deserted spot… Hippocrates

Along with this voluminous mental state, there is frequently a “crude sensation” (“warning”) of (a) smell or (b) taste; (or, when there is no taste, there may be movements, chewing, tasting, spitting). J. H. Jackson