title: Frontal lobe tumoral epilepsy: clinical, neurophysiologic features and predictors of surgical outcome.
abstract: OBJECTIVE
  To review the clinical, neurophysiologic features and surgical outcomes in patients with frontal lobe tumors and chronic intractable seizures.
  
  
  METHODS
  Medical records of patients with intractable epilepsy who underwent resection or stereotactic biopsy of frontal lobe tumor (confirmed by surgical pathology) seen between 1985 and 1999 at Yale University School of Medicine Epilepsy Center were reviewed for age at diagnosis, age at onset of seizures, delay between seizure onset and tumor diagnosis, types and frequencies of seizures, EEG results, use of anticonvulsants, extent of surgery, pathological diagnosis, and tumor recurrence.
  
  
  RESULTS
  Thirty-seven patients were included. Mean age at seizure onset was 31.6 years, and at tumor diagnosis was 36.2 years. Mean duration between onset of seizures and tumor diagnosis was 6.1 years. Seventeen patients had auras. Seizure frequency averaged 7.6 seizures per week, with 58% of patients having more than one seizure type. All patients used anticonvulsants, with 90% eventually using polytherapy. All patients eventually underwent at least one surgical procedure. Only 13 (35.1%) patients were class I. Twelve (32.4%) patients were class II, seven (18.9%) class III, and five (13.5%) class IV. No statistically significant differences were seen between good and poor long-term seizure outcome in relation to specific tumor pathology, seizure types, or type of resection.
  
  
  CONCLUSIONS
  Long-term surgical outcomes in tumoral frontal lobe epilepsy are more favorable than those in nontumoral intractable frontal lobe epilepsy (65% class I or II) and less favorable than those in other tumoral epilepsy (overall, 70% class I). Frontal location of intracranial neoplasm may predict a less favorable long-term epilepsy prognosis than tumoral epilepsy in general, an observation for which several explanations are proposed.
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, Connecticut 06520-8018, USA. mmzid@med.unc.edu
authors.forename: Megdad M
authors.initials: MM
authors.lastname: Zaatreh
authors.forename: Dennis D
authors.initials: DD
authors.lastname: Spencer
authors.forename: James L
authors.initials: JL
authors.lastname: Thompson
authors.forename: Hal
authors.initials: H
authors.lastname: Blumenfeld
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Novotny
authors.forename: Richard H
authors.initials: RH
authors.lastname: Mattson
authors.forename: Susan S
authors.initials: SS
authors.lastname: Spencer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000503:physiopathology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography / Q000706:statistics & numerical data*; D017034:Epilepsy, Frontal Lobe / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data; D016896:Treatment Outcome