Frontal Lobe Epilepsy: A Primer for Psychiatrists and a Systematic Review of Psychiatric Manifestations

Psychosomatics. Sep-Oct 2016;57(5):445-64. doi: 10.1016/j.psym.2016.05.005. Epub 2016 May 16.

Abstract

Background: Frontal lobe epilepsy (FLE) can masquerade as a primary psychiatric condition, be misdiagnosed in-lieu of a true psychiatric disorder, or may be comorbid with psychiatric illness.

Objectives: To (1) qualitatively review psychiatric manifestations of FLE and (2) to systematically review the cases/case series of psychiatric manifestations of FLE presented in the literature to date.

Methods: A systematic review of the literature was performed following the PRISMA guidelines and using PubMed/Medline, PsychInfo, and Cochrane database of systematic reviews to identify cases and case series of psychiatric manifestations of FLE.

Results: A total of 35 separate articles were identified. Further, 17 patients primarily presented with psychosis, 33 with affective symptoms, and 16 with personality changes. Also, 62% of cases were males and 38% were females. Ages ranged from 2-83 years with the average age of 32.7. Prior psychiatric history was reported in 27.3% of cases. Causes of seizure were known in 53%, with the most common causes being dysplasia and tumor. Only 6 cases (<10%) did not have electroencephalographic correlations. Psychiatric manifestations were primarily ictal in 74.3% of the cases. Associated manifestations included motor (63.6%), cognitive (34.8%), and medical (9.0%) findings. Surgery was required in 31.8% of the cases, whereas others were treated with medications alone. All, but 3, patients were seizure free and saw an improvement in symptoms with treatment.

Conclusions: Given the complexity and multifunctionality of the frontal lobes, FLE can present with complex, psychiatric manifestations, with associated motor, cognitive, and medical changes; thus, psychiatrists should keep FLE on the differential diagnosis of complex neuropsychiatric cases.

Keywords: behavior; epilepsy; frontal lobe; mood; neuropsychiatry.; seizures.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Affect / physiology
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Cognition Disorders / diagnosis
  • Cognition Disorders / physiopathology
  • Cognition Disorders / psychology
  • Electroencephalography
  • Epilepsies, Partial / diagnosis
  • Epilepsies, Partial / etiology
  • Epilepsies, Partial / physiopathology
  • Epilepsies, Partial / psychology
  • Epilepsy, Frontal Lobe / diagnosis*
  • Epilepsy, Frontal Lobe / etiology
  • Epilepsy, Frontal Lobe / physiopathology
  • Epilepsy, Frontal Lobe / psychology*
  • Evaluation Studies as Topic
  • Female
  • Frontal Lobe / physiopathology
  • Humans
  • Male
  • Mental Disorders / diagnosis*
  • Mental Disorders / psychology*
  • Middle Aged
  • Motor Disorders / diagnosis
  • Motor Disorders / physiopathology
  • Motor Disorders / psychology
  • Somatoform Disorders / diagnosis
  • Somatoform Disorders / physiopathology
  • Somatoform Disorders / psychology
  • Young Adult