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Focal functional anatomy of dorsolateral frontocentral seizures

Department of Neurology (Drs. Sutherling, Risinger, Baumgartner, and Wilson) and Division of Neurosurgery (Drs. Crandall, Becker, and Levesque), UCLA School of Medicine, Los Angeles; and Department of Neurosurgery (Dr. Cahan), University of California, Irvine, CA.

We compared 6 patients with dorsolateral frontocentral seizures to 7 patients with temporal lobe seizures. We determined general seizure location by structural lesions in 7 patients, bilateral depth electrodes in 4, and EEG and semiology in 2. We then mapped seizure cortex and essential cortex using chronic ECoG arrays. Two ECoG patterns were similar in frontal and temporal seizures. Focal patterns were near lesions and resections. Regional patterns were distant from lesions but not associated with worse surgical outcome. "Dipolar" seizure patterns occurred in one-half of frontal patients with maps like somatosensory evoked responses, consistent with focal seizure anatomy and involvement of sensorimotor cortex. Dipole location estimates were near centers of seizure cortex determined by lesions, semiology, and outcome. Six temporal patients had focal excisions that gave significant seizure reduction in all. All frontocentral patients had focal excisions that significantly reduced seizures except in 1 patient with progressive disease. We conclude that dorsolateral frontocentral seizures have focal functional anatomy that can be predicted by ictal ECoG.

Address correspondence and reprint requests to Dr. William W. Sutherling, Department of Neurology, Reed Neurological Research Center, 710 Westwood Plaza, Los Angeles, CA 90024-1769.

Presented in part at the 39th annual meeting of the American Academy of Neurology, New York, NY, April 1987.

Supported by the National Institute of Neurological and Communicative Disorders and Stroke, Epilepsy Branch, research grant NS20806 and grants from the Research Society for Parkinson's Disease and Movement Disorders, the Reed Neurological Research Center, and Ponds zur Förderung der wissenschaftlichen Forschung Österreichs (Erwin Schrödinger Stipendium J246M and J334MED). Dr. Sutherling is a recipient of a Teacher Investigator Development Award (NS00678) from the National Institute of Neurological and Communicative Disorders and Stroke and of a Meritt-Putnam Fellowship from the Epilepsy Foundation of America.

Received March 3, 1989. Accepted for publication in final form June 14, 1989.

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