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Epilepsy causes a variety of symptoms, depending on where the seizures originate in the brain. Seizures that begin in the front of the brain (frontal lobe seizures) vary the most from one individual to another and may produce unusual symptoms that can appear to be related to a psychiatric problem or a sleep disorder.

For example, some people will be struck with an inexplicable spate of giggling during frontal lobe seizures, while others may scream, growl or bark. Many frontal lobe seizures occur during sleep, causing people to jump out of bed and run around or pound on things. Bicycle pedaling motions and pelvic thrusting also may occur.

Despite these peculiarities, there are characteristic features of frontal lobe seizures. Frontal lobe epilepsy may produce very brief seizures, often lasting less than a minute, that recur multiple times a day. Frontal lobe seizures can also cause whole-body convulsions.

In many cases of frontal lobe epilepsy, the electroencephalograms (EEGs) may not show the changes characteristic of epileptic seizures. Medications usually can control frontal lobe seizures, but surgery is an option if anti-seizure drugs aren't effective.

Frontal lobe seizures can vary greatly, but some characteristics are commonly noted:

• Frequent seizures
• Clustering of seizures, often during sleep
• Falling, caused by seizures that begin in one area of the brain and rapidly spread into other parts of the brain
• Minimal or no confusion after the seizure
• Variable in causing unconsciousness

Depending on where the seizures originate in the frontal lobes, symptoms may also include:

• Head and eye deviation to one side
• Complete or partial unresponsiveness, or difficulty speaking
• Explosive vocalizations — such as screams, laughter or barking
• Abnormal body posturing, such as one arm extending while the other flexes, as if the person is posing like a fencer
• Behavioral automatisms — such as rocking, bicycle pedaling movements or repetitive hand movements

Frontal lobe seizures can result from abnormalities — such as tumors, vascular malformations or traumatic injuries — in the brain's frontal lobes. An abnormal gene causes a rare inherited disorder called autosomal dominant nocturnal frontal lobe epilepsy. If one of your parents has this form of frontal lobe epilepsy, you have a 50 percent chance of inheriting the gene and developing the disease yourself.

In most cases, however, the cause of frontal lobe epilepsy remains unknown.

Frontal lobe epilepsy occurs in all age groups, often beginning in childhood. It can be difficult to diagnose because its symptoms may be mistaken for psychiatric problems or sleep disorders, such as night terrors. And some people may have both frontal lobe epilepsy and a sleep disorder. It is often possible for the physician to diagnose seizure disorders based on a detailed description of the signs and symptoms and by performing a physical examination.

Magnetic resonance imaging (MRI) scans and electroencephalograms (EEGs) also may be helpful in diagnosing some types of epilepsy, but MRIs and EEGs are often normal in cases of frontal lobe epilepsy.

A helpful diagnostic tool in frontal lobe epilepsy is video-EEG, which is usually performed during an overnight stay at a hospital's sleep clinic. Both a video camera and an EEG monitor run all night. Doctors can then match the physical manifestations of a seizure with what appears on the EEG at precisely that same time.

But video-EEGs are expensive and may not be available locally for everyone. Seizures may not occur every night, so there may be no activity for the video-EEG to record.

All anti-seizure drugs seem to work equally well at controlling frontal lobe seizures, but not everyone becomes seizure-free on medication. In those instances, doctors may recommend surgery to remove the small portion of the brain that produces the seizures.

Because seizures in frontal lobe epilepsy are brief and may spread rapidly to other regions, it's sometimes difficult to pinpoint the area in the brain that needs to be removed. If surgery isn't an option, doctors may suggest implanting a device to stimulate the vagus nerve. This procedure typically reduces seizures by 20 percent to 40 percent.

Because frontal lobe epilepsy may be mistaken for other conditions, people who have the disorder might not receive appropriate treatment. In some cases, people have actually been in protective legal custody for aggression and psychosis. Once the proper medications were provided, their seizures stopped.

Recognizing frontal lobe epilepsy and receiving appropriate treatment can be the first steps toward a more normal life.