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Frontal lobe seizures are very resistant to drug treatment and so people with this type of epilepsy are often considered for surgery. But just as with temporal lobe surgery, they will have to be carefully assessed first of all to make sure they are suitable candidates for surgery.
If the seizures are all arising from the frontal lobe and the MRI scan shows that there is a lesion, then two operations can be done. The first is to remove only the lesion in the hope that this will stop the seizures. The second option is to remove a large chunk of the frontal lobe (frontal lobectomy). This is the operation that is usually done if the lesion is large.
If no lesion is found on the MRI scan, the next step will be to insert depth electrodes while the patient is under a general anaesthetic. Leashes of thin electrode wires are inserted into the frontal lobe through a burr hole in the skull. These are kept in place for one to two weeks, and the EEG activity from them is measured continuously, until enough seizures have been captured to make it clear where they are arising. If they are arising from a single epileptic focus, even though its exact size is uncertain this focus may be removed by taking away a large area of frontal lobe surrounding the focus.
Success of frontal lobe surgery
Frontal lobe surgery is not usually as successful as temporal lobe surgery. If an actual lesion is found by MRI scanning and removed, about 40 per cent of people who have the operation will lose their seizures. If, on the other hand, the MRI shows no clear structural lesion although the EEG shows that there is a focus from which seizures are arising, only between 20 and 30 per cent of patients having the operation will lose their seizures. Unfortunately removal of a frontal lobe often causes personality changes, and this is something that anyone who is considering the operation should discuss in detail with their doctor before making a final decision to go ahead.

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