{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T22:25:02Z","timestamp":1780352702253,"version":"3.54.1"},"reference-count":50,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T00:00:00Z","timestamp":1713225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The objective was to analyze seizure semiology in pediatric frontal lobe epilepsy patients, considering age, to localize the seizure onset zone for surgical resection in focal epilepsy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Fifty patients were identified retrospectively, who achieved seizure freedom after frontal lobe resective surgery at Great Ormond Street Hospital. Video\u2010electroencephalography recordings of preoperative ictal seizure semiology were analyzed, stratifying the data based on resection region (mesial or lateral frontal lobe) and age at surgery (\u22644 vs &gt;4).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Pediatric frontal lobe epilepsy is characterized by frequent, short, complex seizures, similar to adult cohorts. Children with mesial onset had higher occurrence of head deviation (either direction: 55.6% vs 17.4%; <jats:italic>p<\/jats:italic>\u2009=\u20090.02) and contralateral head deviation (22.2% vs 0.0%; <jats:italic>p<\/jats:italic>\u2009=\u20090.03), ictal body\u2010turning (55.6% vs 13.0%; <jats:italic>p<\/jats:italic>\u2009=\u20090.006; ipsilateral: 55.6% vs 4.3%; <jats:italic>p<\/jats:italic>\u2009=\u20090.0003), and complex motor signs (88.9% vs 56.5%; <jats:italic>p<\/jats:italic>\u2009=\u20090.037). Both age groups (\u22644 and &gt;4\u2009years) showed hyperkinetic features (21.1% vs 32.1%), contrary to previous reports. The very young group showed more myoclonic (36.8% vs 3.6%; <jats:italic>p<\/jats:italic>\u2009=\u20090.005) and hypomotor features (31.6% vs 0.0%; <jats:italic>p<\/jats:italic>\u2009=\u20090.003), and fewer behavioral features (36.8% vs 71.4%; <jats:italic>p<\/jats:italic>\u2009=\u20090.03) and reduced responsiveness (31.6% vs 78.6%; <jats:italic>p<\/jats:italic>\u2009=\u20090.002).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>This study presents the most extensive semiological analysis of children with confirmed frontal lobe epilepsy. It identifies semiological features that aid in differentiating between mesial and lateral onset. Despite age\u2010dependent differences, typical frontal lobe features, including hyperkinetic seizures, are observed even in very young children. A better understanding of pediatric seizure semiology may enhance the accuracy of onset identification, and enable earlier presurgical evaluation, improving postsurgical outcomes. 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