Department of Neurology, Mount Sinai Health System, New York
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York
Department of Neurosurgery, Mount Sinai Health System, New York, USA
Correspondence: Gabriela Tantillo
1468 Madison Avenue 210d,
New York, NY 10029, USA
Longstanding epilepsy can lead to modulation of cortical networks over time and unexpected seizure onset zones. Frontal lobe seizures, in particular, can have diverse semiologies and evolution patterns. We present a male patient with drug-resistant epilepsy secondary to severe traumatic brain injury who underwent bilateral stereo electroencephalography (SEEG) for surgical planning. SEEG localized an ictal circular head roll to the right anterior prefrontal region. This was followed by spread to the left orbitofrontal region and later the left amygdala and hippocampus, at which point a different semiology with behavioral arrest, lip smacking and oral automatisms began. This case, in which an ictal circular head roll was localized to the anterior prefrontal region, demonstrates the complexity of broad seizure networks that develop over time, leading to remote seizure spread.