Semiology of seizures

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Semiology of seizures

  1. 1. Seizure semiology Moahmed HamdyAssistant Professor of neurology Alexandria university
  2. 2. • Diagnostic protocols rely on – clinical semiology, – optimized MRI sequences, – video-telemetry, – Functional neuroimaging, – neuropsychology and neuropsychiatry assessments and, at times, – invasive EEG monitoring.
  3. 3. Pitfalls of neuroimaging alone• In adults, 25% of pathologically confirmed cases of focal cortical dysplasia are reported to be MRI-negative prior to surgery (high resolution 3 tesla)
  4. 4. Pitfalls of neuroimaging alone• Increased signal on FLAIR indicative of HS is not always accompanied by hippocampal atrophy,• Neoplasms are the structural substrate in 3- 4% of patients with epilepsy in the general population
  5. 5. • Although MRI-defined structural lesions are a strong predictor of the seizure onset zone, there are reports of well-documented cases in which resections of EEG-defined seizure onset regions that spared structural lesions have resulted in seizure freedom
  6. 6. • Diagnostic protocols rely on – clinical semiology, – optimized MRI sequences, – video-telemetry, – Functional neuroimaging, – neuropsychology and neuropsychiatry assessments and, at times, – invasive EEG monitoring.
  7. 7. Semiology is the 1st and the most important step• Questioning the patient and family• Direct observation while hospitalization• Video-EEG monitoring
  8. 8. • The overall pattern of ictal semiology• The initial subjective phenomenon (aura) and/or objective phenomenon which sometimes make it possible to confirm specific topographic origin• the spatial and temporal articulation of the different ictal phenomenae.• The post-ictal phase (focal deficit)• Conciousness during the attack
  9. 9. From symptom to localization or lateralization• Sensory Phenomena• Psychic Manifestations• Head and Limb Movements• Eye and Eyelid Movements• Dystonic Posturing• Automatisms• Behavioral and Phasic Manifestations• Autonomic Manifestations
  10. 10. From symptom to localization or lateralization• Sensory Phenomena• Psychic Manifestations• Head and Limb Movements• Eye and Eyelid Movements• Dystonic Posturing• Automatisms• Behavioral and Phasic Manifestations• Autonomic Manifestations
  11. 11. Somatosensory phenomenawell localized, discriminatory, and spread relativelyslowly (like a sort of ‘jacksonian march’)• parietal lobe (primary somatosensory cortex, S1)ill-defined, often accompanied by pain, spreadwithin seconds,• posterior insula-parietal operculum (supplementary somatosensory area, S2) and may be contra- or ipsilateral
  12. 12. Lateralized ictalheadache• Ipsilateral temporal or occipitalPost ictal headache• Non localizing
  13. 13. Special sensesGustarory aura• Insular regionVisual aura• Contralateral occipital cortexElementary auditory• Primary auditory cortexComplex auditory• Temproparietal junctionOlfactory aura• Anterior mesiotemporal (uncinate)
  14. 14. From symptom to localization or lateralization• Sensory Phenomena• Psychic Manifestations• Head and Limb Movements• Eye and Eyelid Movements• Dystonic Posturing• Automatisms• Behavioral and Phasic Manifestations• Autonomic Manifestations
  15. 15. Psychic manifestationsDeja vu• Mestiotemporal without lateralizationForced thinking• Frontal or mesiotemporal of the dominant hemisphereIctal fear• AmygdalaIctal autoscopy• Non dominant parietal lobe
  16. 16. From symptom to localization or lateralization• Sensory Phenomena• Psychic Manifestations• Head and Limb Movements• Eye and Eyelid Movements• Dystonic Posturing• Automatisms• Behavioral and Phasic Manifestations• Autonomic Manifestations
  17. 17. Head and limb movementNonversive headturning• Ipsilateral temporal lobeForced (versive) headturning• Contralateral frontal lobeFocal clonic movement• Contralateral frontal lobe
  18. 18. Hyperkinetic seizures• frontal lobeGyratory seizures• Contralateral frontotemporalTodd’s paresis• contralateral
  19. 19. From symptom to localization or lateralization• Sensory Phenomena• Psychic Manifestations• Head and Limb Movements• Eye and Eyelid Movements• Dystonic Posturing• Automatisms• Behavioral and Phasic Manifestations• Autonomic Manifestations
  20. 20. Eye and eyelid movementsUnilateral blinking• Ipsilateral temporal or frontalIctal nystagmus• Contralateral frontal or occipital
  21. 21. From symptom to localization or lateralization• Sensory Phenomena• Psychic Manifestations• Head and Limb Movements• Eye and Eyelid Movements• Dystonic Posturing• Automatisms• Behavioral and Phasic Manifestations• Autonomic Manifestations
  22. 22. Dystonic posturingUnilaterallimbdystonia•Contralateral temporal or frontal
  23. 23. From symptom to localization or lateralization• Sensory Phenomena• Psychic Manifestations• Head and Limb Movements• Eye and Eyelid Movements• Dystonic Posturing• Automatisms• Behavioral and Phasic Manifestations• Autonomic Manifestations
  24. 24. AutomatismUnilateral automatism• Ipsilateral temporal or orbitofrontalPostictal nose wiping• Ipsilateral temporalRhythmic ictal non clonichand movement• Contralateral temporal lobe
  25. 25. From symptom to localization or lateralization• Sensory Phenomena• Psychic Manifestations• Head and Limb Movements• Eye and Eyelid Movements• Dystonic Posturing• Automatisms• Behavioral and Phasic Manifestations• Autonomic Manifestations
  26. 26. Behavioral and phasic manifestationsPost ictal dysnomia•Dominant hemisphereBehavioral arrest•Temporal, or orbitofrontal region
  27. 27. From symptom to localization or lateralization• Sensory Phenomena• Psychic Manifestations• Head and Limb Movements• Eye and Eyelid Movements• Dystonic Posturing• Automatisms• Behavioral and Phasic Manifestations• Autonomic Manifestations
  28. 28. Autonomic manifestationsIctal spitting• Non dominant temporal lobeIctal nausea and vomiting• Anterior insulaIctal laughing• Hypothalamic hamartoma in children and frontal cingulus in adults (non lateralizing)Ictal weeping• Non lateralizing mesiotemporal
  29. 29. Vertigo•Insular-tempro-parietal junctionviscerosensory•mesiotemporal
  30. 30. Thank You

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