Klasifikasi tipe kejang terbaru tahun 2017 oleh ILAE didasarkan pada "onset" kejangnya. Focal atau General. Kenapa kita harus tahu tipe kejang yang diderita ini focal atau general? Bagaimana kita tahu suatu kejang ini focal atau general? Apakah hanya berdasarkan "onset"-nya saja? Seberapa spesifik kah "focal" yang diperlukan untuk menentukan keputusan klinis kita? Apakah "focal" itu cukup sebatas mengetahui hemisfer kanan/kiri, atau sampai menentukan lobus yang terkait, atau gyrus, atau area yang lebih spesifik? Apa gold standar diagnosis topis sumber kejang? Apakah semiologi masih relevan dengan begitu berkembangnya teknologi imaging, EEG, genetika?

1. Seizure Semiology
Introduction
Ersifa Fatimah | Surabaya | 2019

2. Fisher RS, Cross JH, D'Souza C, et al. Instruction
manual for the ILAE 2017 operational
classification of seizure types. Epilepsia. 2017
Apr;58(4):531-542.
2

3. Framework for classification of the epilepsies
3
Scheffer IE, Berkovic S, Capovilla G, et
al. ILAE classification of the
epilepsies: Position paper of the ILAE
Commission for Classification and
Terminology. Epilepsia. 2017
Apr;58(4):512-521

4. How to identify seizure origin?
4

5. 5
Fisher RS, Cross JH, D'Souza C, et al. Instruction
manual for the ILAE 2017 operational
classification of seizure types. Epilepsia. 2017
Apr;58(4):531-542.

6. • Aura | Ictal | Post-ictal
• "..non-localizing but highly lateralizing sign.."
6

7. Localization and lateralization of epileptic signs and symptoms
7
Foldvary-Schaefer N, Unnwongse K. Localizing and lateralizing features of auras and seizures. Epilepsy & Behavior 20 (2011) 160–166

8. Lateralizing signs of focal seizures
8
Foldvary-Schaefer N, Unnwongse K. Localizing and lateralizing features of auras and seizures. Epilepsy & Behavior 20 (2011) 160–166

9. Limitations
9

10. Limitations of using semiology as a localizing tool
• Seizure semiology is subjective
• Inter-rater variability, different epilepsy centers may define symptoms and signs
differently  occurs despite using systematic approach to analyze the seizure
semiology with video recording and highly trained individuals
• Seizure semiology is the manifestation of the activation of the
symptomatogenic zone
• Seizures arising from different epileptogenic zones could activate the same
symptomatogenic zone
• Seizure originating from the same epileptogenic zone could activate different
symptomatogenic zones producing different seizure semiologies
• Seizure semiology does not always permit differentiation of focal or
generalized epilepsies
• Focal epilepsy may trigger seizures of "generalized" semiology, and vice versa
generalized epilepsies may have seizures of focal symptomatology
10Tufenkjian K, Lüders HO. Seizure Semiology: Its Value and Limitations in Localizing the Epileptogenic Zone. J Clin Neurol. 2012 Dec; 8(4): 243–250.

11. The Challenges
11

12. Schematic representation of the
overlapping cortical zones in
epilepsy
Different cortical zones are estimated by the
epileptologists during the presurgical evaluation
of a patient with epilepsy. These zones can often
overlap, providing the epileptologist with
concordant findings for the delineation of the
epileptogenic zone (EZ).
Tamilia E, Madsen JR, Grant PE, Pearl PL and Papadelis C
(2017) Current and Emerging Potential of Magneto-
encephalography in the Detection and Localization of
High-Frequency Oscillations in Epilepsy. Front. Neurol.
8:14.
12

13. Cortical Zones Defined in the Presurgical Evaluation
Cortical Zone Definition Diagnostic Techniques
Irritative zone Area of cortex that generates interictal spikes EEG, MEG, EEG-fMRI
Seizure-onset zone Area of cortex that initiates clinical seizures EEG, ictal SPECT and, to a lesser
degree, f-MRI and MEG
Symptomatogenic zone Area of cortex that, when activated, produces
the initial ictal symptoms or signs
Initial seizure symptomatology
Epileptogenic lesion Macroscopic lesion that is causative of the
epileptic seizures because the lesion itself is
epileptogenic (e.g., cortical dysplasia) or by
secondary hyperexcitability of adjacent
cortex)
MRI
Functional deficit zone Area of cortex that is not functioning
normally in the interictal period
Neurological examination, neuro-
psychological examination and
functional imaging (interictal SPECT
and PET)
Jehi L. The Epileptogenic Zone: Concept and Definition. Epilepsy Curr. 2018 Jan-Feb; 18(1): 12–16.
13

14. Clinical Impact
14

15. Lüders HO, Najm I, Nair D, Widdess-Walsh P, Bingman W. The epileptogenic zone:
general principles. Epileptic Disord. 2006 Aug;8 Suppl 2:S1-9. 15

16. The Future
Advance technology & genetic era  Do we still need “seizure semiology”?
What is the best way to identify seizure origin? Anatomo-electro-clinical analysis is
not enough..
16

17. References
17
• Fisher RS, Cross JH, D'Souza C, et al. Instruction manual for the ILAE 2017
operational classification of seizure types. Epilepsia. 2017 Apr;58(4):531-542.
• Foldvary-Schaefer N, Unnwongse K. Localizing and lateralizing features of auras and
seizures. Epilepsy & Behavior 20 (2011) 160–166
• Jehi L. The Epileptogenic Zone: Concept and Definition. Epilepsy Curr. 2018 Jan-Feb;
18(1): 12–16.
• Lüders HO, Najm I, Nair D, Widdess-Walsh P, Bingman W. The epileptogenic zone:
general principles. Epileptic Disord. 2006 Aug;8 Suppl 2:S1-9.
• Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies:
Position paper of the ILAE Commission for Classification and Terminology. Epilepsia.
2017 Apr;58(4):512-521
• Tamilia E, Madsen JR, Grant PE, Pearl PL and Papadelis C (2017) Current and
Emerging Potential of Magneto-encephalography in the Detection and Localization
of High-Frequency Oscillations in Epilepsy. Front. Neurol. 8:14.
• Tufenkjian K, Lüders HO. Seizure Semiology: Its Value and Limitations in Localizing
the Epileptogenic Zone. J Clin Neurol. 2012 Dec; 8(4): 243–250.

18. Discussion
Thank you
18