Semiology of seizures
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This document discusses seizure semiology and how symptoms can help localize seizure onset zones. It outlines various ictal symptoms including sensory phenomena, psychic manifestations, head and limb movements, eye movements, dystonic posturing, automatisms, behavioral changes, and autonomic symptoms. Each symptom is described and associated brain regions are provided to help lateralize or localize seizure onset. Diagnostic protocols for epilepsy rely on detailed analysis of clinical semiology through video-EEG monitoring combined with neuroimaging and other assessments.
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Semiology of seizures
- 1. Seizure semiology Moahmed Hamdy Assistant Professor of neurology Alexandria university
- 7. • Diagnostic protocols rely on – clinical semiology, – optimized MRI sequences, – video-telemetry, – Functional neuroimaging, – neuropsychology and neuropsychiatry assessments and, at times, – invasive EEG monitoring.
- 8. 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)
- 9. 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
- 10. • 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
- 13. • Diagnostic protocols rely on – clinical semiology, – optimized MRI sequences, – video-telemetry, – Functional neuroimaging, – neuropsychology and neuropsychiatry assessments and, at times, – invasive EEG monitoring.
- 14. Semiology is the 1st and the most important step • Questioning the patient and family • Direct observation while hospitalization • Video-EEG monitoring
- 15. • 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
- 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. 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
- 18. Somatosensory phenomena well localized, discriminatory, and spread relatively slowly (like a sort of ‘jacksonian march’) • parietal lobe (primary somatosensory cortex, S1) ill-defined, often accompanied by pain, spread within seconds, • posterior insula-parietal operculum (supplementary somatosensory area, S2) and may be contra- or ipsilateral
- 19. Lateralized ictal headache • Ipsilateral temporal or occipital Post ictal headache • Non localizing
- 20. Special senses Gustarory aura • Insular region Visual aura • Contralateral occipital cortex Elementary auditory • Primary auditory cortex Complex auditory • Temproparietal junction Olfactory aura • Anterior mesiotemporal (uncinate)
- 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. Psychic manifestations Deja vu • Mestiotemporal without lateralization Forced thinking • Frontal or mesiotemporal of the dominant hemisphere Ictal fear • Amygdala Ictal autoscopy • Non dominant parietal lobe
- 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. Head and limb movement Nonversive head turning • Ipsilateral temporal lobe Forced (versive) head turning • Contralateral frontal lobe Focal clonic movement • Contralateral frontal lobe
- 25. Hyperkinetic seizures • frontal lobe Gyratory seizures • Contralateral frontotemporal Todd’s paresis • contralateral
- 26. 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
- 27. Eye and eyelid movements Unilateral blinking • Ipsilateral temporal or frontal Ictal nystagmus • Contralateral frontal or occipital
- 28. 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
- 30. 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
- 31. Automatism Unilateral automatism • Ipsilateral temporal or orbitofrontal Postictal nose wiping • Ipsilateral temporal Rhythmic ictal non clonic hand movement • Contralateral temporal lobe
- 32. 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
- 33. Behavioral and phasic manifestations Post ictal dysnomia •Dominant hemisphere Behavioral arrest •Temporal, or orbitofrontal region
- 34. 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
- 35. Autonomic manifestations Ictal spitting • Non dominant temporal lobe Ictal nausea and vomiting • Anterior insula Ictal laughing • Hypothalamic hamartoma in children and frontal cingulus in adults (non lateralizing) Ictal weeping • Non lateralizing mesiotemporal
- 38. Thank You