Hostname: page-component-6bf8c574d5-qdpjg Total loading time: 0 Render date: 2025-02-18T00:10:11.219Z Has data issue: false hasContentIssue false
  • English
  • Français

Seizure Semiology: Value in Identifying Seizure Origin

Published online by Cambridge University Press:  02 December 2014

Mohammed M.S. Jan  and
John P. Girvin
Mohammed M.S. Jan
Affiliation:
The Department of Pediatrics, King AbdulAziz University Hospital Department of Neurosciences, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
John P. Girvin
Affiliation:
Department of Neurosciences, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The diagnosis of epilepsy depends upon a number of factors, particularly detailed and accurate seizure history, or semiology. Other diagnostic data, consisting of electroencephalography, video-monitoring of the seizures, and magnetic resonance imaging, are important in any comprehensive epilepsy program, particularly with respect to lateralizing and localizing the seizure focus, if such a focus exists, and with respect to determining the type of seizure or seizure syndrome. The aim of this review is to present a survey of important semiologic characteristics of various seizures that provide the historian with observations, which help to lateralize and localize epileptic zones. Clinical semiology is the starting point of understanding a seizure disorder and making the diagnosis of epilepsy. While it may not provide unequivocal evidence of localization of the epileptic focus, nevertheless it usually directs subsequent investigations, whose concordance is necessary for the ultimate localization.

Résumé:

RÉSUMÉ:

Le diagnostic d'épilepsie repose sur un certain nombre de facteurs, principalement sur une histoire détaillée et exacte des crises c.-à-d. la séméiologie. Les autres données sur lesquelles repose le diagnostic sont l'électroencéphalographie (ÉEG), l'enregistrement sur vidéo et l'imagerie par résonance magnétique (IRM) qui sont importants dans un protocole complet d'évaluation, surtout pour la latéralisation et la localisation du foyer épileptique le cas échéant et pour l'identification du type d'épilepsie ou de syndrome épileptique. Le but de cette revue était de présenter les caractéristiques séméiologiques importantes des différentes épilepsies qui fournissent au clinicien les observations aidant à déterminer la latéralisation et la localisation des zones épileptogènes. La séméiologie clinique est le point de départ de la compréhension d'un désordre épileptique et du processus diagnostique. Bien qu'elle ne fournisse pas toujours une indication non équivoque sur la localisation du foyer épileptique, elle oriente habituellement l'évaluation du patient et la concordance des observations est nécessaire pour sa localisation.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 1 , March 2008 , pp. 22 - 30
Copyright
Copyright © The Canadian Journal of Neurological 2008

References

1. Jan, MM. Clinical review of pediatric epilepsy. Neuroscience. 2005; 10: 255–64.Google ScholarPubMed
2. French, JA, Williamson, PD, Thadani, VM, Darcey, TM, Mattson, RH, Spencer, SS, et al. Characteristics of medial temporal lobe epilepsy. I. Results of history and physical examination. Ann Neurol. 1993; 34: 774–80.Google Scholar
3. Jan, MM. The value of seizure semiology in lateralizing and localizing partially originating seizures. Neurosciences. 2007; 12(3):185–90.Google Scholar
4. Jan, MM. The value of postictal electroencephalogram in temporal lobe seizures. Ann Saudi Med. 1999; 19: 550–3.Google Scholar
5. Jan, MM, Sadler, M, Rahey, SR. Lateralized postictal EEG delta predicts the side of seizure surgery in temporal lobe epilepsy. Epilepsia. 2001; 42: 402–5.Google Scholar
6. Jan, MM, Neville, BGR, Cox, TC, Scott, RC. Convulsive status epilepticus in children with intractable epilepsy is frequently focal in origin. Can J Neurol Sci. 2002; 29: 65–7.Google Scholar
7. Penry, JK, Porter, RJ, Dreifuss, RE. Simultaneous recording of absence seizures with video tape and electroencephalography: a study of 374 seizures in 48 patients. Brain. 1975; 98: 427–40.Google Scholar
8. Falconer, MA, Taylor, DC. Temporal lobe epilepsy: clinical features, pathology, diagnosis, and treatment. In: Price, JH, editor. Modern trends in psychological medicine. New York: Appleton-Century-Crofts; 1970. p. 346–73.Google Scholar
9. Williams, D. The border-land of epilepsy revisited. (The Seventh Gowers Memorial Lecture). Brain. 1975; 98: 1–12.Google Scholar
10. Jan, MM. Assessment of the utility of pediatric EEG. Seizure. 2002; 11: 99–103.Google Scholar
11. Jan, MM, Girvin, JP. Febrile seizures: update and controversies. Neurosciences. 2004; 9: 235–42.Google Scholar
12. O’Brien, T. Multivariate analysis of historical features and seizure semiology in differentiating frontal lobe from temporal lobeonset epilepsy. Epilepsia. 1998; 40: 294–8.Google Scholar
13. So, EL. Value and limitations of seizure semiology in localizing seizure onset. J Clin Neurophysiol. 2006; 23: 353–7.CrossRefGoogle ScholarPubMed
14. Benbadis, S, Kotagal, P, Klem, G. Unilateral blinking: a lateralizing sign in partial seizures. Epilepsia. 1996; 37: 45–8.Google Scholar
15. Yen, DJ, Su, MS, Yiu, CH, Kwan, SY, Tsai, CP, Lin, YY. Ictal speech manifestations in temporal lobe epilepsy: a video-EEG study. Epilepsia. 1996; 37: 45–9.Google Scholar
16. Rego, R, Arnold, S, Noachtar, S. Frontal lobe epilepsy manifesting with seizures consisting of isolated vocalization. Epileptic Disord. 2006; 8: 274–6.Google Scholar
17. Gabr, M, Luders, H, Dinner, D. Speech manifestations lateralization of temporal lobe seizures. Ann Neurol. 1989; 25: 82–6.Google Scholar
18. McKeever, M, Holmes, GL, Russman, VS. Speech abnormalities in seizures: a comparison of absence and partial complex seizures. Brain Lang. 1983; 19: 25–32.Google Scholar
19. Theodore, W, Porter, R, Penry, J. Complex partial seizures: clinical characteristics and differential diagnosis. Neurology. 1983; 33: 1115–21.Google Scholar
20. Penfield, W, Roberts, L. Speech and brain mechanisms. Princeton, NJ: Princeton University Press, 1958.Google Scholar
21. McLachlan, RS. The significance of a history of head and eye turning during seizures. Neurology. 1987; 37: 1617–9.Google Scholar
22. Fakhoury, T, Abou-Khalil, B. Association of ipsilateral head turning and dystonia in temporal lobe seizures. Epilepsia. 1995; 36: 1065–70.Google Scholar
23. Kernan, JC, Devinsky, O, Luciano, DJ, Vazquez, B, Perrine, K. Lateralization significance of head and eye deviation in secondary generalized tonic clonic seizures. Neurology. 1993; 43: 1308–10.Google Scholar
24. Salanova, V, Andermann, F, Olivier, A, Rasmussen, T, Quesney, LF. Occipital lobe epilepsy: electroclinical manifestations, electrocorticography, cortical stimulation and outcome in 42 patients treated between 1930 and 1991. Brain. 1992; 115: 1655–80.Google Scholar
25. Marks, W, Laxer, K. Semiology of temporal lobe seizures in lateralizing seizure focus. Epilepsia. 1998; 39: 721–6.Google Scholar
26. Leutmezer, F, Woginger, S, Antoni, E, Seidl, B, Baumgartner, C. Asymmetric ending of secondarily generalized seizures. a lateralizing sign in TLE. Neurology. 2002; 59: 1252–4.Google Scholar
27. Kotagal, P, Luders, H, Morris, HH, Dinner, DS, Wyllie, E, Godoy, J, et al. Dystonic posturing in complex partial seizures of temporal lobe onset. Neurology. 1989; 39: 196–201.CrossRefGoogle ScholarPubMed
28. Kotagal, P. Lateralizing value of asymmetric tonic limb posturing observed in secondarily generalized tonic-clonic seizures. Epilepsia. 2000; 41: 457–62.Google Scholar
29. Oestreich, LJ, Berg, MJ, Bachmann, DL, Burchfiel, J, Erba, G. Ictal contralateral paresis in complex partial seizures. Epilepsia. 1995; 36: 671–5.CrossRefGoogle ScholarPubMed
30. Kramer, RE, Luders, H, Goldstick, LP, Dinner, DS, Morris, HH, Lesser, RP, et al. Ictus emeticus: an electroclinical analysis. Neurology. 1988; 38: 1048–52.Google Scholar
31. Baumgartner, C, Groppel, G, Leutmezer, F, Aull-Watschinger, S, Pataraia, E, Feucht, M, et al. Ictal urinary urge indicates seizure onset in the nondominant temporal lobe. Neurology. 2000; 55: 432–4.Google Scholar
32. Green, J. Pilomotor seizures. Neurology. 1984; 34: 37–9.Google Scholar
33. Jackson, JH, Stewart, P. Epileptic attacks with a warning of a crude sensation of smell and with the intellectual aura (dreamy state) in a patient who had symptoms pointing to gross organic disease of the right temporo-sphenoidal lobe. Brain. 1899; 22: 534–49.Google Scholar
34. Penfield, W. Temporal lobe epilepsy. Brit J Surg. 1954; 41: 1–7.Google Scholar
35. Penfield, W, Jasper, H. Epilepsy and the functional anatomy of the brain. Boston: Little Brown & Co; 1954. p. 896.Google Scholar
36. Penfield, W. The anatomy of temporal lobe seizures. Proc First Int. Cong Neurol Sci (Brussels). July 1957. p. 11–12.Google Scholar
37. Mullan, S, Penfield, W. Illusions of comparative interpretation and emotion. Arch Neurol Psychiat. 1959; 81: 269–84.Google Scholar
38. Manford, M, Fish, DR, Shorvon, SD. An analysis of clinical seizure patterns and their localizing value in frontal and temporal lobe epilepsies. Brain. 1996; 119: 17–40.Google Scholar
39. Wada, J. Cerebral lateralization and epileptic manifestations. In: Akimoto, H, editor. Advances in Epileptology: XIIIth Epilepsy International Symposium. New York: Raven Press; 1982. p. 366–72.Google Scholar
40. Geyer, JD, Payne, TA, Faught, E, Drury, I. Postical nose-rubbing in the diagnosis, lateralization, and localization of seizures. Neurology. 1999; 52: 7443–54.Google Scholar
41. Macrae, D. Isolated fear. A temporal lobe aura. Neurology 1954; 4: 497–505.Google Scholar
42. Goldberg-Stern, H, Gadoth, N, Cahill, W, Privitera, M. Language dysfunction after frontal lobe seizures. Neurology. 2004; 62: 1637–8.Google Scholar
43. Ervin, FR. Violence and the brain. Trans Coll Physicians Phila. 1972; 39: 194–203.Google Scholar
44. Walsh, GO. Clinical and EEG correlates of an unusually violent psychomotor seizure. Clin Neurophysiol. 1977; 42: 725.Google Scholar
45. Geschwind, N. Interictal behavioral changes in epilepsy. Epilepsia. 1983; 24: 23–30.Google Scholar
46. Mitchell, W, Falconer, MA, Hill, D. Epilepsy with fetishism relieved by temporal lobectomy. Lancet, 1954; 267: 626–30.Google Scholar
47. Waxman, SG, Geschwind, N. Hypergraphia in temporal lobe epilepsy. Neurology. 1974; 24: 629–36.CrossRefGoogle ScholarPubMed
48. Florindo, I, Bisulli, F, Pittau, F, Naldi, I, Striano, P, Striano, S, et al. Lateralizing value of the auditory aura in partial seizures. Epilepsia. 2006; 47: 68–72.Google Scholar
49. Geier, S, Bancaud, J, Talairach, J, Bonis, A, Szikla, G, Enjelvin, M. The seizures of frontal lobe epilepsy: a study of clinical manifestations. Neurology. 1977; 27: 951–8.Google Scholar
50. Geier, S, Bancaud, J, Talairach, J, Bonis, A, Enjelvin, M, Hoosard-Bouchard, H. Automatisms during frontal lobe epileptic seizures. Brain. 1976; 99: 447–58.Google Scholar
51. Rasmussen, T. Characteristics of a pure culture of frontal lobe epilepsy. Epilepsia. 1983; 24: 482–93.Google Scholar
52. Ludwig, B, Ajmone-Marsan, C, Van Buren, J. Cerebral seizures of probable orbitofrontal origin. Epilepsia. 1975; 16: 141–58.Google Scholar
53. Waterman, K, Purves, SJ, Kosaka, B, Strauss, E, Wada, JA. An epileptic syndrome caused by mesial frontal lobe seizure foci. Neurology. 1987; 37: 577–82.Google Scholar
54. Morris, HH 3rd, Dinner, DS, Luders, H, Wyllie, E, Kramer, R. Supplementary motor seizures: clinical and electroencephalographic findings. Epilepsia. 1988; 29: 1075–82.Google Scholar
55. Ajmone-Marsan, C, The epileptic seizure: its functional morphology and diagnostic significance: a clinical-electrographic analysis of metrazol-induced attacks. 1957, Springfield, IL: Charles C. Thomas.Google Scholar
56. Mauguiere, F, Courjon, J. Somatosensory epilepsy: a review of 127 cases. Brain. 1978; 101: 307–32.CrossRefGoogle ScholarPubMed
57. Lewin, W, Phillips, CG. Observations on partial removal of the postcentral gyrus for pain. J Neurol Neurosurg Psychiat. 1952; 15: 143–7.Google Scholar
58. Kofman, O, Tasker, R. Ipsilateral and focal inhibitory seizures. Neurology. 1967; 17: 1082–6.Google Scholar
59. Gastaut, H, Poirier, F, Payan, H, Salamon, G, Toga, M, Virouroux, M. H.H.E. syndrome. Hemiconvulsions, hemiplegic epilepsy. Epilepsia. 1960; 1: 418–77.Google Scholar
60. Boesebeck, F, Schulz, R, May, T, Ebner, A. Lateralizing semiology predicts the seizure outcome after epilepsy surgery in the posterior cortex. Brain. 2002; 125: 2320–31.Google Scholar
61. Krsek, P, Tichy, M, Hajek, M, Dezortova, M, Zamecnik, J, Zedka, M, et al. Successful epilepsy surgery with a resection contralateral to a suspected epileptogenic lesion. Epileptic Disord. 2007; 15: 82–9.Google Scholar
62. Rathke, KM, Schauble, B, Fessler, JA, So, EL. Reliability of seizure semiology in multifocal epilepsy. Neurology. 2002; 58: 214.Google Scholar
63. Zhou, D, Wang, Y, Hopp, P, Kerling, F, Kirchner, A, Pauli, E, et al. Influence on ictal seizure semiology of rapid withdrawal of carbamazepine and valproate in monotherapy. Epilepsia. 2002; 43: 386–93.Google Scholar
64. So, EL, Fisch, BJ. Drug withdrawal and other activating techniques. In: Engel, J, Pedley, TA, editors. Epilepsy: a comprehensive textbook. Vol 1. Philadelphia: Lippincott-Raven; 1997. p. 1021–7.Google Scholar
65. Serles, W, Caramanos, Z, Lindinger, G, Pataraia, E, Baumgartner, C. Combining ictal surface-electroencephalography and seizure semiology improves patient lateralization in temporal lobe epilepsy. Epilepsia. 2000; 41: 1567–73.Google Scholar
66. Chee, MW, Kotagal, P, Van Ness, PC, Gragg, L, Murphy, D, Luders, HO. Lateralizing signs in intractable partial epilepsy: blinded multiple observer analysis. Neurology. 1993; 43: 2519–25.Google Scholar
67. Fontana, E, Negrini, F, Francione, S, Mai, R, Osanni, E, Menna, E, et al. Temporal lobe epilepsy in children: electroclinical study of 77 cases. Epilepsia. 2006; 47: 26–30.Google Scholar
68. Fogarasi, A, Jokeit, H, Faveret, E, Janszky, J, Tuxhorn, I. The effect of age on seizure semiology in childhood temporal lobe epilepsy. Epilepsia. 2002; 43: 638–43.Google Scholar
69. Fogarasi, A, Janszky, J, Faveret, E, Pieper, T, Tuxhorn, I. A detailed analysis of frontal lobe seizure semiology in children younger than 7 years. Epilepsia. 2001; 42: 80–5.Google Scholar
70. Nordli, DR Jr, Kuroda, MM, Hirsch, LJ. The ontogeny of partial seizures in infants and young children. Epilepsia. 2001; 42: 986–90.Google Scholar