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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