A different look on the importance of lateralization and localization of figure 4 symptoms in epilepsy

Abstract

Background Clinical seizure semiology provides valuable information in the evaluation of focal-onset bilateral tonic–clonic seizures. In the evaluation of these patients, long-term video-EEG monitoring (VEM) and neuroimaging studies are of great significance in determining lateralization together with clinical semiology. In this study, we examined the features of the figure 4 sign that we detected in patients with refractory epilepsy whom we followed up in the VEM unit. Methods In the study, 175 patients followed in the VEM unit were examined. Twenty-two patients for whom the figure 4 sign was detected were included in the study. Patients with the side indicated by the figure 4 sign comply with ictal EEG compatible were named as 1st group (G1), and those not were named as 2nd group (G2). Demographic characteristics, seizure type, number of seizures per month, duration of epilepsy, number of seizures during VEM, duration of figure 4 sign, medical history, and cranial MRI characteristics were compared between the two groups. Results When G1 and G2 were compared, it was observed that temporal lobe seizures were statistically significantly higher in G1. When the figure 4 sign durations were examined, this period was 16.3 ± 8.2 s in frontal lobe seizures and 20.8 ± 7.4 s in temporal lobe seizures. When the duration of the figure 4 sign was examined by gender, it was found that the duration was longer in males, which was statistically significant. Conclusion In conclusion, it is essential to evaluate ictal EEG findings together with brain imaging while performing semiological localization and lateralization in epileptic patients.