Semiological Seizure Classification*

Abstract

Summary:We propose an epileptic seizure classification based exclusively on ictal semiology. In this semiological seizure classification (SSC), seizures are classified as follows: The SSC identifies in detail the somatotopic distribution of the ictal semiology as well as the seizure evolution. The advantages of a pure SSC, as opposed to the current classification of the International League Against Epilepsy (ILAE), which is actually a classification of electroclinical syndromes, are discussed. Key Words: Seizure classification-Ictal semiology-Auras-Motor seizures-Paroxysmal events.The International League Against Epilepsy (ILAE) introduced a seizure classification in 1981 based on clinical semiology, interictal EEG findings, and ictal EEG patterns (1). The assumption behind such a classification, which is actually a classification of electroclinical features, is the existence of a strict one-to-one correlation between clinical-ictal semiology and interictalhctal EEG findings. Detailed analysis of clinical semiology and EEG findings shows, however, that this assumption is frequently incorrect (2), particularly for infants (3).

Longer duration of epilepsy and earlier age at epilepsy onset correlate with impaired cognitive development in infancy

“…Clinical evaluation included EEG monitoring and MRI. Seizures were classified according to the semiological seizure classification [17]. A developmental quotient was calculated for each case (DQ = Bayley Scales of Infant Development mental age divided by subject's biological age) as previously described [11].…”

Conveying clinical reasoning based on visual observation via eye-movement modelling examples

“…In such cases, it is crucial to carefully observe which parts of the infant body are involved and how and when these body parts move, and to assess the level of consciousness of the infant (i.e., diagnosis based on the semiology of ictal events, cf. International League Against Epilepsy 2010; Lüders et al 1998). According to Nordli et al (1997), infantile seizures are often so subtle that even skilled observers may fail to identify the seizures correctly.…”

Autonomic Seizures Versus Syncope in 18q‐ Deletion Syndrome: A Case Report

“…Other autonomic features, such as a pale or flushed face, changes in blood pressure, or sweating, can be prominent (5,6). It has recently been suggested that such seizures be classified as autonomic, provided there is objective documentation of significant ictal autonomic changes (7). Cardiac anomalies, however, can cause syncopal events, and syncope can be associated with tachycardia, changes in facial color, sweating, and symmetric or even asymmetric convulsive movements; in such cases, these events are classified as convulsive syncope (8).…”