Structured testing during seizures: A practical guide for assessing and interpreting ictal and postictal signs during video EEG long term monitoring

Abstract

Background: Ictal and postictal testing carried out in long-term epilepsy monitoring units is often sub-optimal. Recently, a European consensus protocol for testing patients during and after seizures was developed by a joint taskforce of the International League Against Epilepsy-Commission on European Affairs and the European Epilepsy Monitoring Unit Association. Aim: Using this recently developed standardised assessment battery as a framework, the goal of this narrative review is to outline the proposed testing procedure in detail and explain the rationale for each individual component, focusing on the underlying neurobiology. This is intended to serve as an educational resource for staff working in epilepsy monitoring units. Methods: A literature review of PubMed was performed; using the search terms "seizure", "ictal", "postictal", "testing", "examination", and "interview". Relevant literature was reviewed and relevant references were chosen. The work is presented as a narrative review. Results: The proposed standardised assessment battery provides a comprehensive and user-friendly format for ictal-postictal testing, and examines consciousness, language, motor, sensory, and visual function. Conclusion: The standardised approach proposed has the potential to make full use of data recorded during video EEG increasing the diagnostic yield with regards to lateralisation and localisation, aiding both presurgical and diagnostic studies.

Implementation of a New Clinical Testing Tool to Assess Patients During Ictal and Postictal Periods

“…The newly designed testing tool (for use among adults) was developed based on the International League Against Epilepsy European joint task force consensus statement on ictal testing 21 and standardized ictal assessment set. 7,17 The tool is linked as a Supplemental Figure, available at http://links.lww.com/JNN/A404, and consists of written questions relating to 4 domains relevant to neurological status during seizures. Temporal lobe epilepsy is the most common epilepsy syndrome that is responsive to surgical management, and patients with temporal lobe epilepsy require VEM.…”

If seizures left speechless: CA-P-S C-A-R-E, a proposal of a new ictal language evaluation protocol

“…An epileptic discharge involving primary language areas may induce transient and reversible aphasia, which may show similar aphasic manifestations as other aetiologies [3,4]. The characterization of language deficits during ictal testing should be performed soon after ictal onset, in order to differentiate aphasia from other language/cognitive disturbances, obtaining key localizing and lateralizing information [5]. Indeed, some disturbances such as impaired awareness may be related to seizure propagation and should not be used as localizing signs.…”

Anfallssemiologie und Anfallstestung in der EEG-Monitoring-Einheit

“…Eine genaue Anfallstestung durch qualifiziertes Personal ist dafür essenziell [18]. Dieser Artikel ist eine deutschsprachige Zusammenfassung des Beitrags "Structured testing during seizures: A practical guide for assessing and interpreting ictal and postictal signs during video EEG long term monitoring" [8] erschienen in Seizure. Eine entsprechende Erlaubnis seitens des Editors und des Journals wurde eingeholt.…”

“…(Mod. nach Foldvary-Schaefer und Unnwongse[5], Kinney et al[8], Loddenkemper und Kotagal[13])Verwendet wird hier zur separaten neuroanatomischen Einordnung verschiedener Anfallssymptome, die auch nacheinander auftreten können, eine semiologische Anfallsklassifikation im Unterschied zur aktuellen ILAE-Klassifikation, die nur das erste Anfallssymptom berücksichtigt. Der primäre Fokus dieser Tabelle liegt auf der Anfallstestung und nicht auf der Klassifikation der Anfälle Motorische Anfallssemiologie.…”

“…(Mod. nach Foldvary-Schaefer und Unnwongse[5], Kinney et al[8], Loddenkemper und Kotagal[13]) M.O. Kinney hat ein Stipendium und Reisekosten von UCB erhalten.…”