Asymmetric ending of secondarily generalized seizures A lateralizing sign in TLE

Leutmezer, Fritz; Wöginger, S.; E, De Antoni; Seidl, B.; Baumgärtner, C.

doi:10.1212/01.wnl.0000027189.12839.dc

Cited by 27 publications

(22 citation statements)

References 7 publications

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“…In localization-related epilepsies, it has been seen that clonic jerking often ends asynchronously, ipsilateral to the hemisphere of seizure origin, in up to 80% of the patients with temporal lobe epilepsy. [5657] The mean durations of these phases were: Phase 3, 9.5 s; Phase 4, 8.5 s; Phase 5, 18.5 s; and Phase 6 and 7 together, 43.5 s. No GTCs lasted longer than 2 min. Only 27% of the seizures had all five phases of the main seizure, but tonic Phase 5 and clonic Phases 6–7 were present in 95 and 98%, respectively.…”

Section: Video-eeg Telemetrymentioning

confidence: 99%

The adolescent or adult with generalized tonic-clonic seizures

Gursahani

Gupta

2012

Ann Indian Acad Neurol

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Primary and secondary generalized tonic–clonic seizures (GTCs) together constitute up to 50% of adolescent and adult patients with epilepsy as diagnosed by history and EEG. Syncope and psychogenic nonepileptic seizures are major differential diagnoses and must be carefully excluded in therapy-resistant cases. Individual episodes can have up to seven phases in secondarily generalized GTCs. The distinction between primary and secondary GTCs depends mainly on history and EEG, and yield can be improved with sleep deprivation or overnight recording. Epilepsies with primary or unclassified GTCs can respond to any one of the five broad-spectrum antiepileptic drugs (AEDs): valproate, lamotrigine, levetiracetam, topiramate and zonisamide. Unless a focal onset is clearly confirmed, a sodium-channel blocking AED should not be used in the initial treatment of these conditions.

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Section: Video-eeg Telemetrymentioning

confidence: 99%

The adolescent or adult with generalized tonic-clonic seizures

Gursahani

Gupta

2012

Ann Indian Acad Neurol

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“…Not only the clinical symptoms during the early phase of focal seizures, but also signs appearing at the beginning of the secondary generalization, like forced ictal head version (Bleasel et al., 1997; Janszky et al., 2001; Jobst et al., 2001; Bonelli & Baumgartner, 2002) or asymmetric tonic limb posturing (figure 4 sign) (Bleasel et al., 1997; Kotagal et al., 2000) or even at the end of secondary generalized tonic–clonic seizures (sGTCS) are highly informative for seizure lateralization. Asymmetric ending of the clonic phase of sGTCS, so‐called asymmetric seizure termination (AST), has been described as a lateralizing sign in temporal lobe epilepsy (TLE) (Leutmezer et al., 2002a; Trinka et al., 2002). Only one recent study analyzed AST in frontal lobe epilepsy (FLE) (Bonelli et al., 2007).…”

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confidence: 99%

Asymmetric seizure termination in primary and secondary generalized tonic–clonic seizures

Walser¹,

Unterberger²,

Dobesberger³

et al. 2009

Epilepsia

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SUMMARYPurpose: In temporal lobe epilepsies an asymmetric termination (AST) of the clonic phase of secondary generalized tonic-clonic seizures (sGTCS) reliably lateralizes the side of seizure onset. The last clonic activity occurs ipsilateral to the side of the seizure onset zone. We compared the prevalence and lateralizing value of AST in sGTCS of frontal and temporal lobe origin as well as in primary generalized tonic-clonic seizures (pGTCS). Methods: We analyzed 177 seizures in 84 consecutive patients. Forty-one patients had temporal lobe epilepsy (TLE), 24 frontal lobe epilepsy (FLE), and 19 had nonfocal (primary) generalized epilepsies (GE). All patients underwent intensive video-EEG (electroencephalography) monitoring, high-resolution magnetic resonance imaging (MRI), neuropsychological testing, and single photon emission computed tomography/positron emission tomography (SPECT/PET) when feasible. Two investigators blinded for diagnosis, EEG, and imaging data assessed frequency and side of the last clonic jerk. Results: AST occurred in 63% of patients with TLE (47% of seizures), in 71% with FLE (60% of seizures), and in 42% with GE (21% of seizures). These results were not significant for patients, but significant for seizures in TLE versus GE and in FLE versus GE (p < 0.001). The positive predictive value (PPV) for the side of seizure onset was 74% (p = 0.003) in TLE and 75% (p = 0.008) in FLE. Discussion: AST in sGTCS lateralizes the side of seizure onset in TLE and in FLE to the ipsilateral hemisphere with a high PPV. However, AST was also observed in GE. Therefore, asymmetric clinical signs should not inevitably lead to the assumption of focal epilepsy syndromes.

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“…■ Key words epilepsy surgery · seizure semeiology · lateralizing signs · infants generalized seizure [13], postictal Todd's paralysis [19] and postictal dysphasia [18].…”

Section: Introductionmentioning

confidence: 99%

Lateralizing signs during seizures in infants

et al. 2004

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Reliable lateralizing signs included focal clonic activity and predominantly unilateral spasms. Focal tonic activity, nystagmus and postictal hemiparesis were also consistently contralateral but were observed only in few patients. Tonic eye version was unreliable and could not be used to lateralize seizure onset. The sequence of eye and head version evolving to generalized tonic clonic convulsions was not seen in this age group.

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Asymmetric ending of secondarily generalized seizures A lateralizing sign in TLE

Cited by 27 publications

References 7 publications

The adolescent or adult with generalized tonic-clonic seizures

The adolescent or adult with generalized tonic-clonic seizures

Asymmetric seizure termination in primary and secondary generalized tonic–clonic seizures

Lateralizing signs during seizures in infants

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