Epileptic seizure semiology in different age groups

Abstract

Aims. Seizure semiology provides information about the eloquent cortex involved during a seizure and helps to generate a hypothesis regarding the localization of the epileptogenic zone (EZ), a prerequisite for surgical management of epilepsy. We aimed to study the seizure semiology among all different age groups to better characterize semiological changes that occur with age. Methods. We performed a retrospective review of video‐EEG data in paediatric and adult patients admitted to the Epilepsy Monitoring Unit over a three‐year period. Authors independently reviewed and classified the seizure semiology while blinded to clinical, EEG, and neuroimaging data. A total of 270 patients were included in the study. Results. The most frequent EZ in patients who were one month to three years old was undetermined. Focal epilepsy became more frequent in patients older than 10 years. Among patients with focal epilepsy, a posterior quadrant EZ was most frequent in children younger than three years old, a temporal EZ between three and six years old, and a frontal EZ between six and 10 years old. The temporal lobe was the most frequent location for focal EZ in patients older than 18 years. Auras, automotor seizures, and generalized tonic‐clonic seizures were extremely infrequent in patients younger than 10 years old. The youngest patient with auras was 5.7 years old. The youngest patient with automotor seizures was 3.7 years old. We identified only three patients with generalized tonic‐clonic seizures who were younger than 10 years (aged six months, 6.6 years, and nine years, respectively). Patients younger than three years exhibited mostly generalized simple motor seizures and hypomotor seizures. Generalized epileptic spasms, generalized tonic seizures, and generalized clonic seizures were infrequent in patients older than 10 years. Conclusion. Seizure semiology and electroencephalographic changes most likely reflect the maturation of cortical functions.

Late‐onset epilepsy and 25‐year cognitive change: The Atherosclerosis Risk in Communities (ARIC) study

“…We also do not have information about the type and frequency of participants’ seizures, and whether there was a difference between participants with and without medically refractory epilepsy. However, other studies of LOE have shown that new seizures in older patients are overwhelmingly focal rather than generalized‐onset seizures, 2,45 and in characterized series the majority are temporal 46,47 or frontal 1 in origin; this cohort is likely to be similar. MRI was not available for many participants, precluding assessment for mesial temporal pathology.…”

Association between semiologic, autonomic, and electrographic seizure characteristics in children with generalized tonic-clonic seizures

“…In children under the age of 10, epilepsy of generalized or unknown onset is the most common. In older children and adults, focal epilepsy becomes the most common, and seizure semiology starts to resemble that of adults, possibly reflecting cortical maturation [35]. Differences may be attributed to maturation of the nervous system.…”

Critique of the 2017 epileptic seizure and epilepsy classifications

“…There are some seizure types that only infrequently occur in infants (such as “generalized” tonic–clonic seizures, automotor seizures, and auras), and other seizure types are seen mainly in infants (such as epileptic spasms) . The easiest way to resolve this complexity is to include within a unified framework all possible seizures (statuses) and have the user choose the seizure type that applies in any given situation.…”