Lateralizing signs during seizures in infants

Abstract

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.

Intractable Epilepsy in Childhood: Presurgical Evaluation and Treatment

“…[15] Çocukluk çağında iktal semiyolojiyi değerlendirirken nö-betlerin yaş ve nörolojik gelişimle birlikte değişeceği, eriş-kin yaş grubundan farklı klinik davranış özellikleri ve EEG bulguları göstereceğinin bilinmesi gerekir. [16][17][18][19][20][21][22] Örneğin 7 yaş altı çocuklarda frontal lob epilepsi daha çok epileptik spazm, belirsiz davranış değişiklikleri, spontan aktivitenin durması gibi bulgular verir; temporal lob epilepsi hem motor hem EEG bulguları açısıdan fokal bulgular yerine diffüz/ bilateral özellikler gösterebilir. [16][17][18][19][20][21][22] Çocukluk çağında EEG bulguları değerlendirilirken, jeneralize iktal ve interiktal deşarjlar her zaman cerrahi açıdan olumsuz sonuçlar olacağına işaret etmez.…”

Anforderungen an ein Epilepsiezentrum für Kinder und Jugendliche

“…Lateralisationszeichen. Bei Kleinkindern sind unilaterale klonische oder tonische Anfälle und eine postiktale Hemiparese verläss-liche Lateralisationszeichen (Anfallsursprungszone kontralateral zur klinischen Symptomatik, [9]). Neuropsychologische Untersuchungen dienen zur Diagnose von neuropsychologischen Defiziten, die Lokalisationshinweise auf die Läsion bieten können.…”

Seizure Semiology: An Overview of the ‘Inverse Problem’

“…Postictal paresis (Todd’s phenomenon) is another excellent lateralizing sign [39]: it is consistently contralateral to the seizure onset, with a median duration of only 3 min, and without a difference between temporal and frontal seizure origin [40]. It has been mainly associated with unilateral dystonia and ictal limb immobility.…”

“…Unilateral blinking points to an ipsilateral, mostly temporal or frontal seizure focus [44], but might also be encountered in occipital seizures [45]. Ictal nystagmus is the consequence of a contralateral hemisphere seizure, either in the regions responsible for contralateral saccades, or in the locations inducing ipsilateral smooth pursuit [39,46,47]. …”

“…Isolated eye deviation per se does not seem to have a lateralizing value, especially in young children [39]. Unilateral blinking points to an ipsilateral, mostly temporal or frontal seizure focus [44], but might also be encountered in occipital seizures [45].…”