Seizure semiology: ILAE glossary of terms and their significance

Beniczky, Sándor; Tatum, William O.; Blumenfeld, Hal; Stefan, Hermann; Mani, Jayanti; Maillard, Louis; Fahoum, Firas; Vinayan, Kollencheri Puthenveettil; Mayor, Luis Carlos; Vlachou, Maria; Margitta, Seeck; Ryvlin, Philippe; Kahane, Philippe

doi:10.1684/epd.2022.1430

Cited by 36 publications

(44 citation statements)

References 437 publications

(618 reference statements)

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“…21,22,24 The study by Wang et al 25 reports a duration of <400 ms for myoclonic seizures (based on EMG measurements), which is a much higher upper limit. The ILAE defines myoclonic seizures with an upper duration of 100 ms. 26,27 Our data suggest updating this to <150 ms.…”

Section: Myoclonic Seizuresmentioning

confidence: 64%

“…Several previous studies reported a duration of epileptic spasms between 0.2 and 2 s, which is close to our findings. 28 , 29 , 30 The seizure duration of epileptic spasms defined in the ILAE position paper for epileptic syndromes is 1–3 s, 2 and the ILAE glossary states 0.5–2 s. 26 , 27 As no reference is given, we assume it was based on expert opinion. Our results are very close to this, but in rare cases spasms can be outside the range specified in the ILAE glossary.…”

Section: Discussionmentioning

confidence: 99%

“…The ILAE glossary gives an imprecise definition of tonic seizure duration: “a few seconds to minutes.” 26 , 27 In addition, the ILAE position paper on epilepsy syndromes in infants and neonates states that tonic seizures last longer than epileptic spasms, which last up to 3 s. 2 Other papers mention tonic seizure durations of over 3 s to a couple of minutes. 13 , 14 , 25 , 30 Excluding the outliers, we measured generalized tonic seizure duration (cumulative) between 3–36 s (range: 2.5–50.5 s).…”

Section: Discussionmentioning

confidence: 99%

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Duration of epileptic seizure types: A data‐driven approach

et al. 2023

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Objective: To determine the duration of epileptic seizure types in patients who did not undergo withdrawal of antiseizure medication.Methods: From a large, structured database of 11 919 consecutive, routine videoelectroencephalograpy (EEG) recordings, labeled using the SCORE (Standardized Computer-Based Organized Reporting of EEG) system, we extracted and analyzed 2742 seizures. For each seizure type we determined median duration and range after removal of outliers (2.5-97.5 percentile). We used surface electromyography (EMG) for accurate measurement of short motor seizures.

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Section: Myoclonic Seizuresmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Duration of epileptic seizure types: A data‐driven approach

et al. 2023

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“…Unilateral ictal tonic of the cervical almost always lateralizes to the hemisphere ipsilateral to the seizure‐onset zone. For versive seizure, the direction of the rotation mostly lateralizes the seizure‐onset zone to the contralateral hemisphere, rarely ipsilateral hemisphere (depending on mechanisms of rapid eye movement or smooth pursuit eye movements) 12,15 . If the clinical features of unilateral cervical tonic is mastered, its lateralization value is extremely high.…”

Section: Discussionmentioning

confidence: 99%

Semiology characteristics and location of epileptogenic zone in motor seizures of axial and shoulder girdle muscles assessed by video stereoelectroencephalography study in 65 patients

Zhang

Wang

Yang

et al. 2023

Epileptic Disorders

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Objective: To study the semiology characteristics of motor seizures of axial and shoulder girdle muscles (ASMs) by stereoelectroencephalography (SEEG) and its value in determining location of epileptogenic zone. Methods: A total of 598 patients underwent SEEG assessment in Sanbo BrainHospital were reviewed; 65 patients with ASMs selected. Thirteen semiology feature items were extracted according to the location and symmetry of involved axial muscles, direction of movement, etc. Seizures were grouped with items, and the k-means was used to analyze association between ASMs semiology characteristics and seizure-onset zone (SOZ). Results:The SOZs of ASMs involved 23 combinations of seven different brain regions: 31 patients (47.7%) had one brain region, 19 (29.2%) had two, 14 (21.5%) had three, and one patient (1.5%) had four. One hundred and fifteen brain regions were analyzed. Seven brain regions accounted for a significant difference in chi-square test, χ 2 = 62.79, p < 0.0001, with the highest proportion of insular and perisylvian. The k-means method identified two clusters: cluster 1 had a high degree of agreement with temporal lobe epilepsy (12/15), characterized by less shrug-like movement, later involvement of axial shoulder girdle muscles, longer duration, and lower seizure frequency; cluster 2 had a high degree of agreement with posterior cortex epilepsy (14/18), characterized by earlier involvement of axial shoulder girdle muscles, shorter duration, and higher seizure frequency. In frontal lobe, insular and perisylvian, anterior and middle cingulate gyrus, are the two categories accounted for similar proportion. Seizure-onset lateralized at the contralateral of unilateral cervical tonic, with rate of seizure-free was 73.7%. Significance:The incidence of ASMs is high in insular and perisylvian. Unilateral cervical tonic seizures have good lateralizing value. Based on semiology characteristics, ASMs can be roughly clustered into two categories, which can only

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“…A specific dynamic evolution of motor signs, consisting of a progressive slowing of the clonic phase, has been observed in GCSs (both in generalized tonic‐clonic seizures and in focal‐to‐bilateral tonic‐clonic seizures). After the initial tonic phase, the muscle activity is interrupted by inhibitory (silent) periods of gradually increasing duration, resulting in a deceleration of the clonic jerks, until the seizure eventually stops 11 , 12 , 13 , 14 , 15 (Figure 1A ). We further refer to this progressively increasing duration of the silent period as a progressive slowing of clonic phase.…”

Section: Introductionmentioning

confidence: 99%

Progressive slowing of clonic phase predicts postictal generalized EEG suppression

et al. 2022

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Objective: Postictal generalized electroencephalography (EEG) suppression (PGES) is a surrogate marker of sudden unexpected death in epilepsy (SUDEP).It is still unclear which ictal phenomena lead to prolonged PGES and increased risk of SUDEP. Semiology features of generalized convulsive seizure (GCS type 1) have been reported as a predictor of prolonged PGES. Progressive slowing of clonic phase (PSCP) has been observed in GCSs, with gradually increasing inhibitory periods interrupting the tonic contractions. We hypothesized that PSCP is associated with prolonged PGES. Methods:We analyzed 90 bilateral convulsive seizures in 50 consecutive patients (21 female; age: 11-62 years, median: 31 years) recruited to video-EEG monitoring. Five raters, blinded to all other data, independently assessed the presence of PSCP. PGES and seizure semiology were evaluated independently. We determined inter-rater agreement (IRA) for the presence of PSCP, and we evaluated its association, as well as that of other ictal features, with the occurrence of PGES, prolonged PGES (≥20 s) and very prolonged PGES (≥50 s) using multivariate logistic regression analysis. Results: We found substantial IRA for the presence of PSCP (percent agreement: 80%; beyond-chance agreement coefficient: .655). PSCP was an independent predictor of the occurrence of PGES and prolonged PGES (p < .001). All seizures with very prolonged PGES had PSCP. GCS type 1 was an independent predictor of occurrence of PGES (p = .02) and prolonged PGES (p = .03) but not of very prolonged PGES. Only half of the seizures with very prolonged PGES were GCS type 1.Significance: PSCP predicts prolonged PGES, emphasizing the importance of gradually increasing inhibitory phenomena at the end of the seizures. Our findings shed more light on the ictal phenomena leading to increased risk of SUDEP.These phenomena may provide basis for algorithms implemented into wearable devices for identifying GCS with increased risk of SUDEP.

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Seizure semiology: ILAE glossary of terms and their significance

Abstract: 451Legend for video sequences Supplementary video 1 A patient with an atonic seizure, presenting as atonia of the neck and trunk musculature.

Cited by 36 publications

References 437 publications

Duration of epileptic seizure types: A data‐driven approach

Duration of epileptic seizure types: A data‐driven approach

Semiology characteristics and location of epileptogenic zone in motor seizures of axial and shoulder girdle muscles assessed by video stereoelectroencephalography study in 65 patients

Progressive slowing of clonic phase predicts postictal generalized EEG suppression

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