TS5 2

Seizure semiology according to anatomical
origin
Korean Epilepsy Congress 9 June 2012
Dr Chak wai kwong

Associate consultant
Department of Paediatrics and Adolescent Medicine
Tuen Mun Hospital NT West Cluster
Horonary Clinical Associate Professor

The University of Hong Kong
Why Seizure Semiology important ?
By studying the clinical features of seizure alone,

in around 78% of patients, the area responsible
for seizures can be lateralized to a hemisphere
Seizure Semiology is an essential tool for
diagnosing epileptic patients
provide information about the localization and
lateralization of the symptomatic zone
offer valuable information in pre-surgical
evaluation
Gonzalo Alarcon et al. Oxford Specialist Handbooks in Neurology Epilepsy p. 417
Roadmap
Video EEG monitoring and Epilepsy Surgery
Case series illustration
Literature review of different seizure
semiology with lateralizing and localization
significance
Types of Seizure Semiology
Aura
Ictal positive motor phenomena and negative
motor phenomena
Ictal automatism
Ictal Language phenomena
Ictal autonomic symptoms
Postictal features
Aura of vertigo and visual hallucination
Ictal nystagmus
Is associated with ictal EEG onset,
contralateral to the fast phase of the
nystagmus.
This lateralising sign often occurs in epilepsies
originating from posterior brain regions
(Kaplan and TUSA, 1993; Stolz,1991; Tusa
,1990) and has been observed in 10% of
patients with occipital lobe epilepsy (Salanova
,1992)
Cordula Stoyke et al. Video atlas of lateralising and localising seizure phenomena. Epileptic Disord Vol 2011;13(2):113-24
Aura (Simple Partial Seizure)
Lateralizing sign Lateralization/Localization

Dj vu Mesial temporal onset
(feeling that what is happening has
already happened)
Hearing sounds or melodies Lateral temporal onset
Unilateral tingling Contralateral onset near somatosensory

area
Unilateral elementary visual symptoms Contralateral occipital onset
(flashing lights, circles, colours)
Complex visual hallucination Occipital, parieto-occipital or frontal onset
Thought disorder (thought implanted on Frontal onset

someones head)
Lateralizing sign Frequency Lateralizing Value Symptomatic zone
Aura
Unilateral sensory 6.1 % epilepsy 89% contralateral Brodmann areas

aura patients 1,2,3
Hemifield visual 28.6% OLE 100% Brodmann areas
aura contralateral 17-19 and
adjacent areas
F/9 year Occipital Epilepsy
Seizure onset at 2 year of age
Complex partial seizure: eye blinking, eye deviate to
right, impair consciousness, vomiting, twitching of
right upper limbs for few minutes
5-6 times per day
put on Carbamazepine with good response
Seizure free for four years
Carbamazepine stopped at 2006
Seizure relapse one month later
add Phenobarbitone and Sodium Valproate, still
frequent seizure
Interictal left occipital spike wave
Ictal fast rhythm over left occipital region
Left occipital focal cortical dysplasia
Progress
added Phenobarbitone and Clobazam
Seizure frequency: daily seizure to once every 3 to 4
days
changed Clobazam to Valproate, better seizure control
Current Medication: Epilim Chrono 200mg bd,
Phenobaritone 60 mg bd
Sufferred from sedative side effect
High serum Phenobarbitone level
Study in mainstream school
Poor concentration and memory
6 year old girl with Tuberous Sclerosis
Left upper and lower

limb spasticity
Hx of infantile spasm
Start Carbamazepine
and Vigabatrin
Episodic dystonic
twitching of left hand
and fingers
Left hand focal motor seizure
Cortical tubers resection at Primary motor area
Unilateral clonic seizure
The significance of localisation and lateralizsation was first
recognized, (Jackson, 1890) which consist of regular,
repeated, short contractions of various muscle groups(0.2-
5Hz).
involve the distal part of the extremities or face and most
probably orginate from the primary motor or premotor area.
(Noachtar and Arnold, 2000).
have a positive predictive value of 92% for seizure onset in
the contralateral hemisphere (Janszky, 2001)
In FLE, clonic seizures occur early in seizure evolution and
consciousness remains unclouded at the beginning of
the clonic activity (Manford,1996).
In TLE, clonic seizures typically occur later, after
automatisms and consciousness is disturbed.(Noachter
and Arnold, 2000)
Unilateral tonic seizure
Tonic seizures
consist of a unilateral or bilateral contraction of one or more
muscle groups, usually lasting for more than three seconds,
leading to tonic posturing (Noachtar and Arnold, 2000).
If clearly unilateral, they have a high lateralising value for
seizure onset in contralateral hemisphere.
Tonic seizures occur more often in extratemporal lobe
epilepsies (79%) than in temporal lobe epilepsies (1.7%)
(Werhahn et al., 2000)
Generally, tonic activity is generated by epileptic activation of
the cortical motor areas i.e. the primary motor and
supplementary sensorimotor areas (Bleasel et al.,1997;
Luders and Noachtar, 2000; Penfield and Jasper, 1954)
Head and eye deviation
Versive seizure
consist of a lateral eye deviation, which is followed by a head
and trunk deviation in the same direction.
defined as a forced and involuntary head movement resulting
in sustained unnatural positioning (Wyllie 1986a),
have a high specificity(>90%) of lateralisation for a
contralateral seizure onset zone (Chee 1993; Steinhoff 1998),
particularly when occurring immediately prior to
generalisation (Kernan 1993).
is highly probable due to epileptic activation of the frontal
eye field which is contralateral to the side to which the eyes or
head turn (Penfield and Jasper 1954).
Non-forced head deviation
is not a lateralising sign unless it ends before generalisation or
is followed by contralateral forced head deviation
(Kernan,1993)
Cordula Stoyke et al. Video atlas of lateralising and localising seizure phenomena. Epileptic Disord
Vol 2011;13(2):113-24
Head and eye deviation
In FLE, it occur significantly earlier
In TLE, it occur later following a
disturbance of consciousness, reflecting the
spread of epileptic activity to the frontal
lobe.
In TLE, initially head turns ipsilaterally then
contralaterally before secondary generalisation
(ODwyer 2007)
Cordula Stoyke et al. Video atlas of lateralising and localising seizure phenomena.
Epileptic Disord Vol 2011;13(2):113-24
The figure 4 sign
Asymmetric tonic limb posturing (e.g. Figure

of Four: one elbow extended while the other
arm flexed) at the onset of secondary GTCS, is
a valuable lateralising sign.
In 35 of 39 patients with secondary GTCS, the
extended elbow was found to be
contralateral to the side of ictal EEG on onset
(Kotagal et al., 2000)
Asymmetric termination of
generalised tonic clonic seziures
The clonic phase of a generalised tonic clonic
seizures may end asymmetrically with clonic
jerks persisting in the limbs ipsilateral to
hemisphere of seizure onset
Based on two series of patients with temporal
lobe epilepsy (Leutmezer 2002; Trinka 2002), it
was shown to be a frequent lateralising sign
(43% and 66%), occurred 80% ipsilaterally to the
seizure onset zone with excellent inter-
oberserver reliability.
Right upper limb dystonic posturing
Left TLE
Andrew Bleasel et al. Lateralizing Value
and Semiology of Ictal Limb Posturig and Version in Temporal Lobe and Extratemporal Epilepsy Epilepsia, 38(2):168-174, 1997
Unilateral Dystonic Hand Posturing
defined as unnatural tonic posturing with a rotatory
component, reliably indicates seizure onset in the
contralateral hemisphere (Bleasel 1997; Chee 1993; Kotagal
1989).
In these studies, positive predictive value of seizure onset in
the contralateral hemisphere was between 92-100%.
occurs more often in patients with mesial temporal lobe
epilepsy than in patients with neocortical temporal lobe
epilepsy (Pfander 2002)
occurs later in seizure evolution in TLE than in extraTLE (Lieb
1991, Lieb 1986)
Often associated with simultaneous manual automatisms in
the contralateral hand.
Dystonic posturing
Tonic limb posturing
Version
Occurred earlier in
extratemporal seizures
than in temporal seizures
Postictal paresis
Is the oldest known lateralising signs, first published by
Bravais in 1827
Is a relatively frequent lateralising sign and incidence of
ranges in different studies from 6.1-40% ( Adam et al.,
2000; Gallmetzer et al.,2004; Leutmezer et al.,1988; Rolak
et al.,1992)
It appears regularly contralateral to the seizure onset zone
(Adam et al., 2000; Gallmetzer et al., 2004; Kellinghaus and
Kotagal, 2004; Leutmezer et al., 1998)
Seems to be more frequent in patients with underlying
focal brain lesion (Adam et al.,2000; Rolak et al., 1992), as
well as in seizures with tonic or clonic phenomena
(Gallmetzer et al.,2004, kellinghau and Kotagal, 2004).
Ictal unilateral akinesia
/immobile limb
observed in 5.8% of patients with focal epilepsy
(Oestreich 1995) and 11.8% of patients with TLE
(Bleasel 1997) and points to the contralateral
hemisphere as the site of seizure onset(Bleasel 1997;
Noachtar and Luder 1999; Oestreich 1995)
Need to rule out increased muscle tone or dystonic
posturing
caused by epileptic activation of one of negative
motor areas in the frontal lobe, immediately anterior
to the motor face area, close to Boca's speech area and
anterior to the face region of the supplementary
sensoriomotor area (Luder,1995)
Lateralising sign
Left limbs, facial clonic and
tonic convulsion
Both eyes deviate to left
Versive seizure to left
Left arm extension, right
arm flexion (Figure of four)
Asymmetrical tonic
posturing preceding
secondary generalised
seizure
Asymmetrical termination
of GTCS
Right hemispheric ED,
unilateral PLEDs
MRI BRAIN
CLINICAL HISTORY:
intractable epilepsy with history of prolonged febrile convulsion, one of twin baby. PET scan
showed right hemispheric hypometabolism, PE no focal neurological deficit; previous MRI
NAD, please book 3T MRI scan for progress
TECHNIQUE:
AXIAL T1W, T2W, DWI, T1W+C
CORONAL 3D T2 FLAIR, T1W+C, 3D T1W TFE
SAGITTAL T1W IR
FINDINGS:
Volume loss is noted at right hippocampus associated with FLAIR hyperintensities. Volume
loss of adjacent white matter is also evident.
The right cerebral sulci including the right collateral sulcus are also prominent compared to
left side.
Contralateral hippocampus appears normal.
Ventricular system and sulcal spaces are normal.
No midline shift nor extraaxial fluid collection is noted.
OPINION:
Features probably represent right mesial temporal sclerosis.
Unilateral ictal eye blinking
As lateralising sign in seizures originating from
the temporal lobe was first reported by Wada
(Wada, 1980)
Ictal eye blinking is a rare motor phenomenon
(0.8-1.5%) which is observed in temporal and
extratemporal epilepsies and is highly suggestive
of ipsilateral seizure onset (Benbadis, 1996;
Henkel,1999).
The symptomatic zone generating ipsilateral
blinking is still unclear.
Unilateral manual automatisms
Were reported to be associated with
ipsilateral seizures onset (Wada, 1982). This
observation is frequently associated with
more or less obvious dystonia of the
contralateral hand or arm.
The lateralising significance of dystonic hand
posturing alone is greater than that of
ipsilateral automatisms alone (Kotagal,1991;
Mirzadjanova,2010)
Seizure Semiology
Right eye blinking
Right manual
automatism
Oral automatism
Ictal Speech
11year MTLE Right Mesial Temporal FCD
Right temporal lobectomy
11year old boy with Mesial Temporal Lobe
Epilepsy
Seizure since 6 year old
Change in consciousness,
behavioural arrest, eye staring,
bilateral hand movement, right more
prominent, mouthing
Medication: Carbamazepine,
Valproate, Clobazam
Daily seizure
MRI: Right sided anterio-inferior
temporal lesion ? Cortical dysplasia
Deteriorated school result with poor
memory since seizure onset
12 year old girl
Video of Versive Seizure
Perictal water drinking
As a localising sign was first reported in a large
series of patients in 1981 by Remilard; it was
proposed that ictal drinking is caused by
epileptic discharges arising from the
temporal lobe (Remilard 1981).
In seven patients with temporal lobe
epilepsies of the non-dominant hemisphere
and the incidence was reported to be 15.3 %
(Trinka et al.,2003)
Automatism with preserved
responsiveness
observed in 10% of patients with right

temporal lobe epilepsy (Ebner 1995; Noachtar
1992)
So far, one patient with left mesial temporal
lobe epilepsy and right hemisphere speech
dominance has been reported (Park 2001)
Postictal aphasia
Is a common features in seizures orginated from the
temporal lobe and is suggestive of a seizure onset in the
speech dominant hemisphere (Fakhoury 1994; Gaber 1989).
It can be difficult to clarify the type of aphasia or sensorial
(Wernicke) aphasia or distinguish between aphasia and
impaired consciousness with motor dysfunction.
Required a specialised testing during and after the seizure in
video-EEG monitoring units
Postictal aphasia can be observed more frequently than ictal
aphasia. It may due to frequently altered consciousness
during seizures originated from non-dominant temporal lobe
which makes it difficult to reliably test ictal speech (Gabr
1989)
Ictal speech
Defined as intact speech mechanisms consisting
of identifiable (clearly understandable) words or
phases well articulated and linguistically correct
(Gabr et al., 1989) usually indicates the non-
dominant hemisphere as the site of seizure onset
In 83-100% of the investigated patients with ictal
speech, seizure arose from the non-dominant
temporal lobe (Chee 1993; Fakhoury 1994;
Koerner and Laxer 1998; Steinhoff 1998)
Ictal drinking
Ictal speech
Right temporal onset
Ictal fear
Right amydala onset
Seizure semiology: Overview of some ictal or postictal clinical
features with regard to anatomical origin and their reliability
Andrea O. Rossetti et al. Seizure Semiology: An overview of the Inverse Problem Eur Neurol 2010;63:3-10
Clinical features Anatomical origin Lateralization Reliability

Ictal fear Amygdala, None High
hippocampus
Forced head version Frontal, Temporal Contralateral to the High
(Slow, gradual, side towards which
sustained and the head rotates
extreme rotation of (patient looks away
head) from focus)
Nonversive head Temporal ipsilateral Moderate
turning
Nystagmus Frontal eye field or Contralateral to fast High
parieto-temporal component
junction
Ictal laughing Hypothalamus, None Moderate
temporal,
mesiofrontal
Aug 2009
Apr 2009
Right hemispheric
seizure onset
Ictal drinking
Ictal speech
Right temporal lobe
onset
Ictal fear
Right amydala onset
Ictal body turning along horizontal axis gave a
55.2% positive predictive value, which improved
to 85.7% when clustered with restlessness, facial
expressions of anxiety and fear, and barking.
Ictal body turning along the horizontal body axia
and semiology with physiological movements are
not only prevalent semiology items of mesial
frontal lobe epilepsy but they distinguish mesial
frontal from lateral frontal and orbitofrontal
seizures.
Seizure Semiology: Overview of some ictal or postictal clinical
features with regard to anatomical origin and their reliability
Andrea O. Rossetti et al. Seizure Semiology: An overview of the Inverse Problem Eur Neurol 2010;63:3-10
Clinical features Anatomical origin Lateralization Reliability

Ictal eye closure Nonepileptic seizure None High
Asymmetric Temporal, Frontal Ipsilateral ( to last High
termination of cloni cloni)
Postictal unilateral Frontal, Temporal Contralateral High
paralysis or
weakness
Postictal Frontal, temporal, Dominant High
aphasia/dysnomia parietal hemisphere
Ictal Vomiting
is rare lateralising sign
observed in 2.8% of 178 patients with medically
refractory temporal lobe epilepsy (Baungartner
1999).
In a series of 31 patients with TLE, 10% showed
ictal vomiting or retching and an epigastric aura
was strongly correlated with the occurrence of
ictal vomiting (Kotagal 1995)
predicts an ictal onset in non-dominant temporal
lobe epilepsy (Devinsky 1995; Kotagal 1995;
Kramer 1988)
Ictal vomiting
Three patients with ictal emesis during dominant

temporal lobe onset seizures have been
described (Chenet al.,1999; Schauble et al.,2002).
Former studies suggest that insular cortex and
medial and lateral temporal structures are
associated with nauseas and vomiting in epileptic
seizures (Baumgartner et al.,1999; Fiol et
al.,1988; Kramer eta l.,1988; Pendfield and
Jaspeer,1954)
Hypomotor seizure
Luders et al. Semiological seizure classification Epilepsia 1998.39(9):1006-13.
Characterized by negative features (atonic;

astatic; hypomotor; akinetic and aphasic seizure)
Characterized by arrest or significant decrease of
behavoural motor activity with indeterminate
level of consciousness.
common in Paediatric epilepsy
Children with exclusively hypomotor seizure have
most frequently temporal lobe epilepsy
Hypermotor seizures associated with other
semiology, can arises from any lobe
Ictal vomiting, behavioural arrest/hypomotor seizure, eye
staring, head nodding
developmental regression
right temporal ganglioglioma
58
Seizure semiology transitions with
age
Ictal automatisms,
number of different
lateralizing signs
increased with age
Aura, emotional
symptoms and
autonomic signs
occurred independently
of patients ages.
Predictive Clinical Factors for Differential Diagnosis of
Children Extratemporal epilepsy (FLE vs PCE)
(aged 11months to 12 years)
Forgarasi A, Tuxhorn I et al. Epilepsia 2005
Frontal Lobe Epilepsy Posterior Cortex Epilepsy

Somatosensory aura Visual aura
Hypermotor seizure Nytagmus
Tonic seizure Versive seizure
Myclonic seizures, epileptic spasms, psychomotor seizures, atonic seizures,

oral and manual automatism, vocalization and eye deviation appeared in both
groups without significant differences in their frequency
Characteristic features described in adults extratemporal epilepsies were
frequently missing during childhood seizures, especially in infants and
preschool children.
Ictal features help only a little in differentiating childhood FLE from PCE
Nocturnal appearance and the type of aura have high localizing value;
therefore an accurate history taking is still an essential element of paediatric
presurgical evaluation
Video of ictal laughing
Hypothalamic harmatoma
Ictal laughing
Gelastic seizure
Complex partial seizure
GTCS
Take home message
A variety of signs and symptoms may occur during epileptic
seizures have a lateralising or localising significance with
high reliability and positive predictive value, they provide
valuable information in seizure localization and propagation
But there is still some exceptional cases reported
Brain maturation have the effect on seizure semiology
which should be aware, while analyzing paediatric seizure
pattern especially in early age
Temporal lobe seizure semiology undergoes transition
from the paediatric to more adult type clinical pattern
Characteristic features described in adults extratempral
epilepsies were frequently missing in childhood seizure
References
Aileen McGonigal et al. Practical Neurology, 2004, 4, 260-273
Andras Fogarasi, Ingrid Tuxhorn et al. Age-dependnet seizure semiology in
Temporal Lobe Epilepsy Epilepsia, 48(9):1697-1702,2007
Andras Forgarasi, Tuxhorn I et al. Predictive Clinical Factors for Differential
Diagnosis of Children Extratemporal epilepsy Epilepsia 2005
Andrea O. Rossetti et al. Seizure Semiology: An overview of the Inverse Problem
Eur Neurol, 2010;63:3-10
Andrew Bleasel et al. Lateralizing Value and Semiology of Ictal Limb Posturig and
Version in Temporal Lobe and Extratemporal Epilepsy Epilepsia, 38(2):168-174,
1997
Tobias Loddenkemper et al. Lateralizing signs during seizures in focal epilepsy
Epilepsy & behavior 7 (2005) 1-17
Cordula Stoyke et al. Video atlas of lateralising and localising seizure phenomena.
Epileptic Disord Vol 2011;13(2):113-24
V Nagaraddi , HO Luders Autonomic seizures: localizing and lateralizing value,
Textbook of epilepsy surgery p443-p447
Thank you
Video of CPZ
Ictal body turning along horizontal axis gave a
55.2% positive predictive value, which improved
to 85.7% when clustered with restlessness, facial
expressions of anxiety and fear, and barking.
Ictal body turning along the horizontal body axia
and semiology with physiological movements are
not only prevalent semiology items of mesial
frontal lobe epilepsy but they distinguish mesial
frontal from lateral frontal and orbitofrontal
seizures.
and Semiology of Ictal Limb Posturing and Version in Temporal Lobe and Extratemporal Epilepsy Epilepsia, 38(2):168-174,
Frontal seizure semiology in
dorsolateral view
Dr Aileen McGonigal et al. Practical Neurology, 2004, 4, 260-273
Frontal seizure semiology in medial view
Dr Aileen McGonigal et al Practical Neurology, 2004, 4, 260-273
Negative motor phenomena
Epileptic negative mycolonus
Consists of short phases of muscle atonia and is
clinically observed only during muscle contraction, i.e.,
it doses not occur when the patient is at rest (Tassinari
and Gastaut, 1969)
focal negative motor phenomena are frequently
preceded by epileptiform discharges in the
contralateral central region (20-30ms before atonia).
The primary somatosenory motor cortex (Ikeda
etal.,2000), the premotor cortex (Baumgartner,1996,
Meletti, 2000) and the postcentral cortex
(Noachtar,1997) have been identified as possible
generators
Motor
Tobias Loddenkemper et al. Lateralizing signs during seizures in focal epilepsy Epilepsy & behavior 7 (2005) 1-17
Version 22.2% FLE 100% contralateral Brodmann areas 6,8

Clonic activity 44.4% FLE 83% contralateral Brodmann areas 4,6
Tonic activity 48.1% FLE 89% contralateral SMA, Brodmann area 6,

Anterior Cingular Gyrus
Figure of-4-sign 17.7% TLE; 89% contralateral SMA or Prefrontal Areas
15% ETLE
Unilateral dystonic 43.9% TLE 100% contralateral; Activation of Basal Ganglia
posturing
Unilateral automatism Ipsilateral
Automatisms and 5.7% TLE 100% non-dominant Unknown, possible impairment of

preserved consciousness with left or bilateral
consciousness hippocampal impairment
Unilateral ictal 1.5% EMU patients 83% ipsilateral Unknown
eyeblinking
Ictal urinary urge
Is typically expressed ictally or postictally
This symptom was associated with non-dominant
temporal lobe seizure onset in a series of six
patients, whose seizures where characterised by
an aura of ictal urinary urge (Baumgartner 2000)
These result were confirmed by an additional six
patients (0.4% of all patients with TLE) in a series
of 3446 patients who underwent video-EEG
monitoring (Loddenkemper 2003)
Ictal spitting
Is a rare epileptic phenomenon in focal epilepsy and indicate a

seizure onset in the non-dominant Temporal lobe
Of the patient studies in monitoring units, 0.3% presents with ictal
spitting. EEG onset was lateralised to the right non-dominant
hemisphere in all 12 patients evaluated recently(Kellinghaus et
al.,2003)
In another study(Voss et al.,1999), ictal spitting was present in five
of 2500 patients; all five patients had righty temporal lobe epilepsy
as determined by seziure freedom or greater than 90% seizure
reduction after epilepsy surgery (Voss et al., 1999)
A case with ictal spitting in a patient with a left mesial temporal
lobe epilepsy was reported (Ozkara et al.,2000). Interestingly, the
intracartid amobarbital test demonstrated a right hemispheric
speech dominance.
Ictal unilateral piloerection
Occur unilaterally or bilaterally and are
classified as a subtype of autonomic seizures
Is a rare phenomenon in epileptic seizures
(0.14%), predominantly occurring in patients
with TLE (Loddenkemper 2004) and usually
associated with a seizure onset in ipsilateral
hemisphere (Scoppetta 1989, Yu 1998)
V Nagaraddi , HO Luders Autonomic seizures: localizing and lateralizing value, Textbook of epilepsy surgery
p443-p447
Sign Lateralization Location

Epigastric aura Moderate None Mesiotemporal, Insula,
reliability SMA
Ictal spitting 0.3% EMU 75% non- Temporal lobe and Insular
patients dominant cortex
Possible asymmetry of
Central Autonomic Network
Ictal vomiting/retching 2% EMU 81% non- Medial, lateral superior,

patients dominant inferior nondominant
Temporal Lobe and Papez
circuit
Insular cortex
Early childhood OLE
Ictal piloerection 0.04% of Ipsilateral to Temporal lobe
occur unilaterally EMU onset of focal
had a Jacksonian march patients epilepsy
Ictal Non-dominant Temporal lobe

Urinary urge
Postictal nose rubbing
Is a frequent and easy to assess lateralising sign in

patients with TLE (Geyer et al.,1999; Leutmezer et al.,
1988; Wennberg,2001)
The hand used for nose rubbing was ipsilateral to
hemisphere of seizure onset in 45.2-97.3 % of all
patients with TLE (Hirsh et al.,1998; Leutmezer et al.,
1998; Wennberg, 2001) with no statistically significant
difference between right and left temporal lobe
epilepsy.
The ipsilateral hand is most probably due to mild
paresis or neglect of the contralateral arm (Leutmezer
et al.,1998).
Postictal coughing
Can be observed in patients with TLE in 9-13% and seems
to be associated with postictal nose rubbing (Gil-Nagel and
Risinger, 1997; Wennberg,2001)
It is less common in patients with extratemporal epilepsy
(Fauser 2004; Wennberg 2001)
Was considered as right mesiotemporal seizure sign
without statistical significance (Gil-Nagel and Risiniger,
1997; Wennberg, 2001)
a statistically signifant predominace of left temporal seizure
onset in seizures with postictal coughing (Fuser et al)
The lateralising value remain unclear
Tobias Loddenkemper et al. Lateralizing signs during seizures in focal epilepsy Epilepsy & behavior 7 (2005) 1-17
Language
Ictal speech 34.2% EMU patients 83% non-dominant Impairment of areas

other than those
involved in language
production
Ictal dysphasia and 34.2 % EMU patients 100% dominant Impairment of language
aphasia areas
Postictal features
Postictal palsy 0.6% EMU patients 93% contralateral Possible exhaustion or

inhibition of Brodmann
areas 4,6
Postictal nosewiping 53.2% TLE 92% ipsilateral to hand Unknown
/postictal cough used in postictal nose increased
wiping parasympathetic activity
cause increase nasal/
bronchial secretions

TS5 2

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

TS5 2

Uploaded by

Copyright:

Available Formats

Seizure semiology according to anatomical

Korean Epilepsy Congress 9 June 2012

Dr Chak wai kwong

Horonary Clinical Associate Professor

By studying the clinical features of seizure alone,

Lateralizing sign Lateralization/Localization

Unilateral tingling Contralateral onset near somatosensory

Thought disorder (thought implanted on Frontal onset

Unilateral sensory 6.1 % epilepsy 89% contralateral Brodmann areas

Left upper and lower

Asymmetric tonic limb posturing (e.g. Figure

observed in 10% of patients with right

Clinical features Anatomical origin Lateralization Reliability

Clinical features Anatomical origin Lateralization Reliability

Three patients with ictal emesis during dominant

Characterized by negative features (atonic;

Frontal Lobe Epilepsy Posterior Cortex Epilepsy

Myclonic seizures, epileptic spasms, psychomotor seizures, atonic seizures,

Version 22.2% FLE 100% contralateral Brodmann areas 6,8

Tonic activity 48.1% FLE 89% contralateral SMA, Brodmann area 6,

Unilateral automatism Ipsilateral

Automatisms and 5.7% TLE 100% non-dominant Unknown, possible impairment of

Is a rare epileptic phenomenon in focal epilepsy and indicate a

Sign Lateralization Location

Ictal vomiting/retching 2% EMU 81% non- Medial, lateral superior,

Ictal Non-dominant Temporal lobe

Is a frequent and easy to assess lateralising sign in

Lateralizing sign Frequency Lateralizing Value Symptomatic zone

Ictal speech 34.2% EMU patients 83% non-dominant Impairment of areas

Postictal palsy 0.6% EMU patients 93% contralateral Possible exhaustion or

You might also like