Semiological Seizure Classification
EUN, SO-HEE Pediatric Neurology Korea Korea Univers University ity Ansan Ansan Hospita Hospitall
Classification of Epileptic Seizures ILAE, 1981
Clinical and electrographic classification
Partial
Simple partial seizure Complex partial seizure Partial seizure with secondarily generalization
Absence Tonic, Clonic, Tonic-clonic Tonic-clonic seizure Generalized Myoc Myoclo loni nic c seiz seizur ure e Atonic seizure Unclassified
Classification of Epileptic Seizures ILAE, 1981
Clinical and electrographic classification
Partial
Simple partial seizure Complex partial seizure Partial seizure with secondarily generalization
Absence Tonic, Clonic, Tonic-clonic Tonic-clonic seizure Generalized Myoc Myoclo loni nic c seiz seizur ure e Atonic seizure Unclassified
Classification of Epileptic Seizures ILAE, ~ 2010
Generalized Onset
Focal Onset
Originating at some point within, and rapidly engaging, bilaterally distributed networks
Originating within networks limited to one hemisphere
Classification of Epileptic Seizures ILAE, ~ 2010 Generalized seizures Tonic–clonic (in any combination) Absence Myoclonic Clonic Tonic Atonic Focal seizures Unknown Epileptic spasms
Descriptors of focal seizures according to degree of impairment during seizure Without impairment of consciousness or awareness
- observable motor or autonomic components - su ec ve sensory or psyc c p enomena on y
With impairment of consciousness or awareness
Evolving to a bilateral, convulsive seizure Terms in the Glossary of 2001 ILAE report Epilepsia 42(9):1212-8, 2001
Semiology (증후학)
That branches of linguistics concerned with signs and symptoms
Ictus
A sudden neurologic occurrence such as a stroke or an epileptic seizure Glossary of 2001 ILAE report
Detailed Analysis of Seizure Semiology
Seizure - main symptom of epilepsy
Seizure control - target of treatment
Classification of the epilepsy syndrome
Presurgical workup
Differentiate between epileptic and nonepileptic seizures
Diagnosis of Epilepsy
Neuroimaging
EEG
Seizure Evolution Clinical History Neurologic Exam
Functional Neuroimaging
Integrate
Define precisely
Seizure Semiology
1998, Lüders et al.
Semiolo ical seizure classification
2001, ILAE Commission Report
Glossary of descriptive terminology for ictal semiology
Ictal Phenomena 4 categories
Sensory
Consciousness
Autonomic
Semiological Seizure Classification Lüders et al. (1998)
Prominent Features
Epileptic Seizure
Sensorial sphere
Aura
Consciousness
Dialeptic
Autonomic sphere
seizure
(Autonomic aura)
Autonomic seizure
Motor Seizures
2 major subgroups Simple : “Simple”, unnatural primary motor cortex
Complex : Complexity of movement Generated by widespread neuronal matrices Inappropriate for the situation
Simple Myoclonic Tonic Epileptic spasm Tonic-clonic Versive Subtypes - duration of the muscle contraction - rhythmicity of movement repetition - muscles involved
Complex Hypermotor Automotor Gelastic
Auras
Somatosensory
Auditory
Olfactory
Visual
Gustatory
Autonomic
Abdominal
Psychic
Unclassifiable
Dialeptic Seizures
“Dialeptic”, old Greek, means “to interrupt, stand still, or pass out”
Alteration of consciousness
Episodes of unresponsiveness or decreased responsiveness that area not caused by motor alterations
Associated
with complete or at least partial
amnesia for the episode
Autonomic Seizures
Objective proof of the autonomic alteration . ., monitoring)
vs Autonomic Aura
Special Seizures
Atonic seizures
Astatic seizures
Negative myoclonic seizures
Akinetic seizures
Aphasic seizures
Hypomotor seizures
Summary of Lüders Classification I. EPILEPTIC SEIZURE 1. Motor seizure Simplea Complexb 2. Aura
Tonica
Clonica
Myoclonica
Versivea
Tonic-clonic
Epileptic spasma
Hypermotor b
Automotor b
Gelastic
Somatosensorya Visuala
Auditory
Olfactory
Gustatory
Autonomica Abdominal
Psychic
3. Dialeptic seizureb 4. Autonomic seizurea 5. Special seizure
II. PAROXYSMAL EVENT
Atonica Akinetica
Astatic Aphasicb
Hypomotorb Negative myoclonica
Organic
Psychogenic
2001 ILAE, Terms Describing Epileptic Seizure Semiology
Ictal Phenomenology : Glossary of Ictal Semiology
To provide a standard terminology to communicate
Seizure semiology Ictal semiology : motor / nonmotor / autonomic Modifier : somatotopic / timing / duration / severity Peri-ictal : prodrome / postictal phenomenon
ILAE Terminology
Motor
Sensor
Consciousness
Autonomic
1. Motor - Elementary -
2. Nonmotor 3. Autonomic
Involves musculature in any form. The motor event could consist of an increase (positive) or decrease
1.1 Elementary motor 1.1.1 Tonic 1.1.1.1 Epileptic spasm 1.1.1.2 Postural 1.1.1.2.1 Versive 1.1.1.2.2 Dystonic 1.1.2 Myoclonic . . . 1.1.2.2 Clonic 1.1.2.2.1 Jacksonian march 1.1.3 Tonic-Clonic 1.1.3.1 Generalized tonic-clonic 1.1.4 Atonic 1.1.5 Astatic
A single type of contraction of
1.2 Automatism 1.2. 1
Oroalimentary
1.2. 2
Mimetic
1.2. 3
Manual or pedal
1.2. 4
Gestural
1.2. 5
Hyperkinetic
1.2. 6
Hypokinetic
1.2. 7
Dysphasic
1.2. 8
Dyspraxic
1.2. 9
Gelastic
1.2.10 Dacrystic 1.2.11 Vocal 1.2.12 Verbal
More or less coordinated,
ILAE Terminology 1. Motor
Motor
Sensory
Consciousness
Autonomic
2. Nonmotor - Aura / Sensory seizure - Dyscognitive
3. Autonomic
2.1 Aura / 2.2 Sensory Seizure 2.2.1 Elementary
2.2.2 Experiential
2.2.1.1
Somatosensory
2.2.1.2
Visual
2.2.1.3
Auditory
2.2.2.1 Affective (정서)
2.2.1.5
Gustatory
2.2.2.3 Hallucinatory (환상)
2.2.1.6
Epigastric
2.2.2.4 Illusory (오해)
2.2.1.7
Cephalic
2.2.1.8
Autonomic
A single, unformed phenomenon involving one primary sensory
Affective, mnemonic, or composite perceptual phenomena including illusory or composite hallucinatory
2.3 Dyscognitive Seizure 1. Disturbance of cognition : most apparent features 2. ≥ 2 following components involved or undetermined
Attention : selection of perception or task Emotion : appropriate affection of a perception Memory : store and retrieve percepts or concept Executive function : motor activity
3. Autonomic Events
3.1 Autonomic aura 3.2 Autonomic seizure
4. Somatotopic Modifiers 4.1 Laterality 4.1.1 Unilateral 4.1.1.1 Hemi4.1.2 Generalized (syn. "bilateral") 4.1.2.1 As mmetrical 4.1.2.2 Symmetrical 4.2 Body part 4.3 Centricity 4.3.1 Axial 4.3.2 Proximal limb 4.3.3 Distal limb
5. Modifiers and Descriptors of Seizure Timing 5.1 Incidence 5.1.1 Regular, irregular 5.1.2 Cluster . . 5.1.3.1 Reactive 5.1.3.2 Reflex 5.2 State dependent 5.3 Catamenial
6. Duration
6.1 Status epilepticus
7. Severity 8. Prodrome 9.1 Lateralizing phenomenon .
9. Postictal phenomenon
9.2.1 Impaired cognition 9.2.1.1 Antegrade amnesia 9.2.1.2 Retrograde amnesia 9.2.2 Psychosis
