Semiology of Partial Seizure

Department of Pediatrics, Epilepsy center,

Inje University Sanggye Paik Hospital

Su Jeong You, MD.

Anatomic Classification of
Partial Epilepsies
 Introduction (1)
The classification of an epileptic condition by anatomic
location
occurrence of a specific type of seizures

Classical 4 lobes : not functionally homogenous or

unique regions
FLE 7 anatomic subtype
Frontopolar, Supplementary motor, Dorsolateral, Motor or
Rolandic cortex, Orbitofrontal, Opecular, Cingulate
TLE - 2 anatomic subtype
Mesial, Neocortical
 Introduction(2)

Functional areas with relatively stereotyped clinical

seizure features despite the fact that they encompass
more than one anatomic lobe
Perirolandic area
Temporal-parietal-occipital junction
Regions of frontal parietal operculum and insula
Frontal Lobe Epilepsy
 Frontal Lobe onset

Generally short duration

Often occur several times a day

Frequently nocturnal

Typically unassociated with postictal confusion

Prominent motor manifestations(tonic or postural)

 Frontal Lobe onset

Complex gestural automatisms frequent at onset

Frequent falling, when the discharge is bilateral

Status epilepticus is frequent

Sometimes mistaken for psychogenic seizures

Paroxysmal arousal and motor behaviors -
epileptic
seizure
 Frontopolar

Pseudo-absence
Early and complete loss of contact
Drop attack, tonic seizure, focal clonic
and 2GTCS
 Supplementary Motor

Sudden asymmetric tonic posture (

fencing posture)
Vocalization
Contralateral head & eye deviation
Speech arrest and preserved awareness
 Dorso-Lateral

Contralateral head & eye deviation (

versive seizure )
Focal clonic manifestation
Staring
Gestural automatisms
Aphasia, speech arrest ( Brocas area)
Consciousness is often preserved
 Motor or Rolandic cortex
Contralateral SPS with clonic or tonic
movements
Jacksonian march
postictal hemiparesis or hemiplegia
 Orbitofrontal

Gestural motor automatisms

Olfactory hallucination
Autonomic signs
Enuresis
Bradycardia
 Opercular

SPS with clonic facial movements

Speech arrest
Fear, epigastric aura
Loss of contact
Autonomic signs
 Cingulate

CPS and complex automatisms

Awakening
Buccal movements
Bipedal movements
Autonomic signs
Visual hallucination
Frontal Lobe onset
Frontal Lobe onset
Frontal Lobe onset
Temporal Lobe Epilepsy
 Temporal Lobe onset

Seizures in cluster at intervals or randomly

Duration > 1min
Recovery is gradual
Gradual clouding of consciousness
Marked post-ictal confusion
Often preceded by simple or complex partial seizures
epigastric rising sensation, automatisms
Temporal Lobe Epilepsy
Aura ( Visceral or Experimental )
1

Behavioral arrest with staring

2

Oroalimentary automatisms
3

Contralateral dystonic/tonic posturing

4 Ipsilateral hand automatisms

Looking around
5 Whole body movement

Postictal confusions
6
 Temporal Lobe onset
Not clearly defined in childhood
Difficult to separate frontal lobe epilepsy

Behavioral arrest, orofacial automatism, convulsive

activity much more common
Seizure etiology
Adult mesial temporal sclerosis
Young adult tumor, cortical dysplasia
Temporal Lobe onset
 Seizure Characteristics to
Differentiate MTLE and LTLE
MTLE LTLE
Hx of febrile seizure Yes No
Auras
Auditory and other sensory/experimental Yes
illusions and hallucinations, but not fear
Auras of visceral sensations, fear Yes
Contralateral dystonic posture delayed early
Oral alimentary automatisms early No/delayed
Loss of contact delayed early
Seizure duration short
Propensity to generalize less greater
 Various Lateralization Signs
In Temporal Lobe Seizures (I)
Contralateral signs
Unilateral dystonic/tonic posturing
Unilateral clonic movements
Ictal paresis
Postictal Todd paralysis
Version just before generalization
Ipsilateral signs
Unilateral hand automatims
Unilateral ictal blinking
Postictal nosewiping
 Various Lateralization Signs
In Temporal Lobe Seizures (II)
Nondominant hemisphere signs
Ictal vomiting
Ictal speech
Automatisms with preserved consciousness
Ictal spitting
Dominant hemisphere signs
Postictal aphasia
Temporal Lobe onset
Temporal Lobe onset
Occipital Lobe Epilepsy
 Occipital Lobe onset
Simple visual aura ( sparks, flashes, scotoma, amaurosis)
-> contraversion of eyes and head or forced eyelid closure
Sensation of ocular oscillation
Partial seizure
Infrasylvian spread
temporal lobe ( most common ) CPS
Suprasylvian spread mesially
asymmetric tonic posture
(mesial frontal spread)
Suprasylvian spread laterally
focal motor or sensory seizure
1/3-1/2 : another seizure type
Occipital Lobe onset
Parietal Lobe Epilepsy
 Parietal Lobe onset
Less common
Aura : about 80 %
Somatosensory tingling, feeling of electricity
Intraabdominal sensation ( sinking, choking, nausea)
Visual phenomenon ( metamorphobia with distortion,
foreshortening, elongation)
Negative phenomenon ( numbness, asoatognosia )
Severe vertigo, disorientation in space
Receptive or conductive language disturbance
 Parietal Lobe onset
Clinical features variable spread pattern
Frontal lobe
Asymmetric tonic posture, unilateral clonic activity, contralateral
version, hyperkinetic activity
Temporal lobe
Automatisms, altered consciousness
Parietal Lobe onset
Benign childhood epilepsy
with centrotemporal spikes
 Characteristics
for Pediatric Patients
Ictal semiology is often differs and vague in
immature brain
Often impossible to assess the level of
consciousness
Difficult to assess partial onset or aura
The younger, the more vague
Epileptogenic foci are often diffuse and multifocal
 Conclusions
Ictal semiology of partial seizure
Reflect the localization of seizure onset zone
and propagation pattern of seizure
Give useful information about lateralization
Reflect only the symptomatic zone, give only
indirect information about epileptogenic zone
Ictal semiology in pediatric partial seizure
understanding of immature brain and mature
brain