Semiology of seizures

1. Seizure semiology Moahmed Hamdy Assistant Professor of neurology Alexandria university

2. Diagnostic protocols rely on clinical semiology , optimized MRI sequences, video-telemetry, Functional neuroimaging , neuropsychology and neuropsychiatry assessments and, at times, invasive EEG monitoring.

3. Pitfalls of neuroimaging alone In adults, 25% of pathologically confirmed cases of focal cortical dysplasia are reported to be MRI-negative prior to surgery (high resolution 3 tesla )

4. Pitfalls of neuroimaging alone Increased signal on FLAIR indicative of HS is not always accompanied by hippocampal atrophy, Neoplasms are the structural substrate in 3-4% of patients with epilepsy in the general population

5. Although MRI-defined structural lesions are a strong predictor of the seizure onset zone, there are reports of well-documented cases in which resections of EEG-defined seizure onset regions that spared structural lesions have resulted in seizure freedom

6. Diagnostic protocols rely on clinical semiology , optimized MRI sequences, video-telemetry, Functional neuroimaging , neuropsychology and neuropsychiatry assessments and, at times, invasive EEG monitoring.

7. Semiology is the 1 st and the most important step Questioning the patient and family Direct observation while hospitalization Video-EEG monitoring

8. The overall pattern of ictal semiology The initial subjective phenomenon (aura) and/or objective phenomenon which sometimes make it possible to confirm specific topographic origin the spatial and temporal articulation of the different ictal phenomenae . The post- ictal phase (focal deficit) Conciousness during the attack

9. From symptom to localization or lateralization Sensory Phenomena Psychic Manifestations Head and Limb Movements Eye and Eyelid Movements Dystonic Posturing Automatisms Behavioral and Phasic Manifestations Autonomic Manifestations

10. From symptom to localization or lateralization Sensory Phenomena Psychic Manifestations Head and Limb Movements Eye and Eyelid Movements Dystonic Posturing Automatisms Behavioral and Phasic Manifestations Autonomic Manifestations

11. Somatosensory phenomena

12. Special senses

13. From symptom to localization or lateralization Sensory Phenomena Psychic Manifestations Head and Limb Movements Eye and Eyelid Movements Dystonic Posturing Automatisms Behavioral and Phasic Manifestations Autonomic Manifestations

14. Psychic manifestations

15. From symptom to localization or lateralization Sensory Phenomena Psychic Manifestations Head and Limb Movements Eye and Eyelid Movements Dystonic Posturing Automatisms Behavioral and Phasic Manifestations Autonomic Manifestations

16. Head and limb movement

17. From symptom to localization or lateralization Sensory Phenomena Psychic Manifestations Head and Limb Movements Eye and Eyelid Movements Dystonic Posturing Automatisms Behavioral and Phasic Manifestations Autonomic Manifestations

18. Eye and eyelid movements

19. From symptom to localization or lateralization Sensory Phenomena Psychic Manifestations Head and Limb Movements Eye and Eyelid Movements Dystonic Posturing Automatisms Behavioral and Phasic Manifestations Autonomic Manifestations

20. Dystonic posturing

21. From symptom to localization or lateralization Sensory Phenomena Psychic Manifestations Head and Limb Movements Eye and Eyelid Movements Dystonic Posturing Automatisms Behavioral and Phasic Manifestations Autonomic Manifestations

22. Automatism

23. From symptom to localization or lateralization Sensory Phenomena Psychic Manifestations Head and Limb Movements Eye and Eyelid Movements Dystonic Posturing Automatisms Behavioral and Phasic Manifestations Autonomic Manifestations

24. Behavioral and phasic manifestations

25. From symptom to localization or lateralization Sensory Phenomena Psychic Manifestations Head and Limb Movements Eye and Eyelid Movements Dystonic Posturing Automatisms Behavioral and Phasic Manifestations Autonomic Manifestations

26. Autonomic manifestations

27. Thank You