The following project attempts to create a knowledge structure that can classify and describe information related to seizures and epilepsies. This is done by creating what is known as an 'ontology' which represents concepts specific to the domain of epilepsy. Intrinsic to which is describing/illustrating/demonstrating the relationships between the individual ‘pieces’ of information.
A classification system for epileptic seizures: The proposed classification for epilepsy seizures in the 2010 report has been criticized for not using the 2006 ILAE classification core group report (Engel, 2006), discarding terms (e.g., complex focal seizures), and the absence of terms to describe status epilepticus (Panayiotopoulos, 2011). The critical review recommended building consensus around the classification of “focal, myoclonic, or absence seizures,” but did not offer a specific model for classifying seizures (Panayiotopoulos, 2011).
Neural ElectroMagnetic Ontologies (NEMO) models electrophysiologic data terms, including electroencephalography (EEG) and functional Magnetic Resonance Imaging (MRI) related terms (Dou et al., 2007),
Look at SNOMED CT
An Epilepsy Syndrome and Seizure Type Ontology that describes the various epilepsy syndromes based on their features. The features include seizure types and EEG results that also have their own features.
Noachter 1999
Noachter 1999
Scheuermann 2009
Laboratory Finding: A representation of a quality of a specimen that is the output of a laboratory test and that can support an inference to an assertion about some quality of the patient.
Normal Value: A value for a quality reported in a lab report and asserted by the testing lab or the kit manufacturer to be normal based on a statistical treatment of values from a reference population.
Scheuermann 2009
Laboratory Finding: A representation of a quality of a specimen that is the output of a laboratory test and that can support an inference to an assertion about some quality of the patient.
Normal Value: A value for a quality reported in a lab report and asserted by the testing lab or the kit manufacturer to be normal based on a statistical treatment of values from a reference population.
Noachter 1999
Scheuermann 2009
Again we can distinguish the special usage ‘symptom of’: a clinician may attribute a symptom as being a symptom of some specific disease
Scheuermann 2009
Again we can distinguish the special usage ‘symptom of’: a clinician may attribute a symptom as being a symptom of some specific disease
Noachter 1999
Scheuermann 2009
Laboratory Finding: A representation of a quality of a specimen that is the output of a laboratory test and that can support an inference to an assertion about some quality of the patient.
Scheuermann 2009
Laboratory Finding: A representation of a quality of a specimen that is the output of a laboratory test and that can support an inference to an assertion about some quality of the patient.
Is a versus part of throughtout the whole ontology
Are these examples or components of?
Bancaud 1981
Autonomic symptoms: epigastric sensation
ILAE 1989
Rising Epigastric Discomfort
Nausea
Sinking Feeling
Luders 1998
Abdominal Aura
Patients with temporal lobe epilepsy frequently have auras with abdominal sensations. Some of these abdominal auras are most probably the expression of increased abdominal peristalsis and therefore correspond to a subgroup of autonomic auras (or autonomic seizures, if the alteration of peristalsis has been documented). In other cases, they may be an expression of activation of sensory cortical areas of the abdominal viscera. Independent of the pathogenesis, these abdominal auras are closely related to temporal lobe epilepsy; therefore, it appears useful to classify them independently as abdominal auras.
Blume 2001
2.2.1.6 Epigastric: Abdominal discomfort including nausea, emptiness, tightness, churning, butterflies, malaise, pain, and hunger, sensation may rise to chest or throat. Some phenomena may reflect octal autonomic dysfunction.
Blume 2003
Aurae include epigastric sensation, fear and various types of visual, olfactory, or auditory experiential phenomena
Luders 1998
Abdominal Aura
Patients with temporal lobe epilepsy frequently have auras with abdominal sensations. Some of these abdominal auras are most probably the expression of increased abdominal peristalsis and therefore correspond to a subgroup of autonomic auras (or autonomic seizures, if the alteration of peristalsis has been documented). In other cases, they may be an expression of activation of sensory cortical areas of the abdominal viscera. Independent of the pathogenesis, these abdominal auras are closely related to temporal lobe epilepsy; therefore, it appears useful to classify them independently as abdominal auras.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
JB: Irrelevant in epilepsy
Refers to where a limb is held
Luders 1998
Blume 2001
Epigastric: Abdominal discomfort including nausea, emptiness, tightness, churning, butterflies, malaise, pain, and hunger; sensation may rise to chest or throat. Some phenomena may reflect ictal autonomic dysfunction.
Abnormal or Seizure Pattern?
Noachter 1999
Seizure Pattern, EEG
Phenomenon consisting of repetitive EEG discharges with relatively abrupt onset and termination and characteristic pattern of evolution lasting at least several seconds. These EEG patterns are seen during epileptic seizures. Frequent interictal epileptiform discharges are a usually not associated with clinical seizures and thus should be differentiated from electroencephalographic seizure patterns. The component waves or complexes vary in form, frequency, and topography. They are generally rhythmic and frequently display increasing amplitude and decreasing frequency during the same episode. When focal in onset, they tend to spread subsequently to other areas.
Comment: EEG seizure patterns unaccompanied by clinical epileptic manifestations detected by the EEG technician should be referred to as "subclinical" .
Bancaud 1981
A. Absence Seizures
The hallmark of the absence attack is a sudden onset, interruption of ongoing activities, a blank stare, possibly a brief upward rotation of the eyes. If the patient is speaking, speech is slowed or interrupted; if walking, he stands transfixed; if eating, the food will stop on his way to the mouth. Usually the patient will be unresponsive when spoken to. In some, attacks are aborted when the patient is spoken to. The attack lasts from a few seconds to half a minute and evaporates as rapidly as it commenced.
1. Absence with impairment of consciousness only.
The above description fits the description of absence simple in which no other activities take place during the attack.
2. Absence with mild clonic components.
Here the onset of the attack is indistinguishable from the above, but clonic
movements may occur in the eyelids, at the
corner of the mouth, or in other muscle
groups which may vary in severity from almost imperceptible movements to generalized myoclonic jerks. Objects held in the hand may be dropped.
3. Absence with atonic components.
Here there may be a diminution in tone of muscles subserving posture as well as in the limbs leading to drooping of the head, occasionally slumping of the trunk, dropping of the arms, and relaxation of the grip. Rarely, tone is sufficiently diminished to cause this person to fall.
4. Absence with tonic components.
Here during the attack tonic muscular contraction may occur, leading to increase in muscle tone which may affect the extensor muscles or the flexor muscles symmetrically or asymmetrically. If the patient is standing the head may be drawn backward and the trunk may arch. This may lead to retropulsion. The head may tonically draw to one or another side.
5. Absence with automatisms.
(See also prior discussion on automatisms.) Purposeful or quasipurposeful movements occurring in the absence of awareness during an absence attack are frequent and may range from lip licking and swallowing to clothes fumbling or aimless walking. If spoken to the patient may grunt or turn to the spoken voice and when touched or tickled may rub the site. Automatisms are quite elaborate and may consist of combinations of the above-described movements or may be so simple as to be missed by casual observation. Mixed forms of absence frequently occur.
Luders 1998
For example, an episode of altered consciousness associated with generalized 3- Hz, spike-and-wave EEG activity is identified as an absence seizure.
not semiology
Necessary? It's like sour
Blume 2001
Gustatory: Taste sensations including acidic, bitter, salty, sweet, or metallic.
JB: Historical and demonstrate on Physical Examination
ILAE 1989
Acquired epileptic aphasia
(Landau-Kleffner syndrome)
The Landau-Kleffner syndrome is a childhood disorder in which an acquired aphasia, multifocal spike, and spike and wave discharges are associated. Epileptic seizures and behavioral and psychomotor disturbances occur in two-thirds of the patients. There is verbal auditory agnosia and rapid reduction of spontaneous speech. The seizures, usually GTCS or partial motor, are rare, and remit before the age of 15 years, as do the EEG abnormalities.
Scheuermann 2009
Acquired Genetic Disease: A disease whose physical basis is an acquired genetic disorder.
Examples: chronic: benign colonic neoplasia (here the physical basis is an APC mutation); progressive: malignant colon cancer (here the physical basis is a combination of APC, ras and p53 mutations).
Scheuermann 2009
Acquired Genetic Disorder: A genetic disorder acquired by a single cell in an organism that leads to a population of cells within the organism bearing the disorder.
Example: a point mutation acquired in the H-ras gene in colorectal adenoma cells.
Scheuermann 2009
AIDS as a disease that disposes to non-HIV pathogen persistence and duplication (pathological processes) following opportunistic infections that take advantage of a weakened immune system (physical basis).
Engel 2001
Acrocallosal syndrome
Semiology
Epileptic
Nonepileptic
Myoclonous (all characterized by a movement in isolation that looks like myoclonic):
-ep of various types,
-nonep of various types incl movement disorder, p
-provoked
A symptom of basal ganglion disease
Bancaud 1981
Action Myoclonus
Myoclonic Seizures exacerbated by volitional movement (action myoclonus)
Noachter 1999
Activation procedure:
(1) Any procedure designed to enhance or elicit normal or abnormal EEG activity, especially paroxysmal activity.
Examples: hyperventilation, photic stimulation, sleep, injection of convulsant drugs.
(2) Induction of an EEG pattern consisting of a low voltage record which becomes apparent upon blocking of EEG rhythms by physiological or other stimuli such as electrical stimulation of the brain (use in this meaning discouraged).
Bancaud 1981
Addendum
Refers to where a limb is held
Bancaud 1981
Puberty
SIGN 2005
Berg 2010
Blume 2001
Berg 2010
Bancaud 1981
Adult Life
Bancaud 1981
Affective symptomatology. Sensation of extreme pleasure or displeasure, as well as fear and intense depression with feelings of unworthiness and rejection may be experienced during seizures. Unlike those of psychiatrically induced depression, these symptoms tend to come in attacks latsting for a few minutes. Anger or rage is occasionally experienced, but unlike temper tantrums, epileptic anger is apparently unprovoked, and abates rapidly. Fear or terror is the most frequent symptom; It is sudden in onset, usually unprovoked, and may lead to running away. Assocaited with terror, there are freeuqntly objective signs or autonomic activity, inlcuding pupil dilatation, pallor flusing, piloerection, palpation, and hypertension.
Blume 2001
Affective: Components include fear, depression, joy, and (rarely) anger.
Noachter 1999
After-discharge:
(1) EEG seizure pattern following single or repetitive electrical stimulations of a discrete area of the brain via cortical or intracerebral electrodes.
(2) Burst of rhythmic activity following a transient such as an evoked potential or a spike.
1970 Gastaut
Age
1981 Bancaud
Ictal
ILAE 1989
ILAE 1969
Age
ILAE 1989
Age of Onset
2003 Blume
Determination hinges on seizure description, frequency, age at onset, neurological history, functional enquiry, neurological examination and one or more EEGs
2006 Engel
2010 Berg
ILAE 1989
Aicardi syndrome occurs in females and is noted for retinal lacunae and absence of the corpus callosum; infantile spasms with early onset; and often asymmetric, diffuse EEG abnormalities generally asynchronous with suppression burst and/or atypical hypsarrhythmia.
Engel 2001
Aicardi syndrome
Bancaud 1981
Aimless Walking
Lack of movement
Loss or impairment of the power of voluntary movement.
Inability to perform voluntary movements
Negative complex motor seizure
Muscle tone frequently lost
Akinesia: predominant manifestation
Activation of negative motor areas in
frontal & inferior frontal gyri
Only patients w/ preserved consciousness
Bancaud 1981
Apraxia
Luders 1998
Location: Left/right/axial/generalized/bilateral symmetric
Luders 1998
Akinetic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Engel 2001
Inhibitory motor seizure
Akinetic seizures are characterized by the inability to perform voluntary movements. Therefore, they can actually be considered negative complex motor seizures. Muscle tone is also frequently lost, but the akinesia is the most prominent manifestation of the seizure. These seizures are most probably an expression of the activation of the negative motor areas in the mesial frontal and inferior frontal gyri. Only patients in whom consciousness is preserved during the seizures can have akinetic seizures because they .can be tested or tell about the “akinetic” symptoms.
Luders 1998
Akinetic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Akinetic seizures are characterized by the inability to perform voluntary movements. Therefore, they can actually be considered negative complex motor seizures. Muscle tone is also frequently lost, but the akinesia is the most prominent manifestation of the seizure. These seizures are most probably an expression of the activation of the negative motor areas in the mesial frontal and inferior frontal gyri. Only patients in whom consciousness is preserved during the seizures can have akinetic seizures because they .can be tested or tell about the “akinetic” symptoms.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Engel 2001
Alcohol-Withdrawal Seizures
Engel 2001
Alcohol and drug abuse
Bancaud 1981
2014 Fischer
Alcohol-withdrawal
Noachter 1999
Alpha band: Frequency band of 8-13 Hz. Greek letter: 0'..
8-13 Hz
Noachter 1999
Alpha rhythm: Rhythm at 8-13 Hz occurring during wakefulness over the posterior regions of the head, generally with maximum amplitudes over the occipital areas. Amplitude varies but is mostly below 50 uV in the adult. Best seen with the eyes closed and during physical relaxation and relative mental inactivity. Blocked or attenuated by attention, especially visual, and mental effort. Comment: use of term alpha rhythm must be restricted to those rhythms that fulfill these criteria. Activities in the alpha band which differ from the alpha rhythm as regards their topography and/or reactivity, should either have specific appellations (for instance: the mu [u] rhythm) or should be referred to as rhythms of alpha frequency, or alpha activity.
Noachter 1999
Alpha variant rhythms: Certain characteristic EEG rhythms that are recorded most prominently over the posterior regions of the head and differ in frequency but resemble in reactivity the alpha rhythm. Comment: often at a supra or sub-harmonic of alpha frequency may occur when no alpha rhythm is visible (see: fast alpha valiant rhythm; slow alpha variant rhythm.
This is the range of a spike wave.
Noachter 1999
Alpha wave: Wave with duration of 1/8-1/13 s.
1/13-1/8s
Bancaud 1981
Impairment of consciousness
Blume 2001
Visual: Flashing or flickering lights, spots, simple patterns, scotomata, or amaurosis.
Engel 2001
Aminoacidopathies
Unable to relate events in the morning
Bancaud 1981
Diminishes the Amplitude
Bancaud 1981
Amplitude
Noachter 1999
Amplitude: Voltage of EEG waves expressed in microvolts (uV). Measured peak-to-peak. Comment: size of an EEG wave is dependent?upon signal voltage divided by the pen writer or of display sensitivity. EEG depicts the difference in potential between electrode pairs. It is therefore dependent on the method of derivation and has no simple relationship to actual amount of cerebral activity. EEG waves recorded from the surface of the head are attenuated and distorted by intervening structures, particularly the skull.
Bancaud 1981
Increasing in Amplitude
ILAE 1989
Amygdalo-hippocampal (mesiobasal limbic or rhinoencephalic) seizures. Hippocampal seizures are the most common form; the symptoms are those described in the previous paragraphs except that auditory symptoms may not occur. The interictal scalp EEG may be normal, may show interictal unilateral temporal sharp or slow waves, may show bilateral sharp or slow waves, synchronous or asynchronous. The intracranial interictal EEG may show mesial anterior temporal spikes or sharp waves. Seizures are characterized by rising epigastric discomfort, nausea, marked autonomic signs, and other symptoms, including borborygmi, belching, pallor, fullness of the face, flushing of the face, arrest of respiration, pupillary dilatation, fear, panic, and olfactory-gustatory hallucinations.
Gastaut 1970
Anatomic substrate
ILAE 1989
Anaotmy
Engel 2001
Angelman Syndrome
Bancaud 1981
Anger or rage is occassionally experienced, but unlike temper tantrums, epileptic anger is apparently unprovoked, and abates rapidly.
Tancred 2005
The angular gyrus is part of the receptive (sensory) speech area of the brain. Anomic aphasia, in which the patient has difficulty naming objects, occurs with damage to the angular gyrus, suggesting that its function is to associate objects with symbols.
Structures:
Angular Gyrus
Calcarine Sulcus
Central Sulcus
Cerebral Hemisphere
Cingulate Gyrus
Corpus Callosum
Frontal Lobe
Inferior Parietal Lobule
Intraparietal Sulcus
Lateral Fissure
Occipital Lobe
Parieto-occipital Sulcus
Postcentral Gyrus
Postcentral Sulcus
Precuneus
Primary Somatosensory Area
Receptive Speech Area
Superior Parietal Lobule
Superior Temporal Sulcus
Supramarginal Gyrus
The Parietal Lobe is located on the medial and lateral surfaces of the cerebral hemisphere between the frontal and occipital lobes.
Boundaries:
On the lateral surface it extends from the central sulcus anteriorly to an imaginary line drawn downwards from the parieto-occipital sulcus to the preoccipital notch. Inferiorly it is bounded by the lateral fissure and a horizontal line drawn from the lateral fissure to the imaginary line previously described.
On the medial surface it is bounded by the frontal lobe anteriorly, the parieto-occipital fissure posteriorly and the corpus callosum and calcarine sulcus inferiorly.
Gyri and Sulci:
On the lateral surface the parietal lobe is formed by the postcentral gyrus and the superior and inferior parietal lobules. The postcentral gyrus is separated from the two parietal lobules by the postcentral sulcus, which is parallel to the central sulcus. The superior and inferior parietal lobules are separated from each other by the intraparietal sulcus.
The inferior parietal lobule includes the supramarginal and angular gyri. The supramarginal gyrus hooks around the posterior surface of the lateral fissure and the angular gyrus hooks around the posterior end of the superior temporal sulcus.
The medial surface of the parietal lobe includes an extension of the postcentral gyrus, the posterior part of the cingulate gyrus and the precuneus.
Functional Areas:
(1) Primary Somatosensory Area - located on the postcentral gyrus.
(2) In the dominant hemisphere (usually the left) the lower part of the inferior parietal lobule is concerned with the perception and interpretation of language and forms part of the receptive speech (Wernicke's) area.
ILAE 1989
Anterior frontopolar epilepsy
Anterior frontopolar seizure patterns include forced thinking or initial loss of contact and adversive movements of head and eyes, with possible evolution including contraversive movements and axial clonic jerks and falls and autonomic signs.
Blume 2001
Anterograde Amnesia: Impaired ability to remember new material.
Suleiman 2013
Faciobrachial dystonic seizures are seen in adults in association with LGI1 antibodies and often precede the onset of the limbic encephalitis (Irani et al., 2011).
Other NSAbs are less frequently found in adults with limbic encephalitis such as alpha amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) and c-aminobutyric acid B (GABAB) receptor antibodies (Lai et al., 2009; Lancaster et al., 2010; Boronat et al., 2011). Antibodies to glutamic acid decarboxylase (GAD) have been associated with limbic encephalitis (Malter et al., 2010). Although GAD is an intracellular antigen and therefore GAD Abs themselves may not be pathogenic, it is possible that unrecognized NSAbs coexist with GAD Abs (Zuliani et al., 2012).
Limbic encephalitis has been described in association with a number of different autoantibodies including VGKC-complex Abs (Haberlandt et al., 2011; Suleiman et al., 2011a).
Is a or part of?
Blume 2001
Executive function: anticipation, selection, monitoring of consequences, and initiation of motor activity including praxis, speech
Bancaud 1981
exceptionally, fragmentary, primitive, infantile, or antisocial behavior
Noachter 1999
Aperiodic: Applies to:
(1) EEG waves or complexes occurring in a sequence at an irregular rate,
(2) EEG waves or complexes occurring intermittently at irregular intervals.
Cannot speak
Cannot understand spoken language
Cortical language center affected
Bancaud 1981
Aphasia
Pallilalia: involuntary repetition of a syllable or phrase
Phonatory (vocalization or arrest of speech)
ILAE 1989
Language disorders
Speech arrest (rapid reduction of spontaneous speech)
Dysphasia
Receptive or conductive language disturbances
Luders 1998
Cortical stimulation of language centers
Location: Left hemisphere/right hemisphere
Luders 1998
Aphasic Seizure
Location: Left Hemisphere/Right Hemisphere
During aphasic seizures, the patient cannot speak and often cannot understand spoken language. The seizures are probably a negative phenomenon produced by epileptic activation of a cortical language center, a phenomenon similar to that produced by cortical stimulation of language areas.
Luders 1998
Aphasic Seizure
Location: Left Hemisphere/Right Hemisphere
During aphasic seizures, the patient cannot speak and often cannot understand spoken language. The seizures are probably a negative phenomenon produced by epileptic activation of a cortical language center, a phenomenon similar to that produced by cortical stimulation of language areas.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Noachter 1999
Mu Rhythm: Rhythm at 7-11 Hz, composed of arch-shaped waves occurring over the central or centroparietal regions of the scalp during wakefulness. Amplitude varies but is mostly below 50 uV. Blocked or attenuated most clearly by contralateral movement, thought of movement, readiness to move or tactile stimulation. Greek letter: u.
Synonyms: arceau, wicket, comb rhythms (use discouraged).
Bancaus 1981
Head may be drawn backwards and the trunk may arch
Noachter 1999
Change from a lower to a higher level of arousal as manifest in EEG.
Noachter 1999
Arrhythmic activity: A sequence of waves of inconstant period (see rhythm).
Loss of Awareness of part/half of the body
Initial myoclonic jerk
causing loss of balance
Atonia leads to fall
Bancaud 1981
Astatic seizures
Luders 1998
Pathogenesis undefined
Blume 2001
1.1.5 Astatic: Loss of erect posture that results from an atonic, myoclonic, or tonic mechanism. Synonym: drop attack
Bancaud 1981
Astatic seizures
Luders 1998
Astatic seizure
Pathogenesis undefined
Blume 2001
1.1.5 Astatic: Loss of erect posture that results from an atonic, myoclonic, or tonic mechanism. Synonym: drop attack
Astatic seizures consist of epileptic falls. Polygraphic studies show that only in a few patients are the falls the result of atonic seizures. In most patients, a myoclonic jerk causes the patient to lose balance, and the fall itself is produced by an atonia that occurs immediately after the initial myoclonic jerk. Pure generalized tonic seizures may also lead to an epileptic fall. In most patients, however, no video-polygraphic studies are performed and the pathogenesis of the fall is uncertain. It seems useful to classify astatic seizures separately because of the variable pathogenesis of the falls, which usually remains undefined.
Luders 1998
Astatic seizure
Astatic seizures consist of epileptic falls. Polygraphic studies show that only in a few patients are the falls the result of atonic seizures. In most patients, a myoclonic jerk causes the patient to lose balance, and the fall itself is produced by an atonia that occurs immediately after the initial myoclonic jerk. Pure generalized tonic seizures may also lead to an epileptic fall. In most patients, however, no video-polygraphic studies are performed and the pathogenesis of the fall is uncertain. It seems useful to classify astatic seizures separately because of the variable pathogenesis of the falls, which usually remains undefined.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Engel 2001
Astrocytomas
Bancaud 1981
Asymmetrical
Luders 1998
Bilateral Asymmetric
Bilateral asymmetric, axial, and generalized. The terms bilateral asymmetric, axial, and generalized also refer strictly to the somatotopic localization of the clinical semiology.
Bilateral asymmetric means that the symptoms occurred in a bilateral distribution but had a significant degree of asymmetry. The term suggests that the patient has a focal epilepsy.
Blume 2001
Asymmetrical: Clear distinction in quantity and/or distribution of behavior on the two sides.
Noachter 1999
Noachter 1999
Asymmetry: Unequal amplitude of EEG activities over homologous areas on opposite sides of the head.
Bancaud 1981
Asynchronous
Blume 2001
Asynchronous: Motor events occurring not at the same time or at the same rate in sets of body parts.
Noachter 1999
Independent (temporally): Synonym: asynchronous.
Noachter 1999
Asynchrony: The non-simultaneous occurrence of EEG activities over regions on the same or opposite sides of the head.
Loss of postural tone
(head drops, falls, etc)
Preceded by short myoclonic seizure
Bancaud 1981
Absence with atonic components
sudden diminution in muscle tone (fragmentary), leading to a head drop with slackening of the jaw (may lead to face injury by projecting objects), the dropping of a limb or a loss of all muscle tone leading to a slumping to the ground (slumping may be progressive in a rhythmic, successive relaxation manner
Drop attacks (extremely brief atonic seizure)
If loss of consciousness, extremely brief
ILAE 1989
Luders 1998
Blume 2001
1.1.4 Atonic: Sudden loss of diminution of muscle tone without apparent preceding myoclonic or tonic event lasting >1 to 2 s, involving head, trunk, jaw, or limb musculature.
Bancaud 1981
A sudden diminution in muscle tone occurs which may be fragmentary, leading to a head drop with slackening of the jaw, the dropping of a limb or a loss of all muscle tone leading to a slumping to the ground. When these attacks are extremely brief they are known a s ‘‘drop attacks.” If consciousness is lost, this loss is extremely brief. The sudden loss of postural tone in the head and trunk may lead to injury by projecting objects. The face is particularly subject to injury. In the case of more prolonged atonic attacks, the slumping may be progressive in a rhythmic, successive relaxation manner.
(So-called drop attacks may be seen in conditions other than epilepsy, such as brainstem ischemia and narcolepsy cataplexy syndrome.)
Absence with atonic components
Atonic seizures
EEG Seizure Type
Polyspikes and wave or flattening or low-voltage fast activity
EEG interictal Expression
Polyspike and slow wave
ILAE 1989
Luders 1998
Atonic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Blume 2001
1.1.4 Atonic: Sudden loss of diminution of muscle tone without apparent preceding myoclonic or tonic event lasting >1 to 2 s, involving head, trunk, jaw, or limb musculature.
Engel 2001
Myoclonic atonic seizures
Atonic seizures
Berg 2010
Atonic
Location: Left/right/axial/generalized/bilateral asymmetric
Loss of postural tone
(head drops, falls, etc)
Preceded by short myoclonic seizure
Bancaud 1981
Absence with atonic components
sudden diminution in muscle tone (fragmentary), leading to a head drop with slackening of the jaw (may lead to face injury by projecting objects), the dropping of a limb or a loss of all muscle tone leading to a slumping to the ground (slumping may be progressive in a rhythmic, successive relaxation manner
Drop attacks (extremely brief atonic seizure)
If loss of consciousness, extremely brief
ILAE 1989
Luders 1998
Blume 2001
1.1.4 Atonic: Sudden loss of diminution of muscle tone without apparent preceding myoclonic or tonic event lasting >1 to 2 s, involving head, trunk, jaw, or limb musculature.
Tonic seizures cause a loss of postural tone. The result is loss of posture (head drops, falls, and so on). Often these seizures are preceded by a short myoclonic seizure.
Luders 1998
Atonic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Atonic seizures cause a loss of postural tone. The result is loss of posture (head drops, falls, and so on). Often these seizures are preceded by a short myoclonic seizure.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Blume 2001
Components of cognition:
Perception: symbolic conception of sensory information
Attention: appropriate selection of a principal perception or task
Emotion: appropriate affective significance of a perception
Memory: ability to store and retrieve percepts or concepts
Executive function: anticipation, selection, monitoring of consequences, and initiation of motor activity including praxis, speech
Noachter 1999
Attenuation:
(1) Reduction in amplitude of EEG activity. May occur transiently in response to physiological or other stimuli, such as electrical stimulation of the brain, or result from pathological conditions (see blocking).
(2) Reduction of sensitivity of an EEG channel, i.e. decrease of output deflection during operation of sensitivity or filter controls. Customarily expressed as relative reduction of sensitivity at certain stated frequencies (see sensitivity; high frequency filter; low frequency filter).
Bancaud 1981
Atypical Absence Seizure
Clinical Seizure Type
May have:
(a) Changes in tone that are more pronounced than in Typical Absence Seizure
(b) Onset and/or cessation that is not abrupt
EEG Seizure Type
EEG more heterogeneous; may include irregular spike-and-slow-wave complexes, fast activity or other paroxysmal activity. Abnormalities are bilateral but often irregular and asymmetrical.
EEG Interictal Expression
Background usually abnormal; paroxysmal activity (such as spikes or spike-and-slow-wave complexes) frequently irregular and asymmetrical
Bancaud 1981
Atypical Absence
Absence: sudden onset, interruption of ongoing activities, blank stare, brief upward rotation of eyes.
If speaking, speech slowed or interrupted; if walking, transfixed; if eating, food stops, patient usually unresponsive when spoken to
lasts few seconds to half a minute
Begins and ends rapidly
changes in tone more pronounced
Onset and/or cessation that is not abrupt
Luders 1998
Location: Left Hemisphere/Right Hemisphere
Engel 2001
Atypical absence seizures
Eyelid myoclonia w/o absences
Berg 2010
Atypical Absence
Unknown
Amnesia (complete or partial)?
Waxing and waining of consciousness?
Begins and ends abruptly
>20 sec / episode
Noachter 1999
Atypical spike-and-slow-wave complex: Paroxysms consisting of a sequence of spike-and-slow-wave complexes that occur bilaterally but do not meet the criteria of 3 per second spike-and-slow-wave complex.
Bancaud 1981
Crude auditory sensations to music
Rushing noises
Buzzing
ILAE 1989
Luders 1998
Auditory Aura
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Isolated auditory hallucinations or illusions should be classified as auditory auras. More elaborated auditory hallucinations or illusions that occur together with complex alterations of perception (such as alterations of the sense of familiarity of what the patient is seeing or hearing, visual or auditory illusions, or the simultaneous occurrence of complex visual hallucinations, and so on) should be classified as auditory auras only if the auditory hallucination or illusion is clearly the predominant symptom. Otherwise, these complex auras should be classified as psychic auras.
Blume 2001
2.2.1.3 Auditory: Buzzing, drumming sounds or single tones.
Blume 2003
Aurae include epigastric sensation, fear and various types of visual, olfactory, or auditory experiential phenomena
Luders 1998
Auditory Aura
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Isolated auditory hallucinations or illusions should be classified as auditory auras. More elaborated auditory hallucinations or illusions that occur together with complex alterations of perception (such as alterations of the sense of familiarity of what the patient is seeing or hearing, visual or auditory illusions, or the simultaneous occurrence of complex visual hallucinations, and so on) should be classified as auditory auras only if the auditory hallucination or illusion is clearly the predominant symptom. Otherwise, these complex auras should be classified as psychic auras.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Bancaud 1981
Simple Hallucination
Crude Auditory Sensations
Blume 2001
Auditory: Buzzing, drumming sounds or single tones.
Bancaud 1981
Auditory Symptom
Blume 2001
Auditory: Buzzing, drumming sounds or single tones.
Blume 2001
Auditory: Buzzing, drumming sounds or single tones.
Not a semiology
Bancaud 1981
Aura. A frequently used term in the description of epileptic seizures is aura. According to the Dictionary of Epilepsy, this term was introduced by Galen to describe the sensation of a breath of air felt by some subjects prior to the onset of a seizure. Others have referred to the aura as the portion of a seizure experienced before loss of consciousness occurs. This loss of consciousness may be the result of secondary generalization of the seizure discharge or of alteration of consciousness imparted by the development of a complex partial seizure.
The aura is that portion of the seizure which occurs before consciousness is lost and for which memory is retained afterwards. It may be that, as in simple partial seizures, the aura is the whole seizure. Where consciousness is subsequently lost, the aura is, in fact, the signal symptom of a complex partial seizure. An aura is a retrospective term which is described after the seizure is ended.
Luders 1998
Sensorial Sphere
Warning symptoms at beginning of seizure
Aura
Auras are ictal manifestations having sensory, psychosensory, and experiential symptoms.
Auras consist exclusively of subjective symptoms and usually occur at the beginning of a seizure (“warning symptoms”). In general, they are brief (seconds) and only rarely may persist longer (minutes). They may occur in isolation from any other ictal symptom and, if so, tend to last slightly longer. In general, the epileptic nature of auralike symptomatology can be documented objectively only if the aura consistently evolves into a dialeptic or motor seizure or if EEG monitoring demonstrates an EEG seizure pattern during the aura.
2001 Blume
2.1 Aura: Noun: A subjective ictal phenomenon that, in a given patient, may precede an observable seizure; if alone, constitutes a sensory seizure.
2.2 Sensory: A perceptual experience not caused by appropriate stimuli in the external world. Modifies "seizure" or "aura."
Luders 1998
Aura
Auras are ictal manifestations having sensory, psychosensory, and experiential symptoms.
Sensorial Sphere
Warning symptoms at beginning of seizure
Aura
Auras consist exclusively of subjective symptoms and usually occur at the beginning of a seizure (“warning symptoms”). In general, they are brief (seconds) and only rarely may persist longer (minutes). They may occur in isolation from any other ictal symptom and, if so, tend to last slightly longer. In general, the epileptic nature of auralike symptomatology can be documented objectively only if the aura consistently evolves into a dialeptic or motor seizure or if EEG monitoring demonstrates an EEG seizure pattern during the aura.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Engel 2001
Aura Continua
Suleiman 2013
Criteria and supportive features to suspect autoimmune epilepsy in children with seizures:
The following two clinical criteria are used to suspect autoimmune epilepsy associated with NSAbs and GAD antibodies (both are needed)
1 Acute or subacute (<12 weeks) onset of symptoms.
2 Exclusion of other causes (CNS infection, trauma, toxic, tumor, metabolic, previous CNS disease).
The following supportive features would strengthen the suspicion of autoimmune epilepsy (patients should have at least 1 of the following):
1 The presence of a well-defined clinical syndrome such as NMDAR or limbic encephalitis
2 CNS inflammation manifested by at least one of:
a CSF pleocytosis (defined as >5 white cells/mm3) or presence of oligoclonal bands, elevated IgG index, or elevated
neopterin (defined as >30 nM)
b MRI abnormality compatible with an inflammatory or autoimmune encephalitis including increased signal in the
mesiotemporal lobe (LE – like syndrome)
c Inflammatory neuropathology on biopsy
3 History of other antibody mediated condition (e.g., myasthenia gravis), organ specific autoimmunity or other autoimmune
disorders. (It is recognized that epilepsy is more common in many autoimmune disorders including multiple sclerosis, systemic lupus erythematosus, type 1 diabetes mellitus
(T1DM), celiac disease, and autoimmune thyroid disease (Vincent & Crino, 2011).)
4 Response to immunotherapy
Classification categories of suspected autoimmune epilepsy in children identified using the criteria and supportive features in Table 1 (Zuliani et al., modified)
Classification categories expressing the likelihood of autoimmune epilepsy based on the presence of NSAbs and GAD Abs and the response to immunotherapy (see Fig. 1):
Definite autoimmune epilepsy is present if:
Known NSAbs are present in serum or CSF
AND there is response to immunotherapy
Probable autoimmune epilepsy is present if
Known NSAbs are present and no immunotherapy responsiveness demonstrated
(immunotherapy unsuccessful or not given)
OR GAD antibodies are present AND there is response to immunotherapy
Possible autoimmune epilepsy is present if known NSAbs are negative and
GAD antibodies are present and no immunotherapy responsiveness demonstrated
(unsuccessful or not given)
OR GAD antibodies are negative and there is a response to immunotherapy
Unlikely autoimmune epilepsy is present if
Known NSAbs and GAD are negative and there is no response to immunotherapy
Unknown autoimmune epilepsy(a) is present if
Known NSAbs and GAD are negative and immunotherapy is not given
(a)Patients in this category may move to a different category if they receive immunotherapy, such as “possible” if they respond or “unlikely” if they did not respond to immunotherapy.
Bancaud 1981
JB: Any repetitive motion
Bancaud 1981
Automatisms.
(These may occur in both partial and generalized seizures. They are described in detail here for convenience.) In the Dictionary of Epilepsy (Gastaut,1973), automatisms are described as “more or less coordinated adapted (eupractic or dyspractic) involuntary motor activity occurring during the state of clouding of consciousness either in the course of, or after an epileptic seizure, and usually followed by amnesia for the event. The automatism may be simply a continuation of an activity that was going on when the seizure occurred, or, conversely, a new activity developed in association with the ictal impairment of consciousness. Usually, the activity is commonplace in nature, often provoked by the subject’s environment, or by his sensations during the seizure; exceptionally, fragmentary, primitive, infantile, or antisocial behavior is seen. From a symptomatological point of view the following are distinguished: a) eating automatisms (chewing, swallowing); b) automatism of mimicry, expressing the subject’s emotional state (usually of fear) during the seizure; c) gestural automatisms, crude or elaborate; directed toward either the subject or his environment; d) ambulatory automatisms; e) verbal automatisms.”
lctal epileptic automatisms usually represent the release of automatic behavior under the influence of clouding of consciousness that accompanies a generalized or partial epileptic seizure (confusional automatisms). They may occur in complex partial seizures as well as in absence seizures. Postictal epileptic automatisms may follow any severe epileptic seizure, especially a tonic-clonic one, and are usually associated with confusion.
While some regard masticatory or oropharyngeal automatisms as arising from the amygdala or insular and opercular regions, these movements are occasionally seen in the generalized epilepsies, particularly absence seizures, and are not of localizing help. The same is true of mimicry and gestural automatisms. In the latter, fumbling of the clothes, scratching, and other complex motor activity may occur both in complex partial and absence seizures. Ictal speech automatisms are occasionally encountered. Ambulatory seizures again may occur either as prolonged automatisms of absence, particularly prolonged absence continuing, or of complex partial seizures. In the latter, a patient may occasionally continue to drive a car, although may contravene traffic light regulations.
There seems to be little doubt that automatisms are a common feature of different types of epilepsy. While they do not lend themselves to simple anatomic interpretation, they appear to have in common a discharge involving various areas of the limbic system. Crude and elaborate automatisms do occur in patients with absence as well as complex partial seizures. Of greater significance is the precise descriptive history of the seizures, the age of the patient, the presence or absence of an aura and of postictal behavior including the presence or absence of confusion. The EEG is of cardinal localizational importance here.
Luders 1998
Automotor Seizure
Location: Left Hemisphere/Right Hemisphere
Automotor seizures are complex motor seizures in which the main manifestations consist of automatisms involving the distal segments of the hands and feet or the mouth and tongue. Consciousness is usually affected but may be preserved, particularly when the seizure originates from the nondominant hemisphere.
Luders 1998
Automotor seizures
Automotor seizures are complex motor seizures in which the main manifestations consist of automatisms involving the distal segments of the hands and feet or the mouth and tongue. Consciousness is usually affected but may be preserved, particularly when the seizure originates from the nondominant hemisphere.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Bancaud 1981
Autonomic Symptoms
ILAE 1989
Luders 1998
Autonomic Aura
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Seizures consisting primarily of autonomic symptoms are rare. Usually, they are detected by the patient reporting symptoms secondary to the autonomic alteration, e.g., palpitations or ‘‘hot flashes.” Occasionally, they can be documented by appropriate monitoring (e.g., Holter monitor). We classify these episodes as “autonomic auras” when the patient has symptoms most probably produced by an autonomic alteration but we do not have objective proof of the autonomic disturbance.
Autonomic alterations elicited by epileptic activation of autonomic cortical centers produce symptoms that the patient can detect but that observers have difficulty identifying, particularly from a videotape recording (palpitations, hot flashes, and so on). Sensations that most probably are an expression of an epileptic autonomic alteration are classified as autonomic auras even when there is no objective proof of their autonomic pathogenesis (such as palpitations or hot flashes). In contrast, autonomic alterations appropriately documented by polygraphic recordings (tachycardia, blood pressure changes, and so on) or direct visual observation (mydriasis, sweating, flushing, piloerection, and so on) are classified as autonomic seizures
2001 Blume
2.2.1.8 Autonomic: A sensation consistent with involvement of the autonomic nervous system, including cardiovascular, gastrointestinal, sudomotor, vasomotor, and thermoregulatory functions. (Thus "autonomic aura"; cf. "autonomic events" 3.0).
3.0 Autonomic Events
3.1 Autonomic Aura: A sensation consistent with involvement of the autonomic nervous system, including cardiovascular gastrointestinal sudomotor, vasomotor, and thermoregulatory functions (see 2.2.1.8).
Luders 1998
Autonomic Aura
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Seizures consisting primarily of autonomic symptoms are rare. Usually, they are detected by the patient reporting symptoms secondary to the autonomic alteration, e.g., palpitations or ‘‘hot flashes.” Occasionally, they can be documented by appropriate monitoring (e.g., Holter monitor). We classify these episodes as “autonomic auras” when the patient has symptoms most probably produced by an autonomic alteration but we do not have objective proof of the autonomic disturbance.
Autonomic alterations elicited by epileptic activation of autonomic cortical centers produce symptoms that the patient can detect but that observers have difficulty identifying, particularly from a videotape recording (palpitations, hot flashes, and so on). Sensations that most probably are an expression of an epileptic autonomic alteration are classified as autonomic auras even when there is no objective proof of their autonomic pathogenesis (such as palpitations or hot flashes). In contrast, autonomic alterations appropriately documented by polygraphic recordings (tachycardia, blood pressure changes, and so on) or direct visual observation (mydriasis, sweating, flushing, piloerection, and so on) are classified as autonomic seizures
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Bancaud 1981
Autonomic symptoms or signs
Epigastric sensation
Vomiting, pallor, flushing, sweating, piloerection, pupil dilatation, boborygmi, incontinence
ILAE 1989
Pallor
Fullness of the face
Flushing of the face
Arrest of respiration
Pupillary dilatation
Apnea
Borborygmi
Belching
Choking
Luders 1998
Luders 1998
Autonomic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Autonomic seizures are seizures in which the main ictal manifestations are objectively documented autonomic alterations.
“Autonomic seizures” have objective proof of the autonomic alteration whether the patient is aware of the autonomic disturbance or not.
Autonomic seizures consist of episodic alterations of autonomic function that are elicited by activation of autonomic cortical centers activated by an epileptiform discharge. Cases in which the patient reports only sensations that most probably correspond to an autonomic alteration (hot flashes, palpitations, and so on) and for which there is no objective documentation should be classified as autonomic auras (described above). To make the diagnosis of an autonomic seizure, episodes of autonomic dysfunction must be documented by appropriate polygraphic recording (tachycardia, blood pressure changes, and so on) or by direct observation. Documented episodes of autonomic dysfunction may be clinically silent (i.e., the episodes may only be detected by a monitor, without the patient experiencing any unusual symptoms).
Blume 2001
3.2. Autonomic Seizure: An objectively documented and distinct alteration of autonomic nervous system function involving cardiovascular, pupillary, gastrointestinal, sudomotor, vasomotor, and thermoregularity functions.
Blume 2003
Micturition (frequent)
Eyes Open
Pupils (dilated or hippos during attacks
Colour (cyanotic or grey)
Pulse (rapid, strong)
Hypersalivation
SIGN 2006
Autonomic features
Luders 1998
Seizures consisting primarily of autonomic symptoms are rare. Usually, they are detected by the patient reporting symptoms secondary to the autonomic alteration, e.g., palpitations or ‘‘hot flashes.” Occasionally, they can be documented by appropriate monitoring (e.g., Holter monitor). We classify these episodes as “autonomic auras” when the patient has symptoms most probably produced by an autonomic alteration but we do not have objective proof of the autonomic disturbance. In contrast, we classify such episodes as “autonomic seizures” when we have objective proof of the autonomic alteration whether the patient is aware of the autonomic disturbance or not.
Luders 1998
Autonomic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Autonomic seizures are seizures in which the main ictal manifestations are objectively documented autonomic alterations.
“Autonomic seizures” have objective proof of the autonomic alteration whether the patient is aware of the autonomic disturbance or not.
Autonomic seizures consist of episodic alterations of autonomic function that are elicited by activation of autonomic cortical centers activated by an epileptiform discharge. Cases in which the patient reports only sensations that most probably correspond to an autonomic alteration (hot flashes, palpitations, and so on) and for which there is no objective documentation should be classified as autonomic auras (described above). To make the diagnosis of an autonomic seizure, episodes of autonomic dysfunction must be documented by appropriate polygraphic recording (tachycardia, blood pressure changes, and so on) or by direct observation. Documented episodes of autonomic dysfunction may be clinically silent (i.e., the episodes may only be detected by a monitor, without the patient experiencing any unusual symptoms).
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Engel 2001
Autosomal Dominant Nocturnal Frontal Lobe Epilepsy
Engel 2006
Autosomal Dominant Nocturnal Frontal Lobe Epilepsy
ILAE 2010
Autosomal Dominant Nocturnal Frontal Lobe Epilepsy (ADNFLE)
ILAE 2010
Autosomal Dominant Epilepsy with Auditory Features (ADEAF)
Bancaud 1981
Inheritance
ILAE 1989
Inheritance
Luders 1998
2010 Berg
Hereditary predisposition
Bancaud 1981
Inheritance
ILAE 1989
Inheritance
Luders 1998
2010 Berg
Hereditary predisposition
Bancaud 1981
Inheritance
ILAE 1989
Inheritance
Luders 1998
2010 Berg
Hereditary predisposition
Bancaud 1981
Awakes feeling stiff and sore all over
Bancaud 1981
Patient's contact with events during the period in question and its recall
Luders 1998
Axial
Bilateral asymmetric, axial, and generalized. The terms bilateral asymmetric, axial, and generalized also refer strictly to the somatotopic localization of the clinical semiology.
Bilateral asymmetric means that the symptoms occurred in a bilateral distribution but had a significant degree of asymmetry. The term suggests that the patient has a focal epilepsy.
The modifier generalized is used when the manifestations occur in a relatively widespread distribution and there is approximately equal involvement of both sides and of the distal and proximal segments.
The modifier “axial” is used when the manifestations involve predominantly the muscles of the trunk and the proximal muscles of the extremities. Usually patients who have axial or generalized seizures have generalized epilepsy. However, some patients with focal epilepsy may have axial or generalized seizures and, vice versa, patients with generalized epilepsies may have seizures that include significant focal elements. In other words, the relationship between clinical semiology and epileptic syndromes is not one to one.
Blume 2001
Axial: Involves trunk, including neck.
Engel 2001
DIsorders of folic acid and B12 metabolism
Daily and Pedly
American CLinical Neurological Society
Bancaud 1981
Background Abnormal
Assuming this means background activity normal?
Definition: Ongoing activity expressed as frequency of rhythm in posterior head regions, eyes closed, relaxed awake. Also refers to the ongoing rhythms in the rest of the brain (e.g. frontal lobes)
Bancaud 1981
Background activity normal
Noachter 1999
Background activity: Any EEG activity representing the setting in which a given normal or abnormal pattern appears and from which such pattern is distinguished.
Comment: not a synonym of any individual rhythm such as the alpha rhythm.
Noachter 1999
Background slow activity: The frequency of the background rhythm is below the normal value.
Engel 2001
Bacterial meningitis
Noachter 1999
Band: Portion of EEG frequency spectrum, i.e. delta, theta, alpha, beta bands.
Stopping in the middle of an activity
Rage
JB: Both in all, not going to be words used for epilepsy diagnosis.
NO
JB: Irrelevant
for something like Benign Centrotemporal Epilepsy, it’s a defining feature. (negation?)
ILAE 1989
Benign childhood epilepsy with centrotemporal spikes
Benign childhood epilepsy with centrotemporal spikes is a syndrome of brief, simple, partial, hemifacial motor seizures, frequently having associated somatosensory symptoms which have a tendency to evolve into GTCS. Both seizure types are often related to sleep. Onset occurs between the ages of 3 and 13 years (peak 9-10 years), and recovery occurs before the age of 15-16 years. Genetic predisposition is frequent, and there is male predominance. The EEG has blunt high-voltage centrotemporal spikes, often followed by slow waves that are activated by sleep and tend to spread or shift from side to side.
Engel 2001
Benign Childhood Epilepsy with Centrotemporal Spikes
ILAE 2010
Benign Epilepsy of Childhood with Central Temporal Spikes (BECTS)
Fischer 2014
It makes little sense to say that someone has an epilepsy syndrome but not epilepsy. If evidence exists for an epilepsy syndrome, then epilepsy may be presumed to be present, even if the risk of subsequent seizures is low.
Noachter 1999
Benign epileptiform discharges of childhood: Regional or multiregional sharp waves, which are normally followed by a negative slow wave with lower amplitude than the negative peak of the sharp wave and which typically show a bipolar distribution with a positive sink in the mid frontal region. These sharp waves often have a multiregional distribution and are easy to recognize by their typical morphology. If they occur in the centrotemporal region, they are also called "Rolandic spikes". They typically increase during sleep and tend to appear in series.
Noachter 1999
Benign epileptiform transient of sleep (BETS): Small sharp spikes (SSS) of very short duration and low amplitude, often followed by a small theta wave, occurring in the temporal regions during drowsiness and light sleep. This pattern is of little clinical significance (see small sharp spikes).
Engel 2001
Benign Familial Infantile Seizures
ILAE 2010
Benign Familial Infantile Epilepsy
ILAE 2010
Benign Familial Neonatal Epilepsy (BFNE)
Engel 2001
Benign Familial Neonatal Seizures
ILAE 2010
Benign Infantile Epilepsy
Engel 2001
Benign Infantile Seizures
Engel 2001
Benign Infantile Seizures Nonfamilial
ILAE 1989
Benign myoclonic epilepsy in infancy is characterized by brief bursts of generalized myoclonus that occur during the first or second year of life in otherwise normal children who often have a family history of convulsions or epilepsy. EEG recording shows generalized spike-waves occurring in brief bursts during the early stages of sleep. These at- tacks are easily controlled by appropriate treatment. They are not accompanied by any other type of seizure, although GTCS may occur during adolescence. The epilepsy may be accompanied by a relative delay of intellectual development and minor personality disorders.
Engel 2001
Benign Myoclonic Epilepsy In Infancy
ILAE 1989
Benign neonatal convulsions are very frequently repeated clonic or apneic seizures occurring at about the fifth day of life, without known etiology or concomitant metabolic disturbance. Interictal EEG often shows alternating sharp theta waves. There is no recurrence of seizures, and the psychomotor development is not affected.
ILAE 1989
Benign neonatal familial convulsions are rare, dominantly inherited disorders manifesting mostly on the second and third days of life, with clonic or apneic seizures and no specific EEG criteria. History and investigations reveal no etiologic factors. About 14% of these patients later develop epilepsy.
ILAE 2010 Benign Neonatal Seizures (BNS)
Noachter 1999
Beta band: Frequency band from 14 to 40 Hz. Greek letter: Beta (see gamma band).
Noachter 1999
Beta rhythm: In general: any EEG rhythm between 14 and 40 Hz. Most characteristically: a rhythm from 14 to 40 Hz recorded over the frontocentral regions of the head during wakefulness. Amplitude of frontocentral beta rhythm varies but is mostly below 30uV Blocking or attenuation by contralateral movement or tactile stimulation is especially obvious in electrocorticograms. Other beta rhythms are most prominent in other locations or are diffuse.
This is the range of a spike wave.
1/14-1/40s
Need help figuring out General versus Diffuse versus Bilateral
Blume 2001 General
I 6.0
II 4.1.2
Bancaud 1981
Bilateral
Luders 1998
Bilateral Asymmetric
Bilateral asymmetric, axial, and generalized. The terms bilateral asymmetric, axial, and generalized also refer strictly to the somatotopic localization of the clinical semiology.
Bilateral asymmetric means that the symptoms occurred in a bilateral distribution but had a significant degree of asymmetry. The term suggests that the patient has a focal epilepsy.
Noachter 1999
Bilateral: Involving both sides of the head.
Blume 2001
I 6.0
Generalized
(syn. bilateral)
A seizure whose initial semiology indicates, or is consistent with, more than minimal involvement of both cerebral hemispheres.
Blume 2001
II 4.1.2
Generalized: More than minimal involvement of each side as a motor, elementary sensory, or autonomic phenomenon. Motor component can be further modified as asymmetrical and symmetrical.
Noachter 1999
Bilateral: Involving both sides of the head.
Engel 2001
Bilateral perisylvian syndrome
Engel 2001
Disorders of biotin metabolism
Noachter 1999
Bipolar derivation:
(1) Recording from a pair of electrodes.
(2) Method of organizing the linkages of electrodes to recording channels (see bipolar montage).
Noachter 1999
Bipolar montage: Multiple bipolar derivations, with no electrode being common to all derivations. In most instances, bipolar derivations are linked, i.e. adjacent derivations from electrodes along the same line of electrodes have one electrode in common, connected to the input terminal 2 of one amplifier and to the input terminal 1 of the following amplifier (see reference montage).
Bancaud 1981
Tongue may be bitten
Blume 2001
Gustatory: Taste sensations including acidic, bitter, salty, sweet, or metallic.
Bancaud 1981
Bitter
Blume 2001
Gustatory: Taste sensations including acidic, bitter, salty, sweet, or metallic.
Bancaud 1981
Blandk stare
Noachter 1999
Blocking:
(1) Apparent, temporary obliteration of EEG rhythms in response to physiological or other stimuli such as electrical stimulation of the brain (see attenuation).
(2) A condition of temporary unresponsiveness of the EEG amplifier, caused by major overload. Manifested initially by extreme, flat-topped trace excursion(s) lasting up to a few seconds (see overload, clipping).
Blume 2001
Motor: Involves musculature in any form. The motor event could consist of an increase (positive) or decrease (negative) in muscle contraction to produce a movement. Unless noted, the following terms are adjectives modifying “motor seizure” or “seizure” (e.g., “tonic motor seizure or dystonic seizure”), and whose definitions can usually be understood as prefaced by “refers to . . .”
Blume 2001
Epileptic Spasm (Formerly Infantile Spasm):
Noun: A sudden flexion, extension, or mixed extension–flexion of predominantly proximal and truncal muscles that is usually more sustained than a myoclonic movement but not so sustained as a tonic seizure (i.e., ∼1 s). Limited forms may occur: grimacing, head nodding. Epileptic spasms frequently occur in clusters.
Blume 2001
Versive: A sustained, forced conjugate ocular, cephalic, and/or truncal rotation or lateral deviation from the midline.
Blume 2001
Dystonic: Sustained contractions of both agonist and antagonist muscles producing athetoid or twisting movements, which, when prolonged, may produce abnormal postures.
Blume 2001
Postural: Adoption of a posture that may be bilaterally symmetric or asymmetric (as in a “fencing posture”).
Blume 2001
Tonic: A sustained increase in muscle contraction lasting a few seconds to minutes.
Blume 2001
Negative Myoclonic: Interruption of tonic muscular activity for <500 ms without evidence of preceding myoclonia.
Blume 2001
Noun: Traditional term indicating spread of clonic movements through contiguous body parts unilaterally.
Blume 2001
Clonic: Myoclonus that is regularly repetitive, involves the same muscle groups, at a frequency of ∼2–3 c/s, and is prolonged. Synonym: rhythmic myoclonus.
Blume 2001
Myoclonic
Myoclonic (adjective); Myoclonic (noun)
Sudden, brief (<100 ms) involuntary single or multiple contraction(s) of muscles(s) or muscle groups of variable topography (axial, proximal limb, distal).
Blume 2001
Generalized Tonic-Clonic Seizure
(syn. bilateral tonic–clonic seizure) (Formerly “Grand Mal” Seizure)
Noun: Bilateral symmetric tonic contraction and then bilateral clonic contractions of somatic muscles, usually associated with autonomic phenomena.
Blume 2001
Tonic Clonic: A sequence consisting of a tonic followed by a clonic phase. Variants such as clonic–tonic–clonic may be seen.
Blume 2001
Atonic: Sudden loss or diminution of muscle tone without apparent preceding myoclonic or tonic event lasting ~1 to 2 s, involving head, trunk, jaw, or limb musculature.
Blume 2001
Astatic: Loss of erect posture that results from an atonic, myoclonic, or tonic mechanism. Synonym: drop attack.
Blume 2001
Synchronous (Asynchronous): Motor events occurring (not) at the same time or at the same rate in sets of body parts.
Blume 2001
Elementary Motor: A single type of contraction of a muscle or group of muscles that is usually stereotyped and not decomposable into phases. (However, see tonic–clonic, an elementary motor sequence).
Blume 2001
Oroalimentary: Lip smacking, lip pursing, chewing, licking, tooth grinding, or swallowing.
Blume 2001
Mimetic: Facial expression suggesting an emotional state, often fear.
Blume 2001
Manual or Pedal:
1. Indicates principally distal components, bilateral or unilateral.
2. Fumbling, tapping, manipulating movements.
Blume 2001
Gestural: Often unilateral. Fumbling or exploratory movements with the hand, directed toward self or environment. Movements resembling those intended to lend further emotional tone to speech.
Blume 2001
Hyperkinetic: Involves predominantly proximal limb or axial muscles producing irregular sequential ballistic movements, such as pedaling, pelvic thrusting, thrashing, rocking movements. Increase in rate of ongoing movements or inappropriately rapid performance of a movement.
Blume 2001
Hypokinetic: A decrease in amplitude and/or rate or arrest of ongoing motor activity.
Blume 2001
Dysphasic: Impaired communication involving language without dysfunction of relevant primary motor or sensory pathways, manifested as impaired comprehension, anomia, paraphasic errors, or a combination of these.
Blume 2001
Dyspraxic: Inability to perform learned movements spontaneously or on command or imitation despite intact relevant motor and sensory systems and adequate comprehension and cooperation.
Blume 2001
Gelastic: Bursts of laughter or giggling, usually without an appropriate affective tone.
Blume 2001
Dacrystic: Bursts of crying.
Blume 2001
Vocal: Single or repetitive utterances consisting of sounds such as grunts or shrieks.
Blume 2001
Verbal: Single or repetitive utterances consisting of words, phrases, or brief sentences.
Blume 2001
Spontaneous: Stereotyped, involve only self, virtually independent of environmental influences.
Blume 2001
Interactive: Not stereotyped, involve more than self, environmentally influenced.
Blume 2001
AUTOMATISM
Noun: A more or less coordinated, repetitive, motor activity usually occurring when cognition is impaired and for which the subject is usually amnesic afterward. This often resembles a voluntary movement and may consist of an inappropriate continuation of ongoing preictal motor activity. The following adjectives are usually employed to modify “automatism.”
Blume 2001
Blume 2001
Aura: Noun: A subjective ictal phenomenon that, in a given patient, may precede an observable seizure; if alone, constitutes a sensory seizure.
Blume 2001
Somatosensory: Tingling, numbness, electric-shock sensation, pain, sense of movement, or desire to move.
Blume 2001
Visual: Flashing or flickering lights, spots, simple patterns, scotomata, or amaurosis.
Blume 2001
Auditory: Buzzing, drumming sounds or single tones.
Blume 2001
Olfactory: Odor, usually disagreeable.
Blume 2001
Gustatory: Taste sensations including acidic, bitter, salty, sweet, or metallic.
Blume 2001
Epigastric: Abdominal discomfort including nausea, emptiness, tightness, churning, butterflies, malaise, pain, and hunger; sensation may rise to chest or throat. Some phenomena may reflect ictal autonomic dysfunction.
Blume 2001
Cephalic: Sensation in the head such as light-headedness, tingling or headache.
Blume 2001
Autonomic: A sensation consistent with involvement of the autonomic nervous system, including cardiovascular, gastrointestinal, sudomotor, vasomotor, and thermoregulatory functions. (Thus “autonomic aura”; cf. “autonomic events” 3.0).
Blume 2001
Elementary: A single, unformed phenomenon involving one primary sensory modality (e.g., somatosensory, visual, auditory, olfactory, gustatory, epigastric, or cephalic).
Blume 2001
Affective: Components include fear, depression, joy, and (rarely) anger.
Blume 2001
Mnemonic: Components that reflect ictal dysmnesia such as feelings of familiarity (de ́ja`-vu) and unfamiliarity (jamaisvu).
Blume 2001
Hallucinatory: A creation of composite perceptions without corresponding external stimuli involving visual, auditory, somatosensory, olfactory, and/or gustatory phenomena. Example: “hearing” and “seeing” people talking.
Blume 2001
Illusory: An alteration of actual percepts involving the visual, auditory, somatosensory, olfactory, or gustatory systems.
Blume 2001
Experiential: Affective, mnemonic, or composite perceptual phenomena including illusory or composite hallucinatory events; these may appear alone or in combination. Included are feelings of depersonalization. These phenomena have subjective qualities similar to those experienced in life but are recognized by the subject as occurring outside of actual context.
Blume 2001
Sensory: A perceptual experience not caused by appropriate stimuli in the external world. Modifies “seizure” or “aura.”
Blume 2001
Dyscognitive
The term describes events in which
(1) disturbance of cognition is the predominant or most apparent feature, and
(2a) two or more of the following components are involved, or
(2b) involvement of such components remains undetermined.
Otherwise, use the more specific term (e.g., “mnemonic experiential seizure” or “hallucinatory experiential seizure”).
Components of cognition:
Perception: symbolic conception of sensory information
Attention: appropriate selection of a principal perception or task
Emotion: appropriate affective significance of a perception
Memory: ability to store and retrieve percepts or concepts
Executive function: anticipation, selection, monitoring of consequences, and initiation of motor activity including praxis, speech
Blume 2001
Blume 2001
Autonomic Aura: A sensation consistent with involvement of the autonomic nervous system, including cardiovascular, gastrointestinal, sudomotor, vasomotor, and thermoregulatory functions (see 2.2.1.8).
Blume 2001
Autonomic Seizure: An objectively documented and distinct alteration of autonomic nervous system function involving cardiovascular, pupillary, gastrointestinal, sudomotor, vasomotor, and thermoregularity functions.
Blume 2001
Somatotropic Modifiers
Blume 2001
Hemi: A prefix to other descriptors (e.g., hemiclonic).
Blume 2001
Unilateral: Exclusive or virtually exclusive involvement of one side as a motor, sensory, or autonomic phenomenon.
Blume 2001
Asymmetrical: Clear distinction in quantity and/or distribution of behavior on the two sides.
Blume 2001
Symmetrical: Virtual bilateral equality in these respects.
4.1.2 Blume 2001
Generalized: More than minimal involvement of each side as a motor, elementary sensory, or autonomic phenomenon. Motor component can be further modified as asymmetrical and symmetrical.
4.1.2 Blume 2001
Generalized: More than minimal involvement of each side as a motor, elementary sensory, or autonomic phenomenon. Motor component can be further modified as asymmetrical and symmetrical.
Blume 2001
Laterality
Blume 2001
Body Part: Refers to area involved (i.e., arm, leg, face, trunk, and other).
Blume 2001
Axial: Involves trunk, including neck.
Blume 2001
Proximal Limb: Signifies involvement from shoulders to wrist, hip to ankle.
Blume 2001
Distal Limb: Indicates involvement of fingers, hands, toes, and/or feet.
Blume 2001
Centricity: Modifier describes proximity to the body axis.
Blume 2001
The following terms are listed in the form (adjective, noun, verb) according to principal usage; as adjective unless specified.
Blume 2001
Irregular: inconsistent or unpredictable, chaotic intervals between such events.
Blume 2001
Regular: Consistentor predictable intervals between such events.
How to incorporate this?
Blume 2001
Cluster
1. Noun: Incidence of seizures within a given period (usually one or a few days) that exceeds the average incidence over a longer period for the patient.
2. Verb: To vary in incidence as above.
Is this a seizure itself?
Blume 2001
Reactive: Occurring in association with transient systemic perturbation such as intercurrent illness, sleep loss, or emotional stress.
Blume 2001
Reflex: Objectively and consistently demonstrated to be evoked by a specific afferent stimulus or by activity of the patient. Afferent stimuli can be elementary [i.e., unstructured (light flashes, startle, a monotone)] or elaborate [i.e., structured, (a symphony)]. Activity may be elementary [e.g., motor (a movement)]; or elaborate [e.g., cognitive function (reading, chess playing)], or both (reading aloud).
Is this the same as Activation Factors?
Blume 2001
Provocative Factor
Noun: Transient and sporadic endogenous or exogenous element capable of augmenting seizure incidence in persons with chronic epilepsy and evoking seizures in susceptible individuals without epilepsy.
Is this Frequency of Seizure or Occurrence of Seizure?
Blume 2001
Incidence: Noun: Refers to the number of epileptic seizures within a time period or the number of seizure days per unit of time.
Is this in activaiton factors also?
Blume 2001
State Dependent: Occurring exclusively or primarily in the various stages of drowsiness, sleep, or arousal.
Activation factor?
Blume 2001
Catamenial: Seizures occurring principally or exclusively in any one phase of the menstrual cycle.
Blume 2001
Duration: Time between the beginning of initial seizure manifestations, such as the aura, and the cessation of experienced or observed seizure activity. Does not include nonspecific seizure premonitions or postictal states.
Blume 2001
Status Epilepticus: A seizure that shows no clinical signs of arresting after a duration encompassing the great majority of seizures of that type in most patients or recurrent seizures without interictal resumption of baseline central nervous system function.
Blume 2001
Severity: A multicomponent assessment of a seizure by observers and the patient.
Components primarily of observer assessment include duration, extent of motor involvement, impairment of cognitive interaction with environment intra-ictally, maximal number of seizures per unit of time.
Components primarily of patient assessment: extent of injury; emotional, social, and vocational consequences of the attack.
What to do about this?
Blume 2001
Prodrome: A preictal phenomenon. A subjective or objective clinical alteration (e.g., ill-localized sensation or agitation) that heralds the onset of an epileptic seizure but does not form part of it.
Blume 2001
Postictal Phenomenon: A transient clinical abnormality of central nervous system function that appears or becomes accentuated when clinical signs of the ictus have ended.
Blume 2001
Lateralizing: Any unilateral postictal dysfunction relating to motor, language, sensory, and/or integrative functions including visual, auditory, or somatosensory neglect phenomena.
Blume 2001
Anterograde Amnesia: Impaired ability to remember new material.
Blume 2001
Retrograde Amnesia: Impaired ability to recall previously remembered material.
Blume 2001
Impaired Cognition: Decreased cognitive performance involving one or more of perception, attention, emotion, memory, execution, praxis, speech (cf., Dyscognitive, 2.3).
Blume 2001
Psychosis: Misinterpretation of external world in an awake, alert person; involves thought disorder of emotion and socialization.
Blume 2001
Non-Lateralizing Phenomenon: Impaired cognition, amnesia, psychosis.
Blume 2001
These are descriptors of seizures unless specified otherwise.
Engel 2006
Axis 1: Ictal phenomenology—from the Glossary of Descriptive Ictal Terminology, can be used to describe ictal events with any degree of detail needed.
Axis 1 of the diagnostic scheme involves a detailed description of ictal phenomenology utilizing a glossary of descriptive ictal terminology (Blume et al., 2001). This can be extremely valuable for older patients with focal epilepsy who are being evaluated for surgical resection, but is not likely to be necessary in infants and young children, so it is optional.
Blume 2001
INTRODUCTION
This glossary intends to provide a standard terminology for health care workers to communicate what is observed and what a patient reports during a seizure. As this terminology is descriptive and phenomenologic, its use would not imply or require knowledge of ictal pathophysiology, any pathological substrate, or etiology.
Many terms are adjectives modifying “seizure,” which itself is defined under “general terms.” This pertains to seizures with single or multiple components.
Terms in this glossary (e.g., “seizure,” “ictus,” which have widespread applicability in other fields of clinical neuroscience) are herein defined according to their references to epilepsy.
Some terms of this glossary are “fundamental” (i.e., they encompass other more precise words). These can be used as the sole descriptor when data to characterize a phenomenon more precisely are not available. Such include aura, automatism, experiential, motor, and sensory.
A seizure will often consist of two or more phenomena occurring simultaneously or sequentially and should be described accordingly.
Quantitative terms, such as duration of motor events, are not intended as immutable confines, but as clarifying guides to describe clinically observed events.
Scientific progress dictates an evolution of terms to retain their relevance. However, needs of communication in everyday life require that changes be gradual and evolutionary rather than abrupt and revolutionary. The use of synonyms in this glossary reflects incidents in which gradual changes are likely.
Terminology in some areas remains unresolved. Therefore we view this glossary as a dynamic process for which feedback will be welcomed.
PRINCIPLES FOR TERMS AND DEFINITIONS
In developing the “lexique” of this report, we adopted and applied the following principles.
Terms and definitions should
1. Contain features that distinguish or modify seizure entities.
2. Be descriptive of the phenomena involved.
3. Comply with terminology of clinical neuroscience.
4. Use current terminology and definitions wherever
possible.
5. Contain new terms only if necessary.
6. Be easily translatable to other languages.
7. Be readily understood and used by potential users.
Blume 2001
Semiology: That branch of linguistics concerned with signs and symptoms.
Blume 2001
Epileptic seizure: Manifestation(s) of epileptic (excessive and/or hypersynchronous), usually self-limited activity of neurons in the brain.
Blume 2001
Ictus: A sudden neurologic occurrence such as a stroke or an epileptic seizure
Blume 2001
Epilepsy
a) Epileptic Disorder: A chronic neurologic condition characterized by recurrent epileptic seizures.
b) Epilepsies: Those conditions involving chronic recurrent epileptic seizures that can be considered epileptic disorders.
Blume 2001
Epileptic Disorder: A chronic neurologic condition characterized by recurrent epileptic seizures.
Blume 2001
Epilepsies: Those conditions involving chronic recurrent epileptic seizures that can be considered epileptic disorders.
Blume 2001
Focal
(syn. partial)
A seizure whose initial semiology indicates, or is consistent with, initial activation of only part of one cerebral hemisphere.
Blume 2001
I 6.0 Generalized
(syn. bilateral)
A seizure whose initial semiology indicates, or is consistent with, more than minimal involvement of both cerebral hemispheres.
Blume 2001
Convulsion: Primarily a lay term. Episodes of excessive, abnormal muscle contractions, usually bilateral, which may be sustained or interrupted.
Luders 1998
Somatotopic area involved. For seizures involving a distinct somatotopic region, the somatotopic area is specified by simply naming the region itself. These terms can be applied to all seizures marked with superscript a in Table 1. Examples:
Left hand clonic seizure
Throat somatosensory aura
Left foot tonic seizure
Blume 2001
Body Part: Refers to area involved (i.e., arm, leg, face, trunk, and other).
Bancaud 1981
Boborygmi
JB: Both
JB: Both
Bancaud 1981
Hemispheric Involvement
Blume 2001
Body Part: Refers to area involved (i.e., arm, leg, face, trunk, and other).
Trancred 2005
The Brainstem, which consists of the medulla, pons and midbrain is an important control centre for functions such as respiration, arterial pressure, heart rate and the maintenance of equilibrium. It also contains ascending and descending tracts as well as
Structures:
Medulla
Midbrain
Pons
Information:
The brainstem consists of the medulla oblongata, the pons and the midbrain. For further details see individual cards for medulla, pons and midbrain.
2014 Fischer
Some persons might have had a definitive treatment, such as brain surgery, rendering them permanently seizure-free.
Bancaud 1981
Brief
Tancred 2005
Broca's motor speech area is essential for normal speech in that it coordinates the activity of muscles associated with the production of speech.
Tancred 2005
The primary somatosensory area occupies Brodmann's areas 1, 2 and 3
Tancred 2005
The primary visual area occupies area 17
Tancred 2005
The primary somatosensory area occupies Brodmann's areas 1, 2 and 3
Tancred 2005
The primary somatosensory area occupies Brodmann's areas 1, 2 and 3
Tancred 2005
The primary motor area occupies area 4
Tancred 2005
The primary auditory area occupies area 41
Tancred 2005
The motor speech (Broca's) area occupies areas 44 and 45.
Tancred 2005
The motor speech (Broca's) area occupies areas 44 and 45.
Tancred 2005
The premotor area occupies area 6
JB: Oh, what I mean is under the list of provocative factors, there are multiple factors for seizures like alcohol or sleep deprivation or fever
Noachter 1999
Burst: A group of waves which appear and disappear abruptly and are distinguished from background activity by differences in frequency, form and/or amplitude.
Comments:
(1) term does not imply abnormality.
(2) Not a synonym of paroxysm (see paroxysm).
Noachter 1999
Burst suppression: Pattern characterized by bursts of theta and/or delta waves, at times intermixed with faster waves, and intervening periods of low amplitude (below 20 uV).
Comment: EEG pattern that indicates either severe brain dysfunction or is typical for some anesthetic drugs at certain levels of anesthesia.
Blume 2001
Epigastric: Abdominal discomfort including nausea, emptiness, tightness, churning, butterflies, malaise, pain, and hunger; sensation may rise to chest or throat. Some phenomena may reflect ictal autonomic dysfunction.
Bancaud 1981
Buzzing
Blume 2001
Auditory: Buzzing, drumming sounds or single tones.
Trancred 2005
The walls of the calcarine sulcus contain the primary visual cortex, which is essential for the conscious perception of visual stimuli.
Structures:
Brodmann's Areas
Cuneus
Occipital Lobe
Parieto-occipital Sulcus
Primary Visual Area
Information:
The Calcarine Sulcus is a deep sulcus on the medial surface of the occipital lobe, between the cuneus above and the lingual gyrus below. Anteriorly it joins the parieto-occipital sulcus.
The primary visual area, which corresponds to Brodmann's area 17, is located in the walls of the calcarine sulcus.
Engel 2001
Disorders of Carbohydrate Metabolism
ILAE 1981
Cyclic Attack
Blume 2001
Catamenial: Seizures occurring principally or exclusively in any one phase of the menstrual cycle.
Engel 2001
Cavernous Angiomas
Structural brain lesions, such as malformations of cortical development, may elevate risk of seizures long term. Seizures may recur at variable intervals after remission due to removal of an epileptogenic lesion, such as a cavernous malformation.
Engel 2001
Celiac disease
(Epilepsy With Occipital Calcifications And Celiac Disease)
Blume 2001
Centricity: Modifier describes proximity to the body axis.
Tancred 2005
The central sulcus is an important landmark on the surface of the cerebrum because it divides the forntal from the parietal lobes. it also separates the primary motor and somatosensory areas of the cortex.
Structures:
Cerebral Hemisphere
Frontal Lobe
Parietal Lobe
Postcentral Gyrus
Precentral Gyrus
Primary Motor Area
Primary Somatosensory Area
Information:
The Central Sulcus is a prominent groove about 2 cm deep, which extends coronally across the lateral surface of the cerebral hemisphere. It is located between the precentral gyrus (primary motor area) and postcentral gyrus (primary somatosensory area) and is the boundary between the frontal and parietal lobes.
Blume 2001
Cephalic: Sensation in the head such as light-headedness, tingling or headache.
JB: Historical and demonstrate on Physical Examination
Trancred 2005
The Cerebellum has several functions including the maintenance of balance and posture, the maintenance of correct muscle tone, and the planning and coordination of sequential movements.
Structures:
Anterior Lobe
Brainstem
Cerebellar Cortex
Cerebellar Hemisphere
Cerebellar White Centre
Cerebellum - Connections
Cerebellum - Gross
Dentate Nucleus
Fastigial Nucleus
Flocculonodular Lobe
Hindbrain
Horizontal Fissure
Inferior Cerebellar Peduncle
Interposed Nucleus
Midbrain
Middle Cerebellar Peduncle
Paravermal Zone
Pons
Posterior Lobe
Posterolateral Fissure
Primary Fissure
Superior Cerebellar Peduncle
Vermis
Information:
The cerebellum (meaning small cerebrum in latin) is the largest component of the hindbrain and occupies the posterior cranial fossa, dorsal to the brainstem. The superior, middle and inferior cerebellar peduncles attach the cerebellum to the midbrain, pons and medulla respectively.
It is formed by:
(1) an outer cortex, which is very extensive and forms deep transverse folds called folia
(2) a medullary (cerebellar) white centre and
(3) four pairs of deep nuclei, which are embedded in the medullary centre. The largest and most lateral is the dentate nucleus, the fastigial nucleus is most medial. Between these lie the globose and emboliform nuclei which are collectively referred to as the interposed nucleus.
The cerebellum consists of the anterior, posterior and flocculonodular lobes. The anterior lobe is separated from the posterior lobe by the primary fissure. The posterior lobe is separated from the flocculonodular lobe by the posterolateral fissure.
The cerebellum can also be subdivided into 3 longitudinal zones which cut across the lobes - 2 cerebellar hemispheres separated from each other by a midline region known as the vermis. Each hemisphere can be further subdivided on the basis of connections into paravermal and lateral zones.
The cerebellum is important in the maintenance of equilibrium as well as having an important role in postural control and motor coordination. It receives a variety of inputs form the cerebral cortex, brainstem, vestibular part of the inner ear and spinal cord and, on the basis of this information provides for synchronisation of muscle activity, ensuring that the proper muscles contract at the appropriate time, in the correct sequence and with the correct amount of force. Cerebellar damage thus manifests itself by disturbances in balance and equilibrium as well as lack of motor coordination (but without voluntary paresis).
For further details consult the following cards:
cerebellum - connections
cerebellar cortex
Engel 2001
Cerebral calcifications and other lesions
Fischer 2014
if a treating physician is aware that the lesion has generated an enduring predisposition for unprovoked seizures with a risk comparable to those who have had two unprovoked seizures (which we all agree is epilepsy), then that person too should be considered to have epilepsy
ILAE 1989
The juvenile form of ceroid-lipofuscinosis (Spiel-meyer-Vogt-Sjogren disease) is characterized by onset between the ages of 6 and 8 years, a decrease in visual acuity, slowing of psychomotor development, and appearance of cerebellar and extrapyramidal signs. After 1 4 years, GTCS and fragmentary, segmental, and massive myoclonus occur. The EEG shows bursts of slow waves and slow spikes and waves.
ILAE 1989
Kuf’s disease (adult ceroid lipofuscinosis) is a relatively slow, progressive storage disease with frequent generalized seizures that may be very intractable. Unlike juvenile storage disease, the optic fundi may be normal. The main characteristic is an extreme photic sensitivity on slow photic stimulation.
ILAE 1989
Another type of metabolic error is early infantile type of ceroid-lipofuscinosis (Santuavori Haltia Hagberg disease). Massive myoclonus begins between the ages of 5 and 18 months, with a highly suggestive EEG pattern of vanishing EEG.
Engel 2001
Ceroid lipofuscinosis
Engel 2001
Drug or other chemically induced seizures
ILAE 1989
Cherry Red Spot Myoclonus Syndrome
The clinical picture for the cherry red spot myoclonus syndrome (sialidosis with isolated deficit in neuraminidase) is very similar to that of the Ramsay-Hunt syndrome, with myoclonus, photosensitivity, and cerebellar syndrome. Other characteristics include the nearly constant existence of amblyopia and presence of a cherry red spot on fundoscopic examination. The EEG is similar to that of DCM with the following specific features: The polyspike-wave discharges always correspond to a massive myoclonus and there is no photosensitivity
Bancaud 1981
Chewing
Bancaud 1981
Childhood
Blume 2001
Berg 2010
Associated words:
Pyknolepsy
Typical absence epilepsy
Petit Mal
Typical spike-wave
Generalized spike wave
3Hz spike wave
Ethosuximide
ILAE 1989
Childhood Absence Epilepsy
Pyknolepsy occurs in children of school age (peak manifestation age 6-7 years), with a strong genetic predisposition in otherwise normal children. It appears more frequently in girls than in boys. It is characterized by very frequent (several to many per day) absences. The EEG reveals bilateral, synchronous symmetrical spike-waves, usually 3 Hz, on a normal background activity. During adolescence, GTCS often develop. Otherwise, absences may remit or, more rarely, persist as the only seizure type.
Engel 2001
Childhood Absence Epilepsy
ILAE 2010
Childhood Absence Epilepsy
ILAE 1989
Childhood Epilepsy with Occipital Paroxysms
The syndrome of childhood epilepsy with occipital paroxysms is, in general respects, similar to that of benign childhood epilepsy with centrotemporal spikes. The seizures start with visual symptoms (amaurosis, phosphenes, illusions, or hallucinations) and are often followed by a hemiclonic seizure or automatisms. In 25% of cases, the seizures are immediately followed by migrainous headache. The EEG has paroxysms of high-amplitude spike-waves or sharp waves recurring rhythmically on the occipital and posterior temporal areas of one or both hemispheres, but only when the eyes are closed. During seizures, the occipital discharge may spread to the central or temporal region. At present, no definite statement on prognosis is possible.
Engel 2001
Chromosomal Abnormalities
Chronic Disease Course: A disease course that
(a) does not terminate in a return to normal homeostasis and
(b) would, absent intervention, fall within an abnormal homeostatic range.
Examples: acquired deafness; intermittent seizures in a person suffering from epilepsy.
Bancaud 1981
When focal motor seizure activity is continuous it is known as epilepsia partialis continua
ILAE 1989
Chronic Progressive Epilepsia Partialis Continua of Childhood (Kojewnikow's Syndrome)
Blume 2001
Epigastric: Abdominal discomfort including nausea, emptiness, tightness, churning, butterflies, malaise, pain, and hunger; sensation may rise to chest or throat. Some phenomena may reflect ictal autonomic dysfunction.
Trancred 2005
The Cingulate Gyrus is part of the limbic area of the Cerebral Cortex, which functions in the control of innate behaviours (ie. Those related to the survival of the species). Bilateral ablation of the cingulate gyri in animals causes them to become more
Structures:
Anterior Nucleus
Callosal Sulcus
Cerebral Hemisphere
Cingulate Sulcus
Cingulum
Circuit of Papez
Corpus Callosum
Entorhinal Cortex
Limbic System
Parahippocampal Gyrus
Information:
The Cingulate Gyrus is located on the medial surface of the cerebral hemisphere, adjacent to the corpus callosum. It begins under the genu of the corpus callosum and then curves around its dorsal surface and ends just beneath the splenium of the corpus callosum. It is separated from the corpus callosum by the callosal sulcus and its dorsal surface is bounded by the cingulate sulcus.
As part of the Circuit of Papez, the cingulate gyrus receives a major input from the anterior nucleus of the thalamus and from wide areas of the neocortex and in turn projects via the cingulum to the entorhinal cortex of the parahippocampal gyrus.
ILAE 1989
Cingulate. Cingulate seizure patterns are complex partial with complex motor gestural automatisms at onset. Autonomic signs are common, as are changes in mood and affect.
ILAE 1989
Diurnal Cycling
ILAE 1989
The classical phenylketonuria can express itself as a West syndrome. A variant of phenylketonuria with biopterins deficiency causes seizures starting in the second 6 months of life in infants who have been hypotonic since birth. The seizures are generalized motor seizures associated with erratic myoclonic jerks and oculogyric seizures.
The section of all previous epilepsy classification systems
Bancaud 1981
Clinic
ILAE 1989
Clinical characteristics
Scheuermann 2009
Finding: Objective evidence of disease perceptible to the examining
physician (sign) and subjective evidence of disease perceived
by the patient (symptom).
Manifestation of a Disease: A bodily feature of a patient that is
(a) a deviation from clinical normality that exists in virtue of the realization of a disease and
(b) is observable.
Observability includes observable through elicitation of response or through the use of special instruments.
Preclinical Manifestation of a Disease: A manifestation of a disease that exists prior to its
becoming detectable in a clinical history taking or physical examination.
Clinical Manifestation of a Disease: A manifestation of a disease that is detectable in a
clinical history taking or physical examination.
Phenotype =def. – A bodily feature or combination of bodily features of an organism determined by the interaction of the genetic make-up of the organism
and its environment.
Clinical Phenotype =def. – A clinically abnormal phenotype.
Disease Phenotype =def. – A clinically abnormal phenotype that is characteristic of a single disease. A disease phenotype can exist without being observed. Indeed, as technology advances, our ability to detect the underlying components of a disease phenotype will
expand. The full disease phenotype would incorporate the abnormal phenotypes realized at each stage in the development of the disease. As with ‘disorder’ we can also distinguish a less and a more inclusive reading of ‘disease phenotype’. Under the former, a disease phenotype may be a a single type of abnormality characteristic of a given disease; under the latter a disease phenotype is a maximal combination of such single phenotypes, ordered in a temporal sequence characteristic of one or more typical courses for the given disease.
Clinical Picture =def. – A representation of a clinical phenotype that is inferred from the
combination of laboratory, image and clinical findings about a given patient.
Diagnosis =def. – A conclusion of an interpretive process that has as input a clinical picture of a given patient and as output an assertion (diagnostic statement) to the effect that the patient has a disease of such and such a type. A diagnosis is a continuant entity that, once made, will survive through time, and is often supplanted by further diagnoses. The diagnostic process is thus iterative: the clinician is forming hypotheses during history taking, testing these during physical exam, forming new hypotheses as a result, and so on.
As a result of an etiological process, a physical change occurs in the healthy individual giving rise to a disorder whose realizations, which are initially undetectable (preclinical
manifestation), and then become detectable as symptoms and signs (clinical manifestations). The latter constitute in their totality the phenotype for the given disease as instantiated in this specific patient.
They can be observed through physical examination and laboratory testing of specimens derived from the patient, the results of which can be recorded in the medical record as a clinical picture. The clinical picture is interpreted by the physician in arriving at a diagnosis, which serves in turn as the foundation for the development of a patient management plan.
Berg 2010
Clinical Characteristics
Luders 1998
Noachter 1999
Last seizure
Engel 2001
Axis 1 consists of a description of the ictal semiology, using a standardized Glossary of Descriptive Terminology. The description of the ictal event, without reference to etiology, anatomy, or mechanisms, can be very brief or extremely detailed, as required for clinical or research purposes. Although detailed descriptions of the onset and evolution of localized ictal phenomena often are not necessary, they can be useful; for instance, in patients who are candidates for surgical treatment, or for research designed to elucidate the anatomic substrates or pathophysiologic mechanisms underlying specific clinical behaviors. Communication among clinicians, and among researchers, will be greatly enhanced by the establishment of standardized terminology for describing ictal semiology.
Engel 2006
Axis 1: Ictal phenomenology—from the Glossary of Descriptive Ictal Terminology, can be used to describe ictal events with any degree of detail needed.
Axis 1 of the diagnostic scheme involves a detailed description of ictal phenomenology utilizing a glossary of descriptive ictal terminology (Blume et al., 2001). This can be extremely valuable for older patients with focal epilepsy who are being evaluated for surgical resection, but is not likely to be necessary in infants and young children, so it is optional.
Scheuermann 2009
Clinical History: A series of statements representing health-relevant features of a patient.
The term ‘clinical history’ is also sometimes used to refer to the collection of disease courses in a given patient. Even a patient who never went to the doctor may have a clinical history on this reading.
Noachter 1999
Clipping: Distortion of EEG waves which makes them appear flat-topped in the write-out or display. Caused by overload.
Blume is inconsistent
Myoclonic contractions
0.2-5Hz
Muscle contractions
Bancaud 1981
Clonic Seizures
Absence with mild clonic components
Repetitive clonic jerks
As frequency diminishes, amplitude of jerks do not
postictal phase is usually short
Luders 1998
Simple, unnatural movements
Like Broadman 4&6 stimulation
Blume 2001
1.1.2.2 Clonic: Myoclonus that is regularly repetitive, involves the same muscle groups, at a frequency of ~2-3 c/s, and is prolonged. Synonym: rhythmic myoclonus
2003 Blume Clonic limb jerks
Location: Left/right/axial/generalized/bilateral asymmetric
Bancaud 1981
Generalized convuisive seizures occasionally lack a tonic component and are characterized by repetitive clonic jerks. As the frequency diminishes the amplitude of the jerks do not. The postictal phase is usually short. Some generalized convulsive seizures commence with a clonic phase passing into a tonic phase, as described below, leading to a “clonic-tonic-clonic” seizure.
Clonic Seizures
Absence with mild clonic components
Repetitive clonic jerks
As frequency diminishes, amplitude of jerks do not
postictal phase is usually short
EEG Seizure Type
Fast activity (10 c/sec or more) and slow waves; occasional spike-and-wave patterns.
EEG Interictal Expression
Spike-and-wave or polyspike-and-wave discharges
Luders 1998
Clonic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Simple, unnatural movements
Like Broadman 4&6 stimulation
Blume 2001
1.1.2 Myoclonic (adjective/noun): Sudden, brief (<100 ms) involuntary single or multiple contraction(s) of muscle(s) or muscle groups of variable topography (axial, proximal limb, distal).
1.1.2.2 Clonic: Myoclonus that is regularly repetitive, involves the same muscle groups, at a frequency of ~2-3 c/s, and is prolonged. Synonym: rhythmic myoclonus
Engel 2001
Clonic Seizures
W/o and W/ tonic features
Elementary clonic motor signs
Hemi-clonic seizure
Berg 2010
Clonic
Luders 1998
Clonic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Clonic seizures are a series of myoclonic contractions that regularly recur at a rate of 0.2-5/s.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Engel 2001
Clonic Status Epilepticus
Not clinically relevant
Bancaud 1981
Eyes are closed
Blume 2001
Cluster
1. Noun: Incidence of seizures within a given period (usually one or a few days) that exceeds the average incidence over a longer period for the patient.
2. Verb: To vary in incidence as above.
Blume 2001
Cluster
1. Noun: Incidence of seizures within a given period (usually one or a few days) that exceeds the average incidence over a longer period for the patient.
2. Verb: To vary in incidence as above.
Fischer 2014
Co-Morbidity
Engel 2001
Coffin-Lowry syndrome
Cognition piece should be is a or part of?
Blume 2001
Dyscognitive
The term describes events in which
(1) disturbance of cognition is the predominant or most apparent feature, and
(2a) two or more of the following components are involved, or
(2b) involvement of such components remains undetermined.
Otherwise, use the more specific term (e.g., “mnemonic experiential seizure” or “hallucinatory experiential seizure”).
Components of cognition:
Perception: symbolic conception of sensory information
Attention: appropriate selection of a principal perception or task
Emotion: appropriate affective significance of a perception
Memory: ability to store and retrieve percepts or concepts
Executive function: anticipation, selection, monitoring of consequences, and initiation of motor activity including praxis, speech
2014 Fischer
A study of 347 children achieving at least 5-year “complete remission” including at least 5-years free of antiseizure drugs identified late seizure relapses in 6%. One occurred as long as 8 years after the prior seizure. Data were not given for those remaining free of seizures after a 10-year complete remission, but the number would be <6%. After temporal lobe epilepsy surgery,23 54.2% of patients relapse within 6 months; whereas, only 1.9% relapse 4 years after surgery.
Similar results were seen in another study,24 with only 0.6% having seizures in the last year of follow-up, provided that they had been seizure-free for 3 years after surgery.
The definition of the complex febrile seizure is A seizure lasting 15 minutes or longer, multiple seizures within 24 hours. Unilateral focal any of those things would then classify someone as having a complex febrile seizure and why is that important because there’s an epidemiology that relates to of these group of children, as opposed to the ones that don’t have these factors, how many of them would go on to have epilepsy, how many of them will go on to have recurrence of their seizures. So, it is an epidemiologically important and defined.
Luders 1998
Complex Motor Seizure
Location: Left Hemisphere/Right Hemisphere
Complex refers to complex characteristics of the movement
Complex, natural movement but inappropriate for the situation
Not loss of awareness during seizure
Blume 2001
1.2 Automatism
Noun: A more or less coordinated, repetitive, motor activity usually occurring when cognition is impaired and for which the subject is usually amnestic afterward. This often resembles a voluntary movement and may consist of an inappropriate continuation of ongoing preictal motor activity.
The following adjectives are usually employed to modify "automatism."
1.2.1 Oroalimentary: Lip smacking, lip pursing, chewing, licking, tooth grinding, or swallowing.
1.2.2 Mimetic: Facial expression suggesting an emotional state, often fear.
1.2.3 Manual or pedal:
1. Indicates principally distal components, bilateral or unilateral
2. Fumbling tapping, manipulating movements.
1.2.4 Gestural:
Often unilateral.
1. Fumbling or exploratory movements with the hand, directed toward self or environment.
2. Movements resembling those intending to lend further emotional tone to speech.
1.2.5 Hyperkinetic:
1. Involves predominantly proximal limb or axial muscles producing irregular sequential ballistic movements, such as pedaling, pelvic thrusting, thrashing, rocking movements.
2. Increase in rate of ongoing movements or inappropriately rapid performance of a movement.
1.2.6 Hypokinetic: A decrease in amplitude and/or rate or arrest of ongoing motor activity.
1.2.7 Dysphasic: Impaired communication involving language without dysfunction of relevant primary motor or sensory pathways, manifested as impaired comprehension, anomia, paraphasic errors, or a combination of these.
1.2.8 Dyspraxic: Inability to perform learned movements spontaneously or on command or imitation despite intact relevant motor and sensory systems and adequate comprehension and cooperation.
1.2.9 Gelastic: Bursts of laughter or giggling, usually without an appropriate affective tone.
1.2.10 Dacrystic: Bursts of crying.
1.2.11 Vocal: Single or repetitive utterances consisting of sounds such as grunts or shrieks
1.2.12 Verbal: Single or repetitive utterances consisting of words, phrases, or brief sentences.
1.2.13 Spontaneous: Stereotyped, involve only self, virtually independent of environmental influences.
1.2.14 Interactive: Not stereotyped, involve more than self, environmentally influenced.
Luders 1998
Complex Motor Seizures
Complex motor seizures, in which the movements are relatively complex and simulate natural movements, except that they are inappropriate for the situation.
“Complex” herein refers to the complex characteristics of the movement and does not mean that the patient loses awareness during the seizure.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Bancaud 1981
Clinical Seizure Type
Consciousness is impaired during the attack.
1. Simple partial onset followed by impariment of consciousness with or without automatism
2. Impairment of sconsciousness at onset with impairment of consciousness only or with or without automatisms.
EEG Seizure Type
Unilateral or, frequently bilateral discharge, diffuse or focal in temporal or frontotemporal regions.
EEG Interictal Expression
Unilateral or bilateral generally asynchronous focus; usually in the temporal or frontal regions.
Luders 1998
If it is associated with a focal epileptiform discharge or occurs in a patient with a focal epileptic syndrome (even in the absence of a local epileptiform correlate), it is identified as a complex partial seizure.
Bancaud 1981
With more eleborate seizures involving visual or auditory association areas with participation of mobilized memory traces, formed hallucinations occur and these may take the form of scenery, persons, spoken sentences, or music. The character of these percpetions may be normal or distorted.
Noachter 1999
Complex: A sequence of two or more waves having a characteristic form or recurring with a fairly consistent form, distinguished from background activity.
ILAE 1989
Blume 2003
SIGN 2006
Computed Tomography (CT) scan brain imaging may be required for suspected acute symptomatic seizures or in children with focal seizures under the age of three years
Bancaud 1981
Conjunctiva is insensitive
1981 Bancaud, pg 496
Bancaud 1981
Degree of awareness and/or responsiveness of the patient to externally applied stimuli.
Inability to respond normally to exogeneous stimuli by virtue of altered awareness and/or responsiveness
Consciousness preserved.
Scheuermann 2009
Constitutional Genetic Disease: A disease whose physical basis is a constitutional genetic disorder.
Examples: chronic: color blindness, polydactyly; progressive: Down syndrome, Tay-Sachs disease.
Scheuermann 2009
Constitutional Genetic Disorder: A genetic disorder inherited during conception that is borne by all cells in the organism.
Examples: mutation in the hexosaminidase gene leading to Tay-Sachs disease.
Refers to a persistance and a distribution.
Noachter 1999
Continuous Slow Activity: Slow activity that occurs continuously is non-responsive to external stimuli and clearly exceeds the amount considered physiologically normal for the patient's age. As a rule, it is irregular (polymorphic) and lies within the frequency range of delta/theta waves (see intermittent slow activity).
Bancaud 1981
Contralateral
Bancaud 1981
Head turning to one side, usually contraversive to the discharge
Described as a lay term
Syn: Tonic-Clonic, Tonic, or Clonic
A lay term that groups the tonics and/or clonics.
Major Motor: a very old term
Blume 2001
Convulsion: Primarily a lay term. Episodes of excessive, abnormal muscle contractions, usually bilateral, which may be sustained or interrupted.
Engel 2001
Another change in terminology evident in this document is the omission of the words “convulsion” and “convulsive” in the list of epileptic seizure types and epilepsy syndromes. The Task Force thought that these are nonspecific lay terms, and at times improperly used. Consequently it was agreed to be consistent, not only in descriptive ictal terminology, but also in naming epileptic seizure types and syndromes, to avoid these terms. For instance, the Task Force is proposing that the term “febrile convulsions” be replaced by “febrile seizures.”
Trancred 2005
The Corpus Callosum, the largest of the cerebral commissures, allows information to be transmitted from one cerebral hemisphere to the other, enabling memory traces to be stored bilaterally.
Structures:
Cerebral Commissures
Cerebral Hemisphere
Corpus Callosum - Body
Corpus Callosum - Genu
Corpus Callosum - Splenium
Forceps Major
Forceps Minor
Primary Somatosensory Area
Information:
The Corpus Callosum is the largest of the cerebral commissures. It contains approximately 300 million fibres, connecting the cortex of the two cerebral hemispheres. It consists of 4 parts - the splenium (posterior), body, genu (anterior) and rostrum (continous antero-inferiorly with the genu). Fibres from the genu radiate anteriorly into the anterior region of the frontal lobes are known as the forceps minor. Fibres of the splenium, which radiate posteriorly into the occipital lobes are known as the forceps major.
The function of the corpus callosum is to allow for the transfer of information from one hemisphere to another and to enable memory traces to be stored bilaterally. In cases of severe epilepsy the corpus callosum is sometimes severed to limit the extent of seizures, and subsequent behavioural studies in these patients have allowed us to gain some insight into the role of the corpus callosum. While there are no obvious personality, intellectual or motor changes in these 'split-brain' patients, there are some subtle changes particularly in regard to learning. For example, a task learned with one hand cannot then be performed efficiently with the other hand because the memory trace cannot be transferred to the opposite hemisphere. Similarly, an object held in the left hand (but not seen) cannot be described verbally because the somatosensory information cannot be transferred from the primary somatosensory area of the right hemisphere across to the left hemisphere (where the language areas are usually located)
Engel 2001
Malformations due to abnormal cortical developments
Includes eye movement abnormalities
Bancaud 1981
Cry
Trancred 2005
The Cuneus includes the primary visual area for the lower half of the visual (which is essential for the conscious appreciation of visual stimuli) as well as part of the visual association area.
Structures:
Calcarine Sulcus
Cuneus
Lingual Gyrus
Parahippocampal Gyrus
Parieto-occipital Sulcus
Primary Visual Area
Information:
The occipital lobe occupies the posterior part of the cerebral hemisphere.
Boundaries:
On the lateral surface it is located posterior to an imaginary line extending from the parieto-occipital sulcus to the pre-occipital notch. On the medial surface it is bounded posterior to the parieto-occipital fissure and by an imaginary line extending from the splenium of the corpus callosum to the pre-occipital notch.
Sulci and Gyri:
The medial surface of the occipital lobe is divided into two parts by the calcarine sulcus, a deep groove which extends posteriorly from the parieto-occipital fissure to the posterior pole. The cuneus is the wedge-shaped area which lies between the parieto-occipital fissure and the calcarine sulcus. The inferior bank of the calcarine sulcus is formed by the lingual gyrus, a posterior extension of the parahippocampal gyrus of the temporal lobe.
The lateral surface of the occipital lobe is formed by some inconstantly-shaped gyri, which are collectively referred to as the lateral occipital gyri.
Functional Areas:
The occipital lobe contains the primary visual area of the cortex, which is located around the calcarine sulcus. Only a thin strip of the primary visual cortex is visible on the medial surface of the brain (on either side of the calcarine sulcus) because most of it is buried within the depths of the sulcus.
Fischer 2014
Cure
“Cure” implies a risk for future seizures no greater than that of the baseline unaffected population, but after a history of epilepsy such a low risk is never achieved.
Delineation of circumstances in which epilepsy is definitively cured is beyond the scope of this paper.
Bancaud 1981
Cyanosis
Bancaud 1981
Inhibits respiration and cyanosis may occur
Check definition with buchhalter
Noachter 1999
Cycle: The complete sequence of potential changes undergone by individual components of a sequence of regularly repeated EEG waves or complexes.
Engel 2001
Cysticcercosis
ILAE 1989
Metabolism errors in the neonate include nonketotic hyperglycinemia and D-glycericacidemia, showing early myoclonic encephalopathy with erratic myoclonus, partial seizures, and suppression-burst EEG patterns.
Engel 2001
D-Glyceric Acidemia
Blume 2001
Dacrystic: Bursts of crying.
Bancaud 1981
Deep respiration
Bancaud 1981
Deep Sleep
Noachter 1999
Deep Sleep: Non-REM sleep stages 3 and 4 (Rechtschaffen and Kales 1968).
ILAE 1989
Degenerative progressive myoclonic epilepsy (Lundborg type)
The so-called degenerative progressive myoclonic epilepsy (Lundborg type) also falls into this category. The only significant well-individualized group is the Finnish type, described by Koskiniemi et al. (1974). Onset occurs between the ages of 8 and 13 years, with myoclonus (segmental, fragmentary, and massive) and GTCS, associated cerebellar ataxia, and slowly progressive although generally mild mental deterioration. The EEG shows slow abnormalities (theta rhythms and later, delta rhythms), with generalized spike-waves predominantly in the frontal area and photosensitivity. Patients survive >15 years.
Bancaud 1981
A distorted memory experience such as distorted memory experience.
Deja-entendu: a sensation as if a naive auditory experience had been experienced before
Bancaud 1981
A distorted memory experience such as distorted memory experience (deja vu).
Deja Vu: Sensation as if a naive experience had been experienced before.
Noachter 1999
Delta Band: Frequency band under 4 Hz. Greek letter: delta. Comment: for practical purposes lower frequency limit is 0.5 Hz, as DC potential differences are not monitored in conventional EEGs.
0.5-4Hz
Noachter 1999
Delta Brush: Delta wave with superimposed fast activity.
Comment: normal finding in neonatal EEG.
Noachter 1999
Delta Brushes: Rhythmic spindle-like activity (10-25 uV) superimposed on 0.3-1.5 Hz slow waves (25-250 uV) in preterm infants.
Noachter 1999
Rhythm under 4 Hz
Noachter 1999
Delta Wave: Wave with duration over 1/4 s.
>1/4-2s
Engel 2001
Dentatorubropallidoluysian atrophy
Bancaud 1981
Depersonalization
Bancaud 1981
Illusion: These take the form of distorted perceptions in which objects may appear deformed.
Polyoptic illusions such as monocular diplopia, distortions of size (macropsia or micropsia) or of distance may occur. Similarly, distortions of sound, including microacusia and macroacusia, may be experienced. Depersonalization, as if the person were outside his body, may occur. Altered perception of size or weight of a limb may be noted.
Bancaud 1981
Intense Depression
Blume 2001
Somatosensory: Tingling, numbness, electric-shock sensation, pain, sense of movement, or desire to move.
Bancaud 1981
Detachment
2013 Suleiman
Previous terms used to describe similar syndromes include devastating epileptic encephalopathy in schoolaged children (DESC) (Mikaeloff et al., 2006) and acute encephalitis with refractory repetitive partial seizures (AERRPS) (Sakuma, 2009). These conditions are characterized by new-onset refractory focal status epilepticus, preceded by fever or infection in previously normal children, followed by a chronic phase of refractory focal epilepsy and severe neurologic impairment (Sakuma et al., 2010). The cause of these conditions is unknown and underlying immune mechanisms have been proposed (Sakuma et al., 2010; Specchio et al., 2010; Nabbout et al., 2011) but not proven.
ILAE 1989
Intellectual Development
Psychomotor (retardation, development arrest)
Mental Retardation
Precocious Puberty
Berg 2010
Developmental anteceents and consequents
Developmental neurobiology
Suleiman 2013
T1DM is a T cell–mediated autoimmune disorder, and there is an increased prevalence of epilepsy in children with this disease (Schober et al., 2012).
Engel 2006
The intention is that the seizure-type diagnosis will have implications with respect to etiology, approaches to diagnostic evaluation, treatment and prognosis.
Luders 1998
Consciousness Sphere
Ictal episodes in which the main manifestation is an alteration of consciousness independent of EEG
Definition: Episodes of unresponsiveness or decreased responsiveness that are not caused by motor alterations
Location: Left Hemisphere/Right Hemisphere
“Dialeptic” seizures have as their main ictal manifestations an alteration of consciousness that is independent of ictal EEG manifestations. The new term “dialeptic” seizure has been coined to differentiate this concept from absence seizures (dialeptic seizures with a generalized ictal EEG) and complex partial seizures (dialeptic seizures with a focal ictal EEG).
Dialeptic seizures is a new term coined to identify seizures in which the predominant symptomatology consists of an alteration of consciousness (see discussion of terminology above). Alteration of consciousness is difficult to define. However, for the purpose of identifying dialeptic seizures, we classify altered consciousness as does the ILAE classification of epileptic electroclinical complexes, e.g., as episodes of unresponsiveness or decreased responsiveness that are not caused by motor alterations. Dialeptic seizures are associated with complete or at least partial amnesia for the episode; therefore, amnesia of the episode is necessary to establish the diagnosis of dialeptic seizure.
Luders 1998
Dialeptic Seizure
Location: Left Hemisphere/Right Hemisphere
“Dialeptic” seizures have as their main ictal manifestations an alteration of consciousness that is independent of ictal EEG manifestations. The new term “dialeptic” seizure has been coined to differentiate this concept from absence seizures (dialeptic seizures with a generalized ictal EEG) and complex partial seizures (dialeptic seizures with a focal ictal EEG).
Dialeptic seizures is a new term coined to identify seizures in which the predominant symptomatology consists of an alteration of consciousness (see discussion of terminology above). Alteration of consciousness is difficult to define. However, for the purpose of identifying dialeptic seizures, we classify altered consciousness as does the ILAE classification of epileptic electroclinical complexes, e.g., as episodes of unresponsiveness or decreased responsiveness that are not caused by motor alterations. Dialeptic seizures are associated with complete or at least partial amnesia for the episode; therefore, amnesia of the episode is necessary to establish the diagnosis of dialeptic seizure.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Engel 2001
Absence Status Epilepticus
Trancred 2005
The Diencephalon, which consists of the thalamus, hypothalamus, epithalamus and subthalamus, is involved many functions including sensory processing, motor control and maintenance of homeostasis.
Structures:
Epithalamus
Fornix
Hypothalamus
Internal Capsule
Lamina Terminalis
Lateral Ventricle
Mammillary Body
Midbrain
Optic Chiasm
Optic Tract
Posterior Commissure
Subthalamus
Telencephalon
Thalamus
Third Ventricle
Information:
Diencephalon
Location and Relations:
The diencephalon lies intermediate between the midbrain (posteriorly) and the telencephalon (which covers it laterally and anteriorly). It extends from lamina terminalis (anteriorly) to a line drawn between the posterior commissure and the posterior border of the mammillary bodies (posteriorly). On its dorsal surface it is covered by the fornix medially and the lateral ventricles further laterally. Its lateral surface is covered by a huge mass of white matter called the internal capsule. Its ventral surface is covered anteriorly and laterally by the optic chiasm and tracts. Its medial surface forms the lateral wall and floor of the third ventricle.
Components:
(i) the (dorsal) thalamus - occupies 80% of the diencephalon. It is the main relay station en route to the cortex for all sensory systems except olfaction (smell) and it plays an important role in coordinating and regulating levels of activity in the cerebral cortex, through its involvement in the reticular activating system.
(ii) The hypothalamus - separated from the thalamus by the hypothalamic sulcus. It functions to coordinate visceral activity throughout the body.
(iii) The epithalamus - which lies on the medial side of the thalamus, which plays an important role in the regulation of circadian rhythms.
(iv) The subthalamus - which lies intermediate between the thalamus and midbrain and is not seen in sagittal section. It has an important motor function.
1981 Bancaud
Diffuse
Noachter 1999
Diffuse: Occurring over large areas of one or both sides of the head (see generalized).
1981 Bancaud
Diffuse
Noachter 1999
Diffuse: Occurring over large areas of one or both sides of the head (see generalized).
Noachter 1999
Diphasic Wave: Complex consisting of two wave components developed on alternate sides of the baseline.
Noachter 1999
Dipolar: An EEG voltage field that displays both negative and positive maxima.
Noachter 1999
Dipole: A theoretical point-like EEG source produced by a separation of negative and positive charge.
Comment: commonly used to describe a cortical source that generates an EEG field in which both negative and positive maxima can be recorded, e.g. the "horizontal dipole" of so called Rolandic spikes.
Bancaud 1981
Noachter 1999
Discharge: Interpretive term commonly used to designate epileptiform and seizure patterns (see epileptiform pattern, seizure pattern).
Contained here are lists of epilepsy syndromes or diseases in which epilepsy is present.
Scheuermann 2009
Disease
A disposition
(i) to undergo pathological processes that
(ii) exists in an organism because of one or more disorders in that organism.
Diseases as dispositions rooted in physical disorders in the organism and realized in pathological processes.
(1) to the existence of pre-clinical manifestations of disease (disorders can exist before they are realized in overt pathological processes);
(2) to the combinations of disease and predispositions to disease which can exist within a single patient (as when an instance of disease of type A in a given patient is a risk factor for
a second disease of type B); and
(3) to the fact that the disease course and the clinical picture may vary widely between patients who have the same disease.
Disorder
A causally relatively isolated combination of physical components that is
(a) clinically abnormal and
(b) maximal, in the sense that it is not a part of some larger such combination.
Such disorders are the physical basis of disease. A disease comes into existence because some physical component becomes malformed.
Scheuermann 2009
Disease Course: The totality of all processes through which a given disease instance is realized.
Note that for any given patient it may at any given point in time be difficult to determine which type of disease course is involved. A single episode of transient paralysis may be insufficient to arrive at a diagnosis of multiple sclerosis until a second episode occurs. Although the disposition was present at the time of the initial episode, our ability to diagnose the underlying disorder is limited by the manifestations that have been observed up to that point in time.
not semiology
Bancaud 1981
Displeasure
Blume 2001
Distal Limb: Indicates involvement of fingers, hands, toes, and/or feet.
Bancaud 1981
Illusion: These take the form of distorted perceptions in which objects may appear deformed.
Polyoptic illusions such as monocular diplopia, distortions of size (macropsia or micropsia) or of distance may occur. Similarly, distortions of sound, including microacusia and macroacusia, may be experienced. Depersonalization, as if the person were outside his body, may occur. Altered perception of size or weight of a limb may be noted.
Bancaud 1981
A distorted memory experience such as distorted memory experience (distortion of time sense)
Bancaud 1981
Currently perceiving a distortion of time sense.
Noachter 1999
Focus: A limited region of the scalp, cerebral cortex, or depth of the brain displaying a given EEG activity, either normal or abnormal.
Noachter 1999
Asymmetry: Unequal amplitude of EEG activities over homologous areas on opposite sides of the head.
This discusses the anatomic distribution of seizure semiology.
ILAE 1989
Diurnal Cycling
ILAE 1989
Dorsolateral. Dorsolateral seizure patterns may be tonic or, less commonly, clonic with versive eye and head movements and speech arrest.
SCN1A Syndrome
Dravet, the relation to the gait, the regression in language, tone,
Engel 2001
Dravet's Syndrome
ILAE 2010
Dravet's Syndrome
Bancaud 1981
Currently in a dreamy state
Bancaud 1981
Drooping of the head
Bancaud 1981
Objects held int he hand may be dropped.
Dropping of the arms
Bancaud 1981
Drowsiness or somnolence implies a sleep state from which the patient can be aroused to make appropriate motor and verbal responses.
Engel 2001
Alcohol and drug abuse
Engel 2001
Drug or other chemically induced seizures
Blume 2001
Auditory: Buzzing, drumming sounds or single tones.
Blume 2001
Duration: Time between the beginning of initial seizure manifestations, such as the aura, and the cessation of experienced or observed seizure activity. Does not include nonspecific seizure premonitions or postictal states.
Noachter 1999
Duration:
(1) The interval from beginning to end of an individual wave or complex. Comment: the duration of the cycle of individual components of a sequence of regularly repeating waves or complexes is referred to as the period of the wave or complex.
(2) The time that a sequence of waves or complexes or any other distinguishable feature lasts in an EEG record.
Noachter 1999
Duration:
(1) The interval from beginning to end of an individual wave or complex. Comment: the duration of the cycle of individual components of a sequence of regularly repeating waves or complexes is referred to as the period of the wave or complex.
(2) The time that a sequence of waves or complexes or any other distinguishable feature lasts in an EEG record.
Noachter 1999
Duration:
(1) The interval from beginning to end of an individual wave or complex. Comment: the duration of the cycle of individual components of a sequence of regularly repeating waves or complexes is referred to as the period of the wave or complex.
(2) The time that a sequence of waves or complexes or any other distinguishable feature lasts in an EEG record.
Bancaud 1981. These include dreamy states, distortions of time sense, sensations of unreality, detachment, or depersonalization.
Blume 2001
Dyscognitive
The term describes events in which (1) disturbance of cognition is the predominant or most apparent feature, and (2a) two or more of the following components are involved, or (2b) involvement of such components remains undetermined. Otherwise, use the more specific term (e.g., “mnemonic experiential seizure” or “hallucinatory experiential seizure”).
Components of cognition:
perception: symbolic conception of sensory information
attention: appropriate selection of a principal perception or task
emotion: appropriate affective significance of a perception
memory: ability to store and retrieve percepts or concepts
executive function: anticipation, selection, monitoring of consequences, and initiation of motor activity including praxis, speech
"I just can't remember something" or "I am completely awake and alert, my attention is "
Blume 2001
Dyscognitive
The term describes events in which
(1) disturbance of cognition is the predominant or most apparent feature, and
(2a) two or more of the following components are involved, or
(2b) involvement of such components remains undetermined.
Otherwise, use the more specific term (e.g., “mnemonic experiential seizure” or “hallucinatory experiential seizure”).
Components of cognition:
Perception: symbolic conception of sensory information
Attention: appropriate selection of a principal perception or task
Emotion: appropriate affective significance of a perception
Memory: ability to store and retrieve percepts or concepts
Executive function: anticipation, selection, monitoring of consequences, and initiation of motor activity including praxis, speech
Engel 2001
DNET
Bancaud 1981
A distorted memory experience such as distorted memory experience (distortion of time sense, a dreamy state, a flashback, deja vu, jamais-vu, panoramic vision)
Any Impairment of memory.
Bancaud 1981
Dysphasia
Mayo Clinic Website
Definition: A language disorder that affects a person's ability to communicate.
Blume 2001
Dysphasic: Impaired communication involving language without dysfunction of relevant primary motor or sensory pathways, manifested as impaired comprehension, anomia, paraphasic errors, or a combination of these.
Blume 2001
Dyspraxic: Inability to perform learned movements spontaneously or on command or imitation despite intact relevant motor and sensory systems and adequate comprehension and cooperation.
ILAE 1989
Dyssynergia cerebellaris myoclonia (DCM) with epilepsy
Dyssynergia cerebellaris myoclonia (DCM) with epilepsy (Ramsay-Hunt syndrome) appears between the ages of 6 and 20 years (mean 11 years) with myoclonias or GTCS. Above all, the myoclonic syndrome is characterized by action and intention myoclonus. The GTCS are rare and sensitive to therapy. Mental deterioration, when present, is slow. Most of the neurologic manifestations are limited to cerebellar signs. In the EEG, the background activity remains normal, with generalized paroxysmal abnormalities (spikes, spike-waves, and polyspike-waves), and photosensitivity. During REM sleep, rapid polyspikes appear, localized in the central and vertex regions.
Blume 2001
Dystonic: Sustained contractions of both agonist and antagonist muscles producing athetoid or twisting movements, which, when prolonged, may produce abnormal postures.
ILAE 1969
EEG
Bancaud 1981
EEG
ILAE 1989
EEG
Type (intracranial, scalp), location, laterality, chronicity
Luders 1998
EEG findings not used to classify epileptic seizures, used to differentiate between epileptic seizures and non epileptic paroxysmal events
Paroxysmal: EEG Does Not Show Ictal EEG
Noachter 1999
Electroencephalogram: Record of electrical activity of the brain taken by means of electrodes placed on the surface of the head, unless otherwise specified.
Abbreviation: EEG.
Noachter 1999
Electroencephalography:
(1) The science relating to the electrical activity of the brain.
(2) The practice of recording and interpreting electroencephalograms.
Abbreviation: EEG.
Blume 2003
Determination hinges on seizure description, frequency, age at onset, neurological history, functional enquiry, neurological examination and one or more EEGs
SIGN 2003
EEG
Antiepielptic drug medication should not usually be started before an EEG recording since it may mask a syndromic diagnosis
Standard EEG w/ synchonized video
repeat EEG recordings and sleep EEG
Short/long term video EEG recording
AmbulatoryEEG recording
Fischer 2014
EEG
1970 Gastaut
Electroencephalographic seizure type
Interictal expression
SIGN 2006 Electrocardiography
Engel 2001
Early-Onset Benign Childhood Occipital Epilepsy (Panayiotopoulos Type)
ILAE 1989
Early infantile epileptic encephalopathy with suppression burst
This syndrome, described by Ohtahara et al. (1976), is defined by very early onset, within the first few months of life, frequent tonic spasms, and suppression burst EEG pattern in both waking and sleeping states. Partial seizures may occur. Myoclonic seizures are rare. Etiology and underlying pathology are obscure. The prognosis is serious with severe psychomotor retardation and seizure intractability; often there is evolution to the West syndrome at age 4-6 months.
ILAE 1989
Early myoclonic encephalopathy
The principal features of early myoclonic encephalopathy are onset occurring before age 3 months, initially fragmentary myoclonus, and then erratic partial seizures, massive myoclonias, or tonic spasms. The EEG is characterized by suppression-burst activity, which may evolve into hypsarrhythmia. The course is severe, psychomotor development is arrested, and death may occur in the first year. Familial cases are frequent and suggest the influence of one or several congenital metabolic errors, but there is no constant genetic pattern.
Engel 2001
Early Myoclonic Encephalopathy
ILAE 2010
Early Myoclonic Encephalopathy (EME)
Engel 2001
Early Onset Benign Childhood Occipital Epilepsy - Panayiotopoulos Type
Engel 2001
Immediate and early post cerebral insult seizures
Engel 2001
Immediate and early posttraumatic seizures
Engel 2001
Eating
Blume 2003
Berg 2010
Blume 2001
Somatosensory: Tingling, numbness, electric-shock sensation, pain, sense of movement, or desire to move.
Ictal
ILAE 1989
Electroencephalographic characteristics
ILAE 1989
2010 Berg
Electrographic characteristics
Electrophysiology
Bancaud 1981
(Seizure) symptoms tend to come in attacks lasting for a few minutes.
Blume 2001
Components of cognition:
Perception: symbolic conception of sensory information
Attention: appropriate selection of a principal perception or task
Emotion: appropriate affective significance of a perception
Memory: ability to store and retrieve percepts or concepts
Executive function: anticipation, selection, monitoring of consequences, and initiation of motor activity including praxis, speech
Interview not semiology
Noachter 1999
Encoches Frontal: Frontal sharp waves in newborns.
Engel 2006
The objective will be to make any new classification adaptable to be used for specific purposes, including exchange of clinical information among physicians, teaching, clinical research activities such as epidemiological studies and drug trials, basic research, and genetic investigations.
Table 1: Proposed diagnostic scheme for people with epileptic seizures and with epilepsy
Epileptic seizures and epilepsy syndromes are to be described and categorized according to a system that utilizes standardized terminology and that is sufficiently flexible to take into account the following practical and dynamic aspects of epilepsy diagnosis:
(1) Some patients cannot be given a recognized syndromic diagnosis.
(2) Seizure types and syndromes change as new information is obtained.
(3) Complete and detailed descriptions of ictal phenomenology are not always necessary.
(4) Multiple classification schemes can, and should, be designed for specific purposes (e.g. communication and teaching; therapeutic trials; epidemiological investigations; selection of surgical candidates; basic research; genetic characterizations).
This diagnostic scheme is divided into five parts, or Axes, organized to facilitate a logical clinical approach to the development of hypotheses
necessary to determine the diagnostic studies and therapeutic strategies to be undertaken in individual patients:
Axis 1: Ictal phenomenology—from the Glossary of Descriptive Ictal Terminology, can be used to describe ictal events with any degree of detail needed.
Asix 2: Seizure type: from the List of Epileptic Seizures. Localization within the brain and precipitating stimuli for reflex seizures should be specified when appropriate.
Axis 3: Syndrome: from the List of Epilepsy Syndromes, with the understanding that a syndromic diagnosis may not always be possible.
Axis 4: Etiology: from a Classification of Diseases Frequently Associated with Epileptic Seizures or Epilepsy Syndromes when possible, genetic defects, or specific pathological substrates for symptomatic focal epilepsies.
Axis 5: Impairment: this optional, but often useful, additional diagnostic parameter can be derived from an impairment classification adapted from the WHO ICIDH-2.
The diagnostic scheme described here will be made up of flexible and dynamic modules within which the Task Force will make periodic changes and updates as needed, with the approval of the Executive Committee. The Task Force is proposing that this diagnostic scheme include the development of flexible, rather than rigid, classifications, eliminating the need for the General Assembly, which meets only once every 2 years, to agree on every revision. Acceptance of this diagnostic scheme, therefore, does not exclude the creation of various classification systems for seizures and syndromes, or the continued use of some aspects of the current classification. The Task Force will be concerned with the construction of classification systems during the next Executive term, but it is anticipated that seizures and syndromes will not be organized into fixed dichotomous classifications, but rather categorized in various ways for various purposes.
Engel 2006
Epileptic seizure type: An ictal event believed to represent a unique pathophysiological mechanism and anatomical substrate. This is a diagnostic entity with etiological, therapeutic and prognostic implications (new concept).
Engel 2006
Epilepsy syndrome: A complex of signs and symptoms that define a unique epilepsy condition with different etiologies. This must involve more than just the seizure type; thus frontal lobe seizures per se, for instance, do not constitute a syndrome (changed concept).
Engel 2006
Epilepsy disease: A pathological condition with a single specific, well-defined etiology. Thus, progressive myoclonus epilepsy is a syndrome, but Unverricht–Lundborg is a disease (new concept).
Engel 2006
Epileptic encephalopathy: A condition in which the epileptic processes themselves are believed to contribute to the disturbance in cerebral function (new concept)
Engel 2006
Benign epilepsy syndrome: A syndrome characterized by epileptic seizures that are easily treated, or require no treatment and remit without sequelae (clarified concept).
Engel 2001
Reflex epilepsy syndrome: A syndrome in which all epileptic seizures are precipitated by sensory stimuli. Reflex seizures that occur in focal and generalized epilepsy syndromes that are also associated with spontaneous seizures are listed as seizure types. Isolated reflex seizures can also occur in situations that do not necessarily require a diagnosis of epilepsy. Seizures precipitated by other special circumstances, such as fever or alcohol withdrawal, are not reflex seizures (changed concept).
Engel 2006
Focal seizures and syndromes: Replaces the terms partial seizures and localization-related syndromes (changed terms).
Engel 2006
Simple and complex partial epileptic seizures: These terms are no longer recommended, nor will they be replaced. Ictal impairment of consciousness will be described when appropriate for individual seizures, but will not be used to classify specific seizure types (new concept).
Engel 2006
Idiopathic epilepsy syndromes: A syndrome that is only epilepsy, with no underlying structural brain lesion or other neurological signs or symptoms. These are presumed to be genetic and are usually age-dependent (unchanged term).
Engel 2006
Table 1: Definitions of key terms
Epileptic seizure type: An ictal event believed to represent a unique pathophysiological mechanism and anatomical substrate. This is a diagnostic entity with etiological, therapeutic and prognostic implications (new concept).
Epilepsy syndrome: A complex of signs and symptoms that define a unique epilepsy condition with different etiologies. This must involve more than just the seizure type; thus frontal lobe seizures per se, for instance, do not constitute a syndrome (changed concept).
Epilepsy disease: A pathological condition with a single specific, well-defined etiology. Thus, progressive myoclonus epilepsy is a syndrome, but Unverricht–Lundborg is a disease (new concept).
Epileptic encephalopathy: A condition in which the epileptic processes themselves are believed to contribute to the disturbance in cerebral function (new concept)
Benign epilepsy syndrome: A syndrome characterized by epileptic seizures that are easily treated, or require no treatment and remit without sequelae (clarified concept).
Reflex epilepsy syndrome: A syndrome in which all epileptic seizures are precipitated by sensory stimuli. Reflex seizures that occur in focal and generalized epilepsy syndromes that are also associated with spontaneous seizures are listed as seizure types. Isolated reflex seizures can also occur in situations that do not necessarily require a diagnosis of epilepsy. Seizures precipitated by other special circumstances, such as fever or alcohol withdrawal, are not reflex seizures (changed concept).
Focal seizures and syndromes: Replaces the terms partial seizures and localization-related syndromes (changed terms).
Simple and complex partial epileptic seizures: These terms are no longer recommended, nor will they be replaced. Ictal impairment of consciousness will be described when appropriate for individual seizures, but will not be used to classify specific seizure types (new concept)
Idiopathic epilepsy syndromes: A syndrome that is only epilepsy, with no underlying structural brain lesion or other neurological signs or symptoms. These are presumed to be genetic and are usually age-dependent (unchanged term).
Symptomatic epilepsy syndrome: A syndrome in which the epileptic seizures are the result of one or more identifiable structural lesions of the brain (unchanged term).
Probably symptomatic epilepsy syndrome: Synonymous with, but preferred to, the term cryptogenic, used to define syndromes that are believed to be symptomatic, but no etiology has been identified (new term).
Engel 2006
Symptomatic epilepsy syndrome: A syndrome in which the epileptic seizures are the result of one or more identifiable structural lesions of the brain (unchanged term).
Engel 2006
Probably symptomatic epilepsy syndrome: Synonymous with, but preferred to, the term cryptogenic, used to define syndromes that are believed to be symptomatic, but no etiology has been identified (new term).
Engel 2001
An example of classification of epilepsy syndromes
Engel 2001
An example of a classification of diseases frequently associated with epileptic seizures or syndromes
Engel 2001
Absence Status Epilepticus
Engel 2001
Acrocallosal syndrome
Engel 2001
Aicardi syndrome
Engel 2001
Alcohol-Withdrawal Seizures
Engel 2001
Alcohol and drug abuse
Engel 2001
Aminoacidopathies
Engel 2001
Angelman Syndrome
Engel 2001
Astrocytomas
Engel 2001
Atonic Seizures
Engel 2001
Atypical Absence Seizures
Engel 2001
Aura Continua
Engel 2001
Autosomal Dominant Nocturnal Frontal Lobe Epilepsy
Engel 2001
Axis 1 consists of a description of the ictal semiology, using a standardized Glossary of Descriptive Terminology. The description of the ictal event, without reference to etiology, anatomy, or mechanisms, can be very brief or extremely detailed, as required for clinical or research purposes. Although detailed descriptions of the onset and evolution of localized ictal phenomena often are not necessary, they can be useful; for instance, in patients who are candidates for surgical treatment, or for research designed to elucidate the anatomic substrates or pathophysiologic mechanisms underlying specific clinical behaviors. Communication among clinicians, and among researchers, will be greatly enhanced by the establishment of standardized terminology for describing ictal semiology.
Engel 2006
Axis 1: Ictal phenomenology—from the Glossary of Descriptive Ictal Terminology, can be used to describe ictal events with any degree of detail needed.
Axis 1 of the diagnostic scheme involves a detailed description of ictal phenomenology utilizing a glossary of descriptive ictal terminology (Blume et al., 2001). This can be extremely valuable for older patients with focal epilepsy who are being evaluated for surgical resection, but is not likely to be necessary in infants and young children, so it is optional.
Engel 2001
Epileptic seizure type: An ictal event believed to represent a unique pathophysiological mechanism and anatomical substrate. This is a diagnostic entity with etiological, therapeutic and prognostic implications (new concept).
Axis 2 is the epileptic seizure type, or types, experienced by the patient, derived from a list of accepted seizure types that represent diagnostic entities with etiologic, therapeutic, and/or prognostic implications. Localization within the brain should be specified when this is appropriate, and in the case of reflex seizures, the specific stimulus also will be specified here. The Task Force has constructed a list of accepted epileptic seizure types, including forms of status epilepticus, and precipitating factors for reflex seizures (Table 3). Seizure types have been divided into self-limited seizures and continuous seizures, and further divided into generalized seizures and focal seizures, but it is anticipated that other approaches to organization, categorization, and classification of seizure types will be devised for specific purposes.
Engel 2006
Asix 2: Seizure type: from the List of Epileptic Seizures. Localization within the brain and precipitating stimuli for reflex seizures should be specified when appropriate.
Axis 2 is diagnosis of specific seizure type(s).
The concept of seizure type as a diagnostic entity, rather than merely a description of clinical behavior and EEG, as in the current 1981 seizure classification (Commission of ILAE, 1981), is a new concept (Engel, 2001). The intention is that the seizure-type diagnosis will have implications with respect to etiology, approaches to diagnostic evaluation, treatment and prognosis. One criticism of the ILAE approach to classification is that syndromic diagnoses often cannot be made. The establishment of seizure types as diagnostic entities makes it possible for patient management and prognosis to be derived from a diagnosis of a specific seizure type when a syndromic diagnosis is not evident. Recognized seizure types are listed in Table 3. Whereas there remains controversy regarding some seizure types, particularly focal seizures that occur mostly in older children and adults, there is general agreement on those seizure types that occur in infancy and early childhood.
Criteria for evaluating epileptic seizure types could include pathophysiologic mechanisms; anatomic substrates; response to AEDs; ictal EEG patterns; propagation; postictal features: and the epilepsy syndromes in which they occur.
Engel 2001
Axis 3 is the syndromic diagnosis derived from a list of accepted epilepsy syndromes (Table 4), although it is understood that a syndromic diagnosis may not always be possible. The recommended list distinguishes between epilepsy syndromes and conditions with epileptic seizures that do not require a diagnosis of epilepsy, and also identifies which syndromes are still in development. It is important to stress that the list shown in Table 4 contains syndromes that are still under discussion, such as the new concept of Idiopathic generalized epilepsies with variable phenotypes, and the reflex epilepsies, and that the Task Force will continue to revise this list based on the results of further deliberations, input from the membership, and new information. As with epileptic seizures, it is anticipated that different approaches to organization, categorization, and classification of epilepsy syndromes will be created for specific purposes. One example of an approach to classification of epilepsy syndromes is shown in Table 5. Whereas this classification system may be easy for epileptologists to understand, a more simplified version will likely be constructed for teaching purposes, and used by primary care physicians, whereas more detailed, or completely different, classification systems might be necessary for epidemiologic studies, clinical drug trials, presurgical evaluation, basic research, and genetic characterizations.
Engel 2006
Axis 3: Syndrome: from the List of Epilepsy Syndromes, with the understanding that a syndromic diagnosis may not always be possible.
Axis 3 is diagnosis of a specific syndrome. Recognized syndromes are listed in Table 4. Approximately half of these occur in infancy and early childhood, most of which are non-controversial.
Criteria for evaluating epilepsy syndromes could include epileptic seizure type(s); age of onset;
progressive nature; interictal EEG; associated interictal signs and symptoms; pathophysiologic mechanisms; anatomic substrates; etiological categories: and genetic basis. Seizure types and syndromes will be proposed as testable working hypotheses subject to verification, falsification and revision. At any point, hypotheses can be disproved as new information becomes available.
Organizing the list of recognized syndromes into one or more classifications is the next step in this process. Features that might be considered when organizing syndromes of infancy and early childhood into clusters with specific commonalities include autosomaldominant epilepsies; epileptic encephalopathies; idiopathic generalized epilepsies; idiopathic focal epilepsies: and the family of GEFS+ conditions.
Engel 2001
Axis 4 will specify etiology when this is known. The etiology could consist of a specific disease derived from a classification of diseases frequently associated with epileptic seizures or syndromes (Table 6), a genetic defect, or a specific pathologic substrate, for instance for the symptomatic focal epilepsies. The classification of diseases frequently associated with epileptic seizures shown in Table 6 is preliminary and will require considerable effort over the course of the next Executive Term to be made as comprehensive as possible.
Engel 2006
Axis 4: Etiology: from a Classification of Diseases Frequently Associated with Epileptic Seizures or Epilepsy Syndromes when possible, genetic defects, or specific pathological substrates for symptomatic focal epilepsies.
Engel 2001
Axis 5 is an optional designation of the degree of impairment caused by the epileptic condition. Classification of impairment will be derived from the World Health Organization ICIDH-2 International Classification of Functioning and Disability (5), which is currently in preparation. Modification may be necessary for application to seizure disorders.
Engel 2006
Axis 5: Impairment: this optional, but often useful, additional diagnostic parameter can be derived from an impairment classification adapted from the WHO ICIDH-2.
Axis 5 is an optional assessment of impairment taken from the WHO ICIDH-2 classification. This Axis is intended for application to older patients.
Engel 2001
Bacterial meningitis
Engel 2001
Benign Childhood Epilepsy with Centrotemporal Spikes
Engel 2001
Benign Familial Infantile Seizures
Engel 2001
Benign Familial Neonatal Seizures
Engel 2001
Benign Infantile Seizures
Engel 2001
Benign Infantile Seizures Nonfamilial
Engel 2001
Benign Myoclonic Epilepsy In Infancy
Engel 2001
Benign Neonatal Seizures
Engel 2001
Bilateral perisylvian syndrome
Engel 2001
Cavernous Angiomas
Engel 2001
Celiac disease
(Epilepsy With Occipital Calcifications And Celiac Disease)
Engel 2001
Cerebral calcifications and other lesions
Engel 2001
Ceroid lipofuscinosis
Engel 2001
Childhood absence epilepsy
Engel 2001
Chromosomal Abnormalities
Engel 2001
Clonic Seizures
Engel 2001
Clonic Seizures With Tonic Features
Engel 2001
Clonic Seizures Without Tonic Features
Engel 2001
Clonic Status Epilepticus
Engel 2001
Engel 2001
Continuous Seizure Types
Engel 2001
Cysticcercosis
Engel 2001
D-Glyceric Acidemia
Engel 2001
Dentatorubropallidoluysian atrophy
Engel 2001
Disorders of biotin metabolism
Engel 2001
Disorders of Carbohydrate Metabolism
Engel 2001
DIsorders of folic acid and B12 metabolism
Engel 2001
Drug or other chemically induced seizures
Engel 2001
DNET
Engel 2001
Early-Onset Benign Childhood Occipital Epilepsy (Panayiotopoulos Type)
Engel 2001
Early Myoclonic Encephalopathy
Engel 2001
Early Onset Benign Childhood Occipital Epilepsy - Panayiotopoulos Type
Engel 2001
Eating
Engel 2001
Epidermal nevus syndrome
Engel 2001
Epilepsia Partialis Continua of Kojevnikov
Engel 2001
Epilepsy with continuous spike-and-waves during slow-wave sleep - Other than LKS.
Engel 2001
Epilepsy with Generalized Tonic-Clonic Seizures Only
Engel 2001
Epilepsy with Myoclonic - Astatic Seizures
Engel 2001
Epilepsy with myoclonic absences
Engel 2001
Epilepsy with myoclonic astatic seizures
Engel 2001
Epileptic encephalopathies
(in which the epileptiform abnormalities may contribute to progressive dysfunction)
Engel 2001
Eyelid Myoclonia
Engel 2001
Eyelid Myoclonia With Absences
Engel 2001
Eyelid Myoclonia Without Absences
Engel 2001
Familial autosomal dominant focal epilepsies
Engel 2001
Familial Focal Epilepsy with Variable Foci
Syndromes in development
Engel 2001
Familial Temporal Lobe Seizures
Engel 2001
Familial temporal lobe epilepsy
Engel 2001
Febrile Seizures
Engel 2001
Flickering Lights: Color_To_Be_Specified_When_Possible
Engel 2001
Focal heterotopia
Engel 2001
Focal Motor Seizures
Engel 2001
Focal Motor Seizures with Asymmetrical Tonic Motor Seizures
Engel 2001
Focal Motor Seizures With Elementary Clonic Motor Signs
Engel 2001
Focal Motor Seizures with Focal Negative Myoclonus
Engel 2001
Focal Motor Seizures With Hyperkinetic Atomatisms
Engel 2001
Focal Motor Seizures With Inhibitory Motor Seizures
Engel 2001
Focal Motor Seizures With Typical Temporal Lobe Automatisms
Engel 2001
Focal or multifocal cortical dysplasia
Engel 2001
Focal Seizures
Engel 2001
Focal Sensory Seizures
Engel 2001
Focal Sensory Seizures With Elementary Sensory Symptoms
Engel 2001
Focal Sensory Seizures With Experiential Sensory Symptoms
Engel 2001
Focal Status Epilepticus
Engel 2001
Fragile X syndrome
Engel 2001
Fructose 1-6 diphsphatase deficiency
Engel 2001
Fumarase deficiency
Engel 2001
Gangliocytoma
Engel 2001
Ganglioglioma
Engel 2001
Gelastic Seizures
Engel 2001
Generalized Epilepsies with Febrile Seizures Plus
Syndromes in development
Engel 2001
Generalized Seizures
Engel 2001
Generalized Status Epilepticus
Engel 2001
Generalized Tonic-Clonic Status Epilepticus
Engel 2001
Glucose transport protein deficiency
Engel 2001
Glycogen-storage disorders
Engel 2001
Head injury
Engel 2001
Hemiclonic Seizures
Engel 2001
Hemiconvulsion-Hemiplegia Epilepsy (HHE) Syndrome
Engel 2001
Hemiconvulsive Status
Engel 2001
Hemimegalencephaly
Engel 2001
Herpes encephalitis
Engel 2001
Hot Water
Engel 2001
Huntington disease
Engel 2001
Hypermelanosis of Ito
Engel 2001
Hypothalamic Hamartoma
(With Gelastic Seizures)
Engel 2001
Idiopathic focal epilepsies of infancy and childhood
Engel 2001
Idiopathic generalized epilepsies
Engel 2001
Idiopathic Generalized Epilepsies with Variable Phenotypes
Engel 2001
Idiopathic Photosensitive Occipital Lobe Epilepsy
Engel 2001
Immediate and early post cerebral insult seizures
Engel 2001
Immediate and early posttraumatic seizures
Engel 2001
Inherited metabolic disorders
Engel 2001
Inversion duplication 15 syndrome
Engel 2001
Isolated lissencephaly sequence
Engel 2001
Juvenile Absence Epilepsy
Engel 2001
Juvenile Myoclonic Epilepsy
Engel 2001
Krabbe Disease
Engel 2001
Lafora Disease
Engel 2001
Late Onset Childhood Occipital Epilepsy - Gastaut Type
Engel 2001
Late-Onset Childhood Occipital Epilepsy (Gastaut Type)
Engel 2001
Lesion due to cerebrovascular incident (CVI)
Engel 2001
Lesion due to HIV
Engel 2001
Lesion due to toxoplasmosis
Engel 2001
Limbic epilepsies
Engel 2001
Limbic Status Epilepticus (Psychomotor Status)
Engel 2001
Malformations due to abnormal cortical developments
2001 Engel
Maple syrup urine disease
Engel 2001
Mesial Temporal Lobe Epilepsy defined by specific etiologies
Engel 2001
Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis
Engel 2001
Microcephaly
Engel 2001
Microdysgenesis
Engel 2001
Migrating Partial Seizures of Early Infancy
Syndromes in development
Engel 2001
Migrating Partial Seizures of Infancy
Syndromes in development
Engel 2001
Miscellaneous
Engel 2001
Mitochondrial diseases
Engel 2001
MELAS
Engel 2001
Monogenic mendelian diseases with complex pathogenetic mechanisms
Engel 2001
Music
Engel 2001
Myoclonic Absence Seizures
Engel 2001
Myoclonic Atonic Seizures
Engel 2001
Myoclonic Seizures
Engel 2001
Myoclonic Status Epilepticus
Engel 2001
Myoclonic Status in Nonprogressive Encephalopathies
Syndromes in development
Engel 2001
MERRF
Engel 2001
Negative Myoclonus
Engel 2001
Neocortical Epilepsies
Engel 2001
Neuroaxonal Dystrophy
Engel 2001
Neurocutaneous disorders
Engel 2001
Neurofibromatosis
Engel 2001
Nonketotic hyperglycinemia
Engel 2001
Northern epilepsy syndrome
Engel 2001
Occipital Lobe Seizures
Engel 2001
Ohtahara Syndrome
Engel 2001
Oligoepilepsy
Engel 2001
Other cerebral malformations
Engel 2001
Other organic acidurias
Engel 2001
Other postnatal factors
Engel 2001
Other Types Defined by Location and Etiology
Engel 2001
Other Visual Sensitive Epilepsies
Engel 2001
Other Visual Stimuli
Engel 2001
Parietal Lobe Seizures
Engel 2001
Partial monosomy 4p
Engel 2001
Patterns
Engel 2001
Periventricular leukomalacia
Engel 2001
Periventricular nodular heterotopia
Engel 2001
Peroxisomal disorders
2001 Engel
Phenylketonuria
Engel 2001
Porencephaly
Engel 2001
Postnatal infections
Engel 2001
Praxis
Engel 2001
Precipitating stimuli for reflex seizures.
Engel 2001
Prenatal or perinatal ischemic or anoxic lesions or cerebral infections causing nonprogressive encephalopathies
Engel 2001
Primary Reading Epilepsy
Engel 2001
PEHO syndrome
Engel 2001
Progressive myoclonic epilepsies
Engel 2001
Progressive Myoclonus Epilepsies
Engel 2001
Propionic acidemia
Engel 2001
The Task Force agreed that it would not be possible to replace the current international classifications with similar revised and updated classifications that would be universally accepted and meet all the clinical and research needs such a formal organizational system would be expected to provide. Rather, the Task Force is proposing a diagnostic scheme that makes use of standardized terminology and concepts to describe individual patients
Engel 2006
Engel 2001
Propioceptive
Engel 2001
Pyridoxine dependency
Engel 2001
Pyruvate dehydrogenase deficiency
Engel 2001
Rarely Repeated Seizures
Engel 2001
Rasmussen Syndrome
Engel 2001
Reading
Engel 2001
Reflex Epilepsies
Reflex epilepsy syndrome: A syndrome in which all epileptic seizures are precipitated by sensory stimuli. Reflex seizures that occur in focal and generalized epilepsy syndromes that are also associated with spontaneous seizures are listed as seizure types. Isolated reflex seizures can also occur in situations that do not necessarily require a diagnosis of epilepsy. Seizures precipitated by other special circumstances, such as fever or alcohol withdrawal, are not reflex seizures (changed concept).
Engel 2001
Reflex Seizures
Engel 2001
Respiratory chain defects
Engel 2001
Rett syndrome
Engel 2001
Ring 20 chromosome
Engel 2001
Sanfilippo syndrome
Engel 2001
Schizencephalies
Engel 2001
Secondarily Generalized Seizures
Engel 2001
Seizures not necessarily requiring a diagnosis of epilepsy
Engel 2001
Self-Limited Seizure Type
Engel 2001
Sialidosis
Engel 2001
Single seizures or isolated cluster of seizures
Engel 2001
Somatosensory
Engel 2001
Spasms
Engel 2001
Startle
Engel 2001
Startle Epilepsy
Engel 2001
Stroke
Engel 2001
Subcortical band heterotopia
Engel 2001
Sulphite-Oxidase Deficiency
Engel 2001
Supplementary Motor Seizures
Engel 2001
Symptomatic or probably symptomatic focal epilepsies
Engel 2001
Temporoparietooccipital Junction Seizures
Engel 2001
Thinking
Engel 2001
Tonic-Clonic Seizures
Engel 2001
Tonic-Clonic Seizures Variations Beginning With A Clonic Phase
Engel 2001
Tonic-Clonic Seizures Variations Begining With A Myoclonic Phase
Engel 2001
Tonic Seizures
Engel 2001
Tonic Status Epilepticus
Engel 2001
Trisomy 12p
Engel 2001
Tuberous sclerosis complex
Engel 2001
Tumors
Engel 2001
Typical Absence Seizures
Engel 2001
Unilateral polymicrogyria
Engel 2001
Urea Cycle Disorders
Engel 2001
Visual Stimuli
Engel 2001
West Syndrome
Engel 2001
X-linked lissencephaly
Engel 2006
Autosomal Dominant Nocturnal Frontal Lobe Epilepsy
Scheuermann 2009
Disease correlates with genetic and environmental variables
ILAE 1989
Rare
Sign 2006
epidemiology
Recurrence risk
Remission rate
Berg 2010 epideimiology
Engel 2001
Epidermal nevus syndrome
Blume 2001
Epigastric: Abdominal discomfort including nausea, emptiness, tightness, churning, butterflies, malaise, pain, and hunger; sensation may rise to chest or throat. Some phenomena may reflect ictal autonomic dysfunction.
Blume 2001
Epigastric: Abdominal discomfort including nausea, emptiness, tightness, churning, butterflies, malaise, pain, and hunger; sensation may rise to chest or throat. Some phenomena may reflect ictal autonomic dysfunction.
Blume 2001
Epigastric: Abdominal discomfort including nausea, emptiness, tightness, churning, butterflies, malaise, pain, and hunger; sensation may rise to chest or throat. Some phenomena may reflect ictal autonomic dysfunction.
Blume 2001
Epigastric: Abdominal discomfort including nausea, emptiness, tightness, churning, butterflies, malaise, pain, and hunger; sensation may rise to chest or throat. Some phenomena may reflect ictal autonomic dysfunction.
Blume 2001
Epigastric: Abdominal discomfort including nausea, emptiness, tightness, churning, butterflies, malaise, pain, and hunger; sensation may rise to chest or throat. Some phenomena may reflect ictal autonomic dysfunction.
Bancaud 1981
Under this name have been described cases of simple partial seizures with focal motor signs without a march, usually consisting of clonic spasms, which remain confined to the part of the body in which they originate, but which persist with little or no intermission for hours or days at a stretch. Consciousness is usually preserved, but postictal weakness is frequently evident.
Very localized motor status
When focal motor seizure activity is continuous
Engel 2001
Epilepsia Partialis Continua of Kojevnikov
ILAE 1989
Epilepsy with GTCS on awakening is a syndrome with onset occurring mostly in the second decade of life. The GTCS occur exclusively or predominantly (>90% of the time) shortly after awakening regardless of the time of day or in a second seizure peak in the evening period of relaxation. If other seizures occur, they are mostly absence or myoclonic, as in juvenile myoclonic epilepsy. Seizures may be precipitated by sleep deprivation and other external factors. Genetic predisposition is relatively frequent. The EEG shows one of the patterns of idiopathic generalized epilepsy. There is a significant correlation with photosensitivity.
Luders 1998
Epilepsy classification
The semiological seizure classification is a classification of the semiology of the seizures only. The epileptic syndrome, however, is defined by considering all clinical information (semiological seizure type, interictal EEG, ictal EEG, functional and anatomic neuroimaging, seizure evolution over time, neurological examination, and so on). In our institutions, we first define the epiteptic syndrome, then list the semiological characteristics of the patient’s seizures, state the presumed cause of the epileptic syndrome, and record important additional medical conditions which the patient has. This approach summarizes the essential features of the epilepsy and has been described in detail elsewhere (6). Some illustrative examples follow.
1. Left Mesial Temporal Lobe Epilepsy
Seizures: Abdominal aura --> automotor seizure
Cause: Left mesial temporal sclerosis
Related medical conditions: Febrile convulsions, Memory deficit, Cerebellar atrophy
2. Absence Epilepsy
Seizures: Typical dialeptic seizure --> generalized tonic-clonic seizure
Cause: Genetic
Related medical conditions:None
3. Lennox-Gastaut syndrome
Seizures: Generalized tonic seizure, Dialeptic seizure, Astatic seizure
Cause: Tuberous sclerosis
Related medical conditions: Mental retardation, Depression
4. Right Frontal Epilepsy
Seizures: Asymmetric bilateral tonic seizure --> Left arm clonic seizure --> Generalized tonic clonic seizure
Cause: Right mesial frontal cortical dysplasia
Related medical conditions: Schizophrenia, Mild mental retardation
Engel 2006
Epilepsy disease: A pathological condition with a single specific, well-defined etiology. Thus, progressive myoclonus epilepsy is a syndrome, but Unverricht–Lundborg is a disease (new concept).
Scheuermann 2009
Epilepsy as a disease that disposes to the occurrence of seizures (pathological processes) due to an underlying abnormality in the neuronal circuitry of the brain (physical basis)
Fischer 2014
Definition is usually practically applied as having two unprovoked seizures >24 h apart.
The task force proposed that epilepsy be considered to be a diseaseof the brain defined by any of the following conditions:
(1) At least two unprovoked (or reflex) seizures occurring >24 h apart;
(2) one unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years;
(3) diagnosis of an epilepsy syndrome
Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures, and by theneurobiologic, cognitive, psychological, and social consequences of this condition. The definition of epilepsy requires the occurrence of at least one epileptic seizure.
Term disease may (butnot always) convey a more lasting derangement of normal function
The ILAE and the International Bureau for Epilepsy (IBE) have recently agreed that epilepsy is best considered to be a disease.
Epilepsy exists in a patient who has had a seizure and whose brain, for whatever reason, demonstrates a pathologic and enduring tendency to have recurrent seizures. This tendency can be imagined as a pathologic lowering of the seizure threshold, when compared to persons without the condition.
It makes little sense to say that someone has an epilepsy syndrome but not epilepsy. If evidence exists for an epilepsy syndrome, then epilepsy may be presumed to be present, even if the risk of subsequent seizures is low.
Before release, check with ILAE 2014
Should we get rid fo epilepsy syndrome completely?
Fischer 2014
It makes little sense to say that someone has an epilepsy syndrome but not epilepsy. If evidence exists for an epilepsy syndrome, then epilepsy may be presumed to be present, even if the risk of subsequent seizures is low.
This is a list of epilepsy syndromes (cited epilepsy syndromes 1989-2014)
ILAE 1989
An epileptic syndrome is an epileptic disorder characterized by a cluster of signs and symptoms customarily occurring together; these include such items as type of seizure, etiology, anatomy, precipitating factors, age of onset, severity, chronicity, diurnal and circadian cycling, and sometimes prognosis. However, in contradistinction to a disease, a syndrome does not necessarily have a common etiology and prognosis.
Engel 2006
Epilepsy syndrome: A complex of signs and symptoms that define a unique epilepsy condition with different etiologies. This must involve more than just the seizure type; thus frontal lobe seizures per se, for instance, do not constitute a syndrome (changed concept).
Fischer 2014
epilepsy syndrome
ILAE 1989
Epilepsy with continuous spike-waves during slow-wave sleep
Epilepsy with continuous spike-waves during slow sleep results from the association of various seizure types, partial or generalized, occurring during sleep, and atypical absences when awake. Tonic seizures do not occur. The characteristic EEG pattern consists of continuous diffuse spike-waves during slow wave sleep, which is noted after onset of seizures. Duration varies from months to years. Despite the usually benign evolution of seizures, prognosis is guarded because of the appearance of neuropsychologic disorders.
Engel 2001
Epilepsy with continuous spike-and-waves during slow-wave sleep - Other than LKS.
ILAE 2010 Epilepsy of Infancy with Migrating Focal Seizures
ILAE 2010
Epilepsy with Generalized Tonic-Clonic Seizures Alone
ILAE 1989
Epilepsy with myoclonic-astatic seizures
Manifestations of myoclonic-astatic seizures begin between the ages of 7 months and 6 years (mostly between the ages of 2 and 5 years), with (except if seizures begin in the first year) twice as many boys affected. There is frequently hereditary predisposition and usually a normal developmental background. The seizures are myoclonic, astatic, myoclonic-astatic, absence with clonic and tonic components, and tonic-clonic. Status frequently occurs. Tonic seizures develop late in the course of unfavorable cases. The EEG, initially often normal except for 4-7-Hz rhythms, may have irregular fast spike-wave or polyspike wave. Course and outcome are variable.
Engel 2001
Epilepsy with Myoclonic - Astatic Seizures
ILAE 1989
Epilepsy with myoclonic absences
The syndrome of epilepsy with myoclonic absences is clinically characterized by absences accompanied by severe bilateral rhythmical clonic jerks, often associated with a tonic contraction. On the EEG, these clinical features are always accompanied by bilateral, synchronous, and symmetrical discharge of rhythmical spike-waves at 3 Hz, similar to childhood absence. Seizures occur many times a day. Awareness of the jerks may be maintained. Associated seizures are rare. Age of onset is -7 years, and there is a male preponderance. Prognosis is less favorable than in pyknolepsy owing to resistance to therapy of the seizures, mental deterioration, and possible evolution to other types of epilepsy such as Lennox-Gastaut syndrome.
Engel 2001
Epilepsy with myoclonic absences
Engel 2006
Epileptic encephalopathy: A condition in which the epileptic processes themselves are believed to contribute to the disturbance in cerebral function (new concept)
Engel 2001
Epileptic seizure type: An ictal event believed to represent a unique pathophysiological mechanism and anatomical substrate. This is a diagnostic entity with etiological, therapeutic and prognostic implications (new concept).
Bancaud 1981
Focal motor with march
This is a list of epileptic seizure types. The signs and symptoms contained within them are their semiology. So hasSemiology would be a good relationship but the label semiology has nothing to do with what is contained in this box which are epileptic seizure types.
ILAE 1969
Clinical Seizure Type
Bancaud 1981
Unclassified epileptic seizures: includes all seizures that cannot be classified because of inadequate or incomplete data and some that defy classification (e.g. includes some neonatal seizures w/ rhythmic eye movements, chewing, swimming movements)
Preictal
Repeated epileptic seizures:
1) fortuitous attacks, coming unexpectedly and w/o any apparent provocation
2) cyclic attacks, at more or less regular intervals (relation to menstrual, sleep wake cycle
3) attacks provoked by non sensory factors (fatigue, alcohol, emotion) or sensory factors (reflex seizures)
Ictal
Grand mal, petit mal, hysteroid
Status Epilepticus: prolonged or repetitive seizures, when a seizure persists for a sufficient legit of time or repeated frequently enough that recovery between attacks does not occur
1) Partial: jacksonian
2) Generalized: absence status or tonic-clonic status
Epilepsia Partialis continua: continuous focal motor seizure activity (without a march, usually clonic spasms, confined to body part of origin, persist w/ little or no intermission for hours or days at a stretch, consciousness preserved, postictal weakness is frequently evident
Post-ictal
Postictal (Todd's) Paralysis: refers to transient paralysis that may occur following some partial epileptic seizure with focal motor components or somatosensory symptoms, ascribed to neuronal exhaustion due to increased metabolic activity of discharging focus, but may also be attributable to increased inhibition in the region of focus, which may account for its appearance in non-motor somatosensory seizures
ILAE 1989
Type of seizure
Diurnal and Circadian
Clusters at intervals, random
Postictal: confusion, amnesia, gradual recovery, Todd's paralysis
Trigger: sleep
Jacksonian spread, confined
Migrainous headache
bilateral, single, repetitive, arrhythmic, irregular myoclonic jerks
Nonspecific precipitated: sleeplessness, alcohol/drug withdrawal, hyperventilation
Luders 1998
Classification based on predominant clinical manifestation
Paroxysmal: not sufficient evidence to assume a seizure like event was of epileptic nature
EEG can be used to determine whether an episode is epileptic or not
Non-epileptic events are classified only as "paroxysmal events"
Status Epilepticus: replace any seizure with status in the name
Blume 2001:
A seizure will often consist of two or more phenomena occurring simultaneously or sequentially and should be described accordingly
1.0 Semiology: branch of linguistics concerned with signs & symptoms
2.0 Epileptic seizure: manifestation(s) of epileptic (excessive and/or hyper synchronous), usually self-limited activity of neurons in the brain.
3.0 Ictus: A sudden neurologic occurrence such as a stroke or an epileptic seizure
Engel 2001 Self-Limited Seizure Type
Engel 2001 & 2006:
Axis 1: Ictal semiology can be used to describe ictal events w/ any degree of detail needed for clinical/research purposes
Onset and evolution not necessary but helpful
Axis 2: Seizure type from list of epileptic seizures
Reflex epilepsy syndrome: A syndrome in which all epileptic seizures are precipitated by sensory stimuli. Reflex seizures that occur in focal and generalized epilepsy syndromes that also are associated with spontaneous seizures are listed as seizure types. Isolated reflex seizures also can occur in situations that do not necessarily require a diagnosis of epilepsy. Seizures precipitated by other special circumstances, such as fever or alcohol withdrawal, are not reflex seizures
Focal seizures and syndromes: Replaces the terms partial seizures and localization-related syndromes
Reflex seizures in generalized epilepsy syndromes
Secondarily gerneralized seizures
Status epilepticus or continua
Precipitating stimuli for reflex seizures: Visual stimuli (flickering light-color to be specified when possible, patterns, other visual stimuli, thinking, music, eating, praxis, somatosensory, proprioceptive, reading, hot water, startle)
Blume 2003
Precipitating factor: (sleep loss, alcohol withdrawal, flashing lights)
presence of others, situation (awake or asleep)
Timing: duration (1-5 min), onset (sudden), sequence of symptoms (stereotyped), termination (spontaneous)
Sequelae: injury (freq, mild; scalp, face, common), postictal (tired, confused, sleeps)
Determination hinges on seizure description
Catamenial: refers to the appearance or worsening of seizures in the perimenstrual period or, rarely, in the entire second half of the menstrual period if no progesterone is secreted ("inadequate luteal phase" syndrome). This relates to a chift of the ratio between estrogen (proepileptogenic) and progesterone (anti-epileptogenic).
SIGN 2005
Convulsive status epileptics: epileptic activity persisting for 30 minutes, causing a wide spectrum of clinical symptoms. Early treatment before admission to a hospital reduces the length of seizure and leads to the use of fewer drugs
Epileptic seizure: a clinical manifestation of epileptic (excessive and/or hyper synchronous), usually self limiting, activity of neurons in the brain
Generalized seizure: an epileptic seizure whose initial semiology indicates more than minimal involvement of both cerebral hemispheres
Seizure: paroxysmal disturbance of brain function that may be epileptic, syncopal (anoxic) or due to other mechanisms
Semiology: initial symptoms, sign, and their sequence
Status Epilepticus: describes a situation where there is recurrent or continuous seizure activity lasting longer than 30 minutes during which the person does not regain consciousness
Engel 2001
Axis 2 is the epileptic seizure type, or types, experienced by the patient, derived from a list of accepted seizure types that represent diagnostic entities with etiologic, therapeutic, and/or prognostic implications. Localization within the brain should be specified when this is appropriate, and in the case of reflex seizures, the specific stimulus also will be specified here. The Task Force has constructed a list of accepted epileptic seizure types, including forms of status epilepticus, and precipitating factors for reflex seizures (Table 3). Seizure types have been divided into self-limited seizures and continuous seizures, and further divided into generalized seizures and focal seizures, but it is anticipated that other approaches to organization, categorization, and classification of seizure types will be devised for specific purposes.
Asix 2: Seizure type: from the List of Epileptic Seizures. Localization within the brain and precipitating stimuli for reflex seizures should be specified when appropriate.
Axis 2 is diagnosis of specific seizure type(s).
The concept of seizure type as a diagnostic entity, rather than merely a description of clinical behavior and EEG, as in the current 1981 seizure classification (Commission of ILAE, 1981), is a new concept (Engel, 2001). The intention is that the seizure-type diagnosis will have implications with respect to etiology, approaches to diagnostic evaluation, treatment and prognosis. One criticism of the ILAE approach to classification is that syndromic diagnoses often cannot be made. The establishment of seizure types as diagnostic entities makes it possible for patient management and prognosis to be derived from a diagnosis of a specific seizure type when a syndromic diagnosis is not evident. Recognized seizure types are listed in Table 3. Whereas there remains controversy regarding some seizure types, particularly focal seizures that occur mostly in older children and adults, there is general agreement on those seizure types that occur in infancy and early childhood.
Criteria for evaluating epileptic seizure types could include pathophysiologic mechanisms; anatomic substrates; response to AEDs; ictal EEG patterns; propagation; postictal features: and the epilepsy syndromes in which they occur.
2010 Berg
provoking or triggering factors, patterns of seizure occurrence with respect to sleep
natural evolution of seizure types
2014 Fischer
An epileptic seizure is a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.
A seizure that is provoked by a transient factor acting on an otherwise normal brain to temporarily lower the seizure threshold does not count toward a diagnosis of epilepsy.
Muscle contractions
of variable duration that
affects primarily axial muscles
Frequently occurs in clusters:
-short myoclonic jerk
-to a sustained tonic posture
-salaam posture (abduction of both arms)
Bancaud 1981
Postural
Tonic Seizure
Tonic axial seizures with extension of head, neck, and trunk may also occur
Luders 1998
Blume 2001
1.1.1.2 Postural: Adoption of a posture that may be bilaterally symmetric or asymmetric (as in a "fencing posture").
Location: Left/right/axial/generalized/bilateral asymmetric
Luders 1998
Epileptic Spasm
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Simple, unnatural movements
Like Broadman 4&6 stimulation
Blume 2001
1.1.1.1 Epileptic spasm (formerly infantile spasm): Noun: A sudden flexion, extension, or mixed extension flexion of predominantly proximal and truncal muscles that is usually more sustained than a myoclonic movement but not so sustained as a tonic seizure (i.e., ~1s). Limited forms may occur: grimacing, head nodding,. Epileptic spasms frequently occur in clusters
Engel 2001
Spasms
Berg 2010
Spasms: epileptic spasms, infantile spasms
Luders 1998
Epileptic Spasm
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Tonic seizures consist of sustained muscle contractions, usually lasting >3 s, that lead to “positioning.”
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Noachter 1999
Epileptiform Pattern
Synonym: epileptiform discharge, epileptiform activity. Describes transients distinguishable from background activity, with a characteristic spiky morphology, typically, but neither exclusively nor invariably, found in interictal EEGs of people with epilepsy.
Noachter 1999
Epileptiform Pattern
Synonym: epileptiform discharge, epileptiform activity. Describes transients distinguishable from background activity, with a characteristic spiky morphology, typically, but neither exclusively nor invariably, found in interictal EEGs of people with epilepsy.
Noachter 1999
Equipotential: Applies to regions of the head or electrodes that are at the same potential at a given instant in time.
Synonym: isopotential line.
Show the gene section
Etiology should not be confused with provocative factors, as some etiologies will produce an enduring tendency to have seizures. Acute insult versus enduring pathology?
Gastaut 1970
Etiology
ILAE 1989
Etiology
Idiopathic: not preceded or occasioned by another disease other than a possible hereditary predisposition
Idiopathic defined by age-related onset, clinical, EEG, genetics
Cryptogenic: cause hidden or occult, etiology is unknown
Luders 1998
Cause
SIGN 2005
Probable causes
Syncope: transient loss of consciousness due to a sudden decrease in cerebral perfusion of oxygenated blood
Engel 2006
Axis 5: Etiology, from a classification of diseases frequently associated with epileptic seizure or epilepsy syndromes when possible, genetic defects, or specific pathological substrates for symptomatic focal epilepsies
The intention is that the seizure-type diagnosis will have implications with respect to etiology, approaches to diagnostic evaluation, treatment and prognosis.
Scheuermann 2009
Etiological Process: A process in an organism that leads to a subsequent disorder.
The etiological process creates the physical basis of that disposition to pathological processes which is the disease
Berg 2010
specific underlying cause
"cause is no longer equated with prognosis"
Noachter 1999
Event-related (slow) potential: Applied mainly to those evoked potentials elicited by cognitive activities.
Abbreviation: ERP (see evoked potential).
Noachter 1999
Evoked Potential: Wave or complex elicited by and time-locked to a physiological or non-physiological stimulus or event, the timing of which can be reliably assessed, for instance, an electrical stimulus, delivered to a sensory receptor or nerve or applied directly to a discrete area of the brain or a movement (myoclonus).
Comment: computer summation techniques are especially suitable for detecting these and other event-related potentials from the surface of the head.
Bancaud 1981
exceptionally, fragmentary, primitive, infantile, or antisocial behavior
Is a or part of?
Blume 2001
Components of cognition:
Perception: symbolic conception of sensory information
Attention: appropriate selection of a principal perception or task
Emotion: appropriate affective significance of a perception
Memory: ability to store and retrieve percepts or concepts
Executive function: anticipation, selection, monitoring of consequences, and initiation of motor activity including praxis, speech
Bancaud 1981
Extension
Bancaud 1981
Extensor Muscle Group
Bancaud 1981
Extremities
Bancaud 1981
Bancaud 1981
Eyelids
Bancaud 1981
Eyes
it means eyes staring and not moving
JB: Yeah, and in building building it behind it and I suppose this is this this can be again another project what are the synonymies that people use that describe staring or lack of eye movement.
RY: Sure.
JB: Lights on, nobody home. That’s a common one. Looking right through you. That’s a common one.
JB: And, in my note, I have a free text box for the family to describe what they see, before I interpret it.
Bancaud 1981
Face
Bancaud 1981
Tone is sufficiently diminished to cause this person to fall.
Bancaud 1981
Tone is sufficiently diminished to cause this person to fall.
Bancaud 1981
Falling in space
Engel 2001
Familial autosomal dominant focal epilepsies
Engel 2001
Familial Focal Epilepsy with Variable Foci
Syndromes in development
ILAE 2010
Childhood to Adult
Familial Focal Epilepsy with Variable Foci
Engel 2001
Familial Temporal Lobe Epilepsy
Bancaud 1981
A distorted memory experience such as distorted memory experience
ILAE 1989
Epilepsy
Seizures
Convulsions
Febrile Convulsions
SIGN 2006
In all patients with newly diagnosed epilepsy, a 3 generation family history should be taken (siblings, parents, grandparents, uncles, aunts, cousins)
Families with a history of epilepsy should be referred to the clinical genetic seevice particularly if three or more family members of the family are affected
Families should be given information about the genetic aspects of epilepsy and likely recurrence risks
Bancaud 1981
Fast Activity or a Fast Rhythm or 9-10c/sec
10c/sec or more
Noachter 1999
Fast Activity: Activity of frequency higher than alpha, i.e. beta and gamma activity.
Noachter 1999
Fast Alpha Variant Rhythm: Characteristic rhythm at 14-20 Hz, detected most prominently over the posterior regions of the head. May alternate or be intermixed with alpha rhythm. Blocked or attenuated by attention, especially visual, and mental effort.
Noachter 1999
Fast Wave: Wave with duration shorter than alpha waves, i.e. under 1/13 s.
<1/13s
Interview not semiology
Bancaud 1981
Bancaud 1981
Fear or terror is the most frequent sympto; is is sudden in onset, usually unprovoked and may lead to running away.
ILAE 1989
Febrile convulsions
Febrile convulsions are an age-related disorder almost always characterized by generalized seizures occurring during an acute febrile illness. Most febrile convulsions are brief and uncomplicated, but some may be more prolonged and followed by transient or permanent neurologic sequelae, such as the hemiplegia-hemiatrophy-epilepsy(HHE) syndrome. Febrile convulsions tend to recur in about one-third of affected patients. Controversy about the risks of developing epilepsy later have largely been resolved by some recent large studies; the overall risk is probably not more than 4%. The indications for prolonged drug prophylaxis against recurrence of febrile convulsions are now more clearly defined, and most individuals do not require prophylaxis. Essentially, this condition is a relatively benign disorder of early childhood.
Engel 2001
Another change in terminology evident in this document is the omission of the words “convulsion” and “convulsive” in the list of epileptic seizure types and epilepsy syndromes. The Task Force thought that these are nonspecific lay terms, and at times improperly used. Consequently it was agreed to be consistent, not only in descriptive ictal terminology, but also in naming epileptic seizure types and syndromes, to avoid these terms. For instance, the Task Force is proposing that the term “febrile convulsions” be replaced by “febrile seizures.”
Suleiman 2013
Febrile infection-related epilepsy syndrome (van Baalen et al., 2010) or fer-induced refractory epileptic encephalopathy in school-aged children (Nabbout et al., 2010, 2011), both called fever-induced refractory epileptic encephalopathy in school-aged children (FIRES).
Engel 2001
Febrile Seizures
Another change in terminology evident in this document is the omission of the words “convulsion” and “convulsive” in the list of epileptic seizure types and epilepsy syndromes. The Task Force thought that these are nonspecific lay terms, and at times improperly used. Consequently it was agreed to be consistent, not only in descriptive ictal terminology, but also in naming epileptic seizure types and syndromes, to avoid these terms. For instance, the Task Force is proposing that the term “febrile convulsions” be replaced by “febrile seizures.”
ILAE 2010
Febrile Seizures
Seizrues with fever beyond 6 years of age.
Different kinds of seizures w/ or w/o fever who had febrile seizure
SCN1a mutation: 60-70%
Engel 2001
Generalized Epilepsies with Febrile Seizures Plus
Syndromes in development
ILAE 2010
Febrile Seizures Plus (FS+)
Can start in infancy
Associated with Dravet Syndrome
Suleiman 2013
Febrile infection-related epilepsy syndrome (van Baalen et al., 2010) or fer-induced refractory epileptic encephalopathy in school-aged children (Nabbout et al., 2010, 2011), both called fever-induced refractory epileptic encephalopathy in school-aged children (FIRES).
Bancaud 1981
A distorted memory experience such as distorted memory experience (a flashback)
Bancaud 1981
Flashes, Flashing Lights
Blume 2001
Visual: Flashing or flickering lights, spots, simple patterns, scotomata, or amaurosis.
Engel 2001
Flickering Lights: Color_To_Be_Specified_When_Possible
Bancaud 1981
Flexor muscle group
Blume 2001
Visual: Flashing or flickering lights, spots, simple patterns, scotomata, or amaurosis.
Bancaud 1981
Floating
Bancaud 1981
Flushing
Gastaut 1970
Focal Onset
Bancaud 1981
Focal
Noachter 1999
Focal: Limited to a small area of the brain, i.e. recorded in one or two intracranial electrodes (see regional, multifocal).
Blume 2001
Focal
(syn. partial)
A seizure whose initial semiology indicates, or is consistent with, initial activation of only part of one cerebral hemisphere.
Engel 2001
Focal or multifocal cortical dysplasia
Engel 2001
Focal heterotopia
Engel 2001
DIsorders of folic acid and B12 metabolism
Noachter 1999
Form: Shape of a wave. Synonym: wave form, morphology.
Trancred 2005
The Fornix is the major output pathway of the hippocampal formation. It contains fibres which pass from the hippocampus to the septal area, mammillary body and anterior nucleus as well as to the hippocampal formation of the opposite side.
Structures:
Alveus
Anterior Commissure
Anterior Nucleus
Circuit of Papez
Corpus Callosum - Splenium
Fimbria
Fornix - Body
Fornix - Column
Fornix - Crus
Hippocampal Commissure
Hippocampal Formation
Hippocampal Gyrus
Hypothalamus
Interventricular Foramen
Mammillary Body
Thalamus
Information:
The fornix is the major efferent pathway of the hippocampal formation, although it also contains a significant number of afferents to the hippocampus. The hippocampal efferents arise mainly from the pyramidal cells in the hippocampal gyrus and subiculum. They then cross the surface of the hippocampal gyrus as the alveus before aggregating together on its dorsomedial surface to form the first part of the fornix, the fimbria.
The crus of the fornix is a continuation of the fimbria at the caudal end of the hippocampal gyrus, beneath the splenium of the corpus callosum. It passes upwards and medially over the posterior surface of the thalamus. As it approaches the midline just beneath the splenium of the corpus callosum, some fibres decussate to enter the opposite crus forming the hippocampal commissure (these decussating fibres end in the opposite hippocampal formation). Above the dorsal surface of the thalamus, the two crura then merge with each other to form the body of the fornix, which travels forward for a short distance before separating into two columns.
The columns of the fornix curve ventrally in front of the interventricular foramen and posterior to the anterior commissure. Some fibres leave the column of the fornix just above the anterior commissure, forming the precommissural part of the fornix which terminates in the septal area and anterior part of the hypothalamus. The remaining fibres in the fornix form the postcommissural part which traverses the gray matter of the hypothalamus, dividing it into medial and lateral regions. The fibres of the postcommissural part terminate mainly in the mammillary body with a lesser number terminating in the anterior nucleus of the thalamus.
The fornix forms part of the Circuit of Papez and its integrity is essential for the acquisition of new memories.
Engel 2001
Fragile X syndrome
Bancaud 1981
exceptionally, fragmentary, primitive, infantile, or antisocial behavior
Noachter 1999
Frequency: Number of complete cycles of repetitive waves or complexes in 1 s. Measured in cycles per second (c/s) or Hertz (Hz).
Comment: the term Hz seems appropriate when applied to sinusoidal waves such as alpha activity, but seems inappropriate when applied to complex wave forms such as spike-and-slow-wave.
Bancaud 1981
Decreasing in frequency
As the frequency diminishes
Noachter 1999
Frontal Intermittent Rhythmic Delta Activity: Fairly regular, approximately sinusoidal or saw-tooth waves, mostly occurring in bursts at 1.5-2.5 Hz over the frontal areas of one or both sides of the head.
Abbreviation: FIRDA.
Comment: most commonly associated with unspecified encephalopathy.
1981
Frontal also in frontal temporal
Tancred 2005
The frontal lobe controls voluntary movements of the opposite side of the body (primary and premotor areas) and is important in the dtermination of mood, emotional responses, motivational and anxiety levels (prefrontal area).
Structures:
Central Sulcus
Cerebral Hemisphere
Cingulate Gyrus
Corpus Callosum
Gyrus Rectus
Inferior Frontal Gyrus
Inferior Frontal Sulcus
Lateral Fissure
Limbic Area
Middle Frontal Gyrus
Motor Speech (Broca's) Area
Olfactory Sulcus
Olfactory Tract
Orbital Gyri
Pars Opercularis (Inf. Fr. G.)
Pars Orbitalis (Inf. Fr. G.)
Pars Triangularis (Inf. Fr. G.)
Precentral Gyrus
Precentral Sulcus
Prefrontal Area
Premotor Area
Primary Motor Area
Superior Frontal Gyrus
Superior Frontal Sulcus
Triangular Sulcus
Information:
The frontal lobe occupies the anterior part of the cerebral hemisphere.
Boundaries:
On the lateral surface it extends from the frontal pole posteriorly to the central sulcus and is bounded inferiorly by the lateral fissure. On the medial surface it extends posteriorly to an imaginary line from the central sulcus to the corpus callosum.
Sulci and Gyri:
The superolateral surface of the frontal lobe is formed by the superior, middle and inferior frontal gyri which extend in an anteroposterior direction and the precentral gyrus which extends vertically downwards. The superior and inferior frontal gyri are separated by the superior frontal sulcus and the middle and inferior gyri are separated by the inferior frontal sulcus. The precentral sulcus separates the precentral gyrus from the frontal gyri.
The inferior frontal gyrus is divided from anterior to posterior into the pars orbitalis, pars triangularis and pars opercularis by the triangular sulcus. The superior frontal gyrus extends onto the medial surface as far as the cingulate gyrus, the anterior part of which is also included in the frontal lobe. The inferior surface of the frontal lobe is formed by the orbital gyri, which overlie the bony roof of the orbit and gyrus rectus (most medially). The orbital gyri and gyrus rectus are separated by the olfactory sulcus, which contains the olfactory tract.
Functional Areas:
The frontal lobe includes a number of important functional areas:
(1) Primary motor area - located on the precentral gyrus.
(2) Premotor area - located on the anterior part of the precentral gyrus and the adjacent parts of the superior and middle frontal gyri.
(3) Prefrontal area - which includes the remainder of the superior and middle frontal gyri, the orbital part of the inferior frontal gyrus and the orbital gyri.
(4) Motor Speech (Broca's) Area - located on the triangular and opercular parts of the inferior frontal gyrus.
(5) Limbic Area - located on the cingulate gyrus.
ILAE 1989
Frontal lobe epilepsies
Frontal lobe epilepsies are characterized by simple partial, complex partial, secondarily generalized seizures or combinations of these. Seizures often occur several times a day and frequently occur during sleep. Frontal lobe partial seizures are sometimes mistaken for psychogenic seizures. Status epilepticus is a frequent complication.
General characteristics
Features strongly suggestive of the diagnosis include:
1. Generally short seizures.
2. Complex partial seizures arising from the frontal lobe, often with minimal or no postictal
confusion.
3. Rapid secondary generalization (more common in seizures of frontal than of temporal lobe epilepsy).
4. Prominent motor manifestations which are tonic or postural.
5. Complex gestural automatisms frequent at onset.
6. Frequent falling when the discharge is bilateral.
A number of seizure types are described below; however, multiple frontal areas may be involved rapidly and specific seizure types may not be discernible.
Engel 2001
Fructose 1-6 diphsphatase deficiency
Engel 2001
Fumarase deficiency
Bancaud 1981
Fumbling of clothes
Noachter 1999
Gamma Band: Frequency band above 40 Hz.
Greek letter: <Beta> (see beta band).
Comment: practically, most electroencephalographs use trace writers that appreciably attenuate frequencies higher than 70 Hz. The customary use of relatively slow paper speeds or time scales further limits the electroencephalographer's ability to resolve visually waves of frequencies higher than 40 Hz. The graphic resolution of computer displays may also limit the visual appreciation of higher frequencies. However, this does not justify limiting unduly the high frequency response of the EEG channels, for EEG waves include transients such as spikes and sharp waves with components at frequencies above 50 Hz (see beta rhythm) (not a synonym).
>40Hz
Noachter 1999
Gamma Rhythm: An EEG rhythm above 40 Hz.
Comment: most commonly recorded with intracranial electrodes.
<1/40s
Engel 2001
Gangliocytoma
Engel 2001
Ganglioglioma
ILAE 1989
A juvenile form of Gaucher disease is marked by onset at ~6-8 years of age, with epileptic seizures of various types, most commonly GTCS or partial motor. The EEG shows progressive deterioration of background activity, abnormal photic response, diffuse paroxysmal abnormalities, and multifocal abnormalities with a clear posterior predominance.
Bancaud 1981
Gelastic seizure laughter
Luders 1998
Gelastic Seizure
Location: Left/right hemisphere
Seizures in which the main motor manifestation is “laughing’’ are termed gelastic seizures. They may be preceded or followed by any other type of seizure. Only seizures in which the main ictal semiology is laughing should be classified as gelastic seizures. These seizures are classified separately because they are common in patients with hypothalamic hamartoma.
Laughing
Preceded/followed by any other seizure type
Complex, natural movement inappropriate for the situation
Common in pts w/ hypothalamic hamartoma
Blume 2001
Gelastic: Bursts of laughter or giggling, usually without an appropriate affective tone.
Engel 2001
Gelastic seizure
ILAE 2010
Gelastic Seizures with Hypothalamic Hamartoma
Luders 1998
Gelastic seizures.
Seizures in which the main motor manifestation is “laughing’’ are termed gelastic seizures. They may be preceded or followed by any other type of seizure. Only seizures in which the main ictal semiology is laughing should be classified as gelastic seizures. These seizures are classified separately because they are common in patients with hypothalamic hamartoma.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Need help figuring out General versus Diffuse versus Bilateral
Blume 2001 General
I 6.0
II 4.1.2
Gastaut 1970
Generalized
Bancaud 1981
Generalized
Luders 1998
The modifier generalized is used when the manifestations occur in a relatively widespread distribution and there is approximately equal involvement of both sides and of the distal and proximal segments.
ILAE 1989
Generalized
Blume 2001
I 6.0
Generalized
(syn. bilateral)
A seizure whose initial semiology indicates, or is consistent with, more than minimal involvement of both cerebral hemispheres.
Blume 2001
II 4.1.2 Generalized: More than minimal involvement of each side as a motor, elementary sensory, or autonomic phenomenon. Motor component can be further modified as asymmetrical and symmetrical.
Noachter 1999
Generalized: Occurring over all regions of the head, usually with a frontal maximum, rarely with an occipital maximum.
ILAE 1989
Precipitated seizures are those in which environmental or internal factors consistently precede the attacks and are differentiated from spontaneous epileptic attacks in which precipitating factors cannot be identified. Certain nonspecific factors (e.g., sleeplessness, alcohol or drug withdrawal, or hyperventilation) are common precipitators and are not specific modes of seizure precipitation. In certain epileptic syndromes, the seizures clearly may be somewhat more susceptible to nonspecific factors, but this is only occasionally useful in classifying epileptic syndromes.
An epilepsy characterized by specific modes of seizure precipitation, however, is one in which a consistent relationship can be recognized between the occurrence of one or more definable nonictal events and subsequent occurrence of a specific stereotyped seizure. Some epilepsies have seizures precipitated by specific sensation or perception (the reflex epilepsies) in which seizures occur in response to discrete or specific stimuli. These stimuli are usually limited in individual patients to a single specific stimulus or a limited number of closely related stimuli. Although the epilepsies which result are usually generalized and of idiopathic nature, certain partial seizures may also occur following acquired lesions, usually involving tactile or proprioceptive stimuli.
Epileptic seizures may also be precipitated by sudden arousal (startle epilepsy); the stimulus is unexpected in nature. The seizures are usually generalized tonic but may be partial and are usually symptomatic.
Seizures precipitated by integration of higher cerebral function such as memory or pattern recognition are most often associated with complex partial epilepsies, but are occasionally observed in generalized epilepsies (such as reading epilepsy). Seizures also occur spontaneously in most such patients.
Bancaud 1981
Generalized Seizures (Convulsive or Nonconvulsive)
Generalized seizures are those in which the first clinical changes indicate initial involvement of both hemispheres. Consciousness may be impiared and this impairment may be the initial manifestation. motor manifestations are bilateral. The ictal electroencephalographic patterns initially are bilateral, and presumably refelct neuronal discharge which is widespread in both hemispheres.
Generalized Seizures
Bancaud 1981
e.g. absence status or tonic clonic status
describing what one sees, generalized (bilateral) is an accurate description
Blume 2001
1.1.3 Tonic-Clonic: A sequence consisting of a tonic followed by a clonic phase. Variants such as clonic-tonic-clonic may be seen.
1.1.3.1 Generalized Tonic-Clonic Seizure: Noun: Bilateral symmetric tonic contraction and then bilateral clonic contractions of somatic muscles, usually associated with autonomic phenomena.
Engel 2001
Epilepsy with Generalized Tonic-Clonic Seizures Only
Luders 1998
Tonic-Clonic Seizure
Generalized tonic-clonic seizures are characterized by an initial tonic posturing of all limbs. The sustained muscle contractions that determined the tonic phase then tend to slow, evolving into a clonic phase with contractions of progressively decreasing frequency until the contractions disappear completely. The muscles included in the tonic and clonic phase should be essentially the same. Focal motor seizures showing such a tonic-clonic evolution are infrequent.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Engel 2001
Generalized Tonic-Clonic Status Epilepticus
ILAE 1989
Presumed genetic etiology
Scheuermann 2009
Disease correlates with genetic and environmental variables
Scheuermann 2009
Genetic Disorder: A disorder whose etiology involves an abnormality in the nucleotide sequence of an organism’s genome.
Scheuermann 2009
Genetic Predisposition to Disease of Type X: A predisposition to disease of type X whose physical basis is a constitutional abnormality in an organism’s genome. This abnormality is the physical basis for the increased risk of acquiring disease X.
Examples: p53 mutation in Li-Fraumeni Syndrome predisposing to cancer; ApoE alleles predisposing to Alzheimer’s disease.
SIGN 2006
molecular genetic test
Blume 2001
Gestural: Often unilateral. Fumbling or exploratory movements with the hand, directed toward self or environment. Movements resembling those intended to lend further emotional tone to speech.
Engel 2001
Glucose transport protein deficiency
Engel 2001
Glycogen-storage disorders
Blume 2001
1.1.3 Tonic-Clonic: A sequence consisting of a tonic followed by a clonic phase. Variants such as clonic-tonic-clonic may be seen.
1.1.3.1 Generalized Tonic-Clonic Seizure: Noun: Bilateral symmetric tonic contraction and then bilateral clonic contractions of somatic muscles, usually associated with autonomic phenomena.
Bancaud 1981
If spoken to, the patient may grunt or turn to the spoken voice and then touched or tickled may rub the site.
Bancaud 1981
Gustatory Aura
Gustatory Hallucination
Pleasant or odious taste hallucinations
Crude (salty, sour, sweet, bitter) to sophisticated
Frequently described as "metallic"
ILAE 1989
Luders 1998
Gustatory Aura
Perception of a taste as an epileptic phenomenon is classified as a gustatory aura. These auras also tend to be associated with complex perceptual alterations. The term gustatory aura should be applied only when the gustatory hallucination is the predominant symptom.
Blume 2001
2.2.1.5 Gustatory: Taste sensations including acidic, bitter, salty sweet, or metallic.
Luders 1998
Gustatory Aura
Perception of a taste as an epileptic phenomenon is classified as a gustatory aura. These auras also tend to be associated with complex perceptual alterations. The term gustatory aura should be applied only when the gustatory hallucination is the predominant symptom.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Bancaud 1981
Pleasant or odious taste hallucinations varying in elaboration from crude (salty, sour, sweet, bitter) to sophisticated and are frequently described as "metallic."
Blume 2001
Gustatory: Taste sensations including acidic, bitter, salty, sweet, or metallic.
Bancaud 1981
Pleasant or odious taste hallucinations varying in elaboration from crude (salty, sour, sweet, bitter) to sophisticated and are frequently described as "metallic."
Blume 2001
Gustatory: Taste sensations including acidic, bitter, salty, sweet, or metallic.
Blume 2001
Gustatory: Taste sensations including acidic, bitter, salty, sweet, or metallic.
Bancaud 1981
Gustatory Symptom
Gustatory Sensation
Blume 2001
Gustatory: Taste sensations including acidic, bitter, salty, sweet, or metallic.
Not a semiology
Blume 2001
Gustatory: Taste sensations including acidic, bitter, salty, sweet, or metallic.
Bancaud 1981
Structured hallucinations: Hallucinations may occur as manifestations or perceptions without a corresponding external stimulus and may affect somatosensory, visual, auditory, olfactory, or gustatory senses. If the seizure arises from the primary receptive area, the hallucination would tend to be rather primitive. In the case of vision, flashing lights may be seen; in the case of auditory perception, rushing noises may occur. With more eleborate seizures involving visual or auditory association areas with participation of mobilized memory traces, formed hallucinations occur and these may take the form of scenery, persons, spoken sentences, or music. The character of these percpetions may be normal or distorted.
Blume 2001
Hallucinatory: A creation of composite perceptions without corresponding external stimuli involving visual, auditory, somatosensory, olfactory, and/or gustatory phenomena. Example: “hearing” and “seeing” people talking.
RY: Okay family …yeah, we got that. So, everytime it talks about right versus left handed what does that mean to you as a neurologist? In terms of the diagnosis of epilepsies?
JB: Handedness? Or, …
RY: yeah, right handed, left-handed ambidextrous.
JB: It has two implications. First is with regard to a language and hemispheric dominance. If someone is right-handed, they have a 98% chance or higher of language being on the left. And so it is there.
RY: But, if it’s on the left side, it is 50-50 right? Or has that changed?
JB: What do you mean?
RY: Meaning if you are left handed, it’s equally…
JB: It’s pretty close to that it is about 60/40. But…
RY: Got it.
JB: But there’s two other issues, one is if someone hasn’t developed handedness that suggests pathology in both hemispheres. And if someone develops handedness too early, so if the story is my three-year-old child has been right-handed since he started playing with a rattle at three months of age, that’s abnormal and what that says is their right hand left hemisphere dominant. The only way that can happen is f there is right hemispheric damange.
RY: Okay and is there a threshold time cut off for that?
JB: You usually think about a year.
Bancaud 1981
Head
Bancaud 1981
Headache
Blume 2001
Cephalic: Sensation in the head such as light-headedness, tingling or headache.
Blume 2001
Hemi: A prefix to other descriptors (e.g., hemiclonic).
Engel 2001
Hemiclonic Seizures
ILAE 2010
Hemiconvulsion-Hemiplegia-Epilepsy
Engel 2001
Hemiconvulsion-Hemiplegia Epilepsy (HHE) Syndrome
Engel 2001
Hemimegalencephaly
Engel 2001
Herpes encephalitis
SIGN 2006
An accurate history of the event should be taken from first-hand witness and the child
Scheuermann 2009
Clinical History Taking: An interview in which a clinician elicits a clinical history from a patient or from a third party who is authorized to make health care decisions on behalf of the patient.
Buchhalter: has to do with reliability (history of observer)
Luders 1998
mentioned in meeting
Engel 2001
Hot Water
Blume 2001
Hyperkinetic: Involves predominantly proximal limb or axial muscles producing irregular sequential ballistic movements, such as pedaling, pelvic thrusting, thrashing, rocking movements. Increase in rate of ongoing movements or inappropriately rapid performance of a movement.
Luders 1998
Hypermotor Seizure
Location: Left Hemisphere/Right Hemisphere
Hypermotor seizures are seizures in which the main manifestations consist of complex movements involving the proximal segments of the limbs and trunk. This results in large movements that appear “violent” when they occur at high speeds. The “complex motor manifestations” imitate normal movements, but the movements are inappropriate for the situation and usually serve no purpose. Frequently, the movements are stereotypically repeated in more or less complex sequences (e.g., pedaling). Consciousness may be preserved during these seizures.
Luders 1998
Hypermotor Seizures
Hypermotor seizures are seizures in which the main manifestations consist of complex movements involving the proximal segments of the limbs and trunk. This results in large movements that appear “violent” when they occur at high speeds. The “complex motor manifestations” imitate normal movements, but the movements are inappropriate for the situation and usually serve no purpose. Frequently, the movements are stereotypically repeated in more or less complex sequences (e.g., pedaling). Consciousness may be preserved during these seizures.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Bancaud 1981
Hypertension
Noachter 1999
Hyperventilation: Deep and regular respiration performed for a period of several minutes. Used as activation procedure.
Synonym: overbreathing (see activation).
Blume 2001
Hypokinetic: A decrease in amplitude and/or rate or arrest of ongoing motor activity.
Engel 2001
Hypermelanosis of Ito
Decrease or total absence of motor activity w/o emergence of new motor manifestations
Used when not possible to test consciousness during or after the seizure (newborns, infants, severe mental retardation)
Consciousness probably altered or consciousness may be preserved
Absence of movement may be expression of akinetic seizure or reaction to an aura
Luders 1998
Luders 1998
Hypomotor Seizure
Location: Left hemisphere/right hemisphere
Decrease or total absence of motor activity w/o emergence of new motor manifestations
Used when not possible to test consciousness during or after the seizure (newborns, infants, severe mental retardation)
Consciousness probably altered or consciousness may be preserved
Absence of movement may be expression of akinetic seizure or reaction to an aura
Luders 1998
Hypomotor seizures have as their main manifestation a decrease or total absence of motor activity without the emergence of new motor manifestations. This classification is used exclusively in patients in whom it is not possible to test consciousness during or after the seizure (such as newborns, infants, and severely mentally retarded patients). In many patients, consciousness is probably altered during the seizures even if by definition consciousness cannot be tested directly. In a few patients with hypomotor seizures, the pathogenesis of the seizures may be different; consciousness may be preserved, and the absence of movement may be an expression of an akinetic seizure or may be a reaction to an aura.
Luders 1998
Hypomotor Seizure
Location: Left hemisphere/right hemisphere
Hypomotor seizures have as their main manifestation a decrease or total absence of motor activity without the emergence of new motor manifestations. This classification is used exclusively in patients in whom it is not possible to test consciousness during or after the seizure (such as newborns, infants, and severely mentally retarded patients). In many patients, consciousness is probably altered during the seizures even if by definition consciousness cannot be tested directly. In a few patients with hypomotor seizures, the pathogenesis of the seizures may be different; consciousness may be preserved, and the absence of movement may be an expression of an akinetic seizure or may be a reaction to an aura.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
This is an instance of a Hamartoma
ILAE 1989
Hypothalamic hamartomas may present with gelastic seizures, precocious puberty, and retardation.
Engel 2001
Hypothalamic Hamartoma
(With Gelastic Seizures)
Trancred 2005
The Hypothalamus is involved in the maintenance of homeostasis, the regulation of feeding, drinking, and sexual activity, circadian rhythms and emotional expression.
Structures:
Arcuate Nucleus
Diencephalon
Hypophysis
Hypothalamic Sulcus
Hypothalamus
Hypothalamus - Connections
Hypothalamus - Nuclei
Lamina Terminalis
Mammillary Body
Neurohypophysis
Optic Tract
Supraoptic Nucleus
Thalamus
Third Ventricle
Information:
The hypothalamus is a small region (approximately 4g in weight) which occupies the ventral part of the diencephalon, separated from the thalamus by the hypothalamic sulcus. Its importance is disproportionate in comparison with its small size. Its functions are associated with the maintenance of homeostasis and with the survival of the species (eg. feeding, drinking, reproduction).
The hypothalamus surrounds the floor and lower lateral sides of the third ventricle. It extends anteriorly as far as the lamina terminalis and caudally to the posterior edge of the mammillary bodies. It can be seen on the ventral surface of the brain behind the optic chiasm and medial to the optic tracts. The region bounded by the optic chiasm and tracts and the mammillary bodies is known as the tuber cinereum. The median eminence, a swelling in the anterior part of the tuber cinereum just behind the optic tracts gives rise to the infundibular stem (infundibulum) which expands to form the infundibular process. Together the median eminence and the infundibular stem and process are called the neurohypophysis. The neurohypophysis constitutes the posterior part of the hypophysis (also known as the pituitary gland).
The fornix passes through the hypothalamus in an anteroposterior direction towards the mammillary body and in so-doing, divides the hypothalamus into medial and lateral parts. The lateral part contains fibre tracts passing through plus some poorly defined nuclei which are collectively referred to as the lateral nuclei. The medial part can be further subdivided into 4 regions:
(i) Preoptic region - anterior to the optic chiasm, adjacent to lamina terminalis. coantains the preoptic nucleus
(ii) Suprachiasmatic region - dorsal to the optic chiasm. Contains supraoptic,suprachiasmatic, paraventricular and anterior nuclei.
(iii) Tuberal region - dorsal to the tuber cinereum. Contains the arcuate, dorsomedian and ventromedian nuclei.
(iv) Posterior (mammillary) region - contains the posterior nucleus and the mammillary body.
Inter-ictal
Noachter 1999
Hypsarrhythmia: Pattern consisting of diffuse high voltage (>300 uV) irregular slow waves interspersed with multiregional spikes and sharp waves over both hemispheres.
Bancaud 1981
I. Partial (Focal, Local) Seizures
Partial seizures are those in which, in general, the first clinical and electroencephalographic changes indicate initial activation of a system of neurons limited to part of one cerebral hemisphere. A partial seizure is classified primarily on the basis of whether or not consciousness is impaired during the attack. When consciousness is not impaired, the seizure is classified as a simple partial seizure. When consciousness is impaired, the seizure is classified as a complex partial seizure. Impairment of consciousness may be the first clinical sign, or simple partial seizures may evolve into complex partial seizures. In patients with impaired consciousness, aberrations of behavior (automatisms) may occur. A partial seizure may not terminate, but instead progress to a generalized motor seizure. Impaired consciousness is defined as the inability to respond normally to exogenous stimuli by virtue of altered awareness and/or responsiveness (vide infra: Definition of Terms).
There is considerable evidence that simple partial seizures usually have unilateral hemispheric involvement and only rarely have bilateral hemispheric involvement; complex partial seizures, however, frequently have bilateral hemispheric involvement.
Partial seizures can be classified into one of the following three fundamental groups:
A. Simple partial seizures
B. Complex partial seizures
1. With impairment of consciousness at onset
2. Simple partial onset followed by impairment of consciousness
C. Partial seizures evolving to generalized tonic-clonic convulsions (GTC)
1. Simple evolving to GTC
2. Complex evolving to GTC (including those with simple partial onset)
Partial Seizures
The fundamental distinction between simple partial seizures and complex partial, seizures is the presence or the impairment of the fully conscious state.
Consciousness has been defined as “that integrating activity by which Man grasps the totality of his phenomenal field” (Evans, 1972) and incorporates it into his experience. It corresponds to “Bewusstsein” and is thus much more than “Vigilance,” for were it only vigilance (which is a degree of clarity) then only confusional states would be representative of disordered consciousness.
Operationally in the context of this classification, consciousness refers to the degree of awareness and/or responsiveness of the patient to externally applied stimuli. Responsiveness refers to the ability of the patient to carry out simple commands or willed movement and awareness refers to the patient’s contact with events during the period in question and its recall. A person aware and unresponsive will be able to recount the events that occurred during an attack and his inability to respond by movement or speech. In this context, unresponsiveness is other than the result of paralysis, aphasia or apraxia.
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
1. With motor signs. Any portion of the body may be involved in focal seizure activity depending on the site of origin of the attack in the motor strip. Focal motor seizures may remain strictly focal or they may spread to contiguous cortical areas producing a sequential involvement of body parts in an epileptic “march.” The seizure is then known as a Jacksonian seizure. Consciousness is usually preserved; however, the discharge may spread to those structures whose participation is likely to result in loss of consciousness and generalized convulsive movements. Other focal motor attacks may be versive with head turning to one side, usually contraversive to the discharge. If speech is involved, this is either in the form of speech arrest or occasionally vocalization. Occasionally a partial dysphasia is seen in the form of epileptic pallilalia with involuntary repetition of a syllable or phrase.
Following focal seizure activity, there may be a localized paralysis in the previously involved region. This is known as Todd’s paralysis and may last from minutes to hours.
When focal motor seizure activity is continuous it is known as epilepsia partialis continua.
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
2. Seizures with autonomic symptoms such as vomiting, pallor, flushing, sweating, piloerection, pupil dilatation, boborygmi, and incontinence may occur as simple partial seizures.
3. With somatosensory or special sensory symptoms. Somatosensory seizures arise from those areas of cortex subserving sensory function, and they are usually described as pins-and-needles or a feeling of numbness. Occasionally a disorder of proprioception or spatial perception occurs. Like motor seizures, somatosensory seizures also may march and also may spread at any time to become complex partial or generalized tonic-clonic seizures as in A.1. Special sensory seizures include visual seizures varying in elaborateness and depending on whether the primary or association areas are involved, from flashing lights to structured visual hallucinatory phenomena, including persons, scenes, etc. (see A.4.f.). Like visual seizures, auditory seizures may also run the gamut from crude auditory sensations to such highly integrated functions as music (see A.4.f.). olfactory sensations, usually in the form of unpleasant odors, may occur.
Gustatory sensations may be pleasant or odious taste hallucinations. They vary in elaboration from crude (salty, sour, sweet, bitter) to sophisticated. They are frequently described as “metallic.”
Vertiginous symptoms include sensations of falling in space, floating, as well as totatory vertigo in a horizontal or vertical plane.
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
2. Seizures with autonomic symptoms such as vomiting, pallor, flushing, sweating, piloerection, pupil dilatation, boborygmi, and incontinence may occur as simple partial seizures.
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
4a: Dysphasia. This was referred to earlier.
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
4b. Dysmnesic symptoms. A distorted memory experience such as distortion of the time sense, a dreamy state, a flashback, or a sensation as if a naive experience had been experienced before, known as deja vu, or as if a previously experienced sensation had not been experienced, known as jamais-vu, may occur. When this refers to auditory experiences these are known as deja-entendu or jamais-entendu. Occasionally as a form of forced thinking, the patient may experience a rapid recollection of episodes from his past life, known as panoramic vision.
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
4c. Cognitive disturbances may be experienced. These include dreamy states; distortions of the time sense; sensations of unreality, detachment, or depersonalization.
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
4d. With affective symptomatology. Sensation of extreme pleasure or displeasure, as well as fear and intense depression with feelings of unworthiness and rejection may be experienced during seizures. Unlike those of psychiatrically induced depression, these symptoms tend to come in attacks lasting for a few minutes. Anger or rage is occasionally experienced, but unlike temper tantrums, epileptic anger is apparently unprovoked, and abates rapidly. Fear or terror is the most frequent symptom; it is sudden in onset, usually unprovoked, and may lead to running away. Associated with the terror, there are frequently objective signs of autonomic activity, including pupil dilatation, pallor, flushing, piloerection, palpitation, and hypertension. Epileptic or gelastic seizure laughter should not, strictly speaking, be classed as an affective symptom because the laughter is usually without affect and hollow. Like other forms of pathological laughter it is often unassociated with true mirth.
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
4e. Illusions. These take the form of distorted perceptions in which objects may
appear deformed. Polyoptic illusions
such as monocular diplopia, distortions
of size (macropsia or micropsia) or of distance may occur. Similarly, distortions of sound, including microacusia and macroacusia, may be experienced. Depersonalization, as if the person were outside his body, may occur. Altered perception of size or weight of a limb may be noted.
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
4f. Structured hallucinations. Hallucinations may occur as manifestations or perceptions without a corresponding external stimulus and may affect somatosensory, visual, auditory, olfactory, or gustatory senses. If the seizure arises from the primary receptive area, the hallucination would tend to be rather primitive. In the case of vision, flashing lights may be seen; in the case of auditory perception, rushing noises may occur. With more elaborate seizures involving visual or auditory association areas with participation of mobilized memory traces, formed hallucinations occur and these may take the form of scenery, persons, spoken sentences, or music. The character of these perceptions may be normal or distorted.
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
4. With psychic symptoms (disturbance of higher cerebral function). These usually occur with impairment of consciousness (i.e., complex partial seizures).
Bancaud 1981
Clinical seizure type:
A. Simple partial seizures (consciousness not impaired)
EEG seizure type:
Local contrarateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG interictal expression:
Local contralateral discharge
Bancaud 1981
Clinical seizure type:
B. Complex partial seizures (with impairment of consciousness; may sometimes begin with simple symptomatology)
EEG seizure type:
Unilateral or, frequently bilateral discharge, diffuse or focal in temporal or frontotemporal regions
EEG interictal expression:
Local contralateral discharge
Unilateral or bilateral generally asynchronous focus; usually in the temporal or frontal regions
Bancaud 1981
Clinical seizure type:
B. Complex partial seizures (with impairment of consciousness; may sometimes begin with simple symptomatology)
EEG seizure type:
Unilateral or, frequently bilateral discharge, diffuse or focal in temporal or frontotemporal regions
EEG interictal expression:
Local contralateral discharge
Unilateral or bilateral generally asynchronous focus; usually in the temporal or frontal regions
Bancaud 1981
Clinical seizure type:
B. Complex partial seizures (with impairment of consciousness; may sometimes begin with simple symptomatology)
EEG seizure type:
Unilateral or, frequently bilateral discharge, diffuse or focal in temporal or frontotemporal regions
EEG interictal expression:
Local contralateral discharge
Unilateral or bilateral generally asynchronous focus; usually in the temporal or frontal regions
Bancaud 1981
Clinical seizure type:
B. Complex partial seizures (with impairment of consciousness; may sometimes begin with simple symptomatology)
EEG seizure type:
Unilateral or, frequently bilateral discharge, diffuse or focal in temporal or frontotemporal regions
EEG interictal expression:
Local contralateral discharge
Unilateral or bilateral generally asynchronous focus; usually in the temporal or frontal regions
Bancaud 1981
Clinical seizure type:
B. Complex partial seizures (with impairment of consciousness; may sometimes begin with simple symptomatology)
EEG seizure type:
Unilateral or, frequently bilateral discharge, diffuse or focal in temporal or frontotemporal regions
EEG interictal expression:
Local contralateral discharge
Unilateral or bilateral generally asynchronous focus; usually in the temporal or frontal regions
Bancaud 1981
Clinical seizure type:
B. Complex partial seizures (with impairment of consciousness; may sometimes begin with simple symptomatology)
EEG seizure type:
Unilateral or, frequently bilateral discharge, diffuse or focal in temporal or frontotemporal regions
EEG interictal expression:
Local contralateral discharge
Unilateral or bilateral generally asynchronous focus; usually in the temporal or frontal regions
Bancaud 1981
Clinical seizure type:
B. Complex partial seizures (with impairment of consciousness; may sometimes begin with simple symptomatology)
EEG seizure type:
Unilateral or, frequently bilateral discharge, diffuse or focal in temporal or frontotemporal regions
EEG interictal expression:
Local contralateral discharge
Unilateral or bilateral generally asynchronous focus; usually in the temporal or frontal regions
B. Seizures with Complex Symptomatology
Automatisms.
(These may occur in both partial and generalized seizures. They are described in detail here for convenience.) In the Dictionary of Epilepsy (Gastaut,1973), automatisms are described as “more or less coordinated adapted (eupractic or dyspractic) involuntary motor activity occurring during the state of clouding of consciousness either in the course of, or after an epileptic seizure, and usually followed by amnesia for the event. The automatism may be simply a continuation of an activity that was going on when the seizure occurred, or, conversely, a new activity developed in association with the ictal impairment of consciousness. Usually, the activity is commonplace in nature, often provoked by the subject’s environment, or by his sensations during the seizure; exceptionally, fragmentary, primitive, infantile, or antisocial behavior is seen. From a symptomatological point of view the following are distinguished: a) eating automatisms (chewing, swallowing); b) automatism of mimicry, expressing the subject’s emotional state (usually of fear) during the seizure; c) gestural automatisms, crude or elaborate; directed toward either the subject or his environment; d) ambulatory automatisms; e) verbal automatisms.”
lctal epileptic automatisms usually represent the release of automatic behavior under the influence of clouding of consciousness that accompanies a generalized or partial epileptic seizure (confusional automatisms). They may occur in complex partial seizures as well as in absence seizures. Postictal epileptic automatisms may follow any severe epileptic seizure, especially a tonic-clonic one, and are usually associated with confusion.
While some regard masticatory or oropharyngeal automatisms as arising from the amygdala or insular and opercular regions, these movements are occasionally seen in the generalized epilepsies, particularly absence seizures, and are not of localizing help. The same is true of mimicry and gestural automatisms. In the latter, fumbling of the clothes, scratching, and other complex motor activity may occur both in complex partial and absence seizures. Ictal speech automatisms are occasionally encountered. Ambulatory seizures again may occur either as prolonged automatisms of absence, particularly prolonged absence continuing, or of complex partial seizures. In the latter, a patient may occasionally continue to drive a car, although may contravene traffic light regulations.
There seems to be little doubt that automatisms are a common feature of different types of epilepsy. While they do not lend themselves to simple anatomic interpretation, they appear to have in common a discharge involving various areas of the limbic system. Crude and elaborate automatisms do occur in patients with absence as well as complex partial seizures. Of greater significance is the precise descriptive history of the seizures, the age of the patient, the presence or absence of an aura and of postictal behavior including the presence or absence of confusion. The EEG is of cardinal localizational importance here.
Drowsiness or somnolence implies a sleep state from which the patient can be aroused to make appropriate motor and verbal responses. In stupor, the patient may make some spontaneous movement and can be aroused by painful or other vigorously applied stimuli to make avoidance movements. The patient in confusion makes inappropriate responses to his environment and is disoriented as regards place or time or person.
Aura. A frequently used term in the description of epileptic seizures is aura. According to the Dictionary of Epilepsy, this term was introduced by Galen to describe the sensation of a breath of air felt by some subjects prior to the onset of a seizure. Others have referred to the aura as the portion of a seizure experienced before loss of consciousness occurs. This loss of consciousness may be the result of secondary generalization of the seizure discharge or of alteration of consciousness imparted by the development of a complex partial seizure.
The aura is that portion of the seizure which occurs before consciousness is lost and for which memory is retained afterwards. It may be that, as in simple partial seizures, the aura is the whole seizure. Where consciousness is subsequently lost, the aura is, in fact, the signal symptom of a complex partial seizure.
An aura is a retrospective term which is described after the seizure is ended.
Bancaud 1981
Clinical seizure type:
C. Partial seizures evolving to secondarily generalized seizures
(This may be generalized tonic-clonic, tonic, or clonic)
EEG seizure type:
EEG interictal expression:
Bancaud 1981
Clinical seizure type:
C. Partial seizures evolving to secondarily generalized seizures
(This may be generalized tonic-clonic, tonic, or clonic)
EEG seizure type:
EEG interictal expression:
Bancaud 1981
Clinical seizure type:
C. Partial seizures evolving to secondarily generalized seizures
(This may be generalized tonic-clonic, tonic, or clonic)
EEG seizure type:
EEG interictal expression:
Bancaud 1981
Clinical seizure type:
C. Partial seizures evolving to secondarily generalized seizures
(This may be generalized tonic-clonic, tonic, or clonic)
EEG seizure type:
EEG interictal expression:
II. GENERALIZED SEIZURES (CONVULSIVE OR NONCONVULSIVE)
Generalized seizures are those in which the first clinical changes indicate initial involvement of both hemi- spheres. Consciousness may be impaired and this impairment may be the initial manifestation. Motor manifestations are bilateral. The ictal electroencephalographic patterns initially are bilateral, and presumably reflect neuronal discharge which is widespread in both hemispheres.
Bancaud 1981
Clinical Seizure Type:
A. 1. Absence seizures
EEG Seizure Type:
Usually regular and symmetrical 3 Hz but may be 2-4 Hz spike- and-slow-wave complexes and may have multiple spike-and-slow- wave complexes. Abnormalities are bilateral
EEG Interictal Expression:
Background activity usually normal although paroxysmal activity (such as spikes or spike-and-slow-wave complexes) may occur. This activity is usually regular and symmetrical.
A. Absence Seizures
The hallmark of the absence attack is a sudden onset, interruption of ongoing activities, a blank stare, possibly a brief upward rotation of the eyes. If the patient is speaking, speech is slowed or interrupted; if walking, he stands transfixed; if eating, the food will stop on his way to the mouth. Usually the patient will be unresponsive when spoken to. In some, attacks are aborted when the patient is spoken to. The attack lasts from a few seconds to half a minute and evaporates as rapidly as it commenced.
A1. Absence with impairment of consciousness only. The above description fits the description of absence simple in which no other activities take place during the attack.
Bancaud 1981
Clinical Seizure Type:
A. 1. Absence seizures
EEG Seizure Type:
Usually regular and symmetrical 3 Hz but may be 2-4 Hz spike- and-slow-wave complexes and may have multiple spike-and-slow- wave complexes. Abnormalities are bilateral
EEG Interictal Expression:
Background activity usually normal although paroxysmal activity (such as spikes or spike-and-slow-wave complexes) may occur. This activity is usually regular and symmetrical.
A. Absence Seizures
The hallmark of the absence attack is a sudden onset, interruption of ongoing activities, a blank stare, possibly a brief upward rotation of the eyes. If the patient is speaking, speech is slowed or interrupted; if walking, he stands transfixed; if eating, the food will stop on his way to the mouth. Usually the patient will be unresponsive when spoken to. In some, attacks are aborted when the patient is spoken to. The attack lasts from a few seconds to half a minute and evaporates as rapidly as it commenced.
A2. Absence with mild clonic components. Here the onset of the attack is indistinguishable from the above, but clonic
movements may occur in the eyelids, at the
corner of the mouth, or in other muscle
groups which may vary in severity from almost imperceptible movements to generalized myoclonic jerks. Objects held in the hand may be dropped.
Bancaud 1981
Clinical Seizure Type:
A. 1. Absence seizures
EEG Seizure Type:
Usually regular and symmetrical 3 Hz but may be 2-4 Hz spike- and-slow-wave complexes and may have multiple spike-and-slow- wave complexes. Abnormalities are bilateral
EEG Interictal Expression:
Background activity usually normal although paroxysmal activity (such as spikes or spike-and-slow-wave complexes) may occur. This activity is usually regular and symmetrical.
A. Absence Seizures
The hallmark of the absence attack is a sudden onset, interruption of ongoing activities, a blank stare, possibly a brief upward rotation of the eyes. If the patient is speaking, speech is slowed or interrupted; if walking, he stands transfixed; if eating, the food will stop on his way to the mouth. Usually the patient will be unresponsive when spoken to. In some, attacks are aborted when the patient is spoken to. The attack lasts from a few seconds to half a minute and evaporates as rapidly as it commenced.
A3. Absence with atonic components. Here there may be a diminution in tone of muscles subserving posture as well as in the limbs leading to drooping of the head, occasionally slumping of the trunk, dropping of the arms, and relaxation of the grip. Rarely, tone is sufficiently diminished to cause this person to fall.
Bancaud 1981
Clinical Seizure Type:
A. 1. Absence seizures
EEG Seizure Type:
Usually regular and symmetrical 3 Hz but may be 2-4 Hz spike- and-slow-wave complexes and may have multiple spike-and-slow- wave complexes. Abnormalities are bilateral
EEG Interictal Expression:
Background activity usually normal although paroxysmal activity (such as spikes or spike-and-slow-wave complexes) may occur. This activity is usually regular and symmetrical.
A. Absence Seizures
The hallmark of the absence attack is a sudden onset, interruption of ongoing activities, a blank stare, possibly a brief upward rotation of the eyes. If the patient is speaking, speech is slowed or interrupted; if walking, he stands transfixed; if eating, the food will stop on his way to the mouth. Usually the patient will be unresponsive when spoken to. In some, attacks are aborted when the patient is spoken to. The attack lasts from a few seconds to half a minute and evaporates as rapidly as it commenced.
A4. Absence with tonic components. Here during the attack tonic muscular contraction may occur, leading to increase in muscle tone which may affect the extensor muscles or the flexor muscles symmetrically or asymmetrically. If the patient is standing the head may be drawn backward and the trunk may arch. This may lead to retropulsion. The head may tonically draw to one or another side.
Bancaud 1981
Clinical Seizure Type:
A. 1. Absence seizures
EEG Seizure Type:
Usually regular and symmetrical 3 Hz but may be 2-4 Hz spike- and-slow-wave complexes and may have multiple spike-and-slow- wave complexes. Abnormalities are bilateral
EEG Interictal Expression:
Background activity usually normal although paroxysmal activity (such as spikes or spike-and-slow-wave complexes) may occur. This activity is usually regular and symmetrical.
A. Absence Seizures
The hallmark of the absence attack is a sudden onset, interruption of ongoing activities, a blank stare, possibly a brief upward rotation of the eyes. If the patient is speaking, speech is slowed or interrupted; if walking, he stands transfixed; if eating, the food will stop on his way to the mouth. Usually the patient will be unresponsive when spoken to. In some, attacks are aborted when the patient is spoken to. The attack lasts from a few seconds to half a minute and evaporates as rapidly as it commenced.
A5. Absence with automatisms. (See also prior discussion on automatisms.) Purposeful or quasipurposeful movements occurring in the absence of awareness during an absence attack are frequent and may range from lip licking and swallowing to clothes fumbling or aimless walking. If spoken to the patient may grunt or turn to the spoken voice and when touched or tickled may rub the site. Automatisms are quite elaborate and may consist of combinations of the above-described movements or may be so simple as to be missed by casual observation. Mixed forms of absence frequently occur.
Bancaud 1981
Clinical Seizure Type:
A. 1. Absence seizures
EEG Seizure Type:
Usually regular and symmetrical 3 Hz but may be 2-4 Hz spike- and-slow-wave complexes and may have multiple spike-and-slow- wave complexes. Abnormalities are bilateral
EEG Interictal Expression:
Background activity usually normal although paroxysmal activity (such as spikes or spike-and-slow-wave complexes) may occur. This activity is usually regular and symmetrical.
Bancaud 1981
Clinical Seizure Type:
A. 1. Absence seizures
EEG Seizure Type:
Usually regular and symmetrical 3 Hz but may be 2-4 Hz spike- and-slow-wave complexes and may have multiple spike-and-slow- wave complexes. Abnormalities are bilateral
EEG Interictal Expression:
Background activity usually normal although paroxysmal activity (such as spikes or spike-and-slow-wave complexes) may occur. This activity is usually regular and symmetrical.
A. Absence Seizures
The hallmark of the absence attack is a sudden onset, interruption of ongoing activities, a blank stare, possibly a brief upward rotation of the eyes. If the patient is speaking, speech is slowed or interrupted; if walking, he stands transfixed; if eating, the food will stop on his way to the mouth. Usually the patient will be unresponsive when spoken to. In some, attacks are aborted when the patient is spoken to. The attack lasts from a few seconds to half a minute and evaporates as rapidly as it commenced.
A1. Absence with impairment of consciousness only. The above description fits the description of absence simple in which no other activities take place during the attack.
A2. Absence with mild clonic components. Here the onset of the attack is indistinguishable from the above, but clonic
movements may occur in the eyelids, at the
corner of the mouth, or in other muscle
groups which may vary in severity from almost imperceptible movements to generalized myoclonic jerks. Objects held in the hand may be dropped.
A3. Absence with atonic components. Here there may be a diminution in tone of muscles subserving posture as well as in the limbs leading to drooping of the head, occasionally slumping of the trunk, dropping of the arms, and relaxation of the grip. Rarely, tone is sufficiently diminished to cause this person to fall.
A4. Absence with tonic components. Here during the attack tonic muscular contraction may occur, leading to increase in muscle tone which may affect the extensor muscles or the flexor muscles symmetrically or asymmetrically. If the patient is standing the head may be drawn backward and the trunk may arch. This may lead to retropulsion. The head may tonically draw to one or another side.
A5. Absence with automatisms. (See also prior discussion on automatisms.) Purposeful or quasipurposeful movements occurring in the absence of awareness during an absence attack are frequent and may range from lip licking and swallowing to clothes fumbling or aimless walking. If spoken to the patient may grunt or turn to the spoken voice and when touched or tickled may rub the site. Automatisms are quite elaborate and may consist of combinations of the above-described movements or may be so simple as to be missed by casual observation. Mixed forms of absence frequently occur.
Bancaud 1981
Clinical Seizure Type:
A. 1. Atypical Absence Seizures
May have:
(a) Changes in tone that are more pronounced than in A.1
(b) Onset and/or cessation that is not abrupt
EEG Seizure Type:
EEG more heterogeneous; may include irregular spike-and-slow- wave complexes, fast activity or other paroxysmal activity. Ab- normalities are bilateral but often irregular and asymmetrical
EEG Interictal Expression:
Background usually abnormal: paroxysmal activity (such as spikes or spike-and-slow-wave complexes) frequently irregular and asymmetrical
Bancaud 1981
Clinical Seizure Type:
A. 1. Atypical Absence Seizures
May have:
(a) Changes in tone that are more pronounced than in A.1
(b) Onset and/or cessation that is not abrupt
EEG Seizure Type:
EEG more heterogeneous; may include irregular spike-and-slow- wave complexes, fast activity or other paroxysmal activity. Ab- normalities are bilateral but often irregular and asymmetrical
EEG Interictal Expression:
Background usually abnormal: paroxysmal activity (such as spikes or spike-and-slow-wave complexes) frequently irregular and asymmetrical
Bancaud 1981
Clinical Seizure Type:
A. 1. Atypical Absence Seizures
May have:
(a) Changes in tone that are more pronounced than in A.1
(b) Onset and/or cessation that is not abrupt
EEG Seizure Type:
EEG more heterogeneous; may include irregular spike-and-slow- wave complexes, fast activity or other paroxysmal activity. Ab- normalities are bilateral but often irregular and asymmetrical
EEG Interictal Expression:
Background usually abnormal: paroxysmal activity (such as spikes or spike-and-slow-wave complexes) frequently irregular and asymmetrical
Bancaud 1981
Clinical Seizure Type:
A. 1. Absence seizures
EEG Seizure Type:
Usually regular and symmetrical 3 Hz but may be 2-4 Hz spike- and-slow-wave complexes and may have multiple spike-and-slow- wave complexes. Abnormalities are bilateral
EEG Interictal Expression:
Background activity usually normal although paroxysmal activity (such as spikes or spike-and-slow-wave complexes) may occur. This activity is usually regular and symmetrical.
Bancaud 1981
Clinical Seizure Type:
B. Myoclonic seizures
Myoclonic jerks
(single or multiple)
EEG Seizure Type:
Polyspike and wave, or sometimes spike and wave or sharp and slow waves
EEG Interictal Expression:
Polyspike and wave, or sometimes spike and wave or sharp and slow waves
Myoclonic Seizures
Myoclonic jerks (single or multiple) are sudden, brief, shock-like contractions which may be generalized or confined to the face and trunk or to one or more extremities or even to individual muscles or groups of muscles. Myoclonic jerks may be rapidly repetitive or relatively isolated. They may occur predominantly around the hours of going to sleep or awakening from sleep. They may be exacerbated by volitional movement (action myoclonus). At times they may be regularly repetitive.
Many instances of myoclonic jerks and action myoclonus are not classified as epileptic seizures. The myoclonic jerks of myoclonus due to spinal cord disease, dyssynergia cerebellaris myoclonica, subcortical segmental myoclonus, paramyoclonus multiplex, and opsoclonus-mymlonus syndrome must be distinguished from epileptic seizures.
Bancaud 1981
Clinical Seizure Type:
C. Clonic seizures
EEG Seizure Type:
Fast activity (10 c/sec or more) and slow waves; occasional spike-and-wave patterns
EEG Interictal Expression:
Spike-and-wave or polyspike-and-wave discharges
Clonic Seizures
Generalized convuisive seizures occasionally lack a tonic component and are characterized by repetitive clonic jerks. As the frequency diminishes the amplitude of the jerks do not. The postictal phase is usually short. Some generalized convulsive seizures commence with a clonic phase passing into a tonic phase, as described below, leading to a “clonic-tonic-clonic” seizure.
Bancaud 1981
Clinical Seizure Type:
D. Tonic seizures
EEG Seizure Type:
Low voltage, fast activity or a fast rhythm of 9- 10 c/sec or more decreasing in frequency and increasing in amplitude
EEG Interictal Expression:
More or less rhythmic discharges of sharp and slow waves, sometimes asymmetrical. Background is often abnormal for age
Tonic Seizures
To quote Gowers, a tonic seizure is “a rigid, violent muscular contraction, fixing the limbs in some strained position. There is usually deviation of the eyes and of the head toward one side, and this may amount to rotation involving the whole body, (sometimes actually causing the patient to turn around, even two or three times). The features are distorted; the color of the face, unchanged at first, rapidly becomes pale and then flushed and ultimately livid as the fixation of the chest by the spasms stops the movements of respiration. The eyes are open or closed; the conjunctiva is insensitive; the pupils dilate widely as cyanosis comes on. As the spasm continues, it commonly changes in its relative intensity in different parts, causing slight alterations in the position of the limbs.”
Tonic axial seizures with extension of head, neck, and trunk may also occur.
Bancaud 1981
Clinical Seizure Type:
E. Tonic-clonic seizures
EEG Seizure Type:
Rhythm at 10 or more c/sec decreasing in frequency and increasing in amplitude during tonic phase, interrupted by slow waves during clonic phase
EEG Interictal Expression:
Polyspike and waves or spike and wave, or, sometimes, sharp and slow wave discharges
Tonic-Clonic Seizures
The most frequently encountered of the generalized seizures are the generalized tonic-clonic seizures, often known as grand mal. Some patients experience a vague ill-described warning, but the majority lose consciousness without any premonitory symptoms. There is a sudden sharp tonic contraction of muscles, and when this involves the respiratory muscles there is stridor, a cry or moan, and the patient falls to the ground in the tonic state, occasionally injuring himself in falling. He lies rigid, and during this stage tonic contraction inhibits respiration and cyanosis may occur. The tongue may be bitten and urine may be passed involuntarily. This tonic stage then gives way to clonic convulsive movements lasting for a variable period of time. During this stage small gusts of grunting respiration may occur between the convulsive movements, but usually the patient remains cyanotic and saliva may froth from the mouth. At the end of this stage, deep respiration occurs and all the muscles relax, after which the patient remains unconscious for a variable period of time and often awakes feeling stiff and sore all over. He then frequently goes into a deep sleep and when he awakens feels quite well apart from soreness and frequently headache. Generalized tonic-clonic convulsions may occur in childhood and in adult life; they are not as frequent as absence seizures, but vary from one a day to one every three months and occasionally to one every few years.
Very short attacks without postictal drowsiness may occur on occasion. .
Bancaud 1981
Clinical Seizure Type:
F. Atonic seizures
(Astatic)
(combinations of the above may occur, e.g., B and F, B and D)
EEG Seizure Type:
Polyspikes and wave or flattening or low-voltage fast activity
EEG Interictal Expression:
Polyspikes and slow wave
Atonic Seizures
A sudden diminution in muscle tone occurs which may be fragmentary, leading to a head drop with slackening of the jaw, the dropping of a limb or a loss of all muscle tone leading to a slumping to the ground. When these attacks are extremely brief they are known a s ‘‘drop attacks.” If consciousness is lost, this loss is extremely brief. The sudden loss of postural tone in the head and trunk may lead to injury by projecting objects. The face is particularly subject to injury. In the case of more prolonged atonic attacks, the slumping may be progressive in a rhythmic, successive relaxation manner.
(So-called drop attacks may be seen in conditions other than epilepsy, such as brainstem ischemia and narcolepsy cataplexy syndrome.)
Bancaud 1981
III. UNCLASSIFIED EPILEPTIC SEIZURES
Includes all seizures that cannot be classified because of inadequate or incomplete data and some that defy classification in hitherto described categories. This includes some neonatal seizures, e.g., rhythmic eye movements, chewing, and swimming movements.
Unclassified Epileptic Seizures
This category includes all seizures that cannot be classified because of inadequate or incomplete data and includes some seizures that by their natures defy classification in the previously defined broad categories. Many seizures occurring in the infant (e.g., rhythmic eye movements, chewing, swimming movements, jittering, and apnea) will be classified here until such time as further experience with video-tape confirmation and electroencephalographic characterization entitles them to subtyping in the extant classification.
IV. ADDENDUM
Repeated epileptic seizures occur under a variety of circumstances:
1. as fortuitous attacks, coming unexpectedly and without any apparent provocation; 2. as cyclic attacks, at more or less regular intervals (e.g., in relation to the menstrual cycle, or the sleep-waking cycle); 3. as attacks provoked by: (a) nonsensory factors (fatigue, alcohol, emotion, etc.), or (b) sensory factors, sometimes referred to as “reflex seizures.”
Prolonged or repetitive seizures (status epilepticus). The term “status epilepticus” is used whenever a seizure persists for a sufficient length of time or is repeated frequently enough that recovery between attacks does not occur. Status epilepticus may be divided into partial (e.g., Jacksonian), or generalized (e.g., absence status or tonic-clonic status). When very localized motor status occurs, it is referred to as epilepsia partialis continua.
Get rid of this
Bancaud 1981
Attacks that comes unexpectedly and without any apparent provocation
Bancaud 1981
Attacks occuring at more or less regular intervals (e.g., in relation to the menstrual cycle, or the sleep-wake cycle)
Bancaud 1981
Epilepsia Partialis Continua
Under this name have been described cases of simple partial seizures with focal motor signs without a march, usually consisting of clonic spasms, which remain confined to the part of the body in which they originate, but which persist with little or no intermission for hours or days at a stretch. Consciousness is usually preserved, but postictal weakness is frequently evident.
Postictal Paralysis (Todd’s Paralysis)
This category refers to the transient paralysis that may occur following some partial epileptic seizures with focal motor components or with somatosensory symptoms. Postictal paralysis has been ascribed to neuronal exhaustion due to the increased metabolic activity of the discharging focus, but it may also be attributable to increased inhibition in the region of the focus, which may account for its appearance in non-motor somatosensory seizures.
Bancaud 1981
The charge to the
Commission was to:
(1) complete the development of a revision of the International
Classification of Epileptic Seizures based
upon a study of videotapes of simultaneously recorded electrical and clinical manifestations of epileptic seizures;
(2) obtain
the majority approval of the Classification
of Epileptic Seizures from the active chapters of the League and other pertinent international societies;
(3) promote the use of
this classification throughout the world;
(4) develop a current dictionary of epilepsy and promote its use throughout the world;
(5) develop a classification of the epilepsies, acquire approval of a classification, and promote its use throughout the world.
ILAE 1989
Idiopathic (primary)
The term idiopathic derives from the Greek “idios,” meaning self, own, or personal. Idiopathic epilepsies and syndromes are described as disorders “not preceded or occasioned by another,” according to the Oxford English Dictionary. There is no underlying cause other than a possible hereditary predisposition. Idiopathic epilepsies are defined by age-related onset, clinical and electroencephalographic characteristics, and a presumed genetic etiology.
Idiopathic localization-related epilepsies are childhood epilepsies with partial seizures and focal EEG abnormalities. They are age-related, without demonstrable anatomic lesions, and are subject to spontaneous remission. Clinically, patients have neither neurologic and intellectual deficit nor a history of antecedent illness, but frequently have a family history of benign epilepsy. The seizures are usually brief and rare, but may be frequent early in the course of the disorder. The seizure patterns may vary from case to case, but usually remain constant in the same child. The EEG is characterized by normal background activity and localized high-voltage repetitive spikes, which are sometimes independently multifocal. Brief bursts of generalized spike-waves can occur. Focal abnormalities are increased by sleep and are without change in morphology.
With Age-Related Onset
ILAE 1989
Idiopathic (primary)
The term idiopathic derives from the Greek “idios,” meaning self, own, or personal. Idiopathic epilepsies and syndromes are described as disorders “not preceded or occasioned by another,” according to the Oxford English Dictionary. There is no underlying cause other than a possible hereditary predisposition. Idiopathic epilepsies are defined by age-related onset, clinical and electroencephalographic characteristics, and a presumed genetic etiology.
ILAE 1989
Epilepsies of known etiology (symptomatic or “secondary” epilepsies) from those that are idiopathic (primary)
Symptomatic epilepsies and syndromes are considered the consequence of a known or suspected disorder of the central nervous system (CNS).
ILAE 1989
Epilepsies of known etiology (symptomatic or “secondary” epilepsies) from those that are idiopathic (primary)
Symptomatic epilepsies and syndromes are considered the consequence of a known or suspected disorder of the central nervous system (CNS).
ILAE 1989
Epilepsies of known etiology (symptomatic or “secondary” epilepsies) from those that are idiopathic (primary)
Symptomatic epilepsies and syndromes are considered the consequence of a known or suspected disorder of the central nervous system (CNS).
ILAE 1989
Cryptogenic Epilepsy
The term cryptogenic refers to a disorder whose cause is hidden or occult. Cryptogenic epilepsies are presumed to be symptomatic, but the etiology is not known. The cryptogenic epilepsies are also age related but often do not have well-defined electroclinical characteristics.
Cryptogenic epilepsies are presumed to be symptomatic and the etiology is unknown. This category thus differs from the previous one by the lack of etiologic evidence (See definitions).
ILAE 1989
Epilepsies with partial or focal seizures (localization-related, partial or focal epilepsies)
Localization-related epilepsies and syndromes are epileptic disorders in which seizure semiology or findings at investigation disclose a localized origin of the seizures. This includes not only patients with small circumscribed constant epileptogenic lesions (anatomic or functional), i.e., true focal epilepsies, but also patients with less well-defined lesions, whose seizures may originate from variable loci. In most symptomatic localization-related epilepsies, the epileptogenic lesions can be traced to one part of one cerebral hemisphere, but in idiopathic age-related epilepsies with focal seizures, corresponding regions of both hemispheres may be functionally involved.
ILAE 1989
Idiopathic generalized epilepsies are forms of generalized epilepsies in which all seizures are initially generalized, with an EEG expression that is a generalized, bilateral, synchronous, symmetrical discharge (such as is described in the seizure classification of the corresponding type). The patient usually has a normal interictal state, without neurologic or neuroradiologic signs. In general, interictal EEGs show normal background activity and generalized discharges, such as spikes, polyspike, spike- wave, and polyspike waves > 3 Hz. The discharges are increased by slow sleep. The various syndromes of idiopathic generalized epilepsies differ mainly in age of onset.
with age-related onset
ILAE 1989
Symptomatic generalized epilepsies and syndromes
Symptomatic generalized epilepsies, most often occurring in infancy and childhood, are characterized by generalized seizures with clinical and EEG features different from those of idiopathic generalized epilepsies. There may be only one type, but more often there are several types, including myoclonic jerks, tonic seizures, atonic seizures, and atypical absences. EEG expression is bilateral but less rhythmical than in idiopathic generalized epilepsies and is more or less asymmetrical. Interictal EEG abnormalities differ from idiopathic generalized epilepsies, appearing as suppression bursts, hypsarrhythmia, slow spike-waves, or generalized fast rhythms. Focal abnormalities may be associated with any of the above. There are clinical, neuropsychologic, and neuroradiologic signs of a usually diffuse, specific, or nonspecific encephalopathy.
ILAE 1989
Epilepsies with generalized seizures (generalized epilepsy)
According to ICE, generalized epilepsies and syndromes are epileptic disorders with generalized seizures, i.e., “seizures in which the first clinical changes indicate initial involvement of both hemispheres. . . . The ictal encephalographic patterns initially are bilateral.”
ILAE 1989
Epilepsies with generalized seizures (generalized epilepsy)
According to ICE, generalized epilepsies and syndromes are epileptic disorders with generalized seizures, i.e., “seizures in which the first clinical changes indicate initial involvement of both hemispheres. . . . The ictal encephalographic patterns initially are bilateral.”
ILAE 1989
There may be two reasons why a determination of whether seizures are focal or generalized cannot be made: (a) The patient has both focal and generalized seizures together or in succession (e.g., partial seizures plus absences), and has both focal and generalized EEG seizure discharges (e.g., temporal spike focus plus independent bilateral spike-wave discharges); and (b) there are no positive signs of either focal or generalized seizure onset. The most common reasons for this are that the seizures occur during sleep, the patient recalls no aura, and ancillary investigations including EEG are not revealing.
ILAE 1989
Two divisions continue to be widely used in this ICE to shape the major classes: The first separates epilepsies with generalized seizures (generalized epilepsy) from epilepsies with partial or focal seizures (localization-related, partial or focal epilepsies). The other separates epilepsies of known etiology (symptomatic or “secondary” epilepsies) from those that are idiopathic (primary) and those that are cryptogenic.
ILAE 1989
Epilepsies with partial or focal seizures (localization-related, partial or focal epilepsies)
ILAE 1989
Epilepsies with partial or focal seizures (localization-related, partial or focal epilepsies)
ILAE 1989
Epilepsies with partial or focal seizures (localization-related, partial or focal epilepsies)
ILAE 1989
Epilepsies with partial or focal seizures (localization-related, partial or focal epilepsies)
Suggested by Buchhalter
Engel 2001
Idiopathic Generalized Epilepsies with Variable Phenotypes
Engel 2001
Idiopathic Photosensitive Occipital Lobe Epilepsy
Bancaud 1981
Illusion: These take the form of distorted perceptions in which objects may appear deformed.
Polyoptic illusions such as monocular diplopia, distortions of size (macropsia or micropsia) or of distance may occur. Similarly, distortions of sound, including microacusia and macroacusia, may be experienced. Depersonalization, as if the person were outside his body, may occur. Altered perception of size or weight of a limb may be noted.
Engel 2001
Immediate and early post cerebral insult seizures
Engel 2001
Immediate and early posttraumatic seizures
Blume 2001
Impaired Cognition: Decreased cognitive performance involving one or more of perception, attention, emotion, memory, execution, praxis, speech (cf., Dyscognitive, 2.3).
An abnormally lower response to passive movement across the joint.
They do not have control of tone.
Bancaud 1981
Diminution in tone of muscles
JB: Historical and demonstrate on Physical Examination
It's an EEG term, it means they occur one after another or repetitively.
Bancaud 1981
Incontinence
Bancaud 1981
Individual Muscle
Blume 2001
Berg 2010
Bancaud 1981
exceptionally, fragmentary, primitive, infantile, or antisocial behavior
Associated with:
Hypsarrhythmia
Electrodecrement
ACTH
ILAE 1989
West Syndrome
Usually, West syndrome consists of a characteristic triad: infantile spasms, arrest of psychomotor development, and hypsarrhythmia, although one element may be missing. Spasms may be flexor, extensor, lightning, or nods, but most commonly they are mixed. Onset peaks between the ages of 4 and 7 months and always occurs before the age of 1 year. Boys are more commonly affected. The prognosis is generally poor. West syndrome may be separated into two groups. The symptomatic group is characterized by previous existence of brain damage signs (psychomotor retardation, neurologic signs, radiologic signs, or other types of seizures) or by a known etiology. The smaller, cryptogenic group is characterized by a lack of previous signs of brain damage and of known etiology. The prognosis appears to be partly based on early therapy with adrenocorticotropic hormone (ACTH) or oral steroids.
Remove from my eyes
Scheuermann 2009
Infectious Disorder: A disorder whose etiology includes the presence of a pathogenic
organism within a host organism or an abnormal imbalance in the normal resident organismal flora.
Infectious Disease: A disease whose physical basis is an infectious disorder.
Examples: transient: seasonal flu; chronic: genital herpes; progressive: Ebola hemorrhagic fever.
Secondary Infection =def. – A disorder consisting in the presence of a pathogenic organism within a host organism that occurs due to the disposition established by a prior infection with a pathogenic organism of a different kind (e.g. cryptosporidiosis in a patient suffering from AIDS).
Tancred 2005
The triangular and opercular parts of the inferior frontal gyrus of the dominant hemisphere form Broca's motor speech area, which controls the production of the correct sounds in speech.
Structures:
Central Sulcus
Cerebral Hemisphere
Cingulate Gyrus
Corpus Callosum
Gyrus Rectus
Inferior Frontal Gyrus
Inferior Frontal Sulcus
Lateral Fissure
Limbic Area
Middle Frontal Gyrus
Motor Speech (Broca's) Area
Olfactory Sulcus
Olfactory Tract
Orbital Gyri
Pars Opercularis (Inf. Fr. G.)
Pars Orbitalis (Inf. Fr. G.)
Pars Triangularis (Inf. Fr. G.)
Precentral Gyrus
Precentral Sulcus
Prefrontal Area
Premotor Area
Primary Motor Area
Superior Frontal Gyrus
Superior Frontal Sulcus
Triangular Sulcus
Information:
The frontal lobe occupies the anterior part of the cerebral hemisphere.
Boundaries:
On the lateral surface it extends from the frontal pole posteriorly to the central sulcus and is bounded inferiorly by the lateral fissure. On the medial surface it extends posteriorly to an imaginary line from the central sulcus to the corpus callosum.
Sulci and Gyri:
The superolateral surface of the frontal lobe is formed by the superior, middle and inferior frontal gyri which extend in an anteroposterior direction and the precentral gyrus which extends vertically downwards. The superior and inferior frontal gyri are separated by the superior frontal sulcus and the middle and inferior gyri are separated by the inferior frontal sulcus. The precentral sulcus separates the precentral gyrus from the frontal gyri.
The inferior frontal gyrus is divided from anterior to posterior into the pars orbitalis, pars triangularis and pars opercularis by the triangular sulcus. The superior frontal gyrus extends onto the medial surface as far as the cingulate gyrus, the anterior part of which is also included in the frontal lobe.
The inferior surface of the frontal lobe is formed by the orbital gyri, which overlie the bony roof of the orbit and gyrus rectus (most medially). The orbital gyri and gyrus rectus are separated by the olfactory sulcus, which contains the olfactory tract.
Functional Areas:
The frontal lobe includes a number of important functional areas:
(1) Primary motor area - located on the precentral gyrus.
(2) Premotor area - located on the anterior part of the precentral gyrus and the adjacent parts of the superior and middle frontal gyri.
(3) Prefrontal area - which includes the remainder of the superior and middle frontal gyri, the orbital part of the inferior frontal gyrus and the orbital gyri.
(4) Motor Speech (Broca's) Area - located on the triangular and opercular parts of the inferior frontal gyrus.
(5) Limbic Area - located on the cingulate gyrus.
Tancred 2005
The Inferior Parietal Lobule is important in the comprehension of verbal information.
Structures:
Collateral Sulcus
Corpus Callosum
Hippocampal Gyrus
Inferior Temporal Gyrus
Inferior Temporal Sulcus
Lateral Fissure
Lateral Ventricle
Middle Temporal Gyrus
Occipitotemporal Gyrus
Parahippocampal Gyrus
Parieto-occipital Sulcus
Primary Auditory Area
Primary Olfactory Area
Superior Temporal Gyrus
Superior Temporal Sulcus
Transverse Temporal Gyrus
Uncus
Information:
The Parietal Lobe is located on the medial and lateral surfaces of the cerebral hemisphere between the frontal and occipital lobes.
Boundaries:
On the lateral surface it extends from the central sulcus anteriorly to an imaginary line drawn downwards from the parieto-occipital sulcus to the preoccipital notch. Inferiorly it is bounded by the lateral fissure and a horizontal line drawn from the lateral fissure to the imaginary line previously described.
On the medial surface it is bounded by the frontal lobe anteriorly, the parieto-occipital fissure posteriorly and the corpus callosum and calcarine sulcus inferiorly.
Gyri and Sulci:
On the lateral surface the parietal lobe is formed by the postcentral gyrus and the superior and inferior parietal lobules. The postcentral gyrus is separated from the two parietal lobules by the postcentral sulcus, which is parallel to the central sulcus. The superior and inferior parietal lobules are separated from each other by the intraparietal sulcus.
The inferior parietal lobule includes the supramarginal and angular gyri. The supramarginal gyrus hooks around the posterior surface of the lateral fissure and the angular gyrus hooks around the posterior end of the superior temporal sulcus. The medial surface of the parietal lobe includes an extension of the postcentral gyrus, the posterior part of the cingulate gyrus and the precuneus.
Functional Areas:
(1) Primary Somatosensory Area - located on the postcentral gyrus.
(2) In the dominant hemisphere (usually the left) the lower part of the inferior parietal lobule is concerned with the perception and interpretation of language and forms part of the receptive speech (Wernicke's) area.
Tancred 2005
The inferior temporal gyrus is part of the association cortex of the temporal lobe.
Structures:
Collateral Sulcus
Corpus Callosum
Hippocampal Gyrus
Inferior Temporal Gyrus
Inferior Temporal Sulcus
Lateral Fissure
Lateral Ventricle
Middle Temporal Gyrus
Occipitotemporal Gyrus
Parahippocampal Gyrus
Parieto-occipital Sulcus
Primary Auditory Area
Primary Olfactory Area
Superior Temporal Gyrus
Superior Temporal Sulcus
Transverse Temporal Gyrus
Uncus
Information:
Boundaries:
On the lateral surface the temporal lobe is bounded posteriorly by the imaginary line extending downwards from the parieto-occipital sulcus to the preoccipital notch. It is bounded superiorly by the lateral fissure and a horizontal line extending from the lateral fissure to meet the imaginary line just described. On the medial surface it is bounded posteriorly by a line extending from the splenium of the corpus callosum to the preoccipital notch.
Gyri and Sulci:
The lateral surface of the temporal lobe is formed by the superior, middle and inferior temporal gyri, which are separated from each other by the superior and inferior temporal sulci. The superior surface of the superior temporal gyrus, which forms the floor of the lateral fissure, is thrown into several transversely oriented folds, which are called the transverse temporal gyri (of Heschl).
The inferomedial surface of the temporal lobe is formed by (from medial to lateral) the parahippocampal gyrus, the occipitotemporal gyrus and the inferior temporal gyrus. The occipitotemporal gyrus is separated from the parahippocampal gyrus by the collateral sulcus and from the inferior temporal gyrus by the occipitotemporal sulcus. The rostral part of the parahippocampal gyrus hooks backward to form a bump on its medial surface called the uncus. Above the parahippocampal gyrus (not visible from the inferior surface) is the hippocampal gyrus, which actually forms the medial wall of the inferior (temporal) horn of the lateral ventricle.
Specific Functional Areas:
(1) Primary Auditory Area - located on the transverse temporal gyri.
(2) Primary Olfactory Area - located on the uncus.
Bancaud 1981
Inheritance
ILAE 1989
Hereditary predisposition, Inheritance
Luders 1998
Berg 2010
Hereditary predisposition
Engel 2001
Inherited metabolic disorders
Is a or part of?
Blume 2001
Executive function: anticipation, selection, monitoring of consequences, and initiation of motor activity including praxis, speech
Bancaud 1981
Conjunctiva is insensitive
Blume 2001
Interactive: Not stereotyped, involve more than self, environmentally influenced.
1981 Bancaud
Interictal
Noachter 1999
Intermittent slow activity: A slow activity that occurs intermittently and is not caused by drowsiness. Intermittent slow can be irregular or rhythmical (see continuous slow activity).
Bancaud 1981
Interruption of ongoing activity
Speaking-->speech is slowed or interrupted
walking-->stands transfixed
eating--> food stops
Tancred 2005
The intraparietal sulcus separates the superior and inferior parietal lobules.
Structures:
Angular Gyrus
Calcarine Sulcus
Central Sulcus
Cerebral Hemisphere
Cingulate Gyrus
Corpus Callosum
Frontal Lobe
Inferior Parietal Lobule
Intraparietal Sulcus
Lateral Fissure
Occipital Lobe
Parieto-occipital Sulcus
Postcentral Gyrus
Postcentral Sulcus
Precuneus
Primary Somatosensory Area
Receptive Speech Area
Superior Parietal Lobule
Superior Temporal Sulcus
Supramarginal Gyrus
Information:
The Parietal Lobe is located on the medial and lateral surfaces of the cerebral hemisphere between the frontal and occipital lobes.
Boundaries:
On the lateral surface it extends from the central sulcus anteriorly to an imaginary line drawn downwards from the parieto-occipital sulcus to the preoccipital notch. Inferiorly it is bounded by the lateral fissure and a horizontal line drawn from the lateral fissure to the imaginary line previously described.
On the medial surface it is bounded by the frontal lobe anteriorly, the parieto-occipital fissure posteriorly and the corpus callosum and calcarine sulcus inferiorly.
Gyri and Sulci:
On the lateral surface the parietal lobe is formed by the postcentral gyrus and the superior and inferior parietal lobules. The postcentral gyrus is separated from the two parietal lobules by the postcentral sulcus, which is parallel to the central sulcus. The superior and inferior parietal lobules are separated from each other by the intraparietal sulcus.
The inferior parietal lobule includes the supramarginal and angular gyri. The supramarginal gyrus hooks around the posterior surface of the lateral fissure and the angular gyrus hooks around the posterior end of the superior temporal sulcus.
The medial surface of the parietal lobe includes an extension of the postcentral gyrus, the posterior part of the cingulate gyrus and the precuneus.
Functional Areas:
(1) Primary Somatosensory Area - located on the postcentral gyrus.
(2) In the dominant hemisphere (usually the left) the lower part of the inferior parietal lobule is concerned with the perception and interpretation of language and forms part of the receptive speech (Wernicke's) area.
Engel 2001
Inversion duplication 15 syndrome
Blume 2001
Irregular: inconsistent or unpredictable, chaotic intervals between such events.
Bancaud 1981
Irregular
Noachter 1999
Irregular: Applies to EEG waves and complexes of inconstant period and/or uneven contour.
Blume 2001
Irregular: inconsistent or unpredictable, chaotic intervals between such events.
Bancaud 1981
Noachter 1999
Isolated: Occurring singly.
Engel 2001
Isolated lissencephaly sequence
Bancaud 1981
A distorted memory experience such as distorted memory experience.
If a previously experienced auditory sensation had not been experienced.
Bancaud 1981
A distorted memory experience such as distorted memory experience (jamais-vu)
Jamais Vu: as if a previously experienced sensation had not been experienced.
ILAE 1989
Late infantile ceroid-lipofuscinosis (Jansky Bielschowski disease) is characterized by onset between the ages of 2 and 4 years of massive myoclonic jerks, atonic, or astatic seizures. The EEG shows slow background rhythms, multifocal spikes, and a characteristic response to intermittent photic stimulation at a slow rate
Bancaud 1981
Jaw
Associated words:
Generalized Spike Wave
ILAE 1989
Juvenile Absence Epilepsy
The absences of juvenile absence epilepsy are the same as in pyknolepsy, but absences with retropulsive movements are less common. Manifestation occurs around puberty. Seizure frequency is lower than in pyknolepsy, with absences occurring less frequently than every day, mostly sporadically. Association with GTCS is frequent, and GTCS precede the absence manifestations more often than in childhood absence epilepsy, often occurring on awakening. Not infrequently, the patients also have myoclonic seizures. Sex distribution is equal. The spike-waves are often >3 Hz. Response to therapy is excellent.
Engel 2001
Juvenile Absence Epilepsy
ILAE 2010
Juvenile Absence Epilepsy
Associated with:
generalized spike wave
ILAE 1989
Impulsive petit mal appears around puberty and is characterized by seizures with bilateral, single or repetitive, arrhythmic, irregular myoclonic jerks, predominantly in the arms. Jerks may cause some patients to fall suddenly. No disturbance of consciousness is noticeable. The disorder may be inherited, and sex distribution is equal. Often, there are GTCS and, less often, infrequent absences. The seizures usually occur shortly after awakening and are often precipitated by sleep deprivation. Interictal and ictal EEG have rapid, generalized, often irregular spike-waves and polyspike-waves; there is no close phase correlation between EEG spikes and jerks. Frequently, the patients are photosensitive. Response to appropriate drugs is good.
Juvenile myoclonic epilepsy is known to be subject to an elevated risk of seizures for several decades, but remissions do still occur.
Engel 2001
Juvenile Myoclonic Epilepsy
Noachter 1999
K Complex: A burst of somewhat variable appearance, consisting most commonly of a high voltage negative slow wave followed by a smaller positive slow wave frequently associated with a sleep spindle. Amplitude is generally maximal in the frontal vertex. K complexes occur during non- REM sleep, apparently spontaneously, or in response to sudden sensory stimuli, and are not specific for any individual sensory modality (see vertex sharp transient).
ILAE 1989
Kojewnikow’s syndrome. Two types of Kojewnikow’s syndrome are recognized, one of which is also known as Rasmussen’s syndrome and is included among the epileptic syndromes of childhood noted under symptomatic seizures. The other type represents a particular form of rolandic partial epilepsy in both adults and children and is related to a variable lesion of the motor cortex. Its principal features are (a) motor partial seizures, always well localized; (b) often late appearance of myoclonus in the same site where somatomotor seizures occur; (c) an EEG with normal background activity and a focal paroxysmal abnormality (spikes and slow waves); (d) occurrence at any age in childhood and adulthood; (e) frequently demonstrable etiology (tumor, vascular); and (f) no progressive evolution of the syndrome (clinical, electroencephalographic or psychological, except in relation to the evolution of the causal lesion). This condition may result from mitochondrialencephalopathy (MELAS).
NOTE: Anatomical origins of some epilepsies are difficult to assign to specific lobes. Such epilepsies include those with pre- and postcentral symptomatology (perirolandic seizures). Such overlap to adjacent anatomic regions also occurs in opercular epilepsy.
In frontal lobe epilepsies, the interictal scalp recordings may show (a) no abnormality; (b) sometimes background asymmetry, frontal spikes or sharp waves; or (c) sharp waves or slow waves (either unilateral or frequently bilateral or unilateral multilobar). Intracranial recordings can sometimes distinguish unilateral from bilateral involvement.
In frontal lobe seizures, various EEG patterns can accompany the initial clinical symptomatology. Uncommonly, the EEG abnormality precedes the seizure onset and then provides important localizing information, such as: (a) frontal or multilobar, often bilateral, low-amplitude fast activity, mixed spikes, rhythmic spikes, rhythmic spike waves, or rhythmic slow waves; or (b) bilateral high amplitude single sharp waves followed by diffuse flattening.
Depending on the methodology, intracranial recordings may provide additional information regarding the chronologic and spatial evolution of the discharges; localization may be difficult.
Engel 2001
Krabbe Disease
ILAE 1989
Kuf’s disease (adult ceroid lipofuscinosis) is a relatively slow, progressive storage disease with frequent generalized seizures that may be very intractable. Unlike juvenile storage disease, the optic fundi may be normal. The main characteristic is an extreme photic sensitivity on slow photic stimulation.
Scheuermann 2009
Laboratory Test: A measurement assay that has as input a patient-derived specimen, and as output a result representing a quality of the specimen.
Engel 2001
Lafora Disease
Onset of Lafora disease occurs between the ages of 6 and 19 years (mean 11.5 years) and is characterized by generalized clonic, GTCS, with a frequent association of partial seizures with visual symptomatology, constant myoclonic jerks (fragmentary, segmental, and massive myoclonus), and rapidly progressive mental deterioration. The EEG shows discharges of fast spike-waves and poly- spike-waves, photosensitivity, deterioration of background activity, and the appearance of multi-focal abnormalities, particularly posteriorly. On the average, death occurs 5.5 years after onset.
Noachter 1999
Lambda Wave: Diphasic sharp transient occurring over the occipital regions of the head of waking subjects during visual exploration. The main component is positive relative to other areas. Time-locked to saccadic eye movement. Amplitude varies but is generally below 50 uV. Greek letter: <lambda>
Engel 2001
Landau-Kleffner Syndrome
ILAE 2010
Landau-Kleffner Syndrome (LKS)
Fischer 2014
continuous spike and waves during sleep and the Landau-Kleffner Syndrome
Engel 2001
Late Onset Childhood Occipital Epilepsy - Gastaut Type
ILAE 2010
Late Onset Childhood Occipital Epilepsy Gastaut Type
Engel 2001
Late-Onset Childhood Occipital Epilepsy (Gastaut Type)
ILAE 1989
Late infantile ceroid-lipofuscinosis (Jansky Bielschowski disease) is characterized by onset between the ages of 2 and 4 years of massive myoclonic jerks, atonic, or astatic seizures. The EEG shows slow background rhythms, multifocal spikes, and a characteristic response to intermittent photic stimulation at a slow rate
Tancred 2005
Function:
The lateral (Sylvian) fissure, which results from the meassive growth of the cerebral hemispheres in primates, separates the temporal lobe from the frontal and parietal lobes.
Structures:
Cerebral Hemisphere
Frontal Lobe
Insula
Parietal Lobe
Superior Temporal Gyrus
Temporal Lobe
Transverse Temporal Gyrus
Information:
The Lateral Fissure (or Fissure of Sylvius) is a deep furrow on the inferior and lateral surfaces of the cerebral hemisphere. On the inferior surface it extends between the frontal and temporal lobes and on the lateral surface it separates the temporal lobe from the frontal and parietal lobes.
The portions of the temporal, parietal and frontal lobes which surround the lateral fissure are referred to as the temporal, parietal and frontal opercula respectively. The temporal operculum is formed by the superior temporal gyrus and extending inwards from this, the transverse temporal gyri.
Gentle separation of the lips of the lateral fissure exposes an area of cortex, called the insula. It is buried within the depths of the fissure and hidden from surface view by the frontal, parietal and temporal opercula which effectivley form a lid over the it
('operculum' is latin for lid).
ILAE 1989
Lateral temporal seizures. Simple seizures characterized by auditory hallucinations or illusions or dreamy states, visual misperceptions, or language disorders in case of language dominant hemisphere focus. These may progress to complex partial seizures if propagation to mesial temporal or extratemporal structures occur. The scalp EEG shows unilateral or bilateral midtemporal or posterior temporal spikes which are most prominent in the lateral derivations.
Noachter 1999
Lateralized: Involving mainly the right or left side of the head (see unilateral; regional).
Blume 2001
Lateralizing: Any unilateral postictal dysfunction relating to motor, language, sensory, and/or integrative functions including visual, auditory, or somatosensory neglect phenomena.
Bancaud 1981
Laughter
Bancaud 1981
head tonically drawn to one or another side
Luders 1998
Left
The terms left and right refer strictly to the somatotopic localization of the symptoms, not the brain region.
Luders 1998
Left hemispheric.
Certain signs may identify the hemisphere of origin of a seizure. These signs include dystonic posturing during a complex motor seizure, preservation of consciousness during an automotor seizure, ictal speech during an automotor seizure, postictal aphasia, and so on. The presence of any of these signs strongly suggests the hemisphere of origin of a seizure. This localizing information is included in the classification by using the modifiers “left or right hemispheric.” These modifiers can be used to describe the seizures marked by superscript b in Table 1. Example: A dialeptic seizure preceded by an abdominal aura and followed by post ictal aphasia should be classified (if the patient is left-hemisphere dominant for language) as abdominal aura → left hemispheric dialeptic seizure. An automotor seizure in which there is no loss of consciousness and which is associated with dystonic posturing of the left hand and arm should be classified as a right hemispheric automotor seizure.
Associated with:
Symptomatic generalized epilepsy syndrome
Cryptogenic generalized epilepsy syndrome
ILAE 1989
Lennox-Gastaut Syndrome (LGS)
Lennox-Gastaut syndrome manifests itself in children aged 1-8 years, but appears mainly in pre-school-age children. The most common seizure types are tonic-axial, atonic, and absence seizures, but other types such as myoclonic, GTCS, or partial are frequently associated with this syndrome. Seizure frequency is high, and status epilepticus is frequent (stuporous states with myoclonias, tonic, and atonic seizures). The EEG usually has abnormal background activity, slow spike-waves <3Hz and, often, multifocal abnormalities. During sleep, bursts of fast rhythms (~10 Hz) appear. In general, there is mental retardation. Seizures are difficult to control, and the development is mostly unfavorable. In 60% of cases, the syndrome occurs in children suffering from a previous encephalopathy, but is primary in other cases.
Engel 2001
Lennox-Gastaut Syndrome
ILAE 2010
Lennox-Gastaut Syndrome (LGS)
Engel 2001
Lesion due to cerebrovascular incident (CVI)
Engel 2001
Lesion due to HIV
Engel 2001
Lesion due to toxoplasmosis
Bancaud 1981
Lip licking
Blume 2001
Cephalic: Sensation in the head such as light-headedness, tingling or headache.
Noachter 1999
Light Sleep: Non-REM sleep stages 1 and 2 (Rechtschaffen and Kales 1968).
Bancaud 1981
Limbs
Suleiman 2013
Engel 2001
Limbic epilepsies
Trancred 2005
The Lingual Gyrus forms the lower bank of the calcarine sulcus, which is the part of the primary visual area which processes information concerning the superior part of the visual field.
Structures:
Calcarine Sulcus
Cuneus
Lingual Gyrus
Parahippocampal Gyrus
Parieto-occipital Sulcus
Primary Visual Area
Information:
The occipital lobe occupies the posterior part of the cerebral hemisphere.
Boundaries:
On the lateral surface it is located posterior to an imaginary line extending from the parieto-occipital sulcus to the pre-occipital notch. On the medial surface it is bounded posterior to the parieto-occipital fissure and by an imaginary line extending from the splenium of the corpus callosum to the pre-occipital notch.
Sulci and Gyri:
The medial surface of the occipital lobe is divided into two parts by the calcarine sulcus, a deep groove which extends posteriorly from the parieto-occipital fissure to the posterior pole. The cuneus is the wedge-shaped area which lies between the parieto-occipital fissure and the calcarine sulcus. The inferior bank of the calcarine sulcus is formed by the lingual gyrus, a posterior extension of the parahippocampal gyrus of the temporal lobe.
The lateral surface of the occipital lobe is formed by some inconstantly-shaped gyri, which are collectively referred to as the lateral occipital gyri.
Functional Areas:
The occipital lobe contains the primary visual area of the cortex, which is located around the calcarine sulcus. Only a thin strip of the primary visual cortex is visible on the medial surface of the brain (on either side of the calacarine sulcus) because most of it is buried within the depths of the sulcus.
ILAE 1989
Lissencephaly-pachygyriais characterized by facial abnormalities and specific computed tomography (CT) scan features, axial hypotonia, and infantile spasms. The EEG shows fast activity of high voltage “alpha-like” patterns without change during wakefulness and sleep.
ILAE 1989
Precipitated seizures are those in which environmental or internal factors consistently precede the attacks and are differentiated from spontaneous epileptic attacks in which precipitating factors cannot be identified. Certain nonspecific factors (e.g., sleeplessness, alcohol or drug withdrawal, or hyperventilation) are common precipitators and are not specific modes of seizure precipitation. In certain epileptic syndromes, the seizures clearly may be somewhat more susceptible to nonspecific factors, but this is only occasionally useful in classifying epileptic syndromes.
An epilepsy characterized by specific modes of seizure precipitation, however, is one in which a consistent relationship can be recognized between the occurrence of one or more definable nonictal events and subsequent occurrence of a specific stereotyped seizure. Some epilepsies have seizures precipitated by specific sensation or perception (the reflex epilepsies) in which seizures occur in response to discrete or specific stimuli. These stimuli are usually limited in individual patients to a single specific stimulus or a limited number of closely related stimuli. Although the epilepsies which result are usually generalized and of idiopathic nature, certain partial seizures may also occur following acquired lesions, usually involving tactile or proprioceptive stimuli.
Epileptic seizures may also be precipitated by sudden arousal (startle epilepsy); the stimulus is unexpected in nature. The seizures are usually generalized tonic but may be partial and are usually symptomatic.
Seizures precipitated by integration of higher cerebral function such as memory or pattern recognition are most often associated with complex partial epilepsies, but are occasionally observed in generalized epilepsies (such as reading epilepsy). Seizures also occur spontaneously in most such patients.
Bancaud 1981
Local
Blume 2001
Body Part: Refers to area involved (i.e., arm, leg, face, trunk, and other).
Tancred 2005
The Longitudinal Fissure separates the two cerebral hemispheres. In situ, it is occupied by a sheet of dura mater known as the falx cerebri.
Structures:
Cerebral Hemisphere
Information:
The longitudinal fissure is the deep midline groove which separates the two cerebral hemispheres.
Spacing out
Feels like they missed something
Bancaud 1981
Loss of Consciousness
Language disorder that affects a person's ability to communicate
Bancaud 1981
Low Voltage
Noachter 1999
Low Voltage EEG: A waking record characterized by activity of amplitude not greater than 20 uV over all head regions. With appropriate instrumental sensitivities this activity can be shown to be composed primarily of beta, theta and, to a lesser degree, delta waves, with or without alpha activity over the posterior areas.
Comments:
(1) Low voltage EEGs are susceptible to change under the influence of certain physiological stimuli, sleep, pharmacological agents and pathological processes.
(2) They should be clearly distinguished from tracings of electrocerebral inactivity and low voltage fast activity.
Noachter 1999
Low Voltage Fast Activity: Refers to the fast, and often recruiting, activity which can be recorded at the onset of an ictal discharge, particularly in invasive EEG recording of a seizure.
Luders 1998
Our seizure classification is based exclusively on ictal seizure semiology, either as reported by the patient or observers or as analyzed directly during video monitoring (Table 1). No EEG findings or other test results influence the classification.
Ictal symptoms can be produced by epileptic interference of one of the following four “spheres”:
a. Sensorial sphere.
b. Consciousness sphere.
c. Autonomic sphere.
d. Motor sphere.
SUMMARY OF THE ESSENTIAL CHARACTERISTICS OF THE SEMIOLOGICAL CLASSIFICATION OF EPILEPTIC SEIZURES
The semiological seizure classification outlined above integrates the following features, which make it particularly useful for everyday application:
1. The terminology applied is as succinct as possible to facilitate everyday use.
2. Whenever available, “classical” terminology, well known to general neurologists and epileptologists, has been used.
3. The classification includes a few new terms, such as automotor, hypomotor, hypermotor, and dialeptic seizures. These new terms have been introduced to avoid confusion with other terms that identify similar seizures but that are defined not by pure semiological criteria but by electroclinical characteristics (see section Dialeptic seizures).
4. The semiological seizure classification includes ‘‘somatotopic modifiers’’ that permit definition of the somatotopic distribution of the ictal symptoms.
5. Each seizure type is considered a component. Different seizure evolutions are expressed by linking the different seizure types (“components”) by an arrow. Types of seizure evolution are not limited arbitrarily. This classification system should permit scientific studies of the most frequent type of seizure evolutions.
6. Ictal symptoms frequently cannot be defined with precision because of inadequate information (for example, a patient may be amnestic of the seizure and there may be no witness to the seizure or a witness may provide an incomplete and inaccurate history). The semiological difference classification permits classification of seizures with different degrees of precision. For example, if we believe that the patient had an epileptic seizure, we classify it as “epileptic seizure.” If the main manifestation was motor, we classify the seizure as a “motor seizure.” If the main manifestation was motor, we classify the seizure as a “motor seizure.” If the motor seizure affected the right arm but we do not know if it was a simple or complex motor seizure, we can classify it as “right arm motor seizure.” If we know that the movements during the seizure were “simple” (see definition above), but we have difficulty in defining the subtype, we can classify the seizure as “right arm simple motor seizure.” And finally, if by history or direct observation we can establish that the movement of the right arm was of clonic type, we can classify the seizure in its maximum degree of precision, namely as “right arm clonic seizure.” In other words, from left to right in Table 1, progressively more precise information is provided about the ictal semiology.
ADVANTAGES OF SEMIOLOGICAL SEIZURE CLASSIFICATION
Semiological classification of epileptic seizures has the following advantages:
1. It provides a terminology that permits clear identification of ictal semiological features independent of any other rest results.
2. It clarifies the difference between seizure classification and epileptic syndrome classification. Many epileptic syndromes may be associated with the same types of seizures (when classified semiologically); therefore, appropriate management of the patient will require that the physician define the epileptic syndrome. For example, establishing that a patient has dialeptic seizures does not tell us whether the patient has generalized epileptic syndrome such as absence epilepsy, which can be treated with ethosuximide, or a focal epileptic syndrome, in which ethosuximide is ineffective.
3. A semiological seizure classification focuses the attention of the observer on clinical semiology.
4. A semiological seizure classification in which we do not assume a one-to-one relationship between clinical semiology and other test results promotes scientific correlation studies between the different types of seizures (classified exclusively on the basis of ictal semiology) and other test results. Such studies should eventually provide better understanding of the significance of different semiological features.
5. A semiological seizure classification, particularly if it is comprehensive, can be applied to any age group. However, certain types of seizures will not occur or will seldom occur in newborn and infants because of their incompletely developed nervous system.
CONCLUSION
In this short outline, we introduce a semiological seizure classification. The present version—or variants of it-has been used in daily clinical practice for >10 years in selected epilepsy centers. The advantages of a semiological seizure classification are stressed.
Luders 1998
Seizures affecting the sensorial sphere exclusively produce no objective signs other than an occasional altered behavior by the patient to an “unexpected” experience. We are aware of their occurrence only if the patient tells us of the sensorial experience. We identify these seizures as auras in good agreement with classical terminology.
Luders 1998
Seizures that interfere primarily with consciousness have been identified by different terms, according to the EEG correlate or to the epileptic syndrome that produces the alteration of consciousness.
For example, an episode of altered consciousness associated with generalized 3- Hz, spike-and-wave EEG activity is identified as an absence seizure, whereas if it is associated with a focal epileptiform discharge or occurs in a patient with a focal epileptic syndrome (even in the absence of a local epileptiform correlate), it is identified as a complex partial seizure. To avoid confusion between terms that identify electroclinical complexes (absence seizure and complex partial seizure) and terms that identify pure ictal signs and symptoms, we coined the term dialeptic seizures for ictal episodes in which the main manifestation is an alteration of consciousness. The term dialeptic derives from the Greek word “dialeipein,” which means “to stand still,” “to interrupt,” or “to pass out.” Other expressions such as ‘‘vacant seizures” or “psychoparetic seizures” were also considered, but we believe that a completely new term has advantages when one is trying to define a new concept, i.e., episodes of alteration of awareness that are independent of the associated ictal or interictal EEG changes. Although no consensus was reached between the authors, we tentatively use the term dialeptic seizures herein.
Luders 1998
Seizures consisting primarily of autonomic symptoms are rare. Usually, they are detected by the patient reporting symptoms secondary to the autonomic alteration, e.g., palpitations or ‘‘hot flashes.” Occasionally, they can be documented by appropriate monitoring (e.g., Holter monitor). We classify these episodes as “autonomic auras” when the patient has symptoms most probably produced by an autonomic alteration but we do not have objective proof of the autonomic disturbance. In contrast, we classify such episodes as “autonomic seizures” when we have objective proof of the autonomic alteration whether the patient is aware of the autonomic disturbance or not.
Luders 1998
Seizures in which the main manifestations are motor phenomena are classified as motor seizures.
Luders 1998
Epileptic Seizure
Seizures frequently include symptoms from two or more spheres. In such case, the seizure is classified according to the predominant clinical manifestations. For example, a patient has loss of awareness with slight eye blinking. Such a seizure would be classified as a dialeptic seizure and not as a motor seizure.
Luders 1998
Somatosensory Aura
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Somatosensory auras consist of abnormal somatosensory sensations (‘‘paresthesias”) that are limited to a clearly defined somatosensory region of the body. Sensations that are poorly localized or consist of vague sensations should be classified as unclassifiable auras (just ‘‘auras”).
Luders 1998
Visual Aura
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Visual hallucinations or illusions,
when occurring in isolation, should be classified as visual auras. More elaborate visual hallucinations or illusions that are associated with other complex distortions of perception (such as alterations of the sense of familiarity of what the patient is seeing or hearing, complex visual or auditory illusions, or the hearing of voices, and so on), should be classified as visual auras only if the visual hallucination or illusion is clearly the predominant symptom, at least for a significant part of the aura. Otherwise, they should be classified as psychic auras (described below). Poorly defined alterations of vision (such as “blurry vision”) should be designated unclassifiable auras.
Luders 1998
Auditory Aura
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Isolated auditory hallucinations or illusions should be classified as auditory auras. More elaborated auditory hallucinations or illusions that occur together with complex alterations of perception (such as alterations of the sense of familiarity of what the patient is seeing or hearing, visual or auditory illusions, or the simultaneous occurrence of complex visual hallucinations, and so on) should be classified as auditory auras only if the auditory hallucination or illusion is clearly the predominant symptom. Otherwise, these complex auras should be classified as psychic auras.
Luders 1998
Olfactory Aura
Perception of a smell as an epileptic phenomenon is classified as an olfactory aura. At times, like auditory and visual hallucinations and illusions, they are associated with other complex alterations of perception. These complex alterations of perception should be classified as psychic auras unless the olfactory aura is clearly the predominant feature.
Luders 1998
Gustatory Aura
Perception of a taste as an epileptic phenomenon is classified as a gustatory aura. These auras also tend to be associated with complex perceptual alterations. The term gustatory aura should be applied only when the gustatory hallucination is the predominant symptom.
Luders 1998
Autonomic Aura
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Seizures consisting primarily of autonomic symptoms are rare. Usually, they are detected by the patient reporting symptoms secondary to the autonomic alteration, e.g., palpitations or ‘‘hot flashes.” Occasionally, they can be documented by appropriate monitoring (e.g., Holter monitor). We classify these episodes as “autonomic auras” when the patient has symptoms most probably produced by an autonomic alteration but we do not have objective proof of the autonomic disturbance.
Autonomic alterations elicited by epileptic activation of autonomic cortical centers produce symptoms that the patient can detect but that observers have difficulty identifying, particularly from a videotape recording (palpitations, hot flashes, and so on). Sensations that most probably are an expression of an epileptic autonomic alteration are classified as autonomic auras even when there is no objective proof of their autonomic pathogenesis (such as palpitations or hot flashes). In contrast, autonomic alterations appropriately documented by polygraphic recordings (tachycardia, blood pressure changes, and so on) or direct visual observation (mydriasis, sweating, flushing, piloerection, and so on) are classified as autonomic seizures
Luders 1998
Abdominal Aura
Patients with temporal lobe epilepsy frequently have auras with abdominal sensations. Some of these abdominal auras are most probably the expression of increased abdominal peristalsis and therefore correspond to a subgroup of autonomic auras (or autonomic seizures, if the alteration of peristalsis has been documented). In other cases, they may be an expression of activation of sensory cortical areas of the abdominal viscera. Independent of the pathogenesis, these abdominal auras are closely related to temporal lobe epilepsy; therefore, it appears useful to classify them independently as abdominal auras.
Luders 1998
Psychic Aura
Psychic auras consist of complex hallucinations and illusions that usually affect different senses. The most typical examples are distortions of familiarity, such as sensations of déjà vu or jamais vu. Frequently these sensations may be associated with emotional alterations, such as fear. In addition, they may occur together with complex visual, auditory or other hallucinations and illusions, including visual hallucinations such as macropsia, micropsia, and so on.
Luders 1998
Aura
Auras are ictal manifestations having sensory, psychosensory, and experiential symptoms.
Auras consist exclusively of subjective symptoms and usually occur at the beginning of a seizure (“warning symptoms”). In general, they are brief (seconds) and only rarely may persist longer (minutes). They may occur in isolation from any other ictal symptom and, if so, tend to last slightly longer. In general, the epileptic nature of auralike symptomatology can be documented objectively only if the aura consistently evolves into a dialeptic or motor seizure or if EEG monitoring demonstrates an EEG seizure pattern during the aura.
Luders 1998
Autonomic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Autonomic seizures are seizures in which the main ictal manifestations are objectively documented autonomic alterations.
“Autonomic seizures” have objective proof of the autonomic alteration whether the patient is aware of the autonomic disturbance or not.
Autonomic seizures consist of episodic alterations of autonomic function that are elicited by activation of autonomic cortical centers activated by an epileptiform discharge. Cases in which the patient reports only sensations that most probably correspond to an autonomic alteration (hot flashes, palpitations, and so on) and for which there is no objective documentation should be classified as autonomic auras (described above). To make the diagnosis of an autonomic seizure, episodes of autonomic dysfunction must be documented by appropriate polygraphic recording (tachycardia, blood pressure changes, and so on) or by direct observation. Documented episodes of autonomic dysfunction may be clinically silent (i.e., the episodes may only be detected by a monitor, without the patient experiencing any unusual symptoms).
Luders 1998
Typical Dialeptic Seizure
Location: Left hemisphere/right hemisphere
Dialeptic seizures for ictal episodes in which the main manifestation is an alteration of consciousness. The term dialeptic derives from the Greek word “dialeipein,” which means “to stand still,” “to interrupt,” or “to pass out.”
Typical dialeptic seizures consist of short episodes of altered consciousness: <20 s. The alteration of consciousness begins and ends abruptly and frequently is associated with rhythmical eye blinking at a rate of ~3 Hz. Patients with generalized absence epilepsy often have typical dialeptic seizures. All seizures that consist mainly of an alteration of consciousness but that are not “typical dialeptic seizures” should be classified as just dialeptic seizures.
Luders 1998
Dialeptic Seizure
Location: Left Hemisphere/Right Hemisphere
“Dialeptic” seizures have as their main ictal manifestations an alteration of consciousness that is independent of ictal EEG manifestations. The new term “dialeptic” seizure has been coined to differentiate this concept from absence seizures (dialeptic seizures with a generalized ictal EEG) and complex partial seizures (dialeptic seizures with a focal ictal EEG).
Dialeptic seizures is a new term coined to identify seizures in which the predominant symptomatology consists of an alteration of consciousness (see discussion of terminology above). Alteration of consciousness is difficult to define. However, for the purpose of identifying dialeptic seizures, we classify altered consciousness as does the ILAE classification of epileptic electroclinical complexes, e.g., as episodes of unresponsiveness or decreased responsiveness that are not caused by motor alterations. Dialeptic seizures are associated with complete or at least partial amnesia for the episode; therefore, amnesia of the episode is necessary to establish the diagnosis of dialeptic seizure.
Luders 1998
Myoclonic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Myoclonic seizures consist of short muscle contractions lasting <400 ms.
Luders 1998
Tonic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Tonic seizures consist of sustained muscle contractions, usually lasting >3 s, that lead to “positioning.”
Luders 1998
Epileptic Spasm
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Tonic seizures consist of sustained muscle contractions, usually lasting >3 s, that lead to “positioning.”
Luders 1998
Clonic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Clonic seizures are a series of myoclonic contractions that regularly recur at a rate of 0.2-5/s.
Luders 1998
Tonic-Clonic Seizure
Generalized tonic-clonic seizures are characterized by an initial tonic posturing of all limbs. The sustained muscle contractions that determined the tonic phase then tend to slow, evolving into a clonic phase with contractions of progressively decreasing frequency until the contractions disappear completely. The muscles included in the tonic and clonic phase should be essentially the same. Focal motor seizures showing such a tonic-clonic evolution are infrequent.
Luders 1998
Versive Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Versive seizures are seizures during which the patient either has a conjugate eye movement to one side or moves the head, and occasionally the whole body, to one side. Only conjugate eye movements or lateral head and body movements that are sustained and extreme should be classified as versive seizure. The lateral movement of the eyes frequently consists of a combination of a smooth tonic lateral movement on which are superimposed small saccades that progressively move the eye out to an extreme position. On other occasions, a smooth lateral movement without any saccades may be observed. The version of body parts has a similar character, but the saccades are replaced by small clonic lateral movements of the head or body. During these lateral movements, the chin frequently moves not only laterally but also upward, resulting in an unnatural position of the eyes and head. Occasionally, the patient’s body will also turn and may complete one or more 360” turns.
Luders 1998
Simple Motor Seizure
Location: Left/right/axial/generalized/bilateral asymmetric
Simple motor seizures in which the motor movements are relatively “simple,” unnatural, and consist of movements similar to movements elicited by electrical stimulation of the primary motor areas (Brodmann areas 4 and 6)
Luders 1998
Hypermotor Seizures
Hypermotor seizures are seizures in which the main manifestations consist of complex movements involving the proximal segments of the limbs and trunk. This results in large movements that appear “violent” when they occur at high speeds. The “complex motor manifestations” imitate normal movements, but the movements are inappropriate for the situation and usually serve no purpose. Frequently, the movements are stereotypically repeated in more or less complex sequences (e.g., pedaling). Consciousness may be preserved during these seizures.
Luders 1998
Gelastic seizures.
Seizures in which the main motor manifestation is “laughing’’ are termed gelastic seizures. They may be preceded or followed by any other type of seizure. Only seizures in which the main ictal semiology is laughing should be classified as gelastic seizures. These seizures are classified separately because they are common in patients with hypothalamic hamartoma.
Luders 1998
Automotor seizures
Automotor seizures are complex motor seizures in which the main manifestations consist of automatisms involving the distal segments of the hands and feet or the mouth and tongue. Consciousness is usually affected but may be preserved, particularly when the seizure originates from the nondominant hemisphere.
Luders 1998
Complex Motor Seizures
Complex motor seizures, in which the movements are relatively complex and simulate natural movements, except that they are inappropriate for the situation.
“Complex” herein refers to the complex characteristics of the movement and does not mean that the patient loses awareness during the seizure.
Luders 1998
Motor Seizures
Seizures in which the main manifestations are motor phenomena are classified as motor seizures.
Seizures in which the main symptomatology are motor signs are identified as motor seizures.
Luders 1998
Atonic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Atonic seizures cause a loss of postural tone. The result is loss of posture (head drops, falls, and so on). Often these seizures are preceded by a short myoclonic seizure.
Luders 1998
Astatic seizure
Astatic seizures consist of epileptic falls. Polygraphic studies show that only in a few patients are the falls the result of atonic seizures. In most patients, a myoclonic jerk causes the patient to lose balance, and the fall itself is produced by an atonia that occurs immediately after the initial myoclonic jerk. Pure generalized tonic seizures may also lead to an epileptic fall. In most patients, however, no video-polygraphic studies are performed and the pathogenesis of the fall is uncertain. It seems useful to classify astatic seizures separately because of the variable pathogenesis of the falls, which usually remains undefined.
Luders 1998
Hypomotor Seizure
Location: Left hemisphere/right hemisphere
Hypomotor seizures have as their main manifestation a decrease or total absence of motor activity without the emergence of new motor manifestations. This classification is used exclusively in patients in whom it is not possible to test consciousness during or after the seizure (such as newborns, infants, and severely mentally retarded patients). In many patients, consciousness is probably altered during the seizures even if by definition consciousness cannot be tested directly. In a few patients with hypomotor seizures, the pathogenesis of the seizures may be different; consciousness may be preserved, and the absence of movement may be an expression of an akinetic seizure or may be a reaction to an aura.
Luders 1998
Akinetic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Akinetic seizures are characterized by the inability to perform voluntary movements. Therefore, they can actually be considered negative complex motor seizures. Muscle tone is also frequently lost, but the akinesia is the most prominent manifestation of the seizure. These seizures are most probably an expression of the activation of the negative motor areas in the mesial frontal and inferior frontal gyri. Only patients in whom consciousness is preserved during the seizures can have akinetic seizures because they .can be tested or tell about the “akinetic” symptoms.
Luders 1998
Negative Myoclonic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Negative myoclonic seizures are seizures that consist of a brief interruption of tonic muscle activity due to an epileptiform discharge. The brief interruption of muscle activity may result in a short, sudden movement similar to a myoclonic jerk. However, the pathogenesis of the movement is a brief loss of muscle tone and not a burst of muscle potentials characteristic of myoclonic seizures. Evidence suggests that these seizures are generated by epileptiform discharges in the primary sensorimotor cortex.
Luders 1998
Aphasic Seizure
Location: Left Hemisphere/Right Hemisphere
During aphasic seizures, the patient cannot speak and often cannot understand spoken language. The seizures are probably a negative phenomenon produced by epileptic activation of a cortical language center, a phenomenon similar to that produced by cortical stimulation of language areas.
Luders 1998
Seizures that cannot be classified in any of the four groups outlined above are categorized as special seizures. This category includes primarily seizures characterized by “negative” motor signs (atonic seizure, akinetic seizures, “hypomotor” seizures, and so on).
Seizures that cannot be classified in one of the four types described above are classified as special seizures. All these seizures are “negative” or “inhibitory” motor seizures except the aphasic seizures that most probably represent ‘‘negative cognitive” seizures.
Luders 1998
Paroxysmal Event
The EEG, findings (ictal or interictal) are not used to classify epileptic seizures in our proposed system. The EEG may be used to differentiate between epileptic seizures and nonepileptic paroxysmal events, however (see section Paroxysmal events).
Paroxysmal events are episodes in which the observer believes that there is not sufficient evidence to assume that a “seizurelike” event was of epileptic nature. If an “ictal” EEG is available, it should not show an ictal EEG pattern. This classification of epileptic seizures is based exclusively on semiology. However, the EEG can be used to determine whether an episode is epileptic or not. Episodes for which there is not sufficient proof of epileptic nature are classified merely as paroxysmal events. Otherwise, this semiological classification would have to be expanded to include the semiology of non-epileptic events, which may be extremely varied. Addressing nonepileptic events would require a different approach to classification.
Luders 1998
Axial
The clinical semiology of many seizures, particularly those in patients with focal epileptic syndromes, tends to have a somatotopic distribution.
Luders 1998
Left
The terms left and right refer strictly to the somatotopic localization of the symptoms, not the brain region.
Luders 1998
Right
The terms left and right refer strictly to the somatotopic localization of the symptoms, not the brain region.
Luders 1998
Somatotopic area involved. For seizures involving a distinct somatotopic region, the somatotopic area is specified by simply naming the region itself. These terms can be applied to all seizures marked with superscript a in Table 1. Examples:
Left hand clonic seizure
Throat somatosensory aura
Left foot tonic seizure
Luders 1998
Axial
Bilateral asymmetric, axial, and generalized. The terms bilateral asymmetric, axial, and generalized also refer strictly to the somatotopic localization of the clinical semiology.
Bilateral asymmetric means that the symptoms occurred in a bilateral distribution but had a significant degree of asymmetry. The term suggests that the patient has a focal epilepsy.
The modifier generalized is used when the manifestations occur in a relatively widespread distribution and there is approximately equal involvement of both sides and of the distal and proximal segments.
The modifier “axial” is used when the manifestations involve predominantly the muscles of the trunk and the proximal muscles of the extremities. Usually patients who have axial or generalized seizures have generalized epilepsy. However, some patients with focal epilepsy may have axial or generalized seizures and, vice versa, patients with generalized epilepsies may have seizures that include significant focal elements. In other words, the relationship between clinical semiology and epileptic syndromes is not one to one.
Luders 1998
Bilateral Asymmetric
Bilateral asymmetric, axial, and generalized. The terms bilateral asymmetric, axial, and generalized also refer strictly to the somatotopic localization of the clinical semiology.
Bilateral asymmetric means that the symptoms occurred in a bilateral distribution but had a significant degree of asymmetry. The term suggests that the patient has a focal epilepsy.
The modifier generalized is used when the manifestations occur in a relatively widespread distribution and there is approximately equal involvement of both sides and of the distal and proximal segments.
The modifier “axial” is used when the manifestations involve predominantly the muscles of the trunk and the proximal muscles of the extremities. Usually patients who have axial or generalized seizures have generalized epilepsy. However, some patients with focal epilepsy may have axial or generalized seizures and, vice versa, patients with generalized epilepsies may have seizures that include significant focal elements. In other words, the relationship between clinical semiology and epileptic syndromes is not one to one.
Luders 1998
Generalized
Bilateral asymmetric, axial, and generalized. The terms bilateral asymmetric, axial, and generalized also refer strictly to the somatotopic localization of the clinical semiology.
Bilateral asymmetric means that the symptoms occurred in a bilateral distribution but had a significant degree of asymmetry. The term suggests that the patient has a focal epilepsy.
The modifier generalized is used when the manifestations occur in a relatively widespread distribution and there is approximately equal involvement of both sides and of the distal and proximal segments.
The modifier “axial” is used when the manifestations involve predominantly the muscles of the trunk and the proximal muscles of the extremities. Usually patients who have axial or generalized seizures have generalized epilepsy. However, some patients with focal epilepsy may have axial or generalized seizures and, vice versa, patients with generalized epilepsies may have seizures that include significant focal elements. In other words, the relationship between clinical semiology and epileptic syndromes is not one to one.
Luders 1998
Left hemispheric.
Certain signs may identify the hemisphere of origin of a seizure. These signs include dystonic posturing during a complex motor seizure, preservation of consciousness during an automotor seizure, ictal speech during an automotor seizure, postictal aphasia, and so on. The presence of any of these signs strongly suggests the hemisphere of origin of a seizure. This localizing information is included in the classification by using the modifiers “left or right hemispheric.” These modifiers can be used to describe the seizures marked by superscript b in Table 1. Example: A dialeptic seizure preceded by an abdominal aura and followed by post ictal aphasia should be classified (if the patient is left-hemisphere dominant for language) as abdominal aura → left hemispheric dialeptic seizure. An automotor seizure in which there is no loss of consciousness and which is associated with dystonic posturing of the left hand and arm should be classified as a right hemispheric automotor seizure.
Luders 1998
Right hemispheric.
Certain signs may identify the hemisphere of origin of a seizure. These signs include dystonic posturing during a complex motor seizure, preservation of consciousness during an automotor seizure, ictal speech during an automotor seizure, postictal aphasia, and so on. The presence of any of these signs strongly suggests the hemisphere of origin of a seizure. This localizing information is included in the classification by using the modifiers “left or right hemispheric.” These modifiers can be used to describe the seizures marked by superscript b in Table 1. Example: A dialeptic seizure preceded by an abdominal aura and followed by post ictal aphasia should be classified (if the patient is left-hemisphere dominant for language) as abdominal aura → left hemispheric dialeptic seizure. An automotor seizure in which there is no loss of consciousness and which is associated with dystonic posturing of the left hand and arm should be classified as a right hemispheric automotor seizure.
Luders 1998
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Somatosensory Aura
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Somatosensory auras consist of abnormal somatosensory sensations (‘‘paresthesias”) that are limited to a clearly defined somatosensory region of the body. Sensations that are poorly localized or consist of vague sensations should be classified as unclassifiable auras (just ‘‘auras”).
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Visual Aura
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Visual hallucinations or illusions,
when occurring in isolation, should be classified as visual auras. More elaborate visual hallucinations or illusions that are associated with other complex distortions of perception (such as alterations of the sense of familiarity of what the patient is seeing or hearing, complex visual or auditory illusions, or the hearing of voices, and so on), should be classified as visual auras only if the visual hallucination or illusion is clearly the predominant symptom, at least for a significant part of the aura. Otherwise, they should be classified as psychic auras (described below). Poorly defined alterations of vision (such as “blurry vision”) should be designated unclassifiable auras.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Auditory Aura
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Isolated auditory hallucinations or illusions should be classified as auditory auras. More elaborated auditory hallucinations or illusions that occur together with complex alterations of perception (such as alterations of the sense of familiarity of what the patient is seeing or hearing, visual or auditory illusions, or the simultaneous occurrence of complex visual hallucinations, and so on) should be classified as auditory auras only if the auditory hallucination or illusion is clearly the predominant symptom. Otherwise, these complex auras should be classified as psychic auras.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Olfactory Aura
Perception of a smell as an epileptic phenomenon is classified as an olfactory aura. At times, like auditory and visual hallucinations and illusions, they are associated with other complex alterations of perception. These complex alterations of perception should be classified as psychic auras unless the olfactory aura is clearly the predominant feature.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Gustatory Aura
Perception of a taste as an epileptic phenomenon is classified as a gustatory aura. These auras also tend to be associated with complex perceptual alterations. The term gustatory aura should be applied only when the gustatory hallucination is the predominant symptom.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Autonomic Aura
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Seizures consisting primarily of autonomic symptoms are rare. Usually, they are detected by the patient reporting symptoms secondary to the autonomic alteration, e.g., palpitations or ‘‘hot flashes.” Occasionally, they can be documented by appropriate monitoring (e.g., Holter monitor). We classify these episodes as “autonomic auras” when the patient has symptoms most probably produced by an autonomic alteration but we do not have objective proof of the autonomic disturbance.
Autonomic alterations elicited by epileptic activation of autonomic cortical centers produce symptoms that the patient can detect but that observers have difficulty identifying, particularly from a videotape recording (palpitations, hot flashes, and so on). Sensations that most probably are an expression of an epileptic autonomic alteration are classified as autonomic auras even when there is no objective proof of their autonomic pathogenesis (such as palpitations or hot flashes). In contrast, autonomic alterations appropriately documented by polygraphic recordings (tachycardia, blood pressure changes, and so on) or direct visual observation (mydriasis, sweating, flushing, piloerection, and so on) are classified as autonomic seizures
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Abdominal Aura
Patients with temporal lobe epilepsy frequently have auras with abdominal sensations. Some of these abdominal auras are most probably the expression of increased abdominal peristalsis and therefore correspond to a subgroup of autonomic auras (or autonomic seizures, if the alteration of peristalsis has been documented). In other cases, they may be an expression of activation of sensory cortical areas of the abdominal viscera. Independent of the pathogenesis, these abdominal auras are closely related to temporal lobe epilepsy; therefore, it appears useful to classify them independently as abdominal auras.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Psychic Aura
Psychic auras consist of complex hallucinations and illusions that usually affect different senses. The most typical examples are distortions of familiarity, such as sensations of déjà vu or jamais vu. Frequently these sensations may be associated with emotional alterations, such as fear. In addition, they may occur together with complex visual, auditory or other hallucinations and illusions, including visual hallucinations such as macropsia, micropsia, and so on.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Aura
Auras are ictal manifestations having sensory, psychosensory, and experiential symptoms.
Sensorial Sphere
Warning symptoms at beginning of seizure
Aura
Auras consist exclusively of subjective symptoms and usually occur at the beginning of a seizure (“warning symptoms”). In general, they are brief (seconds) and only rarely may persist longer (minutes). They may occur in isolation from any other ictal symptom and, if so, tend to last slightly longer. In general, the epileptic nature of auralike symptomatology can be documented objectively only if the aura consistently evolves into a dialeptic or motor seizure or if EEG monitoring demonstrates an EEG seizure pattern during the aura.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Autonomic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Autonomic seizures are seizures in which the main ictal manifestations are objectively documented autonomic alterations.
“Autonomic seizures” have objective proof of the autonomic alteration whether the patient is aware of the autonomic disturbance or not.
Autonomic seizures consist of episodic alterations of autonomic function that are elicited by activation of autonomic cortical centers activated by an epileptiform discharge. Cases in which the patient reports only sensations that most probably correspond to an autonomic alteration (hot flashes, palpitations, and so on) and for which there is no objective documentation should be classified as autonomic auras (described above). To make the diagnosis of an autonomic seizure, episodes of autonomic dysfunction must be documented by appropriate polygraphic recording (tachycardia, blood pressure changes, and so on) or by direct observation. Documented episodes of autonomic dysfunction may be clinically silent (i.e., the episodes may only be detected by a monitor, without the patient experiencing any unusual symptoms).
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Dialeptic Seizure
Location: Left Hemisphere/Right Hemisphere
“Dialeptic” seizures have as their main ictal manifestations an alteration of consciousness that is independent of ictal EEG manifestations. The new term “dialeptic” seizure has been coined to differentiate this concept from absence seizures (dialeptic seizures with a generalized ictal EEG) and complex partial seizures (dialeptic seizures with a focal ictal EEG).
Dialeptic seizures is a new term coined to identify seizures in which the predominant symptomatology consists of an alteration of consciousness (see discussion of terminology above). Alteration of consciousness is difficult to define. However, for the purpose of identifying dialeptic seizures, we classify altered consciousness as does the ILAE classification of epileptic electroclinical complexes, e.g., as episodes of unresponsiveness or decreased responsiveness that are not caused by motor alterations. Dialeptic seizures are associated with complete or at least partial amnesia for the episode; therefore, amnesia of the episode is necessary to establish the diagnosis of dialeptic seizure.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Myoclonic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Myoclonic seizures consist of short muscle contractions lasting <400 ms.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Tonic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Tonic seizures consist of sustained muscle contractions, usually lasting >3 s, that lead to “positioning.”
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Epileptic Spasm
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Tonic seizures consist of sustained muscle contractions, usually lasting >3 s, that lead to “positioning.”
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Clonic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Clonic seizures are a series of myoclonic contractions that regularly recur at a rate of 0.2-5/s.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Tonic-Clonic Seizure
Generalized tonic-clonic seizures are characterized by an initial tonic posturing of all limbs. The sustained muscle contractions that determined the tonic phase then tend to slow, evolving into a clonic phase with contractions of progressively decreasing frequency until the contractions disappear completely. The muscles included in the tonic and clonic phase should be essentially the same. Focal motor seizures showing such a tonic-clonic evolution are infrequent.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Versive Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Versive seizures are seizures during which the patient either has a conjugate eye movement to one side or moves the head, and occasionally the whole body, to one side. Only conjugate eye movements or lateral head and body movements that are sustained and extreme should be classified as versive seizure. The lateral movement of the eyes frequently consists of a combination of a smooth tonic lateral movement on which are superimposed small saccades that progressively move the eye out to an extreme position. On other occasions, a smooth lateral movement without any saccades may be observed. The version of body parts has a similar character, but the saccades are replaced by small clonic lateral movements of the head or body. During these lateral movements, the chin frequently moves not only laterally but also upward, resulting in an unnatural position of the eyes and head. Occasionally, the patient’s body will also turn and may complete one or more 360” turns.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Simple Motor Seizure
Location: Left/right/axial/generalized/bilateral asymmetric
Simple motor seizures in which the motor movements are relatively “simple,” unnatural, and consist of movements similar to movements elicited by electrical stimulation of the primary motor areas (Brodmann areas 4 and 6)
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Hypermotor Seizures
Hypermotor seizures are seizures in which the main manifestations consist of complex movements involving the proximal segments of the limbs and trunk. This results in large movements that appear “violent” when they occur at high speeds. The “complex motor manifestations” imitate normal movements, but the movements are inappropriate for the situation and usually serve no purpose. Frequently, the movements are stereotypically repeated in more or less complex sequences (e.g., pedaling). Consciousness may be preserved during these seizures.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Gelastic seizures.
Seizures in which the main motor manifestation is “laughing’’ are termed gelastic seizures. They may be preceded or followed by any other type of seizure. Only seizures in which the main ictal semiology is laughing should be classified as gelastic seizures. These seizures are classified separately because they are common in patients with hypothalamic hamartoma.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Automotor seizures
Automotor seizures are complex motor seizures in which the main manifestations consist of automatisms involving the distal segments of the hands and feet or the mouth and tongue. Consciousness is usually affected but may be preserved, particularly when the seizure originates from the nondominant hemisphere.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Complex Motor Seizures
Complex motor seizures, in which the movements are relatively complex and simulate natural movements, except that they are inappropriate for the situation.
“Complex” herein refers to the complex characteristics of the movement and does not mean that the patient loses awareness during the seizure.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Motor Seizures
Seizures in which the main manifestations are motor phenomena are classified as motor seizures.
Seizures in which the main symptomatology are motor signs are identified as motor seizures.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Atonic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Atonic seizures cause a loss of postural tone. The result is loss of posture (head drops, falls, and so on). Often these seizures are preceded by a short myoclonic seizure.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Astatic seizure
Astatic seizures consist of epileptic falls. Polygraphic studies show that only in a few patients are the falls the result of atonic seizures. In most patients, a myoclonic jerk causes the patient to lose balance, and the fall itself is produced by an atonia that occurs immediately after the initial myoclonic jerk. Pure generalized tonic seizures may also lead to an epileptic fall. In most patients, however, no video-polygraphic studies are performed and the pathogenesis of the fall is uncertain. It seems useful to classify astatic seizures separately because of the variable pathogenesis of the falls, which usually remains undefined.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Hypomotor Seizure
Location: Left hemisphere/right hemisphere
Hypomotor seizures have as their main manifestation a decrease or total absence of motor activity without the emergence of new motor manifestations. This classification is used exclusively in patients in whom it is not possible to test consciousness during or after the seizure (such as newborns, infants, and severely mentally retarded patients). In many patients, consciousness is probably altered during the seizures even if by definition consciousness cannot be tested directly. In a few patients with hypomotor seizures, the pathogenesis of the seizures may be different; consciousness may be preserved, and the absence of movement may be an expression of an akinetic seizure or may be a reaction to an aura.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Akinetic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Akinetic seizures are characterized by the inability to perform voluntary movements. Therefore, they can actually be considered negative complex motor seizures. Muscle tone is also frequently lost, but the akinesia is the most prominent manifestation of the seizure. These seizures are most probably an expression of the activation of the negative motor areas in the mesial frontal and inferior frontal gyri. Only patients in whom consciousness is preserved during the seizures can have akinetic seizures because they .can be tested or tell about the “akinetic” symptoms.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Negative Myoclonic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Negative myoclonic seizures are seizures that consist of a brief interruption of tonic muscle activity due to an epileptiform discharge. The brief interruption of muscle activity may result in a short, sudden movement similar to a myoclonic jerk. However, the pathogenesis of the movement is a brief loss of muscle tone and not a burst of muscle potentials characteristic of myoclonic seizures. Evidence suggests that these seizures are generated by epileptiform discharges in the primary sensorimotor cortex.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Aphasic Seizure
Location: Left Hemisphere/Right Hemisphere
During aphasic seizures, the patient cannot speak and often cannot understand spoken language. The seizures are probably a negative phenomenon produced by epileptic activation of a cortical language center, a phenomenon similar to that produced by cortical stimulation of language areas.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Seizures that cannot be classified in any of the four groups outlined above are categorized as special seizures. This category includes primarily seizures characterized by “negative” motor signs (atonic seizure, akinetic seizures, “hypomotor” seizures, and so on).
Seizures that cannot be classified in one of the four types described above are classified as special seizures. All these seizures are “negative” or “inhibitory” motor seizures except the aphasic seizures that most probably represent ‘‘negative cognitive” seizures.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Luders 1998
Most seizures consist of symptoms that evolve as the seizure discharge spreads to involve new cortical areas. In the semiological classification of seizures, this evolution is indicated by considering each one of the seizures described above as one component of a seizure. Any given seizure consists of one or more of these components, which are listed in order of appearance and are linked by arrows. Example:
Left visual aura --> left hand clonic seizure --> generalized tonic-clonic seizure
Left visual aura --> bilateral asymmetric tonic seizure --> left arm clonic seizure
Abdominal aura --> left hemispheric automotor seizure
Olfactory aura --> automotor seizure --> left versive seizure --> generalized tonic-clonic seizure
Generalized myoclonic seizure --> generalized tonic-clonic seizure
Typical dialeptic seizure --> generalized tonic-clonic seizure
Typically, we limit the number of seizure components to four for practical purposes.
Luders 1998
Epilepsy classification
The semiological seizure classification is a classification of the semiology of the seizures only. The epileptic syndrome, however, is defined by considering all clinical information (semiological seizure type, interictal EEG, ictal EEG, functional and anatomic neuroimaging, seizure evolution over time, neurological examination, and so on). In our institutions, we first define the epiteptic syndrome, then list the semiological characteristics of the patient’s seizures, state the presumed cause of the epileptic syndrome, and record important additional medical conditions which the patient has. This approach summarizes the essential features of the epilepsy and has been described in detail elsewhere (6). Some illustrative examples follow.
1. Left Mesial Temporal Lobe Epilepsy
Seizures: Abdominal aura --> automotor seizure
Cause: Left mesial temporal sclerosis
Related medical conditions: Febrile convulsions, Memory deficit, Cerebellar atrophy
2. Absence Epilepsy
Seizures: Typical dialeptic seizure --> generalized tonic-clonic seizure
Cause: Genetic
Related medical conditions:None
3. Lennox-Gastaut syndrome
Seizures: Generalized tonic seizure, Dialeptic seizure, Astatic seizure
Cause: Tuberous sclerosis
Related medical conditions: Mental retardation, Depression
4. Right Frontal Epilepsy
Seizures: Asymmetric bilateral tonic seizure --> Left arm clonic seizure --> Generalized tonic clonic seizure
Cause: Right mesial frontal cortical dysplasia
Related medical conditions: Schizophrenia, Mild mental retardation
Luders 1998: Classification
Seizure sequence
Most seizures consist of symptoms that evolve as the seizure discharge spreads to involve new cortical areas. In the semiological classification of seizures, this evolution is indicated by considering each one of the seizures described above as one component of a seizure. Any given seizure consists of one or more of these components, which are listed in order of appearance and are linked by arrows. Example:
Left visual aura → left hand clonic seizure → generalized tonic-clonic seizure
Left visual aura → bilateral asymmetric tonic seizure → left arm clonic seizure
Abdominal aura → left hemispheric automotor seizure
Olfactory aura → automotor seizure → left versive seizure → generalized tonic-clonic seizure
Generalized myoclonic seizure → generalized tonic-clonic seizure
Typical dialeptic seizure → generalized tonic-clonic seizure
Typically, we limit the number of seizure components to four for practical purposes.
Epilepsy classification
The semiological seizure classification is a classification of the semiology of the seizures only. The epileptic syndrome, however, is defined by considering all clinical information (semiological seizure type, interictal EEG, ictal EEG, functional and anatomic neuroimaging, seizure evolution over time, neurological examination, and so on). In our institutions, we first define the epileptic syndrome, then list the semiological characteristics of the patient’s seizures, state the presumed cause of the epileptic syndrome, and record important additional medical conditions which the patient has. This approach summarizes the essential features of the epilepsy and has been described in detail elsewhere (6). Some illustrative examples follow.
SUMMARY OF THE ESSENTIAL CHARACTERISTICS OF THE SEMIOLOGICAL CLASSIFICATION OF EPILEPTIC SEIZURES
The semiological seizure classification outlined above integrates the following features, which make it particularly useful for everyday application:
1. The terminology applied is as succinct as possible to facilitate everyday use.
2. Whenever available, “classical” terminology, well known to general neurologists and epileptologists, has been used.
3. The classification includes a few new terms, such as automotor, hypomotor, hypermotor, and dialeptic seizures. These new terms have been introduced to avoid confusion with other terms that identify similar seizures but that are defined not by pure semiological criteria but by electroclinical characteristics (see section Dialeptic seizures).
4. The semiological seizure classification includes ‘ ‘somatotopic modifiers’ ’ that permit definition of the somatotopic distribution of the ictal symptoms.
5. Each seizure type is considered a component. Different seizure evolutions are expressed by linking the different seizure types (“components”) by an arrow. Types of seizure evolution are not limited arbitrarily. This classification system should permit scientific studies of the most frequent type of seizure evolutions.
6. Ictal symptoms frequently cannot be defined with precision because of inadequate information (for example, a patient may be amnestic of the seizure and there may be no witness to the seizure or a witness may provide an incomplete and inaccurate history). The semiological difference classification permits classification of seizures with different degrees of precision. For example, if we believe that the patient had an epileptic seizure, we classify it as “epileptic seizure.” If the main manifestation was motor, we classify the seizure as a “motor seizure.” If the main manifestation was motor, we classify the seizure as a “motor seizure.” If the motor seizure affected the right arm but we do not know if it was a simple or complex motor seizure, we can classify it as “right arm motor seizure.” If we know that the movements during the seizure were “simple” (see definition above), but we have difficulty in defining the subtype, we can classify the seizure as “right arm simple motor seizure.” And finally, if by history or direct observation we can establish that the movement of the right arm was of clonic type, we can classify the seizure in its maximum degree of precision, namely as “right arm clonic seizure.” In other words, from left to right in Table 1, progressively more precise information is provided about the ictal semiology.
ADVANTAGES OF SEMIOLOGICAL SEIZURE CLASSIFICATION
Semiological classification of epileptic seizures has the following advantages:
1. It provides a terminology that permits clear identification of ictal semiological features independent of any other rest results.
2. It clarifies the difference between seizure classification and epileptic syndrome classification. Many epileptic syndromes may be associated with the same types of seizures (when classified semiologically); therefore, appropriate management of the patient will require that the physician define the epileptic syndrome. For example, establishing that a patient has dialeptic seizures does not tell us whether the patient has a generalized epilpetic syndrome such as absence epilepsy, which can be treated with ethosuximide, or a focal epileptic syndrome, in which ethosuximide is ineffective.
3. A semiological seizure classification focuses the attention of the observer on clinical semiology.
4. A semiological seizure classification in which we do not assume a one-to-one relationship between clinical semiology and other test results promotes scientific correlation studies between the different types of seizures (classified exclusively on the basis of ictal semiology) and other test results. Such studies should eventually provide better understanding of the significance of different semiological features.
5. A semiological seizure classification, particularly if it is comprehensive, can be applied to any age group. However, certain types of seizures will not occur or will seldome occur in newborn and infants because of their incompletely developed nervous system.
CONCLUSION
In this short outline, we introduce a semiological seizure classification. The present version-or variants of it-has been used in daily clinical practice for > 10 years in selected epilepsy centers. The advantages of a semiological seizure classification are stressed.
Bancaud 1981
Illusion: These take the form of distorted perceptions in which objects may appear deformed.
Polyoptic illusions such as monocular diplopia, distortions of size (macropsia or micropsia) or of distance may occur. Similarly, distortions of sound, including microacusia and macroacusia, may be experienced. Depersonalization, as if the person were outside his body, may occur. Altered perception of size or weight of a limb may be noted.
Bancaud 1981
Illusion: These take the form of distorted perceptions in which objects may appear deformed.
Polyoptic illusions such as monocular diplopia, distortions of size (macropsia or micropsia) or of distance may occur. Similarly, distortions of sound, including microacusia and macroacusia, may be experienced. Depersonalization, as if the person were outside his body, may occur. Altered perception of size or weight of a limb may be noted.
Blume 2003
SIGN 2005
Magnetic resonance imagine (MRI) scanning is superior to CT scanning in eleective imaging to ID abn underlying epilepsy and avoids radiation
Most children with epilepsy should have an elective MRI brain scan. (Don't need scan: idiopathic primary generalized epilepsies e.g. childhood absence epilepsy, juvenile myoclonic epilepsy, juvenile absence epilepsy, benign childhood epilepsy with centrotemporal spikes: benign rolandic epilepsy)
Wolf 2006
Structural brain lesions, such as malformations of cortical development, may elevate risk of seizures long term. Seizures may recur at variable intervals after remission due to removal of an epileptogenic lesion, such as a cavernous malformation.
Blume 2001
Manual or Pedal:
1. Indicates principally distal components, bilateral or unilateral.
2. Fumbling, tapping, manipulating movements.
2001 Engel
Maple syrup urine disease
Trancred 2005
The Marginal Sulcus is of significance because it forms the posterior boundary of the paracentral lobule.
Bancaud 1981
spinal cord disease
dyssynergia cerebella's myoclonia
subcortical segmental myoclonus
paramyoclonus multiplex
opsoclonus-myoclonus syndrome
brain stem ischemia (drop attack)
nacrolepsy cataplexy syndrome (drop attack)
ILAE 1989
Febrile Seizures/Convulsions
Tumor, Vascular
MELAS
Alcohol, drugs, eclampsia, nonketotic hyperglycemia
Minor personality disorder
Malformations
Phacomatoses
Hypothalamic hamartoma
Tuberous sclerosis
Neonate
Nonketotic hyperglicinemia
D-glyceriacdemia
Infant
Phenylketonuria
Tay-Sach disease
Sandhoff disease
Ceroid-lipofuscinosis
Santuavori Haltia Hagberg disease
Pyridoxine dependency
Child
Late infantile ceroid-lipofuscinosis (Jansky Bielschowski disease)
Huntington's Disease
Child and Adolescent
Gaucher disease
Ceroid Lipofuscinosis/Spiel-Meyer-Vogt-Sjogern disease
Laflora disease
Degenerative progressive myoclonic epilepsy/Ludnborg Type
Dyssynergia cerebellaris myoclonia with epilpesy/Ramsay-Hunt syndrome
Cherry red spot myoclonus syndrome/Sialidosis with Isolated Deficit in Neuraminidase
Mitochondrial Myopathy
Lactate/pyruvate metabolism abnormality
Adult
Kuf's disease/adult caroid lipofuscinosis
Luders 1998
Schizophrenia
Noachter 1999
Neurologic condition
Engel 2001:
Axis 5: Impairment derived from impairment classification adapted from WHO ICIDH2
Table 6
2003 Blume
Prolonged febrile seizures
Pregnancy
Hemorrhagic/ischemic stroke
1/2 tumors, Trauma, dementia, metabolic disorders
SIGN 2006
Learning difficulties (mild to severe)
cerebral palsy
quadriplegia
hemiplegia
Autism, Down's syndrome, Angelman Syndrome, Rett Syndrome, Fragile X Syndrome, tuberous sclerosis
ADHD
Trancred 2005
The Medulla Oblongata is important in regulating many autonomic functions (including blood pressure, heart rate, respiratory rate, coughing and vomiting reflexes). It also contains nuclei of cranial nerves VII to XI and continuations of the long tracts of the spinal cord.
Structures:
Abducens n. (CN VI)
Accessory n. (CN XI)
Brainstem
Central Canal
CN Nuclei of Medulla
Cuneate Nucleus
Cuneate Nucleus
Cuneate Nucleus
Glossopharyngeal n. (CN IX)
Gracile Nucleus
Hypoglossal n. (CN XII)
Inferior Olivary Nucleus
Pons
Pyramidal Decussation
Reticular Formation
Reticular Formation
Spinal Cord
Tracts of Medulla
Vagus n. (CN X)
Vestibulocochlear n. (CN VIII)
Information:
The medulla oblongata (myelencephalon) is the most caudal part of the brainstem, lying between the spinal cord and the pons. The transition from spinal cord to medulla is characterised by the gradual appearance of the pyramidal decussation, cuneate and gracile nuclei (the dorsal column nuclei) and the cranial nerves (which supply structures in the head and neck). The central canal of the spinal cord continues into the caudal part of the medulla, but with gradual disappearance of the dorsal column nuclei, it eventually opens out to form the fourth ventricle, which is present in the rostral half of the medulla.
Several cranial nerves arise from the ventral surface of the medulla including the hypoglossal n. (CN XII), accessory n. (CN XI), vagus n. (CN X) and glossopharyngeal n. (CN IX). The vestibulocochlear n. (CN VIII), facial n. (CN VII) and abducens n. (CN VI) arise from the junction between the medulla and the pons.
The medulla contains continuations of most of the long tracts of the cervical spinal cord and several others (see tracts of medulla), nuclei associated with cranial nerves (see CN nuclei of medulla) as well as several other important nuclei including those of the medullary reticular formation and the inferior olivary nuclei.
Blume 2001
Components of cognition:
Perception: symbolic conception of sensory information
Attention: appropriate selection of a principal perception or task
Emotion: appropriate affective significance of a perception
Memory: ability to store and retrieve percepts or concepts
Executive function: anticipation, selection, monitoring of consequences, and initiation of motor activity including praxis, speech
Bancaud 1981
Menstrual Cycle
Levels defined by IQ
This was in the core literature review because it was in the ILAE.
Review the name. It's similar to the one already in. Likewise, are patients with mesial temporal lobe epilepsy who have been seizure-free off medications for 10 years after resection of their hippocampal sclerosis considered to still have epilepsy?
Engel 2001
Mesial Temporal Lobe Epilepsy defined by sepcific etiologies
Engel 2001
Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis
ILAE 2010
Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis
Luders 1998
Berg 2010
computational neuroscience, neurochemistry
Blume 2003
SIGN 2006 Metabolic, cytogenic tests
Pyridoxine withdrawal test in children with intractable epilepsy with onset under age 3 years
Limbic origin seizures, dysphoric tastes or smells
Bancaud 1981
Metallic
Blume 2001
Gustatory: Taste sensations including acidic, bitter, salty, sweet, or metallic.
Bancaud 1981
Illusion: These take the form of distorted perceptions in which objects may appear deformed.
Polyoptic illusions such as monocular diplopia, distortions of size (macropsia or micropsia) or of distance may occur. Similarly, distortions of sound, including microacusia and macroacusia, may be experienced. Depersonalization, as if the person were outside his body, may occur. Altered perception of size or weight of a limb may be noted.
Engel 2001
Microcephaly
Engel 2001
Microdysgenesis
Bancaud 1981
Illusion: These take the form of distorted perceptions in which objects may appear deformed.
Polyoptic illusions such as monocular diplopia, distortions of size (macropsia or micropsia) or of distance may occur. Similarly, distortions of sound, including microacusia and macroacusia, may be experienced. Depersonalization, as if the person were outside his body, may occur. Altered perception of size or weight of a limb may be noted.
Trancred 2005
The Midbrain (Mesencephalon) contains the nuclei of cranial nerves III and IV, as well as nuclei associated with motor and autonomic control, and visual and auditory reflexes.
Structures:
Cerebral Aqueduct
Corticobulbar Tract
Corticopontine Tract
Corticospinal Tract
Crus Cerebri
Diencephalon
Edinger-Westphal Nucleus
Inferior Colliculus
Lateral Lemniscus
Medial Lemniscus
Medial Longitudinal Fasciculus
Mesencephalic Nucleus of CN V
Mesencephalon
Oculomotor Nucleus
Periaqueductal Gray
Pons
Red Nucleus
Spinothalamic Tract
Substantia Nigra
Superior Cerebellar Peduncle
Superior Colliculus
Tracts of the Midbrain
Trigeminothalamic Tract
Information:
The midbrain (mesencephalon) is the most rostral part of the brainstem and lies between the pons and the diencephalon. It consists of a tectum, which is located dorsal to the cerebral aqueduct, and paired cerebral peduncles, each of which is demarcated into a tegmentum and a crus cerebri by a pigmented region known as the substantia nigra. The tegmentum is located between the cerebral aqueduct and the substantia nigra. The crus cerebri, which is also known as the basis pedunculi, is formed by 2 large masses of white matter on the ventral surface of the midbrain.
The tectum is formed rostrally by the paired superior colliculi and caudally by the paired inferior colliculi.
The midbrain tegmentum contains several large gray masses including the periaqueductal gray, red nuclei, substantia nigra and several cranial nerve nuclei (oculomotor, Edinger-Westphal, and mesencephalic nucleus of CN V). The tegmentum also contains several tracts including the medial lemniscus, spinothalamic and trigeminothalamic tracts, lateral lemniscus and medial longitudinal fasciculus as well as the decussation of the superior cerebellar peduncle
The crus cerebri contain corticobulbar, corticospinal and corticopontine tracts.
Major tracts present in the midbrain are listed on a separate card (tracts of the midbrain)
Tancred 2005
Most of the middle frontal gyrus is included in the prefrontal area which is involved with certain aspects of behaviour, including motivation, mood, judgement and foresight.
Structures:
Central Sulcus
Cerebral Hemisphere
Cingulate Gyrus
Corpus Callosum
Gyrus Rectus
Inferior Frontal Gyrus
Inferior Frontal Sulcus
Lateral Fissure
Limbic Area
Middle Frontal Gyrus
Motor Speech (Broca's) Area
Olfactory Sulcus
Olfactory Tract
Orbital Gyri
Pars Opercularis (Inf. Fr. G.)
Pars Orbitalis (Inf. Fr. G.)
Pars Triangularis (Inf. Fr. G.)
Precentral Gyrus
Precentral Sulcus
Prefrontal Area
Premotor Area
Premotor Area
Superior Frontal Gyrus
Superior Frontal Sulcus
Triangular Sulcus
Information:
The frontal lobe occupies the anterior part of the cerebral hemisphere.
Boundaries:
On the lateral surface it extends from the frontal pole posteriorly to the central sulcus and is bounded inferiorly by the lateral fissure. On the medial surface it extends posteriorly to an imaginary line from the central sulcus to the corpus callosum.
Sulci and Gyri:
The superolateral surface of the frontal lobe is formed by the superior, middle and inferior frontal gyri which extend in an anteroposterior direction and the precentral gyrus which extends vertically downwards. The superior and inferior frontal gyri are separated by the superior frontal sulcus and the middle and inferior gyri are separated by the inferior frontal sulcus. The precentral sulcus separates the precentral gyrus from the frontal gyri.
The inferior frontal gyrus is divided from anterior to posterior into the pars orbitalis, pars triangularis and pars opercularis by the triangular sulcus. The superior frontal gyrus extends onto the medial surface as far as the cingulate gyrus, the anterior part of which is also included in the frontal lobe.
The inferior surface of the frontal lobe is formed by the orbital gyri, which overlie the bony roof of the orbit and gyrus rectus (most medially). The orbital gyri and gyrus rectus are separated by the olfactory sulcus, which contains the olfactory tract.
Functional Areas:
The frontal lobe includes a number of important functional areas:
(1) Primary motor area - located on the precentral gyrus.
(2) Premotor area - located on the anterior part of the precentral gyrus and the adjacent parts of the superior and middle frontal gyri.
(3) Prefrontal area - which includes the remainder of the superior and middle frontal gyri, the orbital part of the inferior frontal gyrus and the orbital gyri.
(4) Motor Speech (Broca's) Area - located on the triangular and opercular parts of the inferior frontal gyrus.
(5) Limbic Area - located on the cingulate gyrus.
Tancred 2005
The middle temporal gyrus is part of the association cortex of the temporal lobe.
Structures:
Collateral Sulcus
Corpus Callosum
Hippocampal Gyrus
Inferior Temporal Gyrus
Inferior Temporal Sulcus
Lateral Fissure
Lateral Ventricle
Middle Temporal Gyrus
Occipitotemporal Gyrus
Parahippocampal Gyrus
Parieto-occipital Sulcus
Primary Auditory Area
Primary Olfactory Area
Superior Temporal Gyrus
Superior Temporal Sulcus
Transverse Temporal Gyrus
Uncus
Information:
Boundaries:
On the lateral surface the temporal lobe is bounded posteriorly by the imaginary line extending downwards from the parieto-occipital sulcus to the preoccipital notch. It is bounded superiorly by the lateral fissure and a horizontal line extending from the lateral fissure to meet the imaginary line just described.
On the medial surface it is bounded posteriorly by a line extending from the splenium of the corpus callosum to the preoccipital notch.
Gyri and Sulci:
The lateral surface of the temporal lobe is formed by the superior, middle and inferior temporal gyri, which are separated from each other by the superior and inferior temporal sulci. The superior surface of the superior temporal gyrus, which forms the floor of the lateral fissure, is thrown into several transversely oriented folds, which are called the transverse temporal gyri (of Heschl).
The inferomedial surface of the temporal lobe is formed by (from medial to lateral) the parahippocampal gyrus, the occipitotemporal gyrus and the inferior temporal gyrus. The occipitotemporal gyrus is separated from the parahippocampal gyrus by the collateral sulcus and from the inferior temporal gyrus by the occipitotemporal sulcus. The rostral part of the parahippocampal gyrus hooks backward to form a bump on its medial surface called the uncus. Above the parahippocampal gyrus (not visible from the inferior surface) is the hippocampal gyrus, which actually forms the medial wall of the inferior (temporal) horn of the lateral ventricle.
Specific Functional Areas:
(1) Primary Auditory Area - located on the transverse temporal gyri.
(2) Primary Olfactory Area - located on the uncus.
Engel 2001
Migrating Partial Seizures of Early Infancy
Syndromes in development
Engel 2001
Migrating Partial Seizures of Infancy
Syndromes in development
Engel 2001
Miller-Dieker syndrome
Blume 2001
Mimetic: Facial expression suggesting an emotional state, often fear.
Engel 2001
Miscellaneous
Engel 2001
Mitochondrial diseases
Engel 2001
MELAS
Bancaud 1981
Inheritance
ILAE 1989
Inheritance
Luders 1998
2010 Berg
Hereditary predisposition
ILAE 1989
A Ramsay-Hunt-like syndrome can also be associated with a mitochondrial myopathy, with abnormalities of lactate and pyruvate metabolism (Fukuhara et al., 1980).
Blume 2001
Components of cognition:
Perception: symbolic conception of sensory information
Attention: appropriate selection of a principal perception or task
Emotion: appropriate affective significance of a perception
Memory: ability to store and retrieve percepts or concepts
Executive function: anticipation, selection, monitoring of consequences, and initiation of motor activity including praxis, speech
Bancaud 1981
Moan
Is a or part of?
Blume 2001
Executive function: anticipation, selection, monitoring of consequences, and initiation of motor activity including praxis, speech
Bancaud 1981
Illusion: These take the form of distorted perceptions in which objects may appear deformed.
Polyoptic illusions such as monocular diplopia, distortions of size (macropsia or micropsia) or of distance may occur. Similarly, distortions of sound, including microacusia and macroacusia, may be experienced. Depersonalization, as if the person were outside his body, may occur. Altered perception of size or weight of a limb may be noted.
Noachter 1999
Monophasic Wave: Wave developed on one side of the baseline.
Noachter 1999
Monophasic Wave: Wave developed on one side of the baseline.
synonymous with emotion and affect
Remove this
synonymous with emotion and affect
Remove this
Noachter 1999
Morphology:
(1) the study of the form of EEG waves.
(2) The form of EEG waves.
Affects a person's ability to express and understand written and spoken language.
JB: Can have motor or sensory aphasia
ILAE 1989
Motor cortex. Motor cortex epilepsies are mainly characterized by simple partial seizures, and their localization depends on the side and topography of the area involved. In cases of the lower prerolandic area there may be speech arrest, vocalization or dysphasia, tonic-clonic movements of the face on the contralateral side, or swallowing. Generalization of the seizure frequently occurs. In the rolandic area, partial motor seizures without march or jacksonian seizures occur, particularly beginning in the contralateral upper extremities. In the case of seizures involving the paracentral lobule, tonic movements of the ipsilateral foot may occur as well as the expected contralateral leg movements. Postictal or Todd’s paralysis is frequent.
Bancaud 1981
Partial Dysphasia
Language disorder that affects a person's ability to communicate
Bancaud 1981
With Motor Signs
Motor Attack
Luders 1998
Motor Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Seizures in which the main manifestations are motor phenomena are classified as motor seizures. Seizures in which the main symptomatology are motor signs are identified as motor seizures.
Motor seizures are characterized mainly by motor symptoms and are subclassified as simple or complex. Simple motor seizures are characterized by simple, unnatural movements that can be elicited by electrical stimulation of the primary and supplementary motor area (myoclonic, tonic, clonic and tonic-clonic, versive). Complex motor seizures are characterized by complex motor movements that resemble natural movements but that occur in an inappropriate setting (‘‘automatisms’’).
Motor Sphere
Seizures where the main manifestations are motor phenomena
Blume 2001
7.0 Convulsion: Primarily a lay term. Episodes of excessive, abnormal muscle contractions, usually bilateral, which may be sustained or interrupted
1.0 Motor: involves musculature in any form. The motor event could consist of an increase (+) or decrease (-) in muscle contraction to produce a movement. Unless noted, the following terms are adjectives modifying "motor seizure" or "seizure" (e.g., "tonic motor seizure or dystonci seizure"), and whose definitions can usually be understood as prefaced by "refers to…"
Blume 2003
Vocalization
Location
Generalized
Biting
SIGN 2006
Convulsion: seizure characterized by a marked motor activity e.g. jerking and/or stiffness, may be epileptic or non-epileptic
Relates to movement
Tancred 2005
Broca's motor speech area is essential for normal speech in that it coordinates the activity of muscles associated with the production of speech.
Structures:
Aphasia - Expressive
Brodmann’s Areas
Cortical Areas
Inferior Frontal Gyrus
Pars Opercularis (Inf. Fr. G.)
Pars Triangularis (Inf. Fr. G)
Receptive Speech Area
Information:
The Motor Speech (Broca's) Area is located on the pars triangularis and pars opercularis of the inferior frontal gyrus of the dominant (usually the left) hemisphere. It corresponds to Brodmann's areas 44 and 45.
The motor speech area was identified on the basis of clinical observations first reported by Broca in the late nineteenth century. He observed that damage to this area results in producing the sounds associated with speech, a condition known as motor or expressive aphasia. Patients with this condition speak slowly, with poorly produced sounds and as few words as possible (they tend to leave out prepositions and conjunctions - telegraphic speech). Their language comprehension is normal.
This area thus contains the coding essential for the production of speech.
Luders 1998
Motor Seizures
Seizures in which the main manifestations are motor phenomena are classified as motor seizures.
Seizures in which the main symptomatology are motor signs are identified as motor seizures.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Bancaud 1981
Corner of Mouth
Noachter 1999
Mu Rhythm: Rhythm at 7-11 Hz, composed of arch-shaped waves occurring over the central or centroparietal regions of the scalp during wakefulness. Amplitude varies but is mostly below 50 uV. Blocked or attenuated most clearly by contralateral movement, thought of movement, readiness to move or tactile stimulation. Greek letter: u.
Synonyms: arceau, wicket, comb rhythms (use discouraged).
Noachter 1999
Multifocal: More than two or more spatially separated foci (see focal, regional, multiregional).
Engel 2001
Focal or multifocal cortical dysplasia
Bancaud 1981
Multiple
Noachter 1999
Multiregional: Three and more regional foci (see regional).
Bancaud 1981
Contractions
Bancaud 1981
Groups of Muscles
Engel 2001
Music
Bancaud 1981
Music
Difference between music tone versus single tone
Blume 2001
Auditory: Buzzing, drumming sounds or single tones.
Suleiman 2013
Engel 2001
Myoclonic Absence Seizures
Engel 2001
Epilepsy with myoclonic astatic seizures
Engel 2001
Myoclonic Atonic Seizures
ILAE 2010
Myoclonic Atonic Epilepsy
Bancaud 1981
Clonic Convulsive Movements
ILAE 2010
Myoclonic Encephalopathy in Nonprogressive Disorders
ILAE 2010
Myoclonic Epilepsy in Infancy (MEI)
Bancaud 1981
Clinical Seizure Type
Myoclonic jerks (single or multiple)
EEG Seizure Type
Polyspike and wave, or sometimes spike and wave or sharp and slow wave
EEG Interictal Expression
Polyspike and wave, or sometimes spike and wave or sharp and slow wave
Short (<400 ms)
muscle contractions
Luders 1998
Simple, unnatural movements
Like Broadman 4&6 stimulation
Bancaud 1981
Myoclonic jerks (single or multiple) are sudden, brief, shock-like contractions which may be generalized or confined to the face and trunk or to one or more extremities or even to individual muscles or groups of muscles. Myoclonic jerks may be rapidly repetitive or relatively isolated. They may occur predominantly around the hours of going to sleep or awakening from sleep. They may be exacerbated by volitional movement (action myoclonus). At times they may be regularly repetitive.
Many instances of myodonic jerks and action myoclonus are not classified as epileptic seizures. The myoclonic jerks of myoclonus due to spinal cord disease, dyssynergia cerebellaris myoclonica, subcortical segmental myoclonus, paramyoclonus multiplex, and opsoclonus-mymlonus syndrome must be distinguished from epileptic seizures.
ILAE 1989
Myoclonic jerks (fragmentary, segmental, massive myoclonus)
Luders 1998
Myoclonic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Simple, unnatural movements
Like Broadman 4&6 stimulation
Blume 2001
1.1.2 Myoclonic (adjective/noun): Sudden, brief (<100 ms) involuntary single or multiple contraction(s) of muscle(s) or muscle groups of variable topography (axial, proximal limb, distal).
1.1.2.2 Clonic: Myoclonus that is regularly repetitive, involves the same muscle groups, at a frequency of ~2-3 c/s, and is prolonged. Synonym: rhythmic myoclonus
Engel 2001
Myoclonic absence seizures
Myoclonic seizures
Berg 2010
Myoclonic
Location: Left/right/axial/generalized/bilateral asymmetric
Bancaud 1981
Luders 1998
Myoclonic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Myoclonic seizures consist of short muscle contractions lasting <400 ms.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Engel 2001
Myoclonic Status Epilepticus
Engel 2001
Myoclonic Status in Nonprogressive Encephalopathies
Syndromes in development
Engel 2001
MERRF
Bancaud 1981
Tonic muscular contraction
Suleiman 2013
N-methyl-D-aspartate receptor (NMDAR) encephalitis in which 76–83% of patients will have focal, focal dyscognitive, or generalized seizures (Dalmau et al., 2007, 2008, 2011; Irani & Vincent, 2011)
NMDAR encephalitis is well described (Florance et al., 2009)
Blume 2001
Epigastric: Abdominal discomfort including nausea, emptiness, tightness, churning, butterflies, malaise, pain, and hunger; sensation may rise to chest or throat. Some phenomena may reflect ictal autonomic dysfunction.
Bancaud 1981
Neck
ILAE 1989
Luders 1998
Special Seizure
Special seizures include seizures characterized by “negative” features (atonic, astatic, hypomotor, akinetic, and aphasic seizures).
Luders 1998
Seizures that cannot be classified in any of the four groups outlined above are categorized as special seizures. This category includes primarily seizures characterized by “negative” motor signs (atonic seizure, akinetic seizures, “hypomotor” seizures, and so on).
Seizures that cannot be classified in one of the four types described above are classified as special seizures. All these seizures are “negative” or “inhibitory” motor seizures except the aphasic seizures that most probably represent ‘‘negative cognitive” seizures.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Muscle activity interruption
Brief interruption of tonic muscle activity
Short, sudden movement similar to myoclonic jerk
Epileptiform discharge from primary sensorimotor cortex discharge
Luders 1998
Blume 2001
1.1.2.1 Negative Myoclonic: Interruption of tonic muscular activity for <500 ms without evidence of preceding myoclonia
Location: Left/right/axial/generalized/bilateral asymmetric
Luders 1998
Negative Myoclonic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Blume 2001
1.1.2.1 Negative Myoclonic: Interruption of tonic muscular activity for <500 ms without evidence of preceding myoclonia
Engel 2001
(Focal) Negative Myoclonus
Berg 2010
Myoclonic atonic/astatic?
Negative myoclonic seizures are seizures that consist of a brief interruption of tonic muscle activity due to an epileptiform discharge. The brief interruption of muscle activity may result in a short, sudden movement similar to a myoclonic jerk. However, the pathogenesis of the movement is a brief loss of muscle tone and not a burst of muscle potentials characteristic of myoclonic seizures. Evidence suggests that these seizures are generated by epileptiform discharges in the primary sensorimotor cortex.
Luders 1998
Negative Myoclonic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Negative myoclonic seizures are seizures that consist of a brief interruption of tonic muscle activity due to an epileptiform discharge. The brief interruption of muscle activity may result in a short, sudden movement similar to a myoclonic jerk. However, the pathogenesis of the movement is a brief loss of muscle tone and not a burst of muscle potentials characteristic of myoclonic seizures. Evidence suggests that these seizures are generated by epileptiform discharges in the primary sensorimotor cortex.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
ILAE 1989
Neonatal seizures
Neonatal seizures differ from those of older children and adults. The most frequent neonatal seizures are described as subtle because the clinical manifestations are frequently overlooked. These include tonic, horizontal deviation of the eyes with or without jerking, eyelid blinking or fluttering, sucking, smacking, or other buccal-lingual oral movements, swimming or pedaling movements and, occasionally, apneic spells. Other neonatal seizures occur as tonic extension of the limbs, mimicking decerebrate or decorticate posturing. These occur particularly in premature infants. Multifocal clonic seizures characterized by clonic movements of a limb, which may migrate to other body parts or other limbs, or focal clonic seizures, which are much more localized, may occur. In the latter, the infant is usually not unconscious. Rarely, myoclonic seizures may occur, and the EEG pattern is frequently that of suppression-burst activity. The tonic seizures have a poor prognosis because they frequently accompany intraventricular hemorrhage. The myoclonic seizures also have a poor prognosis because they are frequently a part of the early myoclonic encephalopathy syndrome.
Berg 2010
<= 1Month or 44 weeks gestation
Engel 2001
Neuroaxonal Dystrophy
Engel 2001
Neurocutaneous disorders
Fischer 2014
Neurocystercosis
One or more brain cysts in an individual with neurocysticercosis may be incidental findings with no epileptogenic activity in a particular individual. Risk does not equate with causation. When in doubt, practitioners should consider referring a patient to a specialized epilepsy center with experience in diagnosis
Engel 2001
Neurofibromatosis
Engel 2001
Neurofibromatosis
Engel 2001
Neurofibromatosis
Blume 2001
Neuroimaging may aid diagnosis
Berg 2010
imaging
Too vague
ILAE 1989
Memory Deficits/Amnesia
Postictal confusion
Ataxia (Cerebellar)
Pyramidal signs
Cerebellar signs
Interictal myoclonus
Luders 1998
Noachter 1999
Neurologic condition
Blume 2003
Babinski's sign
2003 Blume
Determination hinges on seizure description, frequency, age at onset, neurological history, functional enquiry, neurological examination and one or more EEGs
2010 Berg
Motor and sensory examinations
These are the structural pathologies of larger conditions
Known normal patterns that have no clinical relevance towards diagnosis of something abnormal.
Noachter 1999
Absence: Use of term discouraged when describing EEG patterns.
Terms suggested, whenever appropriate:
spike-and-slow-wave complex;
3/s spike-and-slow-wave complex;
sharp-and-slow- wave complex.
Noachter 1999
Activation procedure:
(1) Any procedure designed to enhance or elicit normal or abnormal EEG activity, especially paroxysmal activity.
Examples: hyperventilation, photic stimulation, sleep, injection of convulsant drugs.
(2) Induction of an EEG pattern consisting of a low voltage record which becomes apparent upon blocking of EEG rhythms by physiological or other stimuli such as electrical stimulation of the brain (use in this meaning discouraged).
Noachter 1999
Active electrode: Use of term discouraged.
Comment: all electrodes may be active including all cephalic references. The use of this term may be acceptable when recording brain signals with a noncephalic reference electrode.
Noachter 1999
After-discharge:
(1) EEG seizure pattern following single or repetitive electrical stimulations of a discrete area of the brain via cortical or intracerebral electrodes.
(2) Burst of rhythmic activity following a transient such as an evoked potential or a spike.
Noachter 1999
Aliasing: Distortion of the EEG signal, which occurs when the signal is digitized at less than half the highest frequency present (see Nyquist theorem).
Noachter 1999
Alpha band: Frequency band of 8-13 Hz. Greek letter: 0'..
Noachter 1999
Alpha rhythm: Rhythm at 8-13 Hz occurring during wakefulness over the posterior regions of the head, generally with maximum amplitudes over the occipital areas. Amplitude varies but is mostly below 50 uV in the adult. Best seen with the eyes closed and during physical relaxation and relative mental inactivity. Blocked or attenuated by attention, especially visual, and mental effort.
Comment: use of term alpha rhythm must be restricted to those rhythms that fulfill these criteria. Activities in the alpha band which differ from the alpha rhythm as regards their topography and/or reactivity, should either have specific appellations (for instance: the mu [u] rhythm) or should be referred to as rhythms of alpha frequency, or alpha activity.
Noachter 1999
Alpha variant rhythms: Certain characteristic EEG rhythms that are recorded most prominently over the posterior regions of the head and differ in frequency but resemble in reactivity the alpha rhythm.
Comment: often at a supra or sub-harmonic of alpha frequency may occur when no alpha rhythm is visible (see: fast alpha valiant rhythm; slow alpha variant rhythm.
Noachter 1999
Alpha wave: Wave with duration of 1/8-1/13 s.
Noachter 1999
Alphoid rhythm: Use of term discouraged.
Term suggested: alpha rhythm.
Noachter 1999
Amplitude: Voltage of EEG waves expressed in microvolts (uV). Measured peak-to-peak. Comment: size of an EEG wave is dependent?upon signal voltage divided by the pen writer or of display sensitivity. EEG depicts the difference in potential between electrode pairs. It is therefore dependent on the method of derivation and has no simple relationship to actual amount of cerebral activity. EEG waves recorded from the surface of the head are attenuated and distorted by intervening structures, particularly the skull.
Noachter 1999
Analog-to-digital conversion (AD conversion): Transformation of a continuous, analog EEG into its digital representation (a discontinuous series of discrete amplitude measurements). AD conversion is characterized by the sampling rate, which is the number of times per second at which the signal is transformed into numbers, and the amplitude resolution, the number of numerical values which can be distinguished within the dynamic range of the system (usually expressed as the number of binary digits).
Noachter 1999
Aperiodic: Applies to:
(1) EEG waves or complexes occurring in a sequence at an irregular rate,
(2) EEG waves or complexes occurring intermittently at irregular intervals.
Noachter 1999
Apotentiality: Use of term discouraged.
Term suggested: record of electrocerebral inactivity.
Noachter 1999
Mu Rhythm: Rhythm at 7-11 Hz, composed of arch-shaped waves occurring over the central or centroparietal regions of the scalp during wakefulness. Amplitude varies but is mostly below 50 uV. Blocked or attenuated most clearly by contralateral movement, thought of movement, readiness to move or tactile stimulation. Greek letter: u.
Synonyms: arceau, wicket, comb rhythms (use discouraged).
Noachter 1999
Change from a lower to a higher level of arousal as manifest in EEG.
Noachter 1999
Arrhythmic activity: A sequence of waves of inconstant period (see rhythm).
Noachter 1999
Artifact:
(1) A potential difference due to an extracerebral source, recorded in EEG tracings.
(2) A modification of the EEG caused by extracerebral factors such as alterations of the media surrounding the brain, instrumental distortion or malfunction, and operational errors.
Noachter 1999
Asymmetry: Unequal amplitude of EEG activities over homologous areas on opposite sides of the head.
Independent (temporally): Synonym: asynchronous.
Noachter 1999
Asynchrony: The non-simultaneous occurrence of EEG activities over regions on the same or opposite sides of the head.
Noachter 1999
Attenuation:
(1) Reduction in amplitude of EEG activity. May occur transiently in response to physiological or other stimuli, such as electrical stimulation of the brain, or result from pathological conditions (see blocking).
(2) Reduction of sensitivity of an EEG channel, i.e. decrease of output deflection during operation of sensitivity or filter controls. Customarily expressed as relative reduction of sensitivity at certain stated frequencies (see sensitivity; high frequency filter; low frequency filter).
Noachter 1999
Atypical spike-and-slow-wave complex: Paroxysms consisting of a sequence of spike-and-slow-wave complexes that occur bilaterally but do not meet the criteria of 3 per second spike-and-slow-wave complex.
Noachter 1999
Augmentation: Increase in amplitude of electrical activity.
Noachter 1999
Average potential reference: Average of the potentials of all or many EEG electrodes, used as a reference.
Synonym: Goldman-Offner reference (use discouraged).
Term suggested: common average reference.
Noachter 1999
Background activity: Any EEG activity representing the setting in which a given normal or abnormal pattern appears and from which such pattern is distinguished.
Comment: not a synonym of any individual rhythm such as the alpha rhythm.
Noachter 1999
Background slow activity: The frequency of the background rhythm is below the normal value.
Noachter 1999
Band: Portion of EEG frequency spectrum, i.e. delta, theta, alpha, beta bands.
Noachter 1999
Basal Electrode: Any electrode located in proximity to the base of the skull (see foramen ovale electrode, nasopharyngeal electrode; sphenoidal electrode).
Noachter 1999
Baseline:
(1) Strictly: line obtained when an identical voltage is applied to the two input terminals of an EEG amplifier or when the instrument is in the calibrate position but no calibration signal is applied.
(2) Loosely: imaginary line corresponding to the approximate mean values of the EEG activity assessed visually in an EEG derivation over a period of time.
Noachter 1999
Benign epileptiform discharges of childhood: Regional or multiregional sharp waves, which are normally followed by a negative slow wave with lower amplitude than the negative peak of the sharp wave and which typically show a bipolar distribution with a positive sink in the mid frontal region. These sharp waves often have a multiregional distribution and are easy to recognize by their typical morphology. If they occur in the centrotemporal region, they are also called "Rolandic spikes". They typically increase during sleep and tend to appear in series.
Noachter 1999
Benign epileptiform transient of sleep (BETS): Small sharp spikes (SSS) of very short duration and low amplitude, often followed by a small theta wave, occurring in the temporal regions during drowsiness and light sleep. This pattern is of little clinical significance (see small sharp spikes).
Noachter 1999
Beta band: Frequency band from 14 to 40 Hz. Greek letter: Beta (see gamma band).
Noachter 1999
Beta rhythm: In general: any EEG rhythm between 14 and 40 Hz. Most characteristically: a rhythm from 14 to 40 Hz recorded over the frontocentral regions of the head during wakefulness. Amplitude of frontocentral beta rhythm varies but is mostly below 30uV Blocking or attenuation by contralateral movement or tactile stimulation is especially obvious in electrocorticograms. Other beta rhythms are most prominent in other locations or are diffuse.
Noachter 1999
Bilateral: Involving both sides of the head.
Noachter 1999
Bisynchronous: Abbreviation for bilaterally synchronous (use discouraged).
Noachter 1999
Bin width: Time, usually expressed in microseconds, elapsing between two successive sampling points in digital EEG (see digital EEG).
Noachter 1999
Biological calibration: See common EEG input test.
Noachter 1999
Biparietal hump: Use of term discouraged.
Term suggested: vertex sharp transient.
Noachter 1999
Biphasic wave: Use of term discouraged.
Term suggested: diphasic wave.
Noachter 1999
Bipolar derivation:
(1) Recording from a pair of electrodes.
(2) Method of organizing the linkages of electrodes to recording channels (see bipolar montage).
Noachter 1999
Bipolar montage: Multiple bipolar derivations, with no electrode being common to all derivations. In most instances, bipolar derivations are linked, i.e. adjacent derivations from electrodes along the same line of electrodes have one electrode in common, connected to the input terminal 2 of one amplifier and to the input terminal 1 of the following amplifier (see reference montage).
Noachter 1999
Bisynchronous: Abbreviation for bilaterally synchronous (use discouraged).
Noachter 1999
Blacklead: Use of term discouraged.
Term suggested: input terminal 1.
Noachter 1999
Blocking:
(1) Apparent, temporary obliteration of EEG rhythms in response to physiological or other stimuli such as electrical stimulation of the brain (see attenuation).
(2) A condition of temporary unresponsiveness of the EEG amplifier, caused by major overload. Manifested initially by extreme, flat-topped trace excursion(s) lasting up to a few seconds (see overload, clipping).
Noachter 1999
Brain wave: Use of term discouraged.
Term suggested: EEG wave.
Noachter 1999
Buffer amplifier: An amplifier, generally with a voltage gain of 1, a high input impedance, and a low output impedance, used to isolate the input signal from the loading effects of an immediately following circuit. In some electroencephalographs, each input is connected to a buffer amplifier located in the jack box to reduce cable artifact and interference.
Noachter 1999
Build-up: Colloquialism. Frequently employed to describe progressive increase in voltage of the EEG or appearance of waves of increasing amplitude, frequently associated with decrease in frequency during hyperventilation. Sometimes applied to hyperventilation or seizure discharges (use discouraged).
Noachter 1999
Burst: A group of waves which appear and disappear abruptly and are distinguished from background activity by differences in frequency, form and/or amplitude.
Comments:
(1) term does not imply abnormality.
(2) Not a synonym of paroxysm (see paroxysm).
Noachter 1999
Burst suppression: Pattern characterized by bursts of theta and/or delta waves, at times intermixed with faster waves, and intervening periods of low amplitude (below 20 uV).
Comment: EEG pattern that indicates either severe brain dysfunction or is typical for some anesthetic drugs at certain levels of anesthesia.
Noachter 1999
Calibration:
(1) Procedure of testing and recording the responses of EEG channels to voltage differences applied to the input terminals of their respective amplifiers.
Comment: DC (usually) or AC voltages of magnitude comparable to the amplitudes of EEG waves are used in this procedure.
(2) The procedure of testing the accuracy of paper speed by means of a time marker (see common EEG input test).
Noachter 1999
Channel: Complete system for the detection, amplification and display of potential differences between a pair of electrodes. Comment: analog electroencephalographs generally have several EEG channels. Digital EEG machines simulate a multichannel display by tracing several voltage time plots on a visual display.
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Circumferential bipolar montage: A montage consisting of linked bipolar derivations in a circular shape around the head. Commonly bilateral longitudinal temporal electrode chains are linked together.
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Clipping: Distortion of EEG waves which makes them appear flat-topped in the write-out or display. Caused by overload.
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Closely spaced electrodes: Additional scalp electrode placed at half distance between the standard electrodes of the ten-twenty system (see ten-ten system, standard electrode, special electrode).
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Comb rhythm: Use of term discouraged.
Term suggested: mu (u) rhythm.
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Common average reference: See average potential reference.
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Common EEG input test: Procedure in which the same pair of EEG electrodes is connected to the two input terminals of all channels of the electroencephalograph.
Synonym: biological calibration.
Comment: used as adjunct to calibration procedure (see calibration).
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Common mode rejection: A characteristic of differential amplifiers whereby they provide markedly reduced amplification of common mode signals, compared to differential signals. Expressed as common mode rejection ratio, i.e. ratio of amplifications of differential and common mode signals.
Example:
(amplification, differential) /
(amplification, common mode) =100,000/1 = 100,000 : 1
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Common Mode Signal: Common component of the two signals applied to the two input terminals of a differential EEG amplifier.
Comment: in EEG recording, external capacitative interference frequently occurs as a common mode signal.
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Common Reference Electrode: A reference electrode connected to the input terminal 2 of several or all EEG amplifiers.
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Common Reference Montage: Several referential derivations sharing a single reference electrode (see referential derivation, reference electrode).
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Complex: A sequence of two or more waves having a characteristic form or recurring with a fairly consistent form, distinguished from background activity.
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Contingent Negative Variation: An event related slow potential elicited in the interval following a premonitory stimulus and a second stimulus to which the subject is required to make a voluntary response. It comprises a progressive negative-going change maximal at the vertex.
Abbreviation: CNV.
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Continuous Slow Activity: Slow activity that occurs continuously is non-responsive to external stimuli and clearly exceeds the amount considered physiologically normal for the patient's age. As a rule, it is irregular (polymorphic) and lies within the frequency range of delta/theta waves (see intermittent slow activity).
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Coronal Bipolar Montage: A montage consisting of derivations from pairs of electrodes along coronal (transverse) linear arrays.
Synonym: transverse bipolar montage.
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Cortical Electrode: Electrode applied directly upon or inserted in the cerebral cortex.
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Cortical Electroencephalogram: See electrocorticogram.
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Cortical Electroencephalography: See electrocorticography.
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Corticogram: Use discouraged.
Term suggested: electrocorticogram.
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Corticography: Term preferred: electrocorticography.
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Cycle: The complete sequence of potential changes undergone by individual components of a sequence of regularly repeated EEG waves or complexes.
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Cycles Per Second: Unit of frequency.
Abbreviation: cis. Equivalent: Hertz (Hz).
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Deep Sleep: Non-REM sleep stages 3 and 4 (Rechtschaffen and Kales 1968).
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Delta Band: Frequency band under 4 Hz. Greek letter: delta. Comment: for practical purposes lower frequency limit is 0.5 Hz, as DC potential differences are not monitored in conventional EEGs.
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Delta Brush: Delta wave with superimposed fast activity.
Comment: normal finding in neonatal EEG.
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Delta Brushes: Rhythmic spindle-like activity (10-25 uV) superimposed on 0.3-1.5 Hz slow waves (25-250 uV) in preterm infants.
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Rhythm under 4 Hz
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Delta Wave: Wave with duration over 1/4 s.
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Depression: Use of term discouraged when describing EEG patterns.
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Depth Electrode: Electrode (usually multicontact electrode) implanted within the brain substance.
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Depth Electroencephalogram: Record of electrical activity of the brain by means of electrodes implanted within the brain substance itself (see stereotactic [stereotaxic] depth electroencephalogram).
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Depth Electroencephalography: Technique of recording depth electroencephalograms (see stereotactic [stereotaxic] depth electroencephalography).
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Derivation:
(1) The process of recording from a pair of electrodes in an EEG channel.
(2) The EEG record obtained by this process.
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Desynchronization: Use of term discouraged when visually describing EEG change.
Terms suggested: blocking, attenuation.
Exception: the term desynchronization is acceptable when describing attenuation of a frequency band based on power spectra analysis of the EEG signal (for instance “event-related desynchronization”).
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Desynchronized: Use of term discouraged when describing EEG pattern (see low voltage EEG).
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REM Sleep: Sleep stage characterized by low amplitude mixed frequency EEG activity, episodic bursts of predominantly horizontal rapid eye movements (REM) and reduction of axial tonic muscle activity; frequently associated with dreams; phasic muscle activity, saw-tooth waves and changes in respiration may occur.
Synonym: paradoxical sleep, desynchronized sleep, dream sleep (use of terms discouraged) (see active sleep, non-REM sleep).
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Differential Amplifier: An amplifier whose output is proportional to the voltage difference between its two input terminals.
Comment: electroencephalographs make use of differential amplifiers in their input stages.
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Differential Signal: Difference between two unlike signals applied to the respective two input terminals of a differential EEG amplifier.
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Diffuse: Occurring over large areas of one or both sides of the head (see generalized).
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Digital EEG:
(1) The representation of an analog EEG signal by a series of numbers related to successive measurements of the magnitude of the signal at equal time intervals.
(2) The practice of electroencephalography using digital representation of EEGs.
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Diphasic Wave: Complex consisting of two wave components developed on alternate sides of the baseline.
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Dipolar: An EEG voltage field that displays both negative and positive maxima.
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Dipole: A theoretical point-like EEG source produced by a separation of negative and positive charge.
Comment: commonly used to describe a cortical source that generates an EEG field in which both negative and positive maxima can be recorded, e.g. the "horizontal dipole" of so called Rolandic spikes.
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Direct Coupled Amplifier: An amplifier in which successive stages are connected (coupled) by devices. The performance of which is not frequency dependent.
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Direct Current Amplifier: An amplifier that is capable of magnifying DC (zero frequency) voltages and slowly varying voltages.
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Discharge: Interpretive term commonly used to designate epileptiform and seizure patterns (see epileptiform pattern, seizure pattern).
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Disk Electrode: Metal disk attached to the scalp with an adhesive such as collodion or paste.
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Disorganization: Gross alteration in frequency, form, topography and/or quantity of physiologic EEG rhythms in
(1) an individual record, relative to previous records in the same subject or the rhythms of homologous regions on the opposite side of the head or
(2) relative to findings in normal subjects of similar age and similar state of vigilance.
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Distortion: An instrument-induced alteration of wave form (see artifact).
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REM Sleep: Sleep stage characterized by low amplitude mixed frequency EEG activity, episodic bursts of predominantly horizontal rapid eye movements (REM) and reduction of axial tonic muscle activity; frequently associated with dreams; phasic muscle activity, saw-tooth waves and changes in respiration may occur.
Synonym: paradoxical sleep, desynchronized sleep, dream sleep (use of terms discouraged) (see active sleep, non-REM sleep).
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Duration:
(1) The interval from beginning to end of an individual wave or complex. Comment: the duration of the cycle of individual components of a sequence of regularly repeating waves or complexes is referred to as the period of the wave or complex.
(2) The time that a sequence of waves or complexes or any other distinguishable feature lasts in an EEG record.
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Dysrhythmia: Use of term discouraged.
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Activity, EEG
An EEG wave or sequence of waves.
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Bandwidth, EEG Channel
Range of frequencies between which the response of an EEG channel is within stated limits. Determined by the frequency response of the amplifier, pen writer, if any, and the frequency filters used.
Comment: the manner in which the EEG channel bandwidth is specified by different manufacturers is not yet standardized. For instance, a bandwidth of 1-70 Hz in a given instrument may indicate that frequencies of 1 and 70 Hz are attenuated by 30% (3 dB) or another stated percent, with intermediate frequencies being less attenuated.
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Noise, EEG Channel
Small fluctuating output of an EEG channel recorded when high sensitivities are used, even if there is no input signal. Measured in microvolts (uV), referenced to the input.
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Time constant, EEG channel
The product of the values of the resistance (in mega-ohms, M<Ohms>) and the capacitance (in microfarads, uF) which make up the time constant control of an EEG channel. This product represents the time required for the trace to fall to 37% of the deflection initially produced when a DC voltage difference is applied to the input terminals of the amplifier. Expressed in seconds (s).
Abbreviation: TC.
Comment: for a simple RC coupling network, the TC is related to the percent reduction in sensitivity of the channel at a given stated low frequency by the equation TC = ?<pi>f, where f is the frequency at which a 30% (3 dB) attenuation occurs. For instance, for a TC of 0.3 s, an attenuation of 30% (3 dB) occurs at 0.5 Hz. Thus, either the time constant or the percent attenuation at a given stated low frequency can be used to designate the same position of the low frequency filter of the EEG channel (see low frequency filter).
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Electrode, EEG
A conducting device applied over or inserted in a region of the scalp or brain.
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Machine, EEG
Use of term discouraged.
Term suggested: electroencephalograph.
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Seizure Pattern, EEG
Phenomenon consisting of repetitive EEG discharges with relatively abrupt onset and termination and characteristic pattern of evolution lasting at least several seconds. These EEG patterns are seen during epileptic seizures. Frequent interictal epileptiform discharges are a usually not associated with clinical seizures and thus should be differentiated from electroencephalographic seizure patterns. The component waves or complexes vary in form, frequency, and topography. They are generally rhythmic and frequently display increasing amplitude and decreasing frequency during the same episode. When focal in onset, they tend to spread subsequently to other areas.
Comment: EEG seizure patterns unaccompanied by clinical epileptic manifestations detected by the EEG technician should be referred to as "subclinical" .
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Status epilepticus, EEG: The occurrence of virtually continuous or repetitive seizure activity in an EEG. Term should be distinguished from clinical status epilepticus.
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Transient, EEG: Any isolated wave or complex, distinguished from background activity.
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Polarity, EEG wave: Sign of potential difference existing at a given time between an electrode affected by a given potential change and another electrode not appreciably, or less, affected by the same change (see polarity convention).
Comment: the apparent "polarity" of an EEG wave is dependent upon the potential difference between two electrodes.
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Earth Connection: Term discouraged.
Synonym: ground connection (preferred term).
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Electrocorticogram: Record of EEG activity obtained by means of electrodes applied directly over or inserted in the cerebral cortex.
Abbreviation: ECoG.
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Electrocorticography: Technique of recording electrical activity of the brain by means of electrodes applied over or implanted in the cerebral cortex.
Abbreviation: ECoG.
Comment: electrocorticography can be performed intraoperatively and extraoperatively.
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Application, electrode: The process of establishing mechanical fixation and electrical connection between an electrode and the subject's scalp or brain.
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Array, electrode: A regular arrangement of electrodes over the scalp or brain or within the brain substance.
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Electrode Impedance: Total effective resistance to alternating current (AC), arising from ohmic resistance and reactance. Measured between pairs of electrodes or, in some electroencephalographs, between each individual electrode and all the other electrodes connected in parallel. Expressed in ohms (generally kilo-ohms, kG).
Comments:
(1) over the EEG frequency range, because the capacitance factor is small, electrode impedance is usually equal to electrode resistance.
(2) Not a synonym of input impedance of EEG amplifier (see electrode resistance; input impedance).
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Electrode Resistance: Total effective resistance to direct current (DC), through the interface between an EEG electrode and the scalp or brain. Measured between pairs of electrodes or, in some electroencephalographs, between each individual electrode and all the other electrodes connected in parallel. Expressed in ohms (generally kilo-ohms, k<ohm>).
Comment: measurement of electrode resistance with DC currents results in varying degrees of electrode polarization (see electrode impedance).
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Electroencephalogram: Record of electrical activity of the brain taken by means of electrodes placed on the surface of the head, unless otherwise specified.
Abbreviation: EEG.
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Electroencephalograph: Instrument employed to record electroencephalograms.
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Electroencephalographic: Appertaining to bioelectrical recording, irrespective of the method employed (in the present context, EEG, ECoG, SEEG, etc.)
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Electroencephalography:
(1) The science relating to the electrical activity of the brain.
(2) The practice of recording and interpreting electroencephalograms.
Abbreviation: EEG.
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Electrogram: Use of term discouraged
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Electrography: Use of term discouraged.
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Encoches Frontal: Frontal sharp waves in newborns.
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Epidural Electrode: Electrode located over the dural covering of the cerebrum.
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Epileptic Pattern: Use of term discouraged.
Term suggested: epileptiform pattern.
What's the difference between this and seizure pattern? Is this the same as one epileptiform discharge?
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Epileptiform Pattern
Synonym: epileptiform discharge, epileptiform activity. Describes transients distinguishable from background activity, with a characteristic spiky morphology, typically, but neither exclusively nor invariably, found in interictal EEGs of people with epilepsy.
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Epoch: A period of time in an EEG record. Duration of epochs is determined arbitrarily.
Example: power spectra were calculated from 10-s epochs.
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Equipotential: Applies to regions of the head or electrodes that are at the same potential at a given instant in time.
Synonym: isopotential line.
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Event-related (slow) potential: Applied mainly to those evoked potentials elicited by cognitive activities.
Abbreviation: ERP (see evoked potential).
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Evoked Potential: Wave or complex elicited by and time-locked to a physiological or non-physiological stimulus or event, the timing of which can be reliably assessed, for instance, an electrical stimulus, delivered to a sensory receptor or nerve or applied directly to a discrete area of the brain or a movement (myoclonus).
Comment: computer summation techniques are especially suitable for detecting these and other event-related potentials from the surface of the head.
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Evoked Response: Tautology. Use of term discouraged.
Term suggested: evoked potential.
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Extracerebral Potential: Any potential that does not originate in the brain, referred to as an artifact in EEG. May arise from electrical interference external to the subject and recording system, the subject, the electrodes and their connections to the subject and the electroencephalograph, and the electroencephalograph itself (see artifact).
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Fast Activity: Activity of frequency higher than alpha, i.e. beta and gamma activity.
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Fast Alpha Variant Rhythm: Characteristic rhythm at 14-20 Hz, detected most prominently over the posterior regions of the head. May alternate or be intermixed with alpha rhythm. Blocked or attenuated by attention, especially visual, and mental effort.
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Fast Wave: Wave with duration shorter than alpha waves, i.e. under 1/13 s.
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Flat EEG: Use of term discouraged
(see low voltage EEG; record of electrocerebral inactivity).
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Focal: Limited to a small area of the brain, i.e. recorded in one or two intracranial electrodes (see regional, multifocal).
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Focus: A limited region of the scalp, cerebral cortex, or depth of the brain displaying a given EEG activity, either normal or abnormal.
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Foramen Ovale Electrode: A multicontact electrode bundle inserted through the foramen ovale to lie in proximity to the parahippocampal gyrus.
Comment: used for presurgical assessment of epilepsy of suspected mesial temporal origin.
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Form: Shape of a wave. Synonym: wave form, morphology.
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Fourteen and 6-Hz Positive Bust: Burst of arch-shaped waves at 13-17 Hz and/or 5-7 Hz but most commonly at 14 and or 6 Hz seen generally over the posterior temporal and adjacent areas of one or both sides of the head during sleep. The sharp peaks of its component waves are positive with respect to other regions. Amplitude varies but is generally below 75 uV.
Comments:
(1) best demonstrated by referential recording using contralateral earlobe or other remote, reference electrodes.
2) This pattern is of no established clinical significance.
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Fourteen and 6 Hz Positive Spikes:
Synonym: 14- and 6-Hz positive burst.
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Frequency: Number of complete cycles of repetitive waves or complexes in 1 s. Measured in cycles per second (c/s) or Hertz (Hz).
Comment: the term Hz seems appropriate when applied to sinusoidal waves such as alpha activity, but seems inappropriate when applied to complex wave forms such as spike-and-slow-wave.
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Frequency Response: see bandwidth, low frequency response, high frequency response.
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Frequency Response Curve: A graph depicting the relationships between output trace deflection or amplifier output and input frequency, for a particular setting of low and high frequency filters.
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Frequency Spectrum: Range of frequencies composing the EEG. Divided into 5 bands termed delta, theta, alpha, beta and gamma (see delta, theta, alpha, beta, gamma bands).
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Frontal Intermittent Rhythmic Delta Activity: Fairly regular, approximately sinusoidal or saw-tooth waves, mostly occurring in bursts at 1.5-2.5 Hz over the frontal areas of one or both sides of the head.
Abbreviation: FIRDA.
Comment: most commonly associated with unspecified encephalopathy.
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G1: Abbreviation for grid 1 (use of term discouraged)
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G2: Abbreviation for grid 2 (use of term discouraged).
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Gain: Ratio of output signal voltage to input signal voltage of an EEG channel.
Example:
Gain = (output voltage)/(input voltage) = 10V/10uV = 1,000,000
Often expressed in decibels (dB), a logarithmic unit. Example: a voltage gain of 10 = 20 dB, of 1000 = 60 dB, of 1,000,000 = 120 dB (see sensitivity).
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Gamma Band: Frequency band above 40 Hz.
Greek letter: <Beta> (see beta band).
Comment: practically, most electroencephalographs use trace writers that appreciably attenuate frequencies higher than 70 Hz. The customary use of relatively slow paper speeds or time scales further limits the electroencephalographer's ability to resolve visually waves of frequencies higher than 40 Hz. The graphic resolution of computer displays may also limit the visual appreciation of higher frequencies. However, this does not justify limiting unduly the high frequency response of the EEG channels, for EEG waves include transients such as spikes and sharp waves with components at frequencies above 50 Hz (see beta rhythm) (not a synonym).
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Gamma Rhythm: An EEG rhythm above 40 Hz.
Comment: most commonly recorded with intracranial electrodes.
What is the difference between generalized vs generalization? Seems generalization means secondarily generalized?
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Generalization: Propagation of EEG activity from limited areas to all regions of the head.
What is the difference between generalized vs generalization? Seems generalization means secondarily generalized?
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Generalized: Occurring over all regions of the head, usually with a frontal maximum, rarely with an occipital maximum.
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Goldman Offner Reference: Occurring over all regions of the head, usually with a frontal maximum, rarely with an occipital maximum.
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Grand Mal: Use of term discouraged.
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Grid 1: Use of term discouraged.
Term suggested: input terminal 1.
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Grid 2: Use of term discouraged.
Term suggested: input terminal 2.
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Ground Connection: Conducting path between the subject and the electroencephalograph, and the electroencephalograph and earth.
Synonym: earth connection.
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Head Cap: A cap that is fitted over the head to hold pad electrodes in position.
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Head Harness: A combination of straps fitted over the head to hold pad electrodes in position.
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Hertz: Unit of frequency. Abbreviation: Hz. Synonym: cycles per second (c/s).
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High Frequency Filter: A circuit that reduces the sensitivity of the EEG channel to relatively high frequencies. For each setting of the high frequency, filter, this attenuation is expressed as percent reduction in output trace deflection at a given frequency, relative to frequencies unaffected by the filter, i.e. in the mid-frequency band of the channel.
Synonym: low pass filter.
Comment: at present high frequency filter designations and their significance are not yet standardized for instruments of different manufactures. For instance, for a given instrument, a position of the high frequency filter control designated as 70 Hz may indicate a 30% (3 dB), or other stated percent, reduction in sensitivity at 70 Hz, compared to the sensitivity, for example, at 10 Hz.
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High Frequency Response: Sensitivity of an EEG channel to relatively high frequencies. Determined by the high frequency response of the amplifier, pen writer, if any, and the high frequency filter used. Expressed as percent reduction in output trace deflection at certain specific high frequencies, relative to other frequencies in the mid-frequency band of the channel.
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High Pass FIlter: Synonym: low frequency filter.
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Hypersynchrony: Use of term discouraged when describing EEG patterns.
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Hyperventilation: Deep and regular respiration performed for a period of several minutes. Used as activation procedure.
Synonym: overbreathing (see activation).
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Hypsarrhythmia: Pattern consisting of diffuse high voltage (>300 uV) irregular slow waves interspersed with multi regional spikes and sharp waves over both hemispheres.
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Hz: Abbreviation for Hertz.
Equivalent: cycles per second (c/s).
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Impedance Meter: An instrument used to measure impedance (see electrode impedance).
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In-phase discrimination: Use of term discouraged.
Term suggested: common mode rejection (not a synonym).
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In-phase signals: Waves with no phase difference between them (see common mode signal) (not a synonym).
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Inactive Electrode: Use of term discouraged (see reference electrode) (not a synonym).
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Index: Percent of time an EEG activity is present in an EEG sample.
Example: alpha index.
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Indifferent electrode: Use of term discouraged.
Term suggested: reference electrode (not a synonym).
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Input: The signal fed into an EEG amplifier (see input terminal 1; input terminal 2).
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Input Circuit: System consisting of the EEG electrodes and intervening tissues, the electrode leads, jack box, input cable, and electrode selectors.
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Input Impedance: Impedance that exists between the two inputs of an EEG amplifier. Measured in ohms (generally mega-ohms, M<Ohms>) with or without the additional specification of input shunt capacitance (measured in picofarads, pF).
Comment: not a synonym of electrode impedance.
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Input Terminal 1: The input terminal of the differential EEG amplifier at which negativity, relative to the other input terminal, produces an upward trace deflection.
Synonyms: "grid 1" (G1), black lead (use discouraged) (see polarity convention).
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Input Terminal 2: The input terminal of the differential EEG amplifier at which negativity, relative to the other input terminal, produces a downward trace deflection.
Synonyms: "grid 2" (G2), white lead (use discouraged) (see polarity convention).
Comment: the connection of an electrode to the input terminal 2 of the EEG amplifier is represented in diagrams as a dotted or dashed line.
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Input Voltage: Potential difference between the two input terminals of a differential EEG amplifier.
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Inter-Electrode Distance: Spacing between pairs of electrodes.
Comment: distances between adjacent electrodes placed according to the standard 10-20 system or more closely spaced electrodes are frequently referred to as short or small inter-electrode distances (10-10 system). Larger distances such as the double or triple distance between standard electrode placements are often termed long or large interelectrode distances.
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Intercerebral Electrode:
Synonym: depth electrode
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Interhemispheric Derivation: Recording between a pair of electrodes located on opposite sides of the head.
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Intermittent slow activity: A slow activity that occurs intermittently and is not caused by drowsiness. Intermittent slow can be irregular or rhythmical (see continuous slow activity).
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Intracerebral Electroencephalogram:
Synonym: depth electroencephalogram.
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Irregular: Applies to EEG waves and complexes of inconstant period and/or uneven contour.
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Isoelectric:
(1) The record obtained from a pair of equipotential electrodes (see equipotential).
(2) Use of term discouraged when describing record of electrocerebral inactivity (see inactivity, record of electrocerebral).
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Isolated: Occurring singly.
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Equipotential: Applies to regions of the head or electrodes that are at the same potential at a given instant in time.
Synonym: isopotential line.
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Map, isopotential:
Synonym: diagram of equipotential lines.
Graphic display of equipotential lines of a potential. The maximum amplitude of the potential is 100% and the fall-off of the potential is shown in arbitrary steps of, for example, 10% of the maximum amplitude.
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K Complex: A burst of somewhat variable appearance, consisting most commonly of a high voltage negative slow wave followed by a smaller positive slow wave frequently associated with a sleep spindle. Amplitude is generally maximal in the frontal vertex. K complexes occur during non- REM sleep, apparently spontaneously, or in response to sudden sensory stimuli, and are not specific for any individual sensory modality (see vertex sharp transient).
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Kappa Rhythm: (Use of term discouraged). Rhythm consisting of bursts of alpha or theta frequency occurring over the temporal areas of the scalp of subjects engaged in mental activity.
Comments:
(1) best recorded between electrodes located lateral to the outer canthus of each eye.
(2) The cerebral origin of this rhythm is considered unproven. It is most probably an ocular artifact caused by discrete lateral oscillations of the eyes.
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Lambda Wave: Diphasic sharp transient occurring over the occipital regions of the head of waking subjects during visual exploration. The main component is positive relative to other areas. Time-locked to saccadic eye movement. Amplitude varies but is generally below 50 uV. Greek letter: <lambda>
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Lambdoid Wave: Use of term discouraged.
Term suggested: positive occipital sharp transient of sleep (POSTS).
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Laplacian Montage: Montage that can be used in digital EEG recordings and consists of a mathematical transformation involving the second spatial derivative; the Laplacian of the potential may be approximated by using the average of all neighboring electrodes as a reference for each site or electrode. Montage used for localization of focal abnormalities on digital EEG (see average potential reference).
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Larval Spike and Slow Wave: Use of term discouraged.
Term suggested: 6-Hz spike-and-slow-wave.
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Lateralized: Involving mainly the right or left side of the head (see unilateral; regional).
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Lead:
Strictly: wire connecting an electrode to the electroencephalograph.
Loosely: synonym of electrode.
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Light Sleep: Non-REM sleep stages 1 and 2 (Rechtschaffen and Kales 1968).
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Linkage: The connection of a pair of electrodes to the two respective input terminals of a differential EEG amplifier (see derivation).
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Longitudinal Bipolar Montage: A montage consisting of derivations from pairs of electrodes along longitudinal, usually antero-posterior, arrays.
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Low Frequency Filter: A circuit that reduces the sensitivity of the EEG channel to relatively low frequencies.
Synonym: high pass filter. For each position of the low frequency filter control, this attenuation is expressed as percent reduction of output trace deflection at a given stated frequency, relative to frequencies unaffected by the filter, i.e. in the mid-frequency band of the channel.
Comment: at present low frequency filter designations and their significance are not yet standardized for instruments of different manufacturers. For instance, in a given instrument, a low frequency filter setting designated I Hz may indicate a 30% (3 dB), or other stated percent, reduction in sensitivity at 1 Hz, compared to the sensitivity, for example, at 10 Hz. The same position of the low frequency filter setting may also be designated by the time constant.
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Low Frequency Response: Sensitivity of an EEG channel to relatively low frequencies. Determined by the low frequency response of the amplifier and by the low frequency filter (time constant) used. Expressed as percent reduction in output trace deflection at certain stated low frequencies, relative to other frequencies in the mid-frequency band of the channel (see low frequency filter, time constant).
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Low pass filter:
Synonym: high frequency filter.
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Low Voltage EEG: A waking record characterized by activity of amplitude not greater than 20 uV over all head regions. With appropriate instrumental sensitivities this activity can be shown to be composed primarily of beta, theta and, to a lesser degree, delta waves, with or without alpha activity over the posterior areas.
Comments:
(1) Low voltage EEGs are susceptible to change under the influence of certain physiological stimuli, sleep, pharmacological agents and pathological processes.
(2) They should be clearly distinguished from tracings of electrocerebral inactivity and low voltage fast activity.
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Low Voltage Fast Activity: Refers to the fast, and often recruiting, activity which can be recorded at the onset of an ictal discharge, particularly in invasive EEG recording of a seizure.
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Low Voltage Fast EEG: Use of term discouraged. Term suggested: low voltage EEG.
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Monomorphic: Use of term discouraged when describing EEG patterns.
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Monophasic Wave: Wave developed on one side of the baseline.
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Monopolar: Use of term discouraged.
Term suggested: referential.
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Monorhythmic: Use of term discouraged when describing EEG patterns.
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Monorhythmic Sinusoidal Delta Activity: Use of term discouraged
(see delta rhythm; frontal (occipital) intermittent rhythmic delta activity).
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Montage: The particular arrangement by which a number of derivations are displayed simultaneously in an EEG record.
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Morphology:
(1) the study of the form of EEG waves.
(2) The form of EEG waves.
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Mu Rhythm: Rhythm at 7-11 Hz, composed of arch-shaped waves occurring over the central or centroparietal regions of the scalp during wakefulness. Amplitude varies but is mostly below 50 uV. Blocked or attenuated most clearly by contralateral movement, thought of movement, readiness to move or tactile stimulation. Greek letter: u.
Synonyms: arceau, wicket, comb rhythms (use discouraged).
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Multifocal: More than two or more spatially separated foci (see focal, regional, multiregional).
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Multiple Spike and Slow Wave Complex: A sequence of two or more spikes associated with one or more slow waves.
Synonym: polyspike-and-slow-wave complex (preferred term).
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Multiple Spike Complex: A sequence of two or more spikes.
Synonym: polyspike complex (preferred term).
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Multiregional: Three and more regional foci (see regional).
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Nasopharyngeal Electrode: Rod electrode introduced through the nose and placed against the nasopharyngeal wall with its tip lying near the body of the sphenoid bone.
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Needle Electrode: Small needle inserted into the subdermal layer of the scalp.
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Neuronal Hyperexcitability: Use of term discouraged when describing EEG patterns.
Noachter 1999
Neutral Electrode: Use of term discouraged.
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Non-REM Sleep: Term summarizing all sleep stages except REM-sleep (see quiet sleep).
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Non-cephalic Reference: Reference electrode that is not on the head.
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Notch Filter: A filter that selectively attenuates a very narrow frequency band, thus producing a sharp notch in the frequency response curve of an EEG channel. A 60- (50) Hz notch filter is used to provide attenuation of 60 (50) Hz interference under extremely unfavorable technical conditions, such as, for instance, recordings in intensive care units.
Noachter 1999
Nyquist Theorem: Accurate digital representation of an EEG signal requires that the sampling rate is at least twice the highest frequency of the signal, i.e. a frequency of 50 Hz requires at least a sampling rate of 100 Hz. Comment: sampling at twice Nyquvist frequency ensures only accurate representation of frequency content. Tolerable reproduction of waveforms requires 5 samples per wave for the fastest components present.
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Occipital Intermittent Delta Activity OIRDA: Fairly regular or approximately sinusoidal waves, mostly occurring in bursts at 2-3 Hz over the occipital areas of one or both sides of the head.
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Ohmmeter: An instrument used to measure resistance (see electrode resistance).
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Organization: The degree to which physiologic EEG rhythms conform to certain ideal characteristics displayed by a majority of subjects in the same age group, without personal or family history of neurologic and psychiatric diseases, or other illnesses that might be associated with dysfunction of the brain.
Comments:
(1) The organization of physiologic EEG rhythms progresses from birth to adulthood.
(2) Poor organization of EEG rhythms such as the alpha rhythm does not necessarily imply abnormality.
Noachter 1999
Out-Of-Phase Signals: Two waves of opposite phases (see differential signal; phase reversal) (not a synonym).
Noachter 1999
Output Voltage: The voltage across the writer/trace of an EEG channel.
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Overbreathing:
Synonym: hyperventilation.
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Overload: Condition caused by applying voltage differences which are larger than the channel is designed for or set to handle to the input terminals of an EEG amplifier. Causes clipping of EEG waves and/or blocking of the amplifier, depending on its magnitude (see clipping, blocking).
Noachter 1999
Pad Electrode: Metal electrode covered with a cotton or felt and gauze pad, held in position by a head cap or harness.
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Paper Speed: Velocity of movement of EEG paper. Expressed in centimeters per second (cm/s) or millimeters per second (m/s).
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REM Sleep: Sleep stage characterized by low amplitude mixed frequency EEG activity, episodic bursts of predominantly horizontal rapid eye movements (REM) and reduction of axial tonic muscle activity; frequently associated with dreams; phasic muscle activity, saw-tooth waves and changes in respiration may occur.
Synonym: paradoxical sleep, desynchronized sleep, dream sleep (use of terms discouraged) (see active sleep, non-REM sleep).
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Paroxysm: Phenomenon with abrupt onset, rapid attainment of a maximum, and sudden termination; distinguished from background activity.
Comment: commonly used to refer to epileptiform patterns and seizure patterns (see epileptiform pattern, seizure pattern).
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Paroxysmal Fast: Fast frequencies in the beta range occurring in trains (see paroxysm, low voltage fast activity).
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Pattern: Any characteristic EEG activity.
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Peak: Point of maximum amplitude of a wave.
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Pen Galvanometer:
Synonym: Pen Writer.
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Pen Motor:
Synonym: pen writer.
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Pen Writer: A writer using ink delivered by a pen.
Synonym: pen galvanometer, pen motor.
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Period: Duration of complete cycle of individual component of a sequence of regularly repeated EEG waves or complexes.
Comment: the period of the individual components of an EEG rhythm is the reciprocal of the frequency of the rhythm.
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Periodic: Applies to:
(1) EEG waves or complexes Occurring in a sequence at an approximately regular rate.
(2) EEG waves or complexes occurring intermittently at approximately regular intervals, generally of one to several seconds.
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Periodic Lateralized Epileptiform Discharges (PLEDs): PLEDs are sharp transients such as sharp waves or spikes, which repeat in a periodical or semiperiodical fashion. They have either a regional or a lateralized distribution. They may also occur independently over both hemispheres. The epileptiform discharges often have multiple phases and a complex morphology. The main component is negative.
Noachter 1999
Petit Mal: Use of term discouraged when describing EEG patterns.
Terms suggested, whenever appropriate:
3 per second spike-and-slow-wave complex,
atypical spike-and-slow-wave complex,
sharp-and-slow-wave complex.
Noachter 1999
Petit Mal Variant: Use of term discouraged when describing EEG patterns.
Terms suggested whenever appropriate:
atypical spike-and-slow-wave complex,
sharp-and-slow-wave complex.
Noachter 1999
Phantom Spike and Slow Wave: Use of term discouraged.
Term suggested: 6/s spike-and-slow-wave.
Noachter 1999
Phantom Spike and Wave: Use of term discouraged.
Term suggested: 6/s spike-and-slow-wave.
Noachter 1999
Phase:
(1) Time or polarity relationships between a point on a wave displayed in a derivation and the identical point on the same wave recorded simultaneously in another derivation.
(2) Time or angular relationships between a point on a wave and the onset of the cycle of the same wave. Usually expressed in degrees or radians.
Noachter 1999
Phase Reversal: Simultaneous trace deflections in opposite directions from two or more channels. Assuming a single generator, a phase reversal is due to the same (or at least similar) signal being simultaneously applied to the input terminal 2 of one differential amplifier and to the input terminal 1 of the other amplifier.
Comment:
(1) this phenomenon is rarely observed in scalp EEGs, but is common in intracranial recordings.
(2) When observed in two linked bipolar derivations, phase reversal indicates that the potential field is maximal or minimal at or near the electrode common to such derivations. In a referential derivation a phase reversal indicates that the reference electrode is neither maximum nor minimum for the signal.
(3) A phase reversal in a referential recording, when assessed using mapping of the potential fields, indicates that the source is located beneath the zero potential line at a depth that can be calculated by modeling
(see phase reversal, bipolar montage, referential montage, differential amplifier, dipole).
Noachter 1999
Photic Driving: Physiologic response consisting of rhythmic activity elicited over the posterior regions of the head by repetitive photic stimulation at frequencies of about 5-30 Hz.
Comments:
(1) term should be limited to activity time-locked to the stimulus and of frequency identical or harmonically related to the stimulus frequency.
(2) Photic driving should be distinguished from the visual evoked potentials elicited by isolated flashes of light or flashes repeated at very low frequencies.
Noachter 1999
Photic Stimulation: Delivery of intermittent flashes of light to the eyes of a subject. Used as EEG activation procedure. Synonym: intermittent photic stimulation (IPS).
Noachter 1999
Photic Stimulator: Device for delivering intermittent flashes of light.
Synonym: stroboscope (use discouraged).
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Photoconvulsive Responses:
Synonym: photoparoxysmal response (preferred term).
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Photomyoclonic Response:
Synonym: myogenic response (preferred term).
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Photomyogenic Response: A response to intermittent photic stimulation characterized by the appearance in the record of brief, repetitive muscular artifacts (spikes) over the anterior regions of the head. These often increase gradually in amplitude as stimuli are continued and cease promptly when the stimulus is withdrawn.
Comment: this response is frequently associated with flutter of the eyelids and vertical oscillations of the eyeballs and sometimes with discrete jerking mostly involving the musculature of the face and head.
Preferred to synonym: photomyoclonic response.
Noachter 1999
Photoparoxysmal Response: Abnormal response to intermittent photic stimulation characterized by spike-and-slow-wave and polyspike-and-slow-wave complexes. Responses are graded from occipital spikes time-locked to the flashes to generalized epileptiform discharges which may outlast the stimulus by a few seconds.
Comment: only the generalized spike-and-wave response shows a strong association with epilepsy, particularly if it is self-sustaining and continues after the stimulus.
Preferred to synonym: photoconvulsive response.
Noachter 1999
Polarity Convention: International agreement whereby differential EEG amplifiers are constructed so that negativity at the input termina1 1 relative to the input terminal 2 of the same amplifier produces an upward trace deflection.
Comment: this convention is contrary to that prevailing in some other biological and non-biological fields.
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Polygraphic Recording: Simultaneous monitoring of multiple physiological measures such as the EEG, respiration, electrocardiogram, electromyogram, eye movement, blood pressure, oxygen saturation, and leg movements, etc.
Noachter 1999
Polymorphic Activity: Use of term discouraged when describing EEG pattern.
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Polyphasic Wave: Wave consisting of two or more components developed on alternating sides of the baseline (see diphasic wave, triphasic wave).
Noachter 1999
Polyrhythmic Activity: Use of term discouraged when describing EEG pattern.
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Polysomnography: Polygraphic recording of sleep (see polygraphic recording).
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Polyspike and Slow Wave Complex:
Synonym: multiple spike-and-slow-wave complex (term discouraged) .
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Polyspike Complex: A sequence of two or more spikes.
Synonym: multiple spike complex (term discouraged).
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Positive occipital sharp transient of sleep (POSTS): Sharp transient maximal over the occipital regions, positive relative to other areas, apparently occurring spontaneously during sleep. May be single or repetitive. Amplitude varies but is generally below 50 uV.
Noachter 1999
Positive Occipital Spike Like Wave of Sleep: Use of term discouraged.
Term suggested: positive occipital sharp transient of sleep (POSTS).
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Potential:
(1) Strictly: voltage.
(2) Loosely: synonym of wave.
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Potential Field: Amplitude distribution of an EEG wave at the surface of the head or cerebral cortex or in the depth of the brain, measured at a given instant in time. Represented in diagrams by equipotential lines (see isopotential map).
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Saw Toothed Bursts: Temporal sharp transients in preterm infants occurring in burst of 3-8 sharp, rhythmic waves at 4-8 Hz, often with high voltage (100-200 uV).
Synonym: premature temporal theta.
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Projected Patterns: Abnormal EEG activities believed to result from a disturbance at a site remote from the recording electrodes. Description of specific EEG patterns preferred.
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Provocation Procedure: Use of term discouraged.
Term suggested: activation
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Pseudoperiodic: Use of term discouraged.
Term suggested: quasiperiodic.
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Psychomotor Variant: Use of term discouraged when describing EEG pattern.
Term suggested: rhythmic temporal theta burst of drowsiness,
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Quantity: Amount of EEG activity with respect to both number and amplitude of waves.
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Quasiperiodic: Applies to EEG waves or complexes that occur at intervals and only approach regularity.
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RC Coupled Amplifier: Abbreviation for resistance-capacitance coupled amplifier
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REM: Rapid eye movements.
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REM Atonia: Reduction of tonic muscle activity during REM sleep.
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REM Sleep: Sleep stage characterized by low amplitude mixed frequency EEG activity, episodic bursts of predominantly horizontal rapid eye movements (REM) and reduction of axial tonic muscle activity; frequently associated with dreams; phasic muscle activity, saw-tooth waves and changes in respiration may occur.
Synonym: paradoxical sleep, desynchronized sleep, dream sleep (use of terms discouraged) (see active sleep, non-REM sleep).
Noachter 1999
Reactivity: Susceptibility of individual rhythms or the EEG as a whole to change following sensory stimulation or other physiologic actions.
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Record: The end product of the EEG recording process.
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Record of Electrocerebral Inactivity: Absence over all regions of the head of identifiable electrical activity of cerebral origin, whether spontaneous or induced by physiological stimuli or pharmacological agents.
Comment: determination of electrocerebral inactivity requires stringent technical precautions. Tracings of electrocerebral inactivity should be clearly distinguished from low voltage EEGs and records displaying delta activity of low amplitude (see low voltage EEG).
Synonym: electrocerebral silence (use of term discouraged).
Noachter 1999
Record of Electrocerebral Silence: Use of term discouraged.
Term suggested: record of electrocerebral inactivity.
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Recording:
(1) The process of obtaining an EEG record.
Synonym: tracing.
(2) The end product of the EEG recording process, most commonly traced on paper or digital storage.
Synonyms: record, tracing.
Noachter 1999
Reference Electrode:
(1) In general: any electrode against which the potential variations of another electrode are measured.
(2) Specifically: a suitable reference electrode is any electrode customarily connected to the input terminal 2 of an EEG amplifier and placed so as to minimize the likelihood of pick-up of the same EEG activity recorded by an exploring electrode, usually connected to the input terminal 1 of the same amplifier, or of other activities.
Comments:
(1) Whatever the location of the reference electrode, the possibility that it might be affected by appreciable EEG potentials should always be considered.
(2) A reference electrode connected to the input terminal 2 of all or several EEG amplifiers is referred to as a common reference electrode.
Noachter 1999
Referential Derivation: Recording from a pair of electrodes consisting of an exploring electrode generally connected to the input terminal 1 and a reference electrode usually connected to the input terminal 2 of an EEG amplifier (see reference electrode, referential montage, common reference montage)
Noachter 1999
Referential Montage: A montage consisting of referential derivations.
Comment: a referential montage in which the reference electrode is common to multiple derivations is referred to as a common reference montage (see referential derivation).
Noachter 1999
Unipolar: Use of term discouraged.
Term suggested: referential.
Noachter 1999
Referential Derivation: Recording from a pair of electrodes consisting of an exploring electrode generally connected to the input terminal 1 and a reference electrode usually connected to the input terminal 2 of an EEG amplifier (see reference electrode, referential montage, common reference montage)
Noachter 1999
Referential Montage: A montage consisting of referential derivations.
Comment: a referential montage in which the reference electrode is common to multiple derivations is referred to as a common reference montage (see referential derivation).
Noachter 1999
Reformatting: Transformation of digitized EEG into different montages. Reformatting requires that the raw EEG signal is recorded to a common reference electrode. Only those electrodes can be included in the reformatting montages which are connected to amplifier input 1.
Noachter 1999
Regional: EEG activity that is limited to a region of the scalp or recorded in 3 or more electrodes in intracranial recordings (see focal, multiregional).
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Regular: Applies to waves or complexes of approximately constant period and relatively uniform appearance.
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Resistance Capacitance Coupled Amplifier: An amplifier in which successive stages are connected (coupled) by networks consisting of capacitors and resistors.
Abbreviation: RC coupled amplifier.
Noachter 1999
Resolution: The resolution of an AD converter (see digital EEG) is specified in binary digits or "bits". For example, a dynamic range of ± 1023 uV (a total span of 2046 uV), converted at 12-bit resolution, will allow the digitized signal to take on values every 0.5 uV.
Noachter 1999
Rhythm: EEG activity consisting of waves of approximately constant period.
Noachter 1999
Phythm En Arceau: Use of term discouraged.
Term suggested: mu (u) rhythm.
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Rhythm of Alpha Frequency:
(1) In general: any rhythm in the alpha band.
(2) Specifically: term should be used to designate those activities in the alpha band which differ from the alpha rhythm as regards their topography and/or reactivity and do not have specific appellations (such as mu rhythm) (see alpha rhythm).
Noachter 1999
Rhythmic Temporal Theta Burst of Drowsiness: Characteristic burst of 4-7 Hz waves frequently notched by faster waves, occurring over the temporal regions of the head during drowsiness. Synonym: psychomotor variant pattern (use discouraged).
Comment: this is a pattern of drowsiness that is of no clinical significance.
Run: Colloquialism. Use of term discouraged.
Term suggested: montage.
Noachter 1999
Saw Tooth Waves: Vertex negative 2-5 Hz waves occurring in series during REM sleep.
Noachter 1999
Saw Toothed Bursts: Temporal sharp transients in preterm infants occurring in burst of 3-8 sharp, rhythmic waves at 4-8 Hz, often with high voltage (100-200 uV).
Synonym: premature temporal theta.
Noachter 1999
Scalp Electrode: Electrode held against, attached to, or inserted in the scalp.
Noachter 1999
Scalp Electroencephalogram: Record of electrical activity of the brain by means of electrodes placed on the surface of the head. The term should be used only to distinguish between scalp and other electroencephalograms such as depth electroencephalograms. In all other instances, a scalp electroencephalogram should be referred to simply as an electroencephalogram (EEG).
Noachter 1999
Scalp Electroencephalography: Technique of recording scalp electroencephalograms. Term should be used only to distinguish between this and other recording techniques such as depth electroencephalography. In all other instances scalp electroencephalography should be referred to simply as electroencephalography (EEG).
Noachter 1999
Secondary Bilateral Synchrony: Spreading of an initially/focal (regional) epileptiform discharge to become generalized.
Comment: secondary bilateral synchrony frequently occurs from midline frontal generators.
Sensitivity: Ratio of input voltage to output trace deflection in an EEG channel. Sensitivity is measured in microvolts per millimeter (uV/mm).
Example:
Sensitivity
= (input voltage)/(output trace deflection)
= 50uV/10mm
=5 uV/mm
Noachter 1999
Sharp and Slow Wave Complex: A sequence of a sharp wave and a slow wave.
Comment: hyphenation facilitates use of term in plural form: sharp-and-slow-wave complexes or sharp-and-slow-waves.
Noachter 1999
Sharp Wave: A transient, clearly distinguished from background activity, with pointed peak at a conventional paper speed or time scale and duration of 70-200 ms, i.e. over 1/4-1/5 s approximately. Main component is generally negative relative to other areas. Amplitude varies.
Comments:
(1) term should be restricted to epileptiform discharges and does not apply to
(a) distinctive physiologic events such as vertex sharp transients, lambda waves and positive occipital sharp transients of sleep,
(b) sharp transients poorly distinguished from background activity and sharp-appearing individual waves of EEG rhythms.
(2) Sharp waves should be differentiated from spikes, i.e. transients having similar characteristics but shorter duration. However, it should be kept in mind that this distinction is largely arbitrary and primarily serves descriptive purposes. As a rule, in ink-written EEG records taken at 3 cm/s, sharp waves occupy more than 2 mm of paper width and spikes 2 mm or less (see spike).
Noachter 1999
Sigma Rhythm: Use of term discouraged.
Term suggested: sleep spindles.
Noachter 1999
Simultaneous: Occurring at the same time. Synonym: synchronous.
Noachter 1999
Sine Wave: Wave having the form of a sine curve.
Noachter 1999
Unipolar Depth Electrode: Use of term discouraged.
Term suggested: single-electrode lead.
Noachter 1999
Single Ended Amplifier: An amplifier that operates on signals that are asymmetric with respect to ground.
Noachter 1999
Sinusoidal: Term applies to EEG waves resembling sine waves
Noachter 1999
Six Hz Spike and Slow Wave: Spike-and-slow-wave complexes at 4-7 Hz, but mostly at 6 Hz occurring generally in brief bursts bilaterally and synchronously, symmetrically or asymmetrically, and either confined to or of larger amplitude over the posterior or anterior regions of the head. Amplitude varies but is generally smaller than that of spike-and-slow-wave complexes repeating at slower rates.
Comment: this pattern is of little clinical significance and should be distinguished from epileptiform discharges.
Noachter 1999
Sleep Onset REM: the occurrence of REM less than 15 min after falling asleep.
Noachter 1999
Sleep Spindle: Burst at 11-15 Hz but mostly at 12-14 Hz generally diffuse but of higher voltage over the central regions of the head, occurring during sleep. Amplitude varies but is mostly below 50 pV in the adult.
Synonym: sigma rhythm (use discouraged).
Noachter 1999
Sleep Stages: Distinctive phases of sleep best demonstrated by polygraphic recordings of the EEG and other variables, including at least eye movements and activity of certain voluntary muscles.
Comment: classified by various systems (Dement and Kleitman 1957; Rechtschaffen and Kales 1968).
Noachter 1999
Slow Activity: Activity of frequency lower than alpha, i.e. theta and delta activities.
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Slow Alpha Variant Rhythms: Characteristic rhythms mostly at 4-5 Hz, recorded most prominently over the posterior regions of the head. Generally alternate, or are intermixed, with alpha rhythm to which they often are harmonically related. Amplitude varies but is frequently close to 50 uV. Blocked or attenuated by attention, especially visual, and mental effort.
Comment: slow alpha variant rhythms should be distinguished from posterior slow waves characteristic of children and adolescents and occasionally seen in young adults.
Noachter 1999
Slow Spike: Use of term discouraged.
Term suggested: sharp wave.
Noachter 1999
Slow Spike and Wave Complex: Use of term discouraged.
Term suggested: sharp-and-slow-wave complex.
Noachter 1999
Slow Wave: Wave with duration longer than alpha waves, i.e. over 1/8 s.
Noachter 1999
Small Sharp Spikes:
Abbreviation: SSS. Synonym for benign epileptiform transients of sleep (BETS) (preferred term).
Noachter 1999
Benign epileptiform transient of sleep (BETS): Small sharp spikes (SSS) of very short duration and low amplitude, often followed by a small theta wave, occurring in the temporal regions during drowsiness and light sleep. This pattern is of little clinical significance (see small sharp spikes).
Noachter 1999
Special Electrode: Any electrode other than standard scalp electrode (see closely spaced electrodes; ten-ten system).
Noachter 1999
Sphenoidal Electrode: Needle or wire electrode inserted through the soft tissues of the face below the zygomatic arch so that its tip lies near the base of the skull in the region of the foramen ovale.
Noachter 1999
Spike: A transient, clearly distinguished from background activity, with pointed peak at a conventional paper speed or time scale and a duration from 20 to under 70 ms, i.e. 1/50-1/15s, approximately. Main component is generally negative relative to other areas. Amplitude varies.
Comments:
(1) term should be restricted to epileptiform discharges. EEG spikes should be differentiated from sharp waves, i.e. transients having similar characteristics but longer durations. However, it should be kept in mind that this distinction is largely arbitrary and primarily serves descriptive purposes. Generally, in ink-written EEG records taken at 3 cm/s, spikes occupy 2 mm or less of paper width and sharp waves more than 2 mm.
(2) EEG spikes should be clearly distinguished from the brief unit spikes recorded from single cells with microelectrode techniques (see sharp wave).
Noachter 1999
Spike and Dome Complex: Use of term discouraged.
Term suggested: spike-and-slow-wave complex.
Noachter 1999
Spike and Slow Wave Complex: A pattern consisting of a spike followed by a slow wave.
Comment: hyphenation facilitates use of term in plural form: spike-and-slow-wave complexes.
Noachter 1999
Spike and Slow Wave Rhythm: Use of term discouraged.
Terms suggested, whenever appropriate:
3 per second spike-and-slow-wave complex,
atypical spike-and-slow wave complex,
sharp-and-slow-wave complex.
Noachter 1999
Spindle: Group of rhythmic waves characterized by a progressively increasing, then gradually decreasing, amplitude (see sleep spindle).
Noachter 1999
Spread: Propagation of EEG waves from one region of the scalp and/or brain to another (see generalization).
Noachter 1999
Standard Electrode: Conventional scalp electrode
(see disk electrode, needle electrode, pad electrode, special electrode).
Noachter 1999
Standard Electrode Placement: Scalp electrode location(s) determined by the ten-twenty system (see ten-twenty system).
Noachter 1999
Stephenson-Gibbs Reference: Use of term discouraged.
Term suggested: sterno-spinal reference electrode.
Noachter 1999
Stereotactic Depth Electroencephalogram:
Abbreviation: SEEG.
Intracerebral EEG recordings using electrodes implanted stereotactically, thus permitting the calculation of electrode?coordinates that can be projected on a stereotactic brain atlas. The abbreviation SDEEG is also acceptable for stereotactic depth electroencephalogram.
tereotactic (stereotaxic) electroencephalography: Technique of recording stereotactic in (stereotaxic) electroencephalograms.
Abbreviation: SEEG.
Noachter 1999
Depth electroencephalography: Technique of recording depth electroencephalograms (see stereotactic [stereotaxic] depth electroencephalography).
Derivation:
(1) The process of recording from a pair of electrodes in an EEG channel.
(2) The EEG record obtained by this process.
Stereotactic Depth Electroencephalogram:
Abbreviation: SEEG.
Intracerebral EEG recordings using electrodes implanted stereotactically, thus permitting the calculation of electrode?coordinates that can be projected on a stereotactic brain atlas. The abbreviation SDEEG is also acceptable for stereotactic depth electroencephalogram.
tereotactic (stereotaxic) electroencephalography: Technique of recording stereotactic in (stereotaxic) electroencephalograms.
Abbreviation: SEEG.
Stereotactic (stereotaxic) electroencephalogram: Abbreviation: SEEG. Intracerebral EEG recordings using electrodes implanted stereotactically, thus permitting the calculation of electrode coordinates that can be projected on a stereotactic brain atlas. The abbreviation SDEEG is also acceptable for stereotactic depth electroencephalogram.
Stereotactic (stereotaxic) electroencephalography: Technique of recording stereotactic in (stereotaxic) electroencephalograms.
Abbreviation: SEEG
Noachter 1999
Stereotactic Depth Electroencephalogram:
Abbreviation: SEEG.
Intracerebral EEG recordings using electrodes implanted stereotactically, thus permitting the calculation of electrode?coordinates that can be projected on a stereotactic brain atlas. The abbreviation SDEEG is also acceptable for stereotactic depth electroencephalogram.
tereotactic (stereotaxic) electroencephalography: Technique of recording stereotactic in (stereotaxic) electroencephalograms.
Abbreviation: SEEG.
Stereotactic (stereotaxic) electroencephalogram: Abbreviation: SEEG. Intracerebral EEG recordings using electrodes implanted stereotactically, thus permitting the calculation of electrode coordinates that can be projected on a stereotactic brain atlas. The abbreviation SDEEG is also acceptable for stereotactic depth electroencephalogram.
Stereotactic (stereotaxic) electroencephalography: Technique of recording stereotactic in (stereotaxic) electroencephalograms.
Abbreviation: SEEG
Noachter 1999
Stereotactic Depth Electroencephalogram:
Abbreviation: SEEG.
Intracerebral EEG recordings using electrodes implanted stereotactically, thus permitting the calculation of electrode?coordinates that can be projected on a stereotactic brain atlas. The abbreviation SDEEG is also acceptable for stereotactic depth electroencephalogram.
tereotactic (stereotaxic) electroencephalography: Technique of recording stereotactic in (stereotaxic) electroencephalograms.
Abbreviation: SEEG.
Stereotactic (stereotaxic) electroencephalogram: Abbreviation: SEEG. Intracerebral EEG recordings using electrodes implanted stereotactically, thus permitting the calculation of electrode coordinates that can be projected on a stereotactic brain atlas. The abbreviation SDEEG is also acceptable for stereotactic depth electroencephalogram.
Stereotactic (stereotaxic) electroencephalography: Technique of recording stereotactic in (stereotaxic) electroencephalograms.
Abbreviation: SEEG
Noachter 1999
Sternospinal Reference: A non-cephalic reference achieved by interconnecting two electrodes placed over the right sterno-clavicular junction and the spine of the seventh cervical vertebra, respectively, and balancing the voltage between them by means of a potentiometer to reduce ECG artifact.
Noachter 1999
Stickon Electrode: Colloquialism. Use of term discouraged. Term suggested: disk electrode.
Noachter 1999
Stroboscope (use discouraged).
Synonym:
Photic Stimulator: Device for delivering intermittent flashes of light.
Noachter 1999
Subclinical Rhythmic Discharges of Adults SREDA: This is a rhythmic pattern seen in the adult age group which consists of a mixture of frequencies, often predominant in the theta range. It may resemble a seizure discharge but is not accompanied by any clinical signs or symptoms. The significance of this pattern is uncertain, but it should be distinguished from an epileptic seizure pattern.
Noachter 1999
Subdural Electrode: Electrode inserted under the dural covering of the cerebrum.
Noachter 1999
Suppression: EEG records showing activity below 10 /uV (reference derivation) are termed background suppression (see burst suppression pattern).
Noachter 1999
Symmetry:
(1) Approximately equal amplitude, frequency and form of EEG activities over homologous areas on opposite sides of the head.
(2) Approximately equal distribution of potentials of unlike polarity on either side of a zero isopotential axis (see phase reversal).
(3) Approximately equal distribution of EEG waves about the baseline.
Noachter 1999
Synchronous: Occurring at the same time. Synonym: simultaneous.
Noachter 1999
Synchrony: The simultaneous occurrence of EEG waves over regions on the same or opposite sides of the head.
Comment: term simultaneous only implies a lack of delay that is measurable with ink writers at customary paper speeds or with standard computer display.
Independent (temporally): Synonym: asynchronous.
Noachter 1999
Ten-Ten System: System of standardized scalp electrode placement. According to this system, additional scalp electrodes are placed at half distance between the standard electrodes of the ten-twenty system (see ten-twenty system, closely spaced electrodes).
Comment: use of additional, supplementary scalp electrodes is indicated for instance during epilepsy monitoring to better localize epileptiform discharges.
Noachter 1999
Ten-Twenty System: System of standardized scalp electrode placement recommended by the International Federation of Societies for Electroencephalography and Clinical Neurophysiology. According to this system, the placements of electrodes is determined by measuring the head from external landmarks and taking 10 or 20% of these measurements.
Comment: the use of additional scalp electrodes, such as anterior temporal electrodes, is indicated in various circumstances (epilepsy monitoring).
Noachter 1999
Theta Band: Frequency band from 4 to under 8 Hz. Greek letter: <theta>.
Noachter 1999
Theta Rhythm: Rhythm with a frequency of 4 to under 8 Hz.
Noachter 1999
Theta Wave: Wave with duration of 1/4 to over 1/8 s.
Noachter 1999
Three Hz Spike-Slow-Wave-Complex: See 3 per second spike-and-slow-wave complex.
Noachter 1999
Three per Second-Spike and Slow Wave Complex: Characteristic paroxysm consisting of a regular sequence of spike-and-slow-wave complexes which:
(1) repeat at 33.5 c/s (measured during the first few seconds of the paroxysm),
(2) are bilateral in their onset and termination, generalized, and usually of maximal amplitude over the frontal areas,
(3) are approximately synchronous and symmetrical on the two sides of the head throughout the paroxysm. Amplitude varies but can reach values of 1000 uV (1 mV) (see atypical spike-and-slow-wave complex).
Noachter 1999
Topography: Spatial distribution of EEG features (voltage fields, spectra, etc.) over the scalp or cerebral cortex.
Noachter 1999
Trace Alternant: A discontinuous pattern of non-REM (quiet) sleep seen in preterm infants of 34 weeks conceptional age or older which can persist up to 3-4 weeks after birth in full term infants. The pattern is characterized by bursts of predominantly slow waves (1-3 Hz, 50-100 uV) appearing approximately every 4-5 s, and intervening periods of low voltage activity of (<50 uV) 4-7 Hz.
Noachter 1999
Trace Continue: Continuous activity, replacing a previously markedly intermittent record during evolution of EEG in preterm infants.
Noachter 1999
Trace Discontinue: Pattern of preterm infants below 34 weeks of conceptional age (CA) characterized by mixed frequency high voltage bursts separated by periods of a very low voltage background.
Noachter 1999
Tracing:
Synonyms: record, recording.
Noachter 1999
Transverse Bipolar Montage:
Synonym: coronal bipolar montage.
Noachter 1999
Triangular Bipolar Montage: A montage consisting of derivations from pairs of electrodes in a group of 3 electrodes arranged in a triangular pattern.
Use of this montage is discouraged, because false lateralization may occur.
Noachter 1999
Triphasic Wave: High-amplitude (over 70 uV) positive sharp transients, which are preceded and followed by relatively low-amplitude negative waves. The first negative wave generally has a lower amplitude than the negative afterwave. The distribution is generalized, and frequently the largest deflections in a bipolar fronto-occipital derivation occur at the frontal electrodes. Triphasic waves tend to have a repetition rate of ca. 1-2 Hz.
Noachter 1999
Unilateral: Confined to one side of the head.
Comments:
(1) unilateral EEG activities may be regional or lateralized to one hemisphere.
(2) They are said to be lateralized to the right or left side of the head.
Noachter 1999
Unipolar: Use of term discouraged.
Term suggested: referential.
Noachter 1999
Referential Derivation: Recording from a pair of electrodes consisting of an exploring electrode generally connected to the input terminal 1 and a reference electrode usually connected to the input terminal 2 of an EEG amplifier (see reference electrode, referential montage, common reference montage)
Noachter 1999
Referential Montage: A montage consisting of referential derivations.
Comment: a referential montage in which the reference electrode is common to multiple derivations is referred to as a common reference montage (see referential derivation).
Noachter 1999
Unipolar Depth Electrode: Use of term discouraged.
Term suggested: single-electrode lead.
Noachter 1999
Unipolar Derivation: Use of term discouraged (see referential derivation).
Noachter 1999
Unipolar Montage: Use of term discouraged.
Term suggested: referential montage.
Noachter 1999
V Wave: Abbreviation for vertex sharp transient.
Noachter 1999
Vertex Sharp Transient: Sharp potential, maximal at the vertex, negative relative to other areas, apparently occurring spontaneously during sleep or in response to a sensory stimulus during sleep or wakefulness. May be single or repetitive. Amplitude varies but rarely exceeds 250 uV .
Abbreviation: V wave (see K complex).
Noachter 1999
Vertex Sharp Wave: Use of term discouraged when describing physiologic vertex sharp transient.
Noachter 1999
Voltage: Derived by multiplying trace amplitude times display or pen output sensitivity (see amplitude).
Noachter 1999
Volume Conduction: Through the process of volume conduction, electrical activity originates from a generator and spreads through a conductive medium to be picked up by a distant recording electrode. Volume conduction is passive and is picked up synchronously at all recording electrodes at the speed of light.
Noachter 1999
Wave: Any change of the potential difference between pairs of electrodes in EEG recording. May arise in the brain (EEG wave) or outside it (extracerebral potential).
Noachter 1999
Wave Form: The shape of an EEG wave.
Noachter 1999
Waveform: The shape of an EEG wave.
Noachter 1999
White Lead: Use of term discouraged. Term suggested: input terminal 2.
Noachter 1999
Wicket Rhythm: Use of term discouraged. Term suggested: mu rhythm.
Noachter 1999
Wicket Spikes: Spike-like monophasic negative single waves or trains of waves occurring over the temporal regions during drowsiness that have an arcuate or mu-like appearance. These are mainly seen in older individuals and represent a benign variant that is of little clinical significance.
Noachter 1999
Writer: System for direct write-out of the output of an EEG channel. Most writers use ink delivered by a pen. In certain instruments, the ink is sprayed as in a jet stream. In other recorders the pen writer uses carbon paper instead of ink. Laser printers are also used in digital EEG.
Noachter 1999
Zero Potential Reference Electrode: Use of term discouraged.
Term suggested: reference electrode (not a synonym.)
Blume 2001
Non-Lateralizing Phenomenon: Impaired cognition, amnesia, psychosis.
Noachter 1999
Non-REM Sleep: Term summarizing all sleep stages except REM-sleep (see quiet sleep).
ILAE 1989
Metabolism errors in the neonate include nonketotic hyperglycinemia and D-glycericacidemia, showing early myoclonic encephalopathy with erratic myoclonus, partial seizures, and suppression-burst EEG patterns.
Engel 2001
Nonketotic hyperglycinemia
Bancaud 1981
Attacks provoked by nonsensory factors (fatigue, alcohol, emotion, etc.)
Blume 2001
Reactive: Occurring in association with transient systemic perturbation such as intercurrent illness, sleep loss, or emotional stress.
Luders 1998
not declined in (academic performance, etc)
Engel 2001
Northern epilepsy syndrome
This is a place holder that negates all information that is related to epilpsy and seizure topics. E.g.
Bancaud 1981
Feeling of numbness
Blume 2001
Somatosensory: Tingling, numbness, electric-shock sensation, pain, sense of movement, or desire to move.
Noachter 1999
Occipital Intermittent Delta Activity OIRDA: Fairly regular or approximately sinusoidal waves, mostly occurring in bursts at 2-3 Hz over the occipital areas of one or both sides of the head.
Tancred 2005
The occipital lobe is involved primarily in the processing and interpretaion of visual information.
Structures:
Calcarine Sulcus
Cuneus
Lingual Gyrus
Parahippocampal Gyrus
Parieto-occipital Sulcus
Primary Visual Area
Information:
The occipital lobe occupies the posterior part of the cerebral hemisphere.
Boundaries:
On the lateral surface it is located posterior to an imaginary line extending from the parieto-occipital sulcus to the pre-occipital notch. On the medial surface it is bounded posterior to the parieto-occipital fissure and by an imaginary line extending from the splenium of the corpus callosum to the pre-occipital notch.
Sulci and Gyri:
The medial surface of the occipital lobe is divided into two parts by the calcarine sulcus, a deep groove which extends posteriorly from the parieto-occipital fissure to the posterior pole. The cuneus is the wedge-shaped area which lies between the parieto-occipital fissure and the calcarine sulcus. The inferior bank of the calcarine sulcus is formed by the lingual gyrus, a posterior extension of the parahippocampal gyrus of the temporal lobe.
The lateral surface of the occipital lobe is formed by some inconstantly-shaped gyri, which are collectively referred to as the lateral occipital gyri.
Functional Areas:
The occipital lobe contains the primary visual area of the cortex, which is located around the calcarine sulcus. Only a thin strip of the primary visual cortex is visible on the medial surface of the brain (on either side of the calacarine sulcus) because most of it is buried within the depths of the sulcus.
ILAE 1989
Occipital Lobe Epilepsy
ILAE 1989
Chronicity
Blume 2001
Incidence: Noun: Refers to the number of epileptic seizures within a time period or the number of seizure days per unit of time.
Wouldn't occurrence be a better word since incidence usually refers to the disease incidence or the newly diagnosed rate of a disease?
Blume 2001
Incidence: Noun: Refers to the number of epileptic seizures within a time period or the number of seizure days per unit of time.
Blume 2001
Olfactory: Odor, usually disagreeable.
Engel 2001
Ohtahara Syndrome
ILAE 2010
Ohtahara
Bancaud 1981
unpleasant odors
ILAE 1989
Luders 1998
Olfactory Aura
Perception of a smell as an epileptic phenomenon is classified as an olfactory aura. At times, like auditory and visual hallucinations and illusions, they are associated with other complex alterations of perception. These complex alterations of perception should be classified as psychic auras unless the olfactory aura is clearly the predominant feature.
Blume 2001
2.2.1.4 Olfactory: Odor, usually disagreeable
Blume 2003
Aurae include epigastric sensation, fear and various types of visual, olfactory, or auditory experiential phenomena
Luders 1998
Olfactory Aura
Perception of a smell as an epileptic phenomenon is classified as an olfactory aura. At times, like auditory and visual hallucinations and illusions, they are associated with other complex alterations of perception. These complex alterations of perception should be classified as psychic auras unless the olfactory aura is clearly the predominant feature.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Bancaud 1981
Olfactory Symptom
Blume 2001
Olfactory: Odor, usually disagreeable.
Not a semiology
Engel 2001
Oligoepilepsy
Fischer 2014
Therefore, epilepsy could be considered present if an unprovoked seizure occurred at age 1 and at age 80, a condition sometimes referred to as oligoepilepsy.
Not clinically relevant
Bancaud 1981
Eyes are open
ILAE 1989
Opercular. Opercular seizure characteristics include mastication, salivation, swallowing, laryngeal symptoms, speech arrest, epigastric aura, fear, and autonomic phenomena. Simple partial seizures, particularly partial clonic facial seizures, are common and may be ipsilateral. If secondary sensory changes occur, numbness may be a symptom, particularly in the hands. Gustatory hallucinations are particularly common in this area.
The specific function of the orbital gyri is not well-understood.
Structures:
Central Sulcus
Cerebral Hemisphere
Cingulate Gyrus
Corpus Callosum
Gyrus Rectus
Inferior Frontal Gyrus
Inferior Frontal Sulcus
Lateral Fissure
Limbic Area
Middle Frontal Gyrus
Motor Speech (Broca’s) Area
Olfactory Sulcus
Olfactory Tract
Orbital Gyri
Pars Opercularis (Inf. Fr. G.)
Pars Orbitalis (Inf. Fr. G.)
Pars Triangularis (Inf. Fr. G)
Precentral Gyrus
Precentral Sulcus
Prefrontal Area
Premotor Area
Primary Motor Area
Superior Frontal Gyrus
Superior Frontal Sulcus
Triangular Sulcus
Information:
The frontal lobe occupies the anterior part of the cerebral hemisphere.
Boundaries:
On the lateral surface it extends from the frontal pole posteriorly to the central sulcus and is bounded inferiorly by the lateral fissure. On the medial surface it extends posteriorly to an imaginary line from the central sulcus to the corpus callosum.
Sulci and Gyri:
The superolateral surface of the frontal lobe is formed by the superior, middle and inferior frontal gyri which extend in an anteroposterior direction and the precentral gyrus which extends vertically downwards. The superior and inferior frontal gyri are separated by the superior frontal sulcus and the middle and inferior gyri are separated by the inferior frontal sulcus. The precentral sulcus separates the precentral gyrus from the frontal gyri.
The inferior frontal gyrus is divided from anterior to posterior into the pars orbitalis, pars triangularis and pars opercularis by the triangular sulcus. The superior frontal gyrus extends onto the medial surface as far as the cingulate gyrus, the anterior part of which is also included in the frontal lobe.
The inferior surface of the frontal lobe is formed by the orbital gyri, which overlie the bony roof of the orbit and gyrus rectus (most medially). The orbital gyri and gyrus rectus are separated by the olfactory sulcus, which contains the olfactory tract.
Functional Areas:
The frontal lobe includes a number of important functional areas:
(1) Primary motor area - located on the precentral gyrus.
(2) Premotor area - located on the anterior part of the precentral gyrus and the adjacent parts of the superior and middle frontal gyri.
(3) Prefrontal area - which includes the remainder of the superior and middle frontal gyri, the orbital part of the inferior frontal gyrus and the orbital gyri.
(4) Motor Speech (Broca's) Area - located on the triangular and opercular parts of the inferior frontal gyrus.
(5) Limbic Area - located on the cingulate gyrus.
ILAE 1989
Orbitofrontal. The orbitofrontal seizure pattern is one of complex partial seizures with initial motor and gestural automatisms, olfactory hallucinations and illusions, and autonomic signs.
Luders 1998
Most seizures consist of symptoms that evolve as the seizure discharge spreads to involve new cortical areas. In the semiological classification of seizures, this evolution is indicated by considering each one of the seizures described above as one component of a seizure. Any given seizure consists of one or more of these components, which are listed in order of appearance and are linked by arrows. Example:
Left visual aura --> left hand clonic seizure --> generalized tonic-clonic seizure
Left visual aura --> bilateral asymmetric tonic seizure --> left arm clonic seizure
Abdominal aura --> left hemispheric automotor seizure
Olfactory aura --> automotor seizure --> left versive seizure --> generalized tonic-clonic seizure
Generalized myoclonic seizure --> generalized tonic-clonic seizure
Typical dialeptic seizure --> generalized tonic-clonic seizure
Typically, we limit the number of seizure components to four for practical purposes.
Blume 2001
Oroalimentary: Lip smacking, lip pursing, chewing, licking, tooth grinding, or swallowing.
Engel 2001
Other cerebral malformations
Engel 2001
Other organic acidurias
Blume 2001
Somatosensory: Tingling, numbness, electric-shock sensation, pain, sense of movement, or desire to move.
Bancaud 1981
Pale
Bancaud 1981
Pallilalia: involuntary repeition of a syllable or phrase
Bancaud 1981
Pallor
Bancaud 1981
Palpitation
Bancaud 1981
A distorted memory experience such as distorted memory experience (panoramic vision)
Trancred 2005
The Paracentral Lobule includes the primary motor and somatosensory areas for the leg and foot and is important in the control of voluntary movements and the localisation and perception of somatosensory stimuli in the leg and foot.
Structures:
Anterior Cerebral a.
Central Sulcus
Cerebrum
Middle Cerebral a.
Postcentral Gyrus
Precentral Gyrus
Primary Motor Area
Primary Somatosensory Area
Information:
The Paracentral Lobule is a region of cortex on the medial surface of the cerebrum which surrounds the medial end of the central sulcus. It is formed by the medial ends of the precentral and postcentral gyri and represents the primary motor and somatosensory areas for the leg and foot.
The paracentral lobule is of some clinical importance because it is supplied by branches of the anterior cerebral artery whereas the remainder of the pre- and postcentral gyri are supplied by branches of the middle cerebral artery. Thus, lesions of the anterior cerebral artery result in loss of sensation and paralysis of muscles in the contralateral leg and foot, whereas lesions of the middle cerebral artery do not affect the leg and foot.
Tancred 2005
The parietal lobe is involved in the recognition of somatosensory stimuli and in the integration of visual, somatosensory and auditory information.
Structures:
Angular Gyrus
Calcarine Sulcus
Central Sulcus
Cerebral Hemisphere
Cingulate Gyrus
Corpus Callosum
Frontal Lobe
Inferior Parietal Lobule
Intraparietal Sulcus
Lateral Fissure
Occipital Lobe
Parieto-occipital Sulcus
Postcentral Gyrus
Postcentral Sulcus
Precuneus
Primary Somatosensory Area
Receptive Speech Area
Superior Temporal Sulcus
Supramarginal Gyrus
Information:
The Parietal Lobe is located on the medial and lateral surfaces of the cerebral hemisphere between the frontal and occipital lobes.
Boundaries:
On the lateral surface it extends from the central sulcus anteriorly to an imaginary line drawn downwards from the parieto-occipital sulcus to the preoccipital notch. Inferiorly it is bounded by the lateral fissure and a horizontal line drawn from the lateral fissure to the imaginary line previously described.
On the medial surface it is bounded by the frontal lobe anteriorly, the parieto-occipital fissure posteriorly and the corpus callosum and calcarine sulcus inferiorly.
Gyri and Sulci:
On the lateral surface the parietal lobe is formed by the postcentral gyrus and the superior and inferior parietal lobules. The postcentral gyrus is separated from the two parietal lobules by the postcentral sulcus, which is parallel to the central sulcus. The superior and inferior parietal lobules are separated from each other by the intraparietal sulcus.
The inferior parietal lobule includes the supramarginal and angular gyri. The supramarginal gyrus hooks around the posterior surface of the lateral fissure and the angular gyrus hooks around the posterior end of the superior temporal sulcus.
The medial surface of the parietal lobe includes an extension of the postcentral gyrus, the posterior part of the cingulate gyrus and the precuneus.
Functional Areas:
(1) Primary Somatosensory Area - located on the postcentral gyrus.
(2) In the dominant hemisphere (usually the left) the lower part of the inferior parietal lobule is concerned with the perception and interpretation of language and forms part of the receptive speech (Wernicke's) area.
ILAE 1989
Parietal lobe epilepsies
Partial lobe epilepsy syndromes are usually characterized by simple partial and secondarily generalized seizures. Most seizures arising in the parietal lobe remain as simple partial seizures, but complex partial seizures may arise out of simple partial seizures and occur with spread beyond the parietal lobe. Seizures arising from the parietal lobe have the following features: Seizures are predominantly sensory with many characteristics. Positive phenomena consist of tingling and a feeling of electricity, which may be confined or may spread in a Jacksonian manner. There may be a desire to move a body part or a sensation as if a part were being moved. Muscle tone may be lost. The parts most frequently involved are those with the largest cortical representation (e.g., the hand, arm, and face). There may be tongue sensations of crawling, stiffness, or coldness, and facial sensory phenomena may occur bilaterally. Occasionally, an intraabdominal sensation of sinking, choking, or nausea may occur, particularly in cases of inferior and lateral parietal lobe involvement. Rarely, there may be pain, which may take the form of a superficial burning dysesthesia, or a vague, very severe, painful sensation. Parietal lobe visual phenomena may occur as hallucinations of a formed variety. Metamorphopsia with distortions, foreshortenings, and elongations may occur, and are more frequently observed in cases of nondominant hemisphere discharges. Negative phenomena include numbness, a feeling that a body part is absent, and a loss of awareness of a part or a half of the body, known as asomatognosia. This is particularly the case with nondominant hemisphere involvement. Severe vertigo or disorientation in space may be indicative of inferior parietal lobe seizures. Seizures in the dominant parietal lobe result in a variety of receptive or conductive languages disturbances. Some well-lateralized genital sensations may occur with paracentral involvement. Some rotatory or postural motor phenomena may occur. Seizures of the paracentral lobule have a tendency to become secondarily generalized.
This is an instance of a Hamartoma
Trancred 2005
The Parieto-occipital sulcus is a deep fissure which separates the parietal from the occipital lobes of the cerebral cortex.
Structures:
Corpus Callosum
Occipital Lobe
Parietal Lobe
Precuneus
Information:
The Parieto-occipital Sulcus is a very deep groove which extends obliquely across the medial surface of the brain, posterior to the corpus callosum. It is forms part of the boundary between the occipital and parietal lobes. Specifically, it is located between the cuneus of the occipital lobe and the precuneus of the parietal lobe.
Noachter 1999
Paroxysm: Phenomenon with abrupt onset, rapid attainment of a maximum, and sudden termination; distinguished from background activity.
Comment: commonly used to refer to epileptiform patterns and seizure patterns (see epileptiform pattern, seizure pattern).
Bancaud 1981
Paroxysmal activity (such as spike-and-slow-wave complexes)
Luders 1998
Paroxysmal Event
The EEG, findings (ictal or interictal) are not used to classify epileptic seizures in our proposed system. The EEG may be used to differentiate between epileptic seizures and nonepileptic paroxysmal events, however (see section Paroxysmal events).
Paroxysmal events are episodes in which the observer believes that there is not sufficient evidence to assume that a “seizurelike” event was of epileptic nature. If an “ictal” EEG is available, it should not show an ictal EEG pattern. This classification of epileptic seizures is based exclusively on semiology. However, the EEG can be used to determine whether an episode is epileptic or not. Episodes for which there is not sufficient proof of epileptic nature are classified merely as paroxysmal events. Otherwise, this semiological classification would have to be expanded to include the semiology of non-epileptic events, which may be extremely varied. Addressing nonepileptic events would require a different approach to classification.
Anything that starts and stops
e.g. coughing, a paroxysm of coughing
Is an epileptiform pattern
Ictal discharge
Noachter 1999
Paroxysmal Fast: Fast frequencies in the beta range occurring in trains (see paroxysm, low voltage fast activity).
Gastaut 1970
Partial Onset
Bancaud 1981
The first clinical and electroencephalographic changes indicate nitial activation of a system of neurons limited to part of one cerebral hemisphere
Engel 2001
The term partial itself has come under criticism because it implies part of a seizure, or part of a syndrome, rather than a seizure or syndrome that begins in part of one hemisphere. For this reason, the 1989 Classification of Epilepsies and Epileptic Syndromes replaced the term partial with “localization-related.” This latter terminology has been cumbersome and is not consistently used. The Task Force is now proposing that the terms partial and localization-related be replaced with the older term “focal,” which remains in common use. It must be strongly emphasized, however, that the term focal does not mean that the epileptogenic region is a small, welldelineated focus of neuronal pathology; focal seizures, as well as focal syndromes, are almost always due to diffuse, and at times widespread, areas of cerebral dysfunction.
Engel 2001
Partial monosomy 4p
Bancaud 1981
Classified primarily whether or not consciousness is impaired during the attack.
Bancaud 1981
A) Simple partial seizures evolving to generlized seizures
B) Complex partial seizures evolving to generalized seizures
C) Simple partial seizures evolving to complex partial seizures evolving to generalized seizures
EEG Seizure Type
Discharges become secondarily and rapidly generalized
Bancaud 1981
e.g. Jacksonian
Engel 2001
Patterns
Noachter 1999
Peak: Point of maximum amplitude of a wave.
Blume 2001
Components of cognition:
Perception: symbolic conception of sensory information
Attention: appropriate selection of a principal perception or task
Emotion: appropriate affective significance of a perception
Memory: ability to store and retrieve percepts or concepts
Executive function: anticipation, selection, monitoring of consequences, and initiation of motor activity including praxis, speech
Noachter 1999
Period: Duration of complete cycle of individual component of a sequence of regularly repeated EEG waves or complexes.
Comment: the period of the individual components of an EEG rhythm is the reciprocal of the frequency of the rhythm.
Noachter 1999
Periodic Lateralized Epileptiform Discharges (PLEDs): PLEDs are sharp transients such as sharp waves or spikes, which repeat in a periodical or semiperiodical fashion. They have either a regional or a lateralized distribution. They may also occur independently over both hemispheres. The epileptiform discharges often have multiple phases and a complex morphology. The main component is negative.
Noachter 1999
Periodic: Applies to:
(1) EEG waves or complexes Occurring in a sequence at an approximately regular rate.
(2) EEG waves or complexes occurring intermittently at approximately regular intervals, generally of one to several seconds.
Engel 2001
Periventricular leukomalacia
Engel 2001
Periventricular nodular heterotopia
Engel 2001
Peroxisomal disorders
Bancaud 1981
Persons
The individual phacomatoses have no typical electroclinical pattern. We emphasize that West syndrome is frequent in tuberous sclerosis, and that generalized and partial seizures may follow the otherwise typical course of infantile spasms. Sturge-Weber syndrome is a frequent cause of simple partial seizures followed by hemiparesis.
Noachter 1999
Phase:
(1) Time or polarity relationships between a point on a wave displayed in a derivation and the identical point on the same wave recorded simultaneously in another derivation.
(2) Time or angular relationships between a point on a wave and the onset of the cycle of the same wave. Usually expressed in degrees or radians.
2001 Engel
Phenylketonuria
Noachter 1999
Photic Driving: Physiologic response consisting of rhythmic activity elicited over the posterior regions of the head by repetitive photic stimulation at frequencies of about 5-30 Hz.
Comments:
(1) term should be limited to activity time-locked to the stimulus and of frequency identical or harmonically related to the stimulus frequency.
(2) Photic driving should be distinguished from the visual evoked potentials elicited by isolated flashes of light or flashes repeated at very low frequencies.
Noachter 1999
Photic Stimulation: Delivery of intermittent flashes of light to the eyes of a subject. Used as EEG activation procedure. Synonym: intermittent photic stimulation (IPS).
Noachter 1999
Photomyogenic Response: A response to intermittent photic stimulation characterized by the appearance in the record of brief, repetitive muscular artifacts (spikes) over the anterior regions of the head. These often increase gradually in amplitude as stimuli are continued and cease promptly when the stimulus is withdrawn.
Comment: this response is frequently associated with flutter of the eyelids and vertical oscillations of the eyeballs and sometimes with discrete jerking mostly involving the musculature of the face and head.
Preferred to synonym: photomyoclonic response.
Ictal Discharge
Noachter 1999
Photoparoxysmal Response: Abnormal response to intermittent photic stimulation characterized by spike-and-slow-wave and polyspike-and-slow-wave complexes. Responses are graded from occipital spikes time-locked to the flashes to generalized epileptiform discharges which may outlast the stimulus by a few seconds.
Comment: only the generalized spike-and-wave response shows a strong association with epilepsy, particularly if it is self-sustaining and continues after the stimulus.
Preferred to synonym: photoconvulsive response.
JB: History and EEG Sign
2014 Fischer
another patient might have photosensitive epilepsy, yet not be considered to have epilepsy because the seizures are provoked by lights
2005 SIGN
Fever
Scheuerman 2009
Physical Examination: A sequence of acts of observing and measuring bodily features of a patient performed by a clinician; measurements may occur with and without elicitation.
2010 Berg
Bancaud 1981
Piloerection
Bancaud 1981
Pins-and-needles sensation
Bancaud 1981
Extreme pleasure
Noachter 1999
Polarity, EEG wave: Sign of potential difference existing at a given time between an electrode affected by a given potential change and another electrode not appreciably, or less, affected by the same change (see polarity convention).
Comment: the apparent "polarity" of an EEG wave is dependent upon the potential difference between two electrodes.
Bancaud 1981
Polyspike and Wave
Polyspike and Slow Wave
Noachter 1999
Polygraphic Recording: Simultaneous monitoring of multiple physiological measures such as the EEG, respiration, electrocardiogram, electromyogram, eye movement, blood pressure, oxygen saturation, and leg movements, etc.
Noachter 1999
Polyphasic Wave: Wave consisting of two or more components developed on alternating sides of the baseline (see diphasic wave, triphasic wave).
Noachter 1999
Polysomnography: Polygraphic recording of sleep (see polygraphic recording).
Noachter 1999
Polyspike and Slow Wave Complex:
Synonym: multiple spike-and-slow-wave complex (term discouraged) .
Noachter 1999
Polyspike Complex: A sequence of two or more spikes.
Synonym: multiple spike complex (term discouraged).
Trancred 2005
The Pons is an important relay center for information passing from the cerebral cortex to the cerebellum. It also contains nuclei cranial nerves V, VI, and VII, respiratory control centers and long motor and sensory tracts.
Structures:
Basis Pontis
CN Nuclei of Pons
Corticobulbar Tract
Corticopontine Tract
Corticospinal Tract
Fourth Ventricle
Hindbrain
Medial Lemniscus
Medulla
Midbrain
Middle Cerebellar Peduncle
Pontine Nuclei
Pontocerebellar Tract
Reticular Formation
Spinothalamic Tract
Tracts of Pons
Information:
The pons is the rostral part of the hindbrain and lies between the medulla and the midbrain. It develops from the metencephalon of the embryonic brain and consists of a tegmentum and a base (the basis pontis).
The pontine tegmentum is located dorsally and forms the rostral part of the floor of the fourth ventricle. It is composed primarily of gray matter and contains the pontine reticular formation (which is continous with the reticular formation of the medulla and midbrain) as well as several cranial nerve nuclei (see CN nuclei of pons) and their associated tracts.
In the basis pontis, islands of gray matter, the pontine nuclei, are interspersed amongst massive numbers of horizontally oriented pontocerebellar fibres and vertically oriented corticopontine, corticospinal and corticobulbar fibres. The pontocerebellar fibres continue laterally as the middle cerebellar peduncle, visible on the ventral surface of the pons. The ascending somatosensory pathways, the medial lemniscus and the spinothalamic tract (referred to collectively at this level as the spinal lemniscus) lie in the dorsal part of the basis pontis, adjacent to the tegmentum.
A list of the major tracts present in cross sections of the pons are listed on another card (tracts of pons).
Engel 2001
Porencephaly
Noachter 1999
Fourteen and 6-Hz Positive Bust: Burst of arch-shaped waves at 13-17 Hz and/or 5-7 Hz but most commonly at 14 and or 6 Hz seen generally over the posterior temporal and adjacent areas of one or both sides of the head during sleep. The sharp peaks of its component waves are positive with respect to other regions. Amplitude varies but is generally below 75 uV.
Comments:
(1) best demonstrated by referential recording using contralateral earlobe or other remote, reference electrodes.
2) This pattern is of no established clinical significance.
Noachter 1999
Positive occipital sharp transient of sleep (POSTS): Sharp transient maximal over the occipital regions, positive relative to other areas, apparently occurring spontaneously during sleep. May be single or repetitive. Amplitude varies but is generally below 50 uV.
Noachter 1999
Fourteen and 6 Hz Positive Spikes:
Synonym: 14- and 6-Hz positive burst.
ILAE 1989
Hypometabolism
Wolf 2006
yes/no, what does it look like, how long does it take, what is the phenomena
Blume 2001
Postictal Phenomenon: A transient clinical abnormality of central nervous system function that appears or becomes accentuated when clinical signs of the ictus have ended.
Tancred 2005
The postcentral gyrus corresponds to the primary somatosensory area, which is essential for the precise localization of somatosensory stimuli.
Structure:
Brodmann’s Areas
Central Sulcus
Cerebrum
Paracentral Lobule
Parietal Lobe
Postcentral Sulcus
Primary Somatosensory Area
Information:
The postcentral gyrus is located in the lateral surface of the cerebrum in the anterior part of the parietal lobe. It is bounded anteriorly by the central sulcus and posteriorly by the postcentral sulcus. Its extends onto the medial surface of the cerebrum, where it forms the anterior part of the paracentral lobule.
The postcentral gyrus corresponds to primary somatosensory area and includes Brodmann's areas 1, 2 and 3.
Tancred 2005
The postcentral sulcus forms the posterior boundary of the postcentral gyrus and separates it fromt he superior and inferior parietal lobules.
Structures:
Parietal Lobe
Postcentral Gyrus
Information:
The postcentral sulcus is located on the parietal lobe, posterior to the postcentral gyrus. It separates the postcentral gyrus from the superior and inferior parietal lobules.
The occurrence of virtually continuous or repetitive seizure activity in an EEG. Term should be distinguished from clinical status epilepticus.
Bancaud 1981
Post-Ictal
Blume 2001
Postictal Phenomenon: A transient clinical abnormality of central nervous system function that appears or becomes accentuated when clinical signs of the ictus have ended.
Engel 2001
Postnatal infections
Engel 2001
Immediate and early posttraumatic seizures
Blume 2001
Postural: Adoption of a posture that may be bilaterally symmetric or asymmetric (as in a “fencing posture”).
JB: Observation of someone in front of you
Noachter 1999
Potential:
(1) Strictly: voltage.
(2) Loosely: synonym of wave.
Blume 2001
Executive function: anticipation, selection, monitoring of consequences, and initiation of motor activity including praxis, speech
Engel 2001
Praxis
Praxis (process), the process by which a theory, lesson, or skill is enacted, practiced, embodied, or realised
Blume 2001
Prodrome: A preictal phenomenon. A subjective or objective clinical alteration (e.g., ill-localized sensation or agitation) that heralds the onset of an epileptic seizure but does not form part of it.
The Precentral Gyrus corresponds to the primary motor area of the cortex which controls voluntary movements of the contralateral half of the body, particularly the distal parts of the limbs.
Structures:
Brodmann’s Areas
Central Sulcus
Cerebrum
Frontal Lobe
Paracentral Lobule
Precentral Sulcus
Primary Motor Area
Information:
The precentral gyrus is located on the lateral surface of the frontal lobe. It contains the primary motor area and corresponds to Brodmann's area 4. It is bounded anteriorly by the precentral sulcus and posteriorly by the central sulcus. It extends onto the medial surface of the cerebrum where it forms the posterior part of the paracentral lobule.
The Precentral Sulcus forms the anterior boundary of the precentral gyrus and separates it from the anterior, middle and inferior frontal gyri.
Structures:
Frontal Lobe
Inferior Frontal Gyrus
Middle Frontal Gyrus
Precentral Gyrus
Superior Frontal Gyrus
Information:
The precentral sulcus is located on the frontal lobe, anterior to the precentral gyrus. It separates the precentral gyrus from the superior, middle and inferior frontal gyri.
Trancred 2005
The function of the Precuneus is not clearly defined.
Structures:
Angular Gyrus
Calcarine Sulcus
Central Sulcus
Cerebral Hemisphere
Cingulate Gyrus
Corpus Callosum
Frontal Lobe
Inferior Parietal Lobule
Intraparietal Sulcus
Lateral Fissure
Occipital Lobe
Parieto-occipital Sulcus
Postcentral Gyrus
Postcentral Sulcus
Precuneus
Primary Somatosensory Area
Receptive Speech Area
Superior Parietal Lobule
Superior Temporal Sulcus
Supramarginal Gyrus
Information:
The Parietal Lobe is located on the medial and lateral surfaces of the cerebral hemisphere between the frontal and occipital lobes.
Boundaries:
On the lateral surface it extends from the central sulcus anteriorly to an imaginary line drawn downwards from the parieto-occipital sulcus to the preoccipital notch. Inferiorly it is bounded by the lateral fissure and a horizontal line drawn from the lateral fissure to the imaginary line previously described.
On the medial surface it is bounded by the frontal lobe anteriorly, the parieto-occipital fissure posteriorly and the corpus callosum and calcarine sulcus inferiorly.
Gyri and Sulci:
On the lateral surface the parietal lobe is formed by the postcentral gyrus and the superior and inferior parietal lobules. The postcentral gyrus is separated from the two parietal lobules by the postcentral sulcus, which is parallel to the central sulcus. The superior and inferior parietal lobules are separated from each other by the intraparietal sulcus.
The inferior parietal lobule includes the supramarginal and angular gyri. The supramarginal gyrus hooks around the posterior surface of the lateral fissure and the angular gyrus hooks around the posterior end of the superior temporal sulcus.
The medial surface of the parietal lobe includes an extension of the postcentral gyrus, the posterior part of the cingulate gyrus and the precuneus.
Functional Areas:
(1) Primary Somatosensory Area - located on the postcentral gyrus.
(2) In the dominant hemisphere (usually the left) the lower part of the inferior parietal lobule is concerned with the perception and interpretation of language and forms part of the receptive speech (Wernicke's) area.
The Prefrontal Area is important in the control of certain aspects of behaviour such as judgement and foresight, and the determination of mood and levels of motivation.
Structures:
Amygdala
Dorsomedial Nucleus
Frontal Lobe
Hypothalamus
Inferior Frontal Gyrus
Middle Frontal Gyrus
Orbital Gyri
Premotor Area
Primary Motor Area
Superior Frontal Gyrus
Information:
The prefrontal area occupies the frontal lobe, anterior to the primary motor and premotor areas. It includes the orbital gyri and the anterior parts of the superior, middle and inferior frontal gyri. It is really a region of association cortex, which is strongly connected to all other areas of cortex as well as the dorsomedial nucleus of the thalamus, the hypothalamus and the amygdala. In humans it is particularly well-developed and plays an important role in certain aspects of behaviour such as judgement and foresight, the determination of mood and levels of motivation.
Damage to the prefrontal cortex produces profound changes in personality. In the 1940's and 50's the a psychosurgical procedure known as frontal leucotomy, which involved severing the subcortical connections of the prefrontal area, was commonly performed to treat psychiatric disorders characterised by anxiety, obsessions and delusions. These patients generally become docile and were unconcerned about previous anxieties, but they showed a loss of drive and motivation and lacked the ability to pursue long and complicated thoughts. The deficits resulting from such surgery were summarised by Tow (1955) as follows:
(i) marked decrease in ability to solve problems and think in abstract terms
(ii) reduced ability to look ahead and plan for the future
(iii) reduced imagination and creativity
(iv) modest reductions in intelligence and vocabulary.
Ref: Tow, P.M. (1955) "Personality Changes Following Frontal Leucotomy." Oxford Univ. Press.
Blume 2001
Prodrome: A preictal phenomenon. A subjective or objective clinical alteration (e.g., ill-localized sensation or agitation) that heralds the onset of an epileptic seizure but does not form part of it.
Noachter 1999
Premature Temporal Theta: Temporal sharp transients in preterm infants occurring in burst of 3-8 sharp, rhythmic waves at 4-8 Hz, often with high voltage (100-200 uV).
Synonym: Saw Toothed Bursts.
The Premotor Area is involved in the control of complex voluntary movements of the contralateral half of the body particularly those of the axial muscles.
Structures:
Brodmann’s Areas
Cortical Areas
Corticospinal Tract
Frontal Lobe
Middle Frontal Gyrus
Primary Motor Area
Superior Frontal Gyrus
Ventral Anterior Nucleus
Ventral Posterior Nucleus
Information:
The premotor area is located in the frontal lobe on the posterior part of the superior and middle frontal gyri. It is adjacent to the primary motor area and corresponds to Brodmann's area 6. Its major inputs come from the primary motor area and the motor (ventral anterior and ventral lateral) nuclei of the thalamus. Major outputs go to the primary motor area and the corticospinal tract.
Like the primary motor area, the premotor area is also topographically organised but it has a higher threshold (is less sensitive) to stimulation which results in contractions of muscle groups, rather than individual muscles.
The premotor area is known to be active just prior to and during a movement and is thought to be involved in some way in programming the activity of neurons in the primary motor area.
Damage to the premotor area results in apraxia, an inability to carry out complex voluntary movements eg. the patients can't dress themselves. The patient can't point to his/her nose voluntarily (if asked to do so) but can do so subconsciously, if, for example, the nose itches.
Engel 2001
Prenatal or perinatal ischemic or anoxic lesions or cerebral infections causing nonprogressive encephalopathies
The Primary Auditory Area of the cortex is involved in the discrimination of different pitches and patterns of sound.
Structures:
Auditory Radiation
Brodmann’s Areas
Cortical Areas
Lateral Fissure
Medial Geniculate Nucleus
Superior Temporal Gyrus
Transverse Temporal Gyrus
Information:
The Primary Auditory Area, which corresponds to Brodmann's area 41, is located on the transverse temporal gyri (of Heschl). These gyri are transversely oriented folds, located in the floor of the lateral fissure, extending inwards from the superior temporal gyrus.
The Primary Auditory Area receives its major input from the medial geniculate nucleus of the thalamus via the auditory radiation. These fibres terminate in layer 4 in a precise tonotopic manner such that sounds of specific frequencies are represented in specific parts of the auditory area, ie. it contains a map of all audible frequencies.
Damage to the primary auditory area of one hemisphere does not result in any significant hearing loss because sounds from each ear are represented bilaterally in the cortex. Bilateral damage does not cause an inability ot detect sound but it does cause in an inability to discriminate different pitches and patterns of sound.
The Primary Motor Area of the cortex, which occupies the Precentral Gyrus controls voluntary movements of the contralateral half of the body, particularly the distal parts of the limbs.
Structures:
Brodmann’s Areas
Cerebral Cortex
Cerebral Cortex - histology
Cortical Areas
Corticospinal Tract
Premotor Area
Primary Somatosensory Area
Ventral Anterior Nucleus
Ventral Horn
Ventral Lateral Nucleus
Information:
The Primary Motor Area of the cerebral cortex is located on the precentral gyrus and corresponds to Brodmann's area 4. The cortex of both primary and premotor areas is of the agranular type, being dominated by pyramidal cells (see Cerebral Cortex - Histology). The primary motor area is characterised by the presence of extremely large pyramidal cells in layer 5. Some of these cells reach100�m in diameter and are known as the giant cells of Betz.
The primary motor area receives inputs from the premotor and primary somatosensory areas of cortex as well as from the motor (ventral lateral and ventral anterior) nuclei of the thalamus.
The major output of the primary motor area is to the corticospinal tract which terminates in the ventral horn of the spinal cord and is particularly important in the control of non-stereotyped movements of the limbs, in particular movements of the hands and fingers.
The primary motor area is somatotopically organised with stimulation resulting in movements of discrete muscle groups in the contralateral half of the body, the muscle group being dependent on the specific location of the stimulus. The somatotopic map of the primary motor area is known as the motor homunculus. Like the sensory homunculus, the head is represented most laterally and the feet most medially. There is a disproportionately large representation of the muscles of the face and hands.
Movements can also be elicited by stimulation of the premotor area but the primary motor area has a lower threshold (ie. is more sensitive) to stimulation.
Damage to the primary motor area results initially in loss of voluntary movement of muscles in the contralateral half of the body (contralateral hemiplegia) but there is a partial recovery with time, so that there is only a weakness of movement (hemiparesis) in the distal muscles of the limbs (particularly those of the hands).
ILAE 1989
Primary reading epilepsy
All or almost all seizures in this syndrome are precipitated by reading (especially aloud) and are independent of the content of the text. They are simple partial motor-involving masticatory muscles, or visual, and if the stimulus is not interrupted, GTCs may occur. The syndrome may be inherited. Onset is typically in late puberty and the course is benign with little tendency to spontaneous seizures. Physical examination and imaging studies are normal but EEG shows spikes or spike-waves in the dominant parieto-temporal region. Generalized spike and wave may also occur.
Engel 2001
Primary Reading Epilepsy
The Primary Somatosensory Area, which occupies the Postcentral Gyrus, is essential for the precise localisation of somatosensory stimuli.
Structures:
Brodmann’s Areas
Cerebral Cortex - General
Cerebral Cortex - Histology
Cortical Areas
Corticospinal Tract
Lateral Fissure
Postcentral Gyrus
Primary Motor Area
Ventral Posterior Nucleus
Information:
The primary somatosensory area of the cerebral cortex occupies the postcentral gyrus and corresponds to Brodmann's areas 1, 2 and 3. Its receives inputs (concerning tactile and proprioceptive sensations in the contralateral half of the body) from the ventral posterior nucleus of the thalamus. These thalamocortical inputs terminate in layer 4 in a precise topographic manner. Those representing sensations from the face terminate most laterally (near the lateral fissure), and those representing the foot terminate most medially. Areas of the body in which tactile sensation is of particular importance have a disproportionately large representation in the somatosensory cortex, eg. the lips, tongue and hand. The resulting somewhat distorted topographic map is known as the sensory homunculus.
The somatosensory cortex also has strong interconnections with the primary motor area (area 4). It also gives rise to a significant number of the fibres in the corticospinal tract (up to 40%).
The primary somatosensory area is essential for the precise localisation of somatosensory stimuli in the contralateral half of the body. If it is damaged their may be some awareness of the stimulus (particularly pain and temperature) but the patient is unable to localise it, and sensations such as discriminative touch and conscious proprioception are completely lost (on the contralateral side).
Trancred 2005
The Primary Visual Area preprocesses from the visual fields of both eyes and is essential for the conscious perception of vision.
Structures:
Brodmann’s Areas
Calcarine Sulcus
Cortical Areas
Cranial Nerve Exam
Fovea
Lateral Geniculate Nucleus
Neocortex - Layer 4
Occipital Lobe
Optic n. (CN II)
Optic Radiation
Optic Tract
Posterior Cerebral a.
Retina
Sagittal - Thal./Midbrain
Visual Fields
Visual System
Information:
The Primary Visual Cortex surrounds the calcarine sulcus on the medial surface of the occipital lobe, most of it being buried within the sulcus. It corresponds to Brodmann's area 17 and is often referred to as the striate cortex because it contains a thin horizontal stripe of white matter (the stria of Gennari) which is visible with the naked eye. This line is visible in the primary visual area in the cross-section Sagittal - Thal./Midbrain.
The primary visual cortex receives its major inputs from the lateral geniculate nucleus
(LGN) of the thalamus via the optic radiation (geniculocalcarine tract). These fibers terminate in a topographic manner in layer 4. (The stria of Gennari is actually formed by the geniculocalcarine fibres passing through layer 4 en route to their sites of termination). The primary visual cortex of one hemisphere receives data (via the LGN) from the contralateral half of the visual field of both eyes. The fovea, the central region of the retina, has a disproportionately large representation in the posterior part of area 17, near the occipital pole. The upper half of the visual field is represented in the lower bank of the calcarine sulcus and the lower half of the visual field is represented in the upper bank.
Damage to the visual cortex (which is supplied by the posterior cerebral artery) results in loss of conscious awareness of vision in the contralateral half of the visual field, a condition described clinically as contralateral homonymous hemianopsia. Occasionally in lesions of the primary visual cortex the foveal region may be unaffected, a condition known as macular sparing.
Bancaud 1981
exceptionally, fragmentary, primitive, infantile, or antisocial behavior
Fischer 2014
In the absence of a seizure documented by video-EEG recording and typical for a person’s recurrent unprovoked seizures, there will be situations where a diagnosis of epilepsy remains uncertain. One approach to these ambiguities would be to define a condition called “probable (or possible) epilepsy.”VI Such an approach has been adopted with other diseases, such as multiple sclerosis with the McDonald criteria, amyotrophic lateral sclerosis with the El Escorial criteria, migraine, and vascular dementia. The ILAE Task Force recognized the subtle, but important, difference between telling a patient that “you have probable epilepsy” versus “you probably have epilepsy.” In the absence of secure information, the latter statement, or another statement simply expressing uncertainty, seemed a more straightforward assertion. Therefore, the Task Force has not defined probable epilepsy as a specific entity, but has left that possibility open for the future.
Blume 2001
Prodrome: A preictal phenomenon. A subjective or objective clinical alteration (e.g., ill-localized sensation or agitation) that heralds the onset of an epileptic seizure but does not form part of it.
Needs to be reviewed
Bancaud 1981
Prognosis
ILAE 1989
Prognosis
Excellent or good: Therapy Response (Controlled by treatment)
Poor: resistance to therapy, seizure intractability
Severe Course
Variable
Recurrence
Mental Deterioration (massively progressive, fast, slow)
Neuropsychologic Disorders
Spontaneous remission
Recovery
Survival (years)
Death
Engel 2001
Bengin epilepsy syndrome: A syndrome characterized by epileptic seizures that are easily treated, require no treatment, remit without sequelae
Prognostic
Blume 2003
"Growing out of it"
Fetal distress or death
Innocuous to fetus
During pregnancy (increase, decrease, unchanged)
Poor preconception seizure control predicts incomplete control in pregnancy
Uncontrolled (seniors): fall may fracture hip, create subdural hematomas, crush vertebra, back pain
SIGN 2006
Prognosis
SUDEP: sudden unexpected death in epilepsy due to underlying neurological impairment and less so underlying epilepsy, seizure-related accidents, status epileptics
Families should be advised if the child has an increased risk of SUDEP. They can be reassured if the risk is considered to be low
Engel 2006
The intention is that the seizure-type diagnosis will have implications with respect to etiology, approaches to diagnostic evaluation, treatment and prognosis.
progressive nature
Berg 2010:
Epileptic encephalopathy: the epileptic activity itself may contribute to severe cognitive and behavioral impairments above and beyond what might be expected from the underlying pathology alone and that these can worsen over time. They tend to be Pharmacoresistant.
"Pharmacoresponsive"=diagnosis of one of the syndromes allows, within a reasonable certainty, the prediction that the seizure will rapidly come under control with appropriate medication
"cause is no longer equated with prognosis"
poor prognosis
Diagnosis often has implications for treatment, management, prognosis
"self limited"
Scheuermann 2009
Progressive Disease Course: A disease course that
(a) does not terminate in a return to homeostasis and
(b) would, absent intervention, involve an increasing deviation from homeostasis
Example: malignant cancer
Engel 2001
PEHO syndrome
Engel 2001
Progressive Myoclonus Epilepsies
ILAE 2010
Progressive Myoclonus Epilepsies (PME)
In the context of explanation this is difficult
ILAE 1989
Prevention/prophylaxis
2003 Blume
Adequate nutrition
folic acid supplementation (4-5mg/d) in any sexually active woman of childbearing age
Quit smoking
alpha-fetoprotein screening, ultrasonography 16-18 weeks gestation
10-20 mg fit K PO in last month of pregnancy
2011
provide information needed for prevention
2014 Fischer
A practical definition allowing earlier diagnosis will be especially useful for prevention of unnecessary risks of physical injuries or social consequences resulting from recurrent seizures in patients deemed to be susceptible to a high risk for recurrence. The revised definition also provides an expanded opportunity for disease-modifying interventions that prevent the progression of epilepsy and onset of comorbidities.
Bancaud 1981
Disorder of prioprioception or spatial perception.
Engel 2001
Propionic acidemia
Engel 2001
Propioceptive
Conditions that elicit a seizure
Bancaud 1981
Blume 2001
Provocative Factor
Noun: Transient and sporadic endogenous or exogenous element capable of augmenting seizure incidence in persons with chronic epilepsy and evoking seizures in susceptible individuals without epilepsy.
Blume 2001
Proximal Limb: Signifies involvement from shoulders to wrist, hip to ankle.
Bancaud 1981
Dysphasic
Dysmnesic (e.g. deja-vu)
Cognitive (e.g. dreamy states, distortions of time sense)
Affective (e.g. fear, anger, etc.)
Illusions (e.g. macropsia)
Structured hallucinations (e.g., music, scenes)
Priopioception
Spatial perception
Vertigionous: falling in space, floating, rotatory vertigo in horizontal/vertical planes
Dysphasia?
Dysmnesic: distorted memory experience, distortion of time sense, dreamy state, flashback, sensation of deja vu or jamais vu, (Auditory: deja-entendu or jamais-entendu), forced thinking, panoramic vision
Cognitive disturbances: dreamy states, distortion of time sense, sensations of unreality, detachment, depersonalization
Affective(attacks for a few minutes, sudden onset, unprovoked, abates quickly): extreme pleasure or displeasure, fear/terror w/ running away & autonomic activity (pupil dilatation, pallor, flushing, piloerection, palpitation, hypertension), intense depression with feelings of unworthiness/rejection, anger/rage
Illusions: Altered perception of size or weight of a limb
Structured hallucinations: affect somatosensory, visual, auditory, olfactory, gustatory senses
Formed hallucinations: mobilized memory traces in the form of scenery, persons, spoken sentences, or music perceived in a normal or distorted way
ILAE 1989
Fear, panic
Changes in mood, affect
Forced thinking
Severe vertigo
Disorientation in space
Verbal auditory agnosia
Luders 1998
Psychic Aura
Psychic auras consist of complex hallucinations and illusions that usually affect different senses. The most typical examples are distortions of familiarity, such as sensations of déjà vu or jamais vu. Frequently these sensations may be associated with emotional alterations, such as fear. In addition, they may occur together with complex visual, auditory or other hallucinations and illusions, including visual hallucinations such as macropsia, micropsia, and so on.
Blume 2001
2.2.2 Experiential: Affective, mnemonic, or composite perceptual phenomena including illusory or composite hallucinatory events; these may appear alone or in combination. Included are feelings of depersonalization. These phenomena have subjective qualities similar to those experienced in life but are recognized by the subject as occurring outside of the actual context.
2.2.2.1 Affective: Components include fear, depression,joy, and (rarely) anger.
2.2.2.2 Mnemonic: Components that reflect octal dysmnesia such as feelings of familiarity (deja-vu) and unfamiliarity (jamais-vu)
2.2.2.3 Hallucinatory: A creation of composite perceptions without corresponding external stimuli involving visual, auditory, somatosensory, olfactory, and/or gustatory phenomena. Example: "hearing" and "seeing" people talking.
2.2.2.4 Illusory: An alteration of actual percepts involving the visual, auditory, somatosensory, olfactory, or gustatory systems.
2.3 Dyscognitive: The term describes events in which
(1) disturbance of cognition is the predominant or most apparent feature, and
(2a) two or more of the following components are involved, or
(2b) involvement of such components remains undetermined. Otherwise, use the more specific term (e.g., "mnemonic experiential seizure" or "hallucinatory experiential seizure").
Engel 2001
Experiential sensory symptoms (assoc w/ temporoparietoccipital junction)
Blume 2203
Cognitive and behavioral aspects
lost awareness
no talking
1 person restrain to prevent injury
Aurae include epigastric sensation, fear and various types of visual, olfactory, or auditory experiential phenomena
Cognition may be impaired during the seizure, manifesting as confusion, a receptive or expressive dysphasia, apraxia, distraction by an experiential phenomenon or amnesia. Thus, the term "dyscognitive" will replace "complex partial" for this seizure type.
Memory may be impaired
Luders 1998
Psychic Aura
Psychic auras consist of complex hallucinations and illusions that usually affect different senses. The most typical examples are distortions of familiarity, such as sensations of déjà vu or jamais vu. Frequently these sensations may be associated with emotional alterations, such as fear. In addition, they may occur together with complex visual, auditory or other hallucinations and illusions, including visual hallucinations such as macropsia, micropsia, and so on.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Bancaud 1981
With Psychic Symptoms that usually occur with impairment of consciousness.
Blume 2001
Psychosis: Misinterpretation of external world in an awake, alert person; involves thought disorder of emotion and socialization.
Bancaud 1981
Pupil dilation
ILAE 1989
Pyridoxine dependency is manifested by seizures that have no suggestive characteristics, but this condition must always be suspected since therapeutic intervention is possible.
Engel 2001
Pyridoxine dependency
Engel 2001
Pyruvate dehydrogenase deficiency
Noachter 1999
Quantity: Amount of EEG activity with respect to both number and amplitude of waves.
Noachter 1999
Quasiperiodic: Applies to EEG waves or complexes that occur at intervals and only approach regularity.
Noachter 1999
REM Atonia: Reduction of tonic muscle activity during REM sleep.
Noachter 1999
REM: Rapid eye movements.
Noachter 1999
REM Sleep: Sleep stage characterized by low amplitude mixed frequency EEG activity, episodic bursts of predominantly horizontal rapid eye movements (REM) and reduction of axial tonic muscle activity; frequently associated with dreams; phasic muscle activity, saw-tooth waves and changes in respiration may occur.
Synonym: paradoxical sleep, desynchronized sleep, dream sleep (use of terms discouraged) (see active sleep, non-REM sleep).
Bancaud 1981
Anger or rage is occassionally experienced, but unlike temper tantrums, epileptic anger is apparently unprovoked, and abates rapidly.
ILAE 1989
A Ramsay-Hunt-like syndrome can also be associated with a mitochondrial myopathy, with abnormalities of lactate and pyruvate metabolism (Fukuhara et al., 1980).
ILAE 1989
Dyssynergia cerebellaris myoclonia (DCM) with epilepsy (Ramsay-Hunt syndrome) appears between the ages of 6 and 20 years (mean 11 years) with myoclonias or GTCS. Above all, the myoclonic syndrome is characterized by action and intention myoclonus. The GTCS are rare and sensitive to therapy. Mental deterioration, when present, is slow. Most of the neurologic manifestations are limited to cerebellar signs. In the EEG, the background activity remains normal, with generalized paroxysmal abnormalities (spikes, spike-waves, and polyspike-waves), and photosensitivity. During REM sleep, rapid polyspikes appear, localized in the central and vertex regions.
Engel 2001
Rasmussen Syndrome
ILAE 1989
Rasmussen's Syndrome
Blume 2001
Reactive: Occurring in association with transient systemic perturbation such as intercurrent illness, sleep loss, or emotional stress.
reflex seizure provacateur not semiology
Engel 2001
Reading
Trancred 2005
The Receptive Speech (Wernicke’s) Area is involved in the comprehension of spoken and written language.
Structures:
Brodmann’s Areas
Middle Cerebral a.
Motor Speech (Broca's) Area
Planum Temporale
Superior Temporal Gyrus
Temporal Lobe
Information:
The receptive speech area (also known as Wernicke's area) is located in the temporal lobe of the dominant hemisphere, mainly on the planum temporale and superior temporal gyrus in Brodmann's areas 21 and 22. Clinical evidence indicates that it is involved in the comprehension of both spoken and written language. In patients with lesions in this area, spontaneous speech sounds fluent with good articulation but the patient uses inappropriate words in the wrong sequence. They are usually not aware of this disability because their ability to comprehend their own language, as well as that produced by others, is impaired. This condition, known commonly as Wernicke's aphasia, usually occurs as a result of occlusion or rupture of the middle cerebral artery or its branches.
Damage to both the receptive and motor speech areas results in a condition known as global aphasia in which both the production and comprehension of language is impaired.
Fischer 2014
Recurrence risk is a function of time, such that the longer the time since the last seizure, the lower the risk.
Otherwise, the Task Force did not agree on a specific interval of time between seizures that would “reset the clock” for counting an event as a second seizure. A rationale for setting such an interval might emerge from future research.
Recurrence risk depends on the type of epilepsy, age, syndrome, etiology, treatment, and many other factors.
The risk of seizure recurrence after unprovoked seizures diminishes with time, although the risk may never reach levels for normal individuals who have not had a prior seizure.Most relapses are early. After a single unprovoked seizure, 80%14,17 to 90%25 of those who had a second did so within 2 years. In one study,5 after a second unprovoked seizure, subsequent seizures occurred within 4 years, but none in the ensuing 3 years, suggesting that the risk may not be zero but is low. The National General Practice Study of Epilepsy in the United Kingdom14 identified a 3-year recurrence risk of 44% after a seizure-free period of 6 months, 32% after 12 months,and 17% after 18 months. No adequate data are available on seizure recurrence risk after being seizure-free and off medication for extended periods of time. Delayed relapses are rare after 5 years. By 10 years off antiseizure medicines, the annual risk for seizures probably is very low.
Bancaud 1981
Reflex Seizure
ILAE 1989
Reflex Epilepsy
Blume 2001
Reflex: Objectively and consistently demonstrated to be evoked by a specific afferent stimulus or by activity of the patient. Afferent stimuli can be elementary [i.e., unstructured (light flashes, startle, a monotone)] or elaborate [i.e., structured, (a symphony)]. Activity may be elementary [e.g., motor (a movement)]; or elaborate [e.g., cognitive function (reading, chess playing)], or both (reading aloud).
Engel 2001
Reflex Epilepsies
Reflex epilepsy syndrome: A syndrome in which all epileptic seizures are precipitated by sensory stimuli. Reflex seizures that occur in focal and generalized epilepsy syndromes that are also associated with spontaneous seizures are listed as seizure types. Isolated reflex seizures can also occur in situations that do not necessarily require a diagnosis of epilepsy. Seizures precipitated by other special circumstances, such as fever or alcohol withdrawal, are not reflex seizures (changed concept).
ILAE 2010
Reflex Epilepsy
Bancaud 1981
Sensory factors also known as Reflex Seizures
Blume 2001
Reflex: Objectively and consistently demonstrated to be evoked by a specific afferent stimulus or by activity of the patient. Afferent stimuli can be elementary [i.e., unstructured (light flashes, startle, a monotone)] or elaborate [i.e., structured, (a symphony)]. Activity may be elementary [e.g., motor (a movement)]; or elaborate [e.g., cognitive function (reading, chess playing)], or both (reading aloud).
Engel 2001
Precipitating stimuli for reflex seizures.
All seizures that have a provoking factor and that are placed in this category by convention as different from other 'provoked seizures' (e.g. fever, metabolic, etc)
I'm picking reflex seizure because it's been mentioned countless times in various places. Provoked seizure seems like a synonym but isn't directly equated: provoked seizure can be considered as being synonymous with a “reactive seizure” or an “acute symptomatic seizure.”
It seems like
Provoked Seizures
-Reflex Seizures
-? Seizures
-Concussion Seizures?
Blume 2001
Reflex: Objectively and consistently demonstrated to be evoked by a specific afferent stimulus or by activity of the patient. Afferent stimuli can be elementary [i.e., unstructured (light flashes, startle, a monotone)] or elaborate [i.e., structured, (a symphony)]. Activity may be elementary [e.g., motor (a movement)]; or elaborate [e.g., cognitive function (reading, chess playing)], or both (reading aloud).
Engel 2001
Reflex Seizures
Fischer 2014
Reflex seizure
The condition of recurrent reflex seizures, for instance in response to photic stimuli, represents provoked seizures that are defined as epilepsy. Even though the seizures are provoked, 8 the tendency to respond repeatedly to such stimuli with seizures meets the conceptual definition of epilepsy, in that reflex epilepsies are associated with an enduring abnormal predisposition to have such seizures.
Noachter 1999
Regional: EEG activity that is limited to a region of the scalp or recorded in 3 or more electrodes in intracranial recordings (see focal, multiregional).
Blume 2001
Regular: Consistentor predictable intervals between such events.
Bancaud 1981
Regular
Blume 2001
Regular: Consistentor predictable intervals between such events.
Noachter 1999
Regular: Applies to waves or complexes of approximately constant period and relatively uniform appearance.
not semiology
Bancaud 1981
Feelings of rejection
Better and now sick again
Poor prognosis and slow progression
Remit: someone gets better
Relapse: Get worse
Repeats
Bancaud 1981
Relaxation of the grip
Muscles relax
Sick and get better
Fischer 2014
Some authorities consider epilepsy to be present, but in remission, after 5 years of seizure freedom
Medical literature uses the term “remission” to imply an abeyance of a disease, but this term is not well-understood by the public, and remission does not convey absence of the disease.
Bancaud 1981
Repetitive
Fischer 2014
Epilepsy is considered to be resolved for individuals who either had an agedependent
epilepsy syndrome but are now past the applicable age or who have remained seizure-free for the last 10 years and off antiseizure medicines for at least the last 5 years.
“Resolved” is not necessarily identical to the conventional view of “remission or “cure.” Different practical definitions may be formed and used for various specific purposes. This revised definition of epilepsy brings the term in concordance with common use.
The Task Force therefore adopted the phrase “resolved.”III When epilepsy is resolved, it implies that the person no longer has epilepsy, although it does not guarantee that it will not return.
The Task Force chose to define epilepsy as being resolved for individuals who had an age-dependent epilepsy syndrome but are now past the applicable age or those who have remained seizure-free for the last 10 years, with no seizure medicines for the last 5 years.
Bancaud 1981
Stops the movements of respiration
Engel 2001
Respiratory chain defects
Bancaud 1981
Ability of the patient to carry out simple commands or willed movement
Retardation in Psychomotor Development = Intellectual disability + Motor Disability
Blume 2001
Retrograde Amnesia: Impaired ability to recall previously remembered material.
Engel 2001
Rett syndrome
ILAE 1989
Psychologic: behavioral, cognitive disturbance
Psychomotor disturbance
Noachter 1999
Rhythm: EEG activity consisting of waves of approximately constant period.
Noachter 1999
Rhythm of Alpha Frequency:
(1) In general: any rhythm in the alpha band.
(2) Specifically: term should be used to designate those activities in the alpha band which differ from the alpha rhythm as regards their topography and/or reactivity and do not have specific appellations (such as mu rhythm) (see alpha rhythm).
Bancaud 1981
Rhythmic
Noachter 1999
Rhythmic Temporal Theta Burst of Drowsiness: Characteristic burst of 4-7 Hz waves frequently notched by faster waves, occurring over the temporal regions of the head during drowsiness.
Synonym: psychomotor variant pattern (use discouraged).
Comment: this is a pattern of drowsiness that is of no clinical significance.
Luders 1998
Right
The terms left and right refer strictly to the somatotopic localization of the symptoms, not the brain region.
Luders 1998
Right hemispheric.
Certain signs may identify the hemisphere of origin of a seizure. These signs include dystonic posturing during a complex motor seizure, preservation of consciousness during an automotor seizure, ictal speech during an automotor seizure, postictal aphasia, and so on. The presence of any of these signs strongly suggests the hemisphere of origin of a seizure. This localizing information is included in the classification by using the modifiers “left or right hemispheric.” These modifiers can be used to describe the seizures marked by superscript b in Table 1. Example: A dialeptic seizure preceded by an abdominal aura and followed by post ictal aphasia should be classified (if the patient is left-hemisphere dominant for language) as abdominal aura → left hemispheric dialeptic seizure. An automotor seizure in which there is no loss of consciousness and which is associated with dystonic posturing of the left hand and arm should be classified as a right hemispheric automotor seizure.
Bancaud 1981
Rigid, violent muscular contraction
Engel 2001
Ring 20 chromosome
Blume 2001
Epigastric: Abdominal discomfort including nausea, emptiness, tightness, churning, butterflies, malaise, pain, and hunger; sensation may rise to chest or throat. Some phenomena may reflect ictal autonomic dysfunction.
ILAE 1989
Rolandic Partial Epilepsy
Bancaud 1981
Rotational Horizontal
Bancaud 1981
Rotational Vertical
Bancaud 1981
If spoken to, the patient may grunt or turn to the spoken voice and then touched or tickled may rub the site.
Bancaud 1981
Rushing Noises
Bancaud 1981
Saliva may froth from the mouth
Blume 2001
Gustatory: Taste sensations including acidic, bitter, salty, sweet, or metallic.
Bancaud 1981
Salty
Blume 2001
Gustatory: Taste sensations including acidic, bitter, salty, sweet, or metallic.
ILAE 1989
Tay-Sachs and Sandhoff disease present with acoustic startle or myoclonus in the first months of life, without EEG manifestations. In the second year, myoclonic jerks and erratic partial seizures occur, along with marked slowing of the background rhythms.
Engel 2001
Sanfilippo syndrome
ILAE 1989
Another type of metabolic error is early infantile type of ceroid-lipofuscinosis (Santuavori Haltia Hagberg disease). Massive myoclonus begins between the ages of 5 and 18 months, with a highly suggestive EEG pattern of vanishing EEG.
Noachter 1999
Saw Tooth Waves: Vertex negative 2-5 Hz waves occurring in series during REM sleep.
Noachter 1999
Saw Toothed Bursts: Temporal sharp transients in preterm infants occurring in burst of 3-8 sharp, rhythmic waves at 4-8 Hz, often with high voltage (100-200 uV).
Synonym: premature temporal theta.
Bancaud 1981
Scenes
Engel 2001
Schizencephalies
Blume 2001
Visual: Flashing or flickering lights, spots, simple patterns, scotomata, or amaurosis.
Bancaud 1981
Scratching
Noachter 1999
Secondary Bilateral Synchrony: Spreading of an initially/focal (regional) epileptiform discharge to become generalized.
Comment: secondary bilateral synchrony frequently occurs from midline frontal generators.
Gastaut 1970
Generalized secondarily
Noachter 1999
Generalization: Propagation of EEG activity from limited areas to all regions of the head.
Engel 2001
Secondarily Generalized Seizures
Expand for later
Blume 2001
The following terms are listed in the form (adjective, noun, verb) according to principal usage; as adjective unless specified.
1970 Gastaut
Clinical seizure type
How often a seizure occurs in a month or year
Is a or part of?
Blume 2001
Executive function: anticipation, selection, monitoring of consequences, and initiation of motor activity including praxis, speech
Need to review this with Buchhalter
Bancaud 1981
Semiology means description of the event
Translates to symptoms
This is the phenotype of the seizure
Engel 2001
The 1981 Classification of Epileptic Seizures also has been criticized because it is not purely semiologic; post hoc etiologic information and EEG data are often required to use it properly, and the dichotomy of “partial” versus “generalized” belies a need to avoid anatomic implications. The Task Force believes that a purely descriptive phenomenologic approach to defining ictal semiology has definite clinical value, and the new diagnostic scheme proposed here includes a modification of a previously proposed classification of ictal phenomenology, as an option that can be used in detail where appropriate.
Bancaud 1981
Distortions of the time sense
Blume 2001
Somatosensory: Tingling, numbness, electric-shock sensation, pain, sense of movement, or desire to move.
Bancaud 1981
Sensory factors also known as Reflex Seizures
Blume 2001
Reflex: Objectively and consistently demonstrated to be evoked by a specific afferent stimulus or by activity of the patient. Afferent stimuli can be elementary [i.e., unstructured (light flashes, startle, a monotone)] or elaborate [i.e., structured, (a symphony)]. Activity may be elementary [e.g., motor (a movement)]; or elaborate [e.g., cognitive function (reading, chess playing)], or both (reading aloud).
Luders 1998
Seizures affecting the sensorial sphere exclusively produce no objective signs other than an occasional altered behavior by the patient to an “unexpected” experience. We are aware of their occurrence only if the patient tells us of the sensorial experience. We identify these seizures as auras in good agreement with classical terminology.
Trancred 2005
The Septal Area is associated with both the olfactory and limbic systems. When stimulated it results in intense feelings of pleasure.
Structures:
Amygdala
Cerebrum
Corpus Callosum
Fornix
Hippocampus
Hypothalamus
Interpeduncular Nucleus
Lamina Terminalis
Limbic System
Medial Forebrain Bundle
Reticular Formation
Septum Pellucidum
Stria Medullaris Thalami
Stria Terminalis
Information:
The Septal Area is located on the medial surface of the cerebrum, ventral to the rostrum of the corpus callosum and anterior to lamina terminalis. It is formed primarily by the subcallosal gyrus together with a few cells which extend onto the septum pellucidum.
The septal area is primarily associated with the limbic system, not the olfactory system as was previously thought.
Afferent Connections:
It receives afferents from the amygdala (via stria terminalis), hippocampus (via the fornix) and the reticular formation of the brainstem (via the medial forebrain bundle).
Efferent Connections:
The largest efferent projection from the septal area is the stria medullaris thalami which terminates in the habenula. The habenula projects to the interpeduncluar nucleus which in turn projects to the autonomic nuclei of the brainstem. The septal area also sends a cholinergic projection to the hippocampus via the fornix. Other efferents from the septal area form the medial forebrain bundle which projects to the hypothalamus and reticular formation of the brainstem.
Function:
The septal area is the main pleasure and reward centre of the brain. Stimulation of the septal area in humans leads to intense feelings of pleasure. Experiments in rats have demonstrated its importance as a reward centre - they will self stimulate the septal area to the exclusion of all other activities, even eating (they will even starve themselves to death). Abalation of the septal area has the opposite effect, extreme dispeasure, sometimes called "septal rage".
Tancred 2005
The Septum Pellucidum is thin sheet of tissue which extends between the corpus callosum and the fornix, forming a partition between the two lateral ventricles. It is composed of two layers of ependymal tissue between which there are scattered groups of neurons.
The Septum Pellucidum forms a partition between the two lateral ventricles. it is made up of ependyma and a few scattered groups of neurons, which are associated with the limbic system.
ILAE 1989
Severe myoclonic epilepsy in infancy
Severe myoclonic epilepsy in infancy is a recently defined syndrome. The characteristics include a family history of epilepsy or febrile convulsions, normal development before onset, seizures beginning during the first year of life in the form of generalized or unilateral febrile clonic seizures, secondary appearance of myoclonic jerks, and often partial seizures. EEGs show generalized spike-waves and polyspike-waves, early photosensitivity, and focal abnormalities. Psychomotor development is retarded from the second year of life on, and ataxia, pyramidal signs, and interictal myoclonus appear. This type of epilepsy is very resistant to all forms of treatment.
Blume 2001
Severity: A multicomponent assessment of a seizure by observers and the patient.
Components primarily of observer assessment include duration, extent of motor involvement, impairment of cognitive interaction with environment intra-ictally, maximal number of seizures per unit of time.
Components primarily of patient assessment: extent of injury; emotional, social, and vocational consequences of the attack.
By most appropriate genetic designation (e.g. XX, XY, etc).
Bancaud 1981
Sharp and Slow Wave
Noachter 1999
Sharp Wave: A transient, clearly distinguished from background activity, with pointed peak at a conventional paper speed or time scale and duration of 70-200 ms, i.e. over 1/4-1/5 s approximately. Main component is generally negative relative to other areas. Amplitude varies.
Comments:
(1) term should be restricted to epileptiform discharges and does not apply to
(a) distinctive physiologic events such as vertex sharp transients, lambda waves and positive occipital sharp transients of sleep,
(b) sharp transients poorly distinguished from background activity and sharp-appearing individual waves of EEG rhythms.
(2) Sharp waves should be differentiated from spikes, i.e. transients having similar characteristics but shorter duration. However, it should be kept in mind that this distinction is largely arbitrary and primarily serves descriptive purposes. As a rule, in ink-written EEG records taken at 3 cm/s, sharp waves occupy more than 2 mm of paper width and spikes 2 mm or less (see spike).
Noachter 1999
Sharp and Slow Wave Complex: A sequence of a sharp wave and a slow wave.
Comment: hyphenation facilitates use of term in plural form: sharp-and-slow-wave complexes or sharp-and-slow-waves.
Bancaud 1981
Short
Engel 2001
Sialidosis
The clinical picture for the cherry red spot myoclonus syndrome (sialidosis with isolated deficit in neuraminidase) is very similar to that of the Ramsay-Hunt syndrome, with myoclonus, photosensitivity, and cerebellar syndrome. Other characteristics include the nearly constant existence of amblyopia and presence of a cherry red spot on fundoscopic examination. The EEG is similar to that of DCM with the following specific features: The polyspike-wave discharges always correspond to a massive myoclonus and there is no photosensitivity
Bancaud 1981
side effects of medications
Luders 1998
Simple Motor Seizure
Location: Left/right/axial/generalized/bilateral asymmetric
Simple motor seizures in which the motor movements are relatively “simple,” unnatural, and consist of movements similar to movements elicited by electrical stimulation of the primary motor areas (Brodmann areas 4 and 6)
Blume 2001
Elementary Motor: A single type of contraction of a muscle or group of muscles that is usually stereotyped and not decomposable into phases. (However, see tonic–clonic, an elementary motor sequence).
Luders 1998
Simple Motor Seizure
Location: Left/right/axial/generalized/bilateral asymmetric
Simple motor seizures in which the motor movements are relatively “simple,” unnatural, and consist of movements similar to movements elicited by electrical stimulation of the primary motor areas (Brodmann areas 4 and 6)
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Bancaud 1981
Clinical Seizure Type
Consciousness is not impaired during the attack
EEG Seizure Type
Local contralateral discharge starting over the corresponding area of cortical representation (not always recorded on the scalp)
EEG Interictal Expression
Local contralateral discharge
Blume 2001
Visual: Flashing or flickering lights, spots, simple patterns, scotomata, or amaurosis.
Noachter 1999
Simultaneous: Occurring at the same time. Synonym: synchronous.
Noachter 1999
Sine Wave: Wave having the form of a sine curve.
Bancaud 1981
Single
Wolf 2006
Blume 2001
Auditory: Buzzing, drumming sounds or single tones.
Noachter 1999
Sinusoidal: Term applies to EEG waves resembling sine waves
Noachter 1999
Six Hz Spike and Slow Wave: Spike-and-slow-wave complexes at 4-7 Hz, but mostly at 6 Hz occurring generally in brief bursts bilaterally and synchronously, symmetrically or asymmetrically, and either confined to or of larger amplitude over the posterior or anterior regions of the head. Amplitude varies but is generally smaller than that of spike-and-slow-wave complexes repeating at slower rates.
Comment: this pattern is of little clinical significance and should be distinguished from epileptiform discharges.
Bancaud 1981
Illusion: These take the form of distorted perceptions in which objects may appear deformed.
Polyoptic illusions such as monocular diplopia, distortions of size (macropsia or micropsia) or of distance may occur. Similarly, distortions of sound, including microacusia and macroacusia, may be experienced. Depersonalization, as if the person were outside his body, may occur. Altered perception of size or weight of a limb may be noted.
Noachter 1999
Sleep Onset REM: the occurrence of REM less than 15 min after falling asleep.
Noachter 1999
Sleep Spindle: Burst at 11-15 Hz but mostly at 12-14 Hz generally diffuse but of higher voltage over the central regions of the head, occurring during sleep. Amplitude varies but is mostly below 50 pV in the adult.
Synonym: sigma rhythm (use discouraged).
Noachter 1999
Sleep Stages: Distinctive phases of sleep best demonstrated by polygraphic recordings of the EEG and other variables, including at least eye movements and activity of certain voluntary muscles.
Comment: classified by various systems (Dement and Kleitman 1957; Rechtschaffen and Kales 1968).
Bancaud 1981
Sleep Wake Cycle
Noachter 1999
Slow Activity: Activity of frequency lower than alpha, i.e. theta and delta activities.
Noachter 1999
Slow Alpha Variant Rhythms: Characteristic rhythms mostly at 4-5 Hz, recorded most prominently over the posterior regions of the head. Generally alternate, or are intermixed, with alpha rhythm to which they often are harmonically related. Amplitude varies but is frequently close to 50 uV. Blocked or attenuated by attention, especially visual, and mental effort.
Comment: slow alpha variant rhythms should be distinguished from posterior slow waves characteristic of children and adolescents and occasionally seen in young adults.
Bancaud 1981
Slow Wave
Spike and Slow Wave Complex
Noachter 1999
Slow Wave: Wave with duration longer than alpha waves, i.e. over 1/8 s.
Bancaud 1981
Slumping of the trunk
Noachter 1999
Small Sharp Spikes:
Abbreviation: SSS. Synonym for benign epileptiform transients of sleep (BETS) (preferred term).
Noachter 1999
Benign epileptiform transient of sleep (BETS): Small sharp spikes (SSS) of very short duration and low amplitude, often followed by a small theta wave, occurring in the temporal regions during drowsiness and light sleep. This pattern is of little clinical significance (see small sharp spikes).
Engel 2001
Somatosensory
Bancaud 1981
pins-and needles or feeling of numbness
Tingling
ILAE 1989
Negative: Numbness, absent body part, asomatognosia
Positive: tingling, feeling of electricity, crawling, coldness
Pain (superficial burning dysesthesia, vague, severe)
Luders 1998
Somatosensory Aura
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Somatosensory auras consist of abnormal somatosensory sensations (‘‘paresthesias”) that are limited to a clearly defined somatosensory region of the body. Sensations that are poorly localized or consist of vague sensations should be classified as unclassifiable auras (just ‘‘auras”).
Blume 2001
2.2 Sensory: A perceptual experience not caused by appropriate stimuli in the external world. Modifies "seizure" or "aura."
2.2.1.1 Somatosensory: Tingling, numbness, electric-shock sensation, pain, sense of movement, or desire to move.
2.2.1.7 Cephalic: Sensation in the head such as light-headedness, tingling or headache.
Luders 1998
Somatosensory Aura
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Somatosensory auras consist of abnormal somatosensory sensations (‘‘paresthesias”) that are limited to a clearly defined somatosensory region of the body. Sensations that are poorly localized or consist of vague sensations should be classified as unclassifiable auras (just ‘‘auras”).
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Bancaud 1981
Somatosensory Symptom
Bancaud 1981
Somatosensory hallucination
Bancaud 1981
Drowsiness or somnolence implies a sleep state from which the patient can be aroused to make appropriate motor and verbal responses.
Bancaud 1981
Sore all over
Bancaud 1981
Illusion: These take the form of distorted perceptions in which objects may appear deformed.
Polyoptic illusions such as monocular diplopia, distortions of size (macropsia or micropsia) or of distance may occur. Similarly, distortions of sound, including microacusia and macroacusia, may be experienced. Depersonalization, as if the person were outside his body, may occur. Altered perception of size or weight of a limb may be noted.
Blume 2001
Gustatory: Taste sensations including acidic, bitter, salty, sweet, or metallic.
Bancaud 1981
Sour
Blume 2001
Gustatory: Taste sensations including acidic, bitter, salty, sweet, or metallic.
Blume 2001
Executive function: anticipation, selection, monitoring of consequences, and initiation of motor activity including praxis, speech
Bancaud 1981
Speech Arrest
ILAE 1989
The juvenile form of ceroid-lipofuscinosis (Spiel-meyer-Vogt-Sjogren disease) is characterized by onset between the ages of 6 and 8 years, a decrease in visual acuity, slowing of psychomotor development, and appearance of cerebellar and extrapyramidal signs. After 1 4 years, GTCS and fragmentary, segmental, and massive myoclonus occur. The EEG shows bursts of slow waves and slow spikes and waves.
Noachter 1999
Spike and Slow Wave Complex: A pattern consisting of a spike followed by a slow wave.
Comment: hyphenation facilitates use of term in plural form: spike-and-slow-wave complexes.
Rapid sharply contoured waveform followed by a slow wave form
1981 Bancaud
Spike Wave
Spike-and-Slow-Wave Complex
Spike and Wave
Noachter 1999
Spike: A transient, clearly distinguished from background activity, with pointed peak at a conventional paper speed or time scale and a duration from 20 to under 70 ms, i.e. 1/50-1/15s, approximately. Main component is generally negative relative to other areas. Amplitude varies.
Comments:
(1) term should be restricted to epileptiform discharges. EEG spikes should be differentiated from sharp waves, i.e. transients having similar characteristics but longer durations. However, it should be kept in mind that this distinction is largely arbitrary and primarily serves descriptive purposes. Generally, in ink-written EEG records taken at 3 cm/s, spikes occupy 2 mm or less of paper width and sharp waves more than 2 mm.
(2) EEG spikes should be clearly distinguished from the brief unit spikes recorded from single cells with microelectrode techniques (see sharp wave).
Bancaud 1981
With more eleborate seizures involving visual or auditory association areas with participation of mobilized memory traces, formed hallucinations occur and these may take the form of scenery, persons, spoken sentences, or music. The character of these percpetions may be normal or distorted.
Blume 2001
Spontaneous: Stereotyped, involve only self, virtually independent of environmental influences.
Blume 2001
Visual: Flashing or flickering lights, spots, simple patterns, scotomata, or amaurosis.
Noachter 1999
Spread: Propagation of EEG waves from one region of the scalp and/or brain to another (see generalization).
Engel 2001
Startle
Engel 2001
Startle Epilepsy
Blume 2001
State Dependent: Occurring exclusively or primarily in the various stages of drowsiness, sleep, or arousal.
Bancaud 1981
The patient in confusion makes inappropriate responses to his environment and is disoriented as regards place or time or person.'
Luders 1998
Seizures that interfere primarily with consciousness have been identified by different terms, according to the EEG correlate or to the epileptic syndrome that produces the alteration of consciousness.
For example, an episode of altered consciousness associated with generalized 3- Hz, spike-and-wave EEG activity is identified as an absence seizure, whereas if it is associated with a focal epileptiform discharge or occurs in a patient with a focal epileptic syndrome (even in the absence of a local epileptiform correlate), it is identified as a complex partial seizure. To avoid confusion between terms that identify electroclinical complexes (absence seizure and complex partial seizure) and terms that identify pure ictal signs and symptoms, we coined the term dialeptic seizures for ictal episodes in which the main manifestation is an alteration of consciousness. The term dialeptic derives from the Greek word “dialeipein,” which means “to stand still,” “to interrupt,” or “to pass out.” Other expressions such as ‘‘vacant seizures” or “psychoparetic seizures” were also considered, but we believe that a completely new term has advantages when one is trying to define a new concept, i.e., episodes of alteration of awareness that are independent of the associated ictal or interictal EEG changes. Although no consensus was reached between the authors, we tentatively use the term dialeptic seizures herein.
Is a large class of Ictal Discharges b/c there can be many different kinds of EEG patterns with status epilepticus
Bancaud 1981
A prolonged or repetitive seizure
Noachter 1999
Status epilepticus, EEG: The occurrence of virtually continuous or repetitive seizure activity in an EEG. Term should be distinguished from clinical status epilepticus.
Bancaud 1981
Status epilepticus: prolonged or repetitive seizures
Used whenever a seizure persists for a sufficient length of time or is repeated frequently enough that recovery between attacks does not occur
Luders 1998
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Engel 2001 Continuous Seizure Types
Bancaud 1981
Feeling Stiff
Bancaud 1981
Stridor
Fischer 2014
patients with a single seizure occurring at least a month after a stroke
Bancaud 1981
ILAE 1989
Luders 1998
Engel 2001 & 2006
Berg 2010
Bancaud 1981
In stupor, the patient may make some spontaneous movement and can be aroused by painful or other vigorously applied stimuli to make avoidance movements.
ILAE 1989
The individual phacomatoses have no typical electroclinical pattern. We emphasize that West syndrome is frequent in tuberous sclerosis, and that generalized and partial seizures may follow the otherwise typical course of infantile spasms. Sturge-Weber syndrome is a frequent cause of simple partial seizures followed by hemiparesis.
Engel 2001
Sturge-Weber syndrome
Noachter 1999
Subclinical Rhythmic Discharges of Adults SREDA: This is a rhythmic pattern seen in the adult age group which consists of a mixture of frequencies, often predominant in the theta range. It may resemble a seizure discharge but is not accompanied by any clinical signs or symptoms. The significance of this pattern is uncertain, but it should be distinguished from an epileptic seizure pattern.
Engel 2001
Subcortical band heterotopia
Engel 2001
Alcohol and drug abuse
Bancaud 1981
Sudden
Engel 2001
Sulphite-Oxidase Deficiency
Trancred 2005
The Superior Frontal Gyrus includes parts of the premotor area (control of complex voluntary movements) and prefrontal area (judgement, foresight, mood and levels of motivation).
Structures:
Central Sulcus
Cerebral Hemisphere
Cingulate Gyrus
Corpus Callosum
Gyrus Rectus
Inferior Frontal Gyrus
Inferior Frontal Sulcus
Lateral Fissure
Limbic Area
Middle Frontal Gyrus
Motor Speech (Broca's) Area
Olfactory Sulcus
Olfactory Tract
Orbital Gyri
Pars Opercularis (Inf. Fr. G.)
Pars Orbitalis (Inf. Fr. G.)
Pars Triangularis (Inf. Fr. G.)
Precentral Gyrus
Precentral Sulcus
Prefrontal Area
Premotor Area
Primary Motor Area
Superior Frontal Gyrus
Superior Frontal Sulcus
Triangular Sulcus
Information:
The frontal lobe occupies the anterior part of the cerebral hemisphere.
Boundaries:
On the lateral surface it extends from the frontal pole posteriorly to the central sulcus and is bounded inferiorly by the lateral fissure. On the medial surface it extends posteriorly to an imaginary line from the central sulcus to the corpus callosum.
Sulci and Gyri:
The superolateral surface of the frontal lobe is formed by the superior, middle and inferior frontal gyri which extend in an anteroposterior direction and the precentral gyrus which extends vertically downwards. The superior and inferior frontal gyri are separated by the superior frontal sulcus and the middle and inferior gyri are separated by the inferior frontal sulcus. The precentral sulcus separates the precentral gyrus from the frontal gyri.
The inferior frontal gyrus is divided from anterior to posterior into the pars orbitalis, pars triangularis and pars opercularis by the triangular sulcus. The superior frontal gyrus extends onto the medial surface as far as the cingulate gyrus, the anterior part of which is also included in the frontal lobe.
The inferior surface of the frontal lobe is formed by the orbital gyri, which overlie the bony roof of the orbit and gyrus rectus (most medially). The orbital gyri and gyrus rectus are separated by the olfactory sulcus, which contains the olfactory tract.
Functional Areas:
The frontal lobe includes a number of important functional areas:
(1) Primary motor area - located on the precentral gyrus.
(2) Premotor area - located on the anterior part of the precentral gyrus and the adjacent parts of the superior and middle frontal gyri.
(3) Prefrontal area - which includes the remainder of the superior and middle frontal gyri, the orbital part of the inferior frontal gyrus and the orbital gyri.
(4) Motor Speech (Broca's) Area - located on the triangular and opercular parts of the inferior frontal gyrus.
(5) Limbic Area - located on the cingulate gyrus.
Trancred 2005
The Superior Frontal Sulcus separates the superior and the middle frontal gyri.
Structures:
Central Sulcus
Cerebral Hemisphere
Cingulate Gyrus
Corpus Callosum
Gyrus Rectus
Inferior Frontal Gyrus
Inferior Frontal Sulcus
Lateral Fissure
Limbic Area
Middle Frontal Gyrus
Motor Speech (Broca's) Area
Olfactory Sulcus
Olfactory Tract
Orbital Gyri
Pars Opercularis (Inf. Fr. G.)
Pars Orbitalis (Inf. Fr. G.)
Pars Triangularis (Inf. Fr. G.)
Precentral Gyrus
Precentral Sulcus
Prefrontal Area
Premotor Area
Primary Motor Area
Superior Frontal Gyrus
Superior Frontal Sulcus
Triangular Sulcus
Information:
The frontal lobe occupies the anterior part of the cerebral hemisphere.
Boundaries:
On the lateral surface it extends from the frontal pole posteriorly to the central sulcus and is bounded inferiorly by the lateral fissure. On the medial surface it extends posteriorly to an imaginary line from the central sulcus to the corpus callosum.
Sulci and Gyri:
The superolateral surface of the frontal lobe is formed by the superior, middle and inferior frontal gyri which extend in an anteroposterior direction and the precentral gyrus which extends vertically downwards. The superior and inferior frontal gyri are separated by the superior frontal sulcus and the middle and inferior gyri are separated by the inferior frontal sulcus. The precentral sulcus separates the precentral gyrus from the frontal gyri.
The inferior frontal gyrus is divided from anterior to posterior into the pars orbitalis, pars triangularis and pars opercularis by the triangular sulcus. The superior frontal gyrus extends onto the medial surface as far as the cingulate gyrus, the anterior part of which is also included in the frontal lobe.
The inferior surface of the frontal lobe is formed by the orbital gyri, which overlie the bony roof of the orbit and gyrus rectus (most medially). The orbital gyri and gyrus rectus are separated by the olfactory sulcus, which contains the olfactory tract.
Functional Areas:
The frontal lobe includes a number of important functional areas:
(1) Primary motor area - located on the precentral gyrus.
(2) Premotor area - located on the anterior part of the precentral gyrus and the adjacent parts of the superior and middle frontal gyri.
(3) Prefrontal area - which includes the remainder of the superior and middle frontal gyri, the orbital part of the inferior frontal gyrus and the orbital gyri.
(4) Motor Speech (Broca's) Area - located on the triangular and opercular parts of the inferior frontal gyrus.
(5) Limbic Area - located on the cingulate gyrus
Trancred 2005
The Superior Parietal Lobule plays an important role in the interpretation of somatosensory information, and in the integration of somatosensory and visual information.
Structures:
Angular Gyrus
Calcarine Sulcus
Central Sulcus
Cerebral Hemisphere
Cingulate Gyrus
Corpus Callosum
Frontal Lobe
Inferior Parietal Lobule
Intraparietal Sulcus
Lateral Fissure
Occipital Lobe
Parieto-occipital Sulcus
Postcentral Gyrus
Postcentral Sulcus
Precuneus
Primary Somatosensory Area
Receptive Speech Area
Superior Parietal Lobule
Superior Temporal Sulcus
Supramarginal Gyrus
Information:
The Parietal Lobe is located on the medial and lateral surfaces of the cerebral hemisphere between the frontal and occipital lobes.
Boundaries:
On the lateral surface it extends from the central sulcus anteriorly to an imaginary line drawn downwards from the parieto-occipital sulcus to the preoccipital notch. Inferiorly it is bounded by the lateral fissure and a horizontal line drawn from the lateral fissure to the imaginary line previously described.
On the medial surface it is bounded by the frontal lobe anteriorly, the parieto-occipital fissure posteriorly and the corpus callosum and calcarine sulcus inferiorly.
Gyri and Sulci:
On the lateral surface the parietal lobe is formed by the postcentral gyrus and the superior and inferior parietal lobules. The postcentral gyrus is separated from the two parietal lobules by the postcentral sulcus, which is parallel to the central sulcus. The superior and inferior parietal lobules are separated from each other by the intraparietal sulcus.
The inferior parietal lobule includes the supramarginal and angular gyri. The supramarginal gyrus hooks around the posterior surface of the lateral fissure and the angular gyrus hooks around the posterior end of the superior temporal sulcus.
The medial surface of the parietal lobe includes an extension of the postcentral gyrus, the posterior part of the cingulate gyrus and the precuneus.
Functional Areas:
(1) Primary Somatosensory Area - located on the postcentral gyrus.
(2) In the dominant hemisphere (usually the left) the lower part of the inferior parietal lobule is concerned with the perception and interpretation of language and forms part of the receptive speech (Wernicke's) area.
Trancred 2005
The Superior Temporal Gyrus contains the auditory (primary and association) areas of the cortex, which are involved in the interpretation of sounds.
Structures:
Collateral Sulcus
Corpus Callosum
Hippocampal Gyrus
Inferior Temporal Gyrus
Inferior Temporal Sulcus
Lateral Fissure
Lateral Ventricle
Middle Temporal Gyrus
Occipitotemporal Gyrus
Parahippocampal Gyrus
Parieto-occipital Sulcus
Primary Auditory Area
Primary Olfactory Area
Superior Temporal Gyrus
Superior Temporal Sulcus
Transverse Temporal Gyrus
Uncus
Information:
Boundaries:
On the lateral surface the temporal lobe is bounded posteriorly by the imaginary line extending downwards from the parieto-occipital sulcus to the preoccipital notch. It is bounded superiorly by the lateral fissure and a horizontal line extending from the lateral fissure to meet the imaginary line just described.
On the medial surface it is bounded posteriorly by a line extending from the splenium of the corpus callosum to the preoccipital notch.
Gyri and Sulci:
The lateral surface of the temporal lobe is formed by the superior, middle and inferior temporal gyri, which are separated from each other by the superior and inferior temporal sulci. The superior surface of the superior temporal gyrus, which forms the floor of the lateral fissure, is thrown into several transversely oriented folds, which are called the transverse temporal gyri (of Heschl).
The inferomedial surface of the temporal lobe is formed by (from medial to lateral) the parahippocampal gyrus, the occipitotemporal gyrus and the inferior temporal gyrus. The occipitotemporal gyrus is separated from the parahippocampal gyrus by the collateral sulcus and from the inferior temporal gyrus by the occipitotemporal sulcus. The rostral part of the parahippocampal gyrus hooks backward to form a bump on its medial surface called the uncus. Above the parahippocampal gyrus (not visible from the inferior surface) is the hippocampal gyrus, which actually forms the medial wall of the inferior (temporal) horn of the lateral ventricle.
Specific Functional Areas:
(1) Primary Auditory Area - located on the transverse temporal gyri.
(2) Primary Olfactory Area - located on the uncus.
Trancred 2005
The Supplementary Motor Area is involved in the control of movement and is particularly important in the initiation of movement.
Structures:
Basal Ganglia
Brainstem
Cerebellum
Corticobulbar Tract
Corticospinal Tract
Paracentral Lobule
Prefrontal Area
Premotor Area
Premotor Area
Reticulospinal Tracts
Rubrospinal Tract
Spinal Cord
Supplementary Motor Area
Ventral Anterior Nucleus
Ventral Posterior Nucleus
Vestibulospinal Tract
Information:
The motor system allows us to move the body and limbs and to maintain our posture and position in space. The control of movement involves continuous sensory input from proprioceptors and external stimuli. The activity of motor neurons is controlled at several levels in the CNS and is therefore said to be organised hierarchically. Automatic responses are organised at the level of the spinal cord whereas more complex responses are organised by successively higher centres.
There are four levels of control in the motor system:
(i) Spinal Cord - connections in the spinal cord control automatic and stereotyped responses to stimuli, both simple (eg. stretch reflex) and more complex (alternate flexor/extensor activity during locomotion).
(ii) Brainstem - tracts originating in the brainstem (such as the reticulospinal, vestibulospinal , rubrospinal tracts) are involved primarily in the stabilisation of posture and the maintenance of balance and correct muscle tone.
(iii) Primary Motor Area of cortex - issues commands for voluntary movements via the corticospinal and corticobulbar tracts.
(iv) Higher motor (premotor and supplementary motor) areas:
Premotor Area of cortex - involved in more complex aspects of movement. Through extensive connections with prefrontal and posterior parietal areas of the cortex, the premotor area is involved in identifying a target in space, choosing the right course of action and programming the movement. It influences the activity of the primary motor area of the cortex as well as providing direct input to the corticospinal and corticobulbar tracts.
Supplementary Motor Area - an extension of the premotor area onto the medial surface of the hemisphere, anterior to the paracentral lobule. It receives strong inputs from the basal ganglia and is known to play a role in the initiation of movements and is always active during speech.
The activity of both the primary and premotor areas is modulated by inputs from the cerebellum and basal ganglia via the motor nuclei of the thalamus (ventral anterior and ventral lateral nuclei).
ILAE 1989
Supplementary motor seizures. In supplementary motor seizures, the seizure patterns are postural, focal tonic, with vocalization, speech arrest, and fencing postures.
Noachter 1999
Suppression: EEG records showing activity below 10 /uV (reference derivation) are termed background suppression (see burst suppression pattern).
Trancred 2005
The Supramarginal Gyrus, part of the receptive speech area which is involved in the perception and interpretation of language.
Structures:
Angular Gyrus
Calcarine Sulcus
Central Sulcus
Cerebral Hemisphere
Cingulate Gyrus
Corpus Callosum
Frontal Lobe
Inferior Parietal Lobule
Intraparietal Sulcus
Lateral Fissure
Occipital Lobe
Parieto-occipital Sulcus
Postcentral Gyrus
Postcentral Sulcus
Precuneus
Primary Somatosensory Area
Receptive Speech Area
Superior Parietal Lobule
Superior Temporal Sulcus
Supramarginal Gyrus
Information:
The Parietal Lobe is located on the medial and lateral surfaces of the cerebral hemisphere between the frontal and occipital lobes.
Boundaries:
On the lateral surface it extends from the central sulcus anteriorly to an imaginary line drawn downwards from the parieto-occipital sulcus to the preoccipital notch. Inferiorly it is bounded by the lateral fissure and a horizontal line drawn from the lateral fissure to the imaginary line previously described.
On the medial surface it is bounded by the frontal lobe anteriorly, the parieto-occipital fissure posteriorly and the corpus callosum and calcarine sulcus inferiorly.
Gyri and Sulci:
On the lateral surface the parietal lobe is formed by the postcentral gyrus and the superior and inferior parietal lobules. The postcentral gyrus is separated from the two parietal lobules by the postcentral sulcus, which is parallel to the central sulcus. The superior and inferior parietal lobules are separated from each other by the intraparietal sulcus.
The inferior parietal lobule includes the supramarginal and angular gyri. The supramarginal gyrus hooks around the posterior surface of the lateral fissure and the angular gyrus hooks around the posterior end of the superior temporal sulcus.
The medial surface of the parietal lobe includes an extension of the postcentral gyrus, the posterior part of the cingulate gyrus and the precuneus.
Functional Areas:
(1) Primary Somatosensory Area - located on the postcentral gyrus.
(2) In the dominant hemisphere (usually the left) the lower part of the inferior parietal lobule is concerned with the perception and interpretation of language and forms part of the receptive speech (Wernicke's) area.
0Hz
Bancaud 1981
Swallowing
Bancaud 1981
Sweating
Blume 2001
Gustatory: Taste sensations including acidic, bitter, salty, sweet, or metallic.
Bancaud 1981
Sweet
Blume 2001
Gustatory: Taste sensations including acidic, bitter, salty, sweet, or metallic.
Bancaud 1981
Bancaud 1981
Symmetrical
Blume 2001
Symmetrical: Virtual bilateral equality in these respects.
Noachter 1999
Symmetry:
(1) Approximately equal amplitude, frequency and form of EEG activities over homologous areas on opposite sides of the head.
(2) Approximately equal distribution of potentials of unlike polarity on either side of a zero isopotential axis (see phase reversal).
(3) Approximately equal distribution of EEG waves about the baseline.
Blume 2001
Synchronous: Motor events occurring at the same time or at the same rate in sets of body parts.
Noachter 1999
Synchronous: Occurring at the same time. Synonym: simultaneous.
Noachter 1999
Synchrony: The simultaneous occurrence of EEG waves over regions on the same or opposite sides of the head.
Comment: term simultaneous only implies a lack of delay that is measurable with ink writers at customary paper speeds or with standard computer display.
Blume 2001
Gustatory: Taste sensations including acidic, bitter, salty, sweet, or metallic.
ILAE 1989
Tay-Sachs and Sandhoff disease present with acoustic startle or myoclonus in the first months of life, without EEG manifestations. In the second year, myoclonic jerks and erratic partial seizures occur, along with marked slowing of the background rhythms.
Tancred 2005
The Cerebral Hemispheres (Telencephalon) are involved in the perception of sensory information, control of voluntary movement, speech, cognition and all aspects of personality and behaviour.
Structures:
Cerebral Hemisphere
Information:
The telencephalon is the more rostral of the two secondary brain vesicles which form from the prosencephalon. The embryonic telencephalon develops into the cerebral hemispheres of the adult brain.
In the adult brain the term 'telencephalon' is interchangable with 'the cerebral hemispheres'
For details regarding the components of the telencephalon in the adult brain, see
'cerebral hemisphere' information card.
1981
Temporal
Also in Frontotemporal
Trancred 2005
The Temporal Lobe includes areas which are important in audition (hearing), memory and innate behaviours.
Structures:
Collateral Sulcus
Corpus Callosum
Hippocampal Gyrus
Inferior Temporal Gyrus
Inferior Temporal Sulcus
Lateral Fissure
Lateral Ventricle
Middle Temporal Gyrus
Occipitotemporal Gyrus
Parahippocampal Gyrus
Parieto-occipital Sulcus
Primary Auditory Area
Primary Olfactory Area
Superior Temporal Gyrus
Superior Temporal Sulcus
Transverse Temporal Gyrus
Uncus
Information:
Boundaries:
On the lateral surface the temporal lobe is bounded posteriorly by the imaginary line extending downwards from the parieto-occipital sulcus to the preoccipital notch. It is bounded superiorly by the lateral fissure and a horizontal line extending from the lateral fissure to meet the imaginary line just described.
On the medial surface it is bounded posteriorly by a line extending from the splenium of the corpus callosum to the preoccipital notch.
Gyri and Sulci:
The lateral surface of the temporal lobe is formed by the superior, middle and inferior temporal gyri, which are separated from each other by the superior and inferior temporal sulci. The superior surface of the superior temporal gyrus, which forms the floor of the lateral fissure, is thrown into several transversely oriented folds, which are called the transverse temporal gyri (of Heschl).
The inferomedial surface of the temporal lobe is formed by (from medial to lateral) the parahippocampal gyrus, the occipitotemporal gyrus and the inferior temporal gyrus. The occipitotemporal gyrus is separated from the parahippocampal gyrus by the collateral sulcus and from the inferior temporal gyrus by the occipitotemporal sulcus. The rostral part of the parahippocampal gyrus hooks backward to form a bump on its medial surface called the uncus. Above the parahippocampal gyrus (not visible from the inferior surface) is the hippocampal gyrus, which actually forms the medial wall of the inferior (temporal) horn of the lateral ventricle.
Specific Functional Areas:
(1) Primary Auditory Area - located on the transverse temporal gyri.
(2) Primary Olfactory Area - located on the uncus.
1989 ILAE
Temporal Lobe Epilepsy
Temporal lobe syndromes are characterized by simple partial seizures, complex partial seizures, and secondarily generalized seizures, or combinations of these. Frequently, there is a history of febrile seizures, and a family history of seizures is common. Memory deficits may occur. On metabolic imaging studies, hypometabolism is frequently observed [e.g., positron emission tomography (PET)]. Unilateral or bilateral temporal lobe spikes are common on EEG. Onset is frequently in childhood or young adulthood. Seizures occur in clusters at intervals or randomly.
General characteristics
Features strongly suggestive of the diagnosis when present include:
1. Simple partial seizures typically characterized by autonomic and/or psychic symptoms and certain sensory phenomena such as olfactory and auditory (including illusions). Most common is an epigastric, often rising, sensation.
2. Complex partial seizures often but not always beginning with motor arrest typically followed by oroalimentary automatism. Other automatisms frequently follow. The duration is typically >1 min. Postictal confusion usually occurs. The attacks are followed by amnesia. Recovery is gradual.
Electroencephalographic characteristics
In temporal lobe epilepsies the interictal scalp EEG may show the following:
1. No abnormality.
2. Slight or marked asymmetry of the background activity.
3. Temporal spikes, sharp waves and/or slow waves, unilateral or bilateral, synchronous but also asynchronous. These findings are not always confined to the temporal region.
4. In addition to scalp EEG findings, intracranial recordings may allow better definition of the intracranial distribution of the interictal abnormalities.
In temporal lobe epilepsies various EEG patterns may accompany the initial clinical ictal symptomatology, including (a) a unilateral or bilateral interruption of background activity; and (b) temporal or multilobar low-amplitude fast activity, rhythmic spikes, or rhythmic slow waves. The onset of the EEG may not correlate with the clinical onset depending on methodology. Intracranial recordings may provide additional information regarding the chronologic and spatial evolution of the discharges.
This is an instance of a Hamartoma
Bancaud 1981
Fear or terror is the most frequent sympto; is is sudden in onset, usually unprovoked and may lead to running away.
Associated with the terror, there are frequently objective signs of autonomic activity, including pupil dilation, pallor, flushing, piloerection, palpitation, and hypertension.
Noachter 1999
Theta Band: Frequency band from 4 to under 8 Hz. Greek letter: <theta>.
Noachter 1999
Theta Rhythm: Rhythm with a frequency of 4 to under 8 Hz.
Noachter 1999
Theta Wave: Wave with duration of 1/4 to over 1/8 s.
Engel 2001
Thinking
Noachter 1999
Three per Second-Spike and Slow Wave Complex: Characteristic paroxysm consisting of a regular sequence of spike-and-slow-wave complexes which:
(1) repeat at 33.5 c/s (measured during the first few seconds of the paroxysm),
(2) are bilateral in their onset and termination, generalized, and usually of maximal amplitude over the frontal areas,
(3) are approximately synchronous and symmetrical on the two sides of the head throughout the paroxysm. Amplitude varies but can reach values of 1000 uV (1 mV) (see atypical spike-and-slow-wave complex).
Thurman 2011
The purpose of this document is to promote consistency in definitions and methods in an effort to enhance future population-based epidemiologic studies, facilitate comparison between populations, and encourage the collection of data useful for the promotion of public health.
Thurman 2011
Acceptability. Data collection may require the acceptance and cooperation of many persons and organizations involved in reporting cases. Subjects may be asked to provide substantial time taking surveys and participating in other assessments. Successful studies and systems do not place costly, difficult, or unacceptable burdens on those who provide data.
Thurman 2011
Accuracy. The closeness of the measurement to the true value is critical. Accuracy of measurements of incidence or prevalence can be characterized by the qualities of sensitivity, specificity, and positive predictive value (PPV) of the tools to collect the data, which are described later in this paper.
Thurman 2011
To assess the public health importance of epilepsy and to design and promote effective health care and service programs it is necessary to describe:
• associations, risk factors, and causes
Thurman 2011
Attributes of epidemiologic studies and surveillance
A number of attributes of epidemiologic studies and surveillance determine their success.
Thurman 2011
To assess the public health importance of epilepsy and to design and promote effective health care and service programs it is necessary to describe:
• associations, risk factors, and causes
Economy. Economical methods reduce the costs and time required to collect and analyze data. Successful studies and systems avoid collecting unnecessary data and rely as much as possible on data from existing data collection systems, when of high quality and appropriate.
Thurman 2011
To assess the public health importance of epilepsy and to design and promote effective health care and service programs it is necessary to describe:
• the magnitude of the problem (e.g., total number of cases; incidence rate, i.e., the rate of new cases occurring in the population; mortality rate, i.e., the rate of deaths occurring with the condition; and prevalence, i.e., the proportion of the population with the condition)
• populations at highest risk of epilepsy (e.g., demographic characteristics)
• associations, risk factors, and causes
• severity and outcome (e.g., seizure frequency and duration, symptoms, comorbidities, resulting disability, and cost of care)
Thurman 2011
Epidemiologic research, which typically involves collecting more extensive data over a limited period and often includes analyses to test novel hypotheses regarding specific questions of etiology or association.
Thurman 2011
To assess the public health importance of epilepsy and to design and promote effective health care and service programs it is necessary to describe:
• the magnitude of the problem
(e.g., total number of cases;
incidence rate, i.e., the rate of new cases occurring in the population;
mortality rate, i.e., the rate of deaths occurring with the condition; and
prevalence, i.e., the proportion of the population with the condition)
Thurman 2011
To assess the public health importance of epilepsy and to design and promote effective health care and service programs it is necessary to describe:
• the magnitude of the problem (e.g., total number of cases; incidence rate, i.e., the rate of new cases occurring in the population; mortality rate, i.e., the rate of deaths occurring with the condition; and prevalence, i.e., the proportion of the population with the condition)
Thurman 2011
To assess the public health importance of epilepsy and to design and promote effective health care and service programs it is necessary to describe:
• the magnitude of the problem
(e.g., total number of cases;
incidence rate, i.e., the rate of new cases occurring in the population;
mortality rate, i.e., the rate of deaths occurring with the condition; and
prevalence, i.e., the proportion of the population with the condition)
Thurman 2011
To assess the public health importance of epilepsy and to design and promote effective health care and service programs it is necessary to describe:
• severity and outcome (e.g., seizure frequency and duration, symptoms, comorbidities, resulting disability, and cost of care)
Thurman 2011
To assess the public health importance of epilepsy and to design and promote effective health care and service programs it is necessary to describe:
• populations at highest risk of epilepsy (e.g., demographic characteristics)
Thurman 2011
To assess the public health importance of epilepsy and to design and promote effective health care and service programs it is necessary to describe:
• the magnitude of the problem
(e.g., total number of cases;
incidence rate, i.e., the rate of new cases occurring in the population;
mortality rate, i.e., the rate of deaths occurring with the condition; and
prevalence, i.e., the proportion of the population with the condition)
Thurman 2011
Public health surveillance is defined as ‘‘the ongoing systematic collection, analysis, and interpretation of health data necessary for designing, implementing, and evaluating public health prevention programs’’ (Guidelines Working Group, 2001).
Examples of public health surveillance include department of health or ministry systems that monitor the incidence of diseases, including communicable diseases, as well as national mortality registries and systems relying on administrative data such as hospital discharge (separation) data.
Thurman 2011
Representativeness. Representative epidemiologic studies and surveillance systems include subjects whose characteristics and experience are similar to the population of interest. They accurately measure and describe the occurrence of epilepsy over time. Representativeness is critical if data are gathered in only a sample of epilepsy cases.
Thurman 2011
To assess the public health importance of epilepsy and to design and promote effective health care and service programs it is necessary to describe:
• associations, risk factors, and causes
Thurman 2011
To assess the public health importance of epilepsy and to design and promote effective health care and service programs it is necessary to describe:
• severity and outcome (e.g., seizure frequency and duration, symptoms, comorbidities, resulting disability, and cost of care)
Thurman 2011
A major purpose of epidemiologic studies and surveillance is to provide the information necessary for primary prevention, for early detection and treatment, for setting public health and health care priorities, and for identifying other education and service needs associated with health conditions
Thurman 2011
To assess the public health importance of epilepsy and to design and promote effective health care and service programs it is necessary to describe:
• the magnitude of the problem
(e.g., total number of cases;
incidence rate, i.e., the rate of new cases occurring in the population;
mortality rate, i.e., the rate of deaths occurring with the condition; and
prevalence, i.e., the proportion of the population with the condition)
Blume 2001
Epigastric: Abdominal discomfort including nausea, emptiness, tightness, churning, butterflies, malaise, pain, and hunger; sensation may rise to chest or throat. Some phenomena may reflect ictal autonomic dysfunction.
the definition of a Risk factor: head trauma, stroke, infection
is related to when the seizure occurs
within 7 days of the initial precipitant, it is considered an acute sequelae
greater than 7 days: considered independently as a risk factorfor epidemiologic purposes
Bancaud 1981
Blume 2001
Somatosensory: Tingling, numbness, electric-shock sensation, pain, sense of movement, or desire to move.
Blume 2001
Cephalic: Sensation in the head such as light-headedness, tingling or headache.
Tone: a response to passive movement across the joint
Nerve and muscle
Neural Axis: neuro starting at cortex white matter, spinal cord
Luders 1998
Seizures in which the main manifestations are motor phenomena are classified as motor seizures.
Bancaud 1981
Tongue may be bitten
Tonic Clonic based on appearance
Initial Phase:
-tonic posturing of all limbs
Tonic Phase:
-muscle sustained contractions
-tend to slow
Evolve to Clonic Phase:
-contractions of progressively decreasing
frequency until contractions disappear completely
-Same muscles in tonic & clonic phase
Sequence: Infrequent focal to tonic-clonic evolution
(May need to have Tonic followed by Clonic Seizure)
Bancaud 1981
Tonic-clonic seizures are grand mal
Preictal
some have vague ill-described warning
majority lose consciousness w/o premonitory symptoms
Ictal
Tonic
Sudden sharp tonic contraction of muscles
Involvement of respiratory muscles: stridor, cry or moan, patient falls to the ground, occasionally injuring themselves
Lies rigid, tonic contraction inhibits respiration & cyanosis occurs
Tongue may be bitten, urine passed involuntarily
Clonic
Convulsive movements for a variable period of time
small gusts of grunting respiration between convulsive movements
usually patient remains cyanotic, saliva may growth from mouth
Postictal
Deep respiration and all muscles relax
patient remains unconscious for a variable period of time
awakes feeling stiff and sure all over
Frequently goes into a deep sleep
Awakens feeling well but has soreness and headache
ILAE 1989
Affects the face
Luders 1998
Simple, unnatural movements
Like Broadman 4&6 stimulation
Blume 2001
1.1.3 Tonic-Clonic: A sequence consisting of a tonic followed by a clonic phase. Variants such as clonic-tonic-clonic may be seen.
1.1.3.1 Generalized Tonic-Clonic Seizure: Noun: Bilateral symmetric tonic contraction and then bilateral clonic contractions of somatic muscles, usually associated with autonomic phenomena.
Bancaud 1981
EEG Seizure Type
Rhythm at 10 or more c/sec decreasing in frequency and increasing in amplitude during tonic phase, interrupted by slow waves during clonic phase.
EEG Interictal Expression
Polyspike and waves or spike and wave, or, sometimes, sharpa and slow wave discharges.
Tonic-clonic seizures are grand mal
Preictal
some have vague ill-described warning
majority lose consciousness w/o premonitory symptoms
Ictal
Tonic
Sudden sharp tonic contraction of muscles
Involvement of respiratory muscles: stridor, cry or moan, patient falls to the ground, occasionally injuring themselves
Lies rigid, tonic contraction inhibits respiration & cyanosis occurs
Tongue may be bitten, urine passed involuntarily
Clonic
Convulsive movements for a variable period of time
small gusts of grunting respiration between convulsive movements
usually patient remains cyanotic, saliva may growth from mouth
Postictal
Deep respiration and all muscles relax
patient remains unconscious for a variable period of time
awakes feeling stiff and sure all over
Frequently goes into a deep sleep
Awakens feeling well but has soreness and headache
ILAE 1989
Affects the face
Luders 1998
Tonic-Clonic Seizure
Simple, unnatural movements
Like Broadman 4&6 stimulation
Blume 2001
1.1.3 Tonic-Clonic: A sequence consisting of a tonic followed by a clonic phase. Variants such as clonic-tonic-clonic may be seen.
1.1.3.1 Generalized Tonic-Clonic Seizure: Noun: Bilateral symmetric tonic contraction and then bilateral clonic contractions of somatic muscles, usually associated with autonomic phenomena.
Engel 2001
Blume 2003
A GTC seizure may evolve immediately from a dyscongitive one and is heralded by contralateral head and eye deviation. Alternatively GTC seizures may appear independently.
Berg 2010
Bancaud 1981
The most frequently encountered of the generalized seizures are the generalized tonic-clonic seizures, often known as grand mal. Some patients experience a vague ill-described warning, but the majority lose consciousness without any premonitory symptoms. There is a sudden sharp tonic contraction of muscles, and when this involves the respiratory muscles there is stridor, a cry or moan, and the patient falls to the ground in the tonic state, occasionally injuring himself in falling. He lies rigid, and during this stage tonic contraction inhibits respiration and cyanosis may occur. The tongue may be bitten and urine may be passed involuntarily. This tonic stage then gives way to clonic convulsive movements lasting for a variable period of time. During this stage small gusts of grunting respiration may occur between the convulsive movements, but usually the patient remains cyanotic and saliva may froth from the mouth. At the end of this stage, deep respiration occurs and all the muscles relax, after which the patient remains unconscious for a variable period of time and often awakes feeling stiff and sore all over. He then frequently goes into a deep sleep and when he awakens feels quite well apart from soreness and frequently headache. Generalized tonic-clonic convulsions may occur in childhood and in adult life; they are not as frequent as absence seizures, but vary from one a day to one every three months and occasionally to one every few years. Very short attacks without postictal drowsiness may occur on occasion.
Engel 2001
Tonic-Clonic Seizure
Luders 1998
Tonic-Clonic Seizure
Generalized tonic-clonic seizures are characterized by an initial tonic posturing of all limbs. The sustained muscle contractions that determined the tonic phase then tend to slow, evolving into a clonic phase with contractions of progressively decreasing frequency until the contractions disappear completely. The muscles included in the tonic and clonic phase should be essentially the same. Focal motor seizures showing such a tonic-clonic evolution are infrequent.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Sustained (> 3 sec)
muscle contractions
that lead to positioning
ILAE 1989
postural (fencing)
focal tonic
Stiffness
Luders 1998
Blume 2001
1.1.1.2.1 Postural: Adoption of a posture that may be bilaterally symmetric or asymmetric (as in a "fencing posture").
Berg 2010
Tonic
Location: Left/right/axial/generalized/bilateral asymmetric
Bancaud 1981
To quote Gowers, a tonic seizure is “a rigid, violent muscular contraction, fixing the limbs in some strained position. There is usually deviation of the eyes and of the head toward one side, and this may amount to rotation involving the whole body, (sometimes actually causing the patient to turn around, even two or three times). The features are distorted; the color of the face, unchanged at first, rapidly becomes pale and then flushed and ultimately livid as the fixation of the chest by the spasms stops the movements of respiration. The eyes are open or closed; the conjunctiva is insensitive; the pupils dilate widely as cyanosis comes on. As the spasm continues, it commonly changes in its relative intensity in different parts, causing slight alterations in the position of the limbs.”
Tonic axial seizures with extension of head, neck, and trunk may also occur.
Absence with tonic components
-affect extensor/flexor (a)symmetrically
-head drawn backwards
-head may tonically draw to one side or another
-trunk arch
-retropulsion
rigid, violent muscular contraction, fixing the limbs in some strained position
Tonic Seizure
EEG Seizure type
Low voltage, fast activity or a fast rhythm of 9-10c/sec or more decreasing in frequency and increasing in amplitude
EEG Interictal Expression
More or less rhythmic discharges of sharpa nd slow waves, sometimes asymmetrical. Background is often abnormal for age.
ILAE 1989
Luders 1998
Tonic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Simple, unnatural movements
Like Broadman 4&6 stimulation
Blume 2001
1.1.1 Tonic: A sustained increase in muscle contractions lasting a few seconds to minutes
1.1.1.2 Postural: Adoption of a posture that may be bilaterally symmetric or asymmetric (as in a "fencing posture").
Engel 2001
Tonic Seizures
Asymmetric tonic motor seizures (assoc w/ supp motor)
Blume 2003
Tonic Posture
Blume 2003
Dystonic posturing should be sought by observation or history-taking, as it almost always occurs in the arm contralateral to seizure origin. Chewing and swallowing may occur. Ictal speech, even if nonsensical suggests involvement of the temporal lobe non dom for language.
Luders 1998
Tonic Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Tonic seizures consist of sustained muscle contractions, usually lasting >3 s, that lead to “positioning.”
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Engel 2001
Tonic Status Epilepticus
Noachter 1999
Trace Alternant: A discontinuous pattern of non-REM (quiet) sleep seen in preterm infants of 34 weeks conceptional age or older which can persist up to 3-4 weeks after birth in full term infants. The pattern is characterized by bursts of predominantly slow waves (1-3 Hz, 50-100 uV) appearing approximately every 4-5 s, and intervening periods of low voltage activity of (<50 uV) 4-7 Hz.
Noachter 1999
Trace Continue: Continuous activity, replacing a previously markedly intermittent record during evolution of EEG in preterm infants.
Noachter 1999
Trace Discontinue: Pattern of preterm infants below 34 weeks of conceptional age (CA) characterized by mixed frequency high voltage bursts separated by periods of a very low voltage background.
Noachter 1999
Transient, EEG: Any isolated wave or complex, distinguished from background activity.
Scheuermann 2009
Transient Disease Course: A disease course that terminates in a return to normal homeostasis.
Example: a bout of flu.
Fischer 2014
Single seizure and dysplasia. A 40-year-old man had a focal seizure characterized by left hand twitching that progressed to a tonic–clonic seizure. This was his only seizure. Magnetic resonance imaging (MRI) shows a probable transmantle dysplasia in the right frontal lobe and EEG shows right frontotemporal interictal spikes. Comment: Although many clinicians would reasonably treat this man with antiseizure medications, the recurrence risk for seizures is not precisely known, and therefore epilepsy cannot yet be said to be present according to either definition. Future epidemiologic studies might clarify this situation.
This is a provocative factor if a seizure occurs less than 7 days from the TBI. It is an etiology if it occurs 7 days or later from the TBI and if the epidemiologic likelihood of a first unprovoked seizure from that etiology is 60% or greater, then you can call the seizure that occurs epilepsy.
Not done but ask for a small review
Bancaud 1981
Therapy
Engel 2001
Therapeutic
Engel 2006
Response to drugs
Berg 2010
Diagnosis often has implications for treatment, management, prognosis
Fischer 2014
A decision for treatment does not necessarily equate to a diagnosis of epilepsy, but it can be taken as a marker for belief in a strong enduring predisposition for further seizures. Conversely, a diagnosis of epilepsy does not necessarily require treatment.
A treatment decision is distinct from a diagnosis, and should be individualized depending upon the desires of the patient, the individual risk-benefit ratio and the available options. The physician should weigh the possible avoidance of a second seizure with associated risks against the risk for drug-related side effects and costs for the patients.
To be clear, the diagnosis of epilepsy and a decision to treat are two related but different issues. Many epileptologists treat for a time after an acute symptomatic seizure (for example, with Herpes encephalitis), with no implication of epilepsy. In contrast, patients with mild seizures, with seizures at very long intervals, or those declining therapy might go untreated even when a diagnosis of epilepsy is beyond dispute.
Noachter 1999
Triphasic Wave: High-amplitude (over 70 uV) positive sharp transients, which are preceded and followed by relatively low-amplitude negative waves. The first negative wave generally has a lower amplitude than the negative afterwave. The distribution is generalized, and frequently the largest deflections in a bipolar fronto-occipital derivation occur at the frontal electrodes. Triphasic waves tend to have a repetition rate of ca. 1-2 Hz.
Engel 2001
Trisomy 12p
Bancaud 1981
Trunk
This is the overall disease, of which hamartomas is the pathologic part of the disease that causes seizures.
Engel 2001
Tuberous sclerosis complex
Engel 2001
Tumors
Bancaud 1981
Typical Absence Seizure
Clinical Seizure Type
(a) Impairment of consciousness only
(b) With mild clonic components
(c) With atonic components
(d) With tonic components
(e) With automatisms
(f) With autonomic components
(b-f may be used alone or in combination)
EEG Seizure Type
Usually regular and symmetrical 3Hz but may be 2-4 Hz spike-and-slow-wave complexes and may have multiple spike-and-slow-wave complexes. Abnormalities are bilateral
EEG Interictal Expression
Background activity usually normal although paroxysmal activity (such as spikes or spike-and-slow-wave complexes) may occur. This activity is usually regular and symmetrical.
Eyelid myoclonia
Myoclonic absence
Bancaud 1981
Absence with impairment of consciousness only
Absence: sudden onset, interruption of ongoing activities, blank stare, brief upward rotation of eyes.
If speaking, speech slowed or interrupted; if walking, transfixed; if eating, food stops, patient usually unresponsive when spoken to
lasts few seconds to half a minute
Begins and ends rapidly
Luders 1998
Typical Dialeptic Seizure
Location: Left hemisphere/right hemisphere
Dialeptic seizures for ictal episodes in which the main manifestation is an alteration of consciousness. The term dialeptic derives from the Greek word “dialeipein,” which means “to stand still,” “to interrupt,” or “to pass out.”
Typical dialeptic seizures consist of short episodes of altered consciousness: <20 s. The alteration of consciousness begins and ends abruptly and frequently is associated with rhythmical eye blinking at a rate of ~3 Hz. Patients with generalized absence epilepsy often have typical dialeptic seizures. All seizures that consist mainly of an alteration of consciousness but that are not “typical dialeptic seizures” should be classified as just dialeptic seizures.
Engel 2001
Typical absence seizures
Eyelid myoclonia w/ absences
Berg 2010
Typical Absence
Unknown
3Hz Rhythmic Eye Blinking
Amnesia (complete or partial)
Alteration of consciousness
Begins and ends abruptly
<20 sec / episode
Blume 2001
Gustatory: Taste sensations including acidic, bitter, salty, sweet, or metallic.
Blume 2001
Gustatory: Taste sensations including acidic, bitter, salty, sweet, or metallic.
Bancaud 1981
This category includes all seizures that cannot be classified because of inadequate or incomplete data and includes some seizures that by their natures defy classification in the previously defined broad categories. Many seizures occurring in the infant (e.g., rhythmic eye movements, chewing, swimming movements, jittering, and apnea) will be classified here until such time as further experience with video-tape confirmation and electroencephalographic characterization entitles them to subtyping in the extant classification.
Bancaud 1981
Unilateral
Noachter 1999
Unilateral: Confined to one side of the head.
Comments:
(1) unilateral EEG activities may be regional or lateralized to one hemisphere.
(2) They are said to be lateralized to the right or left side of the head.
Blume 2001
Unilateral: Exclusive or virtually exclusive involvement of one side as a motor, sensory, or autonomic phenomenon.
Engel 2001
Unilateral polymicrogyria
Noachter 1999
Unipolar: Use of term discouraged.
Term suggested: referential.
Bancaud 1981
Unpleasant odor.
Blume 2001
Olfactory: Odor, usually disagreeable.
Bancaud 1981
Unresponsive when spoken to.
Engel 2001
Unverricht-Lundborg Disease
not semiology
Bancaud 1981
Feelings of unworthiness
Brief upward rotation of the eyes
Engel 2001
Urea Cycle Disorders
Bancaud 1981
Urine may be passed involuntary
Noachter 1999
V Wave: Abbreviation for vertex sharp transient.
Blume 2001
Verbal: Single or repetitive utterances consisting of words, phrases, or brief sentences.
Bancaud 1981
Head turning to one side, usually contraversive to the discharge
Sustained & extreme:
Conjugate eye movement to one side
(Progressive movement of eye to extreme position)
(Smooth tonic lateral movement)
(W or w/o superimposed small saccades)
Moves head or whole body to one side
(Small clonic lateral movements)
(Chin moves lateral and upward)
Unnatural position of Eyes and head
Occasionally body completes 1 or more 360 turns
Bancaud 1981
Versive
Contraversive to discharge
Tonic seizure
rigid, violent muscular contraction, fixing the limbs in some strained position
deviation of the eyes and of the head toward one side, this may amount to rotation involving the whole body (sometimes causing the patient to turn around, even two or three times)
Features are distorted
Color of face becomes pale and flushed, livid as fixation of chest by spasms stops movements of respiration
eyes are open or closed, conjunctiva is insensitive, pupils dilate widely as cyanosis comes on
As spasm continues, it changes in relative intensity in different parts, causing sleigh alterations in limb positions
ILAE 1989
Oculoclonic or oculogyric deviation
Palpebral jerks, forced closure of eyelids
Occular oscillation
Tonic, horizontal deviation of the eyes w/ or w/o jerking, eyelid blinking/fluttering
Luders 1998
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Simple, unnatural movements
Like Broadman 4&6 stimulation
Blume 2001:
1.1.1.2 Postural: Adoption of a posture that may be bilaterally symmetric or asymmetric (as in a "fencing posture").
1.1.1.2.1 Versive: A sustained, forced conjugate ocular, cephalic, and/or truncal rotation or lateral derivation from the midline.
1.1.1.2.2 Dystonic: Sustained contractions of both against and antagonist muscles producing athetoid or twisting movements, which, when prolonged, may produce abnormal postures.
Blume 2003
Head movements to one side or none
Location: Left/right/axial/generalized/bilateral asymmetric
Bancaud 1981
ILAE 1989
Luders 1998
Versive Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Simple, unnatural movements
Like Broadman 4&6 stimulation
Blume 2001:
1.1.1.2 Postural: Adoption of a posture that may be bilaterally symmetric or asymmetric (as in a "fencing posture").
1.1.1.2.1 Versive: A sustained, forced conjugate ocular, cephalic, and/or truncal rotation or lateral derivation from the midline.
1.1.1.2.2 Dystonic: Sustained contractions of both against and antagonist muscles producing athetoid or twisting movements, which, when prolonged, may produce abnormal postures.
Blume 2003
A GTC seizure may evolve immediately from a dyscongitive one and is heralded by contralateral head and eye deviation. Alternatively GTC seizures may appear independently.
Bancaud 1981
Head turning to one side usually contraversive to discharge
Luders 1998
Versive Seizure
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Versive seizures are seizures during which the patient either has a conjugate eye movement to one side or moves the head, and occasionally the whole body, to one side. Only conjugate eye movements or lateral head and body movements that are sustained and extreme should be classified as versive seizure. The lateral movement of the eyes frequently consists of a combination of a smooth tonic lateral movement on which are superimposed small saccades that progressively move the eye out to an extreme position. On other occasions, a smooth lateral movement without any saccades may be observed. The version of body parts has a similar character, but the saccades are replaced by small clonic lateral movements of the head or body. During these lateral movements, the chin frequently moves not only laterally but also upward, resulting in an unnatural position of the eyes and head. Occasionally, the patient’s body will also turn and may complete one or more 360” turns.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Noachter 1999
Vertex Sharp Transient: Sharp potential, maximal at the vertex, negative relative to other areas, apparently occurring spontaneously during sleep or in response to a sensory stimulus during sleep or wakefulness. May be single or repetitive. Amplitude varies but rarely exceeds 250 uV .
Abbreviation: V wave (see K complex).
Bancaud 1981
Vertiginous Symptom
Bancaud 1981
Flashing lights, structured visual hallucinatory phenomena (persons, scenes)
Illusions: monocular diplopia, size, (macropsia/micropsia), distance
Objects may appear deformed
ILAE 1989
Dreamy states, Visual misperceptions
Fleeting visual manifestations
Position: contralateral, entire visual field
Negative: scotoma, hemianopsia, amaurosis
Positive: sparks, flashes, phosphenes
Perceptive illusions (distortions)
Change in size (macropsia, micropsia)
Change in distance
Metamorphosia: object inclination, distortion, shape change (distortion, foreshortening, elongation)
Complex visual perceptions
Heautoscopy (sees own image)
Luders 1998
Visual Aura
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Visual hallucinations or illusions,
when occurring in isolation, should be classified as visual auras. More elaborate visual hallucinations or illusions that are associated with other complex distortions of perception (such as alterations of the sense of familiarity of what the patient is seeing or hearing, complex visual or auditory illusions, or the hearing of voices, and so on), should be classified as visual auras only if the visual hallucination or illusion is clearly the predominant symptom, at least for a significant part of the aura. Otherwise, they should be classified as psychic auras (described below). Poorly defined alterations of vision (such as “blurry vision”) should be designated unclassifiable auras.
Blume 2001
2.2.1.2 Visual: Flashing or flickering lights, spots, simple patterns, scotomata, or amaurosis.
Blume 2003
Aurae include epigastric sensation, fear and various types of visual, olfactory, or auditory experiential phenomena
Luders 1998
Visual Aura
Location: Left/Right/Axial/Generalized/Bilateral Asymmetric
Visual hallucinations or illusions,
when occurring in isolation, should be classified as visual auras. More elaborate visual hallucinations or illusions that are associated with other complex distortions of perception (such as alterations of the sense of familiarity of what the patient is seeing or hearing, complex visual or auditory illusions, or the hearing of voices, and so on), should be classified as visual auras only if the visual hallucination or illusion is clearly the predominant symptom, at least for a significant part of the aura. Otherwise, they should be classified as psychic auras (described below). Poorly defined alterations of vision (such as “blurry vision”) should be designated unclassifiable auras.
Status Epilepticus
Essentially any of the seizure forms described above can manifest as status epilepticus. Status epilepticus is classified in the same way as the seizures by replacing the term “seizure” with “status”-e.g., dialeptic status, right foot clonic status.
Bancaud 1981
Visual Hallucination
Bancaud 1981
Visual Symptom
Blume 2001
Visual: Flashing or flickering lights, spots, simple patterns, scotomata, or amaurosis.
Engel 2001
Other Visual Sensitive Epilepsies
Engel 2001
Visual Stimuli
Scheuermann 2009
Vital sign: A physical sign in which a nonzero value is standardly considered to be an indication that the organism is alive. The relative values for vital signs are often used as measures that can indicate the presence of disease.
Blume 2001
Vocal: Single or repetitive utterances consisting of sounds such as grunts or shrieks.
Bancaud 1981
Vocalization
Noachter 1999
Wave: Any change of the potential difference between pairs of electrodes in EEG recording. May arise in the brain (EEG wave) or outside it (extracerebral potential).
Suleiman 2013
Voltage-gated potassium channel (VGKC)-complex antibody associated autoimmune limbic encephalitis (including leucine rich glioma inactivated 1 [LGI1] and contactin-associated protein-like 2 [CASPR2] antibodies) in which patients often have temporal lobe seizures (Irani et al., 2010; Lai et al., 2010)
Suppression Voltage
JB: Both
Bancaud 1981
Vomiting
Noachter 1999
Wave: Any change of the potential difference between pairs of electrodes in EEG recording. May arise in the brain (EEG wave) or outside it (extracerebral potential).
Noachter 1999
Wave Form: The shape of an EEG wave.
Noachter 1999
Waveform: The shape of an EEG wave.
Bancaud 1981
Illusion: These take the form of distorted perceptions in which objects may appear deformed.
Polyoptic illusions such as monocular diplopia, distortions of size (macropsia or micropsia) or of distance may occur. Similarly, distortions of sound, including microacusia and macroacusia, may be experienced. Depersonalization, as if the person were outside his body, may occur. Altered perception of size or weight of a limb may be noted.
West Syndrome, developmental delay is the defining feature. So so the negation is important
ILAE 1989
West Syndrome
Usually, West syndrome consists of a characteristic triad: infantile spasms, arrest of psychomotor development, and hypsarrhythmia, although one element may be missing. Spasms may be flexor, extensor, lightning, or nods, but most commonly they are mixed. Onset peaks between the ages of 4 and 7 months and always occurs before the age of 1 year. Boys are more commonly affected. The prognosis is generally poor. West syndrome may be separated into two groups. The symptomatic group is characterized by previous existence of brain damage signs (psychomotor retardation, neurologic signs, radiologic signs, or other types of seizures) or by a known etiology. The smaller, cryptogenic group is characterized by a lack of previous signs of brain damage and of known etiology. The prognosis appears to be partly based on early therapy with adrenocorticotropic hormone (ACTH) or oral steroids.
Engel 2001
West Syndrome
ILAE 2010
West Syndrome
Noachter 1999
Wicket Spikes: Spike-like monophasic negative single waves or trains of waves occurring over the temporal regions during drowsiness that have an arcuate or mu-like appearance. These are mainly seen in older individuals and represent a benign variant that is of little clinical significance.
Engel 2001
Wolf-Hirschhorn syndrome
not semiology
Bancaud 1981
Inheritance
ILAE 1989
Inheritance
Luders 1998
2010 Berg
Hereditary predisposition
Bancaud 1981
Inheritance
ILAE 1989
Inheritance
Luders 1998
2010 Berg
Hereditary predisposition
Engel 2001
X-linked lissencephaly
Bancaud 1981
Inheritance
ILAE 1989
Inheritance
Luders 1998
2010 Berg
Hereditary predisposition
Bancaud 1981
Inheritance
ILAE 1989
Inheritance
Luders 1998
2010 Berg
Hereditary predisposition
Bancaud 1981
Grand Mal
Engel 2001
Alpers' disease
Engel 2001
Alzheimer's disease
Blume 2001
Lateralizing: Any unilateral postictal dysfunction relating to motor, language, sensory, and/or integrative functions including visual, auditory, or somatosensory neglect phenomena.
Blume 2001
Lateralizing: Any unilateral postictal dysfunction relating to motor, language, sensory, and/or integrative functions including visual, auditory, or somatosensory neglect phenomena.
Blume 2001
Lateralizing: Any unilateral postictal dysfunction relating to motor, language, sensory, and/or integrative functions including visual, auditory, or somatosensory neglect phenomena.
Tancred 2005
Brodmann's areas are cytocarchitecturally distinct regions of the cerebral cortex.
Regional variations in the number, thickness and composition of the laminae of the cerebral cortex promted Brodmann in 1909 to devise a scheme which divides the cerebral cortex into 52 regions on the basis of cytoarchitecture. This scheme is still in use, the individual regions being referred to a Brodmann's areas. While it is not necessary to remember the location of each of these 42 areas, some of them should be learned:
The primary somatosensory area occupies Brodmann's areas 1, 2 and 3.
The primary visual area occupies area 17
The primary auditory area occupies area 41
The primary motor area occupies area 4
The premotor areas occupies area 6
The motor speech (Broca's) area occupies areas 44 and 45
Bancaud 1981
A distorted memory experience such as distorted memory experience (a dreamy state)
Engel 2001
Alpers' disease
Engel 2001
Alzheimer's disease
Engel 2001
Coffin-Lowry syndrome
Engel 2001
Dravet Syndrome
(previously known as severe myoclonic epilepsy in infancy)
Engel 2001
Dravet's Syndrome
Engel 2001
Epilepsy with cotninuous spike-waves during slow-wave sleep
Engel 2001
Hemiconvulsion-Hemiplegia Syndrome
Engel 2001
Landau-Kleffner Syndrome
Engel 2001
Lennox-Gastaut Syndrome
Engel 2001
Menkes' Disease
Engel 2001
Miller-Dieker syndrome
Engel 2001
Sturge-Weber syndrome
Engel 2001
Unverricht-Lundborg Disease
Engel 2001
Wolf-Hirschhorn syndrome
Suleiman 2013
Graves’ disease is an antibody mediated autoimmune disorder and juvenile myoclonic epilepsy (JME) has been previously associated with Grave’s disease, and may be due to thyroxine causing a lower seizure threshold (Su et al., 1993). Our case 11 was diagnosed to have an idiopathic myoclonic epilepsy (JME) based on her age, seizure phenotype, and EEG abnormality. JME is considered to be a genetic epilepsy, and indeed in this case there was limited evidence that the epilepsy was autoimmune despite the presence of other autoimmune diseases, and her classification was “unknown” as she was negative for NSAbs and received no immunotherapy.
Suleiman 2013
Seizures can occur in Hashimoto’s encephalopathy, which is a rare association of autoimmune Hashimoto’s thyroiditis associated with Abs against thyroid peroxidase and thyroglobulin (Castillo et al., 2006). Patients described with Hashimoto encephalopathy present with broad clinical manifestations and are classically reported to be steroid responsive. The role of thyroid antibodies in Hashimoto encephalopathy is uncertain, and the term “steroid responsive encephalopathy associated with autoimmune thyroiditis” (SREAT) has been used to reflect the hypothesis that Hashimoto encephalopathy may be caused by unidentified neuronal autoantibodies (Castillo et al., 2002; Schauble et al., 2003).
Hamartoma Structure
Engel 2001
Huntington disease
ILAE 1989
An infantile type of Huntington’s disease appears after age 3 years, with a slowing of mental development, followed by dystonia, GTCS, atypical absence seizures, and myoclonic seizures. The EEG shows discharges of generalized spike-waves and polyspike-waves, with the usual photic stimulation rate.
Engel 2001
Huntington disease
Engel 2001
Menkes' Disease
What to do about outgrown, is this remission or resolved?
Bancaud 1981
Localized paralysis in the previously involved region and may last from minutes to hours.
Postictal Paralysis (Todd’s Paralysis)
This category refers to the transient paralysis that may occur following some partial epileptic seizures with focal motor components or with somatosensory symptoms. Postictal paralysis has been ascribed to neuronal exhaustion due to the increased metabolic activity of the discharging focus, but it may also be attributable to increased inhibition in the region of the focus, which may account for its appearance in non-motor somatosensory seizures.
Blume 2001
Lateralizing: Any unilateral postictal dysfunction relating to motor, language, sensory, and/or integrative functions including visual, auditory, or somatosensory neglect phenomena.
JB: Only in seizures, lack of movement following a seizure, as a postictal phenomenon (like confusion or blindness; a negative incarnation of anything that a seizure can do in a positive fashion)
The following project attempts to create a knowledge structure that can classify and describe information related to seizures and epilepsies. This is done by creating what is known as an 'ontology' which represents concepts specific to the domain of epilepsy. Intrinsic to which is describing/illustrating/demonstrating the relationships between the individual ‘pieces’ of information.
A classification system for epileptic seizures: The proposed classification for epilepsy seizures in the 2010 report has been criticized for not using the 2006 ILAE classification core group report (Engel, 2006), discarding terms (e.g., complex focal seizures), and the absence of terms to describe status epilepticus (Panayiotopoulos, 2011). The critical review recommended building consensus around the classification of “focal, myoclonic, or absence seizures,” but did not offer a specific model for classifying seizures (Panayiotopoulos, 2011).
Neural ElectroMagnetic Ontologies (NEMO) models electrophysiologic data terms, including electroencephalography (EEG) and functional Magnetic Resonance Imaging (MRI) related terms (Dou et al., 2007),
Look at SNOMED CT
An Epilepsy Syndrome and Seizure Type Ontology that describes the various epilepsy syndromes based on their features. The features include seizure types and EEG results that also have their own features.
Bancaud 1981
Sign
ILAE 1989
Characterized by a cluster of signs and symptoms customarily occurring together
Scheuermann 2009
A bodily feature of a patient that is observed in a physical examination and is deemed by the clinician to be of clinical significance.
Buchhalter: what is observed (individual or observer) in physical exam and plays a role in the history.
Bancaud 1981
Symptom
ILAE 1989
characterized by a cluster of signs and symptoms customarily occurring together
Scheuermann 2009
Symptom: A bodily feature of a patient that is observed by the patient and is hypothesized by the patient to be a realization of a disease. On some readings of the term, ‘symptom’ refers paradigmatically to pains and other feelings and sensations which are such that they can be observed only by the patient.