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Keywords:

  • Seizure classification;
  • Ictal semiology;
  • Auras;
  • Motor seizures;
  • Paroxysmal events

Summary: We propose an epileptic seizure classification based exclusively on ictal semiology. In this semiological seizure classification (SSC), seizures are classified as follows:

a. Auras are ictal manifestations having sensory, psychosensory, and experiential symptoms.

b. Autonomic seizures are seizures in which the main ictal manifestations are objectively documented autonomic alterations.

c. “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).

d. 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”).

e. Special seizures include seizures characterized by “negative” features (atonic, astatic, hypomotor, akinetic, and aphasic seizures).

The SSC identifies in detail the somatotopic distribution of the ictal semiology as well as the seizure evolution. The advantages of a pure SSC, as opposed to the current classification of the International League Against Epilepsy (ILAE), which is actually a classification of electroclinical syndromes, are discussed.