Abstract
Aim. Signs indicating the end of a focal seizure with loss of awareness and/or responsiveness but without progression to focal or generalizedmotorsymptomsare poorlydefinedandcanbedifficult to determine. Not recognizing the transition from ictal to postictal behaviour can affect seizure reporting accuracy by family members and may lead to delayed or a lack of examination during EEG monitoring, erroneous seizure localization and inadequate medical intervention for prolonged seizure duration. Methods. Our epilepsy monitoring unit database was searched for focal seizures without secondary generalization for the period from 2007 to 2011. The first focal seizure in a patient with loss of awareness and/or responsiveness and/or behavioural arrest, with or without automatisms, was included. Seizures without objective symptoms or inadequate video-EEG qualitywere excluded. Results. A total of 67 patients were included, with an average age of 41.7 years. Thirty-six of the patients had seizures from the left hemisphere and 29 from the right. All patients showed an abrupt change in motor activity and resumed contact with the environment as a sign of clinical seizure ending. Specific ending signs (nose wiping, coughing, sighing, throat clearing, or laughter) were seen in 23 of 47 of temporal lobe seizures and 7 of 20 extra-temporal seizures. Conclusions. Seizure ending signs are often subtle and the most common finding is a sudden change in motor activity and resumption of contact with the environment. More distinct signs, such as nose wiping, coughing or throat clearing, are not specific to temporal lobe onset. A higher proportion of seizures during sleep went unexamined, compared to those during wakefulness. This demonstrates that seizure semiology can be very subtle and arousals from sleep during monitoring should alert staff. Patient accounts of seizure frequency appear to be unreliable and witness reports need to be taken into account. [Published with video sequences].
| Original language | English (US) |
|---|---|
| Pages (from-to) | 255-262 |
| Number of pages | 8 |
| Journal | Epileptic Disorders |
| Volume | 17 |
| Issue number | 3 |
| State | Published - Sep 1 2015 |
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Keywords
- Dyscognitive seizures
- Seizure ending signs
- Seizure semiology
ASJC Scopus subject areas
- Neurology
- Clinical Neurology
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Seizure ending signs in patients with dyscognitive focal seizures. / Gavvala, Jay R.; Gerard, Elizabeth Erway; Macken, Micheal P; Schuele, Stephan U.
In: Epileptic Disorders, Vol. 17, No. 3, 01.09.2015, p. 255-262.Research output: Contribution to journal › Article
TY - JOUR
T1 - Seizure ending signs in patients with dyscognitive focal seizures
AU - Gavvala, Jay R.
AU - Gerard, Elizabeth Erway
AU - Macken, Micheal P
AU - Schuele, Stephan U
PY - 2015/9/1
Y1 - 2015/9/1
N2 - Aim. Signs indicating the end of a focal seizure with loss of awareness and/or responsiveness but without progression to focal or generalizedmotorsymptomsare poorlydefinedandcanbedifficult to determine. Not recognizing the transition from ictal to postictal behaviour can affect seizure reporting accuracy by family members and may lead to delayed or a lack of examination during EEG monitoring, erroneous seizure localization and inadequate medical intervention for prolonged seizure duration. Methods. Our epilepsy monitoring unit database was searched for focal seizures without secondary generalization for the period from 2007 to 2011. The first focal seizure in a patient with loss of awareness and/or responsiveness and/or behavioural arrest, with or without automatisms, was included. Seizures without objective symptoms or inadequate video-EEG qualitywere excluded. Results. A total of 67 patients were included, with an average age of 41.7 years. Thirty-six of the patients had seizures from the left hemisphere and 29 from the right. All patients showed an abrupt change in motor activity and resumed contact with the environment as a sign of clinical seizure ending. Specific ending signs (nose wiping, coughing, sighing, throat clearing, or laughter) were seen in 23 of 47 of temporal lobe seizures and 7 of 20 extra-temporal seizures. Conclusions. Seizure ending signs are often subtle and the most common finding is a sudden change in motor activity and resumption of contact with the environment. More distinct signs, such as nose wiping, coughing or throat clearing, are not specific to temporal lobe onset. A higher proportion of seizures during sleep went unexamined, compared to those during wakefulness. This demonstrates that seizure semiology can be very subtle and arousals from sleep during monitoring should alert staff. Patient accounts of seizure frequency appear to be unreliable and witness reports need to be taken into account. [Published with video sequences].
AB - Aim. Signs indicating the end of a focal seizure with loss of awareness and/or responsiveness but without progression to focal or generalizedmotorsymptomsare poorlydefinedandcanbedifficult to determine. Not recognizing the transition from ictal to postictal behaviour can affect seizure reporting accuracy by family members and may lead to delayed or a lack of examination during EEG monitoring, erroneous seizure localization and inadequate medical intervention for prolonged seizure duration. Methods. Our epilepsy monitoring unit database was searched for focal seizures without secondary generalization for the period from 2007 to 2011. The first focal seizure in a patient with loss of awareness and/or responsiveness and/or behavioural arrest, with or without automatisms, was included. Seizures without objective symptoms or inadequate video-EEG qualitywere excluded. Results. A total of 67 patients were included, with an average age of 41.7 years. Thirty-six of the patients had seizures from the left hemisphere and 29 from the right. All patients showed an abrupt change in motor activity and resumed contact with the environment as a sign of clinical seizure ending. Specific ending signs (nose wiping, coughing, sighing, throat clearing, or laughter) were seen in 23 of 47 of temporal lobe seizures and 7 of 20 extra-temporal seizures. Conclusions. Seizure ending signs are often subtle and the most common finding is a sudden change in motor activity and resumption of contact with the environment. More distinct signs, such as nose wiping, coughing or throat clearing, are not specific to temporal lobe onset. A higher proportion of seizures during sleep went unexamined, compared to those during wakefulness. This demonstrates that seizure semiology can be very subtle and arousals from sleep during monitoring should alert staff. Patient accounts of seizure frequency appear to be unreliable and witness reports need to be taken into account. [Published with video sequences].
KW - Dyscognitive seizures
KW - Seizure ending signs
KW - Seizure semiology
UR - http://www.scopus.com/inward/record.url?scp=84942236290&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84942236290&partnerID=8YFLogxK
M3 - Article
C2 - 26271680
AN - SCOPUS:84942236290
VL - 17
SP - 255
EP - 262
JO - Epileptic Disorders
JF - Epileptic Disorders
SN - 1294-9361
IS - 3
ER -