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Table Summary of Seizure Semiology (Based on CEC Classification) I. Auras /Cognitive Sphere: Subjective sensations before a seizure Somatosenso ry aura Tingling, and warmth in specific body parts primary somatosensory (1,2,3)-contralateral If poor localized -> SSMA ( 6 medial) of frontal lobe Visual Aura Visual hallucinations The primary visual cortex (17) – contralateral if complex -> visual association Auditory Aura Buzzing, ringing sounds Heschl’s gyrus (41,42) of temporal lobe Olfactory Aura The smell of burning rubber or strange odors Uncus (34) of, the temporal lobe Gustatory Aura Bitter or metallic taste Insula cortex Visceral Aura Rising nausea, discomfort Insula cortex
Psychic Aura Déjà vu, fear, hallucinations Amygdala (fear), basal temporal lobe (déjà vu) II. Autonomic Sphere: Objective autonomic symptoms Autonomic Seizures (e.g., heart rate changes, sweating) Iinsula cortex III. Consciousness Sphere Dialectic Seizures Impaired awareness, staring, unresponsiveness Bilateral hippocampal involvement or diffuse cortical dysfunction Limbic associated
- Smell -Déjà vu/psych Insula associated
- Tasting
- Autonomic IV. Motor Sphere: Abnormal movements during seizure A. Simple Motor Seizures (Single-plane movement) Clonic Seizure Repetitive rhythmic jerking : jacksonian march ie spreading from prox to distal primary motor (4) - contralateral Tonic Seizure Sustained muscle contraction asymmetric tonic limb posturing: fencing, figure of 4 signs SSMA (6 medial) – contralateral to the extend arm
Gelastic Seizures Involuntary laughter Hypothalamic hamartoma, frontal lobe V. Special Seizures: Negative Symptoms Atonic Seizure Sudden loss of muscle tone (collapse) The reticular formation, brainstem Astatic Seizure Drop attacks, risk of injury Variable Hypomotor Seizure Staring with reduced movement Variable, often generalized Akinetic Seizure Loss of voluntary movement Negative motor areas Negative Myoclonic Seizure Brief episodes of atonia Motor areas, subcortical mechanisms Aphasic Seizure speech arrest in Broca’s aphasia Ability to repeat (Say again after me) exclude peri- S ylvial language area Naming lost in all kinds of aphasia Broca’s, (44,45) Wernicke’s, (hearing 22 of temporal lobe + reading 39, pronouncing 40 of temporal)
