Seizure semiology and localization: not everything is generalized onset tonic-clonic. 🧠⛈️
Part 2: motor symptoms
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#Neurology #neurotwitter #Teaching #Education #EndNeurophobia
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Part 2: motor symptoms
🤔
#Neurology #neurotwitter #Teaching #Education #EndNeurophobia
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Intro
The following symptoms are frequently seen in focal and focal to bilateral tonic-clonic seizures.
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The following symptoms are frequently seen in focal and focal to bilateral tonic-clonic seizures.
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🚨
This tweetorial is based on:
Epilepsy Behav. 2005 Aug;7(1):1-17.
doi: 10.1016/j.yebeh.2005.04.004
This paper was written using the previous classification system and some data may need an update, nevertheless I find it useful when teaching about seizure semiology. 📓
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This tweetorial is based on:
Epilepsy Behav. 2005 Aug;7(1):1-17.
doi: 10.1016/j.yebeh.2005.04.004
This paper was written using the previous classification system and some data may need an update, nevertheless I find it useful when teaching about seizure semiology. 📓
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Motor symptoms:
1⃣
Sx: Forced Head Turn and Eye Deviation.
Where? Frontal eye and motor areas anterior to the precentral gyrus (Brodmann areas 6 and 8). Contralateral to the head turn.
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1⃣
Sx: Forced Head Turn and Eye Deviation.
Where? Frontal eye and motor areas anterior to the precentral gyrus (Brodmann areas 6 and 8). Contralateral to the head turn.
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Examples are found even in art!
The Transfiguration by Raphael de Sanzio.
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The Transfiguration by Raphael de Sanzio.
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Motor symptoms:
2⃣
Sx: Late version at the end of a bilateral seizure.
Where? Ipsilateral Brodmann area 6.
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2⃣
Sx: Late version at the end of a bilateral seizure.
Where? Ipsilateral Brodmann area 6.
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Motor symptoms:
3⃣
Sx: Unilateral clonic activity.
Where? Contralateral primary motor area (Brodmann area 4).
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3⃣
Sx: Unilateral clonic activity.
Where? Contralateral primary motor area (Brodmann area 4).
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Motor symptoms:
4⃣
Sx: Last clonic jerk.
Where? Ipsilateral to the seizure onset.
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4⃣
Sx: Last clonic jerk.
Where? Ipsilateral to the seizure onset.
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Motor symptoms:
5⃣
Sx: Unilateral tonic activity.
Where? Contralateral frontal lobe.
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5⃣
Sx: Unilateral tonic activity.
Where? Contralateral frontal lobe.
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Motor symptoms:
6⃣
Sx: Asymmetric tonic limb posturing ("figure-of-4 sign" and "Fencing Posture").
Where? Hemisphere (frontal supplemental motor area more than temporal) contralateral to the extended limb.
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6⃣
Sx: Asymmetric tonic limb posturing ("figure-of-4 sign" and "Fencing Posture").
Where? Hemisphere (frontal supplemental motor area more than temporal) contralateral to the extended limb.
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Motor symptoms:
7⃣
Sx: Unilateral dystonic posturing.
Where? Contralateral to the side of seizure onset.
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7⃣
Sx: Unilateral dystonic posturing.
Where? Contralateral to the side of seizure onset.
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Motor symptoms:
8⃣
Sx: Automatisms with preserved responsiveness.
Where? Nondominant temporal lobe.
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8⃣
Sx: Automatisms with preserved responsiveness.
Where? Nondominant temporal lobe.
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Motor symptoms:
9⃣
Sx: Ictal spitting.
Where? Nondominant temporal lobe.
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9⃣
Sx: Ictal spitting.
Where? Nondominant temporal lobe.
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Motor symptoms:
🔟
Sx: Ictal vomiting.
Where? Lateral superior and inferior structures of the nondominant temporal lobe.
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Sx: Ictal vomiting.
Where? Lateral superior and inferior structures of the nondominant temporal lobe.
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Motor symptoms:
1⃣1⃣
Sx: Unilateral ictal eye blinking.
Where? Ipsilateral to the ictal discharge.
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1⃣1⃣
Sx: Unilateral ictal eye blinking.
Where? Ipsilateral to the ictal discharge.
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Motor symptoms:
1⃣2⃣
Sx: Ictal paresis.
Where? Contralateral hemisphere.
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1⃣2⃣
Sx: Ictal paresis.
Where? Contralateral hemisphere.
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This was the second part of the Seizure semiology tweetorial, wait for parts 3 (language features) and 4 (postictal features) in the next couple of days.
Below are the sources.
Hope you liked it! 🤓
17/17
Below are the sources.
Hope you liked it! 🤓
17/17
Sources:
1.- Epilepsy Behav. 2005 Aug;7(1):1-17.
doi: 10.1016/j.yebeh.2005.04.004
2.- Epilepsia. 2017 Apr;58(4):522-530.
doi: 10.1111/epi.13670
3.- Blumenfield's Neuroanatomy Through Clinical Cases. 2nd Edition, 2010.
1.- Epilepsy Behav. 2005 Aug;7(1):1-17.
doi: 10.1016/j.yebeh.2005.04.004
2.- Epilepsia. 2017 Apr;58(4):522-530.
doi: 10.1111/epi.13670
3.- Blumenfield's Neuroanatomy Through Clinical Cases. 2nd Edition, 2010.
Sources:
4.- Mayo Clinic Board Review. Clinical neurology for initial certification and MOC. 2015.
5.- Epilepsy Behav. 2010 Feb;17(2):139-46.
doi: 10.1016/j.yebeh.2009.10.006
4.- Mayo Clinic Board Review. Clinical neurology for initial certification and MOC. 2015.
5.- Epilepsy Behav. 2010 Feb;17(2):139-46.
doi: 10.1016/j.yebeh.2009.10.006
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