Abstracts

Rationale: There is extensive historical and current practical evidence supporting the notion that different seizure semiologies relate to specific anatomical localizations. However, to our knowledge, no systematic analysis of the corresponding electrographic (EEG) data in seizures of different semiology has been reported. The aim of this study was to evaluate the relationship between semiology of seizures in children and adolescenet to the corresponding localization. Methods: Charts of 225 consecutive pediatric epilepsy patients undergoing Video-EEG monitoring (VEM) over 2 years were reviewed. Seizure semiology recorded during VEM was classified according to ILAE seizure semiology terminology and EEG localization, and analyzed based on onset as defined by the EEG data (generalized, frontal, temporal, parietal, occipital or a combination of different lobes). Statistical analysis (binominal test) was performed using SPSS (version 16.0). Results: A total of 1008 seizures were analyzed in 225 children, mean age was 8.5 years 5.7 (range 0-20), with 50% girls. Auras and seizures with automatisms arose predominantly from the temporal lobes (p<0.001). Tonic, clonic and tonic-clonic seizures had most commonly generalized onset (p<0.001). Hypomotor seizures were most frequently seen from the frontal lobes (p<0.001). Hypermotor seizures had most commonly multiple lobes or temporal onset (p<0.001 and p<0.05 respectively). Atonic, myoclonic seizures and spasms had almost exclusively generalized onset (p<0.001). Gelastic seizures had only generalized onset (p<0.001). Dyscognitive seizures had most commonly generalized or temporal onset (p<0.001). Versive seizures had a strong association with multiple lobes being involved at onset (p<0.001). Conclusions: Different seizure semiologies relate to specific brain regions, as identified electrographically. Findings based on EEG provide important information on the seizure epileptogenic zone and seizure propagation, although seizure freedom after resection remains the gold standard for localization. Semiology of seizures can provide important information for epilepsy localization, and should not be overlooked especially in patients undergoing pre-surgical evaluation.