Mastering Epilepsy Semiology

Abstract

  The three principles for the focus diagnosis of epilepsy are semiology, electroencephalography (EEG), and brain imaging. When applying seizure semiology to localization diagnosis, the concept of the symptomatogenic zone is crucial. The symptomatogenic zone may be the seizure onset region itself or an area in the vicinity of the seizure onset region. In seizure semiology, manifestations include positive and negative signs. Clinical-electrical-anatomical diagnosis is important to make a localization diagnosis of the epileptogenic region inferred from the semiology in combination with EEG and imaging studies. Understanding epilepsy semiology is also crucial for the diagnosing of non-epileptic seizures in practice. In this article, we discussed the differential diagnosing between syncope and epileptic seizures. Seizures with brief loss of consciousness are classified into absence seizures and focal impaired awareness seizures, with focal impaired awareness seizures often having temporal or frontal lobe onset. Differential diagnosis of these types of seizures is also presented. Symptoms of frontal lobe-onset seizures can be categorized into lateral, medial, and basal. The characteristics of insular onset seizures are also discussed.