Semiology of epileptic seizures

Background
Epilepsy diagnosis is mainly clinical, as it depends on the detailed analysis of the seizure semiology. This study reviews the systematic way to describe and classify seizure semiology with the help of using electro-clinical methods for better diagnosis and to choose the most effective medical treatment.
Patients and methods
This study was conducted on 60 epileptic patients throughout the period from 1 of October 2016 to 31 of March 2017 in Assiut University Hospital. We excluded patients who lacked eye witness and who had seizures owing to metabolic causes. All patients were subjected to complete general and neurological examination, epilepsy sheet with detailed seizure semiology analysis, and electroencephalogram (EEG).
Results
Prodroma was found in 26 (43.3%) cases, and aura was recorded in 34 (56.7%) cases. Forty (66.7%) cases had automatism more in the form of picking cloths and unresponsiveness. Most cases (63.3%) reported loss of contact with surroundings and 28.3% lost their consciousness. Ipsiversive movement was recorded in 13.3% of cases, whole-body myoclonus was presented in 10% of cases, unilateral nonmarching sensory seizure in 3.3%, 23.3% presented with tonic seizure, and 16.7% with tonic–clonic seizure. Postictal amnesia was seen in 60% of cases, postictal confusion in 46.7%, and postictal Todd's paralysis in 6.7%. Distribution of epileptic activity in EEG was mostly in left fronto-temporal area (20%).
Conclusion
Clinical semiology is the starting point of understanding seizure disorder and making the diagnosis of epilepsy. The correlation between analysis of the development and sequence of semiologic features and EEG findings can identify the seizure initiation and propagation.