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I. GENERAL TERMS
1.0 SEMEIOLOGY (SEMIOLOGY)
That branch of linguistics concerned with signs and symptoms.
2.0 EPILEPTIC SEIZURE
Manifestation(s) of epileptic (excessive and/or hypersynchronous),
usually self-limited activity of neurons in the brain.
3.0 ICTUS
A sudden neurological occurrence such as a stroke or an epileptic
seizure.
4.0 EPILEPSY
a) Epileptic Disorder: A chronic neurological condition characterised
by recurrent epileptic seizures.
b) Epilepsies: Those conditions involving chronic recurrent epileptic
seizures that can be considered epileptic disorders.
5.0 FOCAL (syn. partial)
A seizure whose initial semiology indicates, or is consistent with,
initial activation of only part of one cerebral hemisphere.
6.0 GENERALISED (syn. bilateral)
A seizure whose initial semiology indicates, or is consistent with,
more than minimal involvement of both cerebral hemispheres.
7.0 CONVULSION
Primarily a lay term. Episodes of excessive, abnormal muscle contractions,
usually bilateral, which may be sustained or interrupted.
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II. TERMS DESCRIBING EPILEPTIC SEIZURE SEMEIOLOGY
These are descriptors of seizures unless specified
otherwise.
1.0 MOTOR
Involves musculature in any form. The motor event could consist
of an increase (positive) or decrease (negative) in muscle contraction
to produce a movement.
Unless noted, the following terms are adjectives modifying
"motor seizure" or "seizure" e.g. "tonic motor seizure or dystonic
seizure", and whose definitions can usually be understood as prefaced
by: "refers to ...".
1.1 ELEMENTARY MOTOR
A single type of contraction of a muscle or group of muscles that
is usually stereotyped and not decomposable into phases. (However,
see Tonic-Clonic, an elementary motor sequence).
1.1.1 TONIC
A sustained increase in muscle contraction lasting a few seconds
to minutes.
1.1.1.1 EPILEPTIC SPASM (Formerly
Infantile Spasm)
Noun: A sudden flexion, extension or mixed extension-flexion of
predominantly proximal and truncal muscles which is usually more
sustained than a myoclonic movement but not as sustained as a tonic
seizure i.e. about 1 sec. Limited forms may occur: grimacing, head
nodding.. Epileptic spasms frequently occur in clusters.
1.1.1.2 POSTURAL
Adoption of a posture which may be bilaterally symmetrical or asymmetrical
(as in a "fencing posture").
1.1.1.2.1 VERSIVE
A sustained, forced conjugate ocular, cephalic and/or truncal rotation
or lateral deviation from the midline.
1.1.1.2.2 DYSTONIC
Sustained contractions of both agonist and antagonist muscles producing
athetoid or twisting movements which when prolonged may produce
abnormal postures.
1.1.2 MYOCLONIC (adjective);
MYOCLONUS (noun)
Sudden, brief (< 100 msec) involuntary single or multiple contraction(s)
of muscles(s) or muscle groups of variable topography (axial, proximal
limb, distal).
1.1.2.1 NEGATIVE MYOCLONIC
Interruption of tonic muscular activity for < 500 msec without evidence
of antecedent myoclonia.
1.1.2.2 CLONIC
Myoclonus which is regularly repetitive, involves the same muscle
groups, at a frequency of about 2-3 c/sec, and is prolonged. Synonym:
rhythmic myoclonus.
1.1.2.2.1 JACKSONIAN MARCH
Noun: Traditional term indicating spread of clonic movements through
contiguous body parts unilaterally.
1.1.3 TONIC-CLONIC
A sequence consisting of a tonic followed by a clonic phase. Variants
such as clonic-tonic-clonic may be seen.
1.1.3.1 GENERALISED TONIC-CLONIC
SEIZURE (syn. bilateral tonic-clonic seizure (Formerly "Grand
Mal" Seizure))
Noun: Bilateral symmetrical tonic contraction then bilateral clonic
contractions of somatic muscles usually associated with autonomic
phenomena.
1.1.4 ATONIC
Sudden loss or diminution of muscle tone without apparent preceding
myoclonic or tonic event lasting one to two seconds or more, involving
head, trunk, jaw or limb musculature.
1.1.5 ASTATIC
Loss of erect posture that results from an atonic, myoclonic or
tonic mechanism. Synonym: drop attack.
1.1.6 SYNCHRONOUS (Asynchronous)
Motor events occurring (not) at the same time or at the same rate
in sets of body parts.
1.2 AUTOMATISM
Noun: A more or less coordinated, repetitive, motor activity usually
occurring when cognition is impaired and for which the subject is
usually amnesic afterwards. This often resembles a voluntary movement,
and may consist of inappropriate continuation of ongoing preictal
motor activity.
The following adjectives are usually employed to modify
"automatism".
1.2.1 OROALIMENTARY
Lip smacking, lip pursing, chewing, licking, tooth grinding or swallowing.
1.2.2 MIMETIC
Facial expression suggesting an emotional state, often fear.
1.2.3 MANUAL OR PEDAL
- Indicates principally distal components, bilateral or unilateral.
- Fumbling, tapping, manipulating movements.
1.2.4 GESTURAL
Often unilateral.
- Fumbling or exploratory movements with the hand directed toward
self or environment.
- Movements resembling those intended to lend further emotional
tone to speech.
1.2.5 HYPERKINETIC
- Involves predominantly proximal limb or axial muscles producing
irregular sequential ballistic movements, such as pedalling, pelvic
thrashing, rocking movements.
- Increase in rate of ongoing movements or inappropriately rapid
performance of a movement.
1.2.6 HYPOKINETIC
A decrease in amplitude and/or rate or arrest of ongoing motor activity.
1.2.7 DYSPHASIC
Impaired communication involving language without dysfunction of
relevant primary motor or sensory pathways, manifested as impaired
comprehension, anomia, paraphasic errors or a combination of these.
1.2.8 DYSPRAXIC
Inability to perform learned movements spontaneously or on command
or imitation despite intact relevant motor and sensory systems and
adequate comprehension and cooperation.
1.2.9 GELASTIC
Bursts of laughter or giggling, usually without an appropriate affective
tone.
1.2.10 DACRYSTIC
Bursts of crying.
1.2.11 VOCAL
Single or repetitive utterances consisting of sounds such as grunts
or shrieks.
1.2.12 VERBAL
Single or repetitive utterances consisting of words, phrases or
brief sentences.
1.2.13 SPONTANEOUS
Stereotyped, involve only self, and are virtually independent
of environmental influences.
1.2.14 INTERACTIVE
Not stereotyped, involve more than self, and are environmentally
influenced.
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2.0 NON-MOTOR
2.1 AURA
Noun: A subjective ictal phenomenon that, in a given patient, may
precede an observable seizure; if alone, constitutes a sensory seizure.
2.2 SENSORY
A perceptual experience not caused by appropriate stimuli in the
external world. Modifies "seizure or "aura".
2.2.1 ELEMENTARY
A single, unformed phenomenon involving one primary sensory modality,
e.g. somatosensory, visual, auditory, olfactory, gustatory, epigastric,
or cephalic.
2.2.1.1 SOMATOSENSORY
Tingling, numbness, electric shock sensation, pain, sense of movement,
or desire to move.
2.2.1.2 VISUAL
Flashing or flickering lights, spots, simple patterns, scotomata,
or amaurosis.
2.2.1.3 AUDITORY
Buzzing, drumming sounds or single tones.
2.2.1.4 OLFACTORY
Odour, usually disagreeable.
2.2.1.5 GUSTATORY
Taste sensations including acidic, bitter, salty , sweet or metalic.
2.2.1.6 EPIGASTRIC
Abdominal discomfort including nausea, emptiness, tightness, churning,
butterflies, malaise, pain, and hunger; sensation may rise to chest
or throat. Some phenomena may reflect ictal autonomic dysfunction.
2.2.1.7 CEPHALIC
Sensation in the head such as light headedness, tingling or headache.
2.2.1.8 AUTONOMIC
A sensation consistent with involvement of the autonomic nervous
system, including cardiovascular, gastrointestinal, sudomotor, vasomotor
and thermoregulatory functions. (Thus, "autonomic aura"; cf. "autonomic
seizure" 3.0).
2.2.2 EXPERIENTIAL
Affective, mnemonic or composite perceptual phenomena including
illusory or composite hallucinatory events; these may appear alone
or in combination. Included are feelings of depersonalisation. These
phenomena have subjective qualities similar to those experienced
in life but are recognised by the subject as occurring outside of
actual context.
2.2.2.1 AFFECTIVE
Components include: fear, depression, joy and (rarely) anger.
2.2.2.2 MNEMONIC
Components which reflect ictal dysmnesia such as: feelings as familiarity
(déjà-vu) and unfamiliarity (jamais-vu).
2.2.2.3 HALLUCINATORY
A creation of composite perceptions without corresponding external
stimuli involving visual, auditory, somatosensory, olfactory and/or
gustatory phenomena. Example: "hearing" and "seeing"
people talking.
2.2.2.4 ILLUSORY
An alteration of actual percepts involving the visual, auditory,
somatosensory, olfactory or gustatory systems.
2.3 DYSCOGNITIVE
The term describes events in which: 1) disturbance of cognition
is the prominent or most apparent feature, and 2a) two or more of
the following components are involved, or 2b) contributions of such
components remain undetermined. Otherwise, use more specific term
e.g. mnemonic experimental seziure or "hallucinatory experimental
seizure."
Components of cognition:
- perception: symbolic conception of sensory information
- attention: appropriate selection of a principal perception or
task
- emotion: appropriate affective significance of a perception
- memory: ability to store and retrieve percepts or concepts
- executive function: anticipation, selection, monitoring of consequences,
initiation of motor activity including praxis, speech
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3.0 AUTONOMIC EVENTS
3.1 AUTONOMIC AURA
A sensation consistent with involvement of the autonomic nervous
system, including cardiovascular, gastrointestinal, sudomotor, vasomotor
and thermoregulatory functions. (see 2.3.1.8).
3.2 AUTONOMIC SEIZURE
An objectively documented and distinct alteration of autonomic nervous
system function involving cardiovascular, pupillary, gastrointestinal,
sudomotor, vasomotor and thermoregularity functions.
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4.0 SOMATOTOPIC MODIFIERS
4.1 LATERALITY
4.1.1 UNILATERAL
Exclusive or virtually exclusive involvement of one side as a motor,
sensory or autonomic phenomenon.
4.1.1.1 HEMI-
A prefix to other descriptors e.g. hemiclonic.
4.1.2 GENERALISED (syn.
"bilateral")
More than minimal involvement of each side as a motor, elementary
sensory or autonomic phenomenon.
Motor component: further modified as:
4.1.2.1 ASYMMETRICAL
Clear distinction in quantity and/or distribution of behaviour on
the two sides.
4.1.2.2 SYMMETRICAL
Virtual bilateral equality in these respects.
4.2 BODY PART
Refers to area involved i.e. arm, leg, face, trunk and other.
4.3 CENTRICITY
Modifier describes proximity to the body axis.
4.3.1 AXIAL
Involves trunk, including neck.
4.3.2 PROXIMAL LIMB
Signifies involvement from shoulders to wrist, hip to ankle.
4.3.3 DISTAL LIMB
Indicates involvement of fingers, hands, toes, and/or feet.
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5.0 MODIFIERS AND DESCRIPTORS
OF SEIZURE TIMING
The following terms are listed in the form (adjective, noun, verb)
according to principal usage; as adjective unless specified.
5.1 INCIDENCE
Noun: Refers to the number of epileptic seizures within a time period
or the number of seizure days per unit of time.
5.1.1 REGULAR, IRREGULAR
Consistent (inconsistent) or predictable (unpredictable, chaotic)
intervals between such events.
5.1.2 CLUSTER
1) Noun: Incidence of seizures within a given period (usually one
or a few days) which exceeds the average of incidence over a longer
period for the patient.
2) Verb: To vary in incidence as above.
5.1.3 PROVOCATIVE FACTOR
Noun: Transient and sporadic endogenous or exogenous element capable
of augmenting seizure incidence in persons with chronic epilepsy
and evoking seizures in susceptible non-epileptic individuals.
5.1.3.1 REACTIVE
Occurring in association with transient systemic perturbation such
as intercurrent illness, sleep loss or emotional stress.
5.1.3.2 REFLEX
Objectively and consistently demonstrated to be evoked by a specific
afferent stimulus or by activity of the patient. Afferent stimuli
can be: elementary, i.e. unstructured (light flashes, startle, a
monotone) or elaborate i.e. structured, (a symphony). Activity may
be elementary, e.g. motor (a movement); or elaborate,
e.g. cognitive function (reading, chess playing), or both (reading
aloud).
5.2 STATE DEPENDENT
Occurring exclusively or primarily in the various stages of drowsiness,
sleep, or arousal.
5.3 CATAMENIAL
Seizures occurring principally or exclusively in any one phase of
the menstrual cycle.
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6.0 DURATION
Time between the beginning of initial seizure manifestations, such
as the aura, to the cessation of experienced or observed seizure
activity. Does not include non-specific seizure premonitions or
postictal states.
6.1 STATUS EPILEPTICUS
A seizure which shows no clinical signs of arresting after a duration
encompassing the great majority of seizures of that type in most
patients or recurrent seizures without resumption of baseline central
nervous system function interictally.
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7.0 SEVERITY
A multicomponent assessment of a seizure by observers and the patient.
Components primarily of observer assessment include:
duration, extent of motor involvement, impairment of cognitive interaction
with environment intraictally, maximum number of seizures per unit
of time.
Components primarily of patient assessment: extent
of injury; emotional, social and vocational consequences of the
attack.
8.0 PRODROME
A preictal phenomenon. A subjective or objective clinical alteration,
e.g. ill-localised sensation or agitation, that heralds the onset
of an epileptic seizure but does not form part of it.
9.0 POSTICTAL PHENOMENON
A transient clinical abnormality of central nervous system function
that appears or becomes accentuated when clinical signs of the ictus
have ended.
9.1 LATERALISING (TODD'S (OR
BRAVAIS')) PHENOMENON
Any unilateral postictal dysfunction relating to motor, speech,
somatosensory and/or integrative functions including visual, auditory
or somatosensory neglect phenomena.
9.2 NON-LATERALISING PHENOMENA
Impaired cognition, amnesia, psychosis.
9.2.1 IMPAIRED COGNITION
Decreased cognitive performance involving one or more of: perception,
attention, emotion, memory, execution, praxis, speech (cf Dyscognitive,
2.3).
9.2.2 ANTEROGRADE AMNESIA
Impaired ability to remember new material.
9.2.3 RETROGRADE AMNESIA
Impaired ability to recall previously remembered material.
9.2.4 PSYCHOSIS
Misinterpretation of external world in an awake, alert person; involves
thought disorder of emotion and socialisation.
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