Dr Rajeev Saxena, Dr Anuj Singhal, Dr NC Borah, Dr P Deka, Dr P Deb


Introduction: Ictal recordings have long been considered a critical component of the pre-surgical evaluation. However, with the exception of TLE, the localizing value of Ictal EEG not been extensively studied. In this study, we are trying to correlate the ictal video EEG with semiology of symptoms of seizures. There are lots of studies which are dealing in inter-ictal EEG but very few shows ictal Video EEG correlation with semiological classification of seizure. This will also be the first study involving the population of North-east which had been exclusive from medical research till now in the field of epilepsy.

Methodology: In this pilot study, 100 patients who had paroxysmal event or seizure during Video EEG Monitoring were included in this study. The data was collected by taking clinical history of the patients, Interviewing the attendant and eye witness, Video EEG monitoring. The patient underwent at least 12-hour video EEG and events were recorded. The records of Video EEG were reviewed by electrophysiologist and Clinical semiology of symptoms of seizure was done by the neurologist. Both the semiology of seizure was compared.  After the ictal video EEG recording, the electro physiologist had classified the seizure and at the same time clinical classification of seizure was done independently by the neurologist. The two semiological classifications were compared with each other and noted the variation.

Results: In Ictal phase, tonic movement had occurred in 74% and clonic in 44% of the cases. The version of head and eye (both forced and unforced) was found in the 44% cases. In the complex behavior, oro-alimentary automatism, motor /gestural automatism was found to be 27% and 23% respectively. The extreme fear was associated with both temporal and frontal seizure in 16% cases and laughing or crying was found in 10% case. The hyper motor activity finds worth mentioning especially seizures originating in frontal lobe in 11% cases. The facial grimace was in 10% case and ipsilateral nose rubbing in 4% cases.

Conclusion: Our results, confirm some Ictal clinical sign, when studied in cluster can be used as localization and lateralization of epilepsy. When the clinical semiology of seizure correlated with the ictal Video EEG findings can confirm the localization and lateralization in 76% of cases. Therefore, the finding of our study further consolidated the concept that VEEG and semiology of seizures when done together in detail can be accurate as depicted by the positive predictive value. The other modalities like invasive recording and functional MRI would still be required to ascertain the seizure zone before elective surgery.


seizures, EEG, video EEG, semiology of seizure symptoms

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