SEIZURE SEMIOLOGY TWEETORIAL
#Epilepsy #Neurotwitter #Neurology #Seizure
🧵1/ What is a versive seizure?
Version is defined as clonic or tonic head and eye deviation, unquestionably forced and involuntary, resulting in sustained unnatural positioning of the head and eyes.
#Epilepsy #Neurotwitter #Neurology #Seizure
🧵1/ What is a versive seizure?
Version is defined as clonic or tonic head and eye deviation, unquestionably forced and involuntary, resulting in sustained unnatural positioning of the head and eyes.
2/ The significance of 'version' as a lateralizing feature was first recognized by Sir John Hughlings Jackson in the 19th century. He suggested that consistent initial head-turning to one side indicated a contralateral 'discharging lesion.' #Epilepsy #Neurotwitter #Neurology
3/ The term "adversive" was first used by Foerster and Penfield in 1930. Penfield and Erickson described a 'simple adversive seizure' as "a pantomime of looking at something behind the patient's back" in 1941. #Epilepsy #Seizure #NeuroTwitter #Neurology
4/ Penfield and Kristiansen reported 7 cases out of 222 where the initial seizure manifestation was a simple adversion with retained consciousness, described as "head turning usually along with eyes and body in the same direction", away from the discharging hemisphere. #Epilepsy
5/ Gastaut used the neutral term 'versive' in 1954 and defined it as "motor seizures which by the coordinated action of bilateral synergistic muscles cause turning to one side of the eyes, the head and the body, either together or separately." #Epilepsy #Seizure #NeuroTwitter
6/ Publications, mainly from the Montreal Neurological Institute in the 1980s reported that 'ipsiversion' was almost as common as 'contraversion' and hence, 'version' was not considered to have a high lateralizing value. #Epilepsy #Seizure #Neurology #NeuroTwitter
7/ In 1986, Drs. Wyllie and Lüders proposed a more strict definition of 'version' as written in the first tweet. Versive movements (as opposed to non-versive) were shown to have a high lateralizing value to contralateral hemisphere. #Epilepsy #Neurotwitter
8/ Kernan, et al showed in 1993 that forced head deviation (version) was contralateral to seizure onset hemisphere in >90% of seizures with secondary generalization if the movement continued as the seizure generalized or occurred within 10 seconds of generalization. #Epilepsy
9/ In a study of seizure semiology in temporal and extratemporal epilepsy, Bleasel, et al. observed that version occurred in 35.3% of TLE seizures and was contralateral in 100%. It occurred in 40% of ETLE seizures and was contralateral in 100% as well. #Epilepsy #NeuroTwitter
10/ Marashly, et al. also reported very high lateralizing significance for version in focal epilepsies ending with a secondarily generalized tonic-clonic seizure. #Epilepsy #Seizure #Neurology #NeuroTwitter
11/ The most likely symptomatogenic zone for version is the Frontal eye field (FEF) as has been shown in various cortical stimulation studies, although many other eye fields have been described.
12/ Summary- Versive head and eye movements are forced, sustained, unnatural (as if looking back and over the shoulder). These lateralize to contralateral hemisphere with a very high reliability. The most likely symptomatogenic zone is FEF. #Epilepsy #Seizure #NeuroTwitter
جاري تحميل الاقتراحات...