SEIZURE SEMIOLOGY #TWEETORIAL
๐งต1/ What is a dialeptic seizure?
Dialeptic seizure is defined by a peculiar alteration of consciousness in epilepsy, characterized by complete or partial unresponsiveness w/ motor/behavioral arrest AND amnesia.
#Epilepsy #EEG #SeizureSemiology
๐งต1/ What is a dialeptic seizure?
Dialeptic seizure is defined by a peculiar alteration of consciousness in epilepsy, characterized by complete or partial unresponsiveness w/ motor/behavioral arrest AND amnesia.
#Epilepsy #EEG #SeizureSemiology
2/ The term "dialepsis" was proposed in 1998 to identify and classify this peculiar seizure only by semiology. The term "absence" refers to a subtype of dialeptic seizures which has a characteristic EEG pattern of generalized 3Hz spike and wave (Gen epilepsy).
3/ The term is derived from a Greek verb "ฮดฮนฮฑฮปฮตฮนฯฮตฮนฮฝ" which means "to interrupt", "stand still" or "pass out".
4/ The two critical components to define "dialepsis" are:
a- Complete or partial unresponsiveness during the seizure.
b- amnesia about the seizure (tested on post-ictal interview).
a- Complete or partial unresponsiveness during the seizure.
b- amnesia about the seizure (tested on post-ictal interview).
5/ Dialeptic seizures can be seen in both focal and generalized epilepsies. The term "focal" and "generalized" as used here refer to the "Epileptogenic zone", not a particular syndrome.
6/ As far as epilepsy syndromes are concerned, dialeptic seizures can occur in various syndromes like Absence epilepsy, Juvenile myoclonic epilepsy, Lennox-Gastaut syndrome, Focal epilepsies like Temporal lobe epilepsy.
7/ Dialeptic seizures in Absence epilepsy: These are usually brief, lasting for 4-10 seconds, associated w/ arrest of movement (except some eyelid myoclonus). The EEG pattern is generalized 3Hz spike and wave. The onset & offset are sudden.
8/ Other Generalized Epilepsies: Dialeptic seizures are reported in a significant percentage of JME patients (15-40%). The EEG pattern could consistent of 3Hz spike-wave or a faster run of spikes (typical of JME).
9/ Focal epilepsies: Dialeptic seizures are well described in focal epilepsies as well. Dialepsis, by itself, has minimal localizing/lateralizing value. It is the overall sequence of seizure semiology that helps to localize and lateralize the EZ.
10/ One key feature that can help distinguish temporal lobe epilepsy from frontal lobe epilepsy is the time lag from the onset of dialepsis to the first motor manifestation (like version). It is usually<20s for extra-temporal epilepsies.
11/ Dialeptic seizures are often associated w/ automatisms. Oroalimentary & gesticulatory automatisms are more likely in temporal lobe epilepsy. More proximal arm & leg automatisms (hypermotor) are more likely in frontal lobe epilepsy. Longer the dialepsis, more the automatisms.
12/ Conclusion: Dialepsis is a semiological term which describes the peculiar alteration of consciousness seen in epilepsy patients. It can be seen in both focal & generalized epilepsies. It has minimal localizing & lateralizing value. #Epilepsy #EEG #Neurotwitter
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