Abstracts

Seizure semiology plays an important role in the epilepsy classification proccess. Long-term video EEG evaluation (LTVE) is considered the [ldquo]gold-standard[rdquo] to study seizure semiology. However, LTVE is not always available and seizure semiology has to be inferred from the clinical history. The aim of this study was to compare the seizure semiology reported by the patient in an outpatient tertiary epilepsy clinic with the semiology observed during LTVE to determine the degree of reliability of the symptoms and signs referred by the patients. We analyzed the seizure semiology reported in the outpatient clinic to an experienced epileptologist by all patients with focal epilepsy who underwent presurgical evaluation between 1990-2004 and compared it with the seizure semiology observed during LTVE. Concordance rate was defined as percentage of patients who described a certain seizure semiology which was later confirmed during LTVE. Seizures were classified according to the semiological seizure classification. Recorded seizures were reviewed by two independent observers. We reviewed the medical reports as well as the LTVE evaluation of 330 patients with focal epilepsy who underwent presurgical evaluation (166 men; mean age 36). Epilepsy was classified as frontal in 49 patients (15%), temporal in 205(62%), parieto-occipital in 23(7%) and just focal epilepsy in 53(16%). More patients reported auras before (224) than during LTVE (126). On the contrary, lateralizing signs were seen during LTVE (120) more frequently than reported in the outpatient clinic (77). When lateralizing signs were reported in the outpatient clinic and then observed during LTVE, their concordance rate was 75%(28/36). In frontal lobe epilepsy the seizure semiology agreement before and after LTVE was 41%. The best concordance (100%) was seen in bilateral asymmetric seizures, followed by dialeptic seizures (80%). In TLE the concordance in seizure semiology was 69%, being higher in automotor seizures (79%) and lowest in dialeptic seizures (37%), because up to 60% of automotor seizures were described as dialeptic seizures in the outpatient clinic. In parieto-occipital lobe epilepsy the concordance was 45%, being higher in simple motor seizures (tonic/clonic) (80%) followed by automotor seizures (40%). Considering only seizure types, the highest degree of concordance was seen in automotor seizures (80%), followed by dialeptic seizures (44.6%) focal motor (tonic and clonic) seizures (39%). Concordance in seizure semiology reported by the patients and later observed during LTVE seems to be high in TLE, followed by parieto-occipital and frontal lobe epilepsy. The seizure types that show a higher degree of concordance are automotor, focal motor, and dialeptic seizures. Epileptic auras are more frequently reported before than actually during LTVE; lateralizing signs are seen more often during LTVE, although when patients report them, they usually do it accurately.