Lateralising and localising signs and symptoms of epileptic seizures - Applications for clinical evaluation of epileptic patients

This report reviews the lateralising and localising signs of epileptic seiz ures in respect to the monitoring differential diagnosis of epilepsy. The l ateralising value of epileptic signs and symptoms can frequently be derived from the neuroanatomy. Focal clonic, focal tonic, and versive seizures as well as ictal unilateral dystonia are associated with a seizure onset zone in the contralateral hemisphere. Postictal nose wiping is performed with th e hand ipsilateral to the epileptogenic zone. Similarly, unilateral blinkin g points to an ispilateral seizure onset. Automatisms with preserved consci ousness, ictal speech,and vomiting correlate to an epileptogenic zone in th e nondominant hemisphere, while postictal dysphasia is produced by seizures arising from the dominant hemisphere. Lateralising and localising signs an d symptoms of epileptic seizures are of great help in the differential diag nosis of epilepsy from the first diagnosis of epileptic events to presurgic al video-EEG monitoring.