Glossary of Descriptive Terminology for Ictal Semiology: Report of the ILAE Task Force on Classification and Terminology

Abstract

INTRODUCTION PRINCIPLES FOR TERMS AND DEFINITIONS DATA SOURCES I GENERAL TERMS 1.0 SEMIOLOGY 2.0 EPILEPTIC SEIZURE 3.0 ICTUS 4.0 EPILEPSY 5.0 FOCAL 6.0 GENERALIZED 7.0 CONVULSION II TERMS DESCRIBING EPILEPTIC SEIZURE SEMIOLOGY 1.0 MOTOR 1.1 ELEMENTARY MOTOR 1.1.1 TONIC 1.1.1.1 EPILEPTIC SPASM 1.1.1.2 POSTURAL 1.1.1.2.1 VERSIVE 1.1.1.2.2 DYSTONIC 1.1.2 MYOCLONIC 1.1.2.1 NEGATIVE MYOCLONIC 1.1.2.2 CLONIC 1.1.2.2.1 JACKSONIAN MARCH 1.1.3 TONIC-CLONIC 1.1.3.1 GENERALIZED TONIC-CLONIC SEIZURE 1.1.4 ATONIC 1.1.5 ASTATIC 1.1.6 SYNCHRONOUS 1.2 AUTOMATISM 1.2.1 OROALIMENTARY 1.2.2 MIMETIC 1.2.3 MANUAL OR PEDAL 1.2.4 GESTURAL 1.2.5 HYPERKINETIC 1.2.6 HYPOKINETIC 1.2.7 DYSPHASIC 1.2.8 DYSPRAXIC 1.2.9 GELASTIC 1.2.10 DACRYSTIC 1.2.11 VOCAL 1.2.12 VERBAL 1.2.13 SPONTANEOUS 1.2.14 INTERACTIVE 2.0 NON-MOTOR 2.1 AURA 2.2 SENSORY 2.2.1 ELEMENTARY 2.2.1.1 SOMATOSENSORY 2.2.1.2 VISUAL 2.2.1.3 AUDITORY 2.2.1.4 OLFACTORY 2.2.1.5 GUSTATORY 2.2.1.6 EPIGASTRIC 2.2.1.7 CEPHALIC 2.2.1.8 AUTONOMIC 2.2.2 EXPERIENTIAL 2.2.2.1 AFFECTIVE 2.2.2.2 MNEMONIC 2.2.2.3 HALLUCINATORY 2.2.2.4 ILLUSORY 2.3 DYSCOGNITIVE 3.0 AUTONOMIC EVENTS 3.1 AUTONOMIC AURA 3.2 AUTONOMIC SEIZURE 4.0 SOMATOTOPIC MODIFIERS 4.1 LATERALITY 4.1.1 UNILATERAL 4.1.1.1 HEMI- 4.1.2 GENERALIZED (syn. "bilateral") 4.1.2.1 ASYMMETRICAL 4.1.2.2 SYMMETRICAL 4.2 BODY PART 4.3 CENTRICITY 4.3.1 AXIAL 4.3.2 PROXIMAL LIMB 4.3.3 DISTAL LIMB 5.0 MODIFIERS AND DESCRIPTORS OF SEIZURE TIMING 5.1 INCIDENCE 5.1.1 REGULAR, IRREGULAR 5.1.2 CLUSTER 5.1.3 PROVOCATIVE FACTOR 5.1.3.1 REACTIVE 5.1.3.2 REFLEX 5.2 STATE DEPENDENT 5.3 CATAMENIAL 6.0 DURATION 6.1 STATUS EPILEPTICUS 7.0 SEVERITY 8.0 PRODROME 9.0 POSTICTAL PHENOMENON 9.1 LATERALIZING (TODD'S (OR BRAVAIS') PHENOMENON 9.2 NON-LATERALIZING PHENOMENON 9.2.1 IMPAIRED COGNITION 9.2.1.1 ANTEROGRADE AMNESIA 9.2.1.2 RETROGRADE AMNESIA 9.2.2 PSYCHOSIS This glossary intends to provide a standard terminology for health care workers to communicate what is observed and what a patient reports during a seizure. As this terminology is descriptive and phenomenologic, its use would not imply or require knowledge of ictal pathophysiology, any pathological substrate, or etiology. Many terms are adjectives modifying "seizure," which itself is defined under "general terms." This pertains to seizures with single or multiple components. Terms in this glossary (e.g., "seizure,""ictus," which have widespread applicability in other fields of clinical neuroscience) are herein defined according to their references to epilepsy. Some terms of this glossary are "fundamental" (i.e., they encompass other more precise words). These can be used as the sole descriptor when data to characterize a phenomenon more precisely are not available. Such include aura, automatism, experiential, motor, and sensory. A seizure will often consist of two or more phenomena occurring simultaneously or sequentially and should be described accordingly. Quantitative terms, such as duration of motor events, are not intended as immutable confines, but as clarifying guides to describe clinically observed events. Scientific progress dictates an evolution of terms to retain their relevance. However, needs of communication in everyday life require that changes be gradual and evolutionary rather than abrupt and revolutionary. The use of synonyms in this glossary reflects incidents in which gradual changes are likely. Terminology in some areas remains unresolved. Therefore we view this glossary as a dynamic process for which feedback will be welcomed. In developing the "lexique" of this report, we adopted and applied the following principles. Terms and definitions should Contain features that distinguish or modify seizure entities. Be descriptive of the phenomena involved. Comply with terminology of clinical neuroscience. Use current terminology and definitions wherever possible. Contain new terms only if necessary. Be easily translatable to other languages. Be readily understood and used by potential users. That branch of linguistics concerned with signs and symptoms. Manifestation(s) of epileptic (excessive and/or hypersynchronous), usually self-limited activity of neurons in the brain. A sudden neurologic occurrence such as a stroke or an epileptic seizure. Epileptic Disorder: A chronic neurologic condition characterized by recurrent epileptic seizures. Epilepsies: Those conditions involving chronic recurrent epileptic seizures that can be considered epileptic disorders. A seizure whose initial semiology indicates, or is consistent with, initial activation of only part of one cerebral hemisphere. A seizure whose initial semiology indicates, or is consistent with, more than minimal involvement of both cerebral hemispheres. Primarily a lay term. Episodes of excessive, abnormal muscle contractions, usually bilateral, which may be sustained or interrupted. These are descriptors of seizures unless specified otherwise. Involves musculature in any form. The motor event could consist of an increase (positi