SEMIOLOGI EPILEPSI

Nama pasien :
No CM :
Tanggal :
Diagnosis awal :
Pemeriksa :

No Gejala +/- keterangan Lokasi/lateralisasi

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Awal kejang

somatosensory aura Contralateral primary sensory cortex

visual aura Occipital lobe

visual hallucination Broadmann’s area 17-18

complex visual hallucination Parieto-temporal cortex

Auditory aura Heschell’s gyrus in the superior temporal gyrus

olfactory aura Mesial temporal lobe epilepsy (amygdale)

gustatory aura Insula

abdominal aura Temporal lobe, frontal lobe and insula

autonomic aura Insular cortex

psychic aura Temporal lobe

Ascending epigastric aura Mesial temporal lobe epilepsy

focal onset Lateralization and/or localization

early non-forced head turn(<20s) Ipsilateral to seizure origin

Déjà vu or jamais vu Mesial temporal lobe epilepsy

Fear and panic Mesial temporal lobe epilepsy

Lokalisasi kejang

frekuensi kejang Frequent/daily (frontal), less frequent (temporal)

sleep activation Rolandic or frontal lobe epilepsy

onset kejang Abrupt, explosive (frontal), slower (temporal)

Progression Rapid (frontal), slower (temporal)

initial motionless staring Less common (frontal), common (temporal)

Automatism Less common (frontal), common and longer (temporal)

bipedal automatism Characteristic (frontal)

complex postures Frontal : early, frequent, prominent

Temporal : late, less frequent, less prominent

hyperkinetic motor signs Common (frontal), rare (temporal)

somatosensory symptoms Common (frontal), rare (temporal)

Speech Frontal : loud vocalization (grunting, screaming, moaning)

 Temporal : verbalization speech in non-dominant seizures

durasi kejang Brief (frontal), longer (temporal)

secondary generalization Common (frontal), less common (temporal)

postictal confusion Less prominent/short (frontal), more prominent and longer

(temporal)

postictal dysphasia Frontal : rare, unless it spreads to the dominant temporal lobe

Temporal : common in dominant temporal lobe seizures

Selama kejang

Progression Identify the involved brain regions

Aphasia Aphasia dominant hemisphere

awareness & consciousness Simple vs complex partial/generalized

Dialeptic Mesial temporal longer than frontal lobe

duration status epilepticus Duration status epilepticus

oral automatism Temporal lobe, typically hippocampal

oro-almentary automatism Mesial temporal lobe epilepsy

unilateral limb automatism Ipsilateral to seizure origin

unilateral eye blinks Ipsilateral to seizure origin

bipedal automatism Frontal lobe seizures

ictal spitting/drinking Right temporal seizures

ictal laughter Hypothalamic, mesial temporal or frontal cingulate origin

late forced head turn Contralateral to seizure origin

eye deviation Contralateral to seizure origin

focal clonic jerking Contralateral to seizure origin, peri-rolandic

assymetric clonic ending Ipsilateral to seizure origin

dystonic limb posturing Contralateral to seizure origin

tonic limb posturing Contralateral to seizure origin

fencing posture Contralateral frontal lobe (supplementary motor) seizures

figure of 4 sign Contralateral to the extended limb, usually temporal lobe

unilateral ictal paresis Contralateral to seizure origin

whole body rotation Lateral temporal lobe epilepsy

ictal speech arrest Temporal lobe seizures, usually dominant hemisphere

ictal speech preservation Temporal lobe seizures, usually non-dominant hemisphere

ictus emeticus Temporal seizures

ictal urinary urge Right temporal seizures

piloerection/merinding Left temporal seizures

Pemeriksaan saat kejang

response to communication Level of awareness

Speech (naming, reading) Dominant hemisphere involvement

Memory Temporal lobe involvement

distractibility Frontal lobe involvement

response to passive eye opening To exclude pseudoseizure (tight eye opening closure)

response to physical stimulation Attention, motor dysfunction

weakness or lack of motor control Contralateral to seizure origin

plantar extensor response Unilatereal post-ictal paresis

Setelah kejang

postictal nose wiping Ipsilateral temporal lobe seizures

postictal cough Temporal lobe seizures

confusion/amnesia Suggest complex partial or generalized

unilateral headache Ipsilateral to seizure origin

weakness (todd's paresis) Contralateral hemisphere/seizure origin

visual field defect Occipital lobe involvement

dysphasia Temporal lobe seizures, Dominant hemispheric involvement

Gejala lain

gejala prodromal May precedes GTCS

lingkungan saat muncul To exclude syncope or pseudoseizures

Waktu kejadian Myoclonic or primary (e.g., upon awakening) generalized epilepsy

Berhubungan dengan tidur

Presipitan/pencetus Reflex or photosensitive epilepsy

EEG

MRI