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Hemiclonic seizures
AUTHOR
Henry Hasson MD
EDITOR
Solomon L Moshé MD
Introduction
Overview
• Ictal EEG does not show focal rolandic discharges, but spike or spike-
and-wave discharges, identical to those seen in typical generalized
epilepsies, appear on the contralateral hemisphere.
Historical note. The first account of focal clonic seizures progressing to hemiclonic seizures
can be found as early as 1050 BC in the twenty-fifth Babylonian cuneiform tablet devoted to
miqtu (a disease in which the person loses consciousness and foams at the mouth) (75; 09):
In the time of his possession, while he is sitting down, his (left) eye moves
to the side, a lip puckers, saliva flows from his mouth, and his hand, leg
and trunk on the left side jerk (or, twitch) like a (newly)-slaughtered
sheep, it is miqtu. If at the time of the possession his mind is consciously
aware, (the demon) can be driven out; if at the time of the possession his
mind is not so aware, (the demon) cannot be driven out.
Non-Jacksonian hemiclonic seizures were first mentioned by Gibbs (34) and Lennox (46)
with no particular details. However, it was Henri Gastaut and his associates in Marseilles who
provided superb descriptions of the clinical and EEG manifestations of non-Jacksonian
unilateral and hemiclonic seizures (hemi grand mal and hemiclonic seizures) (32; 30; 58; 59;
23).
• "Hemi grand mal": typical grand mal seizures, but strictly localized to
one side of the body and, electroencephalographically, to the contralateral
hemisphere.
• Those without any sign of cerebral focalization, but suffering from petit
mal or grand mal (32).
Nomenclature and classification. Hemiclonic seizures are profoundly featured in the 1970
ILAE classification as influenced by Gastaut (29):
(i) partial discharge very rapidly spreading over only one hemisphere
(corresponding with only contralateral seizures)
Hemiclonic and unilateral seizures have been detailed by Oller-Daurella and Dravet and also
by Roget in the first edition of the “blue guide” (59; 53).
Subsequent ILAE classifications and proposals do not consider unilateral seizures other than
hemiclonic seizures from ipsilateral propagation of focal clonic seizures to neocortical areas
(26). A related “hemiconvulsion-hemiplegia-epilepsy syndrome” is recognized as an epileptic
syndrome (08; 18).
According to the latest 2014 ILAE epilepsy diagnosis manual, hemiclonic seizures are focal,
and they are classified among those with elementary motor features that involve a
stereotyped contraction of a muscle or group of muscles (18). Such motor features may be
predominantly convulsive (rhythmic jerking (clonic activity)) and may occur alone or in
combination with tonic activity (eg, hemiclonic that is rhythmic jerking (clonic activity)
involving only one side of the body). Conversely, generalized convulsive seizures are
typically bilateral and symmetric although variants with asymmetry including head and eye
deviation can be seen (18). According to Dravet and Seino, “these variations reflect our lack
of knowledge of the true physiopathology of generalized and unilateral seizures…. In practice,
no clear-cut borderline exists between generalized and unilateral clonic seizures, in many
cases, making it difficult if not impossible to classify them” (23).
Hemiclonic seizures are not mentioned in the updated ILAE positional paper on the
classification of seizure types (28) and epilepsies (63). Also, hemiclonic status epilepticus is
not considered in the latest ILAE definition and classification of status epilepticus (71).
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