Published Ahead of Print on July 17, 2015 as 10.1212/WNL.0000000000001843
Comment: Be careful what you ask when interviewing patients with epilepsy Clinicians rely on reported seizure symptomatology, observed semiology, and EEG data to distinguish between focal- and generalized-onset seizures. In the absence of external observations or corroborating EEG findings, it is tempting to believe that if we ask patients the right questions, their description of what a seizure feels like will illuminate the right diagnosis. Specifically, eliciting symptoms usually associated with focal-onset seizures should be clarifying. Not so much, according to the accompanying article by Seneviratne et al.1 The notion that focal seizure symptoms definitively identify focal-onset seizures appears to be dying, if not dead, dogma. In response to a standardized battery of open- and closed-ended questions, approximately half of a cohort of patients with electrodiagnostically confirmed diagnoses of idiopathic generalized epilepsies reported focal seizure symptoms (FSS) including, among others, aphasia, visual phenomena, epigastric sensations, and motor automatisms. There was a suggestion of (but not significant) FSS in particular idiopathic generalized epilepsy subtypes (juvenile absence epilepsy and juvenile myoclonic epilepsy) and a significant correlation of FSS with shorter duration of seizure freedom. Whether FSS reflect seizure refractoriness, better recall of symptoms when seizures are more frequent, or something distinctive about the seizure types themselves remains an open question. Adding to a growing body of literature that is blurring the classic dichotomy of epilepsy syndromes associated with focal- vs generalized-onset seizures,2 these findings commend circumspection: be careful what you ask for, and particularly careful in what you make of it. They also highlight the ongoing importance of EEG in the clinical evaluation of epilepsy; inclusion in the study required confirmation of diagnosis with 24-hour recordings. 1. 2.
Seneviratne U, Woo JJ, Boston RC, Cook M, D’Souza W. Focal seizure symptoms in idiopathic generalized epilepsies. Neurology 2015;85:xxx–xxx. Seneviratne U, Cook M, D’Souza W. Focal abnormalities in idiopathic generalized epilepsy: a critical review of the literature. Epilepsia 2014;55:1157–1169.
J. Craig Henry, MD From Winchester Neurological Consultants, VA. Disclosure: The author reports no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures. Study funding: No targeted funding reported.
© 2015 American Academy of Neurology
ª 2015 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.
1
Be careful what you ask when interviewing patients with epilepsy J. Craig Henry Neurology published online July 17, 2015 DOI 10.1212/WNL.0000000000001843 This information is current as of July 17, 2015 Updated Information & Services
including high resolution figures, can be found at: http://www.neurology.org/content/early/2015/07/17/WNL.0000000000 001843.full.html
Subspecialty Collections
This article, along with others on similar topics, appears in the following collection(s): EEG http://www.neurology.org//cgi/collection/eeg_ Epilepsy semiology http://www.neurology.org//cgi/collection/epilepsy_semiology Generalized seizures http://www.neurology.org//cgi/collection/generalized_seizures Partial seizures http://www.neurology.org//cgi/collection/partial_seizures
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Information about reproducing this article in parts (figures,tables) or in its entirety can be found online at: http://www.neurology.org/misc/about.xhtml#permissions
Reprints
Information about ordering reprints can be found online: http://www.neurology.org/misc/addir.xhtml#reprintsus
Neurology ® is the official journal of the American Academy of Neurology. Published continuously since 1951, it is now a weekly with 48 issues per year. Copyright © 2015 American Academy of Neurology. All rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.
Comment: Be careful what you ask when interviewing patients with epilepsy Clinicians rely on reported seizure symptomatology, observed semiology, and EEG data to distinguish between focal- and generalized-onset seizures. In the absence of external observations or corroborating EEG findings, it is tempting to believe that if we ask patients the right questions, their description of what a seizure feels like will illuminate the right diagnosis. Specifically, eliciting symptoms usually associated with focal-onset seizures should be clarifying. Not so much, according to the accompanying article by Seneviratne et al.1 The notion that focal seizure symptoms definitively identify focal-onset seizures appears to be dying, if not dead, dogma. In response to a standardized battery of open- and closed-ended questions, approximately half of a cohort of patients with electrodiagnostically confirmed diagnoses of idiopathic generalized epilepsies reported focal seizure symptoms (FSS) including, among others, aphasia, visual phenomena, epigastric sensations, and motor automatisms. There was a suggestion of (but not significant) FSS in particular idiopathic generalized epilepsy subtypes (juvenile absence epilepsy and juvenile myoclonic epilepsy) and a significant correlation of FSS with shorter duration of seizure freedom. Whether FSS reflect seizure refractoriness, better recall of symptoms when seizures are more frequent, or something distinctive about the seizure types themselves remains an open question. Adding to a growing body of literature that is blurring the classic dichotomy of epilepsy syndromes associated with focal- vs generalized-onset seizures,2 these findings commend circumspection: be careful what you ask for, and particularly careful in what you make of it. They also highlight the ongoing importance of EEG in the clinical evaluation of epilepsy; inclusion in the study required confirmation of diagnosis with 24-hour recordings. 1. 2.
Seneviratne U, Woo JJ, Boston RC, Cook M, D’Souza W. Focal seizure symptoms in idiopathic generalized epilepsies. Neurology 2015;85:xxx–xxx. Seneviratne U, Cook M, D’Souza W. Focal abnormalities in idiopathic generalized epilepsy: a critical review of the literature. Epilepsia 2014;55:1157–1169.
J. Craig Henry, MD From Winchester Neurological Consultants, VA. Disclosure: The author reports no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures. Study funding: No targeted funding reported.
© 2015 American Academy of Neurology
ª 2015 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.
1
Be careful what you ask when interviewing patients with epilepsy J. Craig Henry Neurology published online July 17, 2015 DOI 10.1212/WNL.0000000000001843 This information is current as of July 17, 2015 Updated Information & Services
including high resolution figures, can be found at: http://www.neurology.org/content/early/2015/07/17/WNL.0000000000 001843.full.html
Subspecialty Collections
This article, along with others on similar topics, appears in the following collection(s): EEG http://www.neurology.org//cgi/collection/eeg_ Epilepsy semiology http://www.neurology.org//cgi/collection/epilepsy_semiology Generalized seizures http://www.neurology.org//cgi/collection/generalized_seizures Partial seizures http://www.neurology.org//cgi/collection/partial_seizures
Permissions & Licensing
Information about reproducing this article in parts (figures,tables) or in its entirety can be found online at: http://www.neurology.org/misc/about.xhtml#permissions
Reprints
Information about ordering reprints can be found online: http://www.neurology.org/misc/addir.xhtml#reprintsus
Neurology ® is the official journal of the American Academy of Neurology. Published continuously since 1951, it is now a weekly with 48 issues per year. Copyright © 2015 American Academy of Neurology. All rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.
