Prodromal symptoms in epileptic patients: Clinical characterization of the pre-ictal phase

Although recent advances in seizure anticipation have been achieved with the development of several biomathematical electroencephalographic (EEG) methods, pre-ictal clinical phenomena have not been extensively investigated. The aim of the study was to thoroughly analyze premonitory or prodromal symptoms (PS) in a randomly selected sample of 100 adult epileptic patients. A semi-structured protocol was used for in-person interviews to both patients and observers. PS were found in 39% of patients, the most frequent ones being behavioral, cognitive and mood changes. Both patients with focal and generalized epilepsies reported prodromes, although they were more frequently found in the former group. PS were mostly perceived preceding complex partial and generalized tonic–clonic seizures. Prodromal symptoms were reported to have an insidious onset and their duration ranged from 30 min to several hours. The potential value of prodromes in seizure anticipation would allow the use of preventive and therapeutic measures, including drugs, neurostimulation procedures and behavioral intervention.