Semiological Seizure Classification: Before and After Video-EEG Monitoring of Seizures

The study objective was to assess the applicability and reliability of the semiological seizure classification in children with epilepsy in outpatient clinics. Ninety patients (age range, 2-16 years) who experienced clinical seizures during prolonged video-electroencephalogram (EEG) monitoring were evaluated. Semiological seizure classification was performed, first based on history obtained from parents of the patient during outpatient follow-up visits and then based on video EEG-monitoring. Kappa statistics (κ) were used to evaluate the consistency of the two rounds of semiological seizure classification. Classification based on history yielded the following distribution: simple motor seizures (66.3%), aura (28%), complex motor seizures (15.8%), special seizures (15.8%), dialeptic seizures (9.3%), and autonomic seizures (3.7%). Classification based on video EEG-monitoring yielded a different distribution: simple motor seizures (55.7%), complex motor seizures (26.9%), automotor seizures (26.9%), aura (23%), dialeptic seizures (22.1%), special seizures (9.6%), and autonomic seizures (1.9%). Negative myoclonic seizures (κ = 1, P = 0.000) and hypermotor seizures (κ = 0.85, P = 0.000) had excellent consistency; somatosensory aura (κ = 0.26, P = 0.012) and automotor seizures (κ = 0.28, P = 0.004) had the lowest consistency. The families or doctors often defined simple motor seizures (decrease of 10.6% from before to after monitoring, κ = 0.44); the proportion of complex motor seizures changed rather from before to after monitoring (11.1%, κ = 0.33). Generally, parents can describe seizures quite well. We suggest that semiological seizure classification is a reliable method applicable for everyday use during outpatient visits, especially if seizure semiology is evaluated individually for each component or if the semiological seizure classification is modified or refined for some seizure components (tonic, clonic, versive, conscious, automotor seizures).