@article{fda600e50a1c468c99503d333572ff07,
title = "Semiologic differences between bilateral tonic-clonic seizures of focal onset and generalized onset",
abstract = "Background: Focal semiologies have been described in idiopathic generalized epilepsies (IGE) and generalized-onset bilateral tonic-clonic seizures (GBTCS). These focal signs may lead to wrong diagnosis and inappropriate choice of antiseizure medications. We sought to investigate the differences in focal semiologic features between GBTCS and focal-onset bilateral tonic-clonic seizures (FBTCS). Methods: We retrospectively reviewed video-EEG data of captured GBTCS and FBTCS over a period of five years. The presence or absence of 12 focal signs as well seizure duration and time to head version was tabulated for each seizure. We used the chi-square test for independence and Fisher's exact test to investigate the occurrence of each focal sign in FBTCS compared with GBTCS. Additionally, we used receiver operating characteristic (ROC) curves to explore if the seizure duration and time to head version from the ictal onset can reliably differentiate between FBTCS and GBTCS. Finally, we employed hierarchical cluster analysis to visualize how these focal signs appear in combination. Results: Head version (p <.001), preceding automatisms (p <.001), eye version (p <.001), unilateral facial clonic activity (p <.001), and mouth deviation (p =.004) were found to be significantly more frequent in FBTCS. Longer seizures were highly in favor of FBTCS whereas shorter time to head version from the ictal onset indicated GBTCS in the ROC curve analysis. Conclusions: Though focal signs occur in GBTCS, careful evaluation of semiology can help the clinician distinguish FBTCS from GBTCS.",
keywords = "Epilepsy, Focal, Generalized, Semiology, Tonic-clonic seizures, Video-EEG monitoring",
author = "Udaya Seneviratne and Harry Christie and Wendyl D'Souza and Mark Cook",
note = "Funding Information: US has received travel and speaker honoraria from Eisai Australia and LivaNova Australia. WDS {\textquoteright}s salary is part-funded by The University of Melbourne . He has received travel, investigator-initiated, scientific advisory board and speaker honoraria from UCB Pharma Australia & Global; investigator-initiated, scientific advisory board, travel and speaker honoraria from Eisai Australia & Global; advisory board honoraria from Liva Nova and Tilray; educational grants from Novartis Pharmaceuticals, Pfizer Pharmaceuticals and Sanofi-Synthelabo; educational; travel and fellowship grants from GSK Neurology Australia, and honoraria from SciGen Pharmaceuticals. He has intellectual and equity interest in the device company EpiMinder. MC has received speaker honoraria from Eisai Australia and UCB Australia, and is Chief Medical Officer for Seer Medical Pty Ltd and EpiMinder Pty Ltd. HC reports no disclosures. Funding Information: US has received travel and speaker honoraria from Eisai Australia and LivaNova Australia. WDS's salary is part-funded by The University of Melbourne. He has received travel, investigator-initiated, scientific advisory board and speaker honoraria from UCB Pharma Australia & Global; investigator-initiated, scientific advisory board, travel and speaker honoraria from Eisai Australia & Global; advisory board honoraria from Liva Nova and Tilray; educational grants from Novartis Pharmaceuticals, Pfizer Pharmaceuticals and Sanofi-Synthelabo; educational; travel and fellowship grants from GSK Neurology Australia, and honoraria from SciGen Pharmaceuticals. He has intellectual and equity interest in the device company EpiMinder. MC has received speaker honoraria from Eisai Australia and UCB Australia, and is Chief Medical Officer for Seer Medical Pty Ltd and EpiMinder Pty Ltd. HC reports no disclosures. Publisher Copyright: {\textcopyright} 2022 Elsevier Inc.",
year = "2022",
month = sep,
day = "1",
doi = "10.1016/j.yebeh.2022.108837",
language = "English",
volume = "134",
journal = "Epilepsy & Behavior",
issn = "1525-5050",
publisher = "Academic Press",
}