title: Side-to-side axial movements. Adding a new sign to the asymmetry of the clonic phase and asymmetric seizure termination in differentiating primary and secondarily generalised tonic-clonic seizures.
abstract: OBJECTIVE
  To study new semiological signs which help distinguish between primary and secondarily generalised tonic-clonic seizures (GTCS).
  
  
  METHODS
  We retrospectively studied 86 GTCS, 13 primary and 73 secondary, in 58 patients who underwent video-EEG (vEEG) evaluation in our epilepsy monitoring unit. Eleven patients had generalised epilepsy and 47 focal epilepsy. Two expert epileptologists, blinded to diagnosis, examined the vEEGs independently for the presence of five semiological signs.
  
  
  RESULTS
  Asymmetry of limb movements in clonic phase, side-to-side axial movements, and asymmetric seizure termination occurred more frequently (p<0.05) in secondary GTCS compared to primary GTCS. Combining asymmetry of limb movements in clonic phase and side-to-side axial movements provided the greatest value in differentiating secondary GTCS from primary GTCS.
  
  
  CONCLUSIONS
  Careful examination of GTCS seizure semiology can help differentiate primary from secondary GTCS. The semiological sign of side-to-side axial movements, which has not previously been studied in this context, may add to existing literature of semiological signs and be of value for the evaluation of surgical patients in the epilepsy monitoring unit. In the out-patient setting, a clear history of these signs may help guide drug treatment choices.
authors.affiliation: Epilepsy Center, University Hospitals Neurological Institute, Case Western Reserve University, USA, Department of Neurology Centro Hospitalar de São João, Porto, Portugal.
authors.forename: Sara
authors.initials: S
authors.lastname: Franca
authors.affiliation: Department of Neurology, Case Western Reserve University.
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Gupta
authors.affiliation: Epilepsy Center, University Hospitals Neurological Institute, Case Western Reserve University, USA, Department of Neurology, Wayne State University, USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Rao
authors.affiliation: Epilepsy Center, University Hospitals Neurological Institute, Case Western Reserve University, USA.
authors.forename: Elia
authors.initials: E
authors.lastname: Pestana
authors.affiliation: Epilepsy Center, University Hospitals Neurological Institute, Case Western Reserve University, USA, Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: Joel
authors.initials: J
authors.lastname: Freitas
authors.affiliation: Epilepsy Center, University Hospitals Neurological Institute, Case Western Reserve University, USA.
authors.forename: Jakrin
authors.initials: J
authors.lastname: Loplumlert
authors.affiliation: Epilepsy Center, University Hospitals Neurological Institute, Case Western Reserve University, USA, Department of Neurology, Case Western Reserve University.
authors.forename: Samden D
authors.initials: SD
authors.lastname: Lhatoo
mesh_terms: D000293:Adolescent; D000328:Adult; D003937:Diagnosis, Differential; D004569:Electroencephalography / Q000379:methods; D004829:Epilepsy, Generalized / Q000175:diagnosis*; D004830:Epilepsy, Tonic-Clonic / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology*; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis*; D014741:Video Recording / Q000379:methods; D055815:Young Adult
keywords: generalized tonic-clonic seizure; primary generalized seizure; secondary generalized seizure; semiology; side-to-side axial movement