A number of investigators have attempted to classify infantile seizures. While no universally accepted infantile seizure classification system yet exists, the unique seizure symptomotology of infants is now recognized
Tonic posturing Symmetric/asymmetric Clonic jerking Unilateral/bilateral Astatic seizures Hypomotor seizures Myoclonic jerks Versive seizures Infantile spasms
(Table 6.4). Infantile seizure semiology includes the following:
1. Tonic posturing. This extremity stiffening may be symmetric or asymmetric. Either type of tonic posturing may reflect either focal or generalized EEG changes.
2. Clonic jerking of one or more limbs. Bilateral clonic jerking typically does not have the synchronous rhythmicity of adult generalized clonic seizures. Although bilateral clonic movement may reflect either a focal or generalized electro-graphic correlate, unilateral clonic jerking of an extremity does correlate with contralateral hemispheric discharge.
3. Astatic events with loss of tone of a part or the whole body.
4. Hypomotor seizures characterized by a distinct but subtle behavioral arrest. If automatisms exist, they are typically subtle and simple, involving restless extremity movements, chewing, and lip-pursing. Complex semipurposeful automatisms are not seen in infants.
5. Myoclonic jerks (isolated or repetitive) can be seen in either a partial or generalized electrographic correlate.
6. Versive seizures consisting most notably of forced eye deviation.
7. Infantile spasms. Infantile spasms are clusters of quick extension or flexion spasms involving the neck, arms, and trunk. The spasms initially resemble a quick jerk that then sustains the posture for a few seconds. It has been debated in the literature whether these seizures should be classified as myoclonic jerks or tonic seizures. Given the distinct seizure semeiology, unique interictal electro-graphic appearance of hypsarythmia, and poor prognosis regarding development, a unique seizure type is proposed for these events (13-16).
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