Difficulties arise when attempting to classify infantile epileptic seizures according to the International League against Epilepsy (ILAE) classification of seizures. In this classification scheme, partial seizures (simple and complex) are separated from generalized seizure types (absence, tonic, clonic, tonic-clonic, atonic, myoclonic). These seizure types are expected to reflect the electrographic onset of the seizure as being either from one region of the brain (focal seizures) or from the entire brain at once (generalized seizures). However, this system is problematic when applied to infantile seizures. First, the child's level of consciousness, required to separate simple from complex partial seizures, cannot be easily or reliably tested for in this age group. Second, the seizure semiology in the infant is often very subtle, with features that do not easily indicate laterality, or even permit categorization into partial or generalized types. In studies that have reviewed the electrographic correlate to the infantile seizure, it became apparent that the clinical seizure traits did not reflect whether the seizure arose from one brain region, or diffusely. For example, bilateral clonic movement may reflect either focal or generalized seizures electrographically. Finally, the seizure semiology of partial seizures is different in infants when compared to older patients. The well-described automatisms of temporal lobe seizures are often not seen in infants. Rather, a behavioral arrest from usual activities may be the most pronounced attribute of a temporal lobe seizure in an infant.
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