On seizure semiology

International audienceThe clinical expression of seizures represents the main symptomatic burden of epilepsy. Neural mechanisms of semiological production in epilepsy, especially for complex behaviors, remain poorly known. In a framework of epilepsy as a network rather than a focal disorder, we can think of semiology as being dynamically produced by a set of interconnected structures, in which specific rhythmic interactions, and not just anatomical localization, are likely to play an important part in clinical expression. This requires a paradigm shift in how we think about seizure organization, including from a presurgical evaluation perspective. Semiology is a key data source, albeit with significant methodological challenges for its use in research, including observer bias and choice of semiologic categories. Better understanding of semiologic categorization and pathophysiological correlates is relevant to seizure classification systems. Advances in knowledge of neural mechanisms as well as anatomic correlates of different semiological patterns could help improve knowledge of epilepsy networks and potentially contribute to therapeutic innovations