John Libbey Eurotext

Side-to-side axial movements Volume 16, issue 1, March 2014


  • Side-to-side axial movements
  • Side-to-side axial movements
  • Side-to-side axial movements


1 Epilepsy Center, University Hospitals Neurological Institute, Case Western Reserve University, USA
2 Department of Neurology Centro Hospitalar de São João, Porto, Portugal
3 Department of Neurology, Case Western Reserve University
4 Department of Neurology, Wayne State University, USA
5 Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal
* Correspondence: Samden D. Lhatoo Department of Neurology, University Hospitals Case Medical Center, 11100 Euclid Ave, Lakeside 3222A, Cleveland, OH 44106, USA

Aim. 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. Conclusion. 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. [Published with video sequences].