Page 6 - Neurological examination of children

Cognition General exam ILAE 2017 Classification of Seizure Types

Interaction: Quality. Concentration Skin: Hypo- or hyperpigmented spots Figure 4
A good description of seizure semiology is helpful for classification of seizures.
Memory: Short and long-term Skeleton: Hypoplasia or hyperplasia.
Asymmetry I

Orientation: Time and place Focal Onset Generalized Onset Unknown Onset
Spine and trunk: Curves. Skin changes.
Spelling, calculation, geography Abdominal reflexes
II
Right/left orientation Head: Head circumference and form. Aware Impaired
Sutures and fontanels Awareness
Agnosia: Show a pencil, asking:
what is this? III
Motor Onset Motor Motor
Pre-schoolers and school children: automatisms tonic-clonic tonic-clonic
Please draw a man atonic clonic epileptic spasms
clonic tonic
epileptic spasms myoclonic Non-Motor
hyperkinetic myoclonic-tonic-clonic behavior arrest
myoclonic myoclonic-atonic
tonic atonic
Table 1 Glasgow Coma Scale epileptic spasms
Non-Motor Onset
4-15 YEARS < 4 YEARS autonomic Non-Motor (absence)
behavior arrest typical
Eyes Open spontaneously Open spontaneously 4 cognitive atypical
Open on verbal command Reaction to speech 3 emotional myoclonic
Open as reaction to pain Reaction to pain 2 sensory eyelid myoclonia
No response No response 1
Best motor Obeys Spont. or obeys verbal command 6
Localizes pain Localizes pain 5
Focal to bilateral tonic-clonic Unclassified
Withdraws Withdraws 4
Abnormal flexion Abnormal flexion 3 Adapted from: Fisher R. et al. Instruction manual for the ILAE 2017 operational classifi-
Abn. extension Abnormal extension 2 cation of seizure types. Epilepsia 2017;58(4):531–542. With author permission.
No response No response 1
Best verbal Oriented Smiles, interacts 5
Disoriented Spontaneous, irritable cry 4
Inappropriate words Cries to pain only 3
Incomprehensible sounds Moans to pain 4
No response No response to pain 1
Range 3 - 15

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