Age-related semiology changes over time

Understanding how seizure semiology changes with age is essential to determine the seizure onset zone. Epilepsy can be considered the prototypical neurologic disorder for demonstrating age-related changes over time. The maturational changes that occur in the brain over the lifespan demonstrate themselves most clearly through semiologic changes. Due to the immaturity of the neonatal brain, seizure recognition is challenging. Electroclinical seizures are classified as motor, non-motor, sequential, or unclassified and are typically focal in onset. During infancy, the most common seizure types are epileptic spasms, myoclonic, tonic, atonic, clonic, and hypomotor/behavioral arrest seizures. Correlation between seizure semiology and localization of seizure onset zone can be variable. The most observed seizure types in preschool-aged children are generalized myoclonic, generalized tonic, focal tonic, or clonic seizures. Many of the epileptic encephalopathies present at this age. Ictal behaviors continue to be limited, but lateralizing motor manifestations during focal seizures are better developed compared to infants. In school-aged children, the most common seizure types involve change in awareness. Seizure semiology at this age resembles that of adults, with increasing number and complexity of seizure components.