{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T22:30:52Z","timestamp":1788647452214,"version":"build-2803163510"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia Open"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the diagnostic contributions of semiology, Electroencephalography (EEG), brain magnetic resonance imaging (MRI), and longitudinal follow\u2010up both, individually and in combination in classifying seizure type (focal\u2010to\u2010bilateral tonic\u2013clonic (FBTC) vs. generalized\u2010onset bilateral tonic\u2013clonic (GBTC)) in children with new\u2010onset bilateral tonic\u2013clonic (BTC) seizures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We prospectively evaluated 249 consecutive children who presented with new\u2010onset BTC seizures. All patients underwent detailed clinical assessment, a 3\u2010h sleep\u2010deprived EEG, an epilepsy protocol brain MRI, and standardized follow\u2010up. Seizures were classified as FBTC or GBTC using predefined criteria. We assessed the diagnostic yield of each modality and their incremental value in improving classification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seizure semiology alone allowed classification in 22% of children. EEG findings enabled classification in 53%, with the highest yield (72%) among children aged 5\u201310\u2009years. MRI revealed epileptogenic lesions in 14%, with structural abnormalities identified in 50% of children with developmental delay. Combining semiology, EEG, and MRI increased the classification yield to 73%, and follow\u2010up further improved this to 81%. Notably, 30.8% of children ultimately diagnosed with GBTC seizures exhibited focal features such as head version or tonic posturing, underscoring the limited specificity of these signs in pediatric BTC seizures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>Accurate classification of new\u2010onset BTC seizures in children cannot rely on semiology alone. A multimodal approach\u2014integrating EEG, MRI, and clinical follow\u2010up\u2014is essential to improve diagnostic accuracy. Our findings emphasize the nonspecific nature of certain focal features in GBTC seizures and advocate for a cautious, evidence\u2010based approach when interpreting semiological signs. These results have direct implications for ASM selection and early management decisions in pediatric epilepsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Plain Language Summary<\/jats:title>\n                    <jats:p>Children who experience a first\u2010time convulsive seizure need an accurate diagnosis to guide appropriate treatment. In our study of 249 children with new onset bilateral tonic\u2013clonic seizures, we found that no single diagnostic tool, whether seizure description, EEG, or MRI, was sufficient on its own. However, when these tools were combined, clinicians were able to correctly determine the seizure type in more than 80% of cases. We also found that some signs typically considered focal, such as head turning, may still appear in generalized seizures. These findings underscore the importance of a multimodal approach to ensure optimal diagnosis and treatment planning for children with new onset seizures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi4.70203","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T09:27:33Z","timestamp":1766482053000},"page":"259-269","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The diagnostic value of semiology,\n                    <scp>EEG<\/scp>\n                    and\n                    <scp>MRI<\/scp>\n                    in new\u2010onset pediatric bilateral tonic\u2013clonic seizures: A\u00a0multimodal analysis"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5214-3839","authenticated-orcid":false,"given":"Badiee","family":"Moussa","sequence":"first","affiliation":[{"name":"Department of Neurology American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6487-8259","authenticated-orcid":false,"given":"Wassim","family":"Nasreddine","sequence":"additional","affiliation":[{"name":"Department of Neurology American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8926-5774","authenticated-orcid":false,"given":"Huda","family":"Abboodi","sequence":"additional","affiliation":[{"name":"Department of Neurology American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5553-5332","authenticated-orcid":false,"given":"Ayman","family":"Beydoun","sequence":"additional","affiliation":[{"name":"Department of Neurology American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghassan","family":"Hmeimess","sequence":"additional","affiliation":[{"name":"Department of Pediatrics St George Hospital Medical University Center, University of Balamand  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2847-2619","authenticated-orcid":false,"given":"Jaafar","family":"Wazne","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Rafic Hariri University Hospital  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7392-4569","authenticated-orcid":false,"given":"Abdel Rahman","family":"Shatila","sequence":"additional","affiliation":[{"name":"Department of Neurology Rizk Hospital, Lebanese American University  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9047-1185","authenticated-orcid":false,"given":"Ahmad","family":"Beydoun","sequence":"additional","affiliation":[{"name":"Department of Neurology American University of Beirut Medical Center  Beirut 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