{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T19:56:13Z","timestamp":1792266973799,"version":"4.4.0"},"reference-count":48,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,1,27]],"date-time":"2024-01-27T00:00:00Z","timestamp":1706313600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Bilateral tonic\u2013clonic seizures with focal semiology or focal interictal electroencephalography (EEG) can occur in both focal and generalized epilepsy types, leading to diagnostic errors and inappropriate therapy. We investigated the prevalence and prognostic values of focal features in patients with idiopathic generalized epilepsy (IGE), and we propose a decision flowchart to distinguish between focal and generalized epilepsy in patients with bilateral tonic\u2013clonic seizures and focal EEG or semiology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed video\u2010EEG recordings of 101 bilateral tonic\u2013clonic seizures from 60 patients (18 with IGE, 42 with focal epilepsy). Diagnosis and therapeutic response were extracted after \u22651\u2010year follow\u2010up. The decision flowchart was based on previous observations and assessed concordance between interictal and ictal EEG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Focal semiology in IGE was observed in 75% of seizures and 77.8% of patients, most often corresponding to forced head version (66.7%). In patients with multiple seizures, direction of head version was consistent across seizures. Focal interictal epileptiform discharges (IEDs) were observed in 61.1% of patients with IGE, whereas focal ictal EEG onset only occurred in 13% of seizures and 16.7% of patients. However, later during the seizures, a reproducible pattern of 7\u2010Hz lateralized ictal rhythm was observed in 56% of seizures, associated with contralateral head version. We did not find correlation between presence of focal features and therapeutic response in IGE patients. Our decision flowchart distinguished between focal and generalized epilepsy in patients with bilateral tonic\u2013clonic seizures and focal features with an accuracy of 96.6%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>Focal semiology associated with bilateral tonic\u2013clonic seizures and focal IEDs are common features in patients with IGE, but focal ictal EEG onset is rare. None of these focal findings appears to influence therapeutic response. By assessing the concordance between interictal and ictal EEG findings, one can accurately distinguish between focal and generalized epilepsies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/epi.17895","type":"journal-article","created":{"date-parts":[[2024,1,27]],"date-time":"2024-01-27T08:14:07Z","timestamp":1706343247000},"page":"725-738","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Focal electroclinical features in generalized tonic\u2013clonic seizures: Decision flowchart for a diagnostic challenge"],"prefix":"10.1111","volume":"65","author":[{"given":"Maria","family":"Vlachou","sequence":"first","affiliation":[{"name":"Department of Clinical Neurophysiology Aarhus University Hospital  Aarhus Denmark"},{"name":"Department of Clinical Medicine Aarhus University  Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7775-6576","authenticated-orcid":false,"given":"Philippe","family":"Ryvlin","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences Lausanne University Hospital  Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sidsel","family":"Armand\u00a0Larsen","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurophysiology Danish Epilepsy Center  Dianalund Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6035-6581","authenticated-orcid":false,"given":"S\u00e1ndor","family":"Beniczky","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurophysiology Aarhus University Hospital  Aarhus Denmark"},{"name":"Department of Clinical Medicine Aarhus University  Aarhus Denmark"},{"name":"Department of Clinical Neurophysiology Danish Epilepsy Center  Dianalund Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1,27]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.55.6.497"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/0896-6974(95)00035-C"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1059-1311(98)90010-3"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-510X(00)00496-2"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1684\/j.1950-6945.2003.tb00005.x"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000877"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001841"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0920-1211(02)00084-0"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1999.tb02055.x"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2008.07.001"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2009.01.007"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0404.2009.01270.x"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1053\/seiz.2000.0432"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000117429"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2015.11.048"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2010.12.014"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0317167100051519"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2021.107769"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2022.108837"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.13670"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2010.02522.x"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.15612"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2017.06.254"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1684\/epd.2022.1430"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.37.10.1617"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1997.tb01467.x"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1994.tb02433.x"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1994.tb02434.x"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1994.tb02432.x"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.17236"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2009.02068.x"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.2000.tb00189.x"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2006.05.002"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2012.03424.x"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1684\/epd.2021.1392"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2015.10.005"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2005.00262.x"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1684\/j.1950-6945.2002.tb00435.x"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2017.08.022"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.13472"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0404.1999.tb07350.x"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000130196.79327.04"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2009.02045.x"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebr.2022.100555"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-016-2538-5"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.0013-9580.2004.45003.x"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.53.3.490"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.51.4.1178"}],"container-title":["Epilepsia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/epi.17895","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T12:46:54Z","timestamp":1747658814000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/epi.17895"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,27]]},"references-count":48,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1111\/epi.17895"],"URL":"https:\/\/doi.org\/10.1111\/epi.17895","archive":["Portico"],"relation":{},"ISSN":["0013-9580","1528-1167"],"issn-type":[{"value":"0013-9580","type":"print"},{"value":"1528-1167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,27]]},"assertion":[{"value":"2023-08-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}