A Protocol Towards Best Practice for Ictal-Postictal Assessment in Children and Adolescents with Epilepsy

Background: Epilepsy is a chronic neurological disorder characterized by recurrent unprovoked seizures, which constitute the unique elementary event of epilepsy. The ictal examination is crucial for seizure phenotyping and neuroanatomic localization of seizure onset. This work aimed to set up a valid and adapted protocol for Ictal-Postictal assessment.Methods: Children with epilepsy aged less than 18 years old were included in the ictal-postictal evaluation based on the procedure developed in 2016 by the European Joint Task Force of ILAE for Testing during seizures. We recorded: age, gender, epileptic syndrome, disease management, seizure duration, and semiology, and completion of different items of the 2016 ILAE procedure for patients Testing during seizures.Results: We evaluated 60 children, 34 males (56.6%) and 26 females (43.3%), with a mean age of 8.4 years old (2-18 years old). The examiner was able to perform the ictal evaluation in 10% of children within a mean seizure duration of more than 4 minutes. He noted he did not attend the seizures of 29 children (48.3%), and the duration of the seizures was less than 2 minutes in 18 children (30%). Ictal cognitive impairment predominantly affected the short-term verbal and visual episodic memory.Conclusions: The approach adopted during this study allowed us to identify the difficulties encountered and to propose adaptations for the tests used. Our results suggest that the cognitive profile of individuals with epilepsy does not correspond to a fixed state but a dynamic state in chronological relation to the occurrence of seizures.