AccScience Publishing / EJMO / Online First / DOI: 10.36922/EJMO026210228
Submit to EJMO
Cite this article
1
Download
68
Views
Related Info Links
Google Scholar
More by Authors Links
Abba Musa Abdullahi
Journal Browser
Volume | Year
Issue
Search
Forthcoming Issue
Current Issue
View All
News and Announcements
View All
REVIEW ARTICLE

Clinical semiology of epileptic seizures: A scoping review of pre-ictal, ictal, and post-ictal phenomenology

Abba Musa Abdullahi1* ,  Abdullahi Abba Suleiman2 ,  Hassana M Abdullahi3
Show Less
1 Department of Life Sciences, Faculty of Life Sciences, University of South Wales, Newport, Wales, United Kingdom
2 Department of Internal Medicine, Federal Teaching Hospital, Katsina, Nigeria
3 Department of Plant and Biotechnology, Faculty of Life Sciences, Bayero University, Kano, Nigeria
EJMO, 026210228 https://doi.org/10.36922/EJMO026210228
Received: 20 May 2026 | Revised: 12 July 2026 | Accepted: 24 July 2026 | Published online: 7 August 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
Download PDF
XML
Cite
Abstract

Introduction: Clinical semiology of epileptic seizures encompasses the spectrum of manifestations occurring before, during, and after seizure events, reflecting the dynamic involvement of functional brain networks. Careful recognition of these clinical phenomena is fundamental for seizure classification, localization of the epileptogenic zone, differential diagnosis, prognostication, and individualized epilepsy management. Although individual aspects of seizure semiology have been extensively described, a comprehensive synthesis spanning the pre-ictal, ictal, and post-ictal phases remains limited.

Objectives: This review aims to map and synthesize the available evidence on the clinical semiology of epileptic seizures across the pre-ictal, ictal, and post-ictal phases, highlighting their epidemiological characteristics, neurobiological basis, diagnostic significance, and clinical applications.

Methods: This scoping review was conducted following the Joanna Briggs Institute methodology and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A comprehensive search of multiple databases was performed without date restrictions. Eligible studies were screened, and evidence was charted descriptively according to the pre-ictal, ictal, and post-ictal phases of epileptic seizures.

Results: A total of 1,120 records were identified, of which 60 studies met the inclusion criteria after screening and full-text review and were included in this review. The included studies demonstrated that pre-ictal manifestations may facilitate seizure prediction and provide important localizing information. Ictal semiology remains the cornerstone of seizure classification, reflecting the anatomical origin and propagation of seizure activity. Post-ictal phenomena contribute valuable diagnostic, lateralizing, and prognostic information. Collectively, the evidence highlights the complementary role of seizure semiology alongside electroencephalography, neuroimaging, and other contemporary diagnostic modalities in comprehensive epilepsy evaluation.

Conclusion: Clinical semiology remains an important component of epilepsy assessment despite advances in modern neurodiagnostic techniques. Mapping the available evidence across the pre-ictal, ictal, and post-ictal phases underscores the continued importance of meticulous clinical observation for accurate diagnosis, seizure localization, patient counseling, and treatment planning, while identifying areas requiring further research to improve precision epilepsy care.

Keywords
Semiology; Phenomenology
Epileptic seizures
Pre-ictal phase
Ictal phase
Post-ictal phase
Prodrome
Aura
Funding
None.
Conflict of interest
The authors declare they have no competing interests.
References

References

  1. Scaramelli A, Braga P, Avellanal A, et al. Prodromal symptoms in epileptic patients: Clinical characterization of the pre-ictal phase. Seizure. 2009;18(4):246-250. doi: 10.1016/j.seizure.2008.10.007
  2. Sarmast ST, Abdullahi AM, Jahan N. Current Classification of Seizures and Epilepsies: Scope, Limitations and Recommendations for Future Action. Cureus. 2020;12(9):e10549. doi: 10.7759/cureus.10549
  3. Noachtar S, Peters AS. Semiology of epileptic seizures: A critical review. Epilepsy Behav. 2009;15(1):2-9. doi: 10.1016/j.yebeh.2009.02.029
  4. Lüders H, Acharya J, Baumgartner C, et al. Semiological Seizure Classification. Epilepsia. 1998;39(9):1006-1013. doi: 10.1111/j.1528-1157.1998.tb01452.x
  5. Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):522-530. doi: 10.1111/epi.13670
  6. Thijs RD. The autonomic signatures of epilepsy: diagnostic clues and novel treatment avenues. Clin Auton Res. 2019;29(2):131-133. doi: 10.1007/s10286-019-00603-1
  7. Haut SR, Hall CB, Borkowski T, Tennen H, Lipton RB. Clinical features of the pre-ictal state: Mood changes and premonitory symptoms. Epilepsy Behav. 2012;23(4):415-421. doi: 10.1016/j.yebeh.2012.02.007
  8. Tatum WO. Mesial Temporal Lobe Epilepsy. J Clin Neurophysiol. 2012;29(5):356-365. doi: 10.1097/WNP.0b013e31826b3ab7
  9. Kuhlmann L, Lehnertz K, Richardson MP, Schelter B, Zaveri HP. Seizure prediction — ready for a new era. Nat Rev Neurol. 2018;14(10):618-630. doi: 10.1038/s41582-018-0055-2
  10. Ryvlin P, Ciumas C, Wisniewski I, Beniczky S. Wearable devices for sudden unexpected death in epilepsy prevention. Epilepsia. 2018;59(suppl 1):61-66. doi: 10.1111/epi.14054
  11. Engel J. The current place of epilepsy surgery. Curr Opin Neurol. 2018;31(2):192-197. doi: 10.1097/WCO.0000000000000528
  12. Peters MDJ, Marnie C, Tricco AC, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18(10):2119-2126. doi: 10.11124/JBIES-20-00167
  13. Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467-473. doi: 10.7326/M18-0850
  14. Patel P, Ferastraoaru V, Gold D, Lipnick A, Jehle R, Haut SR. Clinical characterization of the pre-ictal state in the pediatric population: A caretaker's perspective. Epilepsy Behav. 2017;70:193-197. doi: 10.1016/j.yebeh.2017.02.021
  15. Besag FMC, Vasey MJ. Prodrome in epilepsy. Epilepsy Behav. 2018;83:219-233. doi: 10.1016/j.yebeh.2018.03.019
  16. Mormann F, Andrzejak RG, Elger CE, Lehnertz K. Seizure prediction: the long and winding road. Brain. 2007;130(2):314-333. doi: 10.1093/brain/awl241
  17. Nakken KO, Solaas MH, Kjeldsen MJ, Friis ML, Pellock JM, Corey LA. The occurrence and characteristics of auras in a large epilepsy cohort. Acta Neurol Scand. 2009;119(2):88-93. doi: 10.1111/j.1600-0404.2008.01069.x
  18. Fried I, Spencer DD, Spencer SS. The anatomy of epileptic auras: Focal pathology and surgical outcome. J Neurosurg. 1995;83(1):60-66. doi: 10.3171/jns.1995.83.1.0060
  19. Penry K. Proposal for Revised Clinical and Electroencephalographic Classification of Epileptic Seizures. Epilepsia. 1981;22(4):489-501. doi: 10.1111/j.1528-1157.1981.tb06159.x
  20. Hughes J, Devinsky O, Feldmann E, Bromfield E. Premonitory symptoms in epilepsy. Seizure. 1993;2(3):201-203. doi: 10.1016/S1059-1311(05)80128-1
  21. Spencer D. Auras Are Frequent in Patients With Generalized Epilepsy. Epilepsy Curr. 2015;15(2):75-77. doi: 10.5698/1535-7597-15.2.75
  22. Kotwas I, McGonigal A, Trebuchon A, et al. Self-control of epileptic seizures by nonpharmacological strategies. Epilepsy Behav. 2016;55:157-164. doi: 10.1016/j.yebeh.2015.12.023
  23. Schulze-Bonhage A, Kurth C, Carius A, Steinhoff BJ, Mayer T. Seizure anticipation by patients with focal and generalized epilepsy: A multicentre assessment of premonitory symptoms. Epilepsy Res. 2006;70(1):83-88. doi: 10.1016/j.eplepsyres.2006.02.001
  24. Gagliano L, Bou Assi E, Herrera-Fortin T, Lesage F, Sawan M, Nguyen DK. Epileptic Prodromes: Insights from Surveying 196 Patients and 150 Caregivers. Can J Neurol Sci. 2021;50(1):72-82. doi: 10.1017/cjn.2021.499
  25. Caprara ALF, Tharwat Ali H, Elrefaey A, Elejla SA, Rissardo JP. Somatosensory Auras in Epilepsy: A Narrative Review of the Literature. Medicines. 2023;10(8):49. doi: 10.3390/medicines10080049
  26. Dugan P, Carlson C, Bluvstein J, Chong DJ, Friedman D, Kirsch HE. Auras in generalized epilepsy. Neurology. 2014;83(16):1444-1449. doi: 10.1212/WNL.0000000000000877
  27. Boylan LS, Labovitz DL, Jackson SC, Starner K, Devinsky O. Auras are frequent in idiopathic generalized epilepsy. Neurology. 2006;67(2):343-346. doi: 10.1212/01.wnl.0000225185.37081.97
  28. Kwack DW, Kim DW. Headache Is a Common Aura in Patients with Generalized Seizures. J Epilepsy Res. 2023;13(2):51-54. doi: 10.14581/jer.23008
  29. D'Agnano D, Cernigliaro F, Ferretti A, et al. The Role of the Autonomic Nervous System in Epilepsy and Migraine: A Narrative Review. J Integr Neurosci. 2024;23(7). doi: 10.31083/j.jin2307128
  30. Elliott B, Amarouche M, Shorvon SD. Psychiatric Features of Epilepsy and their Management. In: Treatment of Epilepsy. 3rd ed. Chichester, UK: Wiley-Blackwell; 2009:273-287. doi: 10.1002/9781444316667.ch21
  31. Kovacs N, Auer T, Balas I, et al. Neuroimaging and cognitive changes during déjà vu. Epilepsy Behav. 2009;14(1):190-196. doi: 10.1016/j.yebeh.2008.08.017
  32. Carreño M, Fernández S. Sleep-Related Epilepsy. Curr Treat Options Neurol. 2016;18(5). doi: 10.1007/s11940-016-0402-9
  33. Blair RDG. Temporal Lobe Epilepsy Semiology. Epilepsy Res Treat. 2012;2012:1-10. doi: 10.1155/2012/751510
  34. Fisher RS, Cross JH, D'Souza C, et al. Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia. 2017;58(4):531-542. doi: 10.1111/epi.13671
  35. Foldvary-Schaefer N, Unnwongse K. Localizing and lateralizing features of auras and seizures. Epilepsy Behav. 2011;20(2):160-166. doi: 10.1016/j.yebeh.2010.08.034
  36. Bien CG, Benninger FO, Urbach H, Schramm J, Kurthen M, Elger CE. Localizing value of epileptic visual auras. Brain. 2000;123(2):244-253. doi: 10.1093/brain/123.2.244
  37. Vignal JP, Maillard L, McGonigal A, Chauvel P. The dreamy state: Hallucinations of autobiographic memory evoked by temporal lobe stimulations and seizures. Brain. 2006;130(1):88-99. doi: 10.1093/brain/awl329
  38. Hogan RE, Kaiboriboon K. John Hughlings-Jackson's writings on the auditory aura and localization of the auditory cortex. Epilepsia. 2004;45(7):834-837. doi: 10.1111/j.0013-9580.2004.63303.x
  39. Chen C, Shih Y, Yen D, et al. Olfactory auras in patients with temporal lobe epilepsy. Epilepsia. 2003;44(2):257-260. doi: 10.1046/j.1528-1157.2003.25902.x
  40. Gloor P. Experiential phenomena of temporal lobe epilepsy: Facts and hypotheses. Brain. 1990;113(6):1673-1694. doi: 10.1093/brain/113.6.1673
  41. Bartolomei F, Guye M, Wendling F. Abnormal binding and disruption in large scale networks involved in human partial seizures. EPJ Nonlinear Biomed Phys. 2013;1(1). doi: 10.1140/epjnbp11
  42. Perven G, So NK. Epileptic auras: Phenomenology and neurophysiology. Epileptic Disord. 2015;17(4):349-362. doi: 10.1684/epd.2015.0786
  43. Devinsky O. Sudden unexpected death in epilepsy. N Engl J Med. 2011;365(19):1801-1811. doi: 10.1056/NEJMra1010481
  44. Karoly PJ, Freestone DR, Boston R, et al. Interictal spikes and epileptic seizures: their relationship and underlying rhythmicity. Brain. 2016;139(4):1066-1078. doi: 10.1093/brain/aww019
  45. Abramovici S, Bagić A. Epidemiology of Epilepsy. In: Handbook of Clinical Neurology. Amsterdam, Netherlands: Elsevier; 2016:159-171. doi: 10.1016/B978-0-12-802973-2.00010-0
  46. Giovannini G, Meletti S. Fluid Biomarkers of Neuro-Glial Injury in Human Status Epilepticus: A Systematic Review. Int J Mol Sci. 2023;24(15):12519. doi: 10.3390/ijms241512519
  47. Ghulaxe Y, Joshi A, Chavada J, Huse S, Kalbande B, Sarda PP. Understanding Focal Seizures in Adults: A Comprehensive Review. Cureus. 2023;15(11):e48173. doi: 10.7759/cureus.48173
  48. Beniczky S, Trinka E, Wirrell E, et al. Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy. Epilepsia. 2025;66(6):1804-1823. doi: 10.1111/epi.18338
  49. Blume WT, Lüders HO, Mizrahi E, Tassinari C, van Emde Boas W, Engel J Jr. Glossary of Descriptive Terminology for Ictal Semiology: Report of the ILAE Task Force on Classification and Terminology. Epilepsia. 2001;42(9):1212-1218. doi: 10.1046/j.1528-1157.2001.22001.x
  50. Beniczky S, Tatum WO, Blumenfeld H, et al. Seizure semiology: ILAE glossary of terms and their significance. Epileptic Disord. 2022;24(3):447-495. doi: 10.1684/epd.2022.1430
  51. Fisher RS, Bonner AM. The Revised Definition and Classification of Epilepsy for Neurodiagnostic Technologists. Neurodiagn J. 2018;58(1):1-10. doi: 10.1080/21646821.2018.1428455
  52. Brodie MJ, Zuberi SM, Scheffer IE, Fisher RS. The 2017 ILAE classification of seizure types and the epilepsies: what do people with epilepsy and their caregivers need to know? Epileptic Disord. 2018;20(2):77-87. doi: 10.1684/epd.2018.0957
  53. Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):512-521. doi: 10.1111/epi.13709
  54. Beniczky S, Trinka E, Wirrell E, et al. Practical guide to the updated seizure classification 2025. Epileptic Disord. 2025;27(6):1087-1104. doi: 10.1002/epd2.70110
  55. Rosenow F. Presurgical evaluation of epilepsy. Brain. 2001;124(9):1683-1700. doi: 10.1093/brain/124.9.1683
  56. French JA, Williamson PD, Thadani YVM, et al. Characteristics of Medial Temporal Lobe Epilepsy: I. Results of History and Physical Examination. Ann Neurol. 1993;34(6):774-780. doi: 10.1002/ana.410340604
  57. Maillard L, Vignal JP, Gavaret M, et al. Semiologic and Electrophysiologic Correlations in Temporal Lobe Seizure Subtypes. Epilepsia. 2004;45(12):1590-1599. doi: 10.1111/j.0013-9580.2004.09704.x
  58. Jobst BC, Cascino GD. Resective Epilepsy Surgery for Drug-Resistant Focal Epilepsy A Review. JAMA. 2015;313(3):285-293. doi: 10.1001/jama.2014.17426
  59. Avbersek A, Sisodiya S. Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures? J Neurol Neurosurg Psychiatry. 2010;81(7):719-726. doi: 10.1136/jnnp.2009.197996
  60. Duncan R, Oto M. Predictors of antecedent factors in psychogenic nonepileptic attacks: Multivariate analysis. Neurology. 2008;71(13):1000-1005. doi: 10.1212/01.wnl.0000326593.50863.21
  61. LaFrance WC Jr, Baker GA, Duncan R, Goldstein LH, Reuber M. Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: A staged approach. Epilepsia. 2013;54(11):2005-2018. doi: 10.1111/epi.12356
  62. Fisher RS, Engel JJ Jr. Definition of the postictal state: When does it start and end? Epilepsy Behav. 2010;19(2):100-104. doi: 10.1016/j.yebeh.2010.06.038
  63. Pottkämper JCM, Hofmeijer J, van Waarde JA, van Putten MJAM. The postictal state — What do we know? Epilepsia. 2020;61(6):1045-1061. doi: 10.1111/epi.16519
  64. Braatz V, Martins Custodio H, Leu C, et al. Postictal Psychosis in Epilepsy: A Clinicogenetic Study. Ann Neurol. 2021;90(3):464-476. doi: 10.1002/ana.26174
  65. Subota A, Khan S, Josephson CB, et al. Signs and symptoms of the postictal period in epilepsy: A systematic review and meta-analysis. Epilepsy Behav. 2019;94:243-251. doi: 10.1016/j.yebeh.2019.03.014
  66. Farrell JS, Gaxiola-Valdez I, Wolff MD, et al. Postictal behavioural impairments are due to a severe prolonged hypoperfusion/hypoxia event that is COX-2 dependent. eLife. 2016;5. doi: 10.7554/eLife.19352
  67. Fisher RS, Schachter SC. The Postictal State: A Neglected Entity in the Management of Epilepsy. Epilepsy Behav. 2000;1(1):52-59. doi: 10.1006/ebeh.2000.0023
  68. Hamelin S, Kahane P, Vercueil L. Fatigue in epilepsy: A prospective inter-ictal and post-ictal survey. Epilepsy Res. 2010;91(2-3):153-160. doi: 10.1016/j.eplepsyres.2010.07.006
  69. Lapenta L, Brunetti V, Losurdo A, et al. Transient epileptic amnesia: Clinical report of a cohort of patients. Clin EEG Neurosci. 2014;45(3):179-183. doi: 10.1177/1550059413495201
  70. Adam C, Adam C, Rouleau I, Saint-Hilaire JM. Postictal aphasia and paresis: A clinical and intracerebral EEG study. Can J Neurol Sci. 2000;27(1):49-54. doi: 10.1017/s0317167100051970
  71. Xu SY, Li ZX, Wu XW, Li L, Li CX. Frequency and pathophysiology of post-seizure Todd's paralysis. Med Sci Monit. 2020;26. doi: 10.12659/MSM.920751
  72. Krauss GL, Edwards HB. Postictal Manifestations. In: Encyclopedia of Neurological Sciences. Amsterdam, Netherlands: Elsevier; 2014:953-955. doi: 10.1016/B978-0-12-385157-4.00301-8
  73.  Lipatova LV, Sakovsky IV. Postictal increase in creatine kinase in patients with epilepsy. Epilepsy and paroxysmal conditions. 2024;16(4):333-337. doi: 10.17749/2077-8333/epi.par.con.2024.201
  74. Ryvlin P, Rheims S. Epilepsy surgery: eligibility criteria and presurgical evaluation. Dialogues Clin Neurosci. 2008;10(1):91-103. doi: 10.31887/DCNS.2008.10.1/pryvlin
  75. Beniczky S, Ryvlin P. Standards for testing and clinical validation of seizure detection devices. Epilepsia. 2018;59(suppl 1):9-13. doi: 10.1111/epi.14049
  76. Zelano J, Beniczky S, Surges R, Tomson T. Report of the ILAE SUDEP Task Force on national recommendations and practices around the world regarding the use of wearable seizure detection devices: A global survey. Epilepsia Open. 2023;8(4):1271-1278. doi: 10.1002/epi4.12801
Share
Back to top
Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here
Accept