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

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.