Seizure Types

Front 1

Benign Rolandic Epilepsy

BRE

Back 1

~ No convulsions

~ Genetic

~ Males are twice as likely affected

~ Begins in children between 4-8 years old

~ Most common epilepsy syndrome in childhood

~ Usually nocturnal

~ Brief presentation

~ No psychic manifestations, auras and automatisms

~ Characterized by either simple partial seizures involving the mouth and face or generalized tonic-clonic seizures - Starts at one side of face or mouth and may spread to arm or leg

~ There can be one-sided somatosensory manifestations such as tingling (paresthesia) of one side of the tongue, speech arrest (anarthria), gurgling or grunting noises or drooling

Front 2

Juvenile Myoclonic Epilepsy

Janz Syndrome

JME

Back 2

~ Idiopathic generalized epilepsy (may be inherited)

~ Begins around puberty (after 8-10 years) and typically first manifests itself between the ages of 12 and 18

~ Szs occurring early in the morning (Nearly exclusively 15 to 30 min after awakening but usually within 1-2 hours)

~ No cognitive delays

~ Life long AEDs needed

~ No impairment of consciousness

~ Equal distribution of gender

~ Localized to chromosome B

~ Sz involve neck, shoulders, and arms - either singly or repeated. Most patients also have tonic-clonic seizures and many also have absence seizures

~ Pt seems to throw things in the morning - can be a strong enough force to throw a person to the ground

~ General Tonic-Clonic & Absence Sz

~ Sz may occur later in the day with sleep deprivation

~ These pts also tend to have TC Szs

Front 3

Febrile Seizures

Back 3

~ Begins in children ages 3 mo - 5 years with 2 years being most common

~ It is not considered 'epilepsy' if these szs are reoccurring unless other factors develop

~ Duration is 5 minutes or less

~ Generalized convulsions and looks like TC sz

~ Twice as common in boys as in girls

~ Most common cause of seizure in children, with up to 5% of all children having at least one by age 5 years, but only 2% of children who have these will develop true epilepsy

Front 4

Infantile Spasms


Other Names:
- West's Syndrome
- Jackknife convulsions
- Salaam spasms

- Generalized Flexion Epilepsy
- Massive Myoclonia
- Infantile Epileptic Encephalopathy
- Infantile Myoclonic Encephalopathy

Back 4

~ Begins at 2-7 months and occurs for the first 2 years of life thereafter

~ Usually due to a perinatal insult of the brain

~ Quick jerky lean forward from waist, abrupt head drop to waist (may seem to reach for support)

~ Frequently occurs in clusters especially upon arousal from sleep

~ Tonic or myoclonic seizures

~ Mental and cognitive impairments

Front 5

Myoclonic Seizures

Back 5

~ Generalized

~ Sudden brief (20-100 msec) muscle contraction - generalized or may involve only 1 or a few muscles

~ Jerks can be single or multiple, and reoccurring every few seconds - usually synchronous

~ Can be strong enough to throw someone to the ground

~ No impairment of consciousness

~ No post ictal period

Front 6

Atonic Seizures

Akinetic Seizures

Back 6

~ 'Drop Attacks'

~ No warning - a sudden total loss of muscle tone

~ May need helmet or collosectomy to decrease if not able to tx

Front 7

Tonic Seizures

Back 7

~ Brief (10-30 s) episodes of generalized increase in muscle tone (occasionally will only be a group of muscles)

~ Air rushes to lungs (pt may yell out)

~ Pt loses consciousness and falls due to muscles stiffing and becoming rigid

~ Usually activated by onset of sleep

~ Sudden onset of increased tone in the extensor muscles

~ If standing, the patient typically falls to the ground

~ Postictal impairment with confusion, tiredness, and headache is common. The degree of postictal impairment is usually related to the duration of the seizure

~ Frequently seen in LGS (about 92%)

Front 8

Clonic Seizures

Back 8

~ Altered consciousness

~ Rhythmic bilateral myoclonic jerks occurring in rapid succession (assymetry not uncommon) of arms and legs (muscles will start to contract and relax rapidly)

~ Pt may roll and stretch as the seizure spreads

~ Eyes typically roll back or close and the tongue often suffers bruising sustained by strong jaw contractions and incontinence is seen in some cases, teeth clench, irregular breathing may occur

~ Can occur during non-rem sleep

~ Post ictal symptoms are fatigue, confusion, HA, and sleep

Front 9

Absence Seizures

Petit-Mal

Back 9

~ Generalized (Petit-Mal)

~ Genetic

~ Normal ictal period, no warning before a seizure and no post ictal period

~ Awareness and responsiveness are impaired

~ Very brief

~ Starring

~ Complete alertness immediately afterward

~ Typically last less than 10 seconds, often less than 5 seconds

Front 10

Atypical Absence Seizures

Petit-Mal

Back 10

~ Generalized

~ Considered 'complex'

~ Normal ictal period, no warning before a seizure and no post ictal period

~ Starring and include a change in muscle activity, usually eye blinks, eye rolling, lip smacking, chewing, change in postural tone, and other automatisms

~ Usually more than 10 seconds

Front 11

Nocturnal Seizures

Back 11

~ Seizures occur only while sleeping - usually within the first 2 hours of sleep or the hour before awakening

~ It is focal onset (may be very brief) and secondarily generalized to TC

~ Several common forms of epilepsy, including frontal lobe epilepsy, can manifest in this state

~ If one stays awake at a time when s/he is usually asleep, s/he can have the seizure while awake, which will have symptoms of motor szs on one side of the body, usually the face and may impair speech

Front 12

Tonic Clonic Seizures

Grand Mal or Gran Mal

Back 12

~ Generalized

~ Does not usually occur during the first few months of life but can at any age thereafter

~ Aura may be experienced (which is actually a simple partial sz) then lose complete awareness and start making odd or pointless repetitive movements such as picking at clothes or lip smacking towards the end of the aura (at this point the seizure has progressed to become a complex partial seizure) then gradually spreads to the whole brain

~ Due to physical and nervous exhaustion, postictal sleep invariably follows

~ Confusion and complete amnesia upon regaining consciousness is usually experienced and slowly wears off as the person becomes gradually aware that a seizure occurred

Front 13

Complex Partial Seizures

Psycho-motor Seizures

Temporal Lobe Seizures

Back 13

~ Focal

~ Usually preceded by an aura

~ Usually includes psychiatric symptoms but rarely dejavu or hallucinations, etc.

~ Can arise from any lobe of the brain but mostly from the temporal lobe

~ Symptoms vary depending on area of the brain affected

~ Mostly temporal

~ Automatisms

~ Sometimes resembles drunkenness


~ Loss of consciousness

~ Autonomic symptoms such as vomiting, tachycardia, dizziness, etc may occur

~ Confusion lasts some time after sz

Front 14

Simple Partial

Focal Motor or Focal Sensory

Aura

Back 14

~ Focal

~ Originates from Rolandic area

~ Usually a precursors to a larger seizure but can occur in isolation

~ Usually start suddenly and are very brief

~ No impairment of conscience

~ Can occur at any age

~ Sz produced from motor strip and symptoms will be contralateral

~ Jacksonian March is one example

Front 15

Aversive Seizures

Back 15

~ Caused by a lesion on either of the frontal motor eye fields

~ Focal

~ During a sz, head and eyes or trunk deviate away from the location of the lesion

Front 16

Affective Seizure

Back 16

~ A focal or temporal lobe seizure accompanied by emotional reactions

Front 17

Eneuretic Seizures

Back 17

~ Seizures involving bed wetting

~ Not the same as nocturnal bed wetting

~ This is also often called incontinence

Front 18

Jacksonian Seizures

Back 18

~ Begin as simple partial seizures, which then take on motor symptoms such as twitching of the muscles or limbs, turning the head to the side, paralysis, visual changes, or vertigo may occur

~ A progression of the location of the seizure in the brain, which leads to a particular rhythm in the motor presentation of symptoms

~ Initiated with abnormal electrical activity within the primary motor cortex

~ Unique in that they travel through the primary motor cortex in succession, affecting the corresponding muscles, often beginning with the fingers, which is felt as a tingling sensation. It then affects the hand and then moves on to more proximal areas

~ They can also start at the feet, same tingling (pins and needles), there is cramping of the foot muscles which, due to the signals from the brain, causes great pain

~ Other symptoms include sudden head and eye movements, tingling, numbness, smacking of the lips, and sudden muscle contractions, rhythmic muscle contractions in a part of the body, abnormal num

Front 19

Gelastic Seizures

Back 19

~ Automatism of laughing

~ Rare

~ Involves a sudden burst of energy

~ Usually occurs for no obvious reason and is uncontrollable

~ Slightly more common in males than females

Front 20

Lacrimonic Seizures

Back 20

~ Automatism of crying

Front 21

Neonatal Seizures

Unclassified Seizures

Back 21

~ The neonatal period is limited to the first 28 days of life in a term infant and for premature infants, this term usually is applied until gestational age 44 weeks; ie, the age of the infant from conception to 44 weeks

~ Resembles normal neonate clinical activity

~ Focal and symptomatic with shifting clonic movements that go from one area of the body to another in a disorganized fashion

~ May have HR and resp changes

~ Eye 'swimming' is common

~ Seizures occur over only a few days, and fewer than half of affected infants develop seizures later in life

~ Most are focal

~ Relatively common

Front 22

Sensory Reflex Seizures

Back 22

~ Rare - only a small group develop this

~ Induced by specific stimuli, usually auditory, somatic, olfactory, gustatory, or visceral (with photosensitivity being the most common)

~ May clinically manifest as partial or generalized seizures

~ Reading will usually induce myoclonic jerks of the jaw

~ Other types are eating, musicogenic (complex partial), movement induced and 'Tapping Epilepsy' caused from being touched

Front 23

Status Epilepticus (SE)

Back 23

~ A life-threatening condition in which the brain is in a state of persistent seizure

~ Always considered a medical emergency because there is some evidence that 5 minutes is sufficient to damage neurons and that seizures are unlikely to self-terminate by that time

~ Szs occurring so frequently that pt does not fully recover between them

~ Or a single seizure lasting longer than 30 minutes

~ The mortality rate has the potential to be quite high (at least 20%)

Front 24

Simple Partial Status Epilepticus (SPSE)

Epilepsia Partialis Continua (EPC)

Focal Motor Status

Back 24

~ Constant repetitive clonic activity if a limited muscle segments contralateral to the cortical focus

~ Pt is conscious

~ Some may be surgical candidates

~ Non-convulsive

Front 25

Absence Status Epilepticus

Petit Mal Status

Spike & Wave Stupor

Back 25

~ Alters consciousness

~ Mild clonic movements of hands and eyelids

~ Automatisms of face and hands can occur

~ Most of these pts seem dull and confused but able to carry out daily living activities such as eating, drinking, dressing

~ Can last up to 30 minutes for up to several days

~ Seen in any age but most often adults who failed to out grow childhood disorder

~ Dx is difficult w/o EEG

~ Often misdiagnosed as focal status epilepticus

Front 26

Complex Partial Status Epilepticus (CPSE)

Back 26

~ Rare

~ May occur in convulsive and also one of the only non-convulsive forms in this catagory

~ Twilight state b/t szs with partial responsiveness - involving long-lasting stupor, staring and unresponsiveness

~ Automatism of speech and purposeful movements and eye twitching

~ A series of these will induce total unresponsiveness

~ Dangerously under diagnosed and misdiagnosed

Front 27

Partial Seizures

Back 27

~ Symptoms will vary according to where the seizure occurs

-In the frontal lobe symptoms may include a wave-like sensation in the head
-In the temporal lobe, a feeling of déjà vu; in the parietal lobe, a numbness or tingling;
-In the occipital lobe, visual disturbance or hallucination

Front 28

PGE

Back 28

~ Includes Idopathic TC, Classic Absence, Myoclonic

~ Normal cognitive functioning

~ Easily managed

Front 29

SGE

Back 29

~ Includes Atypical Absence, Tonic, Atonic, Infatile Spasms, LGS

~ Cognitive impairment

~ Difficult to control

Front 30

Frontal Lobe Seizures

Back 30

~ Mostly Simple Partial Sz.

~ Effects reasoning and higher learning.

~ Seizures characterised by unusual symptoms of ‘forced thinking’ and ‘forced acts’. The patient is forced into an obsessive thought (forced thinking) associated with a fairly well-adapted attempt to act on this thought (forced acts).

~ The patient is compulsively ‘forced to fix on something with the eyes’, ‘the brain commands him to do something that he should not do’, ‘a sensation of being forced to open the eyes’. This is often associated with forced bizarre actions of hypermotor seizures.

~ Gaze and gestures of the upper limbs appear to be attracted by some object in the immediate environment, which orients a pseudo-intentional sequence of catching, touching, putting in order, or playing with the hands. Aggressive facial expression and complex vocalisation (menaces, insults, obscenities) precede a sequential gestural pattern such as standing up, then running around the table, spitting, tapping on the table, seemingly speaki

Front 31

Temporal Lobe Seizures

Back 31

~ More Complex Partial Sz. Can be simple focal seizures, complex focal seizures, and secondarily generalized seizures, or combinations of these.

~ Effects emotions.

~ Simple focal seizures typically characterized by autonomic and/or psychic symptoms and certain sensory phenomena such as olfactory and auditory (including illusions). Most common is an epigastric, often rising, sensation.

~ Complex focal seizures often but not always begin with motor arrest typically followed by oroalimentary automatisms. Other automatisms frequently follow. The duration is typically >1 min. Postictal confusion usually occurs. The attacks are followed by amnesia. Recovery is gradual.

Front 32

Parietal Lobe Seizures

Back 32

~ May start at any age. Both sexes are equally affected.

~ Simple focal without impairment of consciousness. They manifest with subjective symptoms (auras).

~ Usually characterized by simple partial and secondarily generalized seizures. Most seizures arising in this lobe remain as simple partial seizures, but complex partial seizures may arise out of simple partial seizures and occur with spread beyond the this lobe. These also have a tendency to become secondarily generalized.

~ Phenomena consist of tingling and a feeling of electricity, which may be confined or may spread in a Jacksonian manner. There may be a desire to move a body part or a sensation as if a part were being moved. Muscle tone may be lost. The parts most frequently involved are those with the largest cortical representation (e.g., the hand, arm, and face). There may be tongue sensations of crawling, stiffness, or coldness, and facial sensory phenomena may occur bilaterally. Occasionally, an intraabdominal sensation of sinking, cho

Front 33

Occipital Lobe Seizures

Back 33

~ May start at any age and at any stage after or during the course of the underlying causative disorder.

~ Usually characterized by simple partial and secondarily generalised seizures. Complex partial seizures may occur with spread beyond this lobe.

~ Often associated with migraines.

Visual manifestations (sparks or flashes, phosphenes). Decreases sight. Such sensations appear in the visual field contralateral to the discharge in the specific visual cortex, but can spread to the entire visual field. Perceptive illusions, in which the objects appear to be distorted, may occur. The following varieties can be distinguished: a change in size (macropsia or micropsia), or a change in distance, an inclination of objects in a given plane of space and distortion of objects or a sudden change of shape (metamorphopsia). Visual hallucinatory seizures are occasionally characterized by complex visual perceptions (e.g. colourful scenes of varying complexity). In some cases, the scene is distorted or made smaller,

Front 34

Subacute Sclerosing Panencephalitis Epilepsy (SSPE)

Back 34

~ Frequent in Morocco since the generalization of measles vaccination in 1982.

~ A 'disease-revealing' seizure, which were widely dominated by partial seizures, secondarily generalized or not (86%), suggesting a focalized encephalitic process.

Front 35

Continuous Spike and Wave Discharges During Sleep (CSWDS)

Back 35

There appears to be an overlap between Landau-Kleffner syndrome and this syndrome.

Front 36

Electrographic Status Epilepticus of Sleep (ESES)

Back 36

Status w/ no clinical symptoms seen only during sleep.

Commonly seen in LKS.