Seizures (types, description, and location)

Type of sz for Generalized

Clinical/subclinical

Generalized sz description

Most often seen with idiopathic or symptomatic generalized epilepsy syndromes.

Evolve in frequency or distribution.

Generalized sz location

All leads but sometimes have a predominance in the Anterior or other region.

Type of sz for Focal

Clinical/subclinical

What are the categories in focal sz

focal aware, focal impaired aware, or focal to bilateral tonic clonic.

Focal aware sz

retains consciousness throughout the sz

Focal impaired aware/unaware sz

Lose consciousness

Focal sz location

Single area which they originate but can be lateralized

GTC type of sz

Clinical

GTC description

Start with period of tonic motor activity that clinically appears as stiffening

EEG appears: significant myogenic artifact. Then, the tracing will evolve into intermittent bursts of spike/Polyspike and slow waves.

Followed by: a period of post-ictal attenuation and/or slowing

GTC location

ALL leads

Focal secondarily generalized type of sz

Clinical/subclinical

Focal Secondarily Generalized description

Start in a limited area on one side of the brain and spread to both sides.

Traumatic brain injuries, brain tumors, stroke, infections, and aneurysms can cause Bilateral Tonic Clonic

Focal Secondarily Generalized location

Specific area then involving all leads.

Temporal lobe sz type

Clinical

Temporal lobe description

May happen by an aura or warning symptom.

Patient can experience abnormal sensation, hallucination, and vivid Déjà vu

Temporal lobe location

Begins in temporal lobe

Tonic sz type

Clincal

Tonic sz description

Consists of extension and stiffening of arms and legs, it may last 10-30 sec

Tonic sz location

Mostly involving all leads

Clonic sz type

Clinical

Clonic sz description

Vigorous repetitive jerking of the arms and legs. It usually lasts 1-3 min.

Clonic sz location

Mostly involving all leads

Frontal lobe sz type

Clinical

Frontal lobe sz description

Clusters of brief focal sz during sleep with spikes in the frontal lobe and have more dramatic movements during the sz such as bicycling, kicking, thrashing, and bouncing up and down.

Difficult to control and are less likely to be candidates for surgery

Frontal lobe sz location

Frontal but may only show EMG and attenuation.

Nocturnal frontal lobe sz type

Clinical

Nocturnal Frontal Lobe sz description

Pt state: Epileptiform abnormalities may only be present during sleep. Sometimes they have vocalization and tonic posturing. Can be mistaken for parasomnias.

EEG appearance: EEG may demonstrate rare frontal or fronto-temporal sharp waves or spikes.

Nocturnal Frontal Lobe sz location

Fronto-temporal leads but may only show EMG and attenuation

Atonic sz type

Clinical

Atonic sz description

A generalized sz and there is no LOC, no aura, and no post-ictal confusion.

It is also called drop attacks like head nodding, falling to the floor abruptly, or a sudden increase in muscle tone (brief tonic sz).

Seen almost exclusively in Lennox-Gastaut Syndrome.

Associated with a sudden loud sound and the EEG is variable.

Atonic sz location

All the leads

Absence sz type

Clinical

Absence sz description

A generalized sz, the patient does NOT have an aura, but has a slight hesitation or pause and stares off, usually lasting a few seconds, with possible automatisms and may spontaneously open their eyes. If the hesitation lasts long enough, the patient is unresponsive to their surroundings.

Absense sz location

All leads; Generalized 3 Hz per second spike and waves. The bursts may be higher amplitude in the frontal lobe but it is still generalized.

Epileptic Spasms/ Myoclonic type of sz

Clinical

Epileptic Spasms/ Myoclonic description

Brief jerking or twitching muscle motions. The sudden unintended muscle motions, known as myoclonic jerks, typically last 1-2 sec.

Myo” means muscle and “clonus” means a rhythmic spasm.

Epileptic spasms/ Myoclonic sz location

Generalized with a spike/wave followed by brief attenuation

Simple partial sz type

Clinical

Simple partial sz description

Simple means no loss of consciousness and partial means focal. There can be motor twitching or sensory symptoms in association with spikes in the contralateral area of the brain that controls that part (motor/sensory strip). An aura could be a simple partial sz.

The patient can recall the entire event and they begin at any age.

If the patient had an aura of a bad taste or smell, has an aura, then a GTC, then their primary disorder is simple partial sz, and they have secondary generalization.

Treatments: phenytoin, carbamazepine, phenobarbital, and primidone.

Simple partial sz location

Central-temporal with possibility of secondary generalization.

Atypical absence sz description

Twitching and staring but with no impairment of consciousness.

This is seen almost exclusively with Lennox-Gastaut Syndrome. This sz can progress (get worse) and become a tonic/clonic sz

Atypical absense sz location

Generalized sz, 1.5-2.5 Hz spike and waves

Complex partial sz description

Either in the temporal (much more common) or frontal one.

Complex means LOC or impaired awareness. Partial means Focal.

Complex partial sz location

Frontal/temporal lobe

Temporal Complex Partial sz description

Gen/focal: A focal sz showing spikes in the temporal lobe.

Aura/LOC: They might start with an aura (a simple partial sz) then lead to LOC, or they may start with a LOC and they frequently have automatisms.

When focal sz originate in the patient’s non-dominant hemisphere, pt are usually able to speak during the sz. When focal sz originate in the patient’s dominant hemisphere, pt may have ictal and post-ictal aphasia.

Temporal complex partial location

Temporal leads

Adversive sz type

Clinical

Adversive sz description

Known as: versive and contraversive.

Gen/focal: focal sz causes a turning of the body, head, or eyes usually in a direction away from the side of the sz discharge.

Location: The focus is usually posterior of the frontal lobe.

Aura/LOC: There may or may not be an aura and there usually is a loss of consciousness.

Jacksonian sz type

Clinical

Jacksonian sz description

The left or right thumb may start jerking, then all the left fingers, then the left hand, then the left arm, then the left side of the face and possibly the left leg. These sz “march” along a certain area of the motor strip. They are focal (primary) but may lead to secondary generalization.

Jacksonian sz location

Specific lead or eventually involving all the leads

Gelastic sz type

Clinical

Gelastic sz description

Sudden emotion such as laughter can manifest a sz.

Accompanied by: forced eye movements, chewing, teeth grinding and or tonic/clonic jerking.

Location: It can start in the temporal lobe (emotion center), occasionally in the frontal lobe or from hypothalamic hamartoma.

Febrile sz type

Clinical

Febrile sz description

When: on the first day of a fever.

Duration: a few min and is usually harmless.

Gen/focal: Generalized tonic/clonic, fall under the special syndromes category and last less than 5 min.

Symptoms: staring, severe shaking, or tightening of the muscles.

A child may lose consciousness

Febrile sz location

Generalized

Infantile spasm sz type

Clinical

Infantile spasm description

What kind of pt: someone that can precede or include West’s syndrome.

Known as: as jack-knife sz and salaam spasms

Gen/focal: generalized sz disorder

Age: age onset between 2 and 7 months

Duration: clusters can last from 1-15 sec.

EEG appearance: The head or body drop forward and the EEG shows hypsarrhythmia and chaotic patterns.

Neonatal sz description

Age onset: birth to 1 month

It is hard to distinguish between normal baby movements or sz. May have pedal movements of arms, changes in heart rate, deviation of eyes, apnea etc.

The EEG may be the only thing that tells us that the baby is seizing.

They fall under the undetermined category.

caused: disorders such as hypoglycemia, Hemorrhage, metabolic disturbance, hypocalcemia etc so to treat, you must get rid of the disorder. If no disorder is found, phenobarbital & phenytoin are used.

Neonatal sz Location

Lateralized and may switch hemisphere