SHEHZAD HUSSAIN

Definition Classification of seizuresPartial seizures

Simple partial and complex partial seizuresComplex partial seizure to sec gen

Generalized seizuresAbsence seizures (Typical, Atypical, eyelid myoclonia, Myoclonic

absence)MyoclonicClonicTonicTonic clonicAtonicUnclassified seizuresREFERENCES

SEIZURES

Seizures are episode of sudden disturbance of mental, motor, sensory or autonomic activity caused by a paroxysmal cerebral malfunction.

CONVULSIONS

Convulsions are violent involuntary contractions of the body musculature. In neurology, the term is usually limited to contractions produced by cerebral seizure activity.

EPILEPSY

A chronic neurologic disorder manifesting by repeated epileptic seizures (attacks or fits) which result from paroxysmal uncontrolled discharges of neurons within the central nervous system.

Epileptic prodrome:- Its change in mode or behavior before the seizure and

could be in hours or days before the seizure event.

AURA: It’s the initial event, signaling the beginning of seizures.

ICTAL or ICTUS: It’s a synonym word for seizure.

POST ICTAL: It’s a period after seizure, usually lasting longer than the seizure itself.

Interictal period:-It’s the time period between two

successive seizure events.  Status Epilepticus:-1. It is described as the recurrence of seizures by intervals too short to allow recovery of the condition that existed before the onset of the seizures.2. *An episode of more than 05 minutes of continuous seizure activity, or 3.*Two or more sequential seizures spanning this period without full recovery between seizures.

(AES)

• The seizers classification being most widely used is proposed by the Commission on classification and Terminology of the International League Against Epilepsy(ILAE).

• Classification is necessary for; New terms & concepts with internationally

accepted terminology Standardization of the seizures types description New concepts regarding Focal and generalized

seizures Better adaptation of etiological terms Electro-clinical diagnosis for seizures etc

•HOW TO RECOGNIZE SEIZURES:-•  Anatomical

(patient history help us to locate the origin of discharge )

•Pathological (infections or lesions help us to

reorganization of Sz)•Clinical

(by self observation during seizure)•Electro diagnostically (by the help of EEG+VEEG recording)

*Also known as focal seizures. *These seizures are

restricted to part of the brain and produce symptoms involving those body parts or mental functions which are most affected by the area of seizure involvement.

PARTIALSEIZURES

SIMPLE PARTIALSEIZURES

COMPLEX PARTIAL SEIZURES

These seizures produce focal motor, sensory, autonomic, mixed or psychic symptoms without change of consciousness.

(a) Partial seizure with motor symptoms:

i. Focal motor seizures consist of sustained tonic contractions or intermitent clonic contraction. They involve the face, one part of the limb or half of the body.ii. Jacksonian seizures are focal motor seizures which involve adjacent part on one side of the body during seizure. This march is due to the spread of seizure activity over adjacent parts of motor cortex.

iii. Versive seizure cause turning of the body, usually in a direction towards the side of the seizure.

iv. Aphasic seizure are characterized by expressive or global loss of language. They result from seizure activity in language area.

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(b) Partial seizures with sensory symptoms:

i. Somatosensory seizure produce sudden sensation such as tingling, heaviness, numbness or burning which, like motor symptoms, either remain in one part of the body or march over parts.ii. Visual seizure produce hallucination of white or coloured simple shapes, for instance stars and flashes or alteration of visual perception.iii. Auditory seizures cause hallucination of simple sounds.iv. Olfactory seizures produce hallucination of odors.v. Gustatory seizure consist hallucination of taste.

(c) Partial seizure with autonomic symptoms: are rarely seen in isolation. Symptoms consist of salivation, perspiration, changes in pupillary size, heart beat, respiration, urinary and epigastric discomfort.

* Psychic auras often originate from the temporal lobe, associated with simple partial seizures:

*Psychic Aura Definition *Déjà vu: An illusion of a familiar memory *Jamais vu: When what should be a familiar visual experience

becomes unfamiliar *Déjà entendu: An auditory illusion of something familiar *Jamais entendu: When what should be a familiar auditory

experience becomes unfamiliar Autoscopy: Seeing oneself in external space, as if the mind has left the body *Derealization: A feeling of unreality of the outside world; the world

seems strange and unreal. *Depersonalization: A feeling of unreality in one’s sense of self;

feeling as if in a dream or watching oneself act *Macro-/Micropsia: Objects appear larger or smaller than usual *Macr-/Micracusia: Sounds are louder or softer than usual

*An epileptic disorder can be symptomatic, idiopathic, or cryptogenic.*Symptomatic is a term that means the etiology is known—usually a structural lesion within the brain. Idiopathic is a term that refers to an epilepsy of presumed genetic etiology without a structural brain *lesion or other neurological signs or symptoms. The term has been replace by “genetic”* Cryptogenic is a term that refers to an *epilepsy that is presumed to be symptomatic but the etiology is unknown (1989). The term *cryptogenic has been replaced by “probably symptomatic”*The observable manifestation of the seizures, is known as semiology.

Often called temporal lobe seizures because they arise from foci in the mesial and inferior part of temporal lobe or adjacent part of frontal lobe.

Symptoms often consist of changes of consciousness which reduce the ability of patient to interact with their surrounding, complete loss of consciousness is not a primary symptoms.

Consist of repetitive movements which seem purposeful but they are unpurposeful. E.g, scratching, chewing, swallowing and lips smacking.In general patient have no recollection or only incomplete memory of events at the onset of seizure such as awareness of bad odour. (Aura).

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*These seizure begin like other partial seizures, they then evolve into generalized seizure.

*These seizures are usually symmetrical tonic-clonic but may be asymmetrical tonic or clonic.

*The partial onset of generalized seizure maybe remembered by the patient.

GENERALIZEDSEIZURE

1)ABSENCE SEIZURE

2) MYOCLONIC SEIZURE

3) INFANTILE SPASM

4) CLONIC SEIZURE5) TONIC SEIZURE6) TONIC CLONIC

SEIZURE

7) ATONIC SEIZURE

Formerly called ‘petit mal’ seizure.

Usually occur in childhood and rarely persist into adulthood.

Usually b/w 4&12 yrs age. TYPICAL:Consist of impairment of

consciousness without loss of muscles tone and posture.

Often manifest as inattention, an empty stare or interruption of speech or motion.

Attacks are often triggered by hyperventilation.

ABSENCESEIZURE

TYPICAL ATYPICAL

*ATYPICAL:

*Characterized by combination of impairment of consciousness and motor or autonomic changes.*May have tonic (stiffness) or clonic (jerking) spells or may

have automatism (involuntary behaviour).*The EEG doesnot have 3/sec spike and wave pattern

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*Absence seizures accompanied by brief, repetitive, often rhythmic, fast (4-6 Hz) myoclonic jerks of the eyelids with simultaneous upward deviation of the eyeballs and extension of the head. Seizures are typically very brief (<6s in duration) and multiple seizures occur on a daily basis. Mostly awareness is retained.*CAUTION If myoclonic seizure with abduction of the

upper limbs  myoclonic absence seizures*MYOCLONIC ABSENCE*Rhythmic myoclonic jerks of the shoulders and arms with

tonic abduction that results in progressive lifting of the arms during the seizure. The myoclonic jerks are typically bilateral but may be unilateral or asymmetric. Perioral myoclonias and rhythmic jerks of the head and legs may occur. Seizures last 10-60 seconds and typically occur daily. Level of awareness varies from complete loss of awareness to retained awareness.

*A myoclonic seizure involves a sudden contraction of muscles and can appear as a jerk of one or both arms or sometimes the head.

*Contraction may recurr at irregular or regular intervals.

*So brief that loss of consciousness cannot be detected.

*They often happen while falling asleep or within a short time of waking up.

*Also known as west syndrome, sallam attacks, jackknife convulsion.*named after the English physician, William james west (1793-

1848), who first described it. *Seen between 4-12 months of age.*Consist of sudden bending forward of the body with stiffness of the

arms and legs.*Tend to occur upon awakening and often occur in clusters of upto

100 spasm at a time.*A specific pattern in EEG called hypsarrythmia seen.•EEG findings showed chaotic background, with multifocal,

independent and burst suppression like epileptic form complexes.•West syndrome is the classical triad of infantile spasms,

hypsarrythmia (a typical EEG Pattern) and mental retardation.

infantile.wmv

*Consist of generalized rhythmical myoclonic movements which last for a minute or more.*Associated with loss of consciousness.*Commonly occurs as febrile seizures in childhood.*EEG findings may include spikes, polyspikes-&-wave

complexes in ictal or interictal period.

TONIC SEIZURE

*Consist of contraction of axial musculature of whole body.*Last upto 1 minute and associated with loss of

consciousness.*EEG background is often abnormal for age. Rhythmic

discharges are seen in ictal or interictal phase.

*Formerly called ‘grand mal’ seizure.*Are most severe form and most common type of generalized

seizure in adults.*Begin suddenly with loss of consciousness, sometimes

preceded by a shrill cry.*During the initial tonic phase, causing stiffness of body,

respiratory arrest with cyanosis, increased heart rate and blood pressure.*After 10-20 seconds, this phase is succeeded by clonic phase.*Now generalized jerky movements of all four limbs occur.*This clonic phase may result in injury, tongue biting, irregular

respiration and foaming at mouth.*This clonic phase stops in about 30 seconds and leave the

patient in deep coma from which he gradually recovers.*Urinary and fecal incontinence may occur in this stage.*EEG findings may include rhythmic decreasing in

frequency and increasing in amplitude during tonic phase, interrupted by slow waves during clonic phase.

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* Consist of sudden loss of muscles tone.

I) Brief Atonic Seizure: . Leads to sudden fall or droop

attack.. Usually last for one or two

seconds.

ii) Long Atonic Seizure:. Sudden loss of consciousness.. Fall to floor and remain

completelyflaccid for one or several minutes.

ATONICSEIZURES

BRIEF ATONICSEIZURES

LONG ATONICSEIZURES

*A prolonged seizure lasts approximately five minutes longer than the person’s normal state of seizure. *This should be regarded as an emergency until proven

otherwise. A prolonged seizure might graduate to status epilepticus.

STATUS EPILEPTICUS*A condition when consciousness does not return between

seizures for more than 30 min. This state may be life-threatening with the development of pyrexia, deepening coma and circullatory collapse. Death occurs in 5-10%.*Status epilepticus is a Medical Emergency.*a duration of 5 minutes of continuous generalized convulsive

activity is used arbitrarily as part of the definition of status epilepticus.

*For a third of epilepsies, the etiology may remain unknown and the epilepsies may not have distinct clinical and electrical features that allow organization by epilepsy syndromes. It is in this group of disorders that more specific phenotyping or time to observe the evolution of the patient's epilepsy may lead to the emergence of subgroups for which an etiological diagnosis can be found.