Epilepsy and an overview of the types of seizures
Based on the type of behavior and brain activity, seizures are divided into two broad categories: generalized and partial (also called local or focal). Classifying the type of seizure helps physicians diagnose whether or not a patient has epilepsy.
Generalized seizures are produced by electrical impulses from throughout the entire brain, whereas partial seizures are produced (at least initially) by electrical impulses in a relatively small part of the brain. The part of the brain generating the seizures is sometimes called the focus.
(Produced by the entire brain)
|1. "Grand Mal" or Generalized tonic-clonic||Unconsciousness, convulsions, muscle rigidity|
|2. Absence||Brief loss of consciousness|
|3. Myoclonic||Sporadic (isolated), jerking movements|
|4. Clonic||Repetitive, jerking movements|
|5. Tonic||Muscle stiffness, rigidity|
|6. Atonic||Loss of muscle tone|
There are six types of generalized seizures. The most common and dramatic, and therefore the most well known, is the generalized convulsion, also called the grand-mal seizure. In this type of seizure, the patient loses consciousness and usually collapses. The loss of consciousness is followed by generalized body stiffening (called the "tonic" phase of the seizure) for 30 to 60 seconds, then by violent jerking (the "clonic" phase) for 30 to 60 seconds, after which the patient goes into a deep sleep (the "postictal" or after-seizure phase). During grand-mal seizures, injuries and accidents may occur, such as tongue biting and urinary incontinence.
Absence seizures cause a short loss of consciousness (just a few seconds) with few or no symptoms. The patient, most often a child, typically interrupts an activity and stares blankly. These seizures begin and end abruptly and may occur several times a day. Patients are usually not aware that they are having a seizure, except that they may be aware of "losing time."
Myoclonic seizures consist of sporadic jerks, usually on both sides of the body. Patients sometimes describe the jerks as brief electrical shocks. When violent, these seizures may result in dropping or involuntarily throwing objects.
Clonic seizures are repetitive, rhythmic jerks that involve both sides of the body at the same time.
Atonic seizures consist of a sudden and general loss of muscle tone, particularly in the arms and legs, which often results in a fall.
(Produced by a small area of the brain)
|1. Simple (awareness is retained)
a. Simple Motor
b. Simple Sensory
c. Simple Psychological
|a. Jerking, muscle rigidity, spasms, head-turning
b. Unusual sensations affecting either the vision, hearing, smell taste or touch
c. Memory or emotional disturbances
(Impairment of awareness)
|Automatisms such as lip smacking, chewing, fidgeting, walking and other repetitive, involuntary but coordinated movements|
|3. Partial seizure with secondary generalization||Symptoms that are initially associated with a preservation of consciousness that then evolves into a loss of consciousness and convulsions.|
Partial seizures are divided into simple, complex and those that evolve into secondary generalized seizures. The difference between simple and complex seizures is that during simple partial seizures, patients retain awareness; during complex partial seizures, they lose awareness.
Simple partial seizures
Simple partial seizures are further subdivided into four categories according to the nature of their symptoms: motor, autonomic, sensory or psychological. Motor symptoms include movements such as jerking and stiffening. Sensory symptoms caused by seizures involve unusual sensations affecting any of the five senses (vision, hearing, smell, taste or touch). When simple partial seizures cause sensory symptoms only (and not motor symptoms), they are called "auras."
Autonomic symptoms affect the autonomic nervous system, which is the group of nerves that control the functions of our organs, like the heart, stomach, bladder, intestines. Therefore autonomic symptoms are things like racing heart beat, stomach upset, diarrhea, loss of bladder control. The only common autonomic symptom is a peculiar sensation in the stomach that is experienced by some patients with a type of epilepsy called temporal lobe epilepsy. Simple partial seizures with psychological symptoms are characterized by various experiences involving memory (the sensation of deja-vu), emotions (such as fear or pleasure), or other complex psychological phenomena.
Complex partial seizures
Complex partial seizures, by definition, include impairment of awareness. Patients seem to be "out of touch," "out of it" or "staring into space" during these seizures. There may also be some "complex" symptoms called automatisms. Automatisms consist of involuntary but coordinated movements that tend to be purposeless and repetitive. Common automatisms include lip smacking, chewing, fidgeting and walking.
Focal seizures, the third kind of partial seizure is one that begins as a focal seizure and evolves into a generalized convulsive ("grand-mal") seizure. Most patients with partial seizures have simple partial, complex partial and secondarily generalized seizures. In about two-thirds of patients with partial epilepsy, seizures can be controlled with medications. Partial seizures that cannot be treated with medications can often be treated surgically.
Reviewed by The Cleveland Clinic Neuroscience Center.
Edited by Edited by Joseph R Carcione, MBA, DO on February 01, 2007
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