Classification of epileptic seizures

Epileptic seizure is a symptom of epilepsy; and can also occur in number of diseases.
 * The type os seizure is determined by: patient history (anamnéza), observation, EEG
 * Determining the type of seizure can help in localising the epilepsy in the central nervous system, to search for ethology of the seizure imaging methods are used.
 * Primary epilepsy – It has a strong genetic predisposition, with no underlying structural, metabolic or pathological abnormality. There are no deviations from the norm in the period between seizures.
 * Secondary (symptomatic) epilepsy – This type is accompanied by other CNS diseases, prognosis for secondary epilepsy is worse than primary epilepsy

Partial epileptic seizure (focal, non focal)

 * It is localization of the epileptic discharge, which can spread to the surroundings or can secondarily generalise; partial seizures are a manifestation of a localised (focal) brain lesion
 * always secondary (tumor, inflammation)

Partial simplex seizure

 * consciousness is preserved, but patient has symptoms:
 * motor (tonic / clonic) – 1 limb segment, Jacksonian motor epilepsy, aversive seizures (from gyrus precentralis)
 * sensory – pseudo-hallucinations, illusions, paresthesia, pain, Jackson's sensitive epilepsy (from the post-central gyrus and sensory cortex)
 * autonomic – TF, DF, nausea, redness, pain
 * psychological – dreamy state, deja vu, depersonalization (from the limbic system and cortex)

Partial seizure with complex symptomatology

 * consciousness impaired: (temporal epilepsy) – aura (uniform crisis, depersonalization, hallucinations / delusions, abdominal aura), seizure (absent gaze, stereotypic movements)
 * loss of consciousness follows a partial simplex seizure
 * loss of consciousness from the beginning

Partial seizure secondarily generalised

 * sensations → to brain → loss of consciousness → thalamocortical circuit → to both the hemispheres
 * prodrome → aura → ictus → postparoxysmal period
 * partial simplex seizure with secondary generalisation
 * complex partial seizure with secondary generalisation
 * partial simplex to complex seizure with secondary generalisation

Generalised epileptic seizure

 * bilateral localised seizure, symmetrical without focal onset
 * the beginnings of epileptic discharges are localised in the meso-diencephalic reticular formation and radiate diffusely throughout the brain
 * with convulsions (convulsive) / without convulsions (non-convulsive)
 * disorder of conciousness seizure states without aura, primary and secondary
 * The typical course has 3 phases: Pre seizure period – aura (maybe absent); seizure itself, which can last for several minutes; then the patient falls asleep
 * absence (petit mal): „shock“ (squinting, twitching eyelids), paleness / flushing, EEG: spike / slow waves
 * typical absence
 * atypical absence
 * myoclonic seizures – fast twitch muscles. convulsions without loss of consciousness, EEG: spike discharge
 * tonic seizure (West Syndrome) – tonic spasms of trunk and flexion of upper limb muscles and extension of lower limb muscles, in children, mental retardation and falls.
 * clonic seizures (childhood and Janz's juvenile myoclonic epilepsy) – less frequency of twitches than myoclonus, loss of conciousness, children
 * atonic seizure (astatic seizure, Lenox-Gastaut syndrome) – loss of postural muscle tone → sudden fall to the ground, may not be a disturbance of consciousness
 * tonic-clonic seizure (grand mal) – loss of consciousness, fall cyanosis, salivation, pupillary areflexia, (1) tonic phase (EEG: high symmetrical spikes) → (2) tonic-clonic phase (↑BP, TF, tonic contractions and short relaxations, EEG: high slow waves / spikes and wave complexes) → (3) relaxation phase (muscle flaccidity and incontinence, EEG: isoelectric line) → awakening and confusion / sleep

Status epilepticus
Mortality of generalised tonic-clonic SE is 10–20 %.
 * 90 % of uncomplicated generalized seizures that last less than 2 minutes and rarely upto 5 minutes, i.e. it is necessary to treat each seizure lasting 5 or maximum 10 minutes as status epilepticus (SE).
 * consciousness is impaired between seizures → brain damage may occur
 * State of emergency! (exhaustion, ↑BP)
 * accompanied by fever, leukocytosis, acidosis and there is a risk of exhaustion and collapse of organism, cerebral hypoxia from respiratory hypoventilation and cerebral edema

Related articles

 * Epilepsy
 * Epilepsy (pediatrics)
 * Epilepsy/PGS
 * Epilepsy/PGS (VPL)
 * Status epilepticus (pediatrics)
 * Surgical treatment of epilepsy
 * Antiepileptic drugs