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Seizures

Seizures are sudden, paroxysmal episodes of neurological dysfunction with or without impairment of consciousness, which may be epileptic (i.e., due to abnormal synchronous electrical activity within the brain, either focally or generally) or nonepileptic in origin ("pseudoseizures", nonepileptic attack disorder). The two varieties may coexist. Seizure morphology may be helpful in establishing etiology and/or focus of onset.

  1. Epileptic:

Idiopathic generalized: tonic-clonic ("grand mal"); absence attack ("petit mal"); myoclonic epilepsy
Partial: simple (no impairment of consciousness), for example jerking of one arm, which may spread sequentially to other body parts (jacksonian march); or complex, in which there is impairment or loss of consciousness: may be associated with specific aura (olfactory, déjà vu, jamais vu) and/or automatisms (motor, e.g., cursive; or emotional, e.g., gelastic, dacrystic); limb posturing (salutatory, fencing posture) and pelvic thrusting may be seen in frontal lobe epilepsy. Secondary generalization of seizures of partial onset may occur.
Investigation of partial seizures to exclude a symptomatic cause is recommended (MR imaging, EEG). Some are amenable to surgical intervention. Otherwise, as for idiopathic generalized epilepsies, various antiepileptic medications are available. Partial seizures may prove more resistant to treatment than generalized seizures.

  1. Nonepileptic:

Often long lasting, thrashing, pelvic thrusting, carpet burns, may have incontinence; past history of physical or sexual abuse. Best treated with psychological approaches, or drug treatment of underlying affective disorders; antiepileptic medications are best avoided.
The differentiation of epileptic from nonepileptic seizures may be difficult; it is sometimes helpful to see a video recording of the attacks, or to undertake in-patient video-telemetry.

 

References

Duncan JS, Shorvon SD, Fish DR. Clinical epilepsy. New York: Churchill Livingstone 1995: 25-101
Lüders H, Acharya J, Baumgartner C et al. Semiological seizure classification. Epilepsia 1998; 39: 1006-1013
Panayiotopoulos CP. A clinical guide to epileptic syndromes and theirtreatment: based on the new ILAE diagnostic scheme. Chipping Norton: Bladon, 2002

 

Cross References

Absence; Aura; Automatism; Déjà vu; Fencer’s posture, Fencin posture; Incontinence; Jacksonian march; Jamais vu; Pelvic thrusting