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Signs and symptoms

Generalized seizures (decreased loc)


o Tonic-clonic [grand mal, generalized tonic-clonic (gtc)]:
Prodrome of unease or irritability hours to days
before the episode( the earliest portion of a seizure
recognized, the only part remembered by the
patient, it may act as warning)
Tonic ictal phase: muscle rigidity
Clonic ictal phase: repetitive violent jerking of face
and limbs, tongue biting, cyanosis, frothing,
incontinence
Post-ictal phase: flaccid limbs, extensor plantar
reflexes, headache, confusion, aching muscles, sore
tongue, amnesia, elevated serum ck lasting hours
o Absence (petit mal): usually only seen in children,
unresponsive for 5-10 s with arrest of activity, staring,
blinking or eye-rolling, no post-ictal confusion; 3 hz spike
and slow wave activity on eeg
o Tonic: muscle rigidity in flexion or extension
o Clonic: repetitive rhythmic jerking movements
o Myoclonic: sporadic contractions localized to muscle
groups of one or more extremities
o Atonic: loss of muscle tone leading to drop attack
Partialseizures
o Simpleorcomplexcansecondarilygeneralize,or
simplecomplexgeneralizedseizures
o Simple(preservedloc)
Motor:postural,phonotory,forcefulturningofeyesand/orhead,
focalmusclerigidity/jerkingjacksonianmarch(spreadingto
adjacentmusclegroups)
Sensory:unusualsensationsaffectingvision,hearing,smell,taste
ortouch
Autonomic:epigastricdiscomfort,pallor,sweating,flushing,
piloerection,pupillarydilatation
Psychiatric:symptomsrarelyoccurwithoutimpairmentof
consciousnessandaremorecommonlycomplexpartial
o Complex(alteredloc)
Patientmayappeartobeawakebutwithimpairmentofawareness
Classiccomplexseizureischaracterizedbyautomatismssuchas
chewing,swallowing,lipsmacking,scratching,fumbling,running,
disrobingandotherstereotypicmovements
Otherforms:dysphasic,dysmnesic(djvu),cognitive(disorientationoftimesense),
affective(fear,anger),illusions,structuredhallucinations(music,scenes,taste,smells),
epigastricfullness