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Seizure

4th Febuary 2013

Introduction
Seizure is a common presentation in the emergency care setting, and newonset epilepsy is the most common cause of unprovoked seizures

Seizures are common in the general population, and about 1 in 10 people will
experience a seizure in their lifetime

The overall annual incidence of acute symptomatic seizures, excluding febrile


seizures, in developed countries is about 39 per 100,000 people

Am Fam Physician 2007;75:1342-1347 Goldman: Goldman's Cecil Medicine, 24th ed

Definition
Seizures are transient events that include symptoms and/or signs of abnormal
excessive hypersynchronous activity in the brain

Epilepsy as a disorder of the brain characterized by an enduring


predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological, and social consequences of this condition

Daroff: Bradley's Neurology in Clinical Practice, 6th ed.

Diagnostic scheme for the classification of seizures and epilepsy


Axis 1: Ictal phenomenologycan be used to describe ictal events with any degree
of detail needed.

Axis 2: Seizure type. Axis 3: Syndrome (understanding that a syndrome diagnosis may not always be
possible).

Axis 4: Etiology. Axis 5: Impairment (optional, but often useful, additional diagnostic parameter).

Daroff: Bradley's Neurology in Clinical Practice, 6th ed.

Seizure Terminology

Motor Non-Motor Autonomic event

Seizure Terminology
Motor manifestations refer to involvement of the musculature, usually with an
increase in muscle contraction that produces a movement

Positive motor can be used to specifically indicate an increase in muscle


contraction

Tonic means a sustained increase in muscle contraction lasting up to minutes Clonic activity refers to a regularly repetitive jerking that is prolonged

Daroff: Bradley's Neurology in Clinical Practice, 6th ed.

Seizure Terminology
Myoclonic jerk or myoclonus refers to a very brief involuntary contraction usually
lasting less than 100 msec

Negative myoclonus refers to an interruption of tonic muscle activity for less


than 500 msec without prior positive contraction

Jacksonian march spreads through contiguous body parts on the same side,
reflecting horizontal spread of seizure activity over the motor strip
clonic phase

Tonic-clonic activity is a sequence of initial tonic posturing that evolves to a

Daroff: Bradley's Neurology in Clinical Practice, 6th ed.

Seizure Terminology
Atonic activity refers to a sudden decrease or loss of muscle tone usually
lasting more than 1 second.

Versive manifestation indicates a sustained or forced deviation of the eyes or


the head to one side.

Automatisms are repetitive motor activities that are more or less coordinated
and resemble a voluntary movement but are not purposeful

Daroff: Bradley's Neurology in Clinical Practice, 6th ed.

Seizure Terminology
Elementary visual hallucinations would consist of flickering or flashing lights and
other simple patterns such as spots, scotomata, or visual loss

Elementary auditory hallucinations include buzzing, ringing, or humming sounds


or single tones, but may also be negative, with loss of hearing

Somatosensory phenomena can include tingling and other paresthesias, shock-like


sensations, numbness, pain, or a sense of movement or a desire to move a body part

Gustatory hallucinations can occur, particularly with a metallic taste

Daroff: Bradley's Neurology in Clinical Practice, 6th ed.

Other Seizure Terminology


Convulsion is an old term typically used to denote a generalized tonic-clonic seizure.
It may also be used to indicate a seizure with prominent motor activity. Nonconvulsive refers to a seizure or status epilepticus without prominent clonic or tonic motor activity. The term is most commonly used with status epilepticus to indicate that seizure activity is predominantly affecting consciousness or behavior, without clonic or tonic activity grand mal is also an old term that is usually synonymous with generalized tonic-clonic seizure petit mal is an old synonym for childhood absence epilepsy (CAE) but is also used to describe absence seizures.

Daroff: Bradley's Neurology in Clinical Practice, 6th ed.

Classification of Seizures

Daroff: Bradley's Neurology in Clinical Practice, 6th ed.

classification of seizures
Seizures that start in one part of one hemisphere are classified as partial (or
partial-onset) seizures, whereas those that start in both hemispheres simultaneously are classified as generalized (or generalized-onset) seizures.

Daroff: Bradley's Neurology in Clinical Practice, 6th ed.

classification of seizures
Focal seizures as originating within networks limited to one hemisphere, with
the possibility of the seizures being discretely localized or more widely distributed, and possibly originating in subcortical structures

Generalized seizures were defined as originating at some point within, and


rapidly engaging, bilaterally distributed networks, which do not necessarily include the entire cortex

Daroff: Bradley's Neurology in Clinical Practice, 6th ed.

Seizure mimics

Syncope
Migraine TIA

Pseudoseizure

Daroff: Bradley's Neurology in Clinical Practice, 6th ed.

Lancet Neurol 2009; 8: 37081

N Engl J Med 2008;359:166-76

Lancet Neurol 2006; 5: 17180

Syncope vs seizure

Lancet Neurol 2006; 5: 17180

Migraine vs Seizure

Lancet Neurol 2009; 8: 37081

Pseudoseizure vs Seizure

Postgrad Med J 2005;81:498504

Pseudoseizure vs Seizure

Postgrad Med J 2005;81:498504

Am Fam Physician 2007;75:1342-1347

Am Fam Physician 2007;75:1342-1347

Nonconvulsive status epilepticus

Nonconvulsive status epilepticus

J Neurol Neurosurg Psychiatry 2003;74:189191

Natural History

Epilepsy & Behavior 12 (2008) 501539

Management

Epilepsy & Behavior 12 (2008) 501539

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