Types of Seizures

(International Classification)
Fall 2017
Types of Seizures Characteristics
A. Generalized  Quickly involves both cerebral hemispheres
(non-focal origin)  Characterized by bilateral synchronous epileptic
discharges in the brain from the onset of the seizure
 In most cases, loss of consciousness for a few seconds to
several minutes
1. Tonic-Clonic (formerly called grand mal)  Most common
 Loss of consciousness
 Fall to ground if upright
 Stiffening of body (tonic phase) for 10-20 seconds
 Subsequent jerking of extremities (clonic phase) for 30-40
seconds
 May be seen:
o Cyanosis
o Excessive salivation
o Tongue or cheek biting
o Incontinence
 Postical
o Usually: muscle soreness, fatigue, sleep for several
hours
o May not feel normal for several hours or day after
o No memory of seizure
 Any tonic-clonic that is preceded by an aura is a partial
seizure that generalizes secondarily.
 Secondary generalized seizure may result in a transient
residual neurologic deficit postictally (Todd’s paralysis; focal
weakness), resolves after varying lengths of time
A. Generalized
(non-focal origin)
2. Absence (formerly called petit mal)
 Typical Absence
 More common in children, rarely into adolescence
 May cease altogether or progress into another type of seizure
 Simple absence
 Brief staring spell lasting only a few seconds
(resembling daydreaming - often unnoticed-lasts less
than 10 seconds)
 Complex absence
 Blank stare accompanied by some type of movement;
blinking, chewing, hand gestures
 Can last up to 30 seconds
 When untreated, may occur up to 100 times/day
 Atypical  May be precipitated by hyperventilation and flashing lights

 Staring spell (as in any absence seizure) accompanied by other

s/s:
 Brief warnings, peculiar behavior during seizure,
confusion after seizure
somewhat responsive.
 Eye blinking or slight jerking movements of the lips
may occur. This behavior can be hard to distinguish
from the person's usual behavior, especially in those
with cognitive impairment.
 Usually last 5 to 30 seconds (commonly more than 10
seconds), with a gradual beginning and ending.
 They generally continue into adulthood
3. Myoclonic  Sudden, excessive jerk or twitch of body or extremities
 Represents a muscle contraction; may be forceful enough to
hurl to ground
 Last no more than a few seconds, but may occur in clusters
A. Generalized
(non-focal origin)
4. Atonic (drop attack)  Either a tonic episode or paroxysmal loss of muscle tone
 Begins suddenly with falling to ground
 Remains conscious; lasts no more than 15 seconds
 Normal activity can be resumed immediately
 Great risk of head injury, protective helmets
6. Tonic  Involve sudden onset of maintained increased tone in the
extensor muscles
 Sudden stiff movements
 Most often occur in sleep, affect both sides of body
 Will fall if standing; usually remains conscious
 Usually last less than 20 seconds
7. Clonic  Begin with loss of consciousness
 Sudden loss of muscle tone followed by rhythmic limb jerking
 May or may not be symmetrical
 Relatively rare
B. Focal (partial) Seizures
(focal origin)
1. Simple focal (consciousness
and alert)
2. Complex focal (loss of
consciousness and alteration in
awareness)
Psychogenic
(pseudoseizures)
Unclassified (idiopathic)
 Caused by focal irritations (Begins in one cerebral hemisphere.)
 May be confined to one side of the brain and remain focal or spread to involve entire
brain, culminating in generalized tonic-clonic (secondary generalized; focal seizure that
generalizes may be so brief it is undetected by patient observer, or on EEG
 Produce sensory, motor, cognitive, or emotional manifestations based on function of
involved area of the brain
 Most often seen in adults, generally less responsive to medical treatment.
 Experience unusual feelings or sensations that may take many forms
 May experience sudden and unexplainable feelings of joy, anger, sadness, or nausea
 May hear, smell, taste, see or feel things that are not real
 Alteration in consciousness may produce a dream like experience
 Eyes open, make movements that may seem purposeful
 Cannot interact with observers
 Strange behaviors; automatisms (such as lip smacking repetitive movements that may not be
appropriate (Picking at clothing, fumbling with objects (real or imaginary), simply walking
away
 May perform embarrassing or dangerous acts; walking into traffic or removing clothes
 May continue an activity initiated before the seizure (counting change or picking items from a
grocery shelf), but after seizure do not remember the activity - Frequently followed by period
of postictal confusion
 Last 30 seconds – 2 minutes
 Psychiatric in origin (diagnosed with video-EEG)
 Resemble epileptic seizures
 Usually in patients with:
 hx of emotional or physical abuse
 Specific traumatic episode
 Some patients have both psychogenic seizures and epilepsy
Occur for no known reason, do not fit into other categories