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Seizure Types

GENERALIZED – seizure activity involves whole brain.
PARTIAL – seizure activity located in portion of brain – behavior reflects area of brain that is damaged.

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Generalized

TONIC-CLONIC – ( grand mal) convulsive  (Most often recognized, but only 10% of those with epilepsy have this type of seizure)

  • Stiffens, may utter cry, loss of consciousness, falls, body jerking
  •  1 – 3 minutes
  • loss of bladder or bowel control or vomiting possible
  • breathing – during tonic phase, breathing may decrease or cease – causing cyanosis (bluing) of lips, face, nail beds – returns during clonic phase though may be irregular
  • after seizure = confusion, exhaustion, possible agitated or depressed.  Won’t remember seizure.  15 min to several hours
  • most likely of seizure types to go into status

MYOCLONIC

  • Brief, shock-like jerks of muscles – usually on both sides of body  at same time
  • Neck, shoulder, upper arms, body, upper legs
  • If something in hand, may get thrown
  • Occurs in variety of epilepsy syndromes
  • Usually no loss of consciousness

TONIC

  • Stiffening of body, arms or legs
  • Less than 20 sec., often during sleep
  • May lose balance & fall
  • May be loss of consciousness

CLONIC

  • Jerking, convulsive movements with no stiffening
  • Loss of consciousness
  • Usually not followed by confusion or tiredness

ATONIC

  • Sudden loss of muscle tone –  head, arm or body falls
  • Brief loss of consciousness
  • Less than 15 seconds
  • Injury common (helmets recommended)

ABSENCE (petit mal)

  • Brief episodes of staring
  • Impaired awareness & lack of responsiveness
  • May be eye blinks, chewing movements
  • 10-20 seconds or less – up to 100s a day
  • most common in children
  • promptly resumes activity – no after effect
  • will have missed ensuing activity, no awareness of seizure

Partial

Very diverse symptoms, may not be recognized as seizures (similar symptoms could have other causes)

Simple Partial – aware, can remember what occurs

  • “auras”
  • generally last only a few minutes
  • Motor seizures – change in muscle activity
    • Involuntary contractions – body jerking, ie. finger or arm, face twitching
    • Weakness of body part – hand (drop object), vocal (difficulty speaking)
  • Sensory – changes in sensation – hallucinations & illusions
    • Touch (numbness, “pins & needles”)
    • Smell (detect odor)
    • Taste
    • Vision (seeing something not there; occasionally momentary loss of vision)
    • Hearing (music, ringing, person’s voice)
  • Autonomic – change in area controlling automatic bodily functions
    • Strange sensations in abdomen (nausea), chest (pressure), head (dizziness)
    • Sweating, heart rate or breathing changes for no reason
  • Psychic – changes that affect how we think, feel & experience things
    • Problems with language function (garbled speech, difficulty understanding spoken or written language, word repetition)
    • Emotions – sudden fear, anxiety, depression, crying, hysterical laughter (spontaneous – not result of something triggering emotion)
    • “déjà vu” (feeling of having lived through this moment before); “jamais vu” (familiar things seems strange); feeling of being on “outside looking in on self” “in a dream” “world isn’t real”

Complex Partial – impaired consciousness or awareness; unable to respond

  • Can include any of behaviors listed under Simple Partial
  • Activity is purposeless, undirected, inappropriate
  • Dazed appearance
  • May wander
  • Can’t understand directions or communicate
  • Automatisms  (staring, lip chewing, picking at clothes)
  • Inappropriate, possible socially embarrassing behaviors (screaming, running, disrobing, “sexual”-appearing movements, unfocused aggression or anger)
  • Lasts 30 sec to 5 minutes or more
  • After seizure:  May be confusion, tiredness for 15 min. to ½ hour

  Secondarily Generalized

  • Starts as a simple (“aura”) or complex partial seizure, then
  • Moves to whole brain seizure – usually tonic-clonic
  • Example:  May start with increased heart rate, chest pressure, sweating, nausea (may be conscious at this time), then moves to dazed behavior, then loss of consciousness with any repetitive movement from tonic-clonic to as subtle as eye fluttering.
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