characteristic

Question 1

Partial seizures

Answer 1

 Begins in one hemisphere of the brain
 Usually results in alterations in:
- Motor function
- Sensory or somatosensory symptoms
- Automatisms, e.g., rubbing hands, lipsmacking, walking, running with no recollection
 May occur in infancy
 Often difficult to recognise in the elderly

Question 2

Simple partial seizures
(a.k.a. simple motor, simple sensory,
simple psychological seizures)

Answer 2

 Partial seizure with no loss of consciousness, i.e., patients may be awake and aware of events throughout

 Some patients may find they are unable to speak or move until seizure is over

 Movements:
Uncontrolled movements can occur in any part of the body (e.g., eyes moving from side to side, blinking, unusual movements of the tongue, twitching of the face)

 Emotions:
sudden sense of fear/something terrible about to happen, anger/rage, joy/happiness

 Sensations:
manifestations of sight, smell, hearing, taste and touch, e.g., visual disturbances, unpleasant smells/tastes, buzzing/ringing sounds, sense of breeze on skin

 Memory:
disturbing visions of people or places from the past (e.g., déjà vu)

Question 3

Complex partial seizures (a.k.a. ‘psychomotor epilepsy’)

Answer 3

 Partial seizure affecting a larger area of the brain (cf. simplex partial seizure), most commonly involving temporal lobes

 Also involves loss or alteration of consciousness; cannot interact normally with other people

 Usually starts with blank stare and loss of contact with surroundings

 Appearance:
May be conscious, eyes may remain open and move about but appears almost in a trance-like state

 Speech:
may be able to speak but words do not make sense; not able to respond; rarely, cry out repeated phrases or scream

 Movements:
typically unorganised, confused and unfocused, e.g., chewing movements of mouth, picking at or fumbling with clothing, mumbling, performing simple unorganised movements over and over again, may also wander around; rarely, agitation

 Memory:
typically memory loss

Question 4

Secondary generalised seizures (a.k.a. partial seizures with secondary generalisations)

Answer 4

 Characteristic of 20-30% of patients with partial seizures
 Occurs when a simplex/complex partial seizure spreads to involve entire brain
 Rate of spread may be so rapid that partial seizure component is hardly noticeable
 Generalised phase usually manifests with tonic, clonic, or tonic-clonic features

Question 5

Generalised seizures

Answer 5

 Begins from both sides of the brain from the beginning of the seizure
 Motor manifestations, if present, are bilateral
 Produces loss of consciousness (briefly or for longer periods of time)

Question 6

2a. Absence seizure (a.k.a. petit mal seizures)

Answer 6

 Usually manifests as basic lapse in awareness that begins and ends abruptly
 Sometimes mistaken as persistent staring
 Lasts only a few seconds – no warning, no after-effects
 Often undetected even if there 50-100 attacks per day
 More common in children than in adults
 First onset usually occurs at 4-12 years old; rarely after 20 years old

 Appearance:
vacant stare, does not speak nor appear to hear, then suddenly resumes previous activity
 Movements:
usually none but longer attacks may be associated with brief myoclonic jerking of eyelids

 Absence seizures differ from complex partial seizures in that they:

1. are never preceded by auras
2. last seconds (rather than minutes)
3. begin frequently and end abruptly
4. produce characteristic EEG pattern with a frequency of ~3 Hz.

Question 7

Tonic-clonic seizures (a.k.a. Grand mal seizures, convulsions)

Answer 7

 Most common and best known type of generalised seizure
 May be preceded by auras
 Begins with stiffening of the limbs (tonic phase) , followed by jerking of limbs and face (~10 jerks/second; clonic phase)

 During tonic phase, breathing may decrease or cease altogether –> cyanosis of nail beds, lips & face; typically returns during clonic phase but may be irregular

 Clonic phase usually lasts ~ 1 minute, after which the brain is extremely hyperpolarised and insensitive to stimuli

 Incontinence may occur, along with biting of the tongue or inside of the mouth; breathing may be noisy and appear to be laboured

 Some patients may experience only the tonic phase, others only the clonic phase, yet others a tonic-clonic-tonic pattern

 Following the seizure, patient may have a headache and appear lethargic, confused or sleepy
 Full recovery takes several minutes to hours

Question 8

2c. Tonic seizures
Sub-groups of tonic-clonic seizures

2d. Clonic seizures
 Manifestations are generally similar with predominance of one phase

Answer 8

2c. Tonic seizures
Sub-groups of tonic-clonic seizures

2d. Clonic seizures
 Manifestations are generally similar with predominance of one phase

Question 9

Myoclonic seizures

Answer 9

 Involves rapid, brief contractions of bodily muscles, usually occurring on both sides of the body concurrently  On occasion, may involve just one arm or one foot
 May be mistaken for sudden jerking or clumsiness
 Variant in non-epileptics: sudden jerking of the foot during sleep

Question 10

Unclassified epileptic seizures

Answer 10

 Cannot be classified because of inadequate or incomplete data
 Cannot be classified in previously described categories

Question 11

Advantages of MICES system:

Disadvantages of modified MICES system:

Answer 11

Advantages of MICES system:
 Seizures can be classified relatively easily
 Allows for choice of prophylactic agent to be selected based on seizure classification

Disadvantages of modified MICES system:
 May be too simplistic in view of unusual presenting symptoms  Not useful if patient has more than one type of seizure, either concurrently or in sequence

Question 12

International Classification of Epilepsies and Epileptic Syndromes & Related Seizure Disorders (ICEES-RSD) takes into account:

Answer 12

 Cause (if known) 
 Precipitating factors 
 Age of onset 
 Characteristic EEG patterns 
 Severity 
 Chronicity, viz., frequency and times of occurrence 
 Family history 
 Prognosis

Question 13

Epileptic syndrome: an epileptic disorder characterised by a cluster of signs and symptoms occurring together

Answer 13

Epileptic syndrome: an epileptic disorder characterised by a cluster of signs and symptoms occurring together

Question 14

Simple First Aid

Answer 14

 Prevent further injury
 Do not force objects into patient’s mouth
 Do not restrain patient’s movements unless they place him in personal danger
 Turn the patient on his side to open the airway and allow secretions to drain
 Do not offer any liquids or food until patient is fully awake
 Start CPR only if patient is not breathing after the end of the seizure
 Let the patient rest until fully awake
 Call an ambulance in the event of injury during the seizure, prolonged seizure (>5 mins) or seizure clustering without resolution (? status epilepticus)