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3153 Seizure & Epilepsy > ILAE Classification of Seizures > Flashcards

ILAE Classification of Seizures Flashcards

1
Q

What are the 3 key features used to classify seizures (of neurological origins)?

A
  1. Mode of onset (focal/generalized/secondarily generalized/unknown)
  2. Impairment of consciousness (simple vs complex)
  • simple: without dyscognitive features / with retained awareness
  • complex: with dyscognitive features / with altered awareness
  1. Other features of the seizure
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2
Q

Describe EEG presentation of focal vs generalized onset seizures

A

Focal

  • Seizure begins in one hemisphere, seen in EEG as one onset area (cortex of the cerebrum)

Generalized

  • Seizure begins in a very deep focus (e.g., in midbrain)
  • Seizure starts deep in the brain and expands out in all directions
  • Involves both hemispheres
  • Cannot be seen on EEG in a single location, appears as though started all over the brain

Take note that seizures always come from a single focus, but are categorized by how they appear on the surface EEG as either focal or generalized

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3
Q

Clinical presentation of a seizure depends on:

A
  • Site of the focus
  • Degree of irritability of the areas of the brain surrounding the focus
  • Intensity of the impulse
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4
Q

List the 3 types of focal/partial onset seizures

A
  • Simple partial seizures/focal seizures with retained awareness/without dyscognitive features
  • Complex partial seizures with dyscognitive features / with altered awareness
  • Secondary generalized seizures (focal seizures evolving to bilateral convulsive seizures)
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5
Q

Describe the presentation of simple partial seizures

A

General presentation:

  • Retained consciousness
  • Abnormal smell or taste
  • Staring spells
  • Retained muscle tone
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6
Q

Simple partial seizure (sensory cortex involvement)
*Parietal lobe

Presentation

A
  • Feelings of numbness or tingling
  • Visual disturbances - flashing lights
  • Rising epigastric sensation

*Parietal lobe: feeling things
*Temporal lobe: hearing things
*Occipital lobe: seeing things

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7
Q

Simple partial seizure (motor cortex involvement)
*Frontal lobe

Presentation

A
  • Clonic movements (twitching, jerking of the arm/face/leg)
  • Speech arrest (involve muscles of articulation - dysarthria)
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8
Q

Simple partial seizure (autonomic cortex involvement)
*Limbic system

Presentation

A
  • Sweating, salivation, pallor
  • BP, HR
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9
Q

Simple partial seizure (psychic/somatosensory cortex involvement)
*Parietal lobe

Presentation

A
  • Flashbacks, deja vu (memory)
  • Visual, auditory, gustatory, olfactory (vision, sound, taste, smell) hallucinations
  • Affective symptoms: fear, depression, anger, irritability
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10
Q

Describe the presentation of complex partial seizures

A
  • Loss of consciousness
  • May be preceded by aura
  • Postictal confusion
  • Complex ictal automatism

Automatisms: automatic repetitive behaviours that occur automatically reflexively during the seizure (e.g., lip smacking, chewing)

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11
Q

Describe the presentation of secondarily generalized seizures

A
  • Initial aura
  • Progress to involve Convulsion +/- Jacksonian march
  • Postictal confusion +/- Todd’s paralysis

Jacksonian march: jerking activity begins with motor activity in one limb, progresses up the entire limb, then throughout the body as more neurons are affected

Todd’s paralysis: weakness on one side of the body, opposite the side where seizure activity began, as a result of postictal depression in brain activity; lasts avg 15h, subsides after 2 days

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12
Q

List the 6 types of generalized onset seizures

A
  • Absence
  • Myoclonic
  • Clonic
  • Tonic
  • Atonic
  • Generalized tonic-clonic
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13
Q

Describe the presentation of absence seizures
“petit mal”

A
  • Basic lapse in awareness - generalized brief staring spells (lasts a few seconds)
  • NEVER preceded by aura
  • 3Hz spike-and-wave EEG

More common in children

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14
Q

Absence seizures can often be confused with complex partial seizures. How to differentiate?

A

Absence seizures:

  • Are NEVER preceded by auras
  • Last seconds (rather than minutes)
  • Begin frequently and end abruptly
  • Produce characteristic 3Hz spike waves EEG pattern

Additionally, complex partial seizures may involve

  • postictal confusion
  • complex ictal automatism
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15
Q

Describe the presentation of clonic seizures

A
  • Sustained jerking, often asymmetrical and irregular; often last up to 1min
  • Violent muscle contractions - convulsions

Most frequent in neonates, infants, young children

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16
Q

Describe the presentation of tonic seizures

A
  • Sudden loss of consciousness and rigid posture of entire body, lasts 10-20s
  • Focal, isolated rigidity (of either one part of body / entire body), stiffness

Occur at all ages in the setting of diffuse cerebral damage and learning disability (like atonic seizures)
Lennox-Gastaut syndrome is a tonic seizure type
Fall backwards

17
Q

Describe the presentation of myoclonic seizures

A
  • Rapid brief contractions of bodily muscles (short twitches/sudden jerk), usually occur on both sides of body concurrently (thought may just involve one arm or one foot as well)
  • Brief single jerks with brief loss of consciousness
  • Without convulsions
  • Little postictal confusion

Myoclonic jerks not always epileptic in origin - e.g., jerk in sleep is non-epileptic

18
Q

Describe the presentation of atonic seizures

A
  • Drop attacks (astatic seizure), patients lost postural tone
  • Short episode followed by immediate recovery

Common in children, they may wear helmet/protective device
Occur at all ages and are ALWAYS a/w diffuse cerebral damage and learning disability (like tonic seizures)
Common in Lennox-Gastaut Syndrome and in myoclonic astatic epilepsy
Fall front

19
Q

Describe the presentation of GTC seizures “Grand Mal”

A

Most often convulsive (though may be nonconvulsive as well)

  • Begin with stiffening of the limbs (tonic), followed by jerking of limbs and face (clonic)

During tonic phase:

  • Breathing may decrease or cease
  • Cyanosis of nail beds, lips, face
  • Asymmetrical tonic: figure of 4 (asymmetrical limb posture, whereby head, arm and leg on same side extended, opposite limbs bend)

During clonic phase:

  • Usually last 1min, after which brain is hyperpolarized and insensitive to stimuli
  • Incontinence due to loss of bladder or bowel control may occur, along with tongue biting
  • Breathing may be noisy, laboured

GTC lasts a few minutes, but less than 5

After seizure:

  • Patient may have headache, appear lethargic, confused, sleepy
  • Full recovery takes several minutes to hours

Aura (?)

3153 Seizure & Epilepsy (13 decks)

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