Epileptic Seizures

In epilepsy, seizures are identified as being either partial or generalized, based on whether part of the brain or the entire brain is affected. Within these two categories, there are many classifications of a seizure, which are identified by the kind of behaviour the seizure produces.

What is a generalized seizure? Tonic-Clonic Seizures (Grand Mal) Absence Seizure (Petit Mal) Myoclonic seizures Atonic seizures	So what is a partial seizure? Simple Partial (Focal Cortical Seizures) Complex Partial Seizures (Psychomotor or Temporal Lobe Seizures)
After a Seizure	Review of Seizure Types

What is a generalized seizure?

Tonic-Clonic Seizures (Grand Mal)

During a tonic-clonic seizure, electric discharges instantaneously involve the entire brain and consciousness is lost from the beginning of the seizure. The individual will suddenly become stiff (tonic phase), become unconscious, and fall to the floor. The person may let out a loud cry as the muscles in the chest and larynx contract and th air rushes between the vocal chords, making a sound. This cry does not indicate pain. Increased pressure in the bladder and bowel may cause incontinence. The individual may bite his/her tongue which can cause bleeding. The extremities will then begin to jerk rhythmically (the clonic phase). Saliva that has not been swallowed during the seizure may froth at the mouth. Breathing may be irregular as the respiratory muscles may be affected. A tonic-clonic seizure generally lasts 1-3 minutes. If the seizure lasts longer than 5 minutes or someone has 2 in a row without recovering in between, medical attention is required.

Absence Seizure (Petit Mal)

During the seizure, the individual loses awareness for a few seconds. It may look as if the person is daydreaming. Because these seizures are brief and subtle they may be difficult to recognize. Therefore, absence seizures are usually not diagnosed until many have occurred. They are likely to continue until the individual is treated with medication. Others should be told of these seizures (especially teachers) so that they will be more tolerant of the child’s apparent “daydreaming”. Because these seizures may occur many times a day, they are likely to interfere with the person’s ability to absorb information. The individual will be unaware of these seizures when they occur and therefore will need to be told what has occurred, once he or she regains awareness.

Myoclonic seizures

“Myo” means “muscle” and a myoclonic seizure is a brief, shock like jerk of a group of muscles. People who do not have epilepsy may experience a jerk like this while falling asleep. This is considered normal. Myoclonic seizures in epilepsy involve sudden jerks of the arms, shoulders, neck, body, or upper legs, affecting both sides at the same time which may result in the person falling. These seizures usually begin in childhood and often are a part of a pattern of epilepsy that may also include other types of seizures.

Atonic seizures

“Atonic” means “without tone” - in these seizures, the muscles lose all strength instead of becoming stiff. The person remains conscious but may fall to the ground without warning. In a milder form, the person’s head may droop or he/she may drop things. These seizures last only seconds and the person recovers right away.

So what is a partial seizure?

In partial seizures the electrical disturbance is limited to a specific area of one cerebral hemisphere (side of the brain). Partial seizures are subdivided into simple partial seizures (in which awareness is retained); and complex partial seizures (in which awareness is impaired or lost). Partial seizures may spread to cause a generalized seizure, in which case the term used is a partial seizure secondarily generalized.

Partial seizures are the most common type of seizure experienced by people with epilepsy. Virtually any movement, sensory, or emotional symptom can occur as part of a partial seizure, including complex visual or auditory hallucinations.

Simple Partial (Focal Cortical Seizures)

A simple partial seizure originates in one area of the brain. The person will not lose consciousness during the seizure but will be unable to control various body movements. The individual’s senses may be distorted causing them to see, hear, or smell things that are not there. They may also experience unusual feelings. The individual will usually be able to talk and answer questions during the seizure and will likely remember what occurred after the seizure. Simple partial seizures typically last 2-10 seconds, but may last longer.

Complex Partial Seizures (Psychomotor or Temporal Lobe Seizures)

A complex partial seizure is limited to one area of the brain. People experience varying degrees of altered levels of consciousness. During the seizure, the individual stops, stares and becomes unaware of the environment and may produce any variety of “inappropriate” automatic behaviours (tapping the desk, picking at one’s clothes, making chewing movements, wandering around). After the seizure there is usually a period of post-ictal confusion. Complex partial seizures typically last 2-4 minutes.

After a seizure

The period immediately after a seizure - called the postictal period - varies depending on the type, duration and intensity of the seizure. Some people may feel fatigue or discomfort from muscle soreness, headache, and pain in the tongue or cheek if bitten. The person is often confused or tired and requires rest to recuperate.

For seizure first-aid see here.

Reprinted from the web site of Epilepsy Ontario

Review of Seizure Types

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Reprinted in part from Epilepsy.com

Seizure Type	Cause & Effect
Tonic-Clonic Seizure	Description: Electric discharges instantaneously involve the entire brain and consciousness is lost right from the beginning of the seizure. What it looks like Tonic: Increase in natural tension and stiffening of the muscles. The individual will fall to the ground and become unconscious. Clonic: Muscles rapidly tighten and relax, creating a jerking motion
Absence Seizure	Description: Literally an absence or brain lapse in awareness. This seizure involves both hemispheres of the brain and impairs consciousness. What it looks like A blank stare, starting and ending abruptly, lasting a few seconds Eyes may blink quickly or roll upwards and may be accompanied by chewing movements of the mouth A complete loss of awareness Person is completely aware once they regain consciousness
Myoclonic	Description & What it looks like: Sudden, brief, massive muscle jerks that involve parts of / entire body.
Atonic	Description & What it looks like: Complete loss of all normal muscle control will result in a sudden collapse and fall to the ground.
Simple Partial Seizure	Description & What it looks like: The specific area of the brain where the seizure begins determines what the seizure will look or feel like. Jerking may begin in one part of the body and proceed to another. A simple partial seizure may secondarily generalize.
Complex Partial Seizure	Description & What it looks like: Usually begins with a blank stare, often followed by chewing and random repetitive activities. There will be no recollection of what happened during the seizure.