Seizure Classification

Kelly Caravetta, CRNP

What is happening with a seizure?

http://www.istockphoto.com/search/text/neurons/filetypes/photos,illustrations.video/source/basic#185a5276

What is happening with a seizure?

Abnormal electrical activity in the braincausing a sudden uncontrolled event

Periods of sustained hyperactivity in the brain

Seizures look different, depending upon whatpart of the brain they affect

The Brain

Brain is divided into 2 hemispheres and 4 lobes

http://commons.wikimedia.org/wiki/File:Cerebral-lobes.png

The 4 lobes of the brain

What do they do?

Frontal ParietalTemporalOccipital

http://www.adamimages.com/illustration/Browse/1/B

The 4 lobes of the brain

Frontal lobes- planning and control of movements

Parietal lobes- deal with sensation

Temporal lobes- important for learning, memory and emotions

Occipital lobes- centers of brain that allow us to see

Classifications

Type of seizure

Type of epilepsy (or syndrome)

(our focus is on seizure types)

Importance of classification

Benefit of experience gained in treatment ofsame type of seizures/epilepsy in past

Certain drugs do not work for one seizure typeor syndrome How (type of) epilepsy will develop over theyears

Seizure types

The main sub-categories are:

Focal (partial) seizuresGeneralized seizuresStatus-Epilepticus

Diagnosis often confused for epilepsy:Non-epileptic seizures

Focal (partial seizures)

http://www.uth.tmc.edu/reynolds//soundbytes/recogSeiz.html

What are focal (partial) seizures?

Epileptic activity only affects one part of the brain

The place in the brain where seizures start iscalled the “focus”

An epileptic focus can be anywhere in the brain.

Can be with or without impairment of consciousness

Types of focal (partial) seizures

Without impairment of consciousness (simplepartial)

With impairment of consciousness (complexpartial)

Evolving to both hemispheres or convulsive seizure

(secondarily generalized)

Focal seizures without loss of awareness (simple partial)

People retain awareness and ablility to recall

-motor or autonomic symptoms- movements of part of the body, nausea or upset stomach

-sensory or psychic symptoms (aura)- numbness, tingling, pain, smell, deja-vu, jamais-vu http://zidbits.com/2011/08/what-is-the-opposite-of-deja-vu/

Focal seizures with impairment of consciousness (complex-partial)

Consciousness is reduced or lost

Occur most commonly in the temporal andfrontal lobes

With sensory or motor symptoms– ex)lip smacking, clear throat, fiddle with

clothes, laugh, staring

Actions purposeless, look as if behavingstrangely

Focal seizures with impairment of consciousness (complex partial, con't)

Seizures look different in everyone, butrepeat same behavior in their seizures

Lasts about 2 minutes or less Some experience an aura prior; confused and

tired afterwards

-Simple partial seizure followed by impairment of consciousness

-With impairment of consciousness on onset

Focal (partial) seizures with impairment of consciousness

Evolving to both sides of the brain (secondarily generalized)

Starts from one area of the brain, theninvolves both hemispheres

Simple partial and/or complex partial seizureprogressing to a generalized seizure

http://graphicwitness.medical.illustration.com,(GeneralizedSeizures, exh 49300c)

Some types of focal epilepsy

Temporal lobe epilepsy http://www.wiredtowninthemovie.com/mindtrip-xml.html

Frontal lobe epilepsy http://www.wiredtowninthemovie.com/mindtrip-xml.html

Temporal lobe epilepsy

Seizures arise from the temporal lobe(s)

Most frequent type of focal epilepsies,constitutes 30-35% of all epilepsies (Panayiotopoulos,2010)

Possible cause- defect or scar in temporallobe

Onset often in childhood or early adulthood

Temporal lobe epilepsy

Symptoms:

Often aura, experience feelings,emotions, sensation rising up from stomach,hear voices, odd smell or taste

Lip smacking, hand rubbing, shouting, laughing orfiddling with buttons on clothes

Seizures usually last 1-2 minutes

Confusion and headache afterwards

Frontal lobe epilepsy

Recurring seizures that arise in the frontal lobe

Second most common focal epilepsy

Possible causes: tumor, head trauma, birthdefect or can be genetic Seizures can be with or without consciousness

Have a tendency to occur in sleep

Mistaken as a non-epileptic seizure or sleep disorder

Frontal lobe epilepsy

Symptoms:

May start with an aura Involve laughing, crying or shouting

Weakness or inability to use certain muscles (trouble speaking)

Can be aware of loss of control of arms & legs

Seizures in one person are similar

Generalized seizures

Epileptic activity affects both hemispheres ofthe brain from onset of seizure

http://www.lhsc.on.ca/eeg/epilepsy.htm

Types of generalized seizures

Tonic-clonic seizure

Tonic

Clonic

Myoclonic seizure

Absence seizure

Atonic

Tonic-Clonic Seizures

Consciousness is lost, no recollectionBody stiffens, may fall, screamArm and leg jerking Frothing at the mouth IncontinenceBitten tongueMay occur in sleep or upon awakening

http://quizlet.com/13025999/neurology-disorders-of-consciousness-flash-cards/

Tonic and Clonic seizures

Tonic- -muscles stiffen, -Consciousness lost-affects whole or part of body-can last 10-20 seconds

Clonic- -consist of rhythmic jerking-various ages

Myoclonic seizures

Brief jerks typically occur 1-2 hours fromwaking up

Usually less than a second

One or many in a short period

May drop an object

Myoclonic seizures

Abnormal movements of arms/shoulder bothsides, sometimes entire body May fall and injure themselves

Sometimes triggered by flashing lights

example: Juvenile Myoclonic Epilepsy

Absence seizures

Short interruption of consciousness

With staring

Brief 5-12 seconds

So brief, may escape detection

More common in children than adults

No warning or after-effect

Atonic seizures

Atonic means “without tone”

Head nods, neck muscles suddenly lose tension, fall

Can injure themselves when they fall, helmetfor protection

Often begin in childhood and last intoadulthood

Status Epilepticus

One seizure quickly follows another

Any seizure can develop into status epilepticus (tonic-clonic status, absence status, complex partial status)

Tonic-clonic (convulsive) status is a medical emergency

Tonic-clonic seizures longer then 5 minutes or happens again after a short break, call an ambulance

Non-epileptic seizures

May look like epileptic seizures

Not caused by electrical disruptions in brain

Tend to change in character over time

Longer than epileptic seizures

Non-epileptic seizures

Occur only in wakefulness

Anti-epileptic drugs do not help

30% of patients with epileptic seizures alsosuffer from non-epileptic seizures(Panayiotopoulos, 2010)

First Aid

Stay calm

Do not insert anything into the person's mouth

Keep person safe, remove dangerous objects

Do not restrain

First Aid

Turn the person on their side, loosen tightclothing

Remain with person after seizure

Call 911 if seizure (convulsive) lasts longerthen 5 minutes or second seizure withoutrecovery from the first

First Aid

http://unitedtruthseekers.com/profiles/blogs/how-to-help-with-seizures

Medical attention required

If a person is pregnant or diabetic

If injured themselves during the seizure

First time seizure

Seizure occurred in water

If seizures continue beyond 5 minutes

Questions?

http://www.jpole-antenna.com/2013/03/29lightning-protection-for-antennas/

ReferencesEpilepsy Foundation. (2009). Types of Seizures.

Retrieved March 18th, 2013 from http://www.epilepsyfoundation.org/get

involved/upload/181TOS.pdf.

Epilepsy.com. (n.d.). New Terms AndConcepts For Seizures And Epilepsy. Retrieved April 1st, 2013 fromhttp://www.epilepsy.com/epilepsy/new-terms-concepts-for-seizures-and-epilepsy.

ReferencesNetter, Frank H., n.d., Absence Seizures

Retrieved April 1st, 2013 fromhttp:/www.netterimages.com/image/1257.htm.

Netter, Frank H., n.d., Complex PartialSeizures. Retrieved April 1st, 2013 fromhttp://www.netterimages.com/image/12156.htm

Panayiotopoulos, C.P.,(2010). A ClinicalGuide to Epileptic Syndromes and TheirTreatment. London, UK: SpringerHealthcare,Ltd.

ReferencesReuber, M., Schahter, S., Elger, C., Altrup, U. (2009). Epilepsy Explained. New York, NY:

Oxford University Press.

Shorvon, S., Guerrini, R., Cook, M., Lhatoo, S., Kennard, C. (2013). Epilepsy and

Epileptic Seizures. Oxford, UK: Oxford UniversityPress.