Seizure Classification

1. Seizure Classification
Kelly Caravetta, CRNP

2. What is happening with a seizure?
http://www.istockphoto.com/search/text/neurons/filetypes/photos,illustrations.video/source/basic#185a52
76

3. What is happening with a seizure?
Abnormal electrical activity in the brain
causing a sudden uncontrolled event
Periods of sustained hyperactivity in the brain
Seizures look different, depending upon what
part of the brain they affect

4. The Brain
Brain is divided into 2 hemispheres
and 4 lobes
http://commons.wikimedia.org/wiki/File:Cerebral-lobes.png

5. The 4 lobes of the brain
What do they do?
Frontal
Parietal
Temporal
Occipital
http://www.adamimages.com/illustration/Browse/1/B

6. 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

7. Classifications
Type of seizure
Type of epilepsy (or syndrome)
(our focus is on seizure types)

8. Importance of classification
Benefit of experience gained in treatment of
same type of seizures/epilepsy in past
Certain drugs do not work for one seizure type
or syndrome

How (type of) epilepsy will develop over the
years

9. Seizure types
The main sub-categories are:
Focal (partial) seizures
Generalized seizures
Status-Epilepticus
Diagnosis often confused for epilepsy:
Non-epileptic seizures

10. Focal (partial seizures)

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

11. What are focal (partial) seizures?
Epileptic activity only affects one part of the brain
The place in the brain where seizures start is
called the “focus”
An epileptic focus can be anywhere in the brain.
Can be with or without impairment of consciousness

12. Types of focal (partial) seizures
Without impairment of consciousness (simple
partial)
With impairment of consciousness (complex
partial)
Evolving to both hemispheres or convulsive
seizure
(secondarily generalized)

13. 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/

14. Focal seizures with impairment of
consciousness (complex-partial)
Consciousness is reduced or lost
Occur most commonly in the temporal and
frontal lobes
With sensory or motor symptoms
–ex)lip smacking, clear throat, fiddle with
clothes, laugh, staring
Actions purposeless, look as if behaving
strangely

15. Focal seizures with impairment of
consciousness (complex partial, con't)
Seizures look different in everyone, but
repeat 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

16. Focal (partial) seizures with
impairment of consciousness

17. Evolving to both sides of the brain
(secondarily generalized)
Starts from one area of the brain, then
involves both hemispheres
Simple partial and/or complex partial seizure
progressing to a generalized seizure
http://graphicwitness.medical.
illustration.com,(Generalized
Seizures, exh 49300c)

18. 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

19. 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 temporal
lobe
Onset often in childhood or early adulthood

20. 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 or
fiddling with buttons on clothes
Seizures usually last 1-2 minutes
Confusion and headache afterwards

21. Frontal lobe epilepsy
Recurring seizures that arise in the frontal lobe
Second most common focal epilepsy
Possible causes: tumor, head trauma, birth
defect 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

22. 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

23. Generalized seizures
Epileptic activity affects both hemispheres of
the brain from onset of seizure

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

24. Types of generalized seizures
Tonic-clonic seizure
Tonic
Clonic
Myoclonic seizure
Absence seizure
Atonic

25. Tonic-Clonic Seizures
Consciousness is lost, no recollection
Body stiffens, may fall, scream
Arm and leg jerking
Frothing at the mouth
Incontinence
Bitten tongue
May occur in sleep or upon awakening
http://quizlet.com/13025999/neurology-disorders-of-consciousness-flash-cards/

26. 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

27. Myoclonic seizures
Brief jerks typically occur 1-2 hours from
waking up
Usually less than a second
One or many in a short period
May drop an object

28. Myoclonic seizures
Abnormal movements of arms/shoulder both
sides, sometimes entire body

May fall and injure themselves
Sometimes triggered by flashing lights
example: Juvenile Myoclonic Epilepsy

29. 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

30. Atonic seizures
Atonic means “without tone”
Head nods, neck muscles suddenly lose
tension, fall
Can injure themselves when they fall, helmet
for protection
Often begin in childhood and last into
adulthood

31. 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

32. 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

33. Non-epileptic seizures
Occur only in wakefulness
Anti-epileptic drugs do not help
30% of patients with epileptic seizures also
suffer from non-epileptic seizures
(Panayiotopoulos, 2010)

34. First Aid
Stay calm
Do not insert anything into the person's
mouth
Keep person safe, remove dangerous
objects
Do not restrain

35. First Aid
Turn the person on their side, loosen tight
clothing
Remain with person after seizure
Call 911 if seizure (convulsive) lasts longer
then 5 minutes or second seizure without
recovery from the first

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

37. 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

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

39. References
Epilepsy 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 And
Concepts For Seizures And Epilepsy.
Retrieved April 1st, 2013 from
http://www.epilepsy.com/epilepsy/new-terms-
concepts-for-seizures-and-epilepsy.

40. References
Netter, Frank H., n.d., Absence Seizures
Retrieved April 1st, 2013 from
http:/www.netterimages.com/image/1257.htm.
Netter, Frank H., n.d., Complex Partial
Seizures. Retrieved April 1st, 2013 from
http://www.netterimages.com/image/12156.
htm
Panayiotopoulos, C.P.,(2010). A Clinical
Guide to Epileptic Syndromes and Their
Treatment. London, UK: Springer
Healthcare,Ltd.

41. References
Reuber, 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.