Seizure Classification


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Seizure Classification

  1. 1. Seizure Classification Kelly Caravetta, CRNP
  2. 2. What is happening with a seizure?, 76
  3. 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. 4. The Brain Brain is divided into 2 hemispheres and 4 lobes
  5. 5. The 4 lobes of the brain What do they do? Frontal Parietal Temporal Occipital
  6. 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. 7. Classifications Type of seizure Type of epilepsy (or syndrome) (our focus is on seizure types)
  8. 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. 9. Seizure types The main sub-categories are: Focal (partial) seizures Generalized seizures Status-Epilepticus Diagnosis often confused for epilepsy: Non-epileptic seizures
  10. 10. Focal (partial seizures)
  11. 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. 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. 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
  14. 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. 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. 16. Focal (partial) seizures with impairment of consciousness
  17. 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.,(Generalized Seizures, exh 49300c)
  18. 18. Some types of focal epilepsy Temporal lobe epilepsy Frontal lobe epilepsy
  19. 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. 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. 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. 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. 23. Generalized seizures Epileptic activity affects both hemispheres of the brain from onset of seizure
  24. 24. Types of generalized seizures Tonic-clonic seizure Tonic Clonic Myoclonic seizure Absence seizure Atonic
  25. 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
  26. 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. 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. 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. 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. 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. 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. 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. 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. 34. First Aid Stay calm Do not insert anything into the person's mouth Keep person safe, remove dangerous objects Do not restrain
  35. 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. 36. First Aid
  37. 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. 38. Questions?
  39. 39. References Epilepsy Foundation. (2009). Types of Seizures. Retrieved March 18th, 2013 from involved/upload/181TOS.pdf. (n.d.). New Terms And Concepts For Seizures And Epilepsy. Retrieved April 1st, 2013 from concepts-for-seizures-and-epilepsy.
  40. 40. References Netter, Frank H., n.d., Absence Seizures Retrieved April 1st, 2013 from http:/ Netter, Frank H., n.d., Complex Partial Seizures. Retrieved April 1st, 2013 from htm Panayiotopoulos, C.P.,(2010). A Clinical Guide to Epileptic Syndromes and Their Treatment. London, UK: Springer Healthcare,Ltd.
  41. 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.