Type and evaluation of seizures

1. TYPES AND
EVALUATION
OF SEIZURES

2. 2
Types of seizure
Seizure
GeneralisedPartial/Focal
ComplexSimple Secondary
generalised
Tonic
Atonic
Myoclonic
Absence
(Petit mal)
Tonic-clonic
(Grand mal)
Clonic

3. 3

4. 4
(1) PARTIAL/FOCAL SEIZURE
ComplexSimple
• NO loss of consciousness
• usually remember
• associated with motor, sensory,
autonomic, or mixed symptoms
• sometimes may complained of
visual, olfactory, or taste
hallucination
• when spreads unilaterally as per
motor cortex = Jacksonian March
• Originate from parietal or temporal lobe
• may associated with automatism
• ass w/ loss of consciousness even if seizure are
not generalised
CPS originating from temporal lobe (psychomotor
epilepsy)
• misdiagnosed as absence seizure
• Brief visceral, olfactory, or visual aura f/b peculiar
posture, tonic jerk of face&limbs or one-side dystonia
• with impairment of consciousness and automatism,
psychomotor, or limbic system symptoms
• may not remember

5. • Progression of partial seizure - spread of discharge to different brain
areas
• For example, seizure may begin as simple partial , progress to
complex partial and subsequently become secondarily generalised
(tonic-clonic)
(2) PARTIAL/FOCAL SEIZURE SECONDARY GENERALISED

6. 6
(3) GENERALISED SEIZURE
Tonic
Atonic
Myoclonic
Absence
(Petit mal)
Tonic-clonic
(Grand mal)
Clonic

7. 7
TONIC SEIZURE
• During the seizure, skeletal muscle go into a sustained spasm for about 30 seconds.
• Child will fall to the ground, due to contraction of all muscles.
• Arms flexed, legs extended.
• Child become
• Unconscious
• Face appear blue
• Pupils are dilated
• Up rolling of eyes
• Frothing of mouth
• Involuntary passing of bowel and bladder

8. 8
ATONIC SEIZURE
 The ictal phenomenon in this seizure is sudden loss of tone
 This may manifest as a head drop or if the patient standing as forward fall
 Duration - short (10-45 seconds), patient usually unaware of occurrence
 Abrupt recovery without after effects

9. 9
CLONIC SEIZURE
• Rhythmic alternating contractions of muscle group.
• Repetitive jerking movements

10. 10
TONIC-CLONIC SEIZURE (GRAND MAL)
• Loss of consciousness is quickly followed
by fall on the ground
• Average duration 2-5 mins
• Most frequent form of childhood epilepsy.
• It has classically 4 phase
• Aura
• Tonic phase
• Clonic phase
• Postictal phase
This precedes
seizure.
Aura may be
sensory, visceral,
motor or autonomic.
Child may complain
of headache,
confusion later.
Rarely, Todd’s
paresis develops.

11. 13
MYOCLONIC SEIZURE
• Sudden, brief shock-like jerk of a muscle or group of muscles,
often occurs in healthy people as they fall asleep
• Epileptic myoclonus usually causes synchronous and bilateral
jerks of the neck, shoulders, upper arms, body and upper legs

12. 14
ABSENCE SEIZURE
• Onset between 4-14 years old, often resolve by age 18
• Brief episodes of staring with impairment of awareness and
responsive that begin without warning and end suddenly
• In simple absence seizure, patient only stares

13. 15
(4) EPILEPTIC SYNDROME
• It is the disorder that manifests 1 or more specific
seizure types and has a specific age of onset and
a specific prognosis.
Benign Rolandic epilepsy
Lennox-Gastaut syndrome
West syndrome (Infantile spasms)
Childhood absence epilepsy
Juvenile myoclonic epilepsy of Janz

14. 16
Benign Rolandic
epilepsy
• Aka benign childhood epilepsy with centrotemporal spikes
• Starts at the age of 5 to 10 years.
• Seizure typically occur during sleep or upon awakening.
• Last for about 2 minutes.
• Affected child have focal motor seizures affecting the face and arm
• Presented with abnormal movement or sensation around the face and
mouth, drooling, rhythmic guttural sound.
• This brings impairment to swallowing and speech.
• This can be manage with anticonvulsant therapy.
• Intellectual outcome is normal and seizure resolved after puberty.

15. 17
Childhood Absence Epilepsy
 Begin in early school years and resolved by adolescence.
 In unresolved case, 44% land up with juvenile myoclonic epilepsy
 Rx: Ethosuximide. For child with GTCS, valproic is preferred.
Juvenile Myoclonic Epilepsy Of Janz
 Begin in early adolescence and young adults.
 Pt has myoclonic jerks (which is more in the morning) +
GTCS + absence seizure
 Rx: Valproic

16. 18
• Onset: between 3-8 months
• It is the brief contraction of neck, trunk and arm muscles, followed by phase
of sustained muscle contractions for about 2 seconds. Followed by a period
of relaxation.
• Occur most frequently upon awakening or going to sleep.
• West syndrome: Infantile spasm (combination of salaam spells : sudden
dropping of the head and flexion of arms) +developmental regression +
abnormal EEG
• Common causes
- hypoxic ischemic encephalopathy (HIE)
- neurocutanoeus syndrome
- perinatal infections
- haemorrhage
- injury
- metabolic disorders
- localized structural malformations
• Rx: Adenocorticotrophic hormone, high dose oral corticosteroid, and vigabatrin
Infantile Spasm

17. 20
Lennox-Gastaut syndrome
• Severe one
• Usual onset late infancy or childhood
• Many children have underlying brain injury/ anoxia
• mixture of all types of seizure.
• DOC : valproic acid, benzodiazepines, ACTH

18. EVALUATION
 Onset
 Duration: The duration of the seizure and state of
consciousness (retained or impaired) should be
documented.
 Aura :The history should determine whether an aura
preceded the convulsion and the behaviour of the
child immediately preceding the seizure. The most
common aura experienced by children consists of
epigastric discomfort or pain and a feeling of fear.

19.  Posture of the patient,
 Presence or absence and distribution of
cyanosis,
 Vocalizations,
 Loss of sphincter control (particularly of the
urinary bladder), and
 Postictal state (including sleep, headache,
and hemiparesis) should be noted.
EVALUATION

20.  In addition to the assessment of cardiorespiratory and
metabolic status described, examination of a child with a
seizure disorder should be geared toward the search for an
organic cause.
 The child’s head circumference, length, and weight are
plotted on a growth chart and compared with previous
measurements.
 A careful general and neurologic examination should be
performed.
EVALUATION

21. REFERENCE
PAGE 552-559 PAGE 2832-2838