Clinical Presentation of Seizures

1. Dr.Avdhesh Agrawal

2.  Sudden loss of consciousness
 Tonic Phase
 Clonic Phase
 Seizure last for 1-2 mins
 Post Ictal Phase – 30 mins to many hours
 Prodrome in small percentage
 Aura + or - .......??
 Recall ......??

3.  Usual Age – 5-8 yrs
 Female preponderance
 Impairment of consciousness
 Very short duration ( 5-10 Sec)
 Abrupt onset and cessation
 Brief interruption, Dropping, Unresponsiveness,
Blinking of eye lids
 No Recognization of events
 10 to Hundreds per day
 Hyperventilation
 1/3 to 1/4th .....GTC/ Juveline Myoclonic Epilepsy
 Atypical Absence

4.  Infantile Spasm- Salaam seizures
 Head Drop and Arm Felxion
 Few to hundred per day
 Benign Myoclonic Epilepsy – Infancy to 3 yrs,
Myoclonic Jerks ( Face, Upper extremity), during
day/ light sleep, disappears during sleep
 Juveline Myoclonic Epilepsy – 8 to 18 yrs,
Myocloinc jerks- awaeking / sleep deprivation,
Alchol and mensturation,3Types coexist-
Myocloinc, Absence and GTC

5.  Drop Attack
 Sudden loss of consciousness and falls down
 ClonicType
 TonicType

6.  Aura +nt
 Jerky movements usually one side of body
 Somato Sensory-Visual,Auditory, Olfactory,
Vertiginous
 Motor- Activity of fixed pattern of face and
hands
 Autonomic- Pallor, Sweating, Flushing,
Pupillary dilatation, piloerection
 Psychiatric- Illusions, Hallucinations

7.  Impairment of consciousness
 With changes in perception and sensation
 All mentioned types of simple partial
 Eyes- Dazed look
 Mouth- Lip Smacking, Drooling
 Abdomen- Nausea,Vomiting
 No recall
 Complex Partial to secondary genralized
seizures

8.  Benign Focal epilepsy with Centrotemporal
spikes
 Manifestation of simple partial seizures
 4-13 yrs ...stops at 15 yrs
 Neurologically normal
 Nocturnal seizures- Face Grimacing/
Vocalizations
 Sensation of paraesthesia

9.  Benign Focal Epilepsy with occipital
paroxysms
 Manifestation of complex partial
 First decade of life
 Occipital lobe related manifestations
 Neurologicaaly normal
 Association with Migrane
 Simple visual hallucinations & transient
blindness with ictal vomitings
 Automatism

10.  Sudden loss of consciousness
 More common than epilepsy
 PotentialTrigger – Heat , Fatigue, Fear, Pain,
Sudden Upright position from supine, bending ,
stretching, prolonged standing, working in
stuffy environment , micturation against
obstruction and paroxysmal cough, CCB
 Light headedness, darkening in front of eyes,
gradually sinking to the ground
 No postical stupor, prostration/ sleep
 TransientThrobbing headache is common

11.  Time duration

12.  Approach
 Choice of Drugs
 MOA
 Side Effects

14. Type of
Seizure
PECS
Americ
a 2005
Europe
2007
DACH Brand 2nd Line
GTC VPA Epilex
200mg/5
ml
Absence ESM VPA VPA
Myoclonic VPA, LTG VPA VPA
Atonic
Simple
Partial
CBZ, OXC CBZ, OXC Tab Zen
200
Complex
Partial
CBZ, OXC CBZ, OXC

17.  Phenobarbitone- Aggresive Outburst,
Insomnia, Hyperactivity, Mood Flactuations
 Carbamazepine- Rash ( Steven Johnson
Syndrome), Agranulocytosis, Aplastic
Anaemia, Liver toxicity
 VPA- wt Gain, Hepatic & PancreaticToxicity,
Menstural Irregularities, Hair Loss

18.  LTG- Rash ( Steven Johnson Syndrome), Less
than other AET ( Headache, tremor, Ataxia).
Rarely LiverToxic
 Phenytoin- Gingival Hyperplasia, Hirsutism,
Nystagmus, Ataxia, Coarseness of Facies ,
Rash ( Steven Johnson Syndrome), Liver
toxicity
 Levetiracetam-, Abnormal Behaviour and
CNS Adverse effects- But less than other
AED, Depressive Mood- More in children