seizure classification
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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.
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