seizure types

In ~2500 B.C., the Sumerians provided the first writings about seizures.{{sfn|Panteliadis|Vassilyadi|Fehlert|Hagel|2017}}{{rp|458}} Later, in ~1050 B.C., Babylonian scholars developed the first seizure classification, inscribing their medical knowledge in the stone tablets called Sakikku or in English "All Diseases."{{sfn|Panteliadis|Vassilyadi|Fehlert|Hagel|2017}}{{rp|458}} This early classification identified febrile seizures, absence seizures, generalized tonic-clonic seizures, focal seizures, impaired awareness seizures, and status epilepticus.{{sfn|Panteliadis|Vassilyadi|Fehlert|Hagel|2017}}{{rp|458}} Samuel-Auguste Tissot (1728–1797) authored Traité de l’Epilepsie, a book describing grand état (generalized tonic-clonic seizures) and petit état (absence seizures).{{sfn|Panteliadis|Vassilyadi|Fehlert|Hagel|2017}}{{rp|460}} Jean-Étienne Dominique Esquirol (1772–1840) later introduced grand mal (generalized tonic-clonic seizures) and petit mal to describe these seizures.{{sfn|Panteliadis|Vassilyadi|Fehlert|Hagel|2017}}{{rp|460}} In 1937, Gibbs and Lennox introduced psychomotor seizures, seizures with "mental, emotional, motor, and autonomic phenomena."{{sfn|Vannemreddy|Stone|Vannemreddy|Slavin|2010}} Henri Gastaut led the effort to develop the ILAE 1969 classification of seizures based on clinical seizure type, electroencephalogram (EEG), anatomical substrate, etiology, and age of onset.{{sfn|Bancaud|Henriksen|Rubio-Donnadieu|Seino|1981}}{{rp|491}} The ILAE 1981 classification of seizure included information from EEG-video seizure recordings, but excluded anatomical substrate, etiology, and age factors, as these factors were "historical or speculative" rather than directly observed.{{sfn|Bancaud|Henriksen|Rubio-Donnadieu|Seino|1981}}{{rp|491}} The ILAE 2017 classification of seizures closely reflects clinical practice, using observed seizure behavior and additional data to identify seizure types.{{sfn|Fisher|Cross|French|Higurashi|2017}}{{rp|523}}

A seizure is a paroxysmal episode of symptoms or altered behavior arising from abnormal excessive or synchronous brain neuronal activity.{{sfn|Fisher|Boas|Blume|Elger|2005}} A focal onset seizure arises from a biological neural network within one cerebral hemisphere, whereas a generalized onset seizure arises from within the cerebral hemispheres rapidly involving both hemispheres.{{sfn|Fisher|Cross|French|Higurashi|2017}}{{rp|526}} Seizure symptoms, seizure behavior, neuroimaging, seizure etiology, EEG, and video recordings help distinguish focal from generalized onset seizures.{{sfn|Fisher|Cross|French|Higurashi|2017}}{{rp|526}} Unknown onset seizures occur if the available information is insufficient to distinguish focal from generalized onset seizures with a $\backslash ge\; 80\%$ confidence.{{sfn|Fisher|Cross|French|Higurashi|2017}}{{rp|524,527}} Focal to bilateral tonic-clonic seizure indicates that the seizure begins as focal seizure then later evolves to a bilateral tonic-clonic seizure.{{sfn|Fisher|Cross|French|Higurashi|2017}}{{rp|525}}

The classification distinguishes focal aware seizures from focal impaired awareness seizures.{{sfn|Fisher|Cross|French|Higurashi|2017}}{{rp|524}} Aware means aware of self and surroundings during the seizure, verified when a person can recall events having occurred during the seizure.{{sfn|Fisher|Cross|French|Higurashi|2017}}{{rp|527}} Impaired awareness occurs even if the recall of events is only partially impaired.{{sfn|Fisher|Cross|French|Higurashi|2017}} Impaired awareness may occur at any time during the seizure.{{sfn|Fisher|Cross|French|Higurashi|2017}} If the level of awareness cannot be determined, the level of awareness is unspecified; this usually occurs for atonic seizures and epileptic spasm seizures.{{sfn|Fisher|Cross|French|Higurashi|2017}}{{rp|525}}

A motor seizure has prominent movement, increased muscle contraction, or decreased muscle contraction as the initial predominant seizure feature.{{sfn|Fisher|Cross|French|Higurashi|2017}} Atonic seizures are a brief 0.5- to 2-second lapses in muscle tone commonly leading to a fall.{{sfn|International League Against Epilepsy|2022a|loc=Generalized onset seizure}} Epileptic spasm seizures are brief 1- to 2-second proximal limb and truncal flexion or extension movements, often repeated.{{sfn|International League Against Epilepsy|2022a|loc=Generalized onset seizure}} Hyperkinetic seizures occur as high amplitude truncal and limb movements such as pedaling, thrashing, and rocking movements.{{sfn|International League Against Epilepsy|2022b|loc=Motor seizure}} Myoclonic seizures are brief jerks of limbs or body lasting milliseconds.{{sfn|International League Against Epilepsy|2022a|loc=Generalized onset seizure}} Tonic seizures are abrupt increases in muscle tone greater than 2 seconds in duration.{{sfn|International League Against Epilepsy|2022a|loc=Generalized onset seizure}} Clonic seizures occur as rhythmic body jerks.{{sfn|International League Against Epilepsy|2022b|loc=Motor seizure}} Myoclonic-atonic seizures begins with one or more jerks (myoclonic phase) followed by a loss of muscle tone (atonic phase).{{sfn|International League Against Epilepsy|2022a|loc=Generalized onset seizure}} Myoclonic-tonic-clonic seizures begin with one or more jerks (myoclonic phase), then body stiffening (tonic-phase), then rhythmic jerks (clonic phase).{{sfn|International League Against Epilepsy|2022a|loc=Generalized onset seizure}} Tonic-clonic seizures begin as symmetrical bilateral body stiffening (tonic phase) followed by rhythmic jerks (clonic phase).{{sfn|International League Against Epilepsy|2022a|loc=Generalized onset seizure}} Myoclonic, atonic, tonic, and myoclonic-atonic seizures may cause abrupt falls, called drop attacks, similar to cataplexy.{{sfn|International League Against Epilepsy|2022c|loc=Epilepsy imitators}} Automatism seizures occur with repetitive stereotyped behaviors.

A non-motor seizure may begin with a sensory, cognitive, autonomic, or emotional symptom, behavioral arrest of activity, or impaired awareness with minor motor activity as the initial predominant seizure feature.{{sfn|Fisher|Cross|French|Higurashi|2017}}

Sensory seizures occur with somatosensory (touch), olfactory (smell), visual, gustatory (taste), vestibular, or thermal sensations.{{sfn|International League Against Epilepsy|2022d|loc=Focal onset seizure}} Cognitive seizures occur with language impairment (e.g. aphasia, dysphasia, anomia), memory impairments (déjà vu, jamais vu), hallucinations, persistent thought (forced thinking), and neglect.{{sfn|International League Against Epilepsy|2022d|loc=Focal onset seizure}} Autonomic seizures occur with palpitations, heart rate changes, nausea, vomiting, piloerection (goose bumps), lacrimation, pupil size changes, or urge to urinate or defecate.{{sfn|International League Against Epilepsy|2022d|loc=Focal onset seizure}} Emotional seizures occur with fear, anxiety, laughing, crying, pleasure, or anger sensations.{{sfn|International League Against Epilepsy|2022d|loc=Focal onset seizure}} These initial symptoms are seizure auras.{{sfn|International League Against Epilepsy|2022e|loc=Sensory seizure}} Behavioral arrest seizures occur as an abrupt cessation of movement.{{sfn|International League Against Epilepsy|2022d|loc=Focal onset seizure}}

Absence seizures occur with a sudden brief impairment in awareness, commonly less than 45 seconds.{{sfn|International League Against Epilepsy|2022a|loc=Generalized onset seizure}} Typical absence seizures may be accompanied by rhythmic facial 3 per second facial movements.{{sfn|International League Against Epilepsy|2022a|loc=Generalized onset seizure}} Atypical absence seizures occur with a less sudden impairment in awareness, often accompanied by a gradual head, limb, or truncal slumping.{{sfn|International League Against Epilepsy|2022a|loc=Generalized onset seizure}} Myoclonic absence seizures occur with myoclonic jerks of arms and shoulders.{{sfn|International League Against Epilepsy|2022a|loc=Generalized onset seizure}} Absence with eyelid myoclonia seizures occur with 4 to 6 per second eyelid myoclonic jerks and upward eye movement.{{sfn|International League Against Epilepsy|2022a|loc=Generalized onset seizure}}

Descriptors are additional seizure behaviors or symptoms that are appended to the seizure diagnosis. Descriptors may be a non-predominant or non-initial seizure feature.{{sfn|Fisher|Cross|French|Higurashi|2017}} Descriptors provide a more complete description of the seizure.{{sfn|Fisher|Cross|French|Higurashi|2017}}

1 - Classify focal seizures as focal aware, focal impaired awareness, or focal unspecified awareness.{{sfn|Fisher|Cross|French|Higurashi|2017}}{{rp|525}}

During the typical 1 minute seizure, a person experiences a familiar (déjà vu) sensation, followed by picking and fumbling hand movements. After this seizure, the person cannot recall what was said during the seizure. Brain magnetic resonance imaging (MRI) shows left hippocampal sclerosis, a brain abnormality associated with focal seizures.{{sfn|Varoglu|Saygi|Acemoglu|Ciger|2009}} This is a focal impaired awareness cognitive seizure with déjà vu. Appending a descriptor, this is a focal impaired awareness cognitive seizure with déjà vu followed by hand automatisms.

During the typical 10 second seizure, a child abruptly stops and stares with 3 per second rhythmic eye fluttering movements. After the seizure, the child cannot recall what occurred during the seizure. An EEG test shows 3 per second spike-wave pattern, an EEG pattern indicating a generalized onset seizure. This generalized onset non-motor (absence) seizure is a typical absence seizure. Appending a descriptor, this is a typical absence seizure with 3 per second eye fluttering movements.

Dyscognitive, simple partial, complex partial, psychic, and secondarily generalized are terms that apply only to the ILAE 1981 classification of seizures.{{sfn|Fisher|Cross|French|Higurashi|2017}}{{rp|525}} The ILAE 2017 classification relies on intact awareness of self and surroundings, but the ILAE 1981 classification relies on intact consciousness, defined as a normal response to an external stimulus due to intact awareness and intact ability to respond.{{sfn|Bancaud|Henriksen|Rubio-Donnadieu|Seino|1981}}{{rp|493}}{{sfn|Fisher|Cross|French|Higurashi|2017}}{{rp|525}} Unlike the ILAE 2017 classification, the ILAE 1981 classification specifies specific EEG patterns for each seizure type.{{sfn|Bancaud|Henriksen|Rubio-Donnadieu|Seino|1981}}{{rp|493–495}}

The associated EEG patterns are not included.{{sfn|Bancaud|Henriksen|Rubio-Donnadieu|Seino|1981}}{{rp|493}}

Partial seizures.{{sfn|Bancaud|Henriksen|Rubio-Donnadieu|Seino|1981}}{{rp|493}}

: Simple partial seizures: consciousness is not impaired.

:* With motor signs

:* With somatosensory or special-sensory symptoms

:* With autonomic symptoms or signs

:* With psychic symptoms

: Complex partial seizures: consciousness is impaired.

:* Simple partial onset, followed by impairment of consciousness

:* With impairment of consciousness at onset

: Partial seizures evolving to secondarily generalized seizures

:* Simple partial seizures evolving to generalized seizures

:* Complex partial seizures evolving to generalized seizures

:* Simple partial seizures evolving to complex partial seizures evolving to generalized seizures

Generalized seizures.{{sfn|Bancaud|Henriksen|Rubio-Donnadieu|Seino|1981}}{{rp|493}}

: Absence seizures

:* Absence seizures

:* Atypical absence seizures

: Myoclonic seizures

: Clonic seizures

: Tonic seizures

: Tonic-clonic seizures

: Atonic seizures

Unclassified epileptic seizures

Status epilepticus is a seizure "lasting longer than 30 minutes or a series of seizures without return to the baseline level of alertness between seizures."{{sfn|Abend|Bearden|Helbig|McGuire|2014}}

Epilepsia partialis continua is a rare type of focal motor seizure, commonly involving the hands or face, which recurs with intervals of seconds or minutes, lasting for extended periods of days or years.{{sfn|Mameniškienė|Wolf|2017}} Common causes are strokes in adults, and focal cortical inflammation in children: Rasmussen's encephalitis, chronic viral infections, or autoimmune encephalitis.{{sfn|Mameniškienė|Wolf|2017}}

Subclinical seizures cause no symptoms and either no altered behavior or very minimal behavioral changes; the clinician recognizes these seizures as an evolving seizure pattern on an EEG recording.{{sfn|Jin|Wang|Yang|Shen|2017}}{{sfn|Freund|Probasco|Ritzl|2018}}

Some forms of seizures have been defined based on symptoms, such as ecstatic seizures and orgasmic seizures.{{cite journal | vauthors = Gschwind M, Picard F | title = Ecstatic Epileptic Seizures: A Glimpse into the Multiple Roles of the Insula | journal = Front Behav Neurosci | volume = 10 | issue = | pages = 21 | date = 2016 | pmid = 26924970 | pmc = 4756129 | doi = 10.3389/fnbeh.2016.00021 | doi-access = free | url = }}{{cite journal | vauthors = Arias M | title = Neurology of ecstatic religious and similar experiences: Ecstatic, orgasmic, and musicogenic seizures. Stendhal syndrome and autoscopic phenomena | journal = Neurologia (Engl Ed) | volume = 34 | issue = 1 | pages = 55–61 | date = 2019 | pmid = 27340019 | doi = 10.1016/j.nrl.2016.04.010 | url = | doi-access = free }}

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{{Seizures and epilepsy}}

Category:Epilepsy

Category:Epilepsy types