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Flashcards in Seizures and Epilepsy Deck (11):

Seizures originating at some point within and rapidly engaging bilaterally distributed networks; these networks can include cortical and subcortical structures, but do not necessarily involve the entire cortex
May be asymmetric

generalized seizures


Seizures originating within networks limited to one hemisphere, discretely localized or more widely distributed
Ictal onset is consistent from one seizure to another, with preferential propagation patterns that can involve the contralateral hemisphere
Complex partial focal dyscognitive/with impaired awareness
Simple partial focal without impairment of consciousness or awareness

focal seizures


Generalized seizures
Childhood or teenage onset
Sudden onset, without aura, prompt offset
Momentary loss of consciousness
Eyelid flutter/minor automatisms
3-15 seconds in duration
family history of seizure
EEG: 3 Hz spike-wave / HV sensitive

absence seizures


Generalized seizures
Sudden stiffening
Extension is maximal in arms
A few seconds in duration
Associated with falls and injury
Extra-temporal origin
Refractory to therapy
EEG: flattening/high frequency discharge

tonic seizures


Generalized seizures
Abrupt onset
Sudden loss in tone
Head drop/falls/injuries
1-2 seconds in duration
poor response to anti-epileptic drugs
poor overall prognosis
EEG: slow spike-wave/flattening

atonic seizures


Generalized seizures
Sudden jerks
Usually bilateral, maximal in arms
One second in duration
Often multiple
May be photic or sensory induced
Often maximal on awakening
EEG: generalized polyspike-wave burst (5-6 Hz)

myoclonic seizures


Generalized seizures
Loss of consciousness
May have a focal or generalized onset, focal onset may evolve to become generalized
Tonic extension of limbs (20-40 seconds duration)
Evolves to rhythmic clonic jerking of extremities (30-50 seconds duration)
Cessation of breathing, tongue biting, incontinence
Post-ictal sleep
EEG: variable, often obscured

tonic-clonic seizures


Motor, sensory, psychic or autonomic signs or symptoms
Preservation of consciousness and awareness
May progress to dyscognitive seizures or tonic-clonic seizures
EEG: interictal-focal sharp or slow; ictal-rhythmic discharge; often normal

focal seizures without impairment of consciousness


Altered consciousness/awareness
Duration 30 seconds to 3 minutes
Purposelessness automatisms (arms, mouth)
Semiology varies with site of origin
EEG: intericteral-sharp waves or spikes; ictal-focal or bilateral rhythmic sharp

focal dyscognitive seizures


Neurological emergency defined as 30 or more minutes of either continuous seizure activity or repetitive seizures with no intervening recovery of consciousness
Classification based on both clinical and electrographic features
Clinically determined by the presence or absence of motor activity (generalized or focal) and the presence of absence of intact consciousness

status epilepticus


Patients can exhibit paroxysmal or continuous tonic or clinic motor activity that may be symmetrical or asymmetrical
Includes primary and secondary generalized seizures and is further subdivided into overt and subtle

generalized convulsive status epilepticus