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Seizure Types and How They Present

A physician and patient will be most successful in determining the type of seizure based upon descriptions that they have received from witnesses to the events and recollections the patient has before and after the events occur. The testing that a physician can order will be most effective when directed towards answering specific questions about specific types of seizures.

Gaining insight into the nature of a patient’s epilepsy requires asking fairly specific questions like “Have you any new memories concerning the way your seizures started?”

Typically a patient may have been talking to a co-worker standing with them when the seizure began. Because it may not seem important, they fail to mention that remarks about feeling sick to the stomach before the seizure occurred. Patients then recall having these feelings several times over the last six months.

While upset stomach is a common complaint, in fact it may be an early portion of a seizure and may help us to determine the type of seizure. Upset stomach routinely does not come on quickly and occur severely immediately and then suddenly vanish. Prompting questions like this help put a “epigastric rising” sensation in place of sick stomache and define the seizure type. That is certainly a very common description of the onset of one kind of seizure referred to as a partial seizure. Patients with partial seizures have a variety of sensations that precede the outwardly obvious seizure. These sensations are in fact themselves a seizure phenomenon. Once called auras, a word that refers to a potential warning sensation, they have been identified as the earliest portions of a seizure. These simple partial seizures are referred to as simple because they do not impair the person’s ability to communicate and are often times not identifiable by anyone other than the patient. They can occur as movements, feelings, or other changes in the senses including hearing, vision, taste and smell, and can also manifest as false memories known as dj vu.

And then patients will ask “I have also been having episodes of dj vu. Can there be more than one type of simple partial seizure?” Simple partial seizures can come in several forms within a single patient. But what comes next people at work will call staring episodes will occur, sometimes along with hand picking. This movement is a common presentation of the next part of a partial seizure known as a complex partial seizure. Patients having these episodes and amnesia (memory loss) are typical of staring episodes called complex partial seizures. Patients do not have memory for the seizure itself and have a variety of automatic movements like picking. These behaviors are called automatisms and generally begin after the patient is experiencing loss of memory. Partial seizures can progress to involve shaking episodes described as tonic and clonic seizures. All of these represent varying appearances of the same basic problem, a partial onset seizure.

There are also seizures described as generalized. Generalized seizures begin in a global fashion throughout the brain and present with various manifestations. These include seizures described as absence (starring spells lasting 2 – 15 seconds), tonic and clonic seizures (stiffening and shaking episodes without a before seizure warning), drop attacks (known as atonic or tonic seizures which cause a patient to fall to the ground), and myoclonic seizures (a brief muscle jerk). These seizures while more common in childhood, do occur in adulthood. The myoclonic seizure (the brief muscle jerk) seen with tonic and clonic seizures often continues into adulthood as part of a seizure syndrome called Juvenile Myoclonic Epilepsy. It is important to gather as much information from people witnessing these seizures in an effort to more accurately define the seizure type. Witnesses and the patient must be asked about the sense of a warning sensation prior to the onset of any event, the preservation of awareness during these events, and how quickly they begin and end. All of these pieces of information will help improve the accuracy of the seizure diagnosis.

The accuracy of the diagnosis is in fact very important as the medications used to treat seizures are not uniformly effective against all seizure types, so incorrectly identifying the type of seizure an individual is experiencing may lead to them receiving less than the most successful treatment for their seizures.

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