Updated: 3/11/2023


Review Topic
Videos / Pods
  • A 16-year-old girl presents to the emergency department with a recent convulsive episode. The mother reports that this episode occured a few hours after awakening, described her movements as myoclonic, and involving the upper extremity. As time progressed, her myoclonus evolved into a generalized tonic-clonic seizure that lasted 3-4 minutes. The patient reported to sleeping only a few hours per night due to upcoming examinations. Physical exam is unremarkable. EEG shows 5-Hz polyspike and slow-wave discharges. (Juvenile myoclonic epilepsy)
  • Clinical definition
    • synchronized and high-frequency neuronal depolarization that results in
      • abnormal behavior and patient experience
    • this is different from epilepsy, which can be simply described as
      • a tendency to have recurrent seizures that are unprovoked
        • febrile seizures are not considered to be epilepsy
  • Other definitions
    • ictal
      • during the seizure
    • postictal
      • after the seizure
    • interictal
      • between seizures
    • aura
      • foc
      • for example, patients may describe a rising epigastric visceral sensation in
        • a seizure affecting the medial temporal limbic structures
    • status epilepticus
      • life threatening seizure episode that occurs
        • continuously or in rapid successions
  • Etiology
    • can be divided into provoked and unprovoked causes
      • provoked
        • substance abuse (e.g., cocaine and MDMA)
        • space occupying lesion (e.g., malignancy and abscess)
        • stroke (e.g., ischemic and hemorrhagic)
        • meningitis and encephalitis
        • hypo- or hyperglycemia
        • hyponatremia
        • hypocalcemia
        • hypomagnesemia
        • medication withdrawal (e.g., benzodiazepine and alcohol)
      • unprovoked
        • underlying neurological disorder (e.g., childhood absence epilepsy and neurofibromatosis)
  • Seizure classification
    • classification is based on the International League Against Epilepsy (ILAE)
    • seizures can be initially divided into
      • focal and generalized
Focal Seizures
  • Clinical definition 
    • abnormal neuronal activity in a localized (focal) part of the brain
  • Partial seizures can
    • secondarily generalize
    • be subdivided into
      • simple partial seizures
      • complex partial seizures
Focal Seizure Types
Seizure Type
Clinical Features
Focal onset seizures with awareness
  • Consciousness is spared
  • Symptoms are dependent on the anatomical location of the seizure
    • e.g., abnormal shapes or flashes when there is a seizure in the primary visual cortex
  • Typically no postictal deficits in brief simple partial seizures
Focal onset seizures without awareness 
  • Consciousness is impaired
    • this can be complete or mild
  • Symptoms are dependent on the anatomical location of the seizure
  • May have automatisms
  • Most common location is in the
    • temporal lobes
Generalized Seizures
  • Clinical definition
    • abnormal neuronal activity in both hemispheres of the brain
  • Generalized seizures
    • is almost always associated with impaired consciousness
    • generalized tonic-clonic (grand mal) seizures is
      • the most common type of generalized seizure
Generalized Seizure Types
Seizure Type
Clinical Features
Absence (petit mal seizures)
  • Most commonly occurs in children
  • Can occur many times in a day
  • Brief episodes (~10 seconds) of unresponsiveness
    • parents may report the patient had a blank stare
    • can occur many times in a day
  • No postictal deficits and automatisms
  • Characteristic EEG finding is
    • generalized 3-4-Hz spike and wave discharges
  • Patients can present with quick and repetitive jerks
  • Typically begins with a tonic phase
    • contraction of all muscles for 10-15 seconds
      • leads to a fall "like a tree"
  • The clonic phase follows the tonic phase
    • rhythmic jerking of the bilateral extremities
  • There are postictal deficits
  • Patients can present with stiffening
  • Patients can present with "drop" seizures
    • can be mistaken as fainting
Febrile Seizures
  • Seen in pediatric patients with fever temperatures exceeding 38°C with no other seizure-provoking etiology
  • Categories
    • simple: generalized, do not last longer than 15 minutes, and no recurrence within 24 hours.
    • complex: focal, do last longer than 15 minutes, and/or recurrence within 24 hours.
  • Treatment
    • Supportive 

Please rate topic.

Average 3.7 of 15 Ratings

Questions (2)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Private Note