Snapshot 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) Introduction Clinical definition login to view 5 more bullets Other definitions login to view 13 more bullets Etiology login to view 13 more bullets Seizure classification login to view 3 more bullets Focal Seizures Clinical definition login to view 1 more bullet Partial seizures can login to view 4 more bullets 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 login to view 1 more bullet Generalized seizures login to view 3 more bullets 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 Myoclonic Patients can present with quick and repetitive jerks Tonic-clonic 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 Tonic Patients can present with stiffening Atonic Patients can present with "drop" seizurescan be mistaken as fainting Febrile Seizures Seen in pediatric patients with fever temperatures exceeding 38°C with no other seizure-provoking etiology Categories login to view 2 more bullets Treatment login to view 1 more bullet