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Updated: Mar 29 2023


  • 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
      • 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
      • 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
      • 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
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