Malformation of cortical development Intrauterine infection Hypoxic-ischemic encephalopathy* Trauma Hemorrhage*
METABOLIC CONDITIONS Hypoglycemia* GENERALIZED SEIZURES Absence (staring, unresponsiveness) *Common.
Simple partial (consciousness not impaired) Motor signs (can be tonic, clonic, myoclonic) Special sensory (visual, auditory, olfactory, gustatory, vertiginous, somatosensory) Autonomic
Complex partial/focal dyscognitive (consciousness impaired) Psychic (déjà vu, fear) Impaired consciousness at onset Development of impaired consciousness
Focal seizures with secondarily generalized convulsions Jacksonian seizures
Tonic (sustained contraction) Clonic (rhythmic contractions) Tonic-clonic (tonic phase followed by clonic phase) Atonic (loss of tone) Myoclonic (rapid, shock-like contraction) Spasms (flexion or extension of trunk and extremities for <2
Underlying cause is identified
Example: Focal epilepsy associated with a remote stroke Idiopathic
Presumed to have a genetic etiology
Example: Benign childhood epilepsy with centrotemporal spikes, childhood absence epilepsy, juvenile myoclonic epilepsy Cryptogenic
Epilepsy of uncertain etiology
Example: Infantile spasms with no identifiable cause and automatisms during complex partial seizures. Automatisms are automatic semipurposeful movements of the mouth (lip smacking, chewing) or extremities (rubbing of fingers, shuffling of feet). Focal seizures that manifest only with psychic or autonomic symptoms, such as a feeling of déjà vu during a temporal lobe seizure, can be difficult to recognize. When focal seizures spread to involve the whole brain and produce a generalized seizure, they are said to have secondarily generalized. Such spread is classically described as progression from face to arm to leg (Jacksonian march). It is often difficult to distinguish primary generalized tonic and clonic seizures from secondarily generalized focal seizures on purely clinical grounds. This distinction is important, however, because evaluation and treatment for focal or generalized epilepsy syndromes are quite different.
Tonic, clonic, and biphasic tonic-clonic seizures may occur alone or in association with other seizure types. Typically the seizure begins abruptly but occasionally is preceded by a series of myoclonic jerks. During a tonic-clonic seizure, consciousness and control of posture are lost, followed by tonic stiffening and upward deviation of the eyes. Pooling of secretions,
Provoking Hyperventilation Variable, but often none maneuver Photic stimulation
Postictal phase None (return Confusion, sleepiness immediately to baseline)
Number of Many per day Infrequent (rarely more seizures
EEG features Interictal: normal Interictal: focal slowing or Ictal: 3-Hz sharp waves generalized spike-Ictal: Focal discharges wave (with or without secondary
Neurological Normal Normal, or focal deficits examination
Neuroimaging Normal* Normal, or focal abnormalities (mesial temporal sclerosis, focal cortical dysplasia, neoplasm, encephalomalacia) *In the proper clinical context, and with an appropriate EEG, a diagnosis of absence epilepsy should be made without neuroimaging.
†Oxcarbazepine and carbamazepine are relatively contraindicated for children with typical absence epilepsy, as their seizures can be exacerbated by these medications.
pupillary dilation, diaphoresis, and hypertension are common. Clonic jerks follow the tonic phase. In the post-ictal phase, the child might be hypotonic. Irritability and headache are common as the child awakens.