4-3. CLASSIFICATION OF EPILEPTIC SEIZURES

Types of epileptic seizures you are most likely to encounter include the following:

a. Petit Mal Seizures. The tendency to this type of seizure is usually inherited. The classic petit mal seizure (also called absence seizure) is characterized by three phases: a sudden vacant expression or stare; stopping any motor activity (akinetic seizure); and myoclonic jerks (contraction and relaxation of muscles) with or without loss of muscle tone. These seizures are very brief (lasting from one to three seconds), and the individual may have as many as 100 of these seizures a day. These seizures are so brief that often the person looks like he is daydreaming or staring. His eyelids may flutter rapidly. Immediately after his attack, the individually returns to his normal activity. The episode is so brief that often neither the patient nor those around him notice anything unusual. The seizure may occur with or without loss of muscle tone. The person's eyes may rotate upward briefly, and he may blink his eyes. His head may droop but rarely fall. Fingers and hands may contract and relax. Usually, he is not incontinent. Petit mal seizures occur mainly in children from three to ten years of age. Such seizures almost never occur in anyone over age 20. If such a seizure does occur, it indicates the presence of organic brain disease. A child with this type of seizure may have grand mal epilepsy as he grows older.

b. Focal Seizures. These seizures are also called Jacksonian seizures, simple seizures, and partial seizures. Motor, sensory, or autonomic functions may be affected. The part or parts of the body affected indicate the particular place in the cerebrum where a lesion is located, the lesion causing the seizure. The seizures are localized or on only one side of the body. The person's head and eyes may turn to one side. Jerking limbs will be on only one side of the body. If the seizure progresses to a generalized convulsion, the person may become unconscious, and the attack may develop into a full grand mal seizure.

c. Grand Mal Seizures. This type of seizure (also called generalized seizure, major seizure, and tonic-clonic seizure) usually lasts two to three minutes but may last as long as ten to fifteen minutes. A person may suffer a grand mal seizure and a petit mal seizure at the same time. There are four phases to a grand mal seizure: the prodromal phase, the tonic phase, the clonic phase, and the postictal phase.

(1) Prodromal phase. In this phase, 50 percent of the patients experience an aura, that is a particular sensation described as an odd or unpleasant sensation rising from the stomach toward the chest and throat; that is a kind of premonition before the seizure occurs. The individual cries out (a respiratory muscle has a spasm) and loses consciousness, falling to the ground. NOTE: Some patients experience the same aura before each seizure. The aura may cause numbness or motor activity such as turning the head and eyes or the spasm of a limb. The aura may be a peculiar sound or baste or a memory from the past.

(2) Tonic phase. This phase is characterized by continuous body tension. There is a sustained contraction of all muscles in the body; the body is rigid with fixed jaws, hands clenched, and legs extended. The person's face may be red or cyanotic due to a spasm of the respiratory muscle. His pupils are dilated, corneal and deep tendon reflexes are absent, and the Babinski sign is positive.

(3) Clonic phase. The person's muscles alternately contract and then relax rapidly. The phase follows the tonic phase in less than a minute. The individual's jerky movements are caused by the alternating contractions and relaxation of his muscles (myoclonic jerking of arms and legs and/or the body trunk). Frothing at the mouth, loss of bladder and bowel control, tongue biting, bruises, and contusions commonly occur during this phase.

(4) Postictal phase. The clonic convulsive phase gradually subsides. The fourth phase characterized by a deep sleep with gradual recovery. When the person awakens, he may be confused, tired, have muscle soreness, and a headache. Encourage him to rest because activity could bring about another attack.

d. Status Epilepticus. Status epilepticus is a medical emergency and is a series of seizures that occur in rapid succession with no intervening periods of consciousness. A grand mal status epilepticus may persist for hours or days resulting in a coma. The coma may be fatal due to hyperthermia (very high body temperature) and exhaustion. If any seizure lasts over ten minutes, the seizure is considered status epilepticus and, therefore, a medical emergency. The cause of status epilepticus is often the result of improper drug therapy for epilepsy. This condition can also occur spontaneously.

e. Psychomotor Seizures. These are seizures that do not adhere to the classic criteria of the grand mal, focal, or petit mal seizures. Characteristics of psychomotor seizures include the following:

(1) The individual loses contact with his environment for one to two minutes.

(2) He does not fall, but he may stagger around performing automatic purposeless movements. Also, he may utter unintelligible sounds, turn his head or eyes, smack his lips, rub his hair, or rub his face.

(3) He does not understand what is said, and he resists help.

(4) He is mentally confused for another one to two minutes after the seizure seems to be over.

(5) Following the seizure, the individual usually does not remember what he did during the attack.

(6) Psychomotor seizures may develop at any age and are usually associated with structural lesions of the temporal lobe of the brain.

f. Hysterical Attacks. This condition may resemble grand mal epilepsy. Characteristics of the attack include the following:

(1) The attack begins slower, and the person's movements are purposeful.

(2) He experiences no tongue biting or incontinence.

(3) He remains conscious.

(4) If and when he falls, he does not usually injure himself.

(5) He may resist help, and the "convulsion" may be erratic and atypical (unusual and not typical of seizures).

(6) The patient usually has a history of emotional upset and neurosis.