1. Classification of epilepsy
Generalized seizures (10%)
• Tonic–clonic
• Absence
Typical
Atypical
Absence with special
features
• Myoclonic absence
• Eyelid myoclonia
• Myoclonic
Myoclonic
Myoclonic atonic
Myoclonic tonic
• Clonic
• Tonic
• Atonic

2. Classification of epilepsy
Focal seizures 80% of adult epilepsies
Simple partial seizures
Focal motor
Focal sensory
Complex partial seizure
Secondarily generalized seizures
Tonic
Clonic
Tonic–clonic

3. Classification Partial-onset seizures
Repeated, stereotypic occurrence of the same experience
focal EEG changes
Simple partial seizures
Complex partial seizure
Secondarily generalized seizures

4. Partial-onset seizures
Simple partial seizures ( normal consciousness)
sensory
motor
autonomic
psychic

5. Somatic motor Jacksonian (focal motor)
Masticatory, salivation, speech arrest
Simple contraversive
Head and eye turning associated with arm movement or athetoid- dystonic postures
Prerolandic gyrus
Amygdaloid
Frontal
Supplementary motor cortex

6. Somatosensory Unformed images, lights, patterns Auditory Vertiginous
Olfactory
Gustatory
Visceral : autonomic
Contralateral occipital
Heschl gyri
Superior temporal
Mesial temporal
Insula
Insular-orbital-frontal
cortex

7. Complex partial seizure
Transient loss of the patient ability to maintain normal contact with environment (Temporal and frontal)
aura
behavioral arrest and is followed by staring
consciousness is impaired (60-90 seconds) The patient is unable to respond appropriately.
Automatisms (chewing, lip smacking, mumbling, and fumbling with the hands)
postictal confusion

8. Secondarily generalized seizures
Generalized tonic clonic convulsion have 1 of the followings
Clear history of aura or obvious lateralization
Post-ectal todds paralysis
Focal EEG record
Focal cortical lesion by imaging

9. Partial-onset seizures

10. Grand mal seizures 10% of all epilepsy
40% of generalized epilepsy & main epilepsy resulting from metabolic derangements
1. Tonic extension & abrupt loss of consciousness of the extremities (10 – 20 sec) falling heavily if standing and risking facial injury. During this phase, breathing stops and central cyanosis may occur

11. Grand mal seizures
2. Clonic rhythmic movements ( 1 min ) urinary incontinence and tongue-biting may occur. A bitten, bleeding tongue after an attack of loss of consciousness is pathognomonic of a generalized seizure.
3. Postictal confusion
Precipitated by hyperventilation, sleep deprivation or photic stimulation
No structural brain abnormality

12. Grand mal seizures

13. Absence seizures
brief episodes of impaired consciousness ( less than 20 sec) without loss of postural control
repetitive blinking
Precipitated by hyperventilation or sleep deprivation & fatigue
40-80% develop tonic clonic seizures
begin during childhood (4-8 year) or adolescence (10-15 year) % remit in adulthood

14. Absence seizures

15. Atypical absence seizures

16. Myoclonic seizures (5-10%)
Myoclonus is a brief, arrhythmic, jerking, motor movements that last less than a second. predominating in the arms
Myoclonus is not always epileptic in origin. (phase I of sleep)
In epilepsy, they are more marked in the morning or on awakening from sleep
Myoclonic seizures often occur as cluster within a few minutes.

17. Myoclonus is tend to be provoked by fatigue, alcohol & sleep deprivation
The onset of presentation years 90% respond to valproate
Commonly associated with
metabolic disorder
degenerative CNS disease
anoxic brain injury

18. Myoclonic seizures

19. Atonic seizures
Brief loss of postural tone (1-2 sec) usually resulting in heavy falls
Consciousness is briefly impaired
No post ictal confusion
Often associated with neurological abnormalities
They only occur in the context of epilepsy syndromes that involve other forms of seizure.

20. Tonic seizures
It consist of sudden-onset tonic extension or flexion of the head, trunk, and/or extremities for several seconds with loss of awareness
They are often associated with other neurological abnormalities.
They are usually seen as part of an epilepsy syndrome and are unlikely to be isolated.

21. Tonic

22. Clonic seizures It consist of rhythmic, motor, jerking movements
Clonic seizures can have a focal origin with or without impaired consciousness.
The ictal EEG correlate consists of bilateral rhythmic epileptiform discharges.

23. Seizures of uncertain generalized or focal nature
occur mainly in infancy.
They signify widespread cortical disturbance
it take the form of marked contractions of the axial musculature, lasting a fraction of a second but recurring in clusters of 5–50, often on awakening.

24. Infantile spasm

25. Pseudoseizures
Its tend to occur in the presence of other people, it precipitated by emotional factors, and prolonged for many minutes or hours.
Completely asynchronous thrashing of the limbs and repeated side-to-side movements of the head
Associated with hand-biting, kicking, trembling, and quivering; pelvic thrusting and opisthotonic arching postures; and screaming or talking during the ictus.
lacking tongue-biting, incontinence, hurtful falls, or postictal confusion.

26. Epilepsy syndromes
Many patients with epilepsy fall into specific patterns, depending on:
Seizure type
Age of onset
Responsiveness to treatment
Genetic testing demonstrate similarities in molecular pathophysiology.

27. Epilepsy syndromes Childhood absence epilepsy Age of onset 4–8 yrs
Frequent brief absences
EEG 3/sec spike and wave complex
Treatment: Ethosuximide ,Sodium valproate, Levetiracetam
Prognosis: 40% develop GTCS, 80% remit in adulthood

28. Epilepsy syndromes Juvenile absence epilepsy Age of onset 10–15 yrs
Less frequent absences than childhood absence
EEG Poly-spike and wave
Treatment: Sodium valproate, Levetiracetam
Prognosis: 80% develop GTCS, 80% seizure-free in adulthood

29. Epilepsy syndromes Juvenile myoclonic epilepsy Age of onset 15–20 yrs
GTCS. absences, morning myoclonus
EEG Poly-spike and wave with photosensitivity
Treatment: Sodium valproate or Levetiracetam
Prognosis: 90% remit with AEDs but relapse if AED withdrawn

30. Epilepsy syndromes GTCS on awakening Age of onset 10–25 yrs
GTCS, sometimes myoclonus
EEG Spike and wave on waking and sleep onset
Treatment: Sodium valproate or Levetiracetam
Prognosis: 65% controlled with AEDs but relapse if AED withdrawn