1. UNCLASSIFIED SEIZURES
PARTIAL SEIZURES
GENERALIZED SEIZURES
UNCLASSIFIED SEIZURES
Simple Partial (consciousness retained)
Motor
Sensory
Autonomic
Psychic
Complex Partial (consciousness impaired)
-Simple partial, followed by impaired consciousness
-Consciousness impaired at onset
Partial seizures with secondary generalization
Absences
-Typical
-Atypical
Generalized tonic-clonic
Tonic
Clonic
Myoclonic
Atonic
Infantile Spasms

2. SIMPLE PARTIAL SEIZURES (SPS)
Motor activity – most common symptom
Asynchronus clonic or tonic movements
Tend to involve the face, neck, and extremities
Some patients complain of aura
Lasts for secs
Patients remain conscious and may verbalize during seizure
No postictal phenomenon

3. May be confused with tics (shoulder shrugging, eye blinking, and facial grimacing and primarily involve the face and shoulders; can be briefly suppressed, but SPS cannot be controlled)
EEG- spikes or sharp waves unilaterally or bilaterally or a multifocal spike pattern

4. COMPLEX PARTIAL SEIZURES (CPS)
May begin with a SPS with or without an aura, followed by impaired consciousness
Aura- vague, unpleasant feeling, epigastric discomfort, or fear – 1/3 of children with SPS or CPS; indicates focal onset
AUTOMATISMS- common feature of CPS in infants and children occurring in about 50-75% of cases
Alimentary automatisms in infants: lip smacking, chewing, swallowing, and excessive salivation
In children: semi-purposeful, incoordinated, unplanned automatisms

5. PARTIAL SEIZURES WITH SECONDARY GENERALIZATION
Secondary generalization – spreading of the epileptiform discharge
Contralateral versive turning of the head, dystonic posturing, and tonic-clonic movements of the extremities and face, including eye blinking
1-2 mins
EEG- anterior temporal lobe sharp waves or focal spikes and multifocal spikes

6. ABSENCE SEIZURES
Sudden cessation of motor activity or speech with a blank facial expression or flickering of the eyelids
More prevalent in girls before 5 years old
Never associated with an aure
Rarely persists longer than 30 secs
Not associated with a postictal state
EEG- 3/sec spike and generalized wave discharge
COMPLEX ABSENCE – myoclonic movement of the face, fingers, or extremities, loss of body tone; EEG – atypical spike and wave discharges 2-2.5/sec

7. GENERALIZED TONIC-CLONIC SEIZURES
Common and may follow a partial seizure with a focal onset
Maybe associated with an aura
Patients suddenly lose consciousness, eyes roll back, and body musculature undergoes tonic contractions, become cyanotic
Clonic phase – rhythmic clonic contractions alternating with relaxation of all muscle groups
Loss of sphincter controll, particularly the bladder

8. Postictally, children are initially semicomatose and typically remain in deep sleep for 30 mins to 2 hrs

9. MYOCLONIC EPILEPSIES OF CHILDHOOD
Repetitive seizures consisting of brief, often symmetric muscular contractions with loss of body tone and falling or slumping forward
BENIGN MYOCLONUS OF INFANCY
TYPICAL MYOCLONIC EPILEPSY OF EARLY CHILDHOOD
COMPLEX MYOCLONIC EPILEPSIES
JUVENILE MYOCLONIC EPILEPSY (Janz Syndrome)
PROGRESSIVE MYOCLONIC EPILEPSIES

10. INFANTILE SPASMS 4-8 months
Brief symmetric contractions of the neck, trunk, and extremities
3 types: flexor, extensor, and mixed
FLEXOR: occur in clusters or volleys and consist of sudden flexion of the neck, arms, and legs onto the trunk
EXTENSOR: extension of the trunk and extremities; least common
MIXED: flexion in some volleys and extension in others; most common
EEG- hypsarrhthmia-chaotic pattern of high voltage, bilaterally asynchronous, slow-wave activity or a modified hypsarrhythmia pattern

11. Cryptogenic or Symptomatic
CRYPTOGENIC: uneventful pregnancy and birth history as well as normal developmental milestones before onset of seizures
SYMPTOMATIC: prenatal, perinatal, and postnatal risk factors

12. NEONATAL SEIZURES
FOCAL – rhythmic twitching or muscle groups, particularly those of the extremities and face
often associated with localized structural lesions as well as with infections and subarachnoid hemorrhage
MULTIFOCAL CLONIC- similar to focal clonic but differ in that many muscle groups are involved, frequently several simultaneously

13. TONIC- rigid posturing of the extremities and trunk, sometimes associated with fixed deviation of the eyes
MYOCLONIC- brief focal or generalized jerks of the extremities or body that tend to involve distal muscle groups
SUBTLE- chewing motions, excessive salivation, and alterations in then respiratory rate including apnea, blinking, nystagmus, bicycling or pedaling movements, and changes in color

14. EEG CLASSIFICATION OF NEONATAL SEIZURES
CLINICAL SEIZURE WITH A CONSISTENT EEG EVENT
CLINICAL SEIZURES WITH INCONSISTENT EEG EVENTS
ELECTRICAL SEIZURES WITH ABSENT CLINICAL SEIZURES

15. CLINICAL SEIZURE WITH A CONSISTENT EEG EVENT
Clinical seizure occurs in relationship to seizure activity recorded on EEG
Includes focal clonic, focal tonic, and some myoclonic seizures
Epileptic and are like to respond to anticonvulsants

16. CLINICAL SEIZURES WITH INCONSISTENT EEG EVENTS
Observed with all generalized tonic seizures and subtle seziures and with some myoclonic seizures
Infants tend to be neurologically depressed or comatose as a result of hypoxic-ischemic encephalopathy
Nonepileptic origin
May not require or respond to antiepileptics

17. ELECTRICAL SEIZURES WITH ABSENT CLINICAL SEIZURES
May develop in comatose infants who are not on anticonvulsants
May persist in patients with focal tonic or clonic seizures without clinical signs after the introduction of an anticonvulsant