So if you've determined
it's a seizure.
Step 1 is to
classify the seizure.
What kind of seizure is it?
And over the years,
there's been many classification systems
that are used to
The oldest of these
considered 3 seizure types,
focal, grand mal and petit mal.
And you'll still see these
words used to describe seizures.
Our prior categorization
system classified seizures
as simple partial,
or secondarily generalized
These are all the
focal onset seizures
or primary generalized seizures.
And alternative classification has
been localization-related epilepsy,
or generalized epilepsy.
Our current classification system considers
focal onset and generalized onset seizures.
The focal onset seizures can
be with retained awareness
and being motor or non-motor
or with altered awareness
and be motor or non-motor.
And then the third category
is focal onset seizures
that progressed to
The generalized onset can be sub
classified as motor or non-motor.
What you see in this table is
regardless of the classification system,
there's 2 basic
types of seizures.
Those that start
in a single focus,
those are the focal, the grand
mal, the simple complex partial,
the localization-related epilepsy,
and the focal onset seizures.
They start out on the surface
of the brain and can progress.
And those are different from
the generalized seizures,
which again have been described
with many words, petit mal,
generalized or generalized onset,
all indicating the same thing.
So when we think about the
current classification system,
League Against Epilepsy,
which is the largest governing
body for epilepsy and seizures,
to evaluate a patient
seizure and classify it.
Seizures can be focal and onset.
Those are seizures that start in
and affect one part of the brain.
And those focal onset seizures can
either be with retained awareness,
or with an impaired awareness.
Focal onset seizures can be
subclassified as being motor and onset,
and we see a number of motor
symptoms automatisms, atonic, clonic,
epileptic spasms, hyperkinetic,
myoclonic or tonic seizures.
Or non-motor in onset with non-motor
automatisms, behavior arrest,
emotional or sensory findings.
And all focal onset seizures
can secondarily generalize
to a secondary generalized
And this category was previously
considered secondary generalized seizures.
Seizures can also be
generalized and onset.
These are seizures that start
from a deep focus in the brain
and manifest throughout the
cortex at the same time.
Again, these can be motor and
onset or non-motor and onset.
And then there's a new category
of unknown seizure onset
used to describe seizures
if doctors are unaware
of where in the brain
the seizure starts.
These unknown onset seizures can also
have motor or non-motor subclassification.
And this group is important.
When we're treating
patients with epilepsy,
patients who are refractory to medications,
we would consider a seizure surgery,
which is good for localization-related
epilepsy or a focal onset seizure,
but we wouldn't consider that
for an unknown onset seizure.
And then there's the last
category of unclassified seizures
where there's not enough information
available about the person seizure,
or an unusual nature of seizure.
And this is really used by
advanced medical professionals
if they are confident that they've
truly ruled out a focal onset,
generalized onset or
unknown onset epilepsy.
And when I'm evaluating a patient,
I really like the older classification.
It helps me to understand how to
categorize this patient seizure
and approach their management.
So I like to consider seizures
as being focal and onset
and either being simple partial,
complex partial or secondarily generalized.
The simple partial seizures are
those with retained awareness.
Those are the auras that
Complex partial seizures
involved alteration of awareness.
Patients may lose consciousness
or they may just be altered,
not able to speak or interact
with the world around them.
And then secondary generalized
tonic-clonic seizures involve convulsions.
These start from a focus,
we can see it on a scalp EEG
and hear it when we're
evaluating patients clinically
through their aura
or ictal onset.
Those are different from the
generalized onset seizures,
and there's 6 generalized
Absence those are
brief small behavioral
myoclonic, atonic, tonic, clonic