Let’s talk about seizure types.
We’ll begin with the focal
and we have simple partial seizure.
What does that mean?
A focal seizure –
Focal, I keep repeating that because
that’s what you want to take out of this.
-- in which awareness and
consciousness is not impaired.
The operative word?
represent positive neurologic
symptoms, what does that mean?
Clonic activity, tingling,
But impairment of
consciousness does not occur.
This is focal.
Versus you could have a partial or
complex partial or complex focal.
A lot of words here.
Otherwise, you have an
attending speaking to you
or you’re reading a clinical vignette
and you’re going to get lost.
And you’re not quite sure
as to what to focus upon.
I’m telling you what to focus on.
Complex partial is complex focal.
Now, this is a focal seizure in which
consciousness is impaired
Why did I pause there for a second?
Because consciousness is not lost.
So now, what you want to do is understand
that impairment does not equal loss.
So here, you do have
impairment of consciousness.
But you do not have
loss of consciousness.
What are we talking about?
So you can see now, if you’ve
never done epilepsy or seizure,
then it could get a little
confusing right now.
And hopefully, through
you’re medical education,
you’ve had a decent
and now I’m telling you what to focus on.
Let’s talk about automatisms.
So now, this becomes interesting.
So automatisms include stereotyped
motor activity without clear purpose,
such as lip smacking,
Literally, your patient while
undergoing complex partial seizures
looks as though
What’s your focus right now?
How much of the brain?
One portion of the brain.
We have simple complex.
What have we not talked about yet or
what types have we not talked about?
we’re going to move
on to generalized now
and the different types
of generalized seizures.
Here, we have generalized
It used to be called grand
mal in French, right?
Big and bad.
So the tonic-clonic seizure
often abbreviated as such
begins with tonic extension
of all four extremities,
followed by clonic jerking.
Oh, it looks bad.
Could it be anymore dramatic?
So now, we’re getting into issues
that are really dangerous.
Tongue-biting, even to the
point where there’s bleeding
and to the point where this
patient, this patient, is bleeding
and might be suffocating
on his or her blood.
It is actually quite scary to look at,
but you maintain composure as a
doctor and know as to what’s going on
because you want to practice
ABC on your patient.
Airway, breathing, circulation.
Urinary incontinence are common.
Postictal lethargy and
confusion, also very common,
so after the episode of ictal.
We have confusion, that’s
often part of this syndrome.
So if this is generalized, how
much of the brain, please?
The entire brain.
What’s another name for this?
Let me get into absence.
At the beginning of this section, I
did an interesting act, didn’t I?
Where I was just staring off into space.
So what was I demonstrating?
This is a generalized seizure.
What does that mean to you?
The entire brain –
Is it coming together for you?
By unresponsiveness, staring,
lasting several seconds.
I probably do that in a regular basis,
but what I was trying to demonstrate
in the beginning of our topic of
seizures, was an absence seizure.
Followed by immediate recovery.
Typically, who’s your patient?
Now, obviously, I’m not a child.
But the staring aspect of it
should give that away for you.
May have hundreds per day.
That’s scary, isn’t it?
The International League Against Epilepsy
has revised its classification of seizures.
The new basic seizure classification
is based on 3 key features:
where seizures begin in the brain,
level of awareness during a seizure,
and other characteristics of seizures.
The onset can be focal, generalized,
unknown, or focal to bilateral.
Focal seizures can be be "aware",
"impaired awareness", or "awareness unknown"
according to the degree of impairment,
while generalized seizures
are all assumed to impair awareness
and thus are not classified accordingly.
Additionally, all seizures are classified
as having a "motor" component
or being "non-motor".