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ADDITIONAL NOTES IN PEDIA NEURO (PART 1) Generalized Seizure: Previously called primary
DR. DIAZ generalized , these engage or involve network or side of the
brain at the onset

ILAE 2017 CLASSIFICATION OF SEIZURE TYPES BASIC VERSION Unknown Onset: If the onset of as seizure is not known,
the unknown onset category. Later on, the seizure type can
FOCAL ONSET be changed if the beginning of a person’s seizure becomes
 Aware / Impaired Awareness clear.
 Motor/ Non-motor Onset
 Focal to Bilateral Tonic Clonic
Focal to Bilateral Seizure: A seizure that starts in one
side or part of the brain and spreads to both sides has
GENERALIZED ONSET
been called a secondary generalized seizures. Now the
 Motor (Tonic Clonic, Other Motor)
term generalized refers only to the start of a seizure. The
 Non-Motor (Absence)
new term for secondary generalized seizure would be focal
to bilateral seizure.
UNKNOWN ONSET
 Motor (Tonic Clonic, Other Motor)
 Non-Motor 2. LEVEL OF AWARENESS DURING THE SEIZURE
 Unclassified
Focal Aware: If awareness remains intact even if the
person is unable to talk or respond during a seizure, the
seizure would be called a focal aware seizure. This
replaces the term simple partial.

Focal Impaired Awareness: If awareness is impaired or

affected at any time during a seizure, even if a person has
a vague idea of what happened, the seizure would be called
focal impaired awareness. This replaces the term complex
partial seizure.

Awareness Unknown: Sometimes it’s not possible to know

2017 REVISED CLASSIFICATION OF SEIZURE - THE NEW BASIC if a person lives alone or has seizures only at night. In this
CLASSIFICATION situation, the awareness term may not be used or it would
be described as awareness unknown.
3 KEY FEATURES
1. Where seizures begin in the brain
Generalized Seizures: These are all presumed to affect a
2. Level of awareness during a seizure
person’s awareness or consciousness in some way. Thus
3. Other features of seizures
no special terms are needed to describe awareness in
generalized seizures.
1. WHERE SEIZURES BEGIN
3. DESCRIBING MOTOR AND OTHER SYMPTOMS
The type of seizure onset is important because it affects
choice of Seizure medication, possibilities for epilepsy
surgery, outlook, and possible causes. Focal Motor Seizure: This means that some type of
movement occurs during the event. For example twitching,
jerking, or stiffening movements of a body part or autisms
Focal Seizures: Previously called partial seizures, these
start in an area or network of cells on one side of the (automatic movements such as licking lips, rubbing hands,
walking, or running)
brain.

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Focal Non-motor Seizure: This type of seizure has other ILAE 2017 CLASSIFICATION OF SEIZURE TYPES EXPANDED
symptoms that occur first such as change in sensation, VERSION
emotions, thinking, or experiences.

It’s also possible for a focal aware or impaired awareness

seizure to be sub-classified as motor or non-motor onset.

Auras: The term aura, which described symptoms a person

may feel in the beginning is seizure, is not in the new
classification. Yet people may continue to use this term. It’s
important to know that in most cases, these early
symptoms may be the start of a seizure.

DESCRIBING GENERALIZED ONSET SEIZURES

 Generalized Motor Seizures: The generalized tonic-clonic

seizure term is still used to describe seizures with
stiffening (tonic) and jerking (clonic). This loosely
corresponds to “grand mal”. Other forms of generalized
motor seizures may happen. Many of these terms have not THE 2017 SEIZURE CLASSIFICATION
changed, and a few new terms have been added.
 Classification of a seizure type is only of the seizure
Generalized Non- Motor Seizures: These are primarily description. This new system will make it easier to describe
absence seizures, and the term corresponds to the old seizures and using common language to talk about them.
term “petit mal”. These seizures involve brief changes in
awareness, staring, and some may have automatic or The new classification is designed to have some flexibility.
repeated movements like lipsmacking. Use of other descriptive terms or even text is encouraged.

DESCRIBING UNKNWON ONSET SEIZURES
When the beginning of a seizure is not known, this
classification still gives away to describe whether features
are motor or non-motor.
THE NEW EXPANDED CLASSIFICATION
The expanded classification keeps the framework of the
basic classification, but adds more seizure types of
features under motor and non-motor seizures are listed
for all types: focal, generalized, and unknown onset.
Most seizures can be classified by signs and symptoms that
happen during a seizure. However, other information is
useful when available. For example, phone videos, EEG
(elelctroencephalogram), MRI (magnetic resonance
imaging), and other brain imaging, blood tests, or gene
tests maybe helpful.
This seizure classification does not change the definition of
epilepsy or epilepsy syndromes. The epilepsy classification
includes the whole clinical picture, with information on
seizure types, causes, EEG pattern, brain imaging, genetics,
and epilepsy syndromes, such as Lennox-Gastaut
Syndrome.

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EPILEPTIC EEG

TREATMENT

CORTICOSTEROID USE…
 Corticosteroid inhibits the synthesis of interleukin 1
BACTERIAL MENINGITIS and TNF.
 There is convincing evidence that corticosteroids
decrease mortality rates and long term neurologic
sequelae in some patients with tuberculous
meningitis by: reducing vasculitis, inflammation,
and ultimately intracranial pressure; lowering the
intracranial pressure limits tissue damage and
favors circulation and anti-tuberculosis drugs
through the brain and meninges.

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