PI: Asst Prof Justin Dauwels Post-Doc: Dr. Lalit-Garg Research Assistant: Abhishek Agrawal

In this review, we explore different seizure types that have been clinically studied in the past. We also distinguish between epileptic and non-epileptic seizures. We explore different methods that are followed for seizure diagnosis.<to be edited>

     SUDEP – Sudden unexpected death in Epilepsy. CBC – Complete Blood Count EEG – Electroencephalogram MRI – Magnetic Resonance Imaging

Below is a brief description of the various sections under which the review is classified: 1. Causes & Diagnosis– 3. The onset of a seizure may result in a fleeting numbness in a part of the body. or a sensation of fear and total state of confusion. Theprobability thatthese people will suffer from a second seizure is as high as 30-40%.Timely diagnosis and treatment may reduce the chance of recurrent seizures by as much as half(4). When the source of seizure inside the brain is localized orlimited to a fixed region. Statistical Relationship between Normal and Epileptic Seizures - . Consciousness is an alert cognitive state in which a person is aware of himself and his situation.Studies(3-4) have revealed that about 4% of people will have an unprovoked seizure by the age of 80. not all epileptic seizures have such drastic consequences.Not all seizures come under the category of epileptic seizures. is defined as a transient symptom of "abnormal excessive or synchronous neuronal activity in the brain"(1). the seizure is termed as a partialor focal-onset seizure. Study (5)points out that the signs and symptoms of an epileptic seizure depends on the type of seizure. The medical syndrome of recurrent. However. Any deviation from this state is termed as “loss of consciousness”. A seizure can last for a period of a few seconds to “Status Epilepticus”.1. The review has been divided into several sections for the purpose of exploring each aspect of epilepsy in detail. occasionally referred to as a fit. Classification&Syndromes– 2. A “cognitive” state is defined as a mental state in which a person is open to reasoning and learning. We will discuss the detailed classification of seizure types in the second section of this review. when the source of seizure inside the brain is distributedor spread over a large region. Generalized seizures are further classified according to their impact on the body. a brief of long term loss of memory. An understanding of the word “Consciousness” in the context of epilepsy is crucial in understanding the symptoms and state of a person during and after an epileptic seizure. Introduction An epileptic seizure. Seizures are classified as per the location of the source of seizure in the brain (7). unprovoked seizures is termed as Epilepsy(2).Seizures are often associated with loss of consciousness or sudden involuntary movement of muscles. Status Epilepticus is a life threatening situation in which the brain is in a state of persistent seizure for duration of at least five minutes(6). On the other hand. visual changes. The external effect of an epileptic seizure that can be perceived can range from wild thrashing movement in the form of convulsions toa full body slump. the seizure is termed as a generalized seizure.

To gain an understanding of this classification. other seizures are also named as per the occurrence of abnormal electrical activity for e. A cortex is the outermost layer of the frontal part of the brain. the electrical activity proceeds through the motor area activating each muscle group or organ. interruptions or senselessness during activity. When a seizure occurs.The most susceptible part of the brain where seizure related abnormal electrical activity can happen is the temporal lobe.g. We first describe the seizure types as per the region of abnormalelectrochemical discharge in the brain.When this excitation is beyond a certain threshold. parietal. Classification& Syndromes The primary cause of a seizure is abnormal electrochemical discharge or disorder in the brain. Each brain celleither excites or inhibits other brain cells through its discharges. When the abnormal electrical activity happens in the motor area.2. . it is important to know about the different regions of the brain. sensory perception seizure (region is sensory cortex). The effect is reflected in the respective organ or part of the body controlled by that particular area. a motor seizure is said to have occurred. then a seizure occurs(7).There are various classifications of epileptic seizures. occipital and temporal. visual perception seizure (region is visual cortex). The figure below is a pictorial representation ofthe key regions of the brain: Fig 1: Brain Regions The brain is divided into two hemispheres each consisting of four lobes: frontal. Seizure in deep temporal lobes often results in loss of consciousness. Similarly.

sensory-motor organs to psychic (abnormal thoughts/perception) and autonomic (body heat rising. The consequences of partial seizures can range from effect on sensory (loss of perception). The consequences of simple partial seizures can be twitching. b) Complex Partial Seizure–It involves loss of memory or consciousness. If there is some confusion or a loss of consciousness.1. It may or may not be accompanied by a loss of memory. abnormal sensations in the body. Under this classification. The symptoms arising from it are localized to a single physical part of the body or a resulting consequence/action. 3. abnormal visions. For instance. motor (twitching). They are: 1. Unclassifiable – All the seizure types which (i) do not come under the above two categories and (ii) for whom reliable scientific evidence on occurrence of abnormal brain activity has not been found come under this category. twitching in arms or face. There are two further subdivisions in this category: a) Generalized/Primary Generalized– the abnormal electrochemical activity is spread right from the seizure onset time. Partial Seizures – These seizures occursonly onone side of the brain.1 Partial Seizures These are seizures which only affect one part of the brain at seizure onset (8-9). Now we describe the above categories in detail. There are two further subdivisions in this category: a) Simple Partial Seizure –It does not involve the loss of memory or consciousness. 2. Generalized Seizures – These seizures occur on both sides of the brain. flushing) effects (10). The consequences can be anywhere from eyelid fluttering or head nodding to sudden loss of consciousness. we have three main categories in which all the seizure types and their consequences have been listed. b) Secondary Generalized –the abnormal electrochemical activity starts from a localized part of the brain and spread to the entire area. sounds or smell and distortions of perception. then the seizure type is comes under complex partial seizure.The person affected by this type of seizure should be able to recall the effects on his body during the period at which seizure occurs.The next and the most widely accepted classification is based on the committee generated conventions of terminology related to seizures (7). 2. gastrointestinal illness. .

the consequence is a tonic-clonic seizure. Secondary generalized seizures can be further sub-divided into Atonic.2. A myoclonic seizure is a single un-sustained or a sequence of random jerks. For instance. A tonic seizure is sudden stiffness of a muscle or a group of muscles which may or may not result in loss of consciousness or abrupt extension of arms or legs of the patient. Absence seizures typically start in childhood but can persist till adulthood.3. The treatment drugs and protocols for secondary and primary generalized seizures are different. surgical methods can be used for secondary seizures as compared to primary as the location of they originate focally.<to be edited> . They are “symptomatic”. The period. idiopathic implies that the seizures don’t have an underlying cause and cryptogenic implies that a symptomatic cause is suspected but hasn’t been found yet (7).2 Secondary Generalized Seizures Seizures that begin focally at one part of the brain and spread to the entire brain area are called secondary generalized seizures. These seizures may be preceded by a warning signal in the form of a heat or tingling sensation. The duration for which the patient experiences these symptoms can be between one to three minutes. Symptomatic implies that seizures have a known underlying cause. When this happens.An atonic seizure originates in people who have previously suffered from a brain injury. They are Absence or petit mal and tonic-clonic or grand mal seizures. mumbling meaningless phrases.There are three terms associated with the identification of the symptoms of the seizures.1 Syndromes of Epileptic Seizures The above classification is not enough to probe into the causes.2 Complex Partial Seizures These seizures primarily arise in the temporal lobes of the brain and hence were earlier called as “temporal lobe” seizures (also called “psychomotor seizures” or “limbic seizures”). The person suffering from Absence seizures can be identified as having staring spells with staring spells coupled with eyelid fluttering or head nodding. 3. 2. the patient suffers from automatisms (11).1. Tonic or Myoclonic seizure types. see (7).1 Generalized/Primary Generalized Seizures There are primarily two types of generalized seizures which come under this category.2. walking around aimlessly etc. during which the complex partial seizure occurs. severity and prognosis of the seizures. “idiopathic” and “cryptogenic”. nausea or distortion of sensory perceptions. Tonic-clonic or grand mal seizures start with sudden loss of consciousness followed by muscle stiffening (tonic activity) and rhythmic jerking (clonic activity). They are senseless and fragmented of activities such as lip smacking.2. 2.

However a head trauma penetrating a brain injury can be a cause for epileptic seizures. For example. low blood sugar. Any malformation due to a birth defect or radiation stresses in the arteries/veins is called as ateriovenous and that in the capillaries are called cavernous malformation (7). Causes and Diagnosis 3. low blood calcium.1 Causes for Focal Seizures Due to Brain Injuries An injury or malfunction of one or more parts of the brain results in focal seizures.3. sufficient oxygen may or may not reach out to the brain cells which may result in seizures.2 Causes for Generalized Seizures Due to Metabolic Imbalances and Medical Reactions Certain generalized seizures arise due to metabolic imbalances but are never sustained or epileptic. fungi and parasites which are commonly present in eatables like pork or unclean fruits and vegetables (7).1 Causes The causes of epilepsy are also called as “etiologies” in medical terminology. alcohol or sedative medication withdrawal. However in typical cases where the brain cells are irritated or suffocated due to presence of a tumor. Another most common etiology for brain seizures is brain infection.The seizures from brain injuries can be diagnosed using an MRI scan. Due to Stroke and Brain Infections During a stroke. focal or spread: we discuss thefollowing etiologies. a seizure ensues. These infections may be caused by certain viruses. certain recreational or prescription drug overdoses.The injuries arising from events like a fall or a blow to the head are too mild to cause of epilepsy. (12). blood flow to a part of the brain stops killing many brain cells which may be a cause of subsequent epileptic seizures.1. It flows out of the brain through the veins. Due to Vascular Malformations and Brain Tumors Blood flows into the brain through arteries and reaches to the brain cells through tiny vessels called capillaries. 3.1. Based on whether the seizures are generalized or partial. Brain hemorrhage may also be an etiology for epilepsy. Often it happens that the seizure occurs several years later after the injury has occurred. 3. seizures may occur due to low oxygen level. This delay is due to the reorganization of nerve fibers inside the brain at the injured area (7). Due to these malformations. . Tumors rarely are a cause of seizures.

It serves as a foundation for treatment and medicine prescription and is even more important than physical examination of the patient (7).The frequency of the light must be between 10 to 25 frames per second for provoking seizures. A complete list of those drugs are given in the appendix A. see (15).2 Diagnosis of Epileptic Seizures There are various tools and techniques for diagnosis and prediction of seizures and epilepsy in patients. A written record or a video may also serve as a good source of information . Photosensitive seizures are seizures caused by flashing lights or certain visual patterns. Audio-Visual games. <to be edited> Due to Idiopathic/Genetic Causes and Photosensitive Seizures The seizures whose causes and treatment are unknown are called idiopathic seizures. It is crucial that the patient give detailed information about what has happened before. The hereditary risk associated with epilepsy is around 5-20 % provided the mother suffers from the disease. electrocardiograph data was obtained from patients who were suffering from refractory (stubborn or unresponsive to treatment) epilepsy. a naturally occurring chemical compound occurring in plants.It is also a major cause of death among individuals with intractable epilepsy (14). <Write-up about syncopes. when exposed to these lights. assistance may be taken from the people who witnessed the seizure happening. public displays or events having these visual patterns can provoke seizures in susceptible individuals (13). Genetic disorders increase the probability of generalized seizure onset rather than themselves being the direct cause.kidney or liver failure. The most important of them are: (a) Medical History (b) Physical Examination (c) EEG Data Medical History It isone of the most important diagnostic tools in epilepsy. About 60 % of all seizures are idiopathic seizures (7). Only a few of the gene defects that may be a cause of epileptic seizures have been identified. This is reflected in the EEG brainwave pattern of the patients suffering from epilepsy. 3. TV Shows. The study (14) suggests that the deaths occur due to cardiac abnormalities during and between seizures. A record of prior episodes and history of seizures enables the doctor to do prognosis about the future occurrences of seizures in the patients (16).3 Sudden Unexpected Death (SUDEP) in Epilepsy Sudden Unexpected death has been the most common cause among deaths due to epilepsy. The data revealed ECG abnormalities and arrhythmias during and after the occurrence of the epileptic seizure for a majority of the patients who were victims of SUDEP. arrhythmias and ion channels to be added> 3. In some cases. Certain over the counter prescription drugs also cause seizures. Melatonin. hyperthyroid diseases.To verify this. animals and microbes is found to reduce seizure frequency in both children and patients with intractable epilepsy (6). where the patient is not able to recall relevant information from his/her memory.1.

An ictal period is defined as the period during which the patient undergoes a seizure. The following questions are important for the patient to answer when he/she is being diagnosed (16): Before the spell:     Did you experience lack of sleep or unusual stress? Were you sick recently? Did you take any kind of medication. getting up from a lying position. heavy exercise)? During the spell:         What time of day was it? Were you just waking up or falling asleep? How did it begin? Was there a warning? Did your eyes. or illegal drugs? What were you doing immediately before the event (for instance. mouth. a majority of people who suffer from epileptic seizure show abnormal EEG patterns during the post ictal period. arms. it can be used to classify seizure type in the brain. It is difficult and impractical to capture and record of EEG data during the ictal period. It is important to understand two terms to gain an understanding of the use of EEG data in epileptic patients: ictal and post-ictal. A person who can read electroencephalogram data can predict the normal brain patterns (7).about the epileptic seizure in the patient. face. standing. see (7). The EEG data can help to predict the part of the brain from where the seizure originated. The spikes occur in the EEG of about 5 to 8 out of every 10 individuals suffering from epilepsy. including over-the-counter medicines. Such spikes are also called as inter-ictal spikes. head. an electrical pattern is elicited in the brain which is typical to a particular seizure type. A post-ictal period refers to the time duration after a seizure has occurred. alcohol.When a seizure occurs. . sitting. Thus. lying down. Luckily. called as spikes. or legs move abnormally? Were you able to talk and respond appropriately? Did you lose control of your bladder or bowels? Did you bite your tongue or the inside of your cheeks? After the spell:     Were you confused or tired? Could you speak normally? Did you have a headache? Did your muscles ache? EEG Data Analysis The electroencephalogram (EEG) measures electrical activity of the brain.

see (19). As part of the diagnostic protocol. see (7). a blood clot. Blood tests are carried out to check for infectious or chemical causes of seizures such as low blood sugar.<compiling material. allergies or drug and toxins in the blood (7). old stroke or a localized collection of pus. It uses energy changes in the magnetic field to produce two dimensional computer images of the brain. kidney or liver failure. calcium or oxygen. more to be added in this section> Physical Examination The two major techniques used during physical examination of epileptic patients are blood tests and medical imaging (such as Magnetic Resonance Imaging or an X-Ray). It also helps to assign and choose the anticonvulsant medications and monitor the possible drug induced side-effects that the patient might face in the future (18).Another method which yields more detailed information about the brain is Magnetic Resonance Imaging (MRI). <currently working on this section> .A CBC provides a standard to the doctor to establish a baseline for the identification of the abnormalities mentioned earlier. a doctor may also ask the patient to undergo a complete blood count test (CBC). Other physical tests such as an X-ray may be carried out to test the possibility of a structural abnormality in the brain such as a tumor.

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