Primary Generalized Seizures

If the entire cerebral cortex is involved in the seizure from the onset of the seizure, the seizure is classified as primary generalized. The following are types of primary generalized seizures:

• Tonic-clonic: Characterized by a sudden loss of consciousness accompanied by tonic extension and rhythmic clonic contractions of all major muscle groups. The duration of the seizure is usually 1 to 3 minutes. These seizures are often described as "grand mal."

• Absence: Characterized by sudden and brief (i.e., several seconds in duration) losses of consciousness without muscle movements. These seizures are often described as daydreaming or blanking out episodes. A common term for these seizures is "petit mal."

• Myoclonic: Characterized by single and very brief jerks of all major muscle groups. Patients with these seizures may not lose consciousness due to the seizure lasting less than 3 to 4 seconds. Patients may describe these seizures as shoulder shrugs or spinal chills. Myoclonic seizures may cluster and build into a generalized tonic-clonic seizure.

FIGURE 30-1. ILAE classification of epileptic seizures (1981). (From Ref. 16.) Table 30-1 ILAE Classification Scheme for Epilepsies and Epilepsy Syndromes

I. Localization-related (focal, local, partial) epilepsies and epileptic syndromes

A. Idiopathic with age-related onset

1. Benign childhood epilepsy with centrotemporal spikes

2. Childhood epilepsy with occipital paroxysms

B. Symptomatic

II. Generalized epilepsies and epileptic syndromes A. Idiopathic and age-related onset

1. Benign neonatal epilepsy

2. Childhood absence epilepsy (pyknolepsy)

3. Juvenile myoclonic epilepsy (impulsive petit mal)

4. Juvenile absence epilepsy with generalized tonic-clonic seizure on awakening

B. Secondary (idiopathic or symptomatic)

1. West's syndrome (infantile spasms)

2. Lennox-Gastaut syndrome

C. Symptomatic

1. Nonspecific etiology (early myoclonic encephalopathy)

2. Specific syndromes (epileptic seizures that may complicate many diseases, e.g., Ramsay-Hunt syndrome, Unverricht's disease)

• Atonic: Characterized by loss of consciousness and muscle tone. No muscle movements are typically noted, and the patient falls if not lying down or sitting in a chair. These seizures may be described as "falling out."

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