Seizure types

Tonic-clonic seizures

• Can have ‘aura’, not prodrome
• Can occur while the patient is lying down, may arise from sleep
• At the beginning of the seizure the person may cry/shout out
• The person will lose consciousness
• Body will stiffen, they will fall if standing
• Lips may turn blue, saliva may run from their mouth and they might bite their tongue
• Rhythmical jerking of the limbs, crescendo in amplitude with gradually slowing (deceleration) following which cardio-respiratory rate may slow
• Usually lasts no longer than three minutes, but is followed by a slow recovery period lasting minutes to hours
• Patient will be amnestic for event

Focal aware seizure (also called ‘auras’ or ‘warnings’ and previously known as simple partial seizures)

• Focal seizures most commonly arise from a single structural variant or abnormality in the brain
• This means that the initial semiology (what the seizure feels like and looks like at the start) will be stereotyped (the same every time)
• Seizure activity can spread to affect the whole brain, so patients can have both focal seizures and tonic-clonic seizures
• No loss of consciousness
• A person may be able to explain the sensation they feel
• Can include:
  • Déjà vu
  • Butterflies in stomach
  • Odd taste
  • Odd smell

Focal seizure with impaired awareness (previously known as complex partial seizures)

• Focal seizures most commonly arise from a single structural variant or abnormality in the brain
• This means that the initial semiology (what the seizure feels like and looks like at the start) will be stereotyped (the same every time)
• Seizure activity can spread to affect the whole brain, so patients can have both focal seizures and tonic-clonic seizures
• May follow a focal aware seizure
• No recollection of the actions they may have carried out
• Response not normal if spoken to
• A person may demonstrate ‘automatisms’ such as:
  • Picking at clothes
  • Lip-smacking
  • Chewing without being aware of this

Typical generalised absence (previously known as petit mal seizures)

• True ‘absence’ seizures are a form of generalised epilepsy and are more common in childhood
• They are distinct from focal seizures with impaired awareness – typically focal seizures arising from the temporal lobe
• Can cause an abrupt loss of consciousness
• The person appears blank/vacant
• The person may not fall, stiffen or jerk

Generalised myoclonic seizures

• The person appears as if something ‘made them jump’
• These seizures can occur singularly or repetitively
• They usually affect the upper body, head and/or arm(s)
• They are distinct from hypnic jerks, which occur just as people fall asleep – these are a benign phenomenon which everyone gets

Generalised atonic seizures (previously known as drop attacks or akinetic seizures)

• The person becomes completely floppy and falls if standing
• They usually fall forwards
• These seizures can cause severe injury
• This type of seizure is often seen in people with a learning disability and in combination with other seizure types
• It is extremely rare for these to occur for the first time in adults

Generalised tonic seizures

• Causes a loss of consciousness
• The person’s body stiffens
• They will often recover quickly
• These seizures can cause injury
• This type of seizure is often seen in people with a learning disability and in combination with other seizure types