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Chapter 7: Disorders of conciousness and memory 309

Table 7.7 Types of seizures
Type of seizure Description
Partial seizures
Simple partial (consciousness maintained) Motor: usually twitching or jerking of one side of the face, or one limb.
Sensory, e.g. auditory or somatosensory.
Autonomic: pallor, sweating, etc.
There may be a Jacksonian March, with the epilepsy progressively involving more
of a limb, e.g. hand, then elbow, then shoulder.
Complex partial (impaired conciousness) May begin as a simple partial then become complex, or be complex from the
start.
Often with disturbance of higher cerebral function, e.g. sense of fear.
Semi-purposeful movements may occur.
The patient has little or no recall of the episode.
Secondary generalised Partial seizures (simple or complex) can progress to secondary generalised
seizures.
Generalised seizures
Nonconvulsive (absence) Impaired conciousness but without falling, although there may be involuntary
movements. Usually last less then 20 s. EEG shows characteristic 3 per second
spike and wave discharges
Convulsive (usually followed by
post-ictal confusion)
Myoclonic Sudden shock-like jerks affecting one part or the whole body
Clonic Generalised jerking
Tonic Rigidity, increased tone, respiration ceases
Tonic–clonic Initial rigid tonic stage during which respiration ceases, then generalised jerking
Micturition, salivation and tongue-biting may occur. If this lasts >30 min, it is
called status epilepticus.
Atonic (drop attacks) Loss of muscle tone causing patient to fall to ground

The main terms used to describe seizures are: gitis, stroke etc which may need urgent treatment. It is
Partial (focal, localised seizure) also important to decide if the patient is likely to have
A partial seizure may be simple (no loss of con- further seizures.

sciousness) or complex (impaired consciousness). Iftheseizurelasts<10minuteswithfullrecovery,with
Generalised (diffuse, whole brain affected) no neurological or systemic disorder the patient can
Ageneralised seizure may be convulsive (jerking, usually be discharged home after a period of observa-

with motor involvement) or non-convulsive (ab- tion. They should be accompanied and be advised not
sence, motor tone unaffected). to drive (see below).
If unwell, pyrexial, persisting neurology or prolonged

Investigations confusion post-seizure – urgent investigation with
The urgency of the tests depends on the clinical findings. imaging, blood test, possibly lumbar puncture is re-
Blood tests – FBC, U&Es, glucose, calcium, magne- quired.

sium, LFTs and thyroid function tests. Prolonged seizures or recurring seizures require inpa-
ECG. tient admission for monitoring and initiation of treat-

EEG may be normal even in genuine epilepsy. ment to control seizures.

MRI(orCTwhereMRIisnotavailable)isincreasingly

used in all patients to look for an underlying lesion.
Status epilepticus
Management This is defined as a prolonged single attack or continuing
With a first seizure, it is important to exclude any under- attacks of epilepsy without intervals of consciousness.
lying cause such as a biochemical disturbance, menin- The duration at which status is diagnosed is variable,