Classification epileptic seizures and epilepsy

A comprehensive taxonomy should embrace classifications of both seizure semiology (i.e. the manifestations of abnormal discharge activity) and of epilepsy syndromes. The position of each seizure type in a seizure classification system is determined by its clinical manifestations, by electroencephalographic changes during the seizure, and by the interictal electroencephalographic abnormalities. A classification of epilepsy syndromes takes into account seizure subtype, and also anatomical substrate, aetiology, age of onset, and other characteristics. Seizure classification is dependent upon entities that are immediately ascertainable; epilepsy syndrome classification depends upon entities (e.g. neuroanatomical substrate) that are more speculative. The International League Against Epilepsy has chosen to give the former priority, while recognizing the importance of the latter.

A familiarity with terminology, with the more common seizure subtypes, and the more commonly encountered epileptic syndromes will assist in an understanding of the psychiatric disorders that occur in patients with epilepsy. The aura is a simple partial seizure, i.e. a seizure of focal onset in which consciousness is retained. It may progress to a complex partial seizure in which consciousness is disturbed, or into a generalized tonic, clonic, or tonic-clonic seizure. It may subside without further development. It rarely lasts for more than a few seconds, although patients often find time estimation difficult. It is to be distinguished from the epileptic prodrome, a period characterized by dysphoria, impaired memory and concentration, and minor motor manifestations, that precedes the seizure and may last for hours or even days. An automatism may be defined as 'a state of clouding of consciousness which occurs during or after a seizure, and during which the individual retains the control of posture and muscle tone and performs simple or complex movements without being aware of what is happening'.(2) The initial phase, consisting of staring or simple chewing movements, may progress to more complex, stereotyped, and repetitive movements such as fumbling or picking. Automatisms rarely last more than a few minutes and are often very brief. They usually arise from temporal lobe discharges, but may be associated with orbital and mesial frontal lesions. The ictus refers to the period of manifest seizure activity. If this persists for 30 min or more it is described as status epilepticus and constitutes a medical emergency ( Table 1).

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Table 1 Classification of seizures

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