Matthew Troester, DO
Specializing in Pediatric Neurology, Epilepsy, Sleep Medicine
Let’s unpack these kinds of questions.
What kind of seizures do I have?
This is one of the more common questions we hear as epileptologists. How we classify seizures into various types is a long, controversial tale with famous anecdotes of esteemed epileptologists refusing to participate in final publications after years long conversations.
What is most important about the types of seizures your child may have is a detailed description of what she or he does during the seizure. Some of the questions epileptologists need answered from parents about various seizures are:
- Is there something triggering these seizures, such as fever, illness, missed doses of medication, trauma/injury, stress, lack of sleep, flashing lights, etc.?
- Does your child know the seizure is going to happen? Does she or he feel, see, smell, taste or hear something before the seizure starts?
- Does the seizure occur at a particular time during the day?
- During the seizure, is your child awake and alert or is she or he unresponsive to voice or physical touch/stimulation?
- Are her or his eyes open?
- Is the child smacking her/his lips or making chewing movements?
- Is she or he moving their hands or arms in an unusual manner – picking at their clothes, rubbing fingers together?
- If your child has convulsions (whole or part of the body shaking), again, are eyes open or closed?
- Just before the convulsion, did your child’s head turn one way or another?
- Do your child’s eyes move to the left, right or roll back into their head?
- Is one side more affected than the other during the convulsion?
- How long was the seizure?
- Was your child sleepy after the seizure?
- Did your child have any weakness after the seizure?
- Does your child remember the seizure?
The answers to these questions help us decide what type of seizure your child might have.
Currently, we classify seizures and epilepsies using the International League Against Epilepsy (ILAE) classification. It was released with much controversy in 2011 replacing documents and terms widely used since the 1980s. It has been an adjustment and leads to confusion even amongst doctors.
It breaks seizures into three types:
- Generalized: These seizures typically come from all over the brain at once and are more a genetic/chemical problem with the brain than a problem with one particular part of the brain
- Focal: These seizures typically come from one part of the brain from something like a birth mark, tumor, infection or consequence of infection, injury or abnormal grouping of blood vessels
- Unknown: Seizures that are difficult to classify as generalized or focal because there is not enough evidence to do so.
Generalized seizures appear in a variety of ways, including:
- Tonic-clonic: Whole body shaking, what is commonly referred to as “grand mal”
- Absence: Staring with or without eyelid fluttering/blinking, what is commonly referred to as “petite mal”
- Clonic: Repetitive jerking
- Tonic: Stiffening
- Atonic: Sudden loss of muscle tone, sometimes called a “drop” seizure
- Myoclonic: Sudden quick jerks, usually briefer and less rhythmic than a clonic seizure
Focal seizures are classified based upon a variety of things including:
- Aura: Something like a warning before a seizure
- Motor movements: For example twitching occurs in just one arm
- Autonomic involvement: Parts of the involuntary nervous system are affected – for example level of oxygen saturation, rate of breathing, heart rate, temperature, pupillary size, etc.
- Awareness/Responsiveness: A seizure in which awareness is altered and now termed “dyscognitive”
In the past, you might have heard your child’s seizures described as “complex partial” or “simple partial,” where a complex partial seizure involved an alteration of consciousness and a simple partial seizure did not involve alteration of consciousness.
As of 2011, those terms, while still used by some and in many ways still valuable, have been replaced using the terms above. For example, what used to be a complex partial seizure is now a focal dyscognitive seizure. What used to be a simple partial seizure is now a focal seizure with retained consciousness, like the aura described above. Sometimes focal seizures turn into tonic-clonic seizures. This used to be called “secondary generalization,” but is now referred to as a focal seizure with evolution into a bilaterally convulsive seizure.
The good news is that you shouldn’t worry so much about what to call a seizure. If doctors can’t even agree about it, why should you worry about it? What is important is that you observe your child during the seizure.
What they do can be very telling and useful to your doctor in thinking about what medicine, if any, needs to be used or what options your child might have for seizure control beyond medications.
It’s easier said than done, but take a deep breath, make sure your child is safe and on her/his side, check your watch or the clock, record the event with your phone if you can, and try to take mental notes about what your child is doing.
What you see and report makes a difference in your child’s care!