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WHAT TYPES OF SEIZURES ARE THERE?
The classification of epilepsy has become quite complicated with a number of suggested classifications over the past two decades. There is now a general feeling that it is better to think in terms of the epilepsies or epilepsy syndromes, rather than of epilepsy per se. Although there is not a universally accepted classification of the epilepsies, especially in childhood, there is general agreement that many are distinctive, not only in terms of their symptoms and management, but also with regard to outlook.
Thus, at present, epilepsy can be discussed in two ways:
by discussing seizure type. In other words, a person may have grand mal seizures. This however does not define precisely the sort of epilepsy that they have, as grand mal seizures may occur in more than one type of epilepsy.
by discussing the type of epilepsy, or the epilepsy syndrome, which that person has. Thus a child may have Infantile spasms as the type of epilepsy, but exhibit myoclonic Jerks and grand mal seizures as their seizure type.
This chapter discusses the various types of seizures which can occur and the next chapter will discuss the various epilepsy syndromes, especially in childhood and adolescence.
From a practical point of view, seizures can be divided into generalised and partial seizures. A generalised seizure implies that abnormal electrical activity involves both halves of the brain (cerebral hemispheres) from the outset. On the other hand, partial seizures start in one cerebral hemisphere and the electrical activity does not spread to the other side of the brain. Thus the term ‘partial seizure’ means that only part of the brain is involved.
As a working rule, a generalised seizure which involves the whole brain is associated with losing consciousness. In partial seizures, consciousness is retained to a greater or lesser extent. In some partial seizures, consciousness may be retained initially but then the fit may become secondarily generalised and the patient will become unconscious in association with a major fit.
There are a number of different types of seizures (fits) which will be discussed in some detail below. However, before doing so, a general comment is warranted. It is of considerable importance that people with epilepsy should know precisely what type of seizures and what type of epilepsy they have. It is not good enough to say “I have epilepsy”. You should be able to say, “I have temporal lobe epilepsy” or “my child has infantile spasms”. The reason that you as an epileptic, or the parent of an epileptic child should know this, is that the outlook for the various types of epilepsy differs. Equally important, from a public relations point of view, people with epilepsy or parents of epileptic children need to be advocates for epilepsy. As we have already discussed, the general public is ill-informed about epilepsy. They believe all epilepsy is a grand mal fit as they have seen on television. Only by being precise about your epilepsy will you be able to educate those around you about epilepsy and its implications.
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