epilepsy

 OLD NOMENCLATURE

Grand mal seizures = generalized tonic clonic seizures

• Petit mal seizures = absence seizures

⚫ Partial seizures

⚫ Simple partial seizures (intact consciousness)

⚫ Complex partial seizures (impaired consciousness)

SEIZURE/AURA SEMIOLOGY

Semiology (auras)

Affective symptoms (fear, depression)

Anxiety (sudden, brief, intense)

Auditory aura (simple e.g. ringing)

Auditory aura (complex e.g.

hallucinations)

Cephalic sensation

More common probable localization

Temporal

Amygdala

Primary auditory cortex

Depends; can involve temporo-, parieto-,

occipital cortex (often contralateral)

Usually frontal

Temporal (mesial)

Epigastric rising sensation

Forced thinking

Gustatory (e.g. bitter, metallic taste)

Jamais vu, déjà vu

Somatosensory

Visual

Frontal, probably left

Temporal

Temporal

Contralateral parietal

Occipital, lateralizing if directed

Wolf et al, Epilept Dis 2020; Jan et al, CJNS 2008; Foldvary-Schaefer et al, Epilep Behav 2011

NEW NOMENCLATURE

Partial seizures => focal seizures

⚫ Simple partial seizures => focal aware seizures

⚫ Complex partial seizures => focal impaired awareness seizures

• Focal to bilateral tonic clonic seizures

Anti-epileptic drugs (AEDs) => Anti-Seizure Medications (ASMs)

FIRST TIME SEIZURE

Within 24 hours - still counts as first-time seizure

⚫ History - risk factors, triggers, focality, semiology

⚫ Labs - CBC, CMP, lactate, medication levels

⚫ Brain imaging-CT head without contrast

- MRI brain-3T Epilepsy/seizure protocol for thins cuts through the temporal lobes

o Can be outpatient

EEG - Can be outpatient

If brain imaging and EEG negative, often hold off on antiseizure medications

Will treat if abnormal EEG or brain imaging