Sharing the vision epilepsy: life’s turning point Gavin Dimitri

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THE EPILEPSY REPORT OCTOBER 2008

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                          THE EPILEPSY REPORT OCTOBER 2008

Seizure 

Type

Seizure 

Family

Age of 

onset

Description

Ease of 

control

Tonic-

Clonic

(Grand Mal)

Generalized

(means the

wave starts out 

all over the

brain at once)

1-20,

rarely

adults

Child’s entire body stiffens all at once. Will fall to floor if standing. Stays stiff without shaking 

for several seconds (tonic phase), then begins to shake, slightly at first, then becoming more 

pronounced and slower (clonic phase). During clonic phase muscles are actually contracting and 

relaxing, giving the appearance of convulsions.Shaking stops. The child is usually not arousable 

up to a few minutes after the seizure stops, breathing sounds laboured and slowly calms down. 

The child usually wants to sleep, sometimes for several hours. Once conscious, the person may 

be temporarily confused after the seizure.

Usually 

easy

Absence

(Petit Mal)

Generalized

4-20,

very

rare in

adults

The child appears to stare into space for a few seconds. Does not fall. There may be slight 

rhythmic movements of the eyelids, hands, head, or other body part. Recovery is instant after the 

seizure, with no lingering confusion.

Usually 

easy

Myoclonic

Generalized

Any age

Sudden, brief, uncontrolled muscle jerk involving the entire body or part of the body (usually the 

upper half.) May cause the child to fall or to appear to throw something they were holding in their 

hand at the time of the seizure. These seizures may occur in groups of many, particularly after 

waking. No impairment of consciousness or very quick return to consciousness after seizure.

Difficult

Tonic

Generalized

Mostly

children

Stiffening of the entire body, lasting a few seconds up to a minute or so. Many “drop attacks” are 

actually tonic seizures.

Difficult

Clonic

Generalized

Mostly

children

Stiffening and relaxing of muscles, usually including the entire body. Gives the appearance of 

“convulsions.

Usually 

easy

Atonic

(drop 

attacks)

Generalized

Mostly

children

Sudden, brief loss of muscle control. The child goes limp. Often falls, with risk of injury from fall. 

No impairment of consciousness or very quick return to consciousness after seizure.

Very 

difficult

Infantile 

Spasm

Generalized

3 to 7(+)

months

Looks like a brief muscle spasm. Arms and legs extend for a moment. Head and chin may move 

toward chest.

Very 

difficult

Complex

Partial

Partial

(means the    

waves  starts 

from just one 

part of the brain)

Any age

Most common kind of epilepsy. Many different presentations, always with loss or impairment of 

consciousness. Often starts with a stare. The child may then make chewing movements, pick at 

their clothing, or wander around. Eyes are open, but the child does not respond to other people. 

Can last several minutes. The child is confused for moments or several minutes or more after the 

seizure ends. Memory disturbance after seizure can last minutes to hours.

Often 

difficult

Simple 

Partial

Partial

Any age

Varied presentation, all with no loss of consciousness. Could be a body part shaking or a change 

of sensation in a body part. Can also be a feeling or a thought that suddenly appears, always the 

same one.

Sometimes

difficult

Secondarily

Generalized

(Grand Mal)

Partial

Any age

Looks like a tonic-clonic seizure, except something else happens before the stiffening phase. 

This seizure starts as either a simple partial or complex partial seizure (see above for possible 

symptoms) before the “wave” spreads to involve the entire brain, at which point the seizure looks 

like a tonic-clonic. Aura before seizure also a clue. Important to recognize the difference from 

tonic-clonic as the treatment is usually different than for tonic-clonic.

Sometimes

difficult

Table 1: Common Seizure Types

even though the child otherwise appears 

normal. There are two kinds of seizures 

that sometimes look alike, but are 

very different and require different 

medications. These are the Absence 

seizure and the Complex Partial seizure. 

Both can appear as little more than a 

momentary lapse of consciousness. 

However, after an Absence seizure there 

is an immediate and complete return 

to full consciousness with no post-ictal 

confusion. A hallmark of a Complex 

Partial seizure is the presence of post-

ictal confusion after the seizure – at least 

for a few seconds, and usually longer.

Surprisingly, what happens during a 

seizure is sometimes the least important 

part of seizure observation. At other 

times it can be of great help. For 

example, Absence seizures usually last 

for several seconds, while Complex 

Partial seizures usually last a couple 

of minutes or more. On the other hand, 

Tonic-Clonic seizures and Partial 

Seizures that Secondarily Generalize 

look the same during the main part of 

the seizure and afterwards. Despite 

appearances, they are entirely different 

kinds of seizures that usually require 

different medications. Sometimes a 

seizure starts as a partial seizure, with 

the “wave” occurring in just part of 

the brain. In some children the “wave” 

continues to spread to involve the 

entire brain. This is what is meant by 

the term Partial Seizure Secondarily 

Generalized. When this happens, the 

behavior on the outside of the child looks 

the same as a Tonic-Clonic seizure: a 

tonic phase of stiffening all over the 

body and sometimes a throaty cry, then 

a clonic phase where the body and 

muscles appear to be jerking.

One of the most common errors in 

seizure observation is to confuse Tonic-

Clonic and Secondarily Generalized 

seizures. The key to distinguishing these 

is to carefully observe what happened 

at the beginning of the seizures (notice 

the plural – you may have to see several 

seizures before you can get this right.) 

True generalized Tonic-Clonic seizures 

never, ever have an aura or warning 

before they occur. If the child can tell 

you he or she is about to have a seizure, 

or if you notice a particular behavior is 

sometimes present at the beginning of 

①

If the seizure focus were located here, the beginning of the seizure (aura) would likely be a strong smell. Some people 

smell something like burnt rubber, rotten eggs, or a rose at the beginning of their seizure. This location is the front tip of the 

temporal lobe of the brain.

②

If the seizure were located here, the beginning of the seizures (aura) would be some change in sensation (sense of touch) in 

the right leg. The sensation could be numbness, tingling, pins and needles, or some other unusual feeling. This location is in 

the ‘sensory strip’ located in the parietal lobe of the brain.

③

If the seizure focus were located here, the symptom would be some sort of muscle twitching, movement, or contraction in 

the right arm. This location is in the ‘motor strip’ of the frontal lobe of the brain.

④

If the seizure were located here, the beginning of the seizure (aura) would likely be some strange change in vision. Bright 

lights might suddenly appear, or colours, darkness, or some other change in vision. This location is in the ‘visual field’ of the 

occipital lobe of the brain.

⑤

If the seizure focus were located here, the beginning of the seizure (aura) would likely be the appearance of someone’s face 

or image. This location is in the temporal lobe of the brain.

⑥

This spot is actually on the inside surface of the temporal lobe. If the seizure focus were located here, the beginning of the 

seizure (aura) would likely be a strong feeling, such as anger, fear, or depression, or a thought or memory.

Figure 1: Seizure Focus & the Brain

Left Side of the brain

the seizure, such as the head turning 

to the side, an unusual arm movement, 

hand movement, sudden change in 

mood, or other odd behavior or sensation 

just before the seizure, then there is 

a good chance it is a Partial Seizure 

Secondarily Generalized rather than a 

Tonic-Clonic seizure. That difference 

changes the treatment strategy.

“Drop attacks” is a common name for 

Atonic seizures. With Atonic seizures, 

the child falls because he or she has a 

sudden loss of muscle tone – the body 

goes limp and drops straight down to the 

floor. Tonic seizures (stiffening of the 

entire body) can also cause a child to fall 

to the floor. In Tonic seizures the body 

gets stiff and falls like a tree rather than 

straight up to down. While both seizures 

may be brief, Tonic seizures tend to 

last longer. Partial seizures can also 

mimic these kinds of seizures, further 

complicating diagnosis. Myoclonic 

seizures, where there is a sudden muscle 

jerk that involves the entire body or part 

of the body, can also cause the child to 

lose balance and fall. It is another type 

of seizure that can be confused with 

Atonic seizures or “drop attacks.”

I hope you are getting the message that 

diagnosis can be difficult, yet a correct 

diagnosis is often essential to successful 

seizure control. Ideally parents should 

know about the many different kinds of 

seizures and the kinds of observations 

that are useful in distinguishing them 

from each other. Unfortunately parents 

seldom have the opportunity to learn 

about seizures and to practice seizure 

observation skills. In the S.E.E. program 

this training requires a couple of hours 

and includes a videotape of different 

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