Epilepsy & Seizures

Increasing Epilepsy Awareness

What is epilepsy?

Prior to understanding types of epilepsy it is important to understand the types of seizures it may cause. There are several types of seizures, which are categorized based on the type of brain activity involves and the changes in behavior they cause. Seizures are divided into two main groups; generalized and partial (also called focal). During generalized seizures, there is activity in both hemispheres of the brain, whereas, during a partial seizure, the activity is restricted to a localized area of the brain.

This condition affects men and women of all ages and races. Epilepsy has several causes including head trauma, brain disorders, and infection, although 50% of the time the cause is unknown. In some cases, there may be warning signs before a seizure, such as changes in vision or taste however for others it may occur with no prior indication.

During a seizure, the brain transmits sudden, short bursts of electrical activity which can cause muscle spasms, loss of motor control, and a variety of other symptoms. What symptoms you will experience as a result of a seizure will depend on the type of seizure you are afflicted by.

Types of Seizure

Prior to understanding types of epilepsy it is important to understand the types of seizures it may cause. There are several types of seizures, which are categorized based on the type of brain activity involves and the changes in behavior they cause. Seizures are divided into two main groups; generalized and partial (also called focal). During generalized seizures, there is activity in both hemispheres of the brain, whereas, during a partial seizure, the activity is restricted to a localized area of the brain.

Clonic Seizures

Clonic seizures cause repetitive and uncontrollable jerking of body parts including the arms and legs. They can occur in one side of the brain (focal) or both sides of the brain (generalized). During generalized clonic seizures the sufferer is usually unconscious while in focal clonic seizures they may retain some level of consciousness.

If you observe someone having a clonic seizure the best way to help is by preventing them from falling or hitting objects while jerking. Restricting or restraining their movement will not help and is not advised. These seizures are rare and typically start in babies and early childhood although they can affect people of any age.

Tonic Seizures

Tonic seizures cause stiffening, tension, or flexion of the body and extremities which can cause the sufferer to fall backward. They typically affect both sides of the brain, although they may begin in a localized area.

Often, tonic seizures happen during sleep and usually last no longer than 20 seconds. Tonic seizures are rare. When they do occur, they are often associated with Lennox-Gastaut syndrome.

Lennox-Gastaut Syndrome is a severe form of infant-onset epilepsy, which causes several different types of seizures including tonic-clonic as well as atonic.

Atonic Seizures

Also called drop attacks: Atonic seizures result in the sudden loss of muscle control causing the body and extremities to go limp. The head may drop suddenly, eyes may droop, and the sufferer may slump or fall forward.

They may affect one or both sides of the brain. This is not a common type of seizure though it may occur with Lennox-Gastaut Syndrome.

Tonic-clonic or Convulsive Seizures

Formerly called grand-mal seizures: This results in electrical activity throughout the brain and the person loses consciousness immediately. Tonic-clonic seizures generally start in both sides of the brain (generalized) but can also begin in one side and progress to both (focal to bilateral). These seizures combine the symptoms seen during tonic and clonic seizures. First the tonic seizure causes the body to stiffen and person fall to the ground, then clonic seizures cause rapid jerking body movements.

A convulsive seizure typically lasts from 1-3 minutes. Sometimes, prior to a tonic-clonic seizure, a person may experience what is known as an aura. An aura is also called a focal aware seizure (FAS). They serve as a warning sign of an impending seizure, giving patients time to prepare. However, an aura may not always lead to a tonic-clonic seizure and occur independently. Auras can be experienced in different ways including:

  • A feeling of deja vu
  • Flashing lights or dark spots in the peripheral vision
  • Ringing or buzzing in the ears
  • A salty or metallic taste in the mouth
  • Heightened sensitivity to sounds
  • A sensation that a limb is larger or smaller than it is

Myoclonic Seizures

Myoclonic seizures usually start between the ages of 3 and 12 years. This type of seizure is very brief, often only lasting or a few seconds. The sufferer will not lose awareness during myoclonic seizures.

He or she will experience muscle spasms, jolts, or twitches that are localized or may affect the whole body. A person who suffers from epilepsy may experience both myoclonic and atonic seizures.

Absence Seizures

Formerly called petit-mal seizures: Activity occurs through the entire brain (generalized) and causes unconsciousness but no convulsions. There are two types of absence seizures: typical and atypical absence seizures. In both forms the sufferer will have a blank stare and seem disconnected. They may also blink rapidly, roll their eyes upward, smack their lips, or gently pull or rub their clothing.

One difference between these types of seizures is that typical absence seizures are shorter, lasting 10 seconds or less, while atypical absence seizures can last between 10 and 30 seconds. In addition, atypical absence seizures build up slower than typical seizures. Typical absence seizures begin and end very suddenly. When the person regains consciousness they may not realize they had an absence seizure. In the case of children, a parent may not always notice them as they can easily be confused with daydreaming.

Status Epilepticus

This term is used to describe seizures that last more than 5 minutes or seizures that occur back-to-back without the person being able to regain consciousness. Status epilepticus can present as convulsive (tonic-clonic) or nonconvulsive seizures. It is considered a medical emergency requiring immediate intervention including anesthetics to calm or sedate the body or benzodiazepines.

Focal Seizures

Focal (partial) seizures occur in specific parts of the brain. They are divided into two main groups.

  • Simple partial seizures (now preferably called focal aware seizures): A simple partial seizure will begin in a local region of the brain (such as the temporal, frontal, parietal, or occipital lobe) but may extend to other areas. During this type of seizure a person remains conscious. Most notably, they experience what is referred to as an “aura”. Auras are described as strange feeling of altered emotion and sensation including perception, vision, smell, and taste. The patient may also experience twitching, jerking, or stiffening of the body. These seizures often last less than two minutes and can be a warning for more intense seizures to come like tonic-clonic seizures. 
  • Complex partial seizures (now preferably called focal impaired awareness seizures): Typically, this type of seizure begins in the temporal or frontal lobe. In the temporal lobe they may begin in the hippocampus or amygdala (the area of the brain which controls memory and emotion). A person is not fully conscious during this type of seizure. They may stare blankly and perform automatisms (involuntary actions like facial twitching, mouth movements, and rubbing clothing).
  • Secondary Generalized Seizure: This term is used to describe focal seizures that develop into generalized seizures (on both sides of the brain).

Types of Epilepsy

Important definitions:

  • Focal (partial): occuring in one area of the brain or hemisphere in the brain
  • Generalized: occurring in both hemispheres of the brain

Brain Functions Areas

  • Touch perception
  • Movement control
  • Manipulation of objects
  • Voluntary movement
  • Planning
  • Intellect
  • Problem solving
  • Abstract reasoning
  • Long term memory
  • Speech comprehension
  • Objects perception
  • Faces recognition
  • Hearing
  • Visual reception
  • Local orientation
  • Shape percention
  • Coordination
  • Balance
  • Reflex motor acts
  • Conduction
  • Tract for pain
  • Temperature and preassure sensations
Rolandic Area of the Brain

Temporal lobe epilepsy (TLE)

Implicit in the name, TLE is epilepsy that originates in the temporal lobe of the brain. TLE accounts for 60 percent of all focal epilepsy. TLE causes focal (partial) seizures that may either impair awareness (called complex partial seizures) or slightly alter perception (called simple partial seizures) also referred to as “auras”. It often begins in children around 10 years old but can start at any age. Some brain functions of the temporal lobe include emotions, memory, speech, and hearing. Becoming seizure free will generally require surgery. It is unlikely that medications alone will eliminate seizures, although medications can help control seizure frequency, duration, and intensity.

There are two forms of TLE: 

  • Mesial temporal lobe epilepsy (MTLE): Around 80 percent of TLE take this form. It begins in the inner area of the temporal lobe such as the hippocampus. It can cause tonic-clonic seizures.
  • Lateral temporal lobe epilepsy (LTLE): This form begins in the outer region of the temporal lobe. It can cause simple and complex partial seizures.

Frontal lobe epilepsy (FLE)

This type of epilepsy can begin at any age. It causes electrical activity in the frontal lobes. FLE causes simple or complex focal seizures or a combination of the two. Usually anti-epileptic drugs can manage FLE, however, surgery or neurostimulation may be necessary. 

Benign Rolandic Epilepsy (BRE)

This form of epilepsy is one of the most common. BRE is also called benign epilepsy with centrotemporal spikes because the seizure is caused by electrical activity that begins in the rolandic/ centrotemporal area of the brain. It is the most common epilepsy in children, affecting children between the ages of 3 and 12 years. BRE causes motor and sensory symptoms in the face including twitching, drooling, numbness, tingling, and speech impairment. BRE develop into tonic-clonic seizures affecting both hemispheres of the brain.

Photosensitive Epilepsy

For an estimated 3 percent of epilepsy sufferers, their condition can be triggered by lights that flash at certain speeds or in certain patterns. This is generally more common in young children and tends to lessen as they age. It causes tonic-clonic seizures.

Catamenial epilepsy

Also called menstrual seizures, this form of epilepsy is specific to menstruating women. Women who suffer from catamenial epilepsy experience more frequent seizures at certain times during their menstrual cycle. Menstrual seizures are caused by hormone changes before or during menstruation including declining progesterone and increasing estrogen levels. Imaging studies like EEG, MRI, and CT can help diagnose catamenial epilepsy, however, a menstrual/seizure journal will help in diagnosis. If seizures are identified to increase during menstrual periods relative to non-menstrual periods, this is an indication of catamenial epilepsy. Catamenial epilepsy is generally treated with anti-seizure medications and drugs that can regulate hormone levels.

Nocturnal Epilepsy

This form of epilepsy only occurs when a person is sleeping, generally in stages of lighter sleep. Between 7.5 and 45 percent of epilepsy sufferers only experience seizures while they are sleeping. For some people, establishing a consistent sleep cycle (circadian rhythm) can help decrease the frequency of nocturnal seizures. Some anticonvulsants may also help but only those that do not disrupt sleep stages. Seizures during the night may go unnoticed. If you awaken with injury, weakness, or headaches this may be a sign of nocturnal epilepsy. Other signs include loss of bladder control during the night, waking in positions you did not fall asleep in, or a disheveled area around you. Sleeping with a partner may also help identify some of the symptoms of seizures during the night.

Refractory Epilepsy

This is also called uncontrolled, drug-resistant, or intractable epilepsy. It refers to epilepsy which is resistant to medication. Refractory epilepsy is common, affecting about 33 percent of epileptics. It is important to choose an experienced epilepsy specialist that prescribes the correct medications for you seizure type. If two types of anti-seizure medications are used to no avail, dietary therapies, lifestyle improvements, surgery, and neurostimulation are the next line of treatment for refractory epilepsy.

Sudden Unexpected Death in Epilepsy (SUDEP)

This refers to the sudden death of a person suffering from epilepsy, who is otherwise healthy, that upon post-mortem evaluation does not have a cause of death. If death is caused by drowning, trauma, or status epilepticus (prolonged seizures) this is not considered SUDEP. The exact cause of SUDEP is unknown and may differ from case to case. Some studies indicate cardiac, respiratory, and neurological factors may contribute to SUDEP.

Lennox-Gastaut syndrome (LGS)

A form of severe epilepsy affecting infants and children (typically between 3 and 5 years old). LGS causes multiple types of seizures including tonic, atonic, and absence seizures. They can also cause cognitive and behavioral impairments like mental retardation (i.e. learning problems) or psychomotor regression (losing recently attained abilities). LGS may delay children from attaining developmental milestones like crawling and sitting.

Dravet Syndrome

A severe and rare form of epilepsy affecting infants. The onset of Dravet Syndrome usually occurs during fever or illness. The most common seizures are myoclonic (muscle twitching or jerking) and tonic-clonic seizures (full body stiffening followed by jerking seizures on the ground). Seizures can be triggered by body or environmental changes in temperature, flashing lights, or strong emotions. Children generally develop disabilities as they age. Treatment can include seizure medications, diet, and neurostimulation. Surgery is not commonly used.

If you or a loved one suffers from recurrent seizures, now is the time to take back control.

Our epilepsy treatment center offers diagnostic, nonsurgical, and surgical treatment options for epilepsy. Our epilepsy specialists, neurologists, and neurosurgeons provide comprehensive treatment options from epilepsy medication to epilepsy surgery. Together we hope to overcome epilepsy and cultivate a life of independence and peace of mind for all those affected by recurrent seizures. If you are searching for a seizure doctor in Miami, contact us today to schedule an appointment.