Epilepsy: classification
The basic classification of epilepsy has changed in recent years. The new basic seizure classification
is based on 3 key features:
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1. Where seizures begin in the brain
2. Level of awareness during a seizure (important as can affect safety during seizure)
3. Other features of seizures
Focal seizures
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previously termed partial seizures
these start in a specific area, on one side of the brain
the level of awareness can vary in focal seizures. The terms
o focal aware (previously termed 'simple partial'),
o focal impaired awareness (previously termed 'complex partial') and awareness
unknown are used to further describe focal seizures
o further to this, focal seizures can be classified as being
 motor (e.g. Jacksonian march),
 non-motor (e.g. déjà vu, jamais vu; ) or
 having other features such as aura
Generalised
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these engage ‫ ﻳﻨﺨﺮط‬- ‫ ﻳﺸﺘﺮك‬or involve networks on both sides of the brain at the onset
consciousness lost immediately. The level of awareness in the above classification is
therefore not needed, as all patients lose consciousness
generalised seizures can be further subdivided into
 motor (e.g. tonic-clonic) and non-motor (e.g. absence)
specific types include:
→ tonic-clonic (grand mal)
→ tonic contractions all ms
→ clonic alteration of contractions of all ms eg: biceps then triceps
→ typical absence (petit mal) attack loss consciousness with staring look
→ atonic akinetic seizures loss of tone in LL
Unknown onset
• this termed is reserved for when the origin of the seizure is unknown
Focal to bilateral seizure
• starts on one side of the brain in a specific area before spreading to both lobes
• previously termed secondary generalized seizures
Focal onset seizures
these start in a specific area, on one side of the brain
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Motor onset
Nonmotor onset
(e.g. Jacksonian march)
(e.g. déjà vu, jamais vu ) or
having other features such as aura
Aware
Aware
Impaired awareness
Impaired awareness
Unknown awareness
Unknown awareness
Focal to bilateral tonic-clonic
starts on one side of the brain in a specific area before spreading to both lobes
Generalized onset seizures
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involve networks on both sides of the brain at the onset
Motor
consciousness lost immediately
Nonmotor (absence)
Atonic
Tonic
Clonic
contractions all ms
Tonic-clonic
(grand mal)
then triceps
alteration of contractions of all ms eg: biceps
Typical (petit mal)
attack loss consciousness with staring look
Atypical = atonic
akinetic seizures loss of tone in LL
Myoclonic
Myoclonic-tonic-clonic
Unknown onset seizures
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origin of the seizure is unknown
Motor
Tonic-clonic
Epileptic spasms
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Nonmotor
Behavior arrest
Unclassified seizures