Difference between revisions of "First-time seizure"

(Causes (First-Time Seizure))
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{{Seizure types}}
{{Seizure types}}
===Causes (First-Time Seizure)===
*Trauma (recent or remote)
*Intracranial hemorrhage (subdural, epidural, subarachnoid, intraparenchymal)
*Structural CNS abnormalities
**Vascular lesion (aneurysm, AVM)
**Mass lesions (primary or metastatic neoplasms)
**Degenerative neurologic diseases
**Congenital brain abnormalities
*Infection (meningitis, encephalitis, abscess)
*Metabolic disturbances
**[[Hypoglycemia]] or [[hyperglycemia]]
**[[Hyponatremia]] or [[hypernatremia]]
**Hyperosmolar states
**[[Hepatic failure]]
**[[Hypocalcemia]], [[hypomagnesemia]] (rare)
*Toxins and drugs
**[[Cocaine]], [[lidocaine]]
**[[Alcohol withdrawal]]
**Drug withdrawal
*[[Eclampsia]] of pregnancy (may occur up to 8wks postpartum)
*[[Hypertensive encephalopathy]]
*Anoxic-ischemic injury ([[cardiac arrest]], severe hypoxemia)
==Clinical Features==
==Clinical Features==

Revision as of 11:52, 25 August 2015


Seizure Types

Classification is based on the international classification from 1981[1]; More recent terms suggested by the ILAE (International League Against Epilepsy) task Force.[2]

Focal seizures

(Older term: partial seizures)

  • Without impairment in consciousness– (AKA Simple partial seizures)
    • With motor signs (ex. facial twiching or rhythmic ipsilateral extremity movements)
    • With sensory symptoms (ex. tingling or pereiving a certain smell)
    • With autonomic symptoms or signs (ex. tachycardia or diaphoresis)
    • With psychic symptoms (including aura, ex. sense of déjà-vu)
  • With impairment in consciousness - (AKA Complex Partial Seizures--Older terms: temporal lobe or psychomotor seizures)
    • Simple partial onset, followed by impairment of consciousness
    • With impairment of consciousness at onset
  • Focal seizures evolving to secondarily generalized seizures
    • Simple partial seizures evolving to generalized seizures
    • Complex partial seizures evolving to generalized seizures
    • Simple partial seizures evolving to complex partial seizures evolving to generalized seizures

Generalized seizures

  • Absence seizures (Older term: petit mal; brief dissociative states without postural changes)
    • Typical absence seizures
    • Atypical absence seizures
  • Myoclonic seizure (violent muscle contractions)
  • Clonic seizures (rhythmic jerking)
  • Tonic seizures (stiffening)
  • Tonic–clonic seizures (Older term: grand mal)
  • Atonic seizures (loss of muscle tone)


  • Sudden Unexpected Death in Epilepsy
  • Generalized tonic-clonic seizure is the major risk factor for SUDEP, and seizure freedom is strongly associated with decreased risk
    • Annual incidence of SUDEP in children is 1 in 4500
    • Incidence in adults is 1 in 1000

Clinical Features

Differential Diagnosis






See Also

External Links


  1. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy. Epilepsia 1981; 22:489.
  2. Epilepsia 2015; 56:1515-1523.
  3. Harden C et al. American Academy of Neurology and the American Epilepsy Society. Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors. Neurology April 25, 2017 vol. 88 no. 17 1674-1680.