Classification of Epilepsy

Classification of epilepsy
Epilepsy can be divided into three main sections include:
1. Grand Mal epilepsy
Grand mal epilepsy is characterized by the onset of excessive loose electrical charge of neurons throughout the brain areas in the cortex, in the inside of the cerebrum, and even in the brain stem and thalamus. Grand mal seizure lasts for 3 or 4 minutes.

2. Petit Mal Epilepsy
Epilepsy is usually marked by the emergence of the unconscious or loss of consciousness for 3 to 30 seconds, during which time it attacks the patient felt like a jolt of some muscle contraction (twitch-like), usually in the head, especially the winking eyes.
3. Focal epilepsy
Focal epilepsy can involve almost any part of the brain, both the local region of the cerebral cortex or more structures in the cerebrum and brain stem. Focal epilepsy caused by a local organic lesions or functional abnormalities.

According to the International League Against Epilepsy (ILAE) in 1981, epilepsy is classified into two namely: based on epileptic seizure and epilepsy syndrome based.

1. Classification by type of epileptic seizure:
A. Partial seizure
Partial seizure is classified into 3 namely,
1) Simple partial (consciousness remains good)
•  With motor symptoms
•  With somatosensory or special sensory symptoms
•  With autonomic symptoms
• With psychic symptoms

These seizures are very different for each person, depending on the part of the brain where the seizures originated. One thing common to every patient that they remain awake and able to remember what happened. Doctors often divide simple partial seizures, into several categories depending on the type of symptoms experienced by patients.
Motoric Seizures
These spasms cause changes in muscle activity. For example, a person may experience abnormal movements such as jerking of fingers or stiffness on most of the body. This movement may be extended or remain on one side of the body (opposite to the affected area of the brain) or extends on both sides. Another example is a weakness that can affect speech. Patients may be aware or not this movement.
Sensory Seizures
These spasms cause changes in sensation. People with sensory seizures may smell or taste something that was not there, hear the ticking, bordering or someone's voice when no actual sound, or feel like needles sensations or numbness (numbness). Perhaps not very painful seizures in some patients. They will feel like spinning. They also may experience an illusion. For brevity they may believe that the car was parked or moving away someone's voice sounded like muffled when it should have been clear.
Autonomic Seizures
These spasms cause changes in the nervous system that automatically controls the functions of the body. These seizures usually include foreign or uncomfortable feeling in the stomach, chest and head, changes in heart rate and breathing, sweating.
Psychic Seizures
These seizures change one's way of thinking, feeling and experience will be something. They may have problems with memory, word reversed when talking, inability to find the right words or have trouble understanding conversation or writing. They may suddenly feel scared, depressed or unhappy for reasons that are not clear. Some patients may feel like they are outside his body, or feel dejavu.

2) Partial Complex (decreased consciousness)
a) Initially simple partial, followed by impaired consciousness
•  simple partial seizures, followed by impaired consciousness
b) The disturbance of consciousness, seizures early
•  With impaired consciousness only

3) Partial seizures are a common secondary

a) the simple Partial become generalized tonic-clonic seizures
b) Partial complex into a generalized tonic-clonic
c) a simple partial and complex partial seizures into generalized tonic-clonic

B. General Seizures
1) Absence / sleep / petit mal
Evoked seizures is characterized by sudden disturbance of consciousness (absence) in a few seconds (about 5-10 seconds) in which the motor stopped and the patient quietly without reaction. This attack usually occurs in children between the ages of 4 to 8 years. At the time lost consciousness, skeletal muscle tonus is not lost until the patient does not fall. When eye attack patients are far-sighted or eye rotates upward and release the things that are hand held. Post-attack, patients will regain consciousness and usually forget that new events experienced. On EEG examination will show a specially named "spike wave" of 3 cycles per second frequency the overall rise.
2) Clonic
Able to form focal clonic convulsions, unilaterally, bilaterally with the initiation of focal and multifocal moved. Focal clonic spasms last 1-3 seconds, terlokalisasi, not accompanied by disturbances of consciousness and usually not followed by a tonic phase. This form of cramps can be caused by trauma cerebri focal contusions on large and full-term infants or by metabolic encephalopaty.
3) Tonic
Form of tonic movements of extremities or general tonic movements of the arm and leg extensions that resemble deserebrasi or leg extension and flexion forearm with decortication form.
4) Tonic-clonic / Grand mal
Patients suddenly fall accompanied by screams, breathing pause and then followed by stiffness of the body. After that show movement tonic-clonic seizures (tonic movements accompanied by relaxation). At the time of the attack, patients are not aware, can bite their own tongue or lips, and can make water reach. Post-attack, patients will regain consciousness slowly and felt his body felt weak and will usually fall asleep afterwards.
5) Myoclonic
Myoclonic evoked seizures arising from any involuntary movement skelet muscle group that appears suddenly and usually only lasts for a moment. Clinical symptoms are seen is the extension and flexion movement or fourth arm member and the occurrence of repeated motion quickly.
6) Atonic
This attack is a rare occurrence. Usually patients will lose muscle strength and falls suddenly

2. Epilepsy syndrome classification based according to ILAE 1989.
a. Related to the location of the focus
1) Idiopathic
•  Benign childhood epilepsy with centrotemporal spikes
•  Childhood epilepsy with occipital paroxysm
2) Symptomatic
•  temporal lobe
• The frontal lobe
• The parietal lobe
•  occipital lobe
b. Common Epilepsy
1) Idiopathic
• Benign familial neonatal convulsions, benign neonatal convulsions
• Benign myoclonic epilepsy in infancy
• Childhood absence epilepsy
• Juvenile absence epilepsy
• Juvenile myoclonic epilepsy (impulsive petit mal)
• Epilepsy with grand mal seizures upon awakening
• Other generalized idiopathic epilepsies
2) General cryptogenic epilepsy or Symptomatic
• West's syndrome (infantile spasms)
• Lennox Gastaut syndrome
• Epilepsy with myoclonic astatic seizures
• Epilepsy with myoclonic absences
3) Symptomatic
• The etiology of non-specific
• Early myoclonic encephalopathy
• Specific disease states presenting with seizures
Epilepsy in infants and children is considered as a syndrome. The definition of epilepsy syndrome, is characterized by a set of clinical symptoms that occur together and both include the type of attack, etiology, anatomy, precipitating factors, age of onset, and severe disease. Known 4 age groups respectively correlate with epilepsy syndromes can be grouped as follows:
1. Neonatal group up to age 3 months
Epileptic seizures in children aged less than 3 months is fragmentary, that is some of the manifestations of epileptic seizures as muscular twitching: eye blinking and eye for a moment usually asymmetrical turned up for a moment, arms twitching, body curving / bending moment. Epileptic seizures are caused by organic lesions structural and long-term prognosis is poor. Simple febrile seizures is not found in this group.
2. The age group of 3 months to 4 years
In this group, febrile seizures often occur, because this group is very susceptible to infection and fever. Febrile seizures, not including epilepsy, but it is a major risk factor for the occurrence of epilepsy. Epilepsy syndrome that often occurs in this group is a syndrome Infantile Spasms or West syndrome and Lennox-Gestaut syndrome or myoclonic epilepsy.
a. Lennox-Gestaut syndrome.
1) Lennox syndrome Gestaut (SLG) is a severe form of epilepsy that usually occurs in children under five and its manifestation in the form of some kind of attack as well as growth and developmental delays.
2) SLG covers 3-11% of patients with epilepsy of child-friendly, first appeared at the age of 1-14 years, an average of 3 years.
3) This type of attack is contained in a patient includes attacks tonic, atonic, myoclonic and atypical absence. The emergence of attack facilitated by drowsiness or even without any stimulus can appear offensive.
4) Some of the factors are the cause of 25% are cryptogenic, symptomatic covering 75% of the population, head injury related to pregnancy, delivery, prematurity and asphyxia, brain infections, brain malformations and the development of metabolic disease involving the brain.
b. West syndrome.
1) this syndrome is also known as infantile spasm. Age of onset ranged from 3-12 months with a peak at the age of 4-7 months.
2) Generally, this type of seizure is characterized by sudden attacks tonic, bilateral and symmetrical.
3) The causes include 10-15% are cryptogenic and 85-90% are symptomatic. Prenatal factors include intrauterine infections (CMV = citomegalo virus), cerebral dysgenesis and cerebral malformations, post-natal causes include cerebral hypoxia, head trauma and infection (meningitis and encephalitis).
3. Age group 4-9 years
In this group, ranging clinical manifestations of primary generalized epilepsy, especially the manifestation of cryptogenic epilepsy or epilepsy because heriditer epileptogenic focus. Type of epilepsy in this group is Petitmal, grand mal and benign epilepsy of childhood with rolandic spikes (BECRS). After the age of 17 years old boy with BECRS can freely attack without using drugs.
4. Age groups over 9 years.
a. Heriditer epilepsy group: BERCS, group focal epilepsy or generalized epilepsy lesionic.
b. Symptomatic epilepsy groups: Temporal lobe epilepsy or psychomotor epilepsy. Unless BECRS, the type of epilepsy patients can still hit epileptic seizure in the next life. Absence epilepsy types may appear in this group.
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