Epileptic seizures are classified according to how they affect the brain (partial or generalized).
Partial seizures are classified as simple, complex, or seizures leading to generalized seizures.
Generalized seizures lack tonic-clonic behavior (petit mal) or present with tonic-clonic seizures (grand mal).
Grand mal seizures follow a typical course and pattern.
A Grand mal seizure is often preceded by an aura, which is experienced as epigastric discomfort, an emotion, or a visual, olfactory, or auditory hallucination. A seizure may follow within seconds to minutes of the aura.
Petit mal seizures are not accompanied by an aura.
Most epileptic seizures are not associated with identifiable triggers. However, some types of seizures may be associated with specific events.
The number of grand mal seizures may vary significantly between patients. Status epilepticus occurs when a patient experiences repeated grand mal seizures without regaining consciousness between the seizures.
Petit mal seizures may occur as a single event that may last for only seconds or as a series of seizures within hours.
Seizures are mostly controlled with medications. Patients will typically take prophylactic medication for several years.
Medication is gradually withdrawn when there is a diminished occurrence of seizures.
Although most patients take only a single medication, several different medications may sometimes be necessary to achieve adequate control.
The most common medications are carbamazepine, phenytoin, valproic acid with phenobarbital or primidone, gabapentin, topiramate, and lamotrigine.
A grand mal seizure may be accompanied by an aura, described as an epigastric discomfort, an emotion, or a visual, olfactory, or auditory hallucination.
A seizure usually follows an aura within seconds to minutes.
The initial phase of a grand mal seizure is a loss of consciousness, a cry, and a tonic muscle spasm, lasting for approximately 30 seconds. Spasm of the respiratory muscles cause cyanosis due to lack of breaths.
A clonic phase with convulsive jerky movements, sometimes accompanied by incontinence and tongue biting, follows the tonic phase.
A postseizure (postictal) phase, characterized by confusion, headache, lethargy, and severe fatigue, sometimes resulting in a deep sleep, is common.