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Epilepsy
can be defined in a number of ways. Firstly, an epileptic seizure can be
described as either a generalised seizure, that encompasses all of the
brain or a partial seizure that involves only part of the brain that is
known as a focus. Generalised seizures fall within two categories that
are primary generalised seizures and secondary generalised seizures.
Primary generalised seizures are sudden onset seizures that involve both
hemispheres of the brain. Secondary generalised seizures start with a
focus as in a partial seizure and the seizure activity spreads across
and to both hemispheres of the brain, (Rogan 1992). An example of a
generalised seizure is that of a tonic clonic seizure whereby the
sufferer falls to the ground and exhibits tonus which is stiffening of
the muscles and clonus which is twitching of the muscles. Tonus and
clonus are usually then followed by a state of confusion before the
sufferer proceeds into a deep sleep. Other examples of generalised
seizures are absence seizures, myoclonic seizures and atonic seizures,
(Rogan 1992). |
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Partial
seizures are confined to one part of the brain. Partial seizures have
also been divided into two categories that are simple partial seizures
and complex partial seizures. Simple partial seizures can be further
subdivided into two categories which are focal motor and focal sensory.
A typical focal motor seizure would produce twitching of the muscles or
bodily movements that are relative to the area of the brain that is
experiencing abnormal electrical discharges. Focal sensory seizures are
similar to focal motor seizures except the disturbances occur in
perception and sensation such as visual or auditory distortions. Focal
sensory seizures can occur in the temporal lobe which can produce
feelings of deja’vu, (Rogan 1992).
Complex partial seizures involve an
impairment of consciousness and can display behaviours that are
inconsistent with the sufferer’s normal behaviour. The person may smack
his/her lips, move objects and undertake activities without no obvious
reasons for doing so. Complex Partial Seizures include seizure behaviour
that used to be classified under Temporal Lobe Epilepsy and Psychomotor
Epilepsy. Both simple and complex partial seizures can become secondary
generalised seizures, (Rogan 1992). |
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There has
been some controversy regarding the classifications of epilepsy. The
findings of The Commission on Classification on Terminology of the
International League Against Epilepsy (1981) differed markedly to the
previous findings of the First International Classification of Seizures
(Gastaut 1970; Gastaut 1973) which was used widely between 1969 and
1981. The revised system argues that the evolution of seizures should be
described. The revised system argues that a seizure such as an absence
which then proceeds to a tonic clonic seizure, would be described as a
convulsive generalised seizure under the earlier classification system
with no acknowledgement of the evolution of the seizure. Under the
revised classification system, the aforementioned seizure would be
designated as a non convulsive to convulsive seizure. Furthermore, the
revised system argued that partial seizures should not be divided into
categories dependent on clinical manifestations. Firstly a partial
seizure that occurs without any conscious impairment is designated as a
simple partial seizure. A partial seizure that involves conscious
impairment is designated as a complex partial seizure. Under the
original classification system, a complex partial seizure was defined as
any partial seizure leading to complicated clinical manifestations with
or without amnesia. This has led to considerable confusion with regard
to what terms such as generalised seizure and complex partial
seizure mean when being used without reference to the classification
system being used. |
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