The spectrum of epilepsy

The spectrum of epilepsy

Questions from healthcare professionals

Q: Is there a form of epilepsy called 'Shims'?

A: This is not a term we are aware of as being related to epilepsy.
July 2011

Q: What is the prevalence of epilepsy by gender? And are there any up-to-date information on rates of remission when on AED'S.

A: There are statistics on the prevalence by gender from the Joint Epilepsy Council, which can be found on their website at http://www.jointepilepsycouncil.org.uk/resources/publications.html and look up 'Epilepsy Prevalence, Incidence and Other Statistics'

You can find information on remission rates on our website under the 'library of articles': 'outcome' section, in the chapter 'The prognosis of epilepsy'.
May 2011

Q:Why does frontal lobe epilepsy cause nocturnal seizures, and why are these seizures usually partial rather than generalised?

A: Seizures are more likely to occur in sleep in many forms of epilepsy. This is thought to be because of the relative balance of network excitability and suppression facilitates excitation during sleep rather than during wake. The seizures are thought to be partial rather than generalised because there are efficient mechanisms to terminate seizure spread.
August 2010

Q: Is it possible for both partial seizures and primary generalised seizures to occur in the same person? If not, what is happening? Are we simply seeing secondary generalisation that is too rapid to detect clinically?

A: It is possible for individuals to have more than one type of seizure, and this depends on the type of epilepsy that they have; different epilepsies have different seizure types associated with them. Some individuals may have secondarily generalised seizures where the partial seizure onset goes unnoticed or unrecognised and in this case further investigations may be needed to clarify if the seizure is of primary partial or generalised onset.

You can find out more about types of seizures and epilepsies in the articles section of this website, where you can download pdfs of papers on various topics. 

Q: What is the difference between the terms fits, convulsions and seizures?

A: There are all terms used, sometimes interchangeably, for the symptoms of epilepsy. Generally we prefer the term 'seizures' because this encompasses all types of epileptic symptoms, whereas 'fits' and 'convulsions' only refer to convulsive seizures. It is worth noting, however, that the term 'seizure' is not synonymous with 'epileptic seizures' as not all seizures are due to epilepsy. 
April 2008

Q: Question: What are the symptoms of focal (or partial) seizures and what is the recommended management for them?

A: Symptoms of focal seizures vary according to the location of epileptic activity. More information about symptoms can be found in the articles section on this site under ’classification of seizures.  Drug treatment of epilepsy is covered in our leaflet ‘epilepsy – medication for adults’ on this website. You can find out more about specific antiepileptic drugs on the MedGuides and British National Formulary websites.
 April 2008

Q: Is there a link between pernicious anaemia and epilepsy?

A: Pernicious anaemia does indeed cause neurological symptoms but to our knowledge and experience seizures are not common. 
August 2007

Q: Is reading epilepsy a focal or generalized epileptic syndrome and what is the drug of choice?
A: Reading epilepsy can be either focal or generalised. The drug of choice will depend on the type of seizure. 
March 2007

Q: Could epileptic ictal discharges arising from occipital cortex lead to head turning?

A: This is most unlikely. 
January 2007

Q: Is there any epileptic condition not manifesting with seizures but where the child damages its tongue, resulting in bleeding from mouth, in the absence of any bleeding disorder?

A: We are not aware of any such form of epilepsy. People can often bite their tongue without having epilepsy. 
August 2006

Q: What is epileptic encephalopathy? Why is West syndrome called that? What is the reason behind the cognitive decline in these patients with epileptic encephalopathy, especially West syndrome?

A: Epileptic encephalopathy is a term now defined within the ILAE classification of the epilepsies. It is a condition where the epileptiform abnormalities themselves are believed to contribute to the progressive disturbance in cerebral function. This said, they must therefore be potentially reversible. West syndrome is an excellent example of this - children present with infantile spasms associated with hypsarrhythmia on the EEG. Developmental plateau and regression are often seen prior to or at presentation. The exact mechanisms involved are as yet unknown, but it is felt to be closely related to the underlying epileptiform activity. Some evidence suggests early treatment is likely to lead to better developmental outcome. Other examples include Landau Kleffner syndrome, Lennox Gastaut syndrome and severe myoclonic epilepsy of infancy. 
January 2006

Q: Do you know of any evidence for symptoms of paranoia presenting two to three days prior to a generalised seizure, which resolve following the seizure?

A: We are not aware of any evidence for this. Symptoms of paranoia have not been seen as part of a prodrome. 
August 2005

Q: What is monogenic epilepsy? Can you give me some examples of monogenic epilepsy?

A: Monogenic epilepsies are associated with a single gene. They include some forms of benign familial neonatal convulsions and JME. 

May 2005

Q: What is the difference between a myoclonic jerk, a tonic seizure and a spasm, in adults?

A: Myoclonic seizures are abrupt, very brief jerking movements, which may involve the whole body or part of it. A tonic seizure involves a sudden increase in the muscle tone of the body such that the person becomes rigid, usually falling backwards. A spasm may be a simple partial motor seizure, if the person is fully conscious and only one limb is involved. However the term spasm could also be used to refer to a myoclonic or tonic seizure. 
April 2005

Q: How long before a seizure is the pre-ictal phase and how long after a seizure can a post-ictal phase continue?

A: Both the pre-ictal and post-ictal phases can last for up to several hours or even longer. 
January 2005

Q: What is myoclonic epilepsy with ragged red fibres?

A: This is a form of progressive myoclonic epilepsy (MERRF syndrome). The progressive myoclonic epilepsies are characterised by myoclonic seizures, generalised tonic clonic seizures, and progressive intellectual deterioration. The prognosis is guarded. 
September 2004

Q: How often can drop attacks with or without loss of consciousness be due to atonic seizures in the absence of any other types of seizures?

A: Drop attacks are atonic seizures. They always involve loss of consciousness, even if this is very brief. 
July 2004

Q: Is it common for epileptic patients to have post-ictal vomiting?

A: This is rare but may happen. Ictal vomiting can be part of occipital seizures. 
July 2004

Q: If a patient develops tonic clonic seizures following carbon monoxide poisoning in adult life, is this by definition focal epilepsy?

A: If the damage is focal as it usually is - that is, areas of focal damage are seen on MRI - then it is focal epilepsy. However there is usually much more diffuse damage that can't always be clearly seen. 
June 2004

Q: What is a cephalic aura?

A: A cephalic aura is an unspecific feeling in the head. 
May 2004

Q: Could automatisms follow generalised tonic-clonic convulsions? Will this be a part of the seizure?

A: Automatisms occur in complex partial seizures. Complex partial seizures may progress to a tonic clonic convulsion – this is called a secondarily generalised seizure. However a generalised tonic clonic seizure will not progress to a complex partial seizure. If automatisms follow a convulsive attack, this may indicate post-ictal confusion. 
May 2004 

Q: What is the epileptic syndrome that almost always occurs during sleep? What is its treatment?

A: All seizure types can occur during sleep, and there are a number of epileptic syndromes where seizures may be nocturnal. When making a diagnosis, the normal investigations should be carried out. Treatment for nocturnal seizures is the same as for seizures that occur during the day. For more information see our articles section. 
May 2004 

 Q: Does nocturnal mean during sleep or during the night? Does frontal lobe epilepsy have a tendency to occur during sleep?

A: Nocturnal seizures are those that occur during sleep. Frontal lobe seizures are frequently nocturnal. 
April 2004

Q: In my epilepsy clinic I face the complaint of headache frequently. Is there epidemiological evidence of this? Could it be a form of seizure?

A: Epidemiological studies suggest that there is an association between migraine and epilepsy, that people with one condition are more likely to have the other condition, than would be expected from prevalence figures for the population as a whole. Migraine attacks may be confused with epileptic seizures, as there may be overlap in the symptoms with which they present. In addition, headache is commonly associated with seizures either in the preictal, ictal or postictal stage. There is a detailed look at this subject in the chapter 'Headache and epilepsy' in 'Managing epilepsy and co-existing disorders' by Ettinger and Devinsky, published Butterworth Heinemann 2002. 
March 2004 

Q: Could you give me a description of 'axial tonic' seizures?

A: The following description is taken from the third edition of 'Aicardi's epilepsy in children' by Arzimanoglou, Guerrini and Aicardi, from the chapter on Lennox-Gastaut syndrome. 'The axial subtype [of tonic seizures] consists of a brief, but sustained, bilateral symmetric contraction of the axial muscles that results in a flexor movement of the head and trunk with apnea that occasionally is preceded by a brief cry. The eyes open and often deviate upwards. Clouding of consciousness and autonomic manifestations are usually associated with this subtype.' 
March 2004

Q: Can focal seizures lead to all the generalised seizure types or just tonic-clonic seizures?

A: The epileptic discharge in a focal (partial) seizure may sometimes spread to involve the whole of the brain, so that a generalised seizure results. This is called a secondarily generalised seizure. Secondarily generalised seizures are usually tonic clonic seizures, however rarely they may take the form of tonic or atonic seizures. 
March 2004 

Q: Can you give me some information on extratemporal epilepsy?

A: Extratemporal means outside the temporal lobe. In epilepsy, extratemporal usually refers to frontal lobe epilepsy. There is an article on frontal lobe epilepsy on this website in our articles section - The spectrum of epilepsy. 
January 2004 
 
Please note: Epilepsy Society is unable to provide a medical opinion on specific cases. Responses contain information relating to the general principles of investigation and management. Answers are not, and should not be assumed to be, direct medical advice.