Generalized nonmotor (absence) seizures—What do absence, generalized, and nonmotor mean?

Abstract

The classification as "generalized nonfocal and nonmotor (absence) seizure" does not covey the complex semiology of a patient's clinical events.

Multifrequency Dynamics of Cortical Neuromagnetic Activity Underlying Seizure Termination in Absence Epilepsy

“…Delta oscillations were mainly produced by cortical pyramidal neurons ( Neckelmann et al, 2000 ; Cardin et al, 2009 ). Abnormal delta oscillations were found to be associated with impairment of consciousness during epileptic seizures, which may be due to an inhibitory effect on the excitability of the cortex ( Shmuel et al, 2002 , 2006 ; Pittau et al, 2013 ; Holler and Trinka, 2015 ; Unterberger et al, 2018 ). However, another study revealed that low-frequency oscillations could also inhibit neural activity in higher-frequency bands and promote seizure termination ( Medvedev, 2002 ; Tenney et al, 2014 ).…”

Seizure Semiology in Focal and Generalized Epilepsies: Distinctive and Overlapping Features

“…The main feature of absence seizures is staring with impaired consciousness and unresponsiveness. 42 While this description overlaps with that of dialeptic seizures of focal origin, absence seizures tend to be much shorter in duration and occur more frequently than focal dialeptic seizures. 27…”

“…Seizures of childhood or juvenile absence epilepsy have the hallmark feature of staring and unresponsiveness; however, associated motor features have been well described and these include eye fluttering 50 or complex automatisms. 42 Focal motor signs seen during absence seizures are rare but can be misleading and include circling, 51 ictal head version, 52 horizontal nystagmus, 53 unilateral repetitive myoclonus, or even a motor sequence comparable to a Jacksonian march. 42 Other generalized epilepsy syndromes such as juvenile myoclonic epilepsy, grand mal upon awakening, and absence epilepsy with perioral myoclonic jerks have also been found to show focal semiological features including figure of four, 48,49 head version, 53 focal clonic, 49 unilateral dystonic posturing, 48 and asymmetric clonic ending.…”

“…42 Focal motor signs seen during absence seizures are rare but can be misleading and include circling, 51 ictal head version, 52 horizontal nystagmus, 53 unilateral repetitive myoclonus, or even a motor sequence comparable to a Jacksonian march. 42 Other generalized epilepsy syndromes such as juvenile myoclonic epilepsy, grand mal upon awakening, and absence epilepsy with perioral myoclonic jerks have also been found to show focal semiological features including figure of four, 48,49 head version, 53 focal clonic, 49 unilateral dystonic posturing, 48 and asymmetric clonic ending. 55 Myoclonic seizures in juvenile myoclonic epilepsy are sometimes reported to be unilateral by patients or observers, 56 but VEEG typically reveals bilateral myoclonic jerks.…”

Ecological Dynamics: An Inspiration for Triggering Epilepsy

“…Pathological state of hippocampus has been found linked to executive functions in 70% patients [61]. Febrile or tonic clonic Unknown eitology Anakinra [33] Focal or Partial Seizures Produced in a specifi c area of brain Perampanel [34] Occipital and parietal lobe seizures Type of aura Focal resection [35,36] Temporo parieto occipital junction seizures Vertigo Surgery [36,37] Focal motor seizures Management dilemma Botulinum toxin [38] Typical temporal lobe automatisms (mesial temporal lobe seizures) Ablated volumes Laser interstitial thermal therapy [39] Hyperkinetic automatisms Kicking, rocking [40] Focal negative myoclonus Centrotemporal spikes Valproate and Levetiracetam [41] Inhibitory motor seizures Eyelid fl uttering [42] Gelastic seizures Hypothalamus is epileptogenic zone Surgery [43] Hemiclonic seizures KCNQ3 mutation Vaiproic acid [44] Secondarily generalized Seizures in cortex Surgery [45] Continuous seizure types…”