Epilepsy: Seizure Classification 2017

• “Grand Mal”
• “Petit Mal”
• Absent”
• “Partial”
• “Generalized”

These terms are most commonly heard when classifying seizures.  However, a new article has been released that reclassifies seizure types based on the beginning of the seizure, level of awareness, and whether movement happens during the event.

“Partial seizures” and “generalized seizures” along with their subsets have been used for over thirty-five years, but have not captured many types of seizures.  The hope is that the new 2017 classification system will.

Let’s take a look at this new system.  According to the International League Against Epilepsy (ILAE), the world’s main scientific body devoted to the study of epilepsy, The new seizure classification breaks down the type by generally using a 3 step process.  However, they do have an expanded system, but for now let’s look at the simple classification:

1. Define where seizure begins:
   • focal seizures ( previously partial): their onset begins on one side/part of the brain
   • Generalized seizures (Previously primary generalized):  both sides of the brain
   • Unknown onset: This category can change later on when new information comes to light.  However, if the onset of a seizure is unclear, it is placed in this category.
   • Focal to bilateral seizure: This type begins in one side/part of the brain and spreads to other areas of the brain.

1. Describe Awareness.  This is extremely important because it affects a person’s safety:
   • Focal aware:  This replaces the term simple partial.  This term is used if a person remains aware during a seizure even if they are unable to speak or respond.
   • Focal impaired awareness:  We will use this term to replace  Complex partial seizures, which was used to define seizures in which a person was unaware even if they have a vague idea of what happened.
   • Awareness unknown: In some cases such as if a person seizes in their sleep or lives alone, it will not be possible to use the awareness term or would be described as awareness unknown.
   • Generalized seizures: no term is needed for generalized seizures because they are presumed to affect a person’s awareness in someway.
2. Describe motor and other symptoms in focal, generalized and unknown seizures:
   • This step is divided into 3 subsets: Focal, Generalized, and unknown
     1. Focal seizures 
        • Focal motor seizure: exactly what the name implies.  Movement occurs whether it is twitching, stiffening, jerking, lip-smacking, etc.
        • Focal non-motor seizure: This type of seizure has other symptoms that occur first, such as changes in sensation, emotions, thinking, or experiences.
        • It is also possible for a focal aware or impaired awareness seizure to be sub-classified as motor or non-motor onset.
        • Auras: this is not a new term, but still may be used to describe feelings, smells, etc before the start of a seizure.
     2. Generalized seizures
        • Generalized motor seizure: This term for this type has not changed over the years and is still used today.  Generalized tonic(stiffening) clonic (jerking) seizures loosely refer to “grand mal”.
        • Generalized non-motor seizure: This involves brief changes in awareness such as staring and/or repeated movements.  These are primarily absence seizures and the term corresponds to the old term “petit mal.”
     3. Unknown Seizures
        • This classification gives a way to describe whether the features of an unknown seizure are motor or non-motor.

You can use these three steps or you can check out the ILAE website for the article and expanded classification which is shown below:

~Siren Cay

“You’re just lazy”:Stigma against Anxiety

Anxiety.  It is an invisible illness that many individuals are affected by.  Anxiety disorders affect 40 million adults in the United States age 18 and older, or 18% of the population. (source: National Institute of Mental Health)

For those of us who endure anxiety disorders, it is quite difficult to explain to those who do not.

Phrases we often hear are:

•  “snap out of it”
• “you’re being ridiculous!”
• “get over yourself”
• “You don’t try hard enough”
• “You’re just lazy”

People misunderstand anxiety disorders for laziness, or a person who is unmotivated to shape a better life for themselves.  This is untrue.  The truth is those with anxiety often do not have reasons for their behaviors, and do try to fight against them.

People who have this disorder will often exhibit many different behavior that society may misunderstand, or fail to recognize as a symptom.

Below are a few of them:

• decline invitations, even if they wish to go somewhere
• Imagine the worst possible scenario in every situation
• compare their success to those who are close in age to them, such as friends and siblings
• the feeling of being too mentally and physically weakened by the affects of their anxiety

Read more here

It is important to change this stigma, because this can help those living with and without the disorder. Here is some information on signs, symptoms, and factors of anxiety disorders.

If you are living with an anxiety disorder, know that you are not alone, and that help is available.

~Siren Cay