Over 40 Different Types Of Seizures.......

Re: Re: Re: Over 40 Different Types Of Seizures.......

Submitted by spiz on Sun, 2006-05-07 - 22:59

Panayiotopaulos Syndrome - characterized mainly by ictal vomiting, head and eye deviation, and sometimes prolonged periods of loss of awareness. In Panayiotopoulos syndrome, seizures comprise an unusual constellation of autonomic, mainly emetic, symptoms often with unilateral deviation of eyes and other more conventional symptoms. Seizures are nocturnal in about two thirds of patients. The full emetic triad (ie, nausea, retching, vomiting) culminates in vomiting in 74% of seizures. Other autonomic symptoms may occur, including pallor, sweating, flushing, cyanosis, mydriasis, miosis, hypersalivation, bladder or bowel incontinence, abnormal intestinal motility, and cardiorespiratory and thermoregulatory alterations. Brief apnea and irregular or heavy breathing is reported to occur in 7% of cases. Ictal cardiorespiratory arrest has also been reported. Headache and cephalic auras that may be autonomic manifestations may occur, particularly at onset. More conventional symptoms may follow, including confusion or unresponsiveness, eyes and head deviation to one side (60-98%), wide opening of eyes without deviation, speech arrest, hemifacial spasms, and visual symptoms or hallucinations (6-9%). The seizures may end with hemiconvulsions, often with jacksonian march (19%) or generalized convulsions (21%). Ictal syncope has been reported to occur in one fifth of cases. Typically, the seizures are infrequent but long; 44% have seizures lasting 30 minutes or more, consisting of autonomic status epilepticus. Hemiconvulsive or generalized convulsive status epilepticus is rare (2%). One third of patients have a single seizure only. About half have 2-5 seizures. Only 5% have more than 10 seizures. In late-onset childhood epilepsy with occipital spikes (Gastaut type), clinical semiology is complex and is characterized by ictal and postictal symptoms. Visual symptoms include (1) transient, partial, or complete loss of vision, (2) elementary or complex visual hallucinations, and (3) visual illusions (eg, micropsia, metamorphosis). Elementary visual hallucinations are the commonest and most characteristic ictal symptoms. These consist of small multicolored circular patterns that often appear in the periphery of a visual field, becoming larger and multiplying in the course of the seizure. Nonvisual ictal symptoms include adversive (versive) seizure manifested as tonic deviation of head and eyes. These are the most common of the ictal motor phenomena. Other motor seizures include (1) hemiclonic convulsions, (2) complex partial seizures with automatisms, and (3) generalized clonic seizures. Other ictal manifestations include dysphasia and dysesthesia. Seizures are commonly diurnal and usually frequent. They are typically short, lasting seconds to less than 3 minutes. Other symptoms include postictal, diffuse, throbbing headache in about half of the patients and vomiting in about 10%. Ictal headache, mainly orbital, is rare. The interictal EEG in Panayiotopoulos syndrome commonly reveals functional, mainly multifocal, high-amplitude sharp and slow wave complexes, with great variability at various electrode locations. All brain regions are involved, although the posterior predominate. About one third of patients never show occipital spikes.