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aeck_me

question..

I just want to ask, can a general seizure become a partial/complex partial seizure. I only know that a partial seizure can become a general seizure in the secondary epilepsy

Comments

Re: question..

There's been a recent classification reorganization and change for classifications, but if you mean "Can a primary generalized seizure directly induce a simple partial seizure and/or a partial complex seizure?", I think the current orthodox answer is "No". Certainly, the physical results from a severe generalized seizure can cause physical damage that later results in another form of epilepsy that includes partial seizures (an example could be differential blood flows resulting in an isolated partial seizure nearly concurrent, but still "after" the primary generalized seizure).

Epileptic "kindling" is mainly observed, or hypothecated, as "spreading out" from a smaller area, instead of "concentrating to" a smaller area. Electroconvulsive Theraphy's (ECT) seemingly coming back into vogue might have biased the latest popular research, but ECT induces generalized seizures as treatments for what-not, and ECT is currently strongly defended as NOT leading to greater likelihood for the development of any forms of epilepsy (IMO, I would suspect words like "directly" as being exploited (for example, ECT can cause death, and near death experiences CAN cause epilepsy)). ECT is sometimes even touted as a treatment for minimizing epilepsy!!!

A defensive pro-ECT article is: http://www.seizure-journal.com/article/PIIS105913110600224X/fulltext Older research cites 300% to 3600% increased incidence of an epileptic seizure with ECT: http://books.google.com/books?id=lFNrR7PZ4qYC&pg=PA88&dq=epilepsy+ect&hl...

But on the very small scale: "These findings strongly suggest that activation of the Fyn signaling pathway is involved in hippocampus-dependent formation of contextual fear memory." and, "This implicates a Fyn-dependent biochemical pathway in the induction but not the maintenance of normal amygdala kindling. fyn is the first gene identified to be required for normal epileptogenesis." From: http://www.ncbi.nlm.nih.gov/pubmed/18691323 and http://www.ncbi.nlm.nih.gov/pubmed/8777897 "Contextual Fear" seems related to aspects of ECT, requiring other additional "treatments".

The "divergent unidirection" of kindling is probably just a confussion from the difference of magnitude based on direction of the kindling "Afferent Nerve Fibers" versus "Efferent Nerve Fibers" posits parts of bidirectional kindling, including from larger areas to smaller areas. A medium for a multidirectional area raises doubt about the orthodox view of kindling only from small to large, and not from large to small. "Susceptibility to Kindling and Neuronal Connections of the Anterior Claustrum" http://www.jneurosci.org/content/21/10/3674.full.pdf cites afferent versus efferent, and the book "Idiopathic Generalized Epilepsies: clinical, experimental, and genetic aspects" by Alain Malafosse (1994), somewhat illustrate the "occult" unknown nature of primary generalized seizures, which necessarily must have a right-and-left connected start. http://books.google.com/books?hl=en&lr=&id=OIclTblRPf4C&oi=fnd&pg=PA349&...
(Sometimes, somewhat still bizarre links to quantum mechanics are made for a "dis-connected" cause).

The nonlinear theory of dynamics apllied to the notion that a "seizure begets a seizure" until a cusp is reached where a "seizure prevents a seizure" sparked a brief fad of neurological catastrophe theory, but the opinion pendulum is presently more at the "a seizure prevents a seizure". Still, "Seizures Beget Seizures: A Lack of Experimental Evidence and Clinical Relevance Fails to Dampen Enthusiasm" by Graeme J Sills, PhD, at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1941905/

After my having about 700 dense clusters of seizures, progressively getting worse over the decades, something seems to be begetting something about the seizures of epilepsy, and while a very intense secondarily generalized tonic-clonic (TC) can sometimes bring an individual cluster to a seemingly abrupt end (it often just terminates my individual awareness of continuing additional seizures in the cluster), my seizures seem to have been making my seizures worse (hopefully to be continually stabilized at less than TC levels with Keppra).

The lazy neurologist's answer to if a general seizure became a documented simple/complex partial seizure, would probably be that the general seizures weren't primary general seizures all along. They were just secondarily generalized seizures brought on by previously unidentified partial seizures, partial seizures that now have been identified and have now at least briefly stopped spreading beyond being partials.

Tadzio

P.S.: Here's a perspective involving on what to call each "seizure type" during each stage of the termination of a generalized seizure: http://www.ncbi.nlm.nih.gov/pubmed/19400875

Re: question..

Tadzio, I became aware of the seizure and epilepsies reclassification proposal (2009), but never found any information about anything actually getting renamed or reclassified. Have you discovered any information about any recent renaming or reclassifications for seizures and or epilepsies?

Bruce (I'm not a doctor, but instead, an epilepsy support group leader, epilepsy advocate, who has epilepsy.)

Re: question..

Hi Spike,

I relied on a reference to the now 16 month old 2010 published report that covers the ILAE's Classification and Terminology 2005-2009, currently unlocked at: http://onlinelibrary.wiley.com/doi/10.1111/j.1528-1167.2010.02522.x/pdf (somewhat the same as the copies I have from May 2009 and July 28, 2009, and also linked again at http://www.ilae-epilepsy.org/Visitors/Centre/ctf/ctfoverview.cfm )

The reference was in the book I quote as stating "The term primary generalized epilepsy has fallen out of vogue with the ILAE...", and maybe what I'm trying to say above about "reverse directional kindling" involving "a larger area to a smaller area" for primary generalized seizures (epilepsies) becoming partial seizures (epilepsies), is somewhere in the ballpark with "Lombroso (328) reported his experience with a mean long-term follow-up of 16 years (up to 22 years) in 58 patients with various primary generalized epilepsies. Thirty-two of these patients had focal features present without structural lesion. He hypothesized either microdysgenesis or the development of localized hyperexcitability in low threshold structures secondary to long-term generalized spike-wave activity." From "Niedermeyer's Electroencephalography: Basic Principles, Clinical Applications, and Related Fields" by Donald L. Schomer, Fernando Lopes da Silva (2011), page 504. http://books.google.com/books?id=xSKqZxXOlukC&pg=PA598&dq=2011+Mode+of+s...

Tadzio