Do you know what a Jacksonian March is?

Wednesday, June 19, 2013

Q: What is a “Jacksonian” seizure?

A. Jacksonian march, also called Jacksonian seizure, is one kind of a simple partial seizure. “Simple” in this context means patients do not lose awareness. Partial means that abnormal neuron firing only occurs in part of the brain, and, accordingly, abnormal movement or sensation is limited to only part of the body. The characteristic features of Jacksonian march are (1) it only occurs on one side of the body; (2) it progresses in a predictable pattern from twitching or a tingling sensation or weakness in a finger, a big toe or the corner of the mouth, thenmarches over a few seconds to the entire hand, foot or facial muscles.

Q: Is it a new seizure type?

A: No, it is not. It is a subtype of partial seizures. It was described in 1870 by John Hughling Jackson, an English neurologist. Jackson considered that parts of the body were represented in discrete parts of the nervous system including both sensory and motor systems. His theory was later confirmed by other neurologists by demonstrating the electrical excitability in a certain part of dog’s brain, the area called motor cortex. Interestingly, Jackson’s wife Elizabeth Dade Jackson had Jacksonian focal seizure before she died of cerebral venous thrombosis in 1876.

Q: What are other features in Jacksonian march?

A: Jacksonian march seizures are generally brief and relatively mild. They are episodic, come and go. There is no confusion afterwards. Sometimes patients may not even notice them. Some patients may also have a phenomenon called “automatism,” such as compulsively licking the lips, fumbling with clothing, or other rhythmic finger movements. Others may experience head turning, eye movement, muscle cramping, numbness, tingling, and a crawling sensation over the skin. Hallucinations can occur too, which can be visual or auditory, meaning patients may see or hear things that are not there.

Q: If someone has symptoms as you just mentioned, are we sure he/she has Jacksonian seizure?

A: No, we cannot be sure because there are diseases that can mimic Jacksonian seizures. For example, migraine can also have hemibody weakness or sensation changes. Patients with stroke can have one side of body weakness or numbness/tingling as well. There is a particular type called capsular warning syndrome in which patients can present with the same symptoms as patients with Jacksonian march seizures, such as short stereotyped episodes of tingling/numbness ascending from the foot to the hand on one side of body.

Q: So how can we distinguish Jacksonian march from its mimics?

A: This can be done by a good description of the symptoms, electroencephalogram (EEG), and brain imaging like magnetic resonance imaging (MRI). EEG-video monitoring can also be helpful in diagnosis.

Q: How do we treat Jacksonian march?

A: In themselves they may not require antiseizure medications since the symptoms are so mild and brief. However, most patients with Jacksonian seizures also have more severe seizures, including full convulsions. Also the seizures may be the manifestations of an underlying cause that may itself require treatment, such as a tumor.

Q: Any other advice to people who are concerned about Jacksonian seizures?

A: Jackson seizures are a type of seizures seen in patients with focal (localized) epilepsy. Talk to your neurologist or epileptologist about your symptoms. Obtain a clear diagnosis and talk with your neurologist or epileptologist about appropriate management plan.

Authored by: Selim R. Benbadis MD | Curtis Keller MD | Lingling Rong MD on 6/2013

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