The structure of this site reflects the importance of seizure type, syndrome, and etiology in

clinical practice. On this website, you will find current classification concepts for seizures,
with their clinical features, video examples, EEG correlate, differential diagnosis and related
epilepsy syndromes. Epilepsy syndromes are detailed by their clinical features, seizure
types, EEG, imaging and genetic correlates and differential diagnoses. The site includes
sections on etiologies of epilepsies and epilepsy imitators with cross-referencing between
these sections and seizure and syndrome sections.

Definition of epilepsy
Epilepsy is a disease of the brain defined by any of the following conditions:

At least two unprovoked (or reflex) seizures occurring more than 24 hours apart

One unprovoked (or reflex) seizure and a probability of further seizures similar to the
general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the
next 10 years

Diagnosis of an epilepsy syndrome

Epilepsy is considered to be resolved for individuals who had an age-dependent self-limited

epilepsy syndrome but who are now past the applicable age, or for those who have remained
seizure-free for the last 10 years, with no seizure medication for the last 5 years.

SEIZURE CLASSIFICATION
A seizure is a transient occurrence of signs and/or symptoms due to abnormal excessive or
synchronous neuronal activity in the brain. A seizure does not necessarily mean that a
person has epilepsy. Seizures fall broadly into two main groups: focal and generalized,
although these categories may not be suitable to describe all seizures. The term 'features'
will be used in this EpilepsyDiagnosis.org to describe both the signs and symptoms that
occur during seizures.

GENERALIZED SEIZURE
A generalized seizure is conceptualized as originating at some point within, and rapidly
engaging, bilaterally distributed networks. Such bilateral networks can include cortical and
subcortical structures, but do not necessarily include the entire cortex. Although individual
seizure onsets can appear localized, the location and lateralization are not consistent from
one seizure to another. Generalized seizures can be asymmetric.

CONVULSIVE
Generalized convulsive seizures are typically bilateral and symmetric although variants with
asymmetry including head and eye deviation can be seen. A tonic clonic seizure is a
seizure consisting of a tonic and a clonic phase, typically in this order, however variations
such as clonic-tonic-clonic are also seen. Aclonic seizure is a seizure involving bilaterally
rhythmic jerking and may occur alone or in combination with tonic activity where there is
bilaterally increased tone of the limbs typically lasting seconds to a minute. The jerking in a
clonic seizure is more sustained and rhythmic than seen in a myoclonic seizure.

ABSENCE - TYPICAL
A typical absence seizure is a generalized seizure with abrupt onset and offset of altered
awareness which can vary in severity (see specific syndromes). Memory for events during
the seizures is usually impaired although there may be some retained awareness particularly
for adolescents. Clonic movements of eyelids, head, eyebrows, chin, perioral or other facial
parts may occur, most typically at 3Hz. Myoclonus of limbs can rarely occur. Oral and manual
automatisms are common and there may be perseveration of behaviors occurring prior to
seizure onset. Absence seizures were previously known as 'petit mal' seizures. Absence
status epilepticus can occur.
CAUTION Individual absence seizure longer than 45 seconds or with a post-ictal phase

consider focal seizure.

CAUTION Onset of absence seizures < 4 years

consider glucose transporter disorders.

MYOCLONIC ABSENCE
Rhythmic myoclonic jerks of the shoulders and arms with tonic abduction that results in
progressive lifting of the arms during the seizure. The myoclonic jerks are typically bilateral
but may be unilateral or asymmetric. Perioral myoclonias and rhythmic jerks of the head and
legs may occur. Seizures last 10-60 seconds and typically occur daily. Level of awareness
varies from complete loss of awareness to retained awareness.

ABSENCE WITH EYELID MYOCLONIA

Absence seizures accompanied by brief, repetitive, often rhythmic, fast (4-6 Hz) myoclonic
jerks of the eyelids with simultaneous upward deviation of the eyeballs and extension of the
head. Seizures are typically very brief (<6s in duration) and multiple seizures occur on a daily
basis. Mostly awareness is retained.
CAUTION If myoclonic seizure with abduction of the upper limbs

seizures

myoclonic absence

ABSENCE - ATYPICAL
An atypical absence seizure has less abrupt onset and offset of loss of awareness than
typical absence seizures. They are often associated with other features such as loss of
muscle tone of the head, trunk or limbs (often a gradual slump) and subtle myoclonic jerks.
Atypical absence seizures often occur in individuals with intellectual impairment.The loss of
awareness may be minimal with the patient continuing an activity, but more slowly or with
mistakes.
CAUTION These seizures can be difficult to recognize in a patient with ongoing slow (<2.5 Hz)

generalized spike-and-wave on EEG, careful correlation between EEG and clinical state is
recommended.

TONIC
A generalized tonic seizure involves bilaterally increased tone of the limbs typically lasting
seconds to a minute. They often occur out of sleep and in runs of varying intensity of tonic
stiffening. The individual is unaware during these events. At the beginning of tonic seizures
with more intense stiffening, individuals may make an expiratory sound. More severe and
prolonged tonic seizures may have a vibratory component which may be confused with clonic
jerking. Tonic seizures often occur in individuals with intellectual impairment.
CAUTION Although asymmetry can occur in a generalized tonic seizure, if consistent focal

features are seen from seizure to seizure

consider focal seizure involving the frontal lobe.

NOTE Tonic seizures are one type of seizure that can result in a "drop attack" (also known as

astatic seizure), other causes of drop attacks include myoclonic (especially in younger
children), atonic and myoclonic-atonic seizures.

ATONIC
An atonic seizure involves sudden loss or diminution of muscle tone without apparent
preceding myoclonic or tonic features. Atonic seizures are very brief (<2 seconds) and may
involve the head, trunk or limbs. Atonic seizures often occur in individuals with intellectual
impairment.
NOTE Atonic seizures are one type of seizure that can result in a "drop attack" (also known as

an astatic seizure), other causes of drop attacks include myoclonic (especially in younger
children), tonic and myoclonic-atonic seizures.

MYOCLONIC

A myoclonic seizure is a single or series of jerks (brief muscle contractions). Each jerk is
typically milliseconds in duration. Myoclonic status epilepticus is characterized by ongoing (>
30 minutes) irregular jerking, often with partially retained awareness.
NOTE Myoclonic seizures are one type of seizure that can result in a "drop attack" (also

known as astatic seizure), other causes of drop attacks include tonic, atonic and myoclonicatonic seizures.