A reflex seizure occurs as a direct response to a particular stimulus or event.
These seizures are experienced by approximately 6 per cent of people with epilepsy. They can be triggered by visual stimulation, a sudden “startle,” or a variety of other factors alone or in combination.
If a patient only has seizures as a result of a certain stimulus, then it is possible to control them by avoidance rather than through pharmaceutical means.
(Pseudo-seizures)
Psychogenic seizures are not classified as a form of epilepsy. They affect between five and 20 per cent of people thought to have epilepsy. Psychogenic seizures can occur at any age, but are more common in people under the age of 55. They occur three times more frequently in women than men. They may arise from various psychological factors, may be prompted by stress, and may occur in response to suggestion.
Such disorders may be self-induced to get attention, to be excused from work, to collect financial compensation, or merely to escape an intolerable social situation. They seldom occur in the absence of others. Trauma related to physical illness has been found to trigger these seizures in elderly individuals. People with early-onset psychogenic seizures often have a history of sexual abuse.
Psychogenic seizures can be characterized by features common with epilepsy like writhing and thrashing movements, quivering, screaming or talking sounds, and falling to the floor. Psychogenic attacks differ from epileptic seizures in that out-of-phase movements of the upper and lower extremities, pelvic thrusting, and side-to-side head movements are evident. However, psychogenic seizures vary from one occurrence to another and are not readily stereotyped.
Indicators like pupillary dilation, depressed corneal reflexes, the presence of Babinski responses, autonomic cardiorespiratory changes, tongue biting and urinary/fecal incontinence are more probable with epilepsy. These are not usually manifested in psychogenic seizures.
Psychogenic seizures may last a couple of minutes or hours, ending as abruptly as they began. A person may experience anxiety prior to an attack, followed by relief and relaxation afterwards. This leads some to postulate that psychogenic seizures may occur as a direct response to stress in order to relieve tension. Afterwards, patients usually have a vague recollection of the seizure, without the usual postictal symptoms of drowsiness and depression.
It is difficult to differentiate between psychogenic and epileptic seizures. One highly reliable indicator of a psychogenic seizure is eye closure during the seizure. When people with epilepsy have seizures, the eyes tend to remain open. Still, statistics indicate that in 20 to 30 per cent of cases, epileptologists are incorrect in attempting to distinguish one from the other.
Although psychogenic seizures are not caused by electrical discharges in the brain and thus do not register any EEG abnormalities, they are often mistaken for epileptic disorders. It is also possible to have both psychogenic seizures and epilepsy. Most patients with psychogenic seizures are misdiagnosed and consequently treated with epilepsy drugs or other epilepsy therapies, sometimes with severe and fatal side effects.
Medications are ineffective in the treatment of psychogenic disorders. Patients who are diagnosed with psychogenic seizures are usually referred to a therapist, to learn to control stress and become familiar with coping techniques. Since the vast majority of psychogenic seizures operate on a psychological level, behavioural manipulation methods may be used.
Nocturnal seizures are usually tonic-clonic. They might occur just after a person has fallen asleep, just before waking, during daytime sleep, or while in a state of drowsiness. People who experience nocturnal seizures may find it difficult to wake up or to stay awake. Although unaware of having had a seizure while asleep, they may arise with a headache. They may have temper tantrums or other destructive behaviour throughout the day.
Nocturnal seizures are very uncommon and their mechanisms poorly understood. The majority of people with nocturnal seizures have idiopathic epilepsy. There is evidence that sleep enhances epileptic discharges in the EEG, though their daytime recordings may appear to be normal. If a pattern of limiting seizures to the hours of slumber is maintained, the chance of them occurring during the daytime is greatly reduced.
Phenytoin may be used to control, or perhaps prevent, nocturnal seizures.
Neonatal seizures occur in babies soon after birth. As many as 1.5 to 2.5 per cent of newborns have seizures in the first month of life. A further 20 per cent of all seizures in children under three years of age are neonatal seizures.
Neonatal disorders are generally classified as subtle, clonic, tonic, and myoclonic.
Subtle attacks are characterized by apneas with cyanosis or hypertonia, episodes of pallor, fixed staring, conjugate eye deviation, finger movements, paroxysmal eye blinking, nystagmus, vasomotor changes, episodic chewing movements, or stereotypic limb movements such as swimming or bicycling motions. Drooling and unusual alertness may accompany neonatal seizures.
While these abnormal behavioural patterns in infants correspond to their seizure types, not all such clinical events are consistently related to EEG discharges. This means not all cases are epileptic in origin.
Neonatal seizures can have many causes, including various metabolic problems, brain damage, or a lack of oxygen during the prenatal period. Cerebral dysmorphism, prenatal infection and vascular occlusion, maternal drug abuse, and a family history of epilepsy can complicate the newborn’s health and may increase the risk of seizures. Furthermore, the seizures themselves may impede brain growth, resulting in cerebral palsy, mental retardation, or epilepsy at a later time.
Benzodiazapines, phenobarbital, and phenytoin may be used to control neonatal seizures. Phenobarbital remains the drug of choice.
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