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The difference between focal and generalized epilepsy: how to quickly identify them?
In neurology, seizure types are classified based on seizure behavior, symptoms, and diagnostic tests. The 2017 classification of epileptic seizures by the International League of Epilepsy (ILAE) has become the international standard for understanding these seizure types. This classification is a revision of the 1981 ILAE classification. It is important to distinguish between different types of epileptic seizures, because different seizure types may have different causes, consequences, and treatments.
Epilepsy is an episodic event of symptoms or behavior caused by abnormal, excessive or synchronized activity of brain neurons.
Historical background
As early as 2500 BC, the Sumerians provided the first documentation of epileptic seizures. Later, in 1050 BC, Babylonian scholars created the first classification of epileptic seizures and inscribed their medical knowledge on a stone tablet called Sakikku, or "All Diseases" in English. This early classification described febrile seizures, absent seizures, generalized tonic-clonic seizures, focal seizures, seizures with impaired consciousness, and status epilepticus. .
Over time, people such as Samuel-Auguste Tissot and Jean-Étienne Dominique Esquirol further classified and described epilepsy and introduced different terms.
The difference between focal and generalized epilepsy
Focal seizures originate from the neural network of one cerebral hemisphere, while generalized seizures originate from both sides of the brain and rapidly spread to both sides. Symptoms, behaviour, neuroimaging and electroencephalography (EEG) testing of both seizure types help professionals differentiate between them. Without enough information, "unknown onset seizures" can occur.
Focal to bilateral tonic-clonic seizures means that the seizure started as a focal epilepsy and then evolved into a bilateral tonic-clonic seizure.
The role of consciousness in epileptic seizures
The classification of epilepsy also distinguishes between focal seizures with clear consciousness and focal seizures with impaired consciousness. In a conscious seizure, the patient has a clear understanding of themselves and their surroundings, whereas impaired consciousness prevents the patient from recalling events that occurred during the seizure.
Whenever the degree of consciousness cannot be determined, it can be called an epileptic seizure of unknown consciousness.
Motor and non-motor seizures
Motor seizures have prominent motor features, whereas non-motor seizures may begin with sensory, cognitive, autonomic, or emotional symptoms. Motor epilepsy includes catalepsy, clonic, myoclonic seizures, etc., while non-motor epilepsy may be accompanied by changes in sensation or mood, and may even cause a brief loss of consciousness.
Scope of ILAE 2017 epilepsy seizure classification
ILAE 2017 classification of epilepsy seizures clearly includes three types of focal epilepsy: seizures with clear focus, seizures with impaired focus, and seizures with unclear focus. This classification system is designed to provide a clearer diagnostic path and help doctors develop personalized treatment plans.
The type of epileptic seizure not only affects the choice of treatment, but also affects the patient's quality of life.
Conclusion
Given the diversity of epilepsy, the ability to correctly identify focal versus generalized seizures is extremely important. This not only helps understand the patient’s specific condition but also allows for effective treatment planning. As neuroscience advances, we can expect to gain a more comprehensive understanding of epilepsy in the future and improve the quality of care for patients. However, with these medical terms and classification systems, can we delve deeper into the true causes behind epileptic seizures and their potential impact on patients’ lives?
