Seizure Types: A Clinical Overview

Concise, clinic-first summaries of common epilepsy syndromes with hallmark features, work-up cues, and treatment notes.

Topic: Epilepsy Level: Intro / Intermediate Tags: temporal-lobe, frontal-lobe, JME, BRE, absence, LGS, Landau-Kleffner, PNES

Overview

Accurate seizure classification shapes testing and therapy. Look for stereotypy, state of awareness, focal signs, triggers, and EEG/MRI patterns. When the picture is inconsistent or drug‑refractory, reassess the diagnosis.

Clinician tip: Video‑EEG monitoring is the gold standard when the diagnosis is uncertain or PNES is suspected.

Syndromes & hallmark features

Temporal Lobe Epilepsy

Features: aura (fear, déjà vu, odors), staring, automatisms; may generalize. Tests: MRI ± hippocampal sclerosis; EEG can be normal. Tx: ASMs; surgery for drug‑resistant cases.

Frontal Lobe Epilepsy

Features: nocturnal, brief motor spells with posturing/vocalizations. Etiology: structural or genetic. Tests: EEG/MRI variable. Tx: ASMs; consider surgery.

Juvenile Myoclonic Epilepsy (JME)

Features: morning myoclonus; ± absence or GTC seizures. Triggers: sleep loss, photic. EEG: generalized, photosensitive. Course: lifelong. Tx: valproate, levetiracetam, lamotrigine.

Benign Rolandic Epilepsy (BRE)

Features: focal facial twitch, speech arrest, drooling; awareness often intact. EEG: centrotemporal spikes. Course: self‑limited (2–4 yrs). Tx: often none unless frequent or developmental effects.

Absence Epilepsy

Features: brief staring (<10 s), minimal postictal; provoked by hyperventilation; eyelid flutter possible. EEG: 3‑Hz spike‑and‑wave. Atypical: longer, with motor features; slow spike‑wave/polyspikes.

Lennox–Gastaut Syndrome (LGS)

Features: multiple seizure types incl. atonic “drop attacks.” EEG: slow (<3 Hz) spike‑and‑wave. Course: persistent; cognitive/behavioral impairment common. Tx: often refractory; polytherapy ± device therapy.

Landau–Kleffner Syndrome

Features: language regression ~age 4; seizures vary and often remit. EEG (sleep): continuous spikes (ESES). Outcome: language/cognitive deficits may persist.

Psychogenic Nonepileptic Seizures (PNES)

Clues: variable semiology, stress‑linked, no EEG correlate, no ASM response. Note: temporal/frontal lobe epilepsy may be misdiagnosed as PNES—use video‑EEG.

Key differences at a glance

Item What to look for Why it matters
Stereotypy Highly similar spells each time Favors epileptic seizures over PNES
State Nocturnal, brief, hypermotor Suggests frontal lobe epilepsy
Triggers Sleep loss, photic stimulation Supports JME/absence epilepsies
EEG signature 3‑Hz spike‑wave; centrotemporal spikes Absence (3‑Hz); BRE (centrotemporal)

Work-up snapshot

  • Detailed semiology + witness/video; assess awareness and postictal state.
  • EEG (± photic, hyperventilation); consider ambulatory or inpatient video‑EEG.
  • MRI brain for focal features, new deficits, or refractory seizures.
Red flag: Frequent atonic “drop attacks” → injury risk; consider protective measures and expedited therapy.

Treatment snapshot

  • ASM selection: tailor to syndrome and comorbidities (e.g., valproate/LEV/LTG for JME).
  • Drug‑resistant focal epilepsy: surgical/neuromodulation evaluation.
  • PNES: avoid ASMs; pursue psychotherapeutic approaches after confirmed diagnosis.
Pearl: Revisit the classification if seizures persist despite two appropriately chosen ASMs.

References

  1. ILAE classification resources and practical clinical reviews (syndrome‑specific).

Educational discussion. Not a substitute for clinical judgment. Consider local protocols and individual factors.