Pediatric emergency medicine trisk 2610 2610
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movements occur. The child is unresponsive during the seizure and remains so
postictally for a variable period. After the seizure, there may be weakness or
paralysis of one or more areas of the body (Todd paralysis). In atonic, or akinetic,
seizures (drop attacks), there is abrupt loss of muscle tone and consciousness.
Myoclonic seizures are characterized by a sudden dropping of the head and
flexion of the arms (jackknifing); however, extensor posturing may also occur.
The episodes occur quickly and frequently, as often as several hundred times
daily.
TABLE 97.2
SEIZURE TYPES
Generalized
Partial (focal)
Absence (petit mal)
Typical
Atypical
Tonic–clonic (grand mal)
Clonic
Tonic
Myoclonic
Akinetic/atonic (drop attacks)
Simple (no impaired consciousness)
Motor
Sensory
Autonomic
Psychic
Complex (impaired consciousness)
Partial seizures becoming partially
generalized
Absence (petit mal) seizures are generalized seizures, marked by sudden and
brief loss of awareness, usually lasting 5 to 30 seconds. With typical absence
seizures, there is no loss of posture or tone and no postictal confusion. There may
be a minor motor component such as eyelid blinking.
The child with simple partial (focal) seizures has unimpaired consciousness.
Motor signs are most common in children, although sensory, autonomic, and
psychic manifestations are possible. The motor activity usually involves the
hands or face and spreads in a fixed pattern determined by the anatomic origin of
the nerve fibers that innervate the various muscle groups. Focal seizures may
become secondarily generalized, in which case there will be alteration of
consciousness. Complex partial seizures, also called psychomotor or temporal
lobe seizures, exhibit a diverse set of clinical features, including alterations of
perception, thought, and sensation. In children, they are usually marked by
