Types of Epilepsy
Seizures are considered a symptom of a broad group of diseases referred to as epilepsy. While there are many different types of seizures, there are also many different types of epilepsy. Additionally, one epilepsy syndrome can have different seizure types. The Mount Sinai Epilepsy Center provides diagnostic and treatment expertise for all types of epilepsy and seizures.
Focal epilepsy seizures are caused by abnormal electrical activity in only one part of the brain and include:
- Benign childhood epilepsy with centrotemporal spikes (also known as benign rolandic epilepsy): This condition affects children 3-13 years of age. Children with this condition often experience seizures just after falling asleep or before awakening. They may experience numbness or “pins and needles” sensation around one side of the mouth or stiffening/twitching of the face, lips, or tongue. Sometimes these seizures then spread to the rest of the body. In addition, some children may have subtle difficulties with language, focus, and concentration. Many will only have a single seizure; rarely are seizures frequent. Therefore, treatment may not be recommended after a single seizure.
- Benign occipital epilepsy: Children with this condition may see bright flashing lights, which can be followed by a headache. This condition is difficult to distinguish from a classic migraine. Some cases of occipital epilepsy cause seizures with nausea, vomiting, and low blood pressure.
- Frontal lobe epilepsy: This is the second most common partial epilepsy in adults. Seizures may manifest as bizarre behaviors such as bicycling. Confusion following such events is often short-lived, if present at all.
- Parietal lobe epilepsy: Seizures of parietal lobe may begin with a tingling or crawling feeling in the skin, a feeling of fear, or vertigo. If they are located on the language-dominant side of the brain, they can result in language dysfunction. People with parietal lobe epilepsy may also experience visual hallucinations, panic attacks, and behavioral arrest (when the body suddenly becomes completely still or rigid). They may encounter localized twitching of a body part and/or alteration of consciousness.
- Temporal lobe epilepsy: This is the most common partial epilepsy in adults. People with temporal lobe epilepsy may experience a feeling of “butterflies in the stomach,” an out-of-body sensation, déjà vu, fear/paranoia, or they may smell/taste things that others do not. Unusual repetitive movements of the hands and mouth may also be present. During a seizure, people with this condition may adopt a stiff posture. Afterwards, they are often confused.
Generalized epilepsy seizures are caused by abnormal electrical activity on both sides of the brain and include:
- Acquired epileptic aphasia (also known as Landau-Kleffner syndrome): In this syndrome, children develop normally for at least the first two years of life and then suffer a loss of language, which is associated with epilepsy. Symptoms become apparent between 3-8 years of age. Typically, people with this condition experience multiple seizure types, and these episodes can occur even while they sleep. Treatment is often effective at controlling seizures, though speech recovery is variable.
- Childhood absence epilepsy: This syndrome typically begins between 4-10 years of age and affects 2-8 percent of people with epilepsy. Seizures manifest as staring spells that last about 10 seconds, with little to no confusion afterwards. They are sometimes accompanied by small movements or jerks. Seizures are characteristically induced by breathing quickly and deeply. This syndrome is highly responsive to medication and rarely persists into adulthood.
- Epilepsy with grand mal upon awakening: This syndrome often begins between 10-20 years of age and features generalized tonic-clonic seizures that tend to occur shortly after awakening and also in the evening during relaxation. People with this condition are sensitive to sleep deprivation and flashing lights. In many cases, there is a family history of epilepsy.
- Juvenile myoclonic epilepsy: This syndrome affects about 10 percent of people with epilepsy and typically begins between 12-18 years of age. Often there is a family history of epilepsy in people affected by this condition. The affected persons or their families often notice jerky movements or “clumsiness,” particularly in the morning and especially after a poor night’s sleep. In addition to jerks (myoclonic seizures), they are often affected by absence seizures and generalized tonic-clonic seizures. People with juvenile myoclonic epilepsy are particularly susceptible to flashing lights, fatigue/sleep deprivation, and alcohol. It is important to get this condition diagnosed since antiepileptic drug therapy controls seizures in most cases. Lifelong therapy is recommended as seizures can return even after prolonged periods of seizure freedom.
- Lennox-Gastaut syndrome: Children affected with Lennox-Gastaut syndrome suffer multiple types of seizures, developmental disabilities, and have characteristic electroencephalography (EEG) findings. They often present with symptoms between 1-8 years of age, most commonly between the ages 3 and 5. There is frequently a history of delayed cognitive functioning prior to presentation. The seizures can include staring spells, tonic (stiffening) seizures, atonic seizures (drop attacks), myoclonic seizures (body jerks), or tonic-clonic seizures (stiffness followed by shaking). Seizure control is difficult and cognitive/behavioral dysfunction is common. Few are able to lead independent adult lives.
- West syndrome: West syndrome is characterized by seizures, developmental arrest, and characteristic EEG findings. It typically begins between 4-8 months of age, although it can begin earlier and has rarely been reported to begin in adulthood. Associated structural or genetic abnormalities are common. The characteristic seizures of West syndrome, referred to as “infantile spasms,” often consist of a jerk that causes the baby to flex the head and raise the arms. These seizures may evolve into difficult-to-treat partial epilepsy or Lennox-Gastaut syndrome (in which case developmental disabilities are almost always seen). Aggressive treatment of this seizure type is warranted, as some infants can develop normally without seizures. Prognosis varies from typical or near-typical development to epilepsy that is difficult to manage to death. Many underlying conditions can cause West syndrome including tuberous sclerosis, intrauterine infections, Aicardi’s syndrome, and metabolic syndromes.
Progressive Myoclonic Syndromes
This is a diverse group of rare disorders that shares a common seizure type (body jerking, or myoclonus) and includes Lafora disease, myoclonic epilepsy with ragged red fibers (MERFF), neuronal ceroid lipofuscinoses, Unverricht-Lundborg disease (also known as Baltic myoclonic epilepsy), sialidosis, and dentatorubral-pallidoluysian atrophy (DRPLA). Family history of epilepsy is common in most cases, as are various other neurological symptoms. Other seizure types in addition to myoclonus are common.
This a broad category of epilepsy refers to seizures that can be reliably triggered by forces in the environment, such as flashing lights, certain visual patterns, reading, or certain sounds. These seizures may impact one part of the brain or both sides.
The Mount Sinai Epilepsy Center
1468 Madison Avenue
Annenberg 2nd floor
New York, New York 10029
Pediatric Epilepsy Monitoring Unit (EMU)
Kravis Children’s Hospital at Mount Sinai
1184 Fifth Avenue, Fourth Floor
New York, NY 10029
1000 10th Avenue, Suite 10G
New York, NY 10019