Classification of causes of seizure syndrome
All causes of seizures in children are divided into primary neurological and extracerebral. Truly neurological causes are associated with organic lesions of the central nervous system: these include congenital anomalies, genetic disorders, neuroinfections, trauma, hypoxic damage, tumors, and vascular pathologies.
Secondary and triggering factors include hyperthermia, acute infections, severe somatic diseases, metabolic disorders, and intoxications. For example, hypoglycemia, hypocalcemia, and hypomagnesemia act as important metabolic triggers that must be ruled out first.
Generalized tonic-clonic seizure: phases and manifestations
A classic generalized tonic-clonic seizure (grand mal) proceeds with a sudden loss of consciousness and a strict sequence of phases:
- Tonic phase: sudden loss of balance, sharp contraction of all muscles, cessation of breathing, and facial discoloration (from pallor to cyanosis), lasting up to 40 seconds.
- Clonic phase: rhythmic muscle contractions and relaxations, foaming at the mouth, involuntary elimination against the background of persistent cyanosis.
- Postictal period: restoration of consciousness transitioning into somnolence—a state of deep obtundation and drowsiness lasting several hours.
Mental disorders and disease course
In childhood epilepsy, acute psychoses may be observed, including twilight states of consciousness with complete amnesia of the period and paroxysmal psychoses of religious or fantastic content. Chronic psychoses are less common and characterized by mundane delusions.
The course of the disease in most cases is progressive with an increasing frequency of seizures. However, there are also favorable variants: onset at age 5–13 years, typical absences without aura, good response to monotherapy, and absence of interictal electroencephalographic changes.
The order of grand mal phases: first the body stiffens (tonic), then it twitches rhythmically (clonic). The reverse order never occurs!
Class and exam questions
How does true epilepsy differ from other seizure states?
The key diagnostic criterion for epilepsy as an independent nosological entity is recurrent and unprovoked seizures.
Why is aspirin contraindicated in children with viral infections?
Taking acetylsalicylic acid during a viral infection can trigger Reye's syndrome—an acute hepatic encephalopathy with fatty degeneration of the liver and brain.
What are the main differences between epileptic and schizophrenic psychoses?
Epileptic psychoses are characterized by a sudden onset, short duration, stereotypy of seizures, and most importantly—the complete absence of negative symptoms specific to schizophrenia.
What else to study on this topic
- Hereditary factors and inheritance patterns in epileptic syndromes
- Electroencephalographic picture and specific activity patterns
- Features of febrile seizures and their distinction from epilepsy
- Differential diagnosis of metabolic disorders in the neonatal period
- Atypical seizure variants and Lennox-Gastaut syndrome
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