Motor phenomena observed during psychomotor attacks, manifested in the form of tonic posture or dystonic installation of limbs, as well as tonic rotation of the head and eyes.
Autonomic symptoms during psychomotor attacks are diverse: pallor or facial flushing, hypersalivation, sweating, mydriasis, etc.
So, the main clinical manifestations of psychomotor attacks are: – Aura;
- automatism;
- impaired consciousness and lack of response to the environment;
- amnesia;
- motor symptoms;
- vegetative symptoms.
Both simple and complex partial paroxysms may be accompanied by secondary
generalization.
Ii. Generalized epileptic seizures are divided into:
a) absans;
b) myoclonic; c) clonic;
d) tonic;
e) tonic-clonic; e) atonic seizures.
Absansa – generalized seizures, accompanied by short-term loss of consciousness, cessation of gaze and the presence of specific patterns in the form of generalized regular spike-wave complexes with a frequency of 3-3.5 Hz on the EEG.
For simple absences are characteristic:
1) sudden start and end;
2) complete, but short-term (5-10 seconds) loss of consciousness;
3) stop gaze;
4) interruption of voluntary motor activity;
5) the absence of falls and pathological movements;
6) provocation of the attack for hyperventilation;
7) a significant frequency of attacks during the day – dozens, a series of attacks. Complicated absences include signs of simple absences combined with clonic,
atonic, tonic components, automatisms (see the chapter “Absanse forms of epilepsy”). Unlike typical absences, atypical ones are characterized by a more gradual onset and
end, longer duration, less profound impairment of consciousness, lower frequency, the presence of post-attack confusion.
Generalized myoclonic seizures
The term “myoclonus” suggested Friedreich in 1881. Myoclonus is a sudden involuntary muscle contraction of a neurogenic nature. Epileptic myoclonus is a rapid muscular contraction caused by the involvement of the central nervous system and combined with the depolarization and hyperpolarization potentials of cortical neurons (Serratosa, Delgado-Escueta, 1993). Generalized myoclonic paroxysms are characterized by bilateral, minor or massive short myoclonias.
Generalized clonic seizures – generalized convulsive paroxysms, combined with repeated bilateral clonic jerking of the limbs. In some cases, a generalized clonic seizure enters the tonic phase, as a result of which clonic-tonic-clonic seizures may occur.
Generalized tonic seizures are characterized by tonic muscle tension, depending on the anatomical localization, these seizures are divided into axial, axoristic, global. Tonic axial seizures are accompanied by the involvement of the muscles of the trunk (axial), and often the muscles of the neck, chewing and facial muscles. With the involvement of the respiratory muscles and abdominal muscles, there is a short-term respiratory failure.
Tonic axorisometic seizures begin similarly to tonic axial paroxysms, but then spread to the proximal extremities.
Global tonic seizures are characterized by the involvement of the axial muscles, as well as the muscles of the proximal and distal limbs.
Generalized tonic-clonic seizures
The earliest descriptions of generalized tonic-clonic seizures are found in ancient Egyptian hieroglyphs dating back to 700 BC.
Generalized tonic-clonic seizure includes 5 phases:
1) the phase of prodromal symptoms is accompanied by headache, mood changes, anxiety, anxiety, drowsiness, etc .;
2) pre-tononic-clonic phase. The most common symptom immediately preceding the development of paroxysm is single clonic jerking. Sometimes there can be a turn of the head and eyes to the side;
3) the tonic-clonic phase begins with a short tonic tension of the axial muscles, accompanied by abduction of the eyeballs upwards and dilation of the pupils. Then the muscle tension quickly spreads to the limbs. The transition of the tonic phase to the clonic phase occurs gradually. During the clonic phase, repeated symmetric clonic twitches of the limbs are noted;
4) the early post-attack phase is accompanied by the restoration of respiration, often by involuntary urination;
5) the phase of post-attack recovery is characterized, as a rule, by immediate sleep. On waking, the patient experiences weakness, fatigue, and headache.
Generalized atonic seizures are characterized by a sudden decrease in muscle tone throughout the body or parts of the body, which may be accompanied by a fall. Atonic attacks have a short duration (1-2 seconds) and varying degrees of severity – from light nods of the head to a sudden fall. These seizures are accompanied by a brief impairment of consciousness, post-attack confusion is rarely observed.