By Ilo E. Leppik MD
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Extra info for Epilepsy: A Guide to Balancing Your Life
These may be bilateral or unilateral and are usually seen in specific epilepsy syndromes. Consciousness is not usually impaired. However, myoclonic activity may also be associated with other neurologic disorders (Creutzfeldt–Jakob disease, anoxia). Furthermore, it may be difficult to readily categorize myoclonus. FIGURE 2-8 Generalized tonic-clonic seizure. Patient was helped to lie down on the rug. Eyes are usually open but may be blinking. 31 Epilepsy: A Guide to Balancing Your Life Tonic-clonic seizures are the most dramatic seizures and start out with the body being stiff (tonic) and then shaking (clonic) (Figure 2-8).
Epileptic seizures, on the other hand, arise from neurons that are damaged or are genetically abnormal. The major features of seizures that distinguish them from usual activity are that they are stereotypical and repetitive. In addition, they lack the typical behavioral modulations observed in voluntary behavior. For example, a clonic seizure involves maximal contraction of skeletal muscles, followed by relaxation, with the cycle usually repeating itself every few seconds. This very primitive pattern of movement accomplishes no useful function and is in marked contrast to the usual complex, modulated activity that our muscles are capable of performing.
Counseling for post-traumatic stress syndrome was instituted because it was clear that she was suffering from nonepileptic seizures of psychogenic origin. About 2 years after onset, she stopped having simple partial 37 Epilepsy: A Guide to Balancing Your Life seizures, and the dose of phenytoin was gradually reduced and then eliminated. Her dose of carbamazepine was then reduced to obtain levels of 4–6 mg/L. Over time, her propensity to have seizures decreased as the brain healed. She is now having no seizures and leading an active life with a career and a family.
Epilepsy: A Guide to Balancing Your Life by Ilo E. Leppik MD