PEDIATRICS Vol. 53 No. 4 April 1974, pp. 548-551
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Unusual Presentations of Epilepsies

Gregory O. Walsh M.D.1

1 Department of Nerology, UCLA Center for the Health Sciences, Los Angeles

Seizures are either focal (partial) or generalized in onset (Table I).1 The manifestation of the seizure is related to the area of the brain involved in the initial electrical seizure discharge. If the initial seizure discharge is related to the motor strip then one might see a Jacksonian type of seizure with first clonic movements of the thumb and fingers, then a march up the hand, arm, face and leg on the contralateral side of the body. If the initial seizure discharge is related to the temporal lobe then one might see impairment of consciousness and automatic movements (automatisms). The "aura" is actually the start of the electrical seizure discharge which is confined to one area of brain. The type of "aura" that a patient has is related to the area of brain involved in the seizure discharge. For example, the olfactory aura of an unusual smell may be related to a mesial temporal lobe or mesial frontal lobe discharge. The aura of an unusual taste is related to a discharge in the insular cortex. If the electrical seizure discharge spreads out to involve other areas of brain or the whole brain then the patient has a secondarily generalized major motor seizure. The important point is to recognize that the seizure was a partial onset seizure becoming secondarily generalized and therefore due to a focal etiology rather than a primary generalized seizure disorder, which affects a particular area of brain which is may be precipitated in response to some stimuli which effects a particular area of brain which is extraordinarily sensitive because of an epileptic lesion in that area.

See table in the PDF file