Jacksonian seizure: what it is, symptoms, and how it evolves.

A summary of the characteristics of Jacksonian seizures and their symptoms.

Epileptic seizures can be of many types, the most common being to end up on the floor shaking and losing consciousness. However, there is a specific type of seizure in which this does not happen: the Jacksonian epileptic seizure..

This type of seizure can be so subtle that the person does not even realize that he or she is having a seizure, since sometimes there is simply a tingling sensation and rarely confusion.

Next we will see more in depth this type of epileptic phenomenon, who described it for the first time, the causes behind its occurrence, diagnosis and most common treatment.

What is Jacksonian epileptic seizure?

Jacksonian seizures are a type of partial seizure with motor symptoms. Other names for this type of seizure are focal seizure, partial (focal) seizure and temporal lobe seizure. They are characterized by first occurring in a very localized form and then spreading to other parts of the body..

The seizure usually spreads in the order of somatotopic representation of the affected area of the cerebral cortex, which has areas responsible for voluntary movements.

Normally, the seizure begins by affecting only a small part of the body, usually a finger, a toe or the corners of the lips. As the seizure progresses, the symptomatology becomes more worrisome, moving to other regions of the body.

What makes this type of epileptic seizure so characteristic is that there are usually no convulsions. They are called "Jacksonian" because they were first discovered by the English neurologist John Jackson in 1870, a scientist who intensively studied brain structure and function.

In all epileptic seizures, abnormal electrical disturbances occur at the cortical level.. Focal seizures occur when this activity occurs in a specific area of the brain. However, in many cases, this activity moves to areas bordering the affected region. This is called secondary generalization.

Partial seizures can be divided into two types. On the one hand we have simple seizures, which do not affect consciousness or memory, and on the other hand we have complex seizures, which do affect these two cognitive domains. Jacksonian seizures are included in simple seizures.

Causes

Partial seizures are the most common type of seizures in people 12 months of age and older.. In people over the age of 65, who are more likely to have cerebrovascular disease or brain tumors, these seizures are also very common.

Among the main causes that may be behind a Jacksonian seizure is multiple sclerosis. Another cause of this type of seizures is the lack of oxygen in the brain (hypoxia), having suffered a cranioencephalic trauma and frontal lobe lesions. They may also be due to atriovenous malformations.

Symptoms

There are two main symptoms that allow us to detect a Jacksonian epileptic seizure. The first is that it is a simple partial seizure, and it only occurs in one part of the body. The second is that this crisis, as we have already mentioned, progresses through the body, starting in a small region and moving to the rest of the body.

Among the first symptoms that we can find we have weakness in a finger that, later, is transferred to the rest of the hand in a few seconds..

People who suffer this type of crisis do not usually present serious damage. This is due to the fact that this type of crisis is usually short and moderate, so mild that sometimes the person is not even aware that he or she has just suffered one. Another thing that is striking about this seizure is that, unlike most seizures, there is no brief period of confusion, there is no brief period of confusion after the seizure..

Among the symptoms that we can find during the experience of a Jacksonian epileptic seizure we have:

• Automatisms, rhythmic behavior or compulsive movements.
• Cramps
• Abnormal Muscle contraction, movements in the head and extremities.
• Episodes of absences, sometimes with repetitive movements.
• Moving the eyes from one side to another.
• Numbness and tingling sensation.
• Abdominal pain or discomfort.
• Visual, olfactory and auditory hallucinations.
• Nausea.
• Reddening of the face.
• Dilated pupils.
• Tachycardia.
• Fainting episodes or periods of memory loss.
• changes in vision
• Déjàvu (feeling as if you have already experienced the current place and time).
• Changes in mood.
• Temporary inability to speak.

Diagnosis

Electroencephalograms (EEG) are usually performed to check the electrical activity of the brain.to check the electrical activity of the patient's brain. People with epileptic seizures show abnormal electrical activity in this test. This same test can show the specific area of the brain where the seizure begins. However, it may be difficult to detect the damaged lesion immediately after the seizure with this test.

MRI and CT scans can be used to study the specific case.. These neuroimaging techniques show where the Jacksonian seizure occurs in the brain. They also serve to see what are the possible causes behind the abnormal brain activity.

Treatment

There are different therapeutic options that are applied to people who have suffered a Jacksonian seizure. Among the main ones are the prescription of antiepileptic drugsValproate, topiramate, vitamin B6, zonisamide, clobazam and carbamazepine. Even so, if the exact area of the brain presenting the seizure is known, surgery can be performed.

Another option is to improve the patient's lifestyle, motivating him/her to adopt better eating habits and to exercise more, as a protection against future attacks.

Bibliographic references:

• Abou-Khalil BW, Gallagher MJ, Macdonald RL (2016). Epilepsies. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 101.
• Kanner AM, Ashman E, Gloss D, et al (2018). Practice guideline update summary: efficacy and tolerability of the new antiepileptic drugs I: treatment of new-onset epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology.;91(2):74-81. PMID: 29898971 pubmed.ncbi.nlm.nih.gov/29898971/.
• Wiebe S (2020). The epilepsies. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier:chap 375.
• Cerdá, J. M., Argani, M. T., Llerda, J. M., González, F. L., Puig, X. S., & Rieger, J. S. (2016). Spanish Society of Neurology official guideline for clinical practice in epilepsy. Neurología, 31(2), 121 - 129.