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

Epileptic seizures can be of many types, the most common being to end up on the ground trembling and losing consciousness. Even so, there is a specific type of crisis in which this does not happen: jacksonian epileptic seizure.

These types of epileptic seizures can be so subtle that the person does not even realize that they are suffering. a crisis, since sometimes you just feel a kind of tingling and confusion rarely occurs.

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

• Related article: "Epilepsy: definition, causes, diagnosis and treatment"

What is the Jacksonian epileptic seizure?

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

The crisis is usually propagated following the order of somatotopic representation of the area of ​​the cerebral cortex that is affected, which has areas that are responsible for movements volunteers.

Normally, the crisis begins by affecting only a small part of the body, usually a finger or toe or the corners of the mouth. As the crisis progresses, the symptoms become more worrisome, moving to other regions of the body.

What makes this type of epileptic seizure so characteristic is that there are usually no seizures. They are called "Jacksonian" because it was 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 epileptic seizures occur when this activity occurs in a specific area of ​​the brain. However, on many occasions, this activity gradually 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 the simple seizures, which would not affect consciousness or memory, and on the other hand we have the complex ones, which do affect these two cognitive domains. Jacksonian epileptic seizures are included within simple seizures.

Causes

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

Among the main causes that may be behind a Jacksonian epileptic seizure is suffering from multiple sclerosis. Another cause behind this type of crisis is the lack of oxygen to the brain (hypoxia), having suffered a head injury and injuries to the frontal lobe. They may also be due to atriovenous malformations.

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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 with a small region and moving to the rest of the body.

Among the first symptoms that we can find we have weakness in one finger that later moves 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 because these types of crises are usually short and moderate, so mild that sometimes not even the person is aware that they have just suffered one. Another thing that stands out about this crisis is that, unlike most of them, there is no brief period of confusion after having suffered it.

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.
• Move the eyes from one side to the other.
• Numbness and tingling sensation.
• Abdominal pain or discomfort.
• Visual, olfactory and auditory hallucinations.
• Nausea.
• Redness of the face.
• Dilated pupils.
• Tachycardia.
• Fainting episodes or periods in which memory loss occurs.
• Changes in vision.
• Déjàvu (feeling as if the current place and time have already been experienced)
• Changes in mood.
• Temporary inability to speak.

Diagnosis

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

Magnetic resonance and computed tomography can be used to study the specific case. These neuroimaging techniques show where the Jacksonian epileptic seizure occurs in the brain. They also serve to see what are the possible causes behind the abnormal activity of the brain.

• You may be interested in: "Electroencephalogram (EEG): what is it and how is it used?"

Treatment

Different therapeutic options are applied to people who have suffered a Jacksonian epileptic seizure. Among the main ones is prescription of antiepileptic drugs, valproate, topiramate, vitamin B6, zonisamide, clobazam and carbamazepine. Even so, if it is known exactly which is the area of ​​the brain that presents the crisis, it is possible to intervene surgically.

Another option is to improve the patient's lifestyle, motivating him to adopt better eating habits and 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
• Cerda, J. M., Argani, M. T., Llerda, J. M., González, F. L., Puig, X. S., & Rieger, J. S. (2016). Official guide of the Spanish Society of Neurology for clinical practice in epilepsy. Neurology, 31(2), 121-129.