SYMPTOMS

What are postural seizures?

Postural seizures are a special type of epileptic seizure, classified as focal motor seizures. They are commonly seen in frontal lobe epilepsy (i.e., epilepsy originating in the frontal lobe of the brain). During an episode, patients exhibit a "fencing posture," hence the name "postural seizure."

What are the characteristics of postural seizures?

Postural seizures have the following features:

• "Fencing posture": During an episode, the patient raises one shoulder and arm with the elbow bent, while the head and eyes turn toward the same side, resembling a fencer.
• Short duration, typically lasting from a few seconds to 1 minute.
• Most commonly seen in frontal lobe epilepsy.
• Can occur at any age.
• Often progresses to generalized seizures (manifesting as loss of consciousness, muscle convulsions, falls, etc.) and may lead to "status epilepticus."

TREATMENT

Can postural seizures be relieved?

Yes. Postural seizures usually last from a few seconds to 1 minute and can resolve on their own. If it is the first episode or the seizure lasts longer than 5 minutes, seek medical attention immediately or call 120.

How to properly assist a patient during a postural seizure?

Postural seizures typically end within minutes. Witnesses can take the following steps:

• Stay calm and help others remain composed.
• Time the seizure. If it lasts longer than 5 minutes, call 120.
• Clear the surroundings of items that may entangle, are hard, or sharp. Monitor the patient's movements to prevent injury during the seizure.
• If the patient falls due to a secondary generalized seizure, gently turn them onto their side to prevent choking on secretions or vomit. Loosen buttons, ties, scarves, etc., to aid breathing. Place soft clothing under their head to prevent injury.
• If the patient briefly loses consciousness, stay with them until fully awake. After they regain consciousness, explain what happened in simple terms and offer reassurance.

Warning! Avoid doing the following:

• Do not restrain the patient or attempt to control their movements.
• Do not place anything in the patient's mouth, including water or food, after they lose consciousness.
• Do not perform mouth-to-mouth resuscitation. Patients usually resume breathing on their own after the seizure.

What are the common treatments for postural seizures?

Medication is the primary treatment for postural seizures, and anti-epileptic drugs are often effective. However, not everyone achieves complete seizure control with medication. In such cases, doctors may prescribe different drugs or combination therapy.

For patients with drug-resistant epilepsy, surgery may be considered if the seizure focus is clearly identified. Post-surgery, medication may still be required.

DIAGNOSIS

Which department should I visit for postural seizures?

Neurology.

What questions might the doctor ask during the consultation?

• Did you experience any unusual sensations before the seizure?
• Were you conscious during the seizure? Did you know you were having a seizure?
• Can you describe what happened during the seizure?
• How long did the seizure last?
• Do all seizures look the same?
• How often do the seizures occur? / How frequently do they happen?
• Can you think of any possible triggers, such as lack of sleep, head injury, etc.?
• Does anyone in your family have similar seizures?

What tests are needed for postural seizures?

• Brain imaging tests: Such as MRI or CT scans, which can help detect structural abnormalities or lesions in the brain to identify the cause early.

• Electroencephalogram (EEG): EEG monitors the brain's electrical activity through electrodes placed on the scalp and can detect abnormal epileptic discharges during seizures. Long-term video EEG not only records epileptic discharges but also captures the patient's condition during seizures, providing more diagnostic information.

• PET or SPECT: Functional brain imaging tests that reflect brain metabolism. By detecting metabolic changes in different brain regions during and between seizures, they help locate the lesion.

POTENTIAL DISEASES

What diseases can cause postural seizures?

Postural seizures are commonly seen in frontal lobe epilepsy, which can be caused by any abnormalities in the frontal lobe of the brain, such as frontal lobe tumors, frontal lobe stroke, trauma, encephalitis, etc. Additionally, a rare genetic disorder—"autosomal dominant nocturnal frontal lobe epilepsy"—can also lead to postural seizures. Other possible causes include alcoholism, lack of sleep, high mental stress, etc. For most patients with postural seizures, the underlying cause remains unknown.