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  • Updated 12.06.2023
  • Released 12.06.2023
  • Expires For CME 12.06.2026

Autonomic seizures



Subjective and objective autonomic alterations frequently occur as either ictal or postictal phenomena in epileptic seizures. However, to be classified as autonomic, a seizure must present with autonomic alterations at its very onset (focal-onset autonomic seizure according to the International League Against Epilepsy [ILAE]) (47). When autonomic symptoms occur during a seizure course, the seizure should be classified according to the symptoms (motor, sensitive, cognitive, etc) that present at its onset.

Autonomic symptoms may be either only subjectively experienced or objectively observed; in both cases, they may occur with or without impairment of awareness. Autonomic symptoms may be the unique manifestations of the seizure (also called “autonomic aura”) or may be followed by symptoms other than autonomic, including bilateral tonic-clonic seizures, as a result of the spreading of the epileptic discharge. Of note, autonomic seizures causing ictal asystole of more than 5 seconds may result in loss of body tone, stiffening, or tonic-clonic movements by causing a reduced brain perfusion.

Autonomic seizures result from a perturbation of the central autonomic network due to an epileptic discharge, in most cases arising from temporal lobe mesial structures. Cardiovascular symptoms are reportedly the most frequent autonomic manifestations; however, the clinical picture of autonomic seizures is very heterogeneous, consisting of any kind of autonomic symptom.

Autonomic seizures occur very frequently in the context of mesial temporal lobe epilepsy (MTLE) and represent the unique manifestation of a peculiar epileptic syndrome in children known as Panayiotopoulos syndrome or early-onset benign occipital epilepsy, now named self-limited epilepsy with autonomic seizures (SeLEAS). This syndrome is comprehensively addressed in a separate MedLink Neurology article.

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