Complex partial seizure (CPS) is caused by anomalous electrical brain activity and is more prevalent in adults [1]. While generalized tonic- clonic seizures involve bilateral cerebral cortices and are associated with loss of consciousness, CPS is primarily accompanied by altered sensorium. A majority of CPSs originate in the temporal lobe and have typical symptoms compared to extratemporal seizures. CPS usually lasts for up to two minutes. The onset in a temporal lobe focus is characterized by an unblinking stare and perioral repetitive, unconscious movements called automatisms, while in frontal lobe CPSs, there are tonic-clonic, motor repetitive movements [2]. Extratemporal CPSs quickly spread to involve the frontal lobe and leads to motor symptoms identical to those seen in frontal lobe CPSs.

Other manifestations of CPS are varied and these are hallucinations (gustatory, olfactory), micropsia or macropsia, severe delusions of harm, déjà vu feelings, personality changes such as hyperreligiosity, hypergraphia, and difficulty finishing sentences [3]. Features which help to localize the side of origin of the seizures include [4] [5]:

• Postictal nose wiping - ipsilateral lobe
• Aphasia or dysphasia - dominant lobe
• Unilateral sensory aura, tonic-clonic activity, unilateral dystonia - contralateral lobe

• Anorexia

  nausea, vomiting, drowsiness, headache, dizziness Rash, Stevens-Johnson syndrome, hemopoietic complications 71.00 (750 mg per day) Felbamate Felbatol 400, 600 400 mg three times daily 400 to 600 mg per week Anorexia, vomiting, insomnia, nausea, headache [aafp.org]

• Yawning

  By Roni Caryn Rabin Ask Well Photo Credit Why Do We Yawn? Reading about yawning makes people yawn. You are probably yawning right now. By Roni Caryn Rabin [nytimes.com]

• Sore Throat

  Call your doctor right away if you experience any of the following symptoms: swelling of the face, eyes, lips, or tongue; trouble swallowing or breathing; hives; fever, swollen glands, or sore throat that do not go away or come and go; painful sores in [aptiom.com]

• Nausea

  Focal onset seizures include: Focal aware seizures During these seizures the person is aware and may experience feelings such as déjà vu, an unpleasant smell or taste, or sensations such as ‘butterflies’ or nausea. [epilepsyfoundation.org.au]

  Symptoms of liver problems include yellowing of your skin or the whites of your eyes, nausea or vomiting, loss of appetite, stomach pain, or dark urine. [aptiom.com]

  Seizures arising from the midline region of the temporal lobe can cause sensations of fear, sensations in the tummy, pallor and nausea. [epilepsyqueensland.com.au]

  In this trial, dizziness, fatigue, headache, somnolence, nausea, and vomiting were the most common side effects of the drug. Hyponatremia and cardiac disturbances remain clinically important problems. [aafp.org]

  A complex seizure can last for a minute or two, and you may feel a warning sign such as a feeling of uneasiness or nausea before the seizure. You may feel sleepy and confused after the seizure. [healthline.com]

• Hypertension

  Although rapid increases in MNSA and heart rate have been found during panic attacks, paroxysmal hypertension and loss of consciousness are not consistent features. 5 The paroxysm consisted of simultaneous hypertension and tachycardia associated with [jnnp.bmj.com]

  Hypertensive microhemorrhages Microbleeds in hypertensive patients younger than CAA ( Diffuse axonal injury (DAI) Posttraumatic hemorrhages in corpus callosum, subcortical white matter and brainstem. [radiologyassistant.nl]

  She had arterial hypertension, using propranolol irregularly, and diabetes mellitus, with no medication. She showed no abnormalities on general physical examination. [scielo.br]

  Causes of Seizures Condition Examples Autoimmune disorders Cerebral vasculitis, anti-NMDA receptor encephalitis, multiple sclerosis (rarely) Cerebral edema Eclampsia, hypertensive encephalopathy Cerebral ischemia or hypoxia Cardiac arrhythmias, carbon [msdmanuals.com]

  […] suspected lacunar stroke; seizure at stroke onset; clinical presentation suggestive of subarachnoid hemorrhage (even if the initial CT scan was normal); evidence or history of intracranial haemorrhage at any time or an intracranial neoplasm; uncompensated hypertension [richtlijnendatabase.nl]

• Prolapse

  Bulletin of the Russian Military Medical Academy. 2019;38(4):63 (Rus) Criteria for adverse prognosis for mitral valve prolapse. Ovchinnikov Y.V., Gadzhieva L.R., Palchenkova M.V., Muracheva N.V., Tkachenko S.B. [journals.eco-vector.com]

  자궁수축실조.산부 uterine infarction/자궁경색증(∼梗塞症).산부 uterine ligament/자궁인대(∼靭帶).산부 uterine myoma/자궁근종(∼筋腫).산부 uterine nerve/해부 uterine orifice/자궁구멍 uterine ostium of uterine tube/자궁관자궁구멍 uterine part/자궁부분 uterine period/자궁기 uterine polyp/자궁폴립,자궁용종산부 uterine prolapse [m.blog.naver.com]

• Visual Hallucination

  BACKGROUND: A complex partial seizure can cause a variety of visual system signs and symptoms, including visual hallucinations, dilated pupils, and changes in vision. [ncbi.nlm.nih.gov]

  For example, a focal aware seizure from the back of the brain (occipital lobe) may cause a visual hallucination, while a seizure from the side of the brain (temporal lobe) may cause a feeling of déjà vu or a strong emotion. [mountsinai.org]

  Symptoms can include: A rising feeling in the stomach Buzzing in the ear Tingling, numbness or stiffening of the arms, legs or face Visual hallucinations The feeling of déjà vu These symptoms vary for each seizure based on where it started in the brain [sharecare.com]

  […] field defects[9] Visual hallucinations (flashing lights, colors, strange patterns)[2] Can be elementary such as shapes, colors or complex hallucinations such as people, animals or scenes Can be caused by occipital lobe seizures[2] Complexity of hallucinations [eyewiki.aao.org]

  Clinical features Simple partial seizures featuring visual hallucinations, gaze deviation, and cortical blindness Transition to temporal or frontal lobe seizures (featuring the respective symptoms) is possible. [amboss.com]

• Withdrawn

  He became pale, sweaty, and mentally withdrawn but did not fall down. Recovery was rapid and associated with transient headache. Previous neurological investigations, including repeated EEG and MRI, were negative. [jnnp.bmj.com]

  Should be withdrawn slowly to minimize the potential of increased seizure frequency. July 4, 2002 [bbbautism.com]

  The patient presented no more seizures nor language alterations and, one month after discharge, the CBZ was withdrawn, using only glybenclamide. DISCUSSION We considered the patient's staring and gestual automatisms as CPS. [scielo.br]

  The first set of analyses of the treatment-failure rate included the data recorded on patients who were withdrawn early for reasons not related to the study treatment, up to the time of withdrawal; these data were censored as of the date when these patients [nejm.org]

• Euphoria

  Some symptoms of a temporal lobe seizure may be related to these functions, including having odd feelings — such as euphoria, deja vu or fear. Temporal lobe seizures are sometimes called focal seizures with impaired awareness. [mayoclinic.org]

  […] or responsiveness, i.e. alteration of consciousness.[11][6] Presentation Complex partial seizures are often preceded by an aura.[12] The seizure aura is a focal aware seizure.[12] The aura may manifest itself as a feeling of déjà vu, jamais vu, fear, euphoria [wikizero.com]

• Aggressive Behavior

  Speak calmly and softly, as any loud or aggressive behavior may agitate them. “Stay with the patient until the seizure is over, and they are safe and do not appear confused. Some people take longer to recover,” suggests Dr. Pillai. [sharecare.com]

  However, unprovoked aggressive behavior is unusual. Left temporal lobe seizures may cause verbal memory abnormalities; right temporal lobe seizures may cause visual spatial memory abnormalities. [msdmanuals.com]

• Aura

  Auras usually last just a few seconds. According to Johns Hopkins Medicine, an aura is a warning sign. These signs take on different forms. [epilepsyu.com]

  An aura may occur at the beginning of a seizure. [uofmhealth.org]

  The clinician must inquire about family history of seizures, any prior history of febrile convulsions, aura, automatisms, disorientation, or unconsciousness. [symptoma.com]

  Auras Are Warning Signs If you suffer from complex partial seizures, you will often be warned by a simple partial seizure or an aura. [livestrong.com]

  These symptoms are all a part of aura as seen in the present case. Activation of reciprocal connections between mesial and neocortical temporal cortex produce aura; epigastric aura is more often encountered in seizures of right temporal foci [13]. [hindawi.com]

• Dizziness

  The patient's memory function markedly improved during 10 months' follow-up with antiepileptic treatment, although he described brief attacks of dizziness. A repeat MRI examination showed normal findings. [ncbi.nlm.nih.gov]

  In clinical trials, the most common side effects seen in people who take KEPPRA include sleepiness, weakness, dizziness, and infection. [vimpat.com]

  Of the newer antiepileptic drugs, gabapentin has the most favorable safety profile, although it can cause somnolence, dizziness, blurred vision, and leukopenia. [aafp.org]

  Distinctive signs can include a change of emotions, involuntary movement of a particular body part, dizziness, and altered senses, such as taste and smells. Generalized onset seizures arise from both sides of the brain at the same time. [utphysicians.com]

• Jamais Vu

  It may consist of a strange smell, taste, sound, or visual disturbance, an unexplained feeling of fear or anxiety, or a sense that everything seems strangely familiar, like it has all happened before (déjà vu), or strangely unfamiliar (jamais vu). [uofmhealth.org]

  A common symptom is the experience we all know as deja vu, when we are convinced we have been somewhere or witnessed something before. Conversely, some people find very familiar things become unrecognisable - jamais vu. [charge.org.uk]

  Others say that they sense that everything seems strangely familiar as if it has all happened before (déjà vu), or that things seem strangely unfamiliar (jamais vu). [rscdiagnosticservices.com]

  (familiarity) or jamais vu (unfamiliarity) laboured speech or inability to speak at all usually the event is remembered in detail When a seizure occurs during sleep, the person will often become semi-conscious and act out a dream they were having while [wikizero.com]

• Automatic Behavior

  All complex partial seizures were associated with changes in facial expressions, and in 87% of the patients automatic behaviors occurred either initially or at some point during the seizures. [pediatrics.aappublications.org]

  Unconscious, automatic behaviors that may occur in complex seizures can include: Rhythmic eye blinking[8] Sucking movements[8] Eyelid flutter found in occipital lobe seizures[2] Lip smacking found in frontal lobe seizures[5] Staring Can be observed in [eyewiki.aao.org]

  Gradual recovery after several minutes of confusion occurs postictally in most patients, however, in some patients automatic behavior like running, walking about, the nondirected violent behavior may occur. [ncbi.nlm.nih.gov]

  Automatic behaviors, such as lip smacking or swallowing may be seen. The person may stare. Their eyes may seem vacant, dilate, and move up and to one side. [eftx.org]

• Vertigo

  Lateral temporal seizures may have vertigo, auditory (buzzing, ringing), or visual symptoms as initial aura symptoms. Auditory aura in only one ear may lateralize seizure to contralateral hemisphere. [ncbi.nlm.nih.gov]

  When overexcitation is confined to a very small area, the patient with epilepsy may have a strange sensation of déja vu, vertigo, fear, or an odd smell without a source. [rxmarijuana.com]

  Auditory-vestibular Auditory-vestibular cortex involvement appears as a hallucination of sound (tinnitus) and vertigo with or without generalization. [dartmouth.edu]

The most important aspect in CPS workup is obtaining a thorough history of the seizure from the patient, relatives, and observers. The clinician must inquire about family history of seizures, any prior history of febrile convulsions, aura, automatisms, disorientation, or unconsciousness. A detailed physical examination may be normal or may reveal evidence of accidental injuries occurring during the seizure.

Routine laboratory tests should include serum electrolytes, calcium, and magnesium levels to exclude other causes of seizures. Urine drug screen should be performed in patients known to be on antiepileptic medications.

Electroencephalography (EEG) is performed as part of the seizure workup in all cases. It is more sensitive in the immediate period following a seizure. However, findings may be non-specific in CPS as the seizure activity is at the subcortical level and patients may be mistaken as suffering from a psychiatric disorder instead.

Neuroimaging with magnetic resonance (MR) scans is indicated to detect CPS associated brain anomalies of the gray matter, tumors, trauma-related sequelae, and lesions of vascular origin [6] [7]. During seizures, single photon emission computed tomography (SPECT) and positron emission tomography (PET) reveal increased metabolic activity in the region of abnormal electrical brain functioning while a "cold footprint" is noted in these regions in the postictal phase [8] [9] [10].

Cerebrospinal fluid analysis is ordered in patients with seizures who are suspected to have an infectious or inflammatory disease.

• Temporal Intermittent Rhythmic Delta Activity

  Temporal intermittent rhythmic delta activity is predictive of temporal lobe epilepsy. Bitemporal sharp wave foci may be noted in 25% to 30% of the patients. [ncbi.nlm.nih.gov]

These patients were treated in a short-term (5 consecutive days) treatment protocol and then released, with weekly phone contact for 6 months following treatment. [ncbi.nlm.nih.gov]

Most people still require medication in conjunction with this treatment. Surgery If other treatments do not help control seizures, surgery may be considered to remove the part of the brain that is causing the seizures. [medicalnewstoday.com]

[…] the brain impaires awareness also known as "focal onset impaired awareness seizures" typically starts in the temporal or frontal lobe Etiology cerebral neoplasms stroke vascular or cerebral malformations infections cerebral autoimmunity head trauma Prognosis [step2.medbullets.com]

Prognosis is variable and may depend on the underlying etiology. [visualdx.com]

Bulletin of the Russian Military Medical Academy. 2019;38(4):63 (Rus) Criteria for adverse prognosis for mitral valve prolapse. Ovchinnikov Y.V., Gadzhieva L.R., Palchenkova M.V., Muracheva N.V., Tkachenko S.B. [journals.eco-vector.com]

Diagnosis: temporal lobe spikes on EEG Treatment Pharmacotherapy: e.g., lamotrigine or levetiracetam Possible surgical treatment in cases of medication resistance Prognosis: unfavorable (only 40% of patients on pharmacotherapy remain asymptomatic) Frontal [amboss.com]

Prognosis The majority of people with epilepsy are able to live normal lives, with few restrictions on their activities. [brainfoundation.org.au]

Occipital lobe epilepsy Epidemiology: rare Etiology: See "Etiology" above. [amboss.com]

The etiology of such psychiatric comorbidities may be related to the seizure or to several other unrelated risk factors. [panafrican-med-journal.com]

Prognosis is variable and may depend on the underlying etiology. [visualdx.com]

Occipital lobe epilepsy Epidemiology: rare Etiology: See "Etiology" above. [amboss.com]

Epidemiology, Classification, and Etiology Epidemiologic studies consistently document an increased incidence of seizure disorders in older adults and suggest that aging is a definite risk factor. 3 In the United States, the annual incidence of seizures [aafp.org]

Epilepsy in Nigeria - a review of etiology, epidemiology. Benin Journal of Postgraduate Medicine. 2006;8(1):1-25. PubMed | Google Scholar [panafrican-med-journal.com]

The epidemiology of epilepsy. Wyllie E, ed. The Treatment of Epilepsy: Principles and Practice. Baltimore, Md: Williams & Wilkins; 1997. 165-2. Cockerell OC. The mortality of epilepsy. Curr Opin Neurol. 1996. 9(2):93-6. [Medline]. [medscape.com]

–This article discusses the epidemiology of psychiatric disturbances in patients with epilepsy and reviews the biological mechanisms that underlie behavioral symptoms. [ncbi.nlm.nih.gov]

This important pathophysiological consequence of a nocturnal complex seizure was identified by respiratory monitoring during a combined video EEG and sleep study. Diagnostic and therapeutic implications are discussed. [ncbi.nlm.nih.gov]

The pathophysiology of epilepsy is not fully understood. [eyewiki.aao.org]

Occasionally, when an episode is seen fortuitously in the laboratory, we may identify pathophysiology previously suspected but not actually seen. [jnnp.bmj.com]

Pathophysiology of altered consciousness during seizures: subtraction SPECT study. Neurology. 2002. 59(6):841-6. [Medline]. Cascino GD. Temporal Lobe Epilepsy is a progressive Neurologic Disorder: time means Neurons!. Neurology. 2009. 72:1718-1719. [medscape.com]

Pathophysiology of disease : an introduction to clinical medicine (6th ed.). New York: McGraw-Hill Medical. ISBN 978-0-07-162167-0. Goldberg, EM; Coulter, DA (May 2013). "Mechanisms of epileptogenesis: a convergence on neural circuit dysfunction.". [realfirstaid.co.uk]

Prevention If you have epilepsy, the best way to prevent seizures is to take prescribed seizure medicines without missing doses. You should also get enough sleep each night, don't fast and avoid drinking too much alcohol. [drugs.com]

Overview, Causes, & Risk Factors Symptoms & Signs Diagnosis & Tests Prevention & Expectations Treatment & Monitoring Attribution View All Overview, Causes, & Risk Factors A seizure is an abnormal change in the electrical activity of the brain. [medicineonline.com]

You can’t always prevent seizures, but you can control them with medications. If you’re on a medication for this purpose, take it as instructed by your doctor and don’t miss doses. [healthline.com]

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