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

• 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]

• Nausea

  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]

  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]

  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]

  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]

• Abnormal Eye Movement

  CASE REPORT: An 8-year-old boy was referred to the clinic by his pediatric neurologist for a comprehensive examination to rule out a visual cause for the abnormal eye movements observed by the patient's mother. [ncbi.nlm.nih.gov]

• Bright Blue Eyes

  Her bright blue eyes are rimmed with emerald specks of green, the brightness of which belies the hordes of medication I know she takes every day. [oneintwentysix.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]

  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]

  […] 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]

• 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]

  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]

  Simple Focal Seizures (Auras) Simple focal seizures, also known as auras, occur in one area on one side of the brain, but may spread from there. The person does not lose consciousness during a simple focal seizure. [hopkinsmedicine.org]

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

  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]

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

• 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]

  (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 [en.wikipedia.org]

  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]

• 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]

• Periodic Lateralized Epileptiform Discharges

  Abstract We describe a patient in whom the only electrographic manifestation of a complex partial seizure recorded by video-EEG telemetry was periodic lateralized epileptiform discharges (PLEDs) with a left anterior temporal emphasis. [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]

Prognosis is variable and may depend on the underlying etiology. [visualdx.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 The majority of people with epilepsy are able to live normal lives, with few restrictions on their activities. [brainfoundation.org.au]

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]

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

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

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

The biochemical basis and pathophysiology of status epilepticus. Neurology 1990;40(Suppl 2):13-23. [ Links ] 11. Krumholz A, Sung GY, Fischer RS, Barry E, Bergey GK, Grattan LM. [scielo.br]

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]

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]

There are several medications that can help prevent focal impaired awareness seizures. [epilepsy.com]

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