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

• Epilepsy

  […] mortality in treatment resistant epilepsy. [ncbi.nlm.nih.gov]

  Synonyms Complex partial seizures with consciousness impaired Epilepsy characterized by intractable complex partial seizures Epilepsy, intractable complex partial seizures Epilepsy, partial frontal lobe, intractable Epilepsy, partial occipital lobe, [icd10data.com]

  […] series. generalized tonic-clonic seizure ( grand mal seizure ) the seizure seen in grand mal epilepsy, marked by loss of consciousness and generalized tonic convulsions followed by clonic convulsions. [medical-dictionary.thefreedictionary.com]

  Lobe Epilepsies, Temporal Lobe Epilepsy, Convulsion psychomotor, Epilepsy temporal lobe, Psychomotor seizures, Epilepsy, Temporal Lobe [Disease/Finding], psychomotor seizure, disorder temporal lobe epilepsy, tle, Epilepsy;temporal lobe, lobe seizures [fpnotebook.com]

• Unconsciousness

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

  Officers found him alone and unconscious behind the wheel of his car, authorities said. An investigation into the incident is ongoing. [latimesblogs.latimes.com]

  Most people appear unconscious in NEAD, although they may show signs of being able to react to their environment to some extent (such as turning to speech, making gestures or other movements with a degree of purpose). [nonepilepticattacks.info]

  They may also become unconscious for a brief period of time. Complex partial seizures and epilepsy For those with epilepsy, this is the most common type of seizure. [healthline.com]

  The temporal lobe is the area of the brain that processes memories and sounds, interprets vision, produces speech, understands language, controls some unconscious/automatic responses such as hunger, thirst, fight-or-flight, emotions, and sexual arousal [my.clevelandclinic.org]

• Pallor

  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]

  Others may experience stomach upset, dizziness, a shiver, a tingling or burning sensation, pallor or flushing. Occasionally there will be the experience of déjà vu during which a person has the sensation of having experienced something before. [edmontonepilepsy.org]

  […] 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 sweating and facial pallor [jnnp.bmj.com]

  Skin can appear pallor, flushed, sweaty, and pupils can be dilated. Some individuals experience incontinence. Petit mal seizures usually begin between ages 4 and 14. The children who get them usually have normal development and intelligence. [cerebralpalsy.org]

  Autonomic features like tachycardia, flushing, and pallor are common. Auras may be followed by impaired awareness and manual and oroalimentary automatisms. [ncbi.nlm.nih.gov]

• 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

  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]

• Muscle Rigidity

  Tonic Muscle stiffness, rigidity 6. Atonic Loss of muscle tone Generalized seizures There are six types of generalized seizures. [medicinenet.com]

  In addition to seizures, symptoms may include unsteadiness, muscle rigidity, and intellectual disability. Reflex Epilepsy In reflex epilepsy, seizures are triggered by specific environmental stimuli. [nyulangone.org]

• Tachycardia

  […] sequence: Aura Focal seizure with impaired awareness (complex partial seizure) Motor symptoms: typically oral alimentary automatisms like lip-smacking; also fidgeting (e.g., with clothing), stretching of the body, or walking in place Autonomic symptoms: tachycardia [amboss.com]

  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]

  Aura presents as epigastric churning, dejavu phenomenon, recurrent intrusive thoughts, hallucination of unpleasant smell, fear, and tachycardia. [hindawi.com]

  Autonomic features like tachycardia, flushing, and pallor are common. Auras may be followed by impaired awareness and manual and oroalimentary automatisms. [ncbi.nlm.nih.gov]

• Pruritus

  […] uremic lung/요독(증)성 폐(尿毒症性肺).내과 uremic medullary cystic disease/요독성 수질낭병(낭성질환)병리 uremic pericarditis/요독(증)성 심막염(尿毒症性心膜炎).내과 uremic pericarditis/요독성 심막염(심낭염)병리 uremic pneumonia/요독(증)성 폐렴 (∼肺炎).내과 uremic polyneuropathy/요독(증)성 다발신경병증(∼多發神經病症).내과 uremic pruritus [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]

• 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]

• Psychiatric Manifestation

  If you have, then the following case vignette of a man admitted to the general hospital with a complex array of neuropsychiatric symptoms should provide the forum for answers to these and other questions related to psychiatric manifestations of seizures [ncbi.nlm.nih.gov]

• Seizure

  Electroencephalography (EEG) is performed as part of the seizure workup in all cases. It is more sensitive in the immediate period following a seizure. [symptoma.com]

  Complex partial seizures are often confused with absence seizures, a type of generalized seizure. Absence seizures, though, never begin with an aura and last only 5 to 15 seconds. [uofmhealth.org]

  See Seizures. com·plex par·tial sei·zure ( kŏm-pleks pahrshăl sēzhŭr ) A partial seizure with impairment of consciousness without features of a generalized seizure. [medical-dictionary.thefreedictionary.com]

  Complex partial seizures are now more commonly referred to as focal onset impaired awareness seizures or focal impaired awareness seizures. [epilepsyu.com]

  This is the first report of a partial epileptic seizure precipitated by vasovagal syncope and the first example of an epileptic seizure induced by syncope in an adult. [ncbi.nlm.nih.gov]

• Confusion

  After a seizure, the person will be confused or disoriented and may have a hard time speaking and swallowing for several minutes. Complex partial seizures are often confused with absence seizures, a type of generalized seizure. [uofmhealth.org]

  It can look like people who are confused or trying to do something purposeful that really is not purposeful. They are just as disabling as big generalized tonic clonic seizures. [howcast.com]

  […] and delirium, following a cluster of seizures [12] Major features are confusion, delirium and aggression [12] No evidence of EEG changes [12] Evidence of EEG changes [12] 2. [hindawi.com]

  […] hand Complex partial epileptic seizures confined to a larger region of the brain than simple partial seizures impaired level awareness about surroundings usually involves the temporal lobe symptoms: glassy stare and lack of response inappropriate or confused [barrowneuro.org]

• 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]

• Focal Seizure

  Complex Focal Seizures Complex focal seizures are often preceded by a simple focal seizure (aura). [hopkinsmedicine.org]

  Complex partial seizures are now preferably called as "focal impaired awareness seizure" or "focal onset impaired awareness seizure." [ncbi.nlm.nih.gov]

  Focal seizures evolving to a bilateral convulsive seizure: It is not uncommon for focal seizures to spread to become generalised. (Usually a tonic clonic seizure). If this happens, it is important to note how the seizure starts. Dr. [epilepsyqueensland.com.au]

• Generalized Seizure

  Abstract A previously healthy 15-year-old boy initially diagnosed to have acute psychotic reaction had a history of a single generalized seizure and prolonged amnestic states of varying intensity and duration. [ncbi.nlm.nih.gov]

  Focal seizures can spread and become bilateral tonic-clonic seizures. Generalized Seizures With generalized seizures, most or all of the brain is involved. Types of generalized seizures include the following. [mountsinai.org]

  Generalized Seizures Generalized seizures begin with a widespread, excessive electrical discharge involving both hemispheres, or sides, of the brain. [nyulangone.org]

  Complex partial seizures are often confused with absence seizures, a type of generalized seizure. Absence seizures, though, never begin with an aura and last only 5 to 15 seconds. [uofmhealth.org]

  […] seen in a generalized tonic-clonic seizure Absence seizures are not associated with loss of tone or urinary continence Absence seizures can be precipitated by hyperventilation or photic stimulation Generalized Tonic Clonic Seizure The most common type [quizlet.com]

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]

1. Khoshbin S. Seizure disorders. In: Stern TA, Herman JB, eds. Psychiatry Update and Board Preparation. 2nd ed. New York, NY: McGraw-Hill. 2004; 287–293.
2. Kotagal P, Arunkumar G, Hammel J, Mascha E. Complex partial seizures of frontal lobe onset statistical analysis of ictal semiology. Seizure. 2003; 12(5):268-281.
3. Geschwind N. Behavioral changes in temporal lobe epilepsy. Psychol Med. 1979;9:217–219.
4. Loddenkemper T, Kotagal P. Lateralizing signs during seizures in focal epilepsy. Epilepsy and Behavior. 2005; 7:1-17.
5. Horvath R, Kalmar Z, Feher N, Fogarasi A, Gyimesi C, Janszky J. Brain lateralization and seizure semiology: ictal clinical lateralizing signs. Ideggyogy Sz.2008; 61(7-8):231-237.
6. King MA, Newton MR, Jackson GD, et al. Epileptology of the first-seizure presentation: a clinical, electroencephalographic, and magnetic resonance imaging study of 300 consecutive patients. Lancet. 1998; 352(9133):1007-1011.
7. Knake S, Triantafyllou C, Wald LL, et al. 3T phased array MRI improves the presurgical evaluation in focal epilepsies: a prospective study. Neurology. 2005; 65(7):1026-1031.
8. Warwick JM. Imaging of brain function using SPECT. Metab Brain Dis. 2004;19:113–123
9. Newberg AB, Alavi A. PET in seizure disorders. Radiol Clin North Am. 2005;43:79–92
10. Roffman JL, Stern TA. A Complex Presentation of Complex Partial Seizures. Prim Care Companion J Clin Psychiatry. 2006; 8(2): 98–100