Complex partial seizure is a type of epilepsy seen in adults as well as children. It is characterized by focal seizures accompanied by altered sensorium, behavioral, somatic and cognitive symptoms with automatisms. A detailed history, followed by electroencephalogram and imaging studies, is necessary to confirm the diagnosis.
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]:
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.