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 . 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 . 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 . Features which help to localize the side of origin of the seizures include  :
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]
Can cause Less Common Side-Effects If individuals experience vomiting and nausea, it usually happens at the initiation of the treatment, then wears off. The uncommon side effect most people are concerned about is hepatic (liver) failure (jaundice). [bbbautism.com]
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]
The memories are rushing through my sight so quickly that, when I try to latch on, my nausea worsens. I dry heave. I dry heave again. I lie my head down on the desk and begin humming a tune, but I don't know what tune it is. I'm just humming to hum. [tay.kinja.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]
During seizure episodes, people can experience auras, muscle jerking, automatisms, altered level of consciousness and convulsions. Some characteristic ophthalmologic signs can also be observed including visual hallucinations, illusions, visual field [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]
- Delusion of Grandeur
A 25-year-old male presented with fluctuations in consciousness, aggressive behaviour, hallucination, and delusions of grandeur lasting a few hours. [hindawi.com]
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]
Abstract A man with a grade II astrocytoma in the medial frontal lobe exhibited complex partial seizures, with the aura being a feeling of extreme embarrassment. [ncbi.nlm.nih.gov]
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 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]
The most common side effects of SABRIL in adults include: problems walking or feeling uncoordinated, feeling dizzy, shaking (tremor), joint pain, memory problems and not thinking clearly, and eye problems like blurry vision, double vision, and eye movements [sabril.net]
In clinical trials, the most common side effects seen in people who take KEPPRA include sleepiness, weakness, dizziness, and infection. [vimpat.com]
At times, I feel as if I am a lone surfer in a tsunami of medication side effects, riding the sickening larger waves of dizziness, confusion, poor appetite, and headaches. [oneintwentysix.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). [healthlinkbc.ca]
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]
vu) Parietal lobe seizures may begin with a contralateral sensation, usually of the positive type (electrical sensation, tingling) Occipital lobe seizures may begin with contralateral visual changes, usually of the positive type (eg, colored lines, spots [emedicine.medscape.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]
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]
behaviors that may occur in complex seizures can include: Rhythmic eye blinking Sucking movements Eyelid flutter found in occipital lobe seizures Lip smacking found in frontal lobe seizures Staring Can be observed in absence seizures that [eyewiki.aao.org]
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]
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  . 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   .
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]
- 3 Hz Spikes
Absence seizures can sometimes present with same symptomatology however ictal EEG will show generalized 3-Hz spike-wave complexes. Symptoms of focal seizures with impaired awareness depend on the area of the brain it is arising from. [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]
lamotrigine or levetiracetam Possible surgical treatment in cases of medication resistance Prognosis: unfavorable (only 40% of patients on pharmacotherapy remain asymptomatic) Frontal lobe epilepsy Etiology: see “Etiology” above Clinical features Usually [amboss.com]
The etiology of such psychiatric comorbidities may be related to the seizure or to several other unrelated risk factors. [ncbi.nlm.nih.gov]
Prognosis is variable and may depend on the underlying etiology. [visualdx.com]
[…] impairment of consciousness, occurring in a patient with focal epilepsy. complex partial seizure Complex seizure, partial complex seizure Neurology A brief, temporary seizure with multiple elaborate sensory, motor, or psychic components; rare in toddlers Etiology [medical-dictionary.thefreedictionary.com]
Occipital lobe epilepsy Epidemiology: rare Etiology: See "Etiology" above. [amboss.com]
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]
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]
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]
Occasionally, when an episode is seen fortuitously in the laboratory, we may identify pathophysiology previously suspected but not actually seen. [jnnp.bmj.com]
The pathophysiology of epilepsy is not fully understood. [eyewiki.aao.org]
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]
Hospital for Sick Children Health A-Z Search a complete list of child health articles expand_more View All Drug A-Z Search a list of articles about medications expand_more View All Learning Hubs Browse a complete list of content groups Healthy Living & Prevention [aboutkidshealth.ca]
There are several medications that can help prevent focal impaired awareness seizures. [epilepsy.com]
Yet preventative seizure medications (anti-epileptic drugs) are often used by many patients with success. Treatment is tailored to the patient according to the unique symptoms that they report or experience. [rscdiagnosticservices.com]
- 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.
- 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.
- Geschwind N. Behavioral changes in temporal lobe epilepsy. Psychol Med. 1979;9:217–219.
- Loddenkemper T, Kotagal P. Lateralizing signs during seizures in focal epilepsy. Epilepsy and Behavior. 2005; 7:1-17.
- 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.
- 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.
- 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.
- Warwick JM. Imaging of brain function using SPECT. Metab Brain Dis. 2004;19:113–123
- Newberg AB, Alavi A. PET in seizure disorders. Radiol Clin North Am. 2005;43:79–92
- Roffman JL, Stern TA. A Complex Presentation of Complex Partial Seizures. Prim Care Companion J Clin Psychiatry. 2006; 8(2): 98–100