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Updated: Apr 26 2019

Simple Partial

  • Snapshot
    • A 39-year-old man presents to the emergency department due to abnormal movement of his left arm. These involuntary abnormal movements last a few minutes and he is aware during these episodes. He also endorses right-sided headaches that are worse in the morning. Medical history is unremarkable. Physical examination is normal. An MRI brain with and without gadolinium demonstrates a right-sided ring-enhancing lesion in the primary motor cortex. Neurosurgery is consulted for removal and histopathological assessment of the mass. (Brain neoplasm)
  • Introduction
    • Definition
      • generation of epileptiform activity in a focal brain region that does not cause any alteration in conciousness
  • Etiology
    • Structural brain abnormality
      • neoplasm
      • hippocampal sclerosis (seen in temporal lobe epilepsy)
      • head trauma
      • vascular malformations
      • stroke
      • perinatal injury
      • cortical dysplasia
  • Pathogenesis
    • The structural brain lesion results in electrogenic variation, creating a focus for epileptogenesis
  • Presentation
    • Symptoms/physical exam
      • dependent on where in the brain the seizure arises from
        • contralateral arm movements if the seizure generates from the region that controls arm movements in the motor cortex
      • no alterations in conciousness (key differentiating feature from complex partial seizures)
  • Imaging
    • MRI brain with and without contrast
      • indication
        • imaging study of choice for the evaluation of first seizure
          • in the emergency setting, CT head with and without contrast is preferred due to how quickly images can be obtained
  • Studies
    • Electroencephalogram (EEG)
      • indication
        • part of the initial evaluation of patients presenting with a first seizure
  • Differential
    • Psychogenic nonepileptic seizures (PNES)
      • differentiating factors
        • most seizure episodes are in front of a witness
        • seizures do not occur during sleep
        • variable and asynchronous muscle movement
    • Migraine with aura
      • differentiating factors
        • patients typically have a pulsatile/throbbing headache
  • Treatment
    • Medical
      • antiepileptic drugs (AED)
        • indication
          • started in patients who are at increased risk of seizure recurrence
            • first address treatable causes of seizure (e.g., hypoglycemia)
            • choice of AED depends on a number of factors (e.g., side-effect profile, cost, and comorbid conditions)
  • Complications
    • Behavioral and cognitive alterations
    • Aspiration
  • Prognosis
    • Partial seizures are at higher risk of seizure recurrence than generalized seizures
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