Updated: 4/19/2021

Complex Partial Seizure

Review Topic
  • A 23-year-old woman is brought to the emergency department by her brother due to "unusual behavior." He states that his sister walked into his room when he was asleep and noticed his sister making "grunting" sounds. She then sat up on her bed and started smacking her lips while staring out into space. The brother asked his sister questions but she was unresponsive. 
  • Definition
    • a type of seizure that 
      • starts in a specific area of 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
    • complex febrile seizure increase the risk of developing complex partial seizure and epilepsy
  • Physical exam
    • automatisms
      • e.g., lip-smacking, chewing movements, and hand rubbing
    • lack of awareness
      • e.g., patient does not respond to questions
    • bicycling movements or hip thrusting
      • seen in seizures that originate in the frontal lobes
    • postictal phase
      • practically obtunded, altered, somnolent
      • Todd paralysis
        • management during postictal phase
          • supportive and monitoring 
  • Management approach
    • the goal is to determine if the seizure is the result of a systemic process or intrinsic CNS dysfunction
      • therefore, a thorough history and physical is essential in the work-up of seizures
  • Electrolytes
    • e.g., sodium, calcium, and magnesium
  • Serum glucose
    • both hypo- and hyperglycemia can result in seizure
  • Prolactin 
    • can be elevated during seizures and is a more specific marker for seizure activity
  • Pregnancy tests
    • this affects the type of anti-epileptic therapy the patient receives if it's indicated
  • Electrocardiogram (ECG)
    • should be performed in all patients since syncope can present as a seizure
  • Encephaloelectrogram (EEG)
    • an essential study in the work-up of seizures
    • if the EEG is normal, it does not rule out that a seizure occurred
  • Neuroimaging
    • e.g., CT or MRI scan of the head
    • should be in all adult patients who present with a first seizure
  • Treat the underlying cause
    • e.g., hypoglycemia, intracranial hemorrhage, infection, and toxic ingestion
  • Medical
    • depends on a number of factors, such as cost, drug-interaction, side-effects, the risk of seizure recurrence, and pregnancy
      • levetiracetam
      • phenytoin/fosphenytoin
      • valproic acid
  • Potentially life-threatening

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