The Partial Seizures

COMPLEX PARTIAL SEIZURES

These attacks usually originate within the temporal lobe and are characterised by a complex aura (initial symptom) and some impairment of consciousness.

Complex partial seizures are generally synonymous with psychomotor epilepsy and temporal lobe epilepsy (though motor, sensory and other partial seizures can be associated with impaired consciousness when propagated through the temporal lobe -extratemporal complex partial seizures).

The seizure origin lies in the medial part of the temporal lobe, hippocampus or lateral surface of the lobe.

Coronal section through the pons showing medial aspect of the temporal lobe and hippocampus

The nature of the attack

The content of attacks may vary in an individual patient. Commonly encountered symptoms include:

Visceral disturbance-. Gustatory (taste) and olfactory (smell) hallucinations, lip smacking, epigastric fullness, choking sensation, nausea, pallor, pupillary changes (dilatation), tachycardia.

Memory disturbance: Deja vu ('something has happened before'), jamais vu ('feeling of unfamiliarity'), depersonalisation, derealisation, flashbacks, formed visual or auditory hallucinations.

Motor disturbance: Fumbling movement, rubbing, chewing, semi-purposeful limb movements.

Affective disturbance: Displeasure, pleasure, depression, elation, fear.

A constellation of these symptoms associated with subtle clouding of consciousness characterises a complex partial seizure.

AUTOMATISM occurs during the state of clouding of consciousness either during or after the attack (postictal) and takes the form on involuntary, often complicated, motor activity. In ambulatory automatism, subjects may 'wander off.

Confusion and headache after an attack are common. The whole episode may last for seconds but occasionally may be prolonged and a rapid succession or cluster of attacks may occur. Attacks show an increased incidence in adolescence and early adult life. A history of birth trauma or febrile convulsions in infancy may be obtained. Lesions in the hippocampus occur as a result of anoxia or from the convulsion itself and act as a source of further epilepsy. When surgery is carried out, hippocampal sclerosis is often found. Occasionally other pathologies are identified, such as hamartomas, vascular malformations and low-grade malignant astrocytomas. 91

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