The Partial Seizures

Partial seizures account for 80% of adult epilepsies. SIMPLE MOTOR SEIZURES

Motor cortex (precentral gyrus of frontal lobe in cerebral cortex)

Motor cortex (precentral gyrus of frontal lobe in cerebral cortex)

These arise in the frontal motor cortex with movements occurring in contralateral face, trunk or limbs.

The Jacksonian motor seizure consists of a 'march' of involuntary movement from one muscle group to the next.

Movement is clonic (shaking) and usually begins in hand or face - these having the largest representative cortical area.

Motor seizures with the above 'march' are quite rare, usually they are less localised, involving many muscle groups simultaneously and are tonic (rigid) or clonic.

After a motor seizure the affected limb(s) may remain weak for some hours before return of function occurs - Todd's paralysis.

Adversive seizures

The patient is aware of movement of the head. Attacks often progress to loss of consciousness and tonic/clonic epilepsy.

The patient's eyes and head turn away from the site of the focal origin usually in the supplementary motor cortex of the frontal lobe with involvement of the frontal 'gaze centre'. Some doubt the localising value of such an attack.

SIMPLE SENSORY SEIZURES

These arise in the sensory cortex, the patient describing paraesthesia or tingling in an extremity or on the face sometimes associated with a sensation of distortion of body image. A 'march' similar to the Jacksonian motor seizure may occur. Motor symptoms occur concurrently - the limb appears weak without involuntary movement.

The representation of limbs, trunk, etc. in the post-Rolandic sensory cortex is similar to that of the motor cortex.

VISUAL, AUDITORY and AUTONOMIC simple partial seizures occur, but are rare.

Motor and sensory seizures indicate structural brain disease, the focal onset localising the lesion. Full investigation is mandatory.

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