complex partial seizure; focal seizure with impaired awareness
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Introduction
- partial seizure in which there is an alteration or loss of consciousness.
- automatisms may occur & the patient is usually amnestic for the event
- it may become generalized.
Etiology
- temporal lobe (psychomotor) epilepsy (most common)
- origination from frontal lobes
Pathology
- alteration of consciousness typically occurs when the seizure spreads to involve one or both temporal lobes[5]
Clinical manifestations
- frequent auras, varied, lasting a few seconds
- consciousness is impaired, but not lost at the onset
- may present as staring spell with loss of awareness, unresponsiveness
- movements may be primitive (automatism)
- sucking, chewing, lip-smacking
- movements may be sophisticated
- running, fighting, destruction, picking at clothes
- tonic-clonic movements may be noted
- duration minutes to hours; 30-90 seconds[5]
- postictal confusion[5]
- high incidence of psychiatric disturbance
- shaking is unilateral & rhythmic[5]
- may have no recollection of event
Diagnostic procedures
- EEG:
- onset is focal
- tonic-clonic movements may occur as epileptiform discharge generalizes
Differential diagnosis
- acute otitis media may present with one or more signs suggestive of complex partial seizure[4]
Management
- lamotrigine is drug of choice
- good choice for elderly partients (> 60 years of age)[5]
- former agents of choice
- alternative agents
- a single agent is effective in controlling seizures in 50% of patients
- attempt therapy with alternative agent prior to initiating combination therapy
- vagus nerve stimulation
- implanted nerve stimulation device inserted subcutaneously into chest
- stimulation of vagus nerve every 5 minutes
- for use in conjunction with anticonvulsive agent
- palliative treatment for patients who are not canditates for surgical resection of epileptic foci[5]
- rarely leads to freedom from seizures[5]
- ketogenic diet
- temporal lobectomy for refractory temporal lobe epilepsy[5]
- benzodiazepine for status epilepticus
More general terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1034-35
- ↑ Alan Gelb, UCSF, Department of Emergency Services, San Francisco General Hospital, 1998
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 645, 662
- ↑ 4.0 4.1 Journal Watch 25(16):132, 2005 Soman TB, Krishnamoorthy KS. Paroxysmal non-epileptic events resembling seizures in children with otitis media. Clin Pediatr (Phila). 2005 Jun;44(5):437-41. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15965551
- ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 17, 19. American College of Physicians, Philadelphia 2006, 2012, 2015, 2021