A complex partial seizure is a type of seizure that occurs in one brain lobe, rather than the entire brain. The seizure affects the consciousness of individuals, and can cause them to lose consciousness.
Specific partial seizures are also more generally referred to as focal onset impaired awareness seizures or focal impaired awareness seizures.
Anyone may have a complex partial seizure while people who have had head trauma, strokes, or brain tumors are at greater risk.
Important facts about complex partial seizures:
- This form of seizure is the most common type experienced by people with epilepsy.
- The symptoms are diverse and can vary from one seizure to another.
- Seizure first aid focuses on keeping the person safe and comfortable.
Symptoms
Common symptoms of complex partial seizures include:
Aura
Aura, known as a simple partial seizure, often precedes seizures. Auras typically only last a couple of seconds.
An aura is a warning sign according to Johns Hopkins Medicine. Such signs take on different types.
Some people may get a feeling of fear, for example, while others may get a peculiar sensation in their bodies, an unusual taste in their mouth, or hear a particular sound.
Impaired consciousness
Individuals with a complex partial seizure are generally unconscious of their surroundings as it occurs.
They won’t respond to others or their surroundings, and usually don’t remember what happens during the episode. They can stare blankly into space, appear daydreaming, or unexpectedly wake up from sleep.
In certain situations, the person may “freeze,” which is called a focal impaired awareness behavior arrest seizure.
Automatisms
In addition to an aura and impaired consciousness, many people often perform repetitive movements, called automatisms. Examples of automatisms are:
Verbal:
- crying
- laughing
- moaning
- repetitive speech
- screaming
Oral:
- chewing
- lip smacking
- swallowing
Manual:
- fumbling
- head rolling
- patting
- picking at things
- removing clothing
- walking
- coordinated movements, such as cycling of the legs or a swimming motion
Symptoms usually last from 30 seconds to 3 minutes.
Complex partial seizures start in the front lobe tend to be shorter than temporal lobe seizures.
The person will become fatigued, disoriented, and confused after the seizure. Though these after-effects last just about 15 minutes, several people can not function normally for many hours.
Causes and triggers
Complex partial seizures are typically caused by epilepsy but anyone may experience them. Other factors which may result in seizures include:
- anxiety
- autism
- brain infection
- depression
- extreme stress
- head injury
- psychological distress or trauma
- stroke
- tumor
Frequently, the cause of seizures is unknown.
Seizure triggers
Complex partial seizures appear to occur without much warning, with the exception of having an aura in the individual. Some important factors likely to cause a seizure include:
- fatigue
- fever
- flashing lights
- intense activity
- loud noises
- low blood sugar or hypoglycemia
- reactions to medications
- stress
- strong emotions, such as anger or anxiety
Diagnosis
A medical diagnosis is necessary before implementing a treatment plan. A doctor can diagnose complex partial seizures by performing one or more of the following:
Medical history
The doctor should try information of what’s going on before, during, and after a seizure.
Typically people can’t remember their seizures. Memory is typically affected, due to changes in brain function.
As a result of this, a doctor may also ask someone who has experienced one or more individual seizures for guidance.
Electroencephalogram (EEG)
This diagnostic procedure measures electric brain activity. Even if the EEG obtains a good outcome, it does not rule out epilepsy or partial complex seizures. Sometimes, the check would need to be carried out again during a seizure for greater accuracy.
Imaging tests
To detect possible triggers of seizures, a CT (computed tomography), an MRI (magnetic resonance imaging), or both, can be performed.
Laboratory tests
Blood or urine may be tested to check electrolyte levels, drug use and antiepileptic drug concentrations if prescribed. Those tests can often reveal the seizures’ underlying cause.
Treatment
Treatment plans are focused on patient symptoms , diagnosis, and in some cases the involvement of other medical problems for people with complex partial seizures. Treatment options include:
Antiepileptic drugs
Medication, such as antiepileptic medications or AEDs, is usually considered as the first line of treatment for people with epilepsy and seizures.
Many people are responding well to medication that may prevent future seizures or rising their frequency and intensity at least.
Some people may benefit from a single medication while others can need a combination of AEDs.
Many individuals can discontinue their medications after a few years of being seizure-free.
However, at least 30 percent of people are not responding to AEDs.
Dietary changes
Dietary therapy can help in seizure control and is usually used in conjunction with AEDs.
A low-carbohydrate high-fat diet, such as ketogenic diet, is considered most effective. It’s essential that a doctor or dietitian, or both, prescribe and monitor dietary changes for seizures.
Responsive neurostimulation (RNS)
In 2013, receptive neurostimulation for seizures was approved by the United States Food and Drug Administration ( FDA).
RNS includes inserting a device around the brain inside the bone to monitor brainwaves for unusual electrical activity. If these are detected, the system will release stimulus pulses that return to normal brainwaves, thereby preventing a seizure.
Early reports indicate that RNS therapy cuts the seizure frequency in half after 2 years of use, and is well accepted by users according to 2015 study.
Vagus nerve stimulation
This procedure includes the implantation of a device wired to the vagus nerve in the neck into the chest. The device sends bursts of energy to the brain to prevent seizures.
Research indicates that vagus nerve stimulation in half of study participants decreases seizures by 50 percent or more while 25 percent of patients do not experience treatment benefits. In conjunction with this treatment most people still need medication.
Surgery
If other therapies do not help control seizures, it may be suggested that surgery removes the part of the brain that causes seizures. The surgery is done when:
- seizures begin in a small portion of the brain only
- the area does not affect speech, language, motor function, vision, or hearing
Before treatment, it is necessary for a person to discuss the risks and benefits of surgery with a doctor thoroughly, because all surgeries carry risks.
What to do if someone is having a seizure
The most important thing to do, is to make the person calm and comfortable. This is particularly important in public areas since some people who experience complex partial seizures can walk out in front of traffic or remove clothing items.
Other measures to take will be rolling the person to their side and shielding their head from injury by putting something soft underneath them. Time the seizure is helpful in case the episode is prolonged, and medical intervention is needed.
Since untreated seizures can lead to complications such as injury or memory loss, it is important to consult with a doctor about episodes of seizure, especially if:
- it is someone’s first ever seizure
- the seizure lasts for 5 minutes or longer
- the person has a fever, diabetes, or may be pregnant
- the person does not regain consciousness after the seizure
If the person is receiving a rescue treatment, they should be given it. A rescue treatment is a drug taken to respond to seizures where appropriate.
Outlook
The outlook for a person with complex partial seizures depends on the cause, the region of the brain where they begin and the care that the patient receives.
Children can outgrow seizures, and with a variety of therapies, including medication and dietary changes, both children and adults can sometimes successfully control their seizures.
Hence, visiting a doctor is necessary if seizures are encountered in order to receive a diagnosis and access to treatments.
