Simple Partial Seizure

A seizure is a symptom that refers to episodic, excessive and disorderly neuronal activity in the brain. Traditionally seizures have been classified into partial and generalized. Partial seizure refers to abnormal neural activity localized to one area of the cerebral hemisphere and having a discernible focal or localized onset. When there is no associated impairment in consciousness, it is called simple partial seizure, and when it is associated with impairment in consciousness, it is called a complex partial seizure. When a partial seizure becomes generalized, it is referred to as a "partial seizure with secondary generalization." New terminology for a simple partial seizure is "focal onset aware seizure." Partial seizures are the most common type of seizures in patients with epilepsy. Complex partial seizures occur more often than simple partial seizures, although most complex partial seizures start as simple partial seizures. Patients with simple partial seizure remain awake and aware throughout the seizure, and some patients can even talk during the episode. It may be difficult to distinguish them from complex partial seizure in infants and patients with cognitive and speech difficulties, as impairment in consciousness can be difficult to assess in these patients. The term "aura" refers to signs and symptoms that occur with a seizure before consciousness is lost and for which memory is intact afterward. Auras that are not followed by seizure should be considered focal aware seizures or simple partial seizures. Depending on clinical signs, symptoms, and EEG localization, focal seizures can be further subdivided into four types: (1) focal motor seizures, (2) focal sensory seizures, (3) autonomic seizures, and (4) psychological seizures. Focal Motor Seizures Focal or partial motor seizure occurs due to an epileptogenic lesion on the contralateral frontal lobe. Motor symptoms constitute the primary clinical manifestation. Typically, consciousness is not impaired in seizures of discrete motor areas. They usually originate from the supplementary motor area and cause turning movements of head and neck to the opposite side and sometimes tonic contractions of the limbs and trunk on the same side. This may or may not be followed by generalized clonic movements. Subdivisions of ictal motor symptoms include elementary (tonic, clonic, dystonic, versive) and automatism (coordinated, repetitive motor activity like lip smacking, tapping, and swallowing). Another classification based on clinical symptomatology uses the terms like focal clonic, focal tonic, or versive seizures. Focal motor seizures are more common on the face, hands, and toes because these areas have disproportionately large cortical representation. The excitatory focus is usually around the rolandic (motor) cortex. If there are accompanying sensory symptoms, the focus may be on post-rolandic convolution. Temporal lobe origin seizures sometimes have head-turning movements on the same side followed by the forceful contraversive turning of the head and body. Following convulsions with predominant focal motor symptoms, patients may have transient, functional, and localized paralysis of the affected limbs. This is known as Todd paralysis and can last minutes to hours, usually in proportion to the duration of the convulsion. This postepileptic paralysis occurs due to persistent focal dysfunction of the affected epileptogenic area and is the signature of a focal seizure. It has significant clinical value in lateralizing the hemisphere of seizure onset. Jacksonian march seizure Jacksonian march seizure starts with tonic contractions in one hand or on one side of the face or the muscles of one foot. This is followed by clonic movements in these parts and sometimes a series of clonic movements with increasing frequency that builds up to a tonic contraction. These movements may spread ("march") from the muscles affected to the other muscles on the same side of the body. In classic Jacksonian march, the seizure spreads from hand to arm to face and then down the leg ipsilaterally, or if it started in the foot, then seizure marches up the leg, down the arm, and then to the face. This typically happens over a short time (20 to 30 seconds). There can be other associated symptoms like automatism (lip smacking or tapping movements), hallucinations, muscle cramping, head-turning, etc. Symptoms are usually mild. These seizures rarely become generalized, and typically consciousness remains intact. Jacksonian march seizure can be mistaken for a transient ischemic attack, migraine, or other condition. Focal Somatosensory Seizures Sensory seizures present as numbness, tingling, crawling sensation, "pins and needles" feeling, and rarely, as pain or thermal sensations. They can be focal or can march to other ipsilateral body parts and usually have focus in or around post-rolandic convolution of the contralateral cerebral hemisphere. Autonomic seizures Autonomic seizures manifest with predominantly altered autonomic function. Some common autonomic signs and symptoms include diaphoresis, shivering, piloerection, rising sensation in epigastrium, nausea, changes in blood pressure and heart rate (commonly tachycardia), and pupillary changes. Autonomic features are common in several nonepileptic conditions, making autonomic seizures harder to diagnose. Some specific epilepsy syndromes with prominent autonomic features include neonatal seizures, epilepsy of infancy with migrating focal seizures, Dravet syndrome, benign epilepsy with centrotemporal spikes, and early-onset benign occipital epilepsy. Psychological seizures Psychological seizures manifest with affective and cognitive symptoms like memory flashback, dream-like events, Deja Vu feeling, hallucinations, anxiety, agitation, and uncontrolled laughter or crying. They arise commonly from the temporal area rather than extratemporal.