PEDBASE.org - The Pediatric Database - Detailed information of COMPLEX PARTIAL SEIZURE (CPS)

COMPLEX PARTIAL SEIZURE (CPS)

DEFINITION:

Seizures characterized by focal epileptiform discharges originating from a portion of one cerebral hemisphere with impaired consciousness.

EPIDEMIOLOGY:

incidence: partial (simple & complex) seizures can account for up to 40% of childhood seizures

PATHOGENESIS:

1. Seizure Characteristics

seizure activity is always preceded by an altered state of consciousness but may or may not be preceded by a simple partial seizure (SPS), i.e., (SPS) -> altered consciousness -> CPS - often (but not always) preceded by an aura
seizure types the same as in SPS:
- motor, sensory, somatosensory, autonomic, psychic
average seizure lasts 1-2 minutes (considerably longer than SPS)
may progress to a secondary generalized seizure with tonic-clonic convulsions
automatisms occur in 50-70% of patients
can rarely get complex partial status epilepticus
period of postictal impairment

2. Automatisms (unusual patterns of behaviour)

1. Types

alimentary - usually seen in infants
ambulatory
gestural - usually seen in older children
mimicking
verbal

2. Characteristics

occur after the altered state of consciousness and thus not remembered by patient
may be perseverative (continuance of action prior to the seizure) or de novo (a new activity after onset of seizure)
may persist into the postictal phase
tend to be stereotyped for each seizure within each child

CLINICAL FEATURES:

1. Neurological Manifestations

1. Altered State of Consciousness

brief blank stare, decreased or altered responsiveness, sudden cessation or pause in activity
may be brief and infrequent and thus overlooked

2. Types of CPS

motor, sensory, somatosensory, autonomic, psychic
see file on "Simple Partial Seizures"

3. Automatisms

1. Alimentary

lip smacking, chewing, swallowing, excessive salivation
prolonged and repetitive alimentary automatisms associated with a blank stare or with a lack of responsiveness almost always indicate CPS in an infant

2. Ambulatory

walking or running in a nondirective, and repetitive fashion

3. Gestural

fumbling with nearby objects
semipurposeful, uncoordinated, and unplanned gestural automatisms including picking and pulling at clothing or the bed sheets, and rubbing or caressing objects

4. Mimicking

emotional facial expressions, i.e., fear

5. Verbal

yelling, laughing, repetitive speech

INVESTIGATIONS:

1. EEG

interictal anterior temporal lobe sharp waves or focal spikes, and multifocal spikes are a frequent finding
about 20% of patients have a normal routine interictal EEG
may also have interictal sharp waves or spikes originating from the frontal, parietal, or occipital lobes

2. Imaging Studies

1. CT/MRI

may identify an abnormality in the temporal lobe - mesial temporal sclerosis, hamartoma, postencephalitic gliosis, subarachnoid cysts, infarction, A-V malformations, and slow-growing gliomas