SIMPLE PARTIAL SEIZURES (SPS)
 
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SIMPLE PARTIAL SEIZURES (SPS)

 

DEFINITION:

Seizures characterized by focal epileptiform discharges originating from a portion of one cerebral hemisphere without impaired consciousness.

EPIDEMIOLOGY:

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

PATHOGENESIS:

1. Seizure Characteristics

  • not associated with an aura
  • average seizure lasts only 10-20 seconds
  • may be characterized by jacksonian march where the seizure spreads to another part of the body
  • are different from automatisms and tics
  • versive seizures consisting of head turning and conjugate eye movements are common in SPS

2. Type of SPS may indicate source:

  • 1. Motor
    • contralateral rolandic strip
  • 2. Sensory
    • visual - occipital or parietal lobes
    • olfactory - temporal lobe
    • auditory - temporal lobe

    • CLINICAL FEATURES:

    1. Neurological Manifestations (Types of SPS)

  • 1. Motor
    • most common symptom of SPS
    • asynchronous clonic or tonic movement tending to involve the face, neck, and/or extremities
  • 2. Sensory
    • auditory, gustatory, olfactory, and visual hallucinations
    • sensations of light, dark, or colour
    • distortions of vision
  • 3. Somatosensory
    • tingling, burning, pain, cold, deadness, or a sense of move-ment in any part of the body
  • 4. Autonomic
    • pallor, flushing, vomiting, sweating, piloerection, tachy-cardia, pupillary dilation
  • 5. Psychic
    • deja vu
    • jamais vu (unfamiliarity when should be familiar)
    • affective feelings of unreality, fear, dread, pleasure, etc.

    • 2. Forms of SPS With Focal Motor Phenomenon

  • 1. Benign Childhood Epilepsy with Centrotemporal Spikes
  • 2. Epilepsia Partialis Continua

    • INVESTIGATIONS:

    1. EEG

    • spikes or sharp waves unilaterally or bilaterally
    • multifocal spike pattern

    MANAGEMENT:

    1. Antiepileptic Mediations

    1. Carbamazepine (Tegretol) - regular or CR

    • treatment of choice for all types of partial seizures
    • drug interactions:
      • erythromycin (Pediazole)
      • if must use, decrease dose of tegretol and moniter levels as erythromycin increases carbamazepine levels
      • decreases effectiveness of birth control pill
    • first used in the late 1950's for trigeminal neuralgia and then as an anticonvulsant
    • moniter CBC and LFT q3m as may get bone marrow suppression and liver dysfunction
    • clinical side effects include ataxia, diplopia, nausea/vomiting lymphadenopathy
    • less effect on cognitive function than dilantin

    2. Others

    • Dilantin
    • Phenobarbital or Primidone
    • two-drug regime

     

     

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