Complex Partial Seizures

Complex partial seizures start in one part of the brain, but usually affect other parts of the brain that involve alertness and awareness. They come in many different forms. The symptoms of a complex partial seizure depend on which part of the brain is affected. Unlike simple partial seizures, complex partial seizures usually involve impaired consciousness; the child may appear aware of his surroundings and may move or speak, but will be confused or unaware of what is going on.

What are other terms for complex partial seizures?

Other terms for complex partial seizures that you may come across include:

  • psychomotor epilepsy
  • temporal lobe epilepsy

How can you tell if your child has complex partial seizures?

Complex Partial Seizures
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Complex partial seizures appear different from person to person, depending on the seizure focus (the affected area of the brain). However, an individual child will usually have the same seizure pattern every time.

It can be hard to identify complex partial seizures in a baby or a young child up to five or six years old, because their nervous systems are less developed than those of older children and adults. A child of this age may suddenly stop what he is doing; his hand or arm may jerk rhythmically, and holding the arm will not stop the jerking; he may raise one or both arms or move his head to one side; in rare cases, his eyes may look to one side.

Auras, such as a feeling of fear or nausea, are very common before complex partial seizures. If the child is not old enough to speak, he may run to his mother and cling to her.

The child may have automatisms, such as:

  • mouth movements, including chewing, lip-smacking, gulping, swallowing, or spitting
  • eye blinking, head turning, or raising one arm
  • hand movements, including picking at the air or at his clothing, gestures, rapid “pill-rolling” movements, grasping at objects
  • rubbing genitalia

The child may also have autonomic symptoms, such as vomiting or retching, drooling, rapid heartbeat or breathing, or going pale.

After the seizure, the child will be confused, and may have no memory of events just before or after the seizure.

How many other children have complex partial seizures?

Complex partial seizures are one of the most common seizure types. Between 8% and 31% of children with epilepsy have complex partial seizures.

What causes complex partial seizures?

Complex partial seizures may start in any lobe of the brain and spread to other areas. They are often symptomatic and can result from head injuries, brain tumours, or malformations. Complex partial seizures can also be idiopathic; they occur in some syndromes such as BECTS or BECOS.

How are complex partial seizures treated?

The treatment for complex partial seizures depends on the underlying cause. In some cases, such as a brain tumour, surgery will probably be advised as the first course of treatment. In other cases, the doctor will prescribe an anti-epileptic drug. If the child continues to have seizures while taking medication, it may be possible to surgically remove the affected area of the brain. This option depends on how close the seizure focus is to essential areas of the brain, such as the speech, language, and motor areas.

What should I do when my child has a complex partial seizure?

What to do in this situation depends on the individual child; let other people know what works for your child. Your child may wander around or perform automatisms (repetitive, apparently purposeful movements). He may react unpredictably if you speak to him or touch him. If your child is having a complex partial seizure:

  • If he is walking or running around, try to be a barrier. Guide him gently away from hot or sharp objects and stairs, as he could hurt himself or fall.
  • Don’t restrain him unless it is absolutely necessary (if he is in an unsafe situation), as he may strike out or try to run away.
  • If you need to touch him, approach him cautiously from the side and speak to him so that he doesn’t feel threatened.
  • In some cases, once the seizure is over, he may be confused or tired. Quietly explain what happened and where he is. Give him time to rest and recover.

What is the outlook for a child with complex partial seizures?

The outlook for a child with complex partial seizures depends on the underlying cause of the seizures. They tend to be more drug-resistant than other types of seizures, remission rates are poorer, and some studies suggest that people with uncontrolled complex partial seizures have poor psychosocial outcomes. However, it is still possible for a child with complex partial seizures to do well.

Elizabeth J. Donner, MD, FRCPC

 

2/4/2010


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