Complex partial seizures are focal seizures originating in the temporal lobe that cause partial alteration of consciousness, usually manifesting as confusion. They may occur at any age but are more common in adolescence and adulthood. Approximately two-thirds of patients also experience generalized seizures.

An aura — typically a complex hallucination, illusion, or unusual sensation — often precedes the seizure. The patient may recognize the aura and lie down before consciousness is impaired.

Pathophysiology

• Originates in the temporal lobe, often involving the limbic system.

• Preceded by auras: audiovisual hallucinations, auditory memories, olfactory sensations, déjà vu, depersonalization, or epigastric rising sensation.

• Seizure leads to altered awareness, automatisms, wandering, or inappropriate behavior.

• Postictal phase includes confusion, drowsiness, amnesia, and possible behavioral changes.

History and Physical Examination

History:

• Ask about preceding auras and note type

• Evaluate frequency, duration, and triggers of seizures

• Note behavioral changes between seizures: anger, mood swings, paranoia, diminished libido, rigid thinking

• Record any head trauma, infection, or CNS disorder history

Physical Examination:

• During seizure: observe for automatisms (lip smacking, wandering, inappropriate acts)

• Assess neurologic status postictally: confusion, drowsiness, amnesia

• Evaluate for focal deficits depending on temporal lobe involvement

Safety Consideration:

• Never attempt to restrain a patient during a seizure; guide gently to a safe area

Medical causes

Special considerations

• Keep patient safe during and immediately after seizure

• Remove dangerous objects and remain with patient until fully alert

• Offer emotional support to patient and family

• Prepare for diagnostic testing: EEG, CT scan, MRI

• Monitor for progression to generalized seizures

Patient counseling

• Teach safety measures during seizures (avoid driving, swimming alone)

• Emphasize importance of medication adherence

• Encourage carrying medical identification

• Discuss coping strategies and involve family or caregivers

Pediatric pointers

• May resemble absence seizures in children

• Causes include birth injury, abuse, infection, or CNS tumor; often idiopathic

• One-third of pediatric cases have unknown cause

• Repeated complex partial seizures may generalize

• Children may experience subtle auras

References

1. Berkowitz CD. Berkowitz’s Pediatrics: A Primary Care Approach. 4th ed. USA: American Academy of Pediatrics; 2012.

2. Buttaro TM, Tybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice. St. Louis, MO: Mosby Elsevier; 2008.

3. McCance KL, Huether SE, Brashers VL, Rote NS. Pathophysiology: The Biologic Basis for Disease in Adults and Children. Maryland Heights, MO: Mosby Elsevier; 2010.

4. Sommers MS, Brunner LS. Pocket Diseases. Philadelphia, PA: F.A. Davis; 2012.