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ULY CLINIC

17 Septemba 2025, 12:24:42

Simple partial seizures

Simple partial seizures are focal epileptic events arising from an irritable focus in the cerebral cortex. They last about 30 seconds and do not impair consciousness. Manifestations depend on the cortical area involved and may be motor, sensory, visual, auditory, or olfactory. Although usually benign, they can evolve into generalized seizures, especially if untreated.

Pathophysiology

Simple partial seizures result from abnormal electrical discharges confined to one cortical region.Mechanisms include:

Hyperexcitable neurons producing repetitive depolarization
Spread along local cortical pathways without reaching areas responsible for awareness
Possible progression into secondary generalized seizures if activity crosses hemispheric connections

History and Physical Examination

History:

Onset, duration, frequency, and evolution of seizure activity
First body part involved and how movements or sensations spread
Presence of aura (visual, olfactory, auditory, or visceral)
Precipitating factors: trauma, infection, stroke, tumors, prior febrile seizures
Past head injuries, neurological illness, or CNS infection
Medications, alcohol, or toxin exposure

Physical Examination:

Assess vital signs, orientation, and postictal state
Observe seizure semiology if witnessed:
- Head/eye deviation, limb jerking, tonic posturing
- Sensory symptoms (tingling, numbness, “electric” feeling)
- Visual or auditory phenomena
After seizure: check motor strength, cranial nerves, sensory function
Look for signs of increased intracranial pressure or infection (papilledema, nuchal rigidity)

Medical Causes

Cause	Onset	Key Features	Associated Signs	Pathophysiology	Management
Brain abscess	Acute or post-resolution	Seizures with headache, vomiting	Drowsiness, ocular changes, hemiparesis, aphasia	Local infection with mass effect and cortical irritation	IV antibiotics ± neurosurgical drainage
Brain tumor	Gradual	Morning headache, sensory/motor deficits	Papilledema, vomiting, aphasia	Mass compressing or infiltrating cortex	Surgical excision ± oncology referral
Head trauma	Weeks–months post-injury	Focal jerking, may generalize	LOC changes, behavioral changes	Cortical scarring or hemorrhage focus	Antiepileptics; manage sequelae
Stroke	Hours–months after event	Focal clonic movements ± sensory loss	Dysarthria, visual loss, hemiplegia	Ischemic or hemorrhagic tissue irritates cortex	Seizure control; treat vascular risk
Idiopathic epilepsy	Any age	Brief stereotyped motor or sensory spells	Usually none	Genetic or unknown neuronal hyperexcitability	Long-term antiepileptic therapy

Special Considerations

Simple partial seizures rarely require emergency measures unless they progress to generalized tonic-clonic activity.
Stay with the patient, ensure a safe environment, and reassure them.
Prepare for EEG, MRI, or CT to localize the epileptogenic focus.

Patient counseling

Explain seizure type, potential triggers, and importance of treatment adherence.
Instruct on keeping a seizure diary noting time, duration, and description.
Advise carrying medical identification and avoiding dangerous activities (e.g., swimming alone, heights).
Stress follow-up if seizures change, lengthen, or generalize.

Pediatric pointers

More common in children; may present as mouth twitching, eye deviation, or limb jerks.
Causes include hemiplegic cerebral palsy, trauma, child abuse, Sturge–Weber syndrome, AV malformation, or focal febrile seizures (~25%).
Careful observation is key as children may have limited ability to describe aura or progression.

References

Buttaro TM, Tybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice. St. Louis, MO: Mosby Elsevier; 2008.
McCance KL, Huether SE, Brashers VL, Rote NS. Pathophysiology: The Biologic Basis for Disease in Adults and Children. Mosby Elsevier; 2010.
Sommers MS, Brunner LS. Pocket Diseases. Philadelphia, PA: F.A. Davis; 2012.