Seizures, complex partial

A complex partial seizure occurs when a focal seizure begins in the temporal lobe and causes a partial alteration of consciousness — usually confusion. Psychomotor seizures can occur at any age, but incidence usually increases during adolescence and adulthood. Two-thirds of patients also have generalized seizures.

An aura — usually a complex hallucination, illusion, or sensation — typically precedes a psychomotor seizure. The hallucination may be audiovisual (images with sounds), auditory (abnormal or normal sounds or voices from the patient’s past), or olfactory (unpleasant smells, such as rotten eggs or burning materials). Other types of auras include sensations of déjà vu, unfamiliarity with surroundings, or depersonalization. Some patients become fearful or anxious, experience lip smacking, or have an unpleasant feeling in the epigastric region that rises toward the chest and throat. The patient usually recognizes the aura and lies down before losing consciousness.

A period of unresponsiveness follows the aura. The patient may experience automatisms, appear dazed and wander aimlessly, perform inappropriate acts (such as undressing in public), be unresponsive, or utter incoherent phrases. After the seizure, the patient is confused, drowsy, and doesn’t remember the seizure. Behavioral automatisms rarely last longer than 5 minutes, but postseizure confusion, agitation, and amnesia may persist.

Between attacks, the patient may exhibit slow and rigid thinking, outbursts of anger and aggressiveness, tedious conversation, a preoccupation with naive philosophical ideas, diminished libido, mood swings, and paranoid tendencies.

History

If you witness a complex partial seizure, never attempt to restrain the patient. Instead, lead him gently to a safe area. (Exception: Don’t approach him if he’s angry or violent.) Calmly encourage him to sit down, and remain with him until he’s fully alert. After the seizure, ask him if he experienced an aura. Record all observations and findings.

Physical assessment

If the patient has had a seizure, examine him for injury. Make sure he has a patent airway, and then perform a complete neurologic assessment.

Medical causes

Brain abscess

If the brain abscess is in the temporal lobe, complex partial seizures commonly occur after the abscess disappears. Related problems may include headache, nausea, vomiting, generalized seizures, and a decreased level of consciousness (LOC). The patient may also develop central facial weakness, auditory receptive aphasia, hemiparesis, and ocular disturbances.

Head trauma

Severe trauma to the temporal lobe (especially from a penetrating injury) can produce complex partial seizures months or years later. The seizures may decrease in frequency and eventually stop. Head trauma also causes generalized seizures and behavior and personality changes.

Temporal lobe tumor

Complex partial seizures may be the first sign of a tumor in the temporal lobe. Other signs and symptoms include headache, pupillary changes, and mental dullness. Increased intracranial pressure may cause a decreased LOC, vomiting and, possibly, papilledema.

Special considerations

After the seizure, remain with the patient to reorient him to his surroundings and to protect him from injury. Keep him in bed until he’s fully alert, and remove harmful objects from the area.

Prepare the patient for diagnostic tests, such as EEG, computed tomography scans, or magnetic resonance imaging.

Pediatric pointers

Complex partial seizures in children may resemble absence seizures (benign generalized seizures thought to originate subcortically). Complex partial seizures can result from birth injury, abuse, infection, or cancer. In about one-third of patients, their cause is unknown.

Repeated complex partial seizures commonly lead to generalized seizures. The child may experience a slight aura, which is rarely as clearly defined as that seen with generalized tonic-clonic seizures.

Patient counseling

Offer emotional support to the patient and his family. Teach them how to cope with seizures. Discuss safety measures to take during a seizure.

Pictures

Book Source Details

• Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Confusion

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Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Confusion: Introduction (review 725 causes)
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More About This Book: Title: Signs & Symptoms: A 2-in-1 Reference for Nurses Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-318-1

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• Confusion (Signs & Symptoms: A 2-in-1 Reference for Nurses)
• Agitation (Nursing: Interpreting Signs and Symptoms)
• Seizures, complex partial (Nursing: Interpreting Signs and Symptoms)
• Confusion (Nursing: Interpreting Signs and Symptoms)
• DELIRIUM (Differential Diagnosis in Primary Care)

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