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 their 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. The patient may 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, utter incoherent phrases, or (rarely) go into a rage or tantrum. 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, a diminished libido, mood swings, and paranoid tendencies.

History and physical examination

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. Obtain a history. Has the patient experienced a seizure in the past? Has he had a recent head injury? Has he experienced any fever, headaches, or periods of confusion? Obtain a complete drug history. Take his vital signs and perform a complete neurologic examination.

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 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.

Herpes simplex encephalitis.Herpes simplex virus commonly attacks the temporal lobe, resulting in complex partial seizures. Other features include fever, headache, coma, and generalized seizures.

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

Nursing considerations

▪ After the seizure, remain with the patient to reorient him to his surroundings and to protect him from injury.

▪ Keep the patient 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 scan, or magnetic resonance imaging.

Patient teaching

▪ Explain the disorder and its treatment.

▪ Offer emotional support to the patient and his family, and teach them how to cope with seizures.

▪ Discuss with the patient and his family safety measures to take during a seizure.

▪ Emphasize compliance with drug therapy.

▪ Stress the importance of carrying medical identification.

Book Source Details

• Book Title: Nursing: Interpreting Signs and Symptoms
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7

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