What does a complex partial seizure look like?

This video illustrates what a complex partial seizure looks like. But what does this even mean? well let's have a close look !

Seizure (fit) is a transient neurological event caused by abnormal electric discharge of neurons within the cerebral hemisphere manifesting as a group of motor/sensory symptoms/signs known as seizure semiology. An individual is said to have epilepsy if he/she has ≥ 2 seizures. Epilepsy is a symptom of an underlying disease process rather than a disease on its own right.

Did you know that about 5% of the population has a single seizure at some point of their lifetime, and if we are to look at every 100,000 people in the UK, about 500 of them will have a diagnosis of epilepsy.

Seizures are often mistaken for syncope or fainting which might be accompanied by general jerkiness just like some seizures. Therefore, it is important to clearly and accurately describe what exactly happened during the event. A witnessed account of what happened is essential since seizures almost always result in memory impairment or loss of consciousness.

So, how can you describe a seizure? let's dissect the event:

PRODROME = alteration of behaviour/mood preceding the attack by hours.

AURA = symptoms occurring immediately before the attack (this is important to indicate a seizure and trace its origin within the brain. For example, unusual sudden strange smell and gut rising feeling localizes to the temporal lobe).

ICTUS = the event itself might present as violent jerky movement affecting the limbs to sudden attacks looking vacant.

POST-ICTUS = this is the period immediately after seizure symptoms. A seizure is often associated with slow recovery (> 5 min) leaving the individual confused and muddled for few minutes even after recovery.

Now we know how to describe seizures, we can move to the next part - classification of seizures. The type of seizure you saw in the video is described as 'partial'. Why is that?

The International League Against Epilepsy (ILAE) classifies seizures according to their origin of onset within the brain. A seizure can be 'generalized' or 'partial'. Generalized seizures arise from a subcortical structure and are associated with synchronized generalized abnormal neuronal firing involving BOTH HEMISPHERES and resulting in impairment of consciousness and bilateral motor manifestations. On the other hand, partial seizures arise from a FOCAL origin within the CEREBRAL CORTEX that may either remain localized or spread more generally to result in a secondary generalized seizure.

A partial seizure can be further classified into 'simple' and 'complex' based on the degree of consciousness. Patients filmed in the video are said to have complex partial seizures because they can't remember what happened and lost awareness of their surroundings. This is due to seizure activity originating in the temporal lobe involving the hippocampus and spreading to the contralateral temporal lobe resulting in amnesia. So, 'complex' means accompanied by alteration of consciousness.

The behavioural features illustrated in the video are involuntary and known as 'automatism' which occurs in 90% of complex partial seizures. As shown above, they present as fumbling movement, rubbing and chewing or as semi-purposeful limb movement (eg opening the curtins and putting on cloths) - other people won't even guess the individual is suffering from a seizure. However, patients experiencing a complex partial seizure often appear distant, staring and unresponsive.

I hope this brief article helped to explain the pattern of symptoms and signs shown in the video, and provided some clarification. Please do not hesitate to ask any questions related to the topic.