Simple partial seizures often precede complex partial seizures, as well as seizures with secondary generalization. The main criterion of simple partial seizures is the safety of consciousness during paroxysms, which manifest as motor, sensory, autonomic-visceral, as well as mental disorders.
Simple partial motor seizures include local tonic or tonic-clonic convulsions, contralateral foci, postural dystonic paroxysms; Adverse and phonatory seizures. Postural dystonic paroxysms (“lateralized postural dystonia”) are most characteristic of VE. Dystonic seizures in CE involve distal limbs (hand more often than foot) on the opposite side of the hearth and consist of a specific fixed athetoid installation. They can be combined with turning of the head also contralaterally to the hearth and manual autopsy of the ipsilateral.
Simple partial sensory seizures occur with CE with varying frequency. For amygdalogoppocampal, olfactory and taste paroxysms are considered typical. Olfactory episodes (“Jackson’s udkusnye attacks”) occur when the hippocampal hook is irritated and manifest as olfactory hallucinations. The paroxysmal sensations of odors that are not currently existing are characteristic. Usually, patients feel one, strictly defined, often sharply unpleasant smell (gasoline, paint, rotting, etc.). The smell can be undifferentiated, difficult to describe. Olfactory hallucinations are often combined with taste. The latter are manifested by the sensation of an unpleasant taste in the mouth, for example, metal, bitterness, burning rubber. Olfactory and taste attacks are rarely the only manifestation of CE, they are usually combined with other types of seizures.
Vegeto-visceral seizures are a typical manifestation of amygdalogoppocampal EE. There are epigastric, cardiac, respiratory and sexual paroxysms. Vegetative-visceral seizures are rarely found in isolation, they are usually included in the structure of complex partial seizures.
Attacks with impaired mental functions underlie amygdalogyppocampal EI.
Characteristic are the dreamlike states described by Jackson in 1880, as well as the phenomena of derealization and depersonalization. The dreamlike states are manifested by the peculiar sensations of “waking dreams”, dreams, fantasies, a sense of unreality, the illusiveness of the surrounding. Objects seem to the patient endowed with some special meaning, “soul”, they flash with a beam of light and bright colors. Sometimes, on the contrary, the world around us becomes dull, dull, meaningless, joyless, frozen. These states can be combined with the phenomena of derealization, in the form of “previously seen (heard, experienced).” In case of dreamlike states, metamorphopsies can be observed: distortion of the size and shape of objects and space, as well as sensations of a change in the course of time — slowing down or speeding up.
Along with the phenomena of derealization, dreamlike states are combined with paroxysms of depersonalization. They are characterized by impaired perception and alienation of the self (autopsy depersonalization). It seems to the patient that his thoughts, feelings, and ideas belong not to him, but to another person. Sometimes he feels like a fabulous hero, a great commander, etc.
When a tonsil complex is involved in the process, affective attacks occur: unmotivated (“animal fear”), panic or rage seizures (dysphoric paroxysms). It should also be noted a special form of paroxysms, manifested by an affect of joy, a feeling of elation, lightness, ecstasy. In foreign literature, such attacks are called Dostoevsky’s epilepsy. The great writer, through the lips of Prince Myshkin, described his feelings during the “ecstatic aura” preceding a generalized convulsive fit.
This is how one of the patients with cryptogenic temporal epilepsy describes her seizures: “1-2 times a month in the last two years I have experienced a state of wakefulness: before falling asleep, I hear the creaking of the opening door, at that moment I already know what will happen, since it has been repeated more than once. I see that it comes in. It is a terrible dwarf whose faces I cannot see, I try to shout, move, but I am absolutely helpless in front of him, powerless to do anything. The dwarf laughs, tells me cynical things touches me i’m experiencing Ayu is such a horror that “hair moves on my head.” When the dwarf leaves, I feel real bliss and immediately fall asleep. Once I tried to relax, not to be afraid of this meeting, and then I experienced a feeling of real flight, ecstasy. When I wake up in the morning, I I remember well that He came again. “
Complicated partial (psychomotor) seizures constitute the “core” of amygdalogapocampal epilepsy. They have three criteria: deactivation with amnesia, lack of response to external stimuli, the presence of automatisms. It must be emphasized that mental disorder is an obligatory sign of complex partial seizures. With EC, there can be observed various types of automatism: custom-alimized, mimetic, gestural (most frequent and typical), speech, ambulatory, sexual, stereotypical hypermotor.
Oroalimentary and mimetic automatisms present no special diagnostic difficulties: the former are manifested by chewing, swallowing, smacking, licking, sucking; the second – with grimaces, mimicry of laughter, surprise, confusion, frowning. Gesture automatisms (hand and trunk) are manifested by quick stereotypical movements like rolling pills, clapping hands, stroking your body, rubbing hand to hand, picking clothes or bed linen, etc. If gestural automatism is one-sided, then it is of great importance for determining the localization of an epileptic focus.
Thus, automatisms arise in the hand on the homolateral focus, and dystonic installation of the Holthausen brush, 1994 develops on the contralateral side, 1994). The most dramatic manifestation of complex partial seizures is ambulatory automatism. They proceed as long, seemingly purposeful, expedient and coordinated movements, usually with interaction. Patients can lay out objects on the table, look around, turn on the receiver, pour water into a glass, etc. Long-term outpatient automatisms turn into epileptic trances (fugues). Trances can manifest themselves in the form of dromomania – patients wander aimlessly through the streets, get into transport, go to other cities. Automatisms with stereotypical hypermotor movements are characterized by motor reactions that occur during sleep in the proximal parts of the lower (pedaling) or upper (boxing) limbs.
Lateral VE (neocortical) is less common than amygda-logyppocampal. The most characteristic seizures in lateral epilepsy are auditory hallucinations, visual hallucinations, episodes of dizziness, speech disorders (“temporal syncope”).
The occurrence of complex auditory hallucinations is most typical for lateral ET. The appearance of auditory illusions and hallucinations is possible – both elementary (noise) and complex (voices, music). Often the attack, starting with auditory hallucinations, goes A mental disorder is an obligatory sign of complex partial seizures. With EC, there can be observed various types of automatism: custom-alimized, mimetic, gestural (most frequent and typical), speech, ambulatory, sexual, stereotypical hypermotor.
Oroalimentary and mimetic automatisms present no special diagnostic difficulties: the former are manifested by chewing, swallowing, smacking, licking, sucking; the second – with grimaces, mimicry of laughter, surprise, confusion, frowning. Gesture automatisms (hand and trunk) are manifested by quick stereotypical movements like rolling pills, clapping hands, stroking your body, rubbing hand to hand, picking clothes or bed linen, etc. If gestural automatism is one-sided, then it is of great importance for determining the localization of an epileptic focus. Thus, automatisms arise in the hand on the homolateral focus, and dystonic installation of the Holthausen brush, 1994 develops on the contralateral side, 1994). The most dramatic manifestation of complex partial seizures is ambulatory automatism. They proceed as long, seemingly purposeful, expedient and coordinated movements, usually with interaction. Patients can lay out objects on the table, look around, turn on the receiver, pour water into a glass, etc. Long-term outpatient automatisms turn into epileptic trances (fugues). Trances can manifest themselves in the form of dromomania – patients wander aimlessly through the streets, get into transport, go to other cities. Automatisms with stereotypical hypermotor movements are characterized by motor reactions that occur during sleep in the proximal parts of the lower (pedaling) or upper (boxing) limbs.
Lateral VE (neocortical) is less common than amygda-logyppocampal. The most characteristic seizures in lateral epilepsy are auditory hallucinations, visual hallucinations, episodes of dizziness, speech disorders (“temporal syncope”).
The occurrence of complex auditory hallucinations is most typical for lateral ET. The appearance of auditory illusions and hallucinations is possible – both elementary (noise) and complex (voices, music). Often the attack, starting with auditory hallucinations, goes complex partial with the gaze stopped and various automatisms.
Visual hallucinations, as a rule, complex, with panoramic vision of people, animals, their moving. Hallucinations are exclusively natural, usually closely related to the patient, his feelings, experiences, sensations. Patients are watching the change of pictures, “like in the movies”, so real and bright are the images. Characterized by ecmnestic hallucinations (hallucinations of memory), manifested in the emergence of images and scenes that had a real place in the lives of patients many years ago. It is important that patients take a critical attitude towards perception frauds, which distinguishes them from patients with mental disorders.
Vestibular seizures manifest with sudden short (10 seconds – 3 minutes) stereotypical vertigo that is systemic. Often during an attack, there are illusions of space change (“walls fall”, “the ceiling goes down”), as well as vegetative symptoms (hyperhidrosis, pallor of the skin, tachycardia). Such paroxysms usually go into a complex partial seizure.
With localization of the lesion in the upper temporal gyrus of the dominant hemisphere (Wernicke speech center), there are bouts of sensory aphasia. Paroxysmal sensory aphasia is manifested in the form of the impossibility of patient perception of oral speech. Perhaps a combination with amusia.
In lateral VE, there can be peculiar seizures described in English-language literature as “temporal syncope”, and in Russian-language such as “faint-like form of epilepsy”. Attacks begin with aura (often dizziness) or occur in isolation. A relatively slow shutdown of consciousness, followed by a “limping” and a fall (the fall is not sharp!), Is characteristic. Perhaps a slight tonic tension of the muscles of the limbs, facial muscles, the emergence of custom or gestural automatism. These attacks should be differentiated with conventional syncope, in which provoking factors are identified (prolonged stationary upright position, stuffiness, etc.) and lipotymia preceding the attacks (“nausea”).