Partial epileptic paroxysms

Partial epileptic paroxysms are attacks in which the initial clinical and EEG manifestations indicate the involvement in the epileptic process of one region of one hemisphere of the brain.

Partial epileptic paroxysms are divided into simple and complex. The principal difference between simple and complex partial seizures is the state of consciousness of the patient at the time of the paroxysm. Simple partial seizures occur with a fully preserved consciousness, while complex partial seizures are characterized by varying degrees of impairment of consciousness.

Simple partial seizures are characterized by intact consciousness and can manifest themselves:
a) motor symptoms;
b) somatosensory or specific sensory symptoms; c) vegetative symptoms;
g) mental symptoms.

Among partial motor seizures, there are focal clonic, focal tonic (versative and postural), and fonatory seizures.

Focal clonic paroxysms (Jackson attacks) are caused by epileptic activity in the precentral gyrus (motor cortex) of the contralateral side and are characterized by repeated rhythmic contractions of muscles in a certain part of the body. Focal clonic seizures can be either localized in one part of the body or spread to other areas of the motor cortex with the sequential involvement of various parts of the body – an “epileptic march”: finger—> brush — fuk— ”face.

Focal tonic paroxysms manifest pronounced violent tension of various muscles. There are versional postural focal clonic paroxysms. Versive attacks are characterized by tonic abduction towards the head, eyes, limbs, and sometimes by turning the whole body.

The epileptic focus in this type of seizure is localized in the frontal, temporal, or occipital lobes of the brain. In 97% of cases head and eye abduction to the contralateral side is observed.

Postural paroxysms are accompanied by a sudden, bilateral increase in muscle tone with a change in body position and posture of the patient, often lead to a fall.

Phonatoric paroxysms are characterized by paroxysmal speech disorders, correlated with epileptic activity on EEG. Clinical manifestations of fatornye attacks can be as in the form of negative symptoms, i.e. impossibility of normal verbal activity (speech arrest, paroxysmal dysarthria, paroxysmal motor or sensory aphasia), and in the form of positive symptoms with involuntary inadequate verbal activity (stereotypical verbal behavior, vocalization, speech automatism, palilalia, verbal hallucinations).

Simple partial seizures with somatosensory or specific sensory symptoms occur when the epileptic focus is localized in the primary somatosensory cortex (postcentral gyrus) and is characterized by numbness, tingling, and crawling in the corresponding part of the body on the contralateral side.

The most frequent clinical manifestation of somatosensory attacks is elementary paresthesia (numbness, tingling).
Sometimes paroxysmal disturbances of temperature and pain sensitivity may occur.

Simple partial seizures with specific sensory symptoms include the following types of paroxysms:

  • visual (paroxysmal amaurosis, visual illusions, simple and complex visual hallucinations);
  • auditory (individual sounds, auditory hallucinations);
  • olfactory (a sudden sensation of any smell);
  • Gustatory (paroxysmal sensations of bitter, sweet, salty);
  • epileptic dizziness (sensations of flight, fall, rotation of one’s body or

Simple partial seizures with autonomic symptoms are characterized by sudden short-term vegetative manifestations (vomiting, pallor, redness or pallor of the face, sweating, dilated pupils).

Simple partial seizures with mental symptoms – paroxysmal violation of higher cortical functions.
It should be noted that simple partial paroxysms (with the exception of motor and sensory) rarely occur in isolation and in most cases represent the aura of complex partial attacks.

Complicated partial paroxysms are attacks that manifest with focal clinical and EEG manifestations and are characterized by partial or complete impairment of consciousness. Clinical manifestations of complex partial seizures are variable and depend on the localization of the primary focus of epileptic activity and the nature of its spread to other areas of the brain. Testing is applied to assess the state of consciousness of the patient at the time of the attack: they ask the patient whether he feels something; if the patient answers in the affirmative, clarify the question: “What do you feel?” Next, ask the question: “What is your name?” and so on according to the scheme:

local_offerevent_note February 3, 2019

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