Partial (focal) seizures

Partial seizures may remain localised or spread to involve neraby cortical regions or the entire cortex.

Simple partial (no alteration of consciousness)

Can deduce the likely location of initial discharge from features at the onset.

• A focus in motor cortex -> unilateral tonic or clonic movement, often limited to one extremity.
• A focus in frontal lobe -> tonic deviation of the head and eyes.
• A focus in the sensory cortex -> sensory hallucinations (e.g. paresthesias or numbness)
• A focus in the occipital -> visual symptoms (esp. flashing lights or distortion of vision)
• A focus in the medial temporal lobe -> bizarre olfactory or gustatory hallucinations

Sensory phenomena are referred to as auras.

Complex partial (consciousness impaired)

Often caused by a focus in the temporal lobe.

Consciousness and/or mentation are affected.

Symptoms

• Automatism - simple, repetitive, purposeless movement (e.g. lip smacking)
• Visceral symptoms - e.g. sensations of butterflies rising up from the epigastrium.
• Hallucinations - olfactory, gustatory, visual, or auditory
• Memory disturbances
• Distorted perception
• Affective disorders - sensations of fear, paranoia, depression, (rarely) elation.

Partial seizures (simple or complex) with secondary generalisation

Partial seizure which later turns into a generalised seizure (with the associated complete loss of consciousness, etc)