Partial Seizures
Partial seizures affect a specific area of the brain and are the most common type of seizures in people with epilepsy. While these seizures can be frightening, most can be controlled with proper treatment and lifestyle adjustments.
Table of contents
- What Are Partial Seizures
- Types of Partial Seizures
- Symptoms
- Causes and Risk Factors
- Diagnosis
- Treatment Options
- Living With Partial Seizures
What Are Partial Seizures
focal seizures, simple partial seizures, complex partial seizures
A partial seizure, also known as a focal seizure, happens when unusual electrical activity affects a small area of the brain rather than the entire brain[1]. These seizures begin in one specific location in the brain, in either the right or left half (called a hemisphere)[2]. Partial seizures are the most common type of seizure, making up more than half of all seizures[4].
The symptoms of partial seizures depend on where in the brain the seizure starts[4]. The temporal lobes are the most common location where partial seizures occur[2]. Unlike generalized seizures, which affect both hemispheres of the brain at the same time and cause symptoms on both sides of the body, partial seizures begin on one side and tend to be less severe[4].
It is important to understand that seizures and epilepsy are not the same thing. A seizure is a single episode with a low risk of happening again. Epilepsy is a disease in which two or more unprovoked seizures occur more than 24 hours apart[2]. About 3 percent of people will be diagnosed with epilepsy during their lifetime, but about 70 percent of people with epilepsy eventually go into remission[14].
- Brain
- Cerebral cortex
- Hippocampus
- Temporal lobes
Types of Partial Seizures
Partial seizures are divided into two main categories based on whether they affect a person’s awareness[3].
Simple partial seizures do not affect awareness or consciousness. When a person has a simple partial seizure, they remain fully aware and can often remember what happened during the seizure[1][7]. These seizures used to be called “simple partial seizures” and are now sometimes referred to as focal onset aware seizures[5]. Simple partial seizures are also known as auras[1].
Simple partial seizures can be categorized by what they affect. Motor seizures affect the muscles of the body. Sensory seizures affect the senses. Autonomic seizures affect automatically controlled functions like heart rate and breathing. Psychic seizures affect feelings or thoughts[1].
Complex partial seizures affect awareness and consciousness. People having this type of seizure may appear to be daydreaming, staring blankly, or acting confused[3][7]. These seizures start in one area of the brain and can travel to another area[2]. Complex partial seizures are the most common type of epilepsy in adults and can last between 30 seconds and 2 minutes[11]. These seizures used to be called “complex partial seizures” and are now sometimes referred to as focal impaired awareness seizures[5].
The main difference between simple and complex partial seizures is impaired awareness and a post-ictal period (the time after the seizure ends) in complex partial seizures[2]. Sometimes people have an aura before having a complex partial seizure. This can serve as a warning sign that a seizure with loss of awareness is about to happen[4].
In some cases, a partial seizure can spread to both sides of the brain. When this happens, it can cause a loss of consciousness and movements on both sides of the body[5]. Healthcare providers call these seizures “focal to bilateral tonic-clonic seizures”[4].
Symptoms
The symptoms of partial seizures vary depending on which area of the brain is affected[1]. People with partial seizures may experience a wide range of symptoms.
Common symptoms include muscle tightening, unusual head movements, blank stares, and eyes moving from side to side[1][3]. Some people experience numbness, tingling, or a sensation like ants crawling on the skin[1]. Others may have hallucinations, which means seeing, smelling, or hearing things that are not actually there[1].
People may also experience pain or discomfort, nausea, sweating, a flushed face, dilated pupils, or a rapid heart rate[1]. Vision changes can occur, and some people feel déjà vu, which is a feeling like the current place and time have been experienced before[1]. Changes in mood or emotion may happen, and some people are unable to speak for a short while[1].
During complex partial seizures, people may show additional symptoms such as lip smacking, eyelid flutters, chewing motions, or finger rubbing[11]. They may make small movements with both hands[11]. Less commonly, people may repeat words or phrases, laugh, scream, or cry during a seizure[11]. Some people may pick at their clothing or appear to act unusually[7].
Causes and Risk Factors
The cause of partial seizures is often unknown[1][3]. Seizure activity happens when the brain’s electrical impulses discharge abnormally, disrupting normal communication between brain cells[2].
Partial seizures can happen more easily if someone has certain brain conditions. They are most common in people who have had head injuries, birth abnormalities of the brain, febrile seizures (seizures caused by fever) in childhood, infections of the brain such as encephalitis, strokes, brain tumors, or other conditions that affect the brain[4].
Certain diseases involving the blood vessels of the brain can raise the risk of partial seizures in patients 65 years of age and older[1][3]. In some cases, a change in certain genes may cause the condition[11].
Seizures are usually more common in boys than girls[11]. Rapid breathing, also called hyperventilation, and flickering lights can trigger seizures in some people[11].
Diagnosis
The most useful way to diagnose partial seizures and epilepsy is an electroencephalogram (EEG)[1][3]. This test records electrical activity in the brain and can show abnormal spikes or waves in electrical activity patterns[1][3]. Different types of epilepsy can be identified with these patterns[1].
Magnetic resonance imaging (MRI) and computed tomography (CT) scans may also be used to look at the cause and location of seizures within the brain[1][3]. These scans can reveal scar tissue, tumors, or structural problems in the brain[1]. The scans can also rule out other possible causes such as a stroke[3].
Treatment Options
For many people with partial seizures, correct treatment can lower or prevent seizures. In some cases, patients may not have any more seizures for the rest of their life[1][3]. Treatment is based on the type of seizure, how often seizures happen, how severe the seizures are, the patient’s age, the patient’s overall health, and the patient’s medical history[1][3].
Anti-seizure medications (also called anti-epileptic medications) are the most common treatment for partial seizures and can be very helpful[1][3][9]. It may take a few tries to find the right medicine and dose. The doctor will watch for side effects to find the best treatment[1][3].
Several medications are widely considered effective in controlling partial seizures. For focal onset seizures, doctors may offer lamotrigine or levetiracetam as first-line treatment. If neither of these are available, then carbamazepine can be used as an alternate first-line treatment. If the first medicine is not successful, an alternative first-line medicine should be tried. Lacosamide may be offered as a second-line option if none of the first-line medicines are effective[15].
About two-thirds of epilepsy patients will respond to either medication alone or combination therapy[9]. Adding second-line drugs to usual treatment can reduce seizure frequency in people with drug-resistant epilepsy, though it may increase side effects such as dizziness and drowsiness[14].
Surgery may be an option if medication cannot control the seizures[1][3]. There is agreement among healthcare providers that temporal lobectomy (removal of part of the temporal lobe) or similar brain surgery can improve seizure control and quality of life in people with drug-resistant temporal lobe epilepsy, though these procedures can cause neurological side effects[14].
Certain lifestyle changes may also be used to help manage partial seizures. A special high-fat, low-carbohydrate diet called a ketogenic diet may help some people, especially children who have not responded to medications[1][3][11]. Getting plenty of sleep and avoiding certain triggers, such as flickering lights, can also help prevent seizures[1][3].
Living With Partial Seizures
Despite the vast majority of partial seizures being harmless, it is important to control them because over time they can lead to memory problems or issues with thinking ability. They can also increase the risk for some mood disorders like depression and anxiety[4].
Many children who begin having seizures by the age of 9 will grow out of the condition by the time they are 18. If a patient is free of seizures for two years, their doctor may slowly reduce the amount of medication they are taking until no more medication is needed[11]. In people with partial or generalized epilepsy who have been seizure-free for at least two years on treatment, almost 60 percent of those who withdraw from medication will remain seizure-free, compared with almost 80 percent who continue treatment[14].
With proper planning, most people with partial seizures are able to lead active, fulfilling lives[16]. Regular, moderate exercise such as walking and biking are great ways to stay active. It is important to make sure seizures are under control before starting any exercise program to decrease the risk for injury[16].
One out of five people living with epilepsy lives alone[19]. People who live alone with epilepsy can take several steps to prepare their loved ones in case they have a seizure. They can also modify their living space to increase their level of safety if they have a seizure when alone[19].
