* Motor simple partial seizures
o Clonic discharges in the sensorimotor cortex cause jerky, rhythmic movements that may remain restricted to one body segment or spread by “jacksonian march.”
o Benign focal epilepsy of childhood accounts for 15-25% of childhood epilepsy and eventually remits by age 16 years.
+ Typical seizures are simple and motor, affect the face or arm, and occur soon after falling asleep or awakening.
+ As it usually remits by age 16 years, this syndrome does not always require treatment.
o Another subtype, epilepsia partialis continua (ie, Kojewnikoff syndrome), includes stereotypical periodic to semiperiodic clonic activity that may persist for years and is often refractory to treatment.
+ Clonic jerking usually involves the thumb or great toe, and may or may not spread to other body parts.
+ This activity has been associated with stroke, tumor, trauma, hypoxia, Rasmussen encephalitis, syndrome of
mitochondrial encephalomyopathy, lactic acidosis, and stroke (MELAS), subacute sclerosing panencephalitis (SSPE), and adult nonketotic hyperglycinemia.
o Tonic-supplementary motor area (SMA) and premotor region discharges produce sustained contractions and unusual postures of a limb.
+ In 72% of cases SMA seizures are not associated with impaired consciousness.
+ Versive-smooth or jerky, tonic contractions of head and eye muscles, usually on the side contralateral to the discharge, often are followed by a secondarily generalized tonic-clonic seizure.
+ Phonatory activation of the primary or supplementary motor cortex produces vocalizations, speech arrest, or aphasia.
* Sensory simple partial seizures
o Somatosensory-primary sensory cortex seizures usually elicit positive or negative sensations contralateral to the discharge.
o Symptoms associated with seizures from the postcentral gyrus include tingling, numbness, pain, heat, cold, agnosia, phantom sensations, or sensations of movement.
o Abdominal pain usually originates from the temporal lobe, and genital pain from the mesial parietal sensory cortex.
o The posterior parietal cortex is the likely origin of limb agnosia.
o Supplemental sensory-secondary sensory cortex seizures may have ipsilateral or bilateral positive or negative sensations or vague axial or diffuse sensations.
o Visual-calcarine cortex discharges produce elemental hallucinations including scintillations, scotomata, colored lights, visual field deficits, or field inversion.
o The visual association cortex is the probable location of origin of complex visual hallucinations and photopsias.
o Auditory SPS from the auditory cortex typically are perceived as simple sounds, rather than words or music.
o Olfactory-uncinate seizures originate from the orbitofrontal cortex and the mesial temporal area. Perceived odors are usually unpleasant, often with a burning quality.
o Gustatory seizures usually are associated with temporal lobe origin, although the insula and parietal operculum also have been implicated. Perceived tastes are typically unpleasant, often with a metallic component.
o Vestibular seizures originate from various areas, including frontal and temporal-parietal-occipital junction. Symptoms include vertigo, a tilting sensation, and vague dizziness.
o Psychic SPS arise predominantly from the temporal and limbic region, including the amygdala, hippocampus, and parahippocampal gyrus. Perceptual hallucinations or illusions are usually complex, visual or auditory, and are rarely bimodal.
+ Includes the déjà vu and jamais vu phenomena
+ Emotional: Fear is usual, but SPS can elicit happiness, sexual arousal, anger, and similar responses.
+ Cognitive: These responses include feelings of depersonalization, unreality, forced thinking, or feelings that may defy description.
* Autonomic simple partial seizures
o Abdominal sensation phenomena
+ These are common in mesial temporal epilepsy but can arise from the operculum and occipital region.
+ Symptoms include nausea, pain, hunger, warmth, and “epigastric rising” sensations, and may be associated with piloerection (ie, gooseflesh).
o Cardiovascular sensations
+ The most common cardiac manifestation of any seizure is sinus tachycardia with arrhythmias, with bradycardia occurring infrequently.
+ Some patients have chest pain or a sensation of palpitation that mimics cardiac disease.
+ Respiratory inhibition has been reported with electrical stimulation of the temporal regions.
o Pupillary symptoms - Miosis, mydriasis, hippus, and unilateral pupillary dilatation
o Urogenital symptoms
+ Seizures from the superior portion of the posterior central gyrus can result in genital sensations, while sexual auras arise more from the limbic or temporal regions.
+ Ictal orgasms have been reported, although rarely, in association with seizures arising from various cerebral locations.
o Other autonomic symptoms - Rarely perspiration, lacrimation, ictal enuresis, or flushing
* Postictal neurological deficits can occur after an SPS as a negative manifestation of the function affected by the seizure (eg, Todd paralysis).
