Partial Epilepsy

Excerpt

Seizure activity manifests when the brain's electrical impulses discharge abnormally, resulting in disrupting or dysregulation of normal neuronal communication. Seizures, whether isolated or recurrent, originate from the brain's cerebral cortex or hippocampus region. The difference between a seizure and epilepsy depends on the number of episodes. A seizure is a single episode with a low risk of recurrence. In contrast, epilepsy is a disease in which two or more unprovoked seizures occur more than 24 hours apart, or a single seizure episode with a probability of further seizures similar to the general recurrence risk after two unprovoked seizures occurring over the next ten years, specifically, 60% or higher. The diagnosis of an epileptic syndrome includes seizures associated with a common etiology, known prognosis, and accepted treatment. The predisposition of epileptic activity is determined by the underlying cause, whether known or unknown. An exception to this rule is fever in children. A child with a simple febrile seizure is typically not diagnosed with epilepsy because the seizure activity will subside when the fever resolves; however, complex febrile seizures are linked with epilepsy.

The 2017 International League Against Epilepsy classification of seizures makes a point of the onset/origin of the seizure in the brain. Seizures can be categorized as partial or generalized. Seizures originating from a single location in the brain are considered to have a focal onset, known as a partial seizure. Seizure activity originating simultaneously from bilateral hemispheres is considered to have a generalized onset. Partial seizures are further divided into simple and complex. Simple partial seizures involve a small portion or a focal area of the brain. Complex partial seizures start in one area and travel to another. The main difference between a simple partial seizure and a complex partial seizure is impaired awareness and a post-ictal period in the latter, which also occurs in a generalized seizure. Thus complex partial seizures and generalized seizures may have similar presentations; however, they differ in that generalized seizures involve both hemispheres of the brain, whereas complex partial seizures travel from one focal area to another. Focal epilepsy and partial epilepsy are used interchangeably.

The international classification also divides partial seizures into two categories based on their respective etiologies: idiopathic partial seizures in which the cause is suggested to have a genetic component, and cryptogenic/symptomatic partial seizures in which the cause is acquired. Partial seizures are further classified into simple partial seizures or seizures with auras. Aura's are sensations the patient experiences, in which the seizure activity manifests hallucinations involving visual, auditory, olfactory, tactile, or taste senses. If a seizure does not follow the aura, it may be considered a focal aware seizure or simple partial.

The diagnosis of epilepsy may negatively impact psychosocial behavior and cognitive function. Therefore, patients consequently develop comorbid conditions or manifest side effects of neuro-modulating medication. Thus, there is an increasingly evident demand for concurrent interprofessional approaches to optimize the treatment of epilepsy in an effort to ensure a better quality of life.