Complex partial seizures in children
Elaine Wyllie, MD
Department of Neurology, The Cleveland Clinic Foundation, One Clinic Center, 9500 Euclid Avenue, Cleveland, Ohio 44195
Hans Luders, MD, PhD
COMPLEX partial seizures (CPS) are not infrequent in children. The majority of adults with CPS had the onset of their epilepsy before the age of 20 years;1 and among children with epilepsy, the seizure type is complex partial in approximately 13% to 25% of patients.2–4 CPS are often intractable to medication, leading to thoughts of possible surgery; and in fact, many of these patients do have a single resectable epileptogenic focus. This review will address some considerations in the identification of pediatric epilepsy surgery candidates and the timing of operation.
The hallmark of partial seizures in children and adults is focal epileptiform discharges localized to a portion of one cerebral hemisphere. With the current classification system, partial seizures are further divided into “simple” or “complex” types: complex partial seizures include impairment of consciousness, and simple partial seizures do not.5 The impairment of consciousness during CPS may occur at onset of the episode or after an initial simple partial seizure with preserved consciousness. When the preceding simple partial seizure is sensory, it is sometimes called an aura.
With this classification system, “complex” does not mean “complicated,” and this variance from the colloquial meaning of the word has caused some confusion.6,7 Another problem has been that the ictal level of consciousness may be difficult to assess, especially in young children. However, the basic distinction between simple and complex partial seizures may be useful in that it identifies those seizures that have the very disabling symptom of altered consciousness. As the. . .