Which clinical history findings are characteristic of complex partial status epilepticus (SE)?

Updated: Feb 13, 2018
  • Author: Julie L Roth, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Complex partial SE often begins with a history of recurrent or prolonged simple partial seizures, or it may follow or precede a generalized convulsive seizure. Patients are often confused and have variable responsiveness. Memory of the event is usually impaired. Behavior may fluctuate or be bizarre.

Many patients have clinical automatisms, as with typical complex partial seizures, including repetitive lip-smacking, fumbling, or swallowing movements. Subtle nystagmus may be observed.

The range of confusion can be great, with some patients having mildly diminished responsiveness and with others in frank stupor or in a catatonic state. Aphasia and other localizing signs and symptoms (eg, focal weakness) may accompany complex partial SE.

Type I complex partial SE refers to recurrent, recognizable complex partial seizures without recovery between seizures. Type II represents continuous, ongoing complex partial seizure activity. Clinical cycling may be most indicative of type I, though this clinical inference may not be highly reliable.

Clinically distinguishing complex partial SE from absence (generalized) nonconvulsive SE may be problematic; an EEG showing focal or lateralized features may be helpful. EEG is a particularly valuable tool in this setting because treatment options may partly depend on this distinction. Knowledge of the patient's interictal EEG and clinical syndrome, when possible, may also help make this important clinical distinction.

As in generalized SE, patients with focal SE often have an established history of epilepsy, and subtherapeutic anticonvulsant levels or other new metabolic or systemic stressors may be implicated in the expression of FSE. Alternatively, acute or chronic focal cerebral injuries of various kinds (especially, vascular insults) may provide the substrate for new-onset focal seizures and SE.


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