An 18-year-old man was evaluated because of recurrent “spells” since the age of 11.

Our patient was an 18-year-old man with a history of complex partial and secondarily generalized seizures. He had had seizures since age 11. His seizures had been refractory to topiramate, oxcarbazepine, and levetiracetam. While being monitored with a video electroencephalography (EEG), he had a complex partial seizure. During the ictal phase, he had sudden onset of a motionless stare and became unresponsive. Next, a tonic abducting posture of both hands was noted. Initially, his right hand was held in a dystonic posture. Some mild lip smacking was noted. He then became restless and exhibited some purposeless hand movements. No sustained gaze deviation was noted. During the postictal phase, he had difficulty speaking and finding words, suggesting postictal dysphasia. A complex automatism was noted in his attempt to use the remote control.

An epileptic seizure is a transient and reversible alteration of movements, sensation, awareness, or behavior caused by a paroxysmal, abnormal, and excessive neuronal discharge. One isolated seizure is not defined as epilepsy. Among patients with a single seizure, only approximately 25% will experience an unprovoked recurrence within 2 years,
that is, in the absence of triggers or risk factors. Epilepsy is typically defined as two or more recurring seizures not provoked by any triggers, including intracranial infections, drug withdrawal, acute metabolic changes, or fever.

The International League Against Epilepsy (ILAE) classification system for seizures divided seizures into two broad categories: partial (focal) seizures and generalized seizures. Partial seizures start in specific locations in the cerebral cortex and are associated with focal ictal and interictal changes during an EEG. Generalized seizures are characterized by generalized involvement of both the cerebral hemispheres from the beginning of the seizure and have no consistent focal areas of ictal onset.

Partial seizures can become secondarily generalized tonic-clonic seizures. Partial seizures are further subdivided into simple partial and complex partial seizures. Consciousness remains intact during a simple partial seizure, whereas consciousness is impaired during a complex partial seizure.

For etiology, the terms idiopathic (unknown cause), symptomatic (identifiable cause), and cryptogenic (hidden or occult cause) have been used, but newer concepts in classifications of the epilepsies are being proposed. Complex partial seizures are the most common seizure type in adults, and the temporal lobe, particularly the medial temporal lobe, is the most common site of epileptogenic focus. There appears to be a strong relationship between complicated febrile seizures during early childhood or infancy and the later development of medial temporal lobe epilepsy. Lateralizing signs can often predict the side of abnormality or epileptogenic region in patients with partial epilepsy.