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A 3-year-old is brought to the emergency room due to a seizure. The parents state that the seizure started with a twitch in the finger and progressed to a twitching eyelid and a blank stare. What type of seizure are the parents describing?

Explanation

• Partial (focal) seizures originate from a specific brain area and often only affect a part of the brain. A partial seizure with sensory signs may include numbness, tingling, paresthesia, or pain originating in one area and spreading to other parts of the body. Partial seizures may be subdivided into simple and complex seizures, based on the effect on consciousness. Simple partial seizures cause no change to consciousness, although they may cause sensory distortions or sensations. Complex partial seizures interrupt consciousness to varying degrees. A complex partial seizure may involve a blank stare and unawareness of the seizure or the unconscious repetition of simple actions, gestures, or verbal noises.

• In some cases, patients with partial (focal) seizures may have motor or sensory symptoms. For example, a patient may have abnormal movements such as jerking of a finger or the eyelids which may spread to other parts of the body. Other examples are changes in sensations such as taste or smell or a feeling of "pins and needles."

Incorrect answers:

• Petit mal (absence seizure) is classified as a generalized seizure. A petit mal seizure usually lasts less than 20 seconds and always involves loss of consciousness. Rhythmic blinking and twitching of the mouth or of an extremity often indicates a petit mal seizure is starting.

• Typical tonic-clonic seizures are generalized seizures. There are usually three stages. 1) Aura: a strange, dizzy, ominous feeling that can last minutes or hours. 2) Tonic phase: the person loses consciousness, and muscles tense. This only lasts a few seconds. 3) Clonic phase: Muscles contract and relax rapidly in convulsions.

• Status epilepticus refers to a seizure that lasts continuously for more than 5 minutes or a series of seizures from which the child does not return to his or her previous level of consciousness. This is a medical emergency.

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