(This blog was originally posted on June 24, 2013)
Conner,
the young boy in my recently published novel, DINGS, suffers from complex partial seizures that aren’t recognized.
This is actually the most common type of seizure and is experienced by 40 to 45
percent of people who have epilepsy. Other terms for the complex partial
seizure include temporal lobe seizure, because they usually come from the
temporal lobe (a small percentage with similar symptoms arise from the frontal
lobe) and psychomotor seizure, because a prominent part of the seizure consists
of psychological symptoms. The newest term is “mesial temporal lobe epilepsy.” Complex
partial seizures get their name because they begin in just one part of the
brain, the temporal lobe (i.e., “partial”). Within the deeper part of the
temporal lobe is the area of the brain that is associated with memory and
emotions. People who experience a complex partial seizure lose contact with their
surroundings. They appear awake but they are not aware of their surroundings
and will respond minimally, or not at all, to communication directed at them.
They do not know or remember what occurred during the event because the seizure
altered their mental state. If the seizure activity in the temporal lobe
spreads to the rest of the brain, the complex partial seizure is said to
generalize secondarily; this provokes a convulsion.
Typically
during the complex partial seizure, the person initially experiences a warning
of a very strange, rising sensation in their midsection associated with a
feeling of inexplicable fear (this is the aura). He or she can also hallucinate
smelling a bad odor—burning rubber is classic—or a metallic taste in the mouth.
Déjà vu, which is a perception of
having experienced a brand new situation as though it had previously been experienced,
is common during this event. A related phenomenon is jamais vu, or the perception of a situation that is common in your
previous experience, but it seems as though it’s your first experience of that
situation. (Normal people also experience a rare déjà vu or jamais vu symptom,
but not at the frequency of people who have this form of epilepsy). Then, the
person “spaces out.” Observers will note a change in the patient’s facial
expression: one of fear. A complex partial seizure is often associated with
chewing and swallowing movements. The person may not experience all of these
phenomena in an aura—they may not experience the déjà vu for one seizure, but will have it during a subsequent
seizure—or the taste or smell hallucinations may not occur with all of the
seizures.
There
are no specific triggers for a complex partial seizure, although stress can
bring one on. This seizure typically lasts seconds to minutes. These are the
most interesting kinds of seizures in that the person can suddenly develop a
vacant stare, stand up, move around and perform various actions. I have seen
people turn sink faucets on and off. The individual has some alert qualities in
that he or she will respond when being spoken to, but in a confused, distant
manner. If you suspect that someone is having a complex partial seizure, test the
person’s responsiveness/alertness to the environment by asking him or her to
perform an action: “Put your right thumb on your left ear.” If the patient looks
at you in confusion and does not respond, the person probably is having a
complex partial seizure. All you can do is, wait for the person to come out of
it and try to safeguard him or her from injury. You must use care in this
attempt, however, because touching or attempting to restrain someone who is
having a complex partial seizure often induces a violent physical reaction that
can result in injury to you and/or to the patient.
Lance Fogan, M.D. is Clinical Professor of Neurology
at the David Geffen School of Medicine at
UCLA. DINGS is his first novel.
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