Absence vs. Complex Partial?

[Dee]

Dear Doctor:

What is the difference between absence seizures and complex partial seizures? I've heard that different drugs are used in each and one won't necessarily work on the other.  I've mentioned in my previous postings that my six-year-old was diagnosed with complex partial in the occipital lobe, predominately on the right.  Video EEG correlated staring and unresponsiveness with spikes and he always resumed activities as if nothing happened.  It sounds like he could fall in either category to me.  However, the Tegretol is not working for him and I think it's made things worse so I asked to wean him off of it.  He had problems one day recently after he took his morning 100 mg. dose.  He suddenly became very lethargic (30 minutes later) and said he didn't feel good.  For the next six hours he appeared to be confused and was having trouble talking.  All he wanted to do was lay on the sofa, but when he did get up he would forget what he wanted.  He walked to the refrigerator a couple of times without opening it and just stood there and stared off into space.  He would call out for someone and when they replied he couldn't remember what he wanted to say.  He would not respond to questions.  He would start to talk and then would stop in mid-sentence and couldn't finish.  A couple of times he got up and just walked around and spit on the floor - really bizarre behavior.  He seemed to be in slow motion.  His usual tics of the heading shaking and hand jerking seemed to have decreased drastically, and when they were present they were slow motions.  In the middle of all this he began to complain of his head hurting real bad.  He said he needed to use the bathroom, but didn't know what he needed to do.  The neuro on-call (it was the weekend) said to take him to our PCP and have a Tegretol level done.  He really didn't think it was toxicity since he was on such

[CCF Neuro[P] MD, RPS]

Dear Dee:

Absence seizures are very brief and very frequent.  They usually occur multiple times in a day.  They have a very characterized EEG pattern of "3 hertz, spike and wave".  They disrupt the pattern of living with brief moments of loss of consciousness, can occur with lip smacking, eye blinking etc.  They occur at play, eating, etc.  There is usually no post-ictal state, no after behavior changes, and incontinence.  Your son sounds like he has partial complex seizures.  I think you would agree that his seizures do not sound in anyway like absence.

Concerning tegratol, I think we already talked about levels and the need to make sure a given drug is at it's optimal level.  Furthermore, this type of epilepsy is very difficult to control.

I hope I have helped clarify the two epilepsies for you.

Sincerely,

CCF Neuro MD

[eeg-tech]

Hi, I was just curious after reading this post. So I have a question for the Dr. I worked in a epilepsy center for awhile. And I remember the subject of Tegretol Induced seizures coming up (but not often). So I can't remember exactly what the theory was. Can Tegretol, in rare cases cause pt's with complex partial seizres to have absence seizures? Or was it if a pt. with absence seizure is somehow put on tegretol, they could have a dramtic increase in their absence seizures? When  this mom mentioned she thought tegretol may have had something to do with this, it made me wonder.

[CCF Neuro[P] MD, RPS]

Dear EEG Tech:

Tegratol would make absence seizures worse.  At the Cleveland Clinic, we call the 3 hertz-spke wave absence, while the variants generalized.  As absence, either classic and variant, are for the vast majority of patients generalized seizures, we would not treat with a partial epilepsy medication.  Tegratol does work on some generalized epilepsies but not in absence.

I hope that I didn't confuse you.

Sincerely,