What is simple partial status epilepticus (SPSE)?

Updated: Feb 13, 2018
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By definition, simple partial SE consists of seizures that are localized to a discrete area of cerebral cortex and produce no alteration in consciousness. Because this form of epilepsy is rare, no good studies have been done to determine its incidence.

Focal SE can arise in any region of the cortex. When motor cortex is affected, the condition is termed epilepsia partialis continua (EPC), which characteristically involves repetitive, often rhythmic, unilateral focal twitching of the limbs and/or face, usually with preservation of consciousness. This sparing of consciousness subcategorizes EPC as a form of simple partial SE.

Other regions of cortex similarly may generate focal SE. These cases are characterized by predictable phenotypes depending on the function of the particular region involved. For example, episodes of focal SE involving primary sensory cortex are expected to be associated with focal sensory symptoms, and occipital focal SE causes focal visual symptoms (eg, flashing spots of light, colorful visual hallucinations). Focal SE of language cortex typically causes aphasia, termed ictal aphasia.

Diagnosis is primarily based on clinical findings. Because of the relatively small area of cerebral cortical involvement, results of conventional scalp EEG are frequently uncharacteristic of the clinical ictal activity, or they may be normal.

In contrast to convulsive SE, simple partial SE is not associated with high rates of morbidity or mortality. Outcomes seem to be related to the underlying etiology, the duration of the SE, the age of the patient, and the medical complications, as in convulsive SE.

Treatment involves the same drugs and general pharmacologic principles as those used for convulsive SE. However, the relatively low morbidity and mortality rates suggest that aggressive treatment might not be needed. For example, if first-line drugs are ineffective, the clinician may elect not to use a general anesthetic agent to stop simple partial SE.

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