eMedicine Specialties > Neurology > Seizures and Epilepsy

Simple Partial Seizures: Follow-up

Author: Jane G Boggs, MD, Associate Professor of Neurology, Wake Forest University; Clinical Associate Professor, Virginia Commonwealth University School of Medicine (Medical College of Virginia)
Contributor Information and Disclosures

Updated: Sep 3, 2009

Follow-up

Further Inpatient Care

  • Patients diagnosed with SPS may require follow-up inpatient care if new patterns of seizures develop.
  • EEG or video-EEG studies are often necessary to clarify the nature of the new seizure type.
  • Neuroimaging and laboratory studies may help in identifying reasons for seizure exacerbations.
  • Medications usually can be adjusted more quickly in inpatients, and hospitalization in a video-EEG-monitoring unit optimizes the safety of rapid adjustment in the doses of medication.

Further Outpatient Care

  • At least monthly outpatient follow-up is recommended when seizures are not well controlled.
  • As seizure control improves, the interval between evaluations can be increased.
  • Seizure-free patients may be monitored by a neurologist once or twice annually.
  • Outpatient laboratory studies should be performed to monitor metabolic effects of the medications used to treat SPS, and to monitor underlying medical conditions.
  • AED levels should be performed when toxicity is suspected, or to confirm adequate compliance or absorption of medications. In the absence of side effects of medication, metabolic changes, or breakthrough seizures, routine monitoring of AED levels usually is not justified.

Prognosis

  • The prognosis of patients with SPS is similar to that of patients with complex partial seizures.
  • Poorly controlled seizures can result in chronic neurological and cognitive complications, the severity of which is largely dependent on the underlying etiology of the seizures.
  • As consciousness is preserved throughout the ictal event, patients with SPS are less likely to suffer from epilepsy-related injuries.
  • However, focal motor SPS still can result in falls and risk of trauma.

Patient Education

  • Patients with SPS have the same requirement for education concerning epilepsy as those individuals with other seizure types.
  • SPS can be mimicked by many other disorders, and reassurance about the diagnosis may be necessary.
  • Education should not be limited only to the patients, but should include family members, caretakers, and employers to limit unnecessary stigmatization and discrimination.

Miscellaneous

Medicolegal Pitfalls

  • The greatest medical/legal pitfall for SPS is in the potential for a misdiagnosis.
  • Video-EEG is extremely helpful to avoid treating the wrong condition.
  • Disability applications, child-custody hearings, and driving restrictions are dependent on a correct diagnosis. Only some state laws allow patients with SPS to drive without a formal medical review by that state.

Special Concerns

  • Although often perceived to be less severe than complex partial and generalized seizures, SPS in pregnancy can be associated with fetal distress.
  • Every effort must be made to control seizures during pregnancy by using appropriate doses of the most successful agent for the individual. If possible, avoid AED drug changes.
 


More on Simple Partial Seizures

Overview: Simple Partial Seizures
Differential Diagnoses & Workup: Simple Partial Seizures
Treatment & Medication: Simple Partial Seizures
Follow-up: Simple Partial Seizures
References
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Further Reading

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Keywords

focal seizures, simple localization-related epilepsy, SPS, epilepsy, simple partial status epilepticus, SPSE, epilepsia partialis continua, Kojewnikoff syndrome, periodic lateralized epileptiform discharges, PLEDs, Landau-Kleffner syndromes, epileptogenic zone, partial seizures, simple partial seizures

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Contributor Information and Disclosures

Author

Jane G Boggs, MD, Associate Professor of Neurology, Wake Forest University; Clinical Associate Professor, Virginia Commonwealth University School of Medicine (Medical College of Virginia)
Jane G Boggs, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, and Stroke Council of the American Heart Association
Disclosure: Abbott Grant/research funds Speaking and teaching; GSK Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Medical Editor

Joseph F Hulihan, MD, Vice President, Medical Affairs, Ortho-McNeil Janssen Scientific Affairs, LLC
Joseph F Hulihan, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, American Headache Society, and American Medical Association
Disclosure: Johnson & Johnson Salary Employment; Johnson & Johnson Stock Employment

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

 
 
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