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Complex partial seizures are often preceded by a seizureaura. The seizure aura is a simple partial seizure. The aura may manifest itself as a feeling of déjà vu, jamais vu, fear, euphoria or depersonalization. The seizure aura might also occur as a visual disturbance, such as tunnel vision or a change in the size of objects (macropsia or micropsia). Once consciousness is impaired, the person may display automatisms such as lip smacking, chewing or swallowing. There may also be loss of memory (amnesia) surrounding the seizure event. The person may still be able to perform routine tasks such as walking, although such movements are not purposeful or planned. Witnesses may not recognize that anything is wrong.
Complex partial seizures might arise from any lobe of the brain. Complex partial seizures most commonly arise from the mesialtemporal lobe, particularly the amygdala, hippocampus, and neocortical regions. A common associated brain abnormality is mesial temporal sclerosis. Mesial temporal sclerosis is a specific pattern of hippocampal neuronal loss accompanied by hippocampal gliosis and atrophy. Complex partial seizures occur when excessive and synchronous electrical brain activity causes impaired awareness and responsiveness. The abnormal electrical activity might spread to the rest of the brain and cause a secondary generalized tonic–clonic seizure.
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