Complex partial seizures refer to focal seizures that start in one hemisphere of the brain and are associated with impairment in consciousness. Complex partial seizures are now preferably called as "focal impaired awareness seizure" or "focal onset impaired awareness seizure." International League Against Epilepsy (ILAE) 2017 classification has categorized seizures based on three key features: the location of seizure onset, level of awareness during a seizure, and other features of seizures. Focal seizures refer to epileptiform activity starting in one area on one side of the brain. If awareness is impaired or affected at any time during the seizure, it is called focal impaired awareness seizure. Focal seizures are further classified into motor onset (automatisms, atonic, clonic, myoclonic, tonic, epileptic spasms, hyperkinetic) and nonmotor onset (autonomic, emotional, sensory, cognitive, behavior arrest) types. A seizure that starts on one side or one part of the brain and then spreads to both sides, earlier referred to secondarily generalized seizures, is now preferably termed as "focal to bilateral seizure." Focal seizures with impaired consciousness can present with or without an aura. Auras can last from a few seconds to as long as 1 to 2 minutes before the consciousness is impaired. Consciousness is maximally impaired in the beginning typically. Most of the seizures with automatisms last longer than 30 seconds, up to 1 to 2 minutes and sometimes can be as long as 10 minutes. Absence seizures can sometimes present with same symptomatology however ictal EEG will show generalized 3-Hz spike-wave complexes. Symptoms of focal seizures with impaired awareness depend on the area of the brain it is arising from. Most of the complex partial seizures arise from the temporal lobe. Extratemporal origin has been reported in at least 10% to 30% of patients. Seizures of Temporal Lobe Origin These are the most common type of focal impaired awareness seizures. Stereotyped automatisms occur in about 40% to 80% of patients with temporal lobe epilepsies. Seizures with predominantly oral and manual automatisms in addition to some other motor manifestations are highly suggestive of temporal lobe origin. About 60% of temporal lobe seizures have a secondary generalization. Gradual recovery after several minutes of confusion occurs postictally in most patients, however, in some patients automatic behavior like running, walking about, the nondirected violent behavior may occur. Temporal lobe focal impaired seizures can have features similar to frontal seizures, but temporal lobe focal impaired seizures typically have slower onset and progression, and more pronounced confusion. Certain features can help in localizing the seizure onset to one hemisphere. Ictal vomiting, ictal speech, urinary urge, and automatisms with intact consciousness suggest seizure onset in the non-dominant hemisphere, and speech disturbance postictally is suggestive of seizure onset in the dominant hemisphere. Upper limb dystonia lateralizes seizure to the opposite hemisphere. In young children with focal seizures of temporal lobe onset, behavioral arrest and unresponsiveness are common. Oroalimentary automatisms tend to occur in children older than age 5. In younger children, symmetric motor movement of the limbs and head nodding is typical. In infants, these seizures may be subtle with few automatisms. In very young infants, central apnea can occur. Temporal focal impaired seizures can be confused with absence seizures as both may have automatisms, but temporal seizures are usually longer in duration and are associated with postictal confusion. Seizures arising from mesial temporal lobe are characterized by auras such as epigastric sensation, deja vu, a feeling of fear, and unpleasant smells. Autonomic features like tachycardia, flushing, and pallor are common. Auras may be followed by impaired awareness and manual and oroalimentary automatisms. Automatisms in the upper limb and /or pupillary dilatation unilaterally may lateralize seizure to the ipsilateral hemisphere. Dystonia in the upper limbs and head and eye version on the opposite side can occur. Lateral temporal seizures may have vertigo, auditory (buzzing, ringing), or visual symptoms as initial aura symptoms. Auditory aura in only one ear may lateralize seizure to contralateral hemisphere. Initial aura is usually not prolonged, and impaired awareness is an early feature. Seizures are of shorter duration and progression to bilateral convulsions is more common than those arising from mesial temporal lobe. Seizures of Frontal Lobe Origin Up to 30% of the patients with focal epilepsy have seizures arising from the frontal lobe. It is the most common extratemporal type. Seizures are accompanied by loss of consciousness in about half of the patients with frontal lobe epilepsy. Focal impaired awareness seizures can arise from various locations within the frontal lobe, except the rolandic strip. These seizures typically are brief, lasting about 30 seconds, occurring in clusters, multiple times a day, are often nocturnal occurring during sleep and have minimal postictal confusion. Motor symptoms are predominant and range from hypermotor thrashing episodes like pelvic thrusting, bicycling movements to asymmetric tonic posturing. Sexual automatisms, bizarre behavior, and vocalizations are common. These seizures often have a stereotypical pattern for each patient. Nocturnal frontal lobe seizures may be mistaken for parasomnias. The ictal EEG may be difficult to interpret because of movement artifacts. Identification based on semiology alone and differentiating from mesial temporal lobe epilepsy may be difficult, however earliest signs and symptoms and their order of appearance may help in distinction. Seizures with hypermotor features are more likely to have ictal focus in the orbitofrontal and frontopolar regions. Temporal lobe seizures have more oroalimentary automatisms, gesturing and fumbling semiology. Epileptiform activity in frontal convexity can cause clonic seizures, and in the supplementary motor area can cause tonic seizures. Unique semiology of supplementary sensorimotor cortex includes deviation of head and eye to the side contralateral to seizure onset, the asymmetrical posturing of upper limbs with an extension of arm contralateral to the side of seizure onset and flexion of ipsilateral arm. Orbitofrontal region seizures are automotor type and manifest prominently with autonomic phenomena like flushing, vocalization, and automatisms. Anterior cingulate gyrus seizures have predominant motor manifestations like hypermotor seizures and complex motor seizures. Posterior cingulate cortex epilepsies predominantly have altered consciousness and automotor seizures as main clinical manifestations. Antero-lateral dorsal convexity seizures may manifest with auras such as dizziness, epigastric sensation, behavioral arrest and speech arrest. Seizures of Parietal Lobe Region Seizures arising from parietal lobe may be difficult to diagnose because of their subjective nature. Positive and /or negative sensory features are common. Sensorimotor phenomenon and vestibular hallucinations suggest onset in the parietal lobe. Paresthesias, visual hallucinations, visual illusions, somatic illusions, vertiginous features can occur. Seizures arising from the dominant hemisphere can cause receptive language impairment. Parietal lobe complex partial seizures can have auras like epigastric sensations, visual hallucinations, panic attacks and behavioral arrest. Often there is involvement of other lobes as the seizure spreads. When focal seizures from parietal lobe spread and involve the temporal lobe, loss of consciousness and automatisms may occur. Seizures of occipital lobe origin Seizures with ictal origin in the occipital lobe are characterized by a visual aura and are difficult to diagnose especially in young children. Visual auras, typically of elementary sensations, ictal blindness, versions of the head and eyes to opposite side, rapid and forced blinking, oculoclonic activity are some features suggesting occipital lobe as an origin of focal seizure with impaired consciousness. Seizures from primary visual cortex can cause bilateral loss of vision in the form of white-out or black-out. Shorter duration of visual aura (less than 2 minutes) can help to differentiate from migraine aura which is typically longer (5 to 15 minutes). Complex, formed visual hallucinations like pictures of people, animals, etc. are associated with seizure onset in the extra-striate cortex. Other symptoms may result from spread to temporal or parietal lobes. Seizures of Insular Lobe Origin Seizures arising from the insula can mimic frontal, temporal, parietal lobe seizures. Origin from the insula is suspected when viscerosensitive symptoms (nausea, vomiting, salivation), motor symptoms (tonic, hypermotor or generalized tonic-clonic movements), and/or sensory symptoms (numbness, tightness, vibration, pain, vertigo) occur at seizure onset.

The aim of the study was to evaluate diagnostic tests for keratoconjunctivitis sicca (Schirmer test, tear break-up time (TBUT) test, and corneal staining with fluorescein and lissamine green dye) in patients with blepharospasm. This prospective study included 60 female patients older than 40 with blepharospasm, divided into two groups according to clinical symptoms. For fluorescein test, the surface under the ROC curve was 1.0 with standard error (SE) 0 and 95% confidence interval (95% CI) 0.940-1.0; for Schirmer test, the surface under the ROC curve was 0.817 with SE 0.0555 and 95% CI 0.696-0.905; for lissamine green test, the surface under the ROC curve was 0.813 with SE 0.056 and 95% CI 0.691-0.902; and for TBUT test, the surface under the ROC curve was 0.772 with SE 0.061 and 95% CI 0.645-0.870. According to the results of ROC curve, which determines the sensitivity and specificity of normal values, comparison of diagnostic tests for keratoconjunctivitis sicca used in this study showed that fluorescein test had the best sensitivity and specificity. Schirmer test should be avoided in patients with blepharospasm because its results are influenced by frequent blinking and are not appropriate for study interpretation. Despite the pathologic values of TBUT test (numerically), this test is still acceptable for patients with blepharospasm because its interval takes more time than the interval between two blinks.

Thick-shell (>5 nm) InP-ZnSe colloidal quantum dots (QDs) grown by a continuous-injection shell growth process are reported. The growth of a thick crystalline shell is attributed to the high temperature of the growth process and the relatively low lattice mismatch between the InP core and ZnSe shell. In addition to a narrow ensemble photoluminescence (PL) line-width (∼40 nm), ensemble and single-particle emission dynamics measurements indicate that blinking and Auger recombination are reduced in these heterostructures. More specifically, high single-dot ON-times (>95%) were obtained for the core-shell QDs, and measured ensemble biexciton lifetimes, τ2x ∼ 540 ps, represent a 7-fold increase compared to InP-ZnS QDs. Further, high-resolution energy dispersive X-ray (EDX) chemical maps directly show for the first time significant incorporation of indium into the shell of the InP-ZnSe QDs. Examination of the atomic structure of the thick-shell QDs by high-angle annular dark-field scanning transmission electron microscopy (HAADF-STEM) reveals structural defects in subpopulations of particles that may mitigate PL efficiencies (∼40% in ensemble), providing insight toward further synthetic refinement. These InP-ZnSe heterostructures represent progress toward fully cadmium-free QDs with superior photophysical properties important in biological labeling and other emission-based technologies.

Heterostructured core/shell quantum dots (QDs) are prized in biomedical imaging and biosensing applications because of their bright, photostable emission and effectiveness as Förster resonance energy transfer (FRET) donors. However, as nanomaterials chemistry has progressed beyond traditional QDs to incorporate new compositions, ultra-thick shells, and alloyed structures, few of these materials have had their optical properties systematically characterized for effective application. For example, thick-shelled QDs, also known as 'giant' QDs (gQDs) are useful in single-particle tracking microscopy because of their reduced blinking, but we know only that CdSe/CdS gQDs are qualitatively brighter than thin-shelled CdSe/CdS in aqueous media. In this study, we quantify the impact of shell thickness on the nanoparticle molar extinction coefficient, quantum yield, brightness, and effectiveness as a FRET donor for CdSe/xCdS core/shell and CdSe/xCdS/ZnS core/shell/shell QDs, with variable thicknesses of the CdS shell (x). Molar extinction coefficients up to three orders of magnitude higher than conventional dyes and forty-fold greater than traditional QDs are reported. When thick CdS shells are combined with ZnS capping, quantum yields following thiol ligand exchange reach nearly 40%-5-10× higher than either the commercially available QDs or gQDs without ZnS caps treated the same way. These results clearly show that thick CdS shells and ZnS capping shells work in concert to provide the brightest possible CdSe-based QDs for bioimaging applications. We demonstrate that thicker shelled gQDs are over 50-fold brighter than their thin-shelled counterparts because of significant increases in their absorption cross-sections and higher quantum yield in aqueous milieu. Consistent with the point-dipole approximation commonly used for QD-FRET, these data show that thick shells contribute to the donor-acceptor distance, reducing FRET efficiency. Despite the reduction in FRET efficiency, even the thickest-shell gQDs exhibited energy transfer. Through this systematic study, we elucidate the tradeoffs between signal output, which is much higher for the gQDs, and FRET efficiency, which decreases with shell thickness. This study serves as a guide to nanobiotechnologists striving to use gQDs in imaging and sensing devices.