A focal seizure starts in one area of one brain hemisphere, so its signs depend on the region involved. Awareness may be kept or impaired, and the seizure can spread to become a bilateral tonic-clonic seizure.
Key symptoms
- Aura: a rising stomach feeling, déjà vu, a strange smell or fear
- Jerking or stiffening of one limb or one side of the face
- Staring with lip smacking or fumbling hands
- Confusion afterward with no memory of the event
What you find on exam
- Neurologic exam for focal deficits
- Temporary weakness after the seizure (Todd paralysis)
- Tongue bite, injuries and vital signs
- Witness description of the event
Tests
- EEG to show focal epileptiform activity
- Brain MRI with an epilepsy protocol
- Glucose, electrolytes, toxicology screen
- CT head in the emergency setting if there is a new deficit or trauma
Treatment basics
- Seizure first aid: protect from injury, time the seizure
- Antiseizure medicine such as lamotrigine or levetiracetam for recurrent seizures or a first seizure with risk factors
- Driving restriction and safety counseling as state law requires
- Epilepsy surgery or neurostimulation for drug-resistant cases
Red flags
- Seizure lasting more than 5 minutes or repeated without recovery
- New focal seizure with fever, headache or a new deficit
- First seizure in pregnancy or after a head injury
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.