Focal Aware Seizures (Simple Partial Seizures)

 

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    What is a focal aware seizure?

    A focal seizure begins in one side of the brain. They were previously called partial seizures. Focal onset seizures are the most common type of seizures experienced by people with epilepsy. For short, the term focal seizure can be used.

    When the seizure begins in one side of the brain and the person has no confusion or loss of awareness of their surroundings during it, it is called a focal aware seizure. This type of seizure was previously called a simple partial seizure.

    Learn about seizures with loss of awareness, called focal impaired awareness seizures (previously complex partial seizures).

    Who is at risk?

    Anybody can get focal aware seizures. They may be more likely in people who have had a head injury, brain infection, stroke, or brain tumor. Yet many times the cause is unknown. 

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    What is it like to have a focal aware seizure?

    When people have focal aware seizures, they are fully awake, alert, and able to recall events during the seizure. Some are "frozen" during the seizure, so they may or may not be able to respond to others during the seizures. Overall, these seizures are brief, usually lasting less than 2 minutes. 

    The symptoms vary depending on what part of the brain they come from. For example, symptoms can involve shaking of one part of the body, an abnormal sensation in one part of the body, sudden onset of nausea, flashing lights or visual symptoms, etc. In most people, the symptoms are very similar from seizure to seizure. 

    Can other health conditions look like focal aware seizures?

    Yes, some symptoms of focal aware (simple partial) seizures are similar to other health conditions, such as:

    • Health symptoms or problems, such as nausea or pain from stomach disorders or tingling and numbness from a pinched nerve, can be mistaken for focal seizures.
    • Hallucinations (smells, tastes, sounds, visions) can accompany psychiatric illness or the use of certain drugs.
    • Some symptoms (such as déja vu) are experienced by almost everyone at some time.
    • Temporary numbness or weakness in a limb or the face sometimes occurs from a transient ischemic attack (TIA), which can be a serious warning sign for a future stroke.
    • Migraines, with or without a significant headache, can produce visual, tingling, or other symptoms that can be confused with a seizure.

    Your health care provider can help determine whether your symptoms may be focal aware (simple partial) seizures or some other condition. Your provider will consider:

    • How often the symptoms occur?
    • Are they stereotyped (similar event-to-event)?
    • What other symptoms happen?
    • Do you have other seizure types?

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    Diagnosing seizures

    What happens after a focal aware seizure?

    When a focal aware seizure ends, the person usually continues doing whatever they were doing before it started. This type of seizure can be a warning or aura before a stronger seizure with loss of consciousness. Care and comfort first aid is all that is needed when a person has a focal aware seizure. 

    How often will they occur?

    It depends. Focal aware seizures vary a lot in how often they occur – some people can have them daily while in others they may be much less common.

    How can I tell if someone is having a focal aware seizure?

    You may not be able to tell because the person is fully alert and able to interact. The person may need to tell you what is happening. 

    How are they diagnosed?

    A complete medical history and physical examination can help rule out other possible causes of the symptoms and assess the likelihood of epilepsy.

    Although electroencephalograms (EEGs) are also helpful, they may not always show seizure discharges during a focal aware seizure. EEG shows abnormal electrical discharges if present at the time of the EEG. However, absence of EEG changes does not rule out seizures.

    A brain MRI (magnetic resonance imaging) or CT (computed tomography) scan may show an underlying cause for seizures. MRI and CT show structural problems in the brain, which would be present even between seizures.

    How are they treated?

    Several treatment options are available that can help prevent further focal onset aware seizures from occurring, including

    If your seizures are not controlled, consider asking for a consult from neurologist that specializes in epilepsy (called an epileptologist). An evaluation at a comprehensive epilepsy center can help you evaluate all treatment options.

    What should I do if I think my loved one or myself may have focal aware seizures?

    If you think that you or loved one may have focal aware seizures, it is important to let your doctor know right away. Seek help to get an accurate diagnosis and treatment plan.

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    Authored By:

    Elaine Kiriakopoulos MD, MSc

    Reviewed By:

    Robert Fisher MD, PhD

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