Focal Seizure

Aka: Focal Seizure, Partial Seizure, Complex Partial Seizure, Focal Seizure With Impairment of Awareness, Simple Partial Seizure, Focal Seizure Without Impairment of Awareness, Jacksonian March, Jacksonian Seizure

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II. Definitions

  1. Focal Seizure (Partial Seizure)
    1. Single hemisphere Seizure (contrast with generalized which involves both hemispheres)
  2. Simple Partial Seizure
    1. Focal Seizure Without Impairment of Awareness
    2. No loss of consciousness or mental status change
  3. Complex Partial Seizure
    1. Focal Seizure With Impairment of Awareness
    2. Example: Temporal Lobe Seizure (Psychomotor Seizure)
  4. Jacksonian March (Jacksonian Seizure)
    1. Focal Partial Seizure with maintained awareness that generalizes to greater distribution of involvement
    2. Generalized symptoms may include lip licking, eye movement, neck rotation, repetitive hand movement
    3. More common in Multiple Sclerosis, older age

III. Types

  1. Awareness
    1. Focal Seizure Without Impairment of Awareness (Simple Partial Seizure)
    2. Focal Seizures with impaired awareness (Complex Partial Seizure)
  2. Subtypes
    1. Motor Seizures (focal motor activity)
    2. Sensory Seizures
    3. Autonomic Seizures (e.g. sweating)
    4. Temporal Lobe Seizure (Psychomotor Seizure)

IV. Symptoms

  1. Focal motor symptoms and somatosensory symptoms
    1. Spreads to other parts of the body
  2. Sensory Symptoms
    1. Visual, auditory, olfactory, or gustatory
  3. Autonomic symptoms (e.g. sweating)
  4. Psychological Symptoms (e.g. Temporal Lobe Seizure)
  5. Altered Level of Consciousness in some episodes

V. Management: Prophylaxis in Children (age <16 years)

  1. Level A evidence
    1. Oxcarbazepine (Trileptal)
  2. Level C evidence
    1. Carbamazepine (Tegretol)
    2. Phenobarbital
    3. Phenytoin (Dilantin)
    4. Topiramate (Topamax)
    5. Valproic Acid (Depakene)
    6. Vigabatrin (Sabril)
  3. Level D evidence
    1. Clobazam (Onfi)
    2. Clonazepam (Klonopin)
    3. Lamotrigine (Lamictal)
    4. Zonisamide (Zonegran)

VI. Management: Prophylaxis for Younger Adults (age 16 to 60 years)

  1. Level A evidence
    1. Carbamazepine (Tegretol)
    2. Levetiracetam (Keppra)
    3. Phenytoin (Dilantin)
    4. Zonisamide (Zonegran)
  2. Level B evidence
    1. Valproic Acid (Depakene)
  3. Level C evidence
    1. Gabapentin (Neurontin)
    2. Lamotrigine (Lamictal)
    3. Oxcarbazepine (Trileptal)
    4. Phenobarbital
    5. Topiramate (Topamax)
    6. Vigabatrin (Sabril)
  4. Level D evidence
    1. Clonazepam (Klonopin)
    2. Primidone (Mysoline)

VII. Management: Prophylaxis for Older Adults (age >60 years)

  1. Level A evidence
    1. Gabapentin (Neurontin)
    2. Lamotrigine (Lamictal)
  2. Level C evidence
    1. Carbamazepine (Tegretol)
  3. Level D evidence
    1. Topiramate (Topamax)
    2. Valproic Acid (Depakene)

VIII. Management: Prophylaxis - New adjunctive agents (2014)

  1. Perampanel (Fycompa)
  2. Eslicarbazepine (Apticom)

IX. References

  1. Liu (2017) Am Fam Physician 96(2): 87-96 [PubMed]

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