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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
- See Also
- Generalized Seizure
- Seizure Disorder
- Definitions
- Focal Seizure (Partial Seizure)
- Single hemisphere Seizure (contrast with generalized which involves both hemispheres)
- Simple Partial Seizure
- Focal Seizure Without Impairment of Awareness
- No loss of consciousness or mental status change
- Complex Partial Seizure
- Focal Seizure With Impairment of Awareness
- Example: Temporal Lobe Seizure (Psychomotor Seizure)
- Jacksonian March (Jacksonian Seizure)
- Focal Partial Seizure with maintained awareness that generalizes to greater distribution of involvement
- Generalized symptoms may include lip licking, eye movement, neck rotation, repetitive hand movement
- More common in Multiple Sclerosis, older age
- Types
- Awareness
- Focal Seizure Without Impairment of Awareness (Simple Partial Seizure)
- Focal Seizures with impaired awareness (Complex Partial Seizure)
- Subtypes
- Motor Seizures (focal motor activity)
- Sensory Seizures
- Autonomic Seizures (e.g. sweating)
- Temporal Lobe Seizure (Psychomotor Seizure)
- Symptoms
- Focal motor symptoms and somatosensory symptoms
- Spreads to other parts of the body
- Sensory Symptoms
- Visual, auditory, olfactory, or gustatory
- Autonomic symptoms (e.g. sweating)
- Psychological Symptoms (e.g. Temporal Lobe Seizure)
- Altered Level of Consciousness in some episodes
- Management: Prophylaxis in Children (age <16 years)
- Level A evidence
- Oxcarbazepine (Trileptal)
- Level C evidence
- Carbamazepine (Tegretol)
- Phenobarbital
- Phenytoin (Dilantin)
- Topiramate (Topamax)
- Valproic Acid (Depakene)
- Vigabatrin (Sabril)
- Level D evidence
- Clobazam (Onfi)
- Clonazepam (Klonopin)
- Lamotrigine (Lamictal)
- Zonisamide (Zonegran)
- Management: Prophylaxis for Younger Adults (age 16 to 60 years)
- Level A evidence
- Carbamazepine (Tegretol)
- Levetiracetam (Keppra)
- Phenytoin (Dilantin)
- Zonisamide (Zonegran)
- Level B evidence
- Valproic Acid (Depakene)
- Level C evidence
- Gabapentin (Neurontin)
- Lamotrigine (Lamictal)
- Oxcarbazepine (Trileptal)
- Phenobarbital
- Topiramate (Topamax)
- Vigabatrin (Sabril)
- Level D evidence
- Clonazepam (Klonopin)
- Primidone (Mysoline)
- Management: Prophylaxis for Older Adults (age >60 years)
- Level A evidence
- Gabapentin (Neurontin)
- Lamotrigine (Lamictal)
- Level C evidence
- Carbamazepine (Tegretol)
- Level D evidence
- Topiramate (Topamax)
- Valproic Acid (Depakene)
- Management: Prophylaxis - New adjunctive agents (2014)
- Perampanel (Fycompa)
- Eslicarbazepine (Apticom)
- References
- Liu (2017) Am Fam Physician 96(2): 87-96 [PubMed]