Focal Seizures

Focal seizures make up a large portion of childhood epilepsies. The word "focal" means that the seizure starts from a specific point (a focus) in the brain. Because the signs depend entirely on where this focus is located in the brain, focal seizures can look incredibly varied.

Focal Seizures With Preserved Awareness

In these seizures, the child is awake, aware of their surroundings, and usually remembers afterward what happened. Depending on the affected region of the brain, the signs may include:

• Movement signs: Involuntary stiffening, jerking, or twitching in a hand, arm, leg, or one side of the face.
• Sensory signs: Tingling, numbness, or a feeling of electricity in one area.
• Visual/auditory signs: Seeing lights, colors, or shapes; hearing sounds or buzzing.
• Autonomic signs: A strange feeling rising from the stomach area, nausea, flushing, paleness, or palpitations.
• Psychic signs: A sudden, causeless fear, feeling as if seeing something familiar for the first time (jamais vu), or feeling as if recognizing something never seen before (déjà vu).

Some children experience these kinds of signs as a "warning" just before a bigger seizure comes. This is called an aura. An aura is actually the very beginning of the seizure itself, but it can give the child a chance to prepare for the approaching seizure (for example, to sit down or move to a safe place).

Focal Seizures With Impaired Awareness

In these seizures, the child's consciousness becomes clouded and their connection with the surroundings is cut off. The child may stare blankly at a point and may not respond when called. Often there are repetitive, purposeless movements called automatisms: lip-smacking, swallowing, chewing motions, fiddling with things with the hands, tugging at clothing, meaningless mumbling. The seizure can last from a few seconds to a few minutes. Afterward, the child is usually tired and confused, and does not remember that moment.

Often Mistaken

Focal seizures with impaired awareness can be missed, interpreted as absent-mindedness, daydreaming, or stubbornness.

If your child sometimes suddenly "switches off," does not respond when called, and then takes a while to come back to themselves, be sure to share this with your doctor.

Seizures That Spread From a Focus

A focal seizure may stay in the region where it started, or the electrical activity may spread and take over the whole brain. In that case, the child loses consciousness and a tonic-clonic (stiffening-thrashing) seizure develops involving the whole body. For a family witnessing it, it is natural to think this seizure was "generalized from the start"; yet the seizure actually began at a focus. To make this distinction, EEG and a good history are important, because the treatment approach may differ.