Focal seizures

When an epileptic seizure starts in one side of the brain, it’s called a focal onset seizure or a focal seizure. Both terms mean the same thing. Until recently these seizures were called partial seizures.

What are the different types of focal seizure?

There are many different types of focal seizure, but they can be split into two main types according to what level of awareness you have during the seizure.

Focal aware seizures

During a focal aware seizure, you stay fully aware of what’s happening around you, even if you can’t move or respond. This type of seizure used to be called a simple partial seizure.

What are auras?

Some people with epilepsy use the word ‘aura’ to describe the feeling they get that warns them they’re about to have a tonic-clonic seizure. The aura is in fact the seizure starting in one side of the brain as a focal aware seizure. The seizure then spreads to affect both sides of the brain. See focal to bilateral tonic-clonic seizures.

Focal aware seizures can also happen on their own, without developing into another seizure type. Some people who have focal aware seizures on their own also call them auras.

Focal impaired awareness seizures

If your awareness of what’s happening around you is affected at any time during your seizure, it’s called a focal impaired awareness seizure. This type of seizure used to be called a complex partial seizure.

Motor or non-motor

Doctors may also use the words motor or non-motor to describe focal seizures. Focal motor describes focal seizures where the main symptoms involve muscle activity, such as jerking, loss of muscle tone or repeated movements. Focal non-motor describes seizures where the main symptoms don’t involve muscle activity. They can include things like changes in emotions, thinking and sensations.

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What happens during a focal seizure?

What happens during a focal seizure depends on which area (lobe) of the brain is affected, and whether the seizure spreads to affect other areas. Some people just experience one symptom during a focal seizure, while others experience several.

Frontal lobes

The symptoms of frontal lobe seizures can sometimes be mistaken for mental health problems or sleep disorders. Some people who have frontal lobe seizures only have them in their sleep. They are usually brief, but often happen in clusters, with several happening in a short space of time. Your awareness may or may not be affected.

Symptoms of seizures in the frontal lobes can include:

  • Pelvic thrusting, kicking, pedalling, thrashing or rocking movements
  • Screaming, swearing or laughing
  • Unintentionally passing urine (urinary incontinence)
  • Your head or eyes turning to one side
  • Having unusual body movements, such as stretching one arm while the other bends
  • Twitching, jerking or stiffening of muscles in one area of your body. The movements may sometimes spread bit by bit to other areas

Occipital lobes

Seizures starting in the occipital lobe often spread to involve other lobes.

Symptoms of seizures starting in the occipital lobe include:

  • Seeing flashing lights, colours or simple patterns
  • Seeing more complex images, such as pictures of people, animals or scenes
  • Not being able to see as well as usual, or not being able to see at all
  • Having eye movements you can’t control, such as your eyes closing, moving to one side or rapidly moving from side-to-side
  • Eyelid fluttering

Parietal lobes

Seizures starting in the parietal lobe often spread to involve other lobes.

Symptoms of seizures starting in the parietal lobes can include:

  • Having feelings of numbness or tingling
  • Prickling, crawling or electric-shock sensations, which may spread along the affected body part
  • Sensations of burning, cold or pain
  • Feeling like part or all of your body is moving or floating
  • Feeling like a body part has shrunk, enlarged or is missing
  • Sexual sensations
  • Difficulty understanding language, reading, writing or doing simple maths
  • Seeing things as larger or smaller than they really are, or seeing things that aren’t there

Temporal lobes

If you have been diagnosed with temporal lobe epilepsy (TLE) it means you have seizures starting in one or other of the temporal lobes. Seizures starting in the temporal lobes are usually focal impaired awareness seizures, but focal aware seizures can also happen. You might start the seizure being aware of what’s happening, and then lose awareness as the seizure progresses.

Symptoms of seizures in the temporal lobes include:

  • Feeling frightened
  • Feeling like what’s happening has happened before (deja vu)
  • Hearing things that aren’t there
  • Experiencing an unpleasant taste or smell
  • Having a rising sensation in your stomach
  • Lip smacking, repeated swallowing or chewing
  • Changes to your skin tone or heart rate
  • Automatic behaviours such as fidgeting, undressing, running or walking

After a temporal lobe seizure you are likely to be confused, and may find it hard to speak for a short time.

How long do focal seizures last?

Most focal aware seizures are brief, lasting between a few seconds and 2 minutes. Focal impaired awareness seizures usually last between one and 2 minutes.

What happens after a focal seizure?

What happens after a focal seizure varies from person to person. You might feel fine after a focal seizure and be able to get back to what you were doing straight away. Or you might feel confused or tired for some time afterwards. You might need to sleep.

Some people find they have temporary weakness or can’t move part of their body after they’ve had a seizure. This is called Todd’s paresis or Todd’s paralysis. It can last from a few minutes up to 36 hours, before going away.

How can someone help me during a focal seizure?

You might not need any help from people around you during a focal seizure, especially if it’s brief and you’re aware of what’s happening. But if you’re not aware of what you’re doing you might need help to guide you away from danger and keep you safe. See our first aid information, or ask them to take our short online course which shows them what to do when someone has a seizure.

See this information with references

If you would like to see this information with references, visit the Advice and Information references section of our website. If you are unable to access the internet, please contact our Epilepsy Action Helpline freephone on 0808 800 5050.

Code: 
B037.06

Epilepsy Action would like to thank Dr John Paul Leach, consultant neurologist at the Queen Elizabeth University Hospital, Glasgow, for this contribution to this information.

Dr Leach has declared no conflict of interest.

  • Updated November 2019
    To be reviewed July 2022

Comments: read the 21 comments or add yours

Comments

Hi I was diagnosed with epilepsy via telephone consult after having a tonic clonic seizure in july 2020. I'd been having lots of deja vu episodes etc before this since Nov 2019.....which the neurologist said were partial seizures. I've heard peaple talk about care plans and epilepsy nurses....are these provided or do you have to ask for them? I'm not due for another phone consult with my neurologist until end of dec and am now having episodes of odd tingling sensations and I keep getting an overwhelming smell of cannabis in my house (but no one is smoking it in or around me or has it in the house) Are these seizure type things? Should I speak to my GP or try and contact the nuerologist? I'm on lamotrigine and having sleep jerks a lot too. I feel a bit on my own after my diagnosis and don't really know what I should do? Although this site has been really helpful.
Many thanks

Submitted by lisa jacobs

Hi Lisa – This must be a tough time for you. We know that a lot of appointments are happening over the phone at the moment and we are monitoring this. The important thing to know is that you’re not on your own and there is support and advice out there for you.

 

It can take a while to get the balance of the right medicine and the right dose for your epilepsy. And sometimes it can take a little while for seizures to settle, especially if you have been increasing your epilepsy medicine to a maintenance dose. But the aim of epilepsy medicines is to try to get as good seizure control as possible.

 

Your GP wouldn’t be able to change your treatment so it would be best to try to try to speak to your neurologist about what’s happening. It can help to keep a diary so you have a record of everything you’re noticing. To get in touch with your consultant you can contact the hospital and ask to speak to the neurology department or your consultant’s secretary.

 

If there’s an epilepsy nurse attached to your neurology department your consultant or their secretary should know how you can contact them. It’s worth knowing if there is a nurse you can talk to as well as the consultant. But not all hospitals have nurses.

 

Some people with complex epilepsies have a care plan but not everyone does. If you think it would be helpful for you to keep a record of your treatment we have a care plan you could download.

 

We have some information for people who are newly diagnosed you might find helpful. This explains some basic information about epilepsy and also has links to managing your epilepsy and support.

 

There’s a lot to take in and you must have a lot of questions. You’d be welcome to call and talk to one of us at the Helpline. We aren’t medically trained but we know a lot about epilepsy. Our number is Freephone 0808 800 5050 and we’re open 8.30 – 8pm Monday to Thursday, 8.30am to 4.30pm Friday and 10am – 4pm Saturday.

 

Regards

Mags

Epilepsy Action Helpline Team

Submitted by Mags - Epilepsy...

Hi there, my name is Claudia.
My daughter has just been diagnosed with Benign Rolandic seizures and the consultant has not started medication yet because she had two seizures 4 months apart. However she had another seizure after only 3weeks from the last one. This one was about 3minutes and I wonder whether they are changing.
Can I ask if seizures of this type are damaging her brain?
Many thanks for your answer.

Submitted by Claudia Marota

Hi Claudia

You must be concerned about your daughter and the seizures she's had recently.

Seizures can change and it can take a little time to establish the pattern of someone's seizures with childhood epilepsy with centro-temporal spikes (benign rolandic epilepsy). So it is worth keeping a record and talking to your daughter's consultant about ongoing treatment. 

Some people can have longer seizures and if your daughter's seizures are frequent her consultant may suggest medicines.

Its unlikely though that these seizures are causing damage to your daughter's brain at the moment. But it might be best to talk over your concerns with your daughter's consultant. 

There's a link here to our information about childhood epilepsy with centro-temporal spikes which may be helpful as well: https://www.epilepsy.org.uk/info/syndromes/benign-rolandic-epilepsy 

You'd be welcome to call us at the Helpline if there's anything you'd like to talk through. Our number is 0808 800 5050 and we're open We are open 8.30 – 8pm Monday to Thursday, 8.30am to 4.30pm Friday and 10am – 4pm Saturday.

Regards

Mags 

Epilepsy Action Helpline Team

Submitted by Mags - Epilepsy...

If my seizure started from grand mal for 8 years then turned into focal, does that mean I'm getting better, a little bit? I'm 48 y/o now.

Submitted by MB

Hi MB

It's good to hear your grand mal seizures have stopped. It's a sign that the epileptic activity in your brain has reduced. If you are on epilepsy medicine it could be the medicine is stopping some of the acitivity but not quiet all of it.

As you are still having focal seizures, are you being seen by an epilepsy specialist so they can review your treatment and look at other possible reasons for your focal seizures to still be happening? They may suggest alterng the dosage of your epilepsy medicine or trying a different epilepsy medicine to fully control the acitivty.

If we can be of any more help, please feel free to contact our helpline Team directly. You can either email helpline@epilepsy.org.uk or phone the Epilepsy Helpline freephone 0808 800 5050. We are open Monday to Friday 8.30am until 5.30pm.


Regards

Diane

Helpline Team

Submitted by Diane - Epileps...

Hi everyone, I have been experiencing the rising feeling in my stomach, and I have tingling all over with burning sensation sometimes as well, pauses in breathing, foggy eyes, and slow heart rate episodes. I have cramping and weakness in my muscles afterward every time pretty much. Does anyone else experience this? Does it sound like seizures?
They happen all the time and I can feel it coming on and know that it has happened before. I do have really bad migraines as well.

Submitted by Shellie
Hi Shellie
 
Thank you for your question. This sounds like an unpleasant experience.
 
If your symptoms are related to epilepsy, it could be some type of focal seizure. In these seizures the epileptic activity starts in just a part of your brain. You may remain alert during this type of seizure, or you may not be aware of what is happening around you. You may have movements that you can’t control, or unusual sensations or feelings. Focal seizures can be very brief or last for minutes.
 
It's best to get a medical diagnosis for your symptons. There are a number of medical conditions that can cause symptoms similar to epilepsy. If you haven’t already, it would be best to talk to your epilepsy specialist regarding this. 
 
If you don't already have a diagnosis of epilepsy, talk to your family doctor, If they thinks it could be epilepsy, they should refer you to an epilepsy specialist for a diagnosis.  This would usually be to a neurologist. The ideal would be to someone with a specialist interest in epilepsy, as there are many different neurological conditions, and neurologists tend to specialise in different ones.
 
If you would like to discuss this with our helpline team, our helpline is freephone 0808 800 5050. Our helpline is open Monday to Thursday 8.30am until 8.00pm, Friday 8.30am until 4.30pm and Saturday 10.00am until 4.00pm.

 
Regards
Diane 
Helpline team
Submitted by Diane - Epileps...

i wonder why days & days later after my seizure do i still feel so lost confused & not right?

Submitted by shannan
Hi
 
It can be normal to feel tired, unwell or confused after a seizure. And the length of time it takes to recover can be different for different people. 
 
But if the way you're feeling at the moment is unusual for you, or its taking longer than normal to recover, it would be a good idea to get in touch with your epilepsy specialist, epilepsy nurse (if you have one) or your GP for advice. 
 
If this isn't possible for you and you're not sure what to do, you can contact NHS 111 for advice: https://www.england.nhs.uk/urgent-emergency-care/nhs-111
 
Regards
 
Jess
Epilepsy Action Helpline Team
Submitted by Jess - Epilepsy...

I’m fairly certain my symptoms align with focal seizures without awareness... or narcolepsy. I haven’t gone to my doctor for testing because I need to be able to drive my vehicle to get myself to work every day. Until doctors are satisfied the condition is controlled, licenses are often suspended.
Before anyone points out the dangers of driving with seizures, I have never had one of my episodes come on unannounced. I have always experienced an aura, and can sometimes fight it.
Starting about 15 years ago, I noticed after a period of only getting a few hours of sleep each night, that I almost seem to be nodding off at my desk. The “sleep attacks”, as I have been calling them, usually start or are triggered when i’m doing reading and typing on a computer (and also sleep deprived). I get that rising feeling that’s been described, and also an overwhelming feeling like I am falling asleep or have taken a sedative of some sort. I literally can’t focus another minute. Next thing I know, I have that falling sensation and jerk “awake” like a kid who has fallen asleep sitting up in his car seat. I focus my eyes and look around, wondering if I just fell asleep and how long I was out for. After a few days of this, I set up my phone to record me at my desk. I watched and saw my eyes unfocus, my face muscle tone go quite slack and it looks like i’m still trying to type. My eyes go quite lazy and are clearly on the verge of rolling back, when I will jerk and give my head a shake and try to focus and then it happens again. Eventually after a couple almost sleeps, the feeling passes. It might come back in five or 10 minutes though and happen a couple more times. Some days I have felt that sensation of falling asleep upwards of 20 times in an afternoon. If I am trying to continue working without drawing attention, I will still get up and go get something from the file room. It will begin happening as I’m walking and sometimes I almost fall because I slip out of awareness for a split second or two and no longer see anything but I can continue moving my body as I had been.. I catch myself midstep, and continue walking… But it is really weird feeling like you’re falling asleep while you’re walking down the hallway.
If I am in a meeting, we’re having a discussion with a superior, I will take a finger and poke into my leg or ribs as hard as I can. I can also pinch myself. The pain signals are enough to keep the event at bay, at least until I am out of the situation with a superior, driving, going downstairs, or anything unsafe.
Usually, I will lie down as soon as I have an opportunity at home. I can then sleep for a long time and usually feel better when I wake up. I am leaning more towards a seizure disorder rather than narcolepsy, as on my recorded video, I do see that I am continuing to work, though I’m not really getting much done. Also, I have had this happen when i’m writing on paper with a pen... then looked down about 10 minutes or so after the event is over and the fogginess is gone. My writing has indeed continued, and I have still taken notes, but I can’t read any of them as I wrote all of them without being able to see the paper. The writing is completely illegible. I’m hesitant, as I’ve already explained with driving restrictions, about pursuing an official diagnosis. I’m not sure doctors would be comfortable with self management without medication. My events are somewhat rare, usually happening when I am overtired… Though when they do occur, they are persistent on and off until I am able to get sleep.
I feel that with a diligent self-care approach, and recognizing that the aura is our preceding one of these attacks, I can keep myself safe with this condition. The medication‘s are quite scary with their side effects, and the way that they alter brain chemistry. If it’s something that isn’t posing a significant health risk to me, I’m very cautious and apprehensive about medicating. I’m sure there are others who have these concerns. I understand, if I were blocking out for minutes at a time or unable to control their onset, or having convulsions and dropping, I would definitely not suggest self managing without medication. I’d love to hear your thoughts.

Submitted by Jen

Dear Jen

Thank you for you comment. 

As we're not medically trained, we're not able to say if your symptoms might be epilepsy or something else. Only an epilepsy specialist would be able to determine whether your experience is related to epilepsy. I’m linking you to our website information about diagnosing epilepsy in case this is helpful to you.

It’s understandable that you are concerned that you might have to stop driving if you speak to your doctor. The driving rules say that you should ask your doctor if your blackouts, fainting or loss of consciousness affect your driving. And that if you have a seizure of any kind you have to stop driving and let DVLA know. Many people with epilepsy get a warning before their seizures but the DVLA would not consider them safe to drive until they have been seizure free for a period of time. This is because warnings are not always reliable, and often it would not be possible to come to a safe stop before losing awareness. 

If you had an accident while driving and the police found out you were having blackouts or possible seizures you could be prosecuted. And your insurance is unlikely to cover you

On the positive side, if you tell your doctor they might help you finding out what is going on and what kind of treatment might be helpful. If your doctor thinks that your symptoms affect your driving you might be able to start driving again later on when you meet driving rules.

If you are diagnosed with epilepsy and have to stop driving, you can apply for free bus travel and disabled persons railcard to help with travel to work. 

Epilepsy medicine, like any other medicine can have side effects, but this is individual. Some people have some side effects and some have none. It also might be worth knowing that epilepsy medicine is the most common treatment for epilepsy. And most people with epilepsy get seizure control with epilepsy medicine. 

But it sounds like that first you might need to find out what your symptoms are related to. I’m also linking you to Narcolepsy UK in case this is helpful to you.

I hope this information helps. But if we can be of any more help, please feel free to contact us again, either by email or the Epilepsy Action Helpline freephone 0808 800 5050. Our helpline is open Monday to Thursday 8.30am until 7.00pm, Friday 8.30am until 4.30pm and Saturday 10.00am until 4.00pm.

Regards

Tove

Submitted by Tove-Epilepsy Action

Hi,
I have had epilepsy for 31years, that I know of. I'm 38. I was seizure free (for the most part) for the last year, I thought I had gotten lucky. But then friday I had 2 gran mals and today I have had 6 focals in the last 9 hours. This is what it used to be like. I have had my veegs, eegs, mri's, ct's, etc. Now have to go for another round of everything. My question is, is it abnormal to have so many focals or partials? (It's not uncommon for me when my seizures are active) But is it 'bad' that I have about 1-3 an hour sometimes and by the end of the day it feels like i have done nothing but live in panic and fear? Do a lot of people have them that often? (I'm on vimpat, fycompa, ativan) Thinking about RNS

Submitted by Danielle

Hi Danielle, this must be upsetting for you especially after being mostly seizure free for a year. We know that epilepsy is individual and patterns of seizures can vary so much. Some people have clusters of focal seizures. So this is a possible pattern for seizures, though we don't know exactly how common this is. 

 

Clusters of focal seizures aren't 'bad' in the sense that they aren't usually considered to be a medical emergency or an increased risk for SUDEP. But they can still impact on your safety and wellbeing as you mentioned.  

 

I hope this review of your epilepsy can offer some way forwards for you. I'm also linking you to our information about getting the right treatment so you can check this is happening for you. 

 

As yet Responsive neurotransmitter therapy (RNS) isn't available in the UK through the NHS. I'm not sure how far you've got in your research but I'm linking you to the Epilepsy Foundation in America's information about RNS. There's also a link here to our full information about treatment in case there's anything helpful for you there. 

 

Regards

Mags

Epilepsy Action Helpline Team

Submitted by Mags - Epilepsy...

I have been spacing out a lot lately. I have ADHD and autism. But when I zone out I'm aware of what's going on and I wanna move to do what I'm supposed to be doing in that moment but I can't. I can't move,I can't respond no matter how bad I want to during that time. Like I'll usually stop dead in my tracks whenever it's talking to someone,doing something like baking or cooking,watching TV or trying to pay attention in class. I take meds for my ADHD but I still don't know if it's just my ADHD or if It's a focal seizure. While I was even reading this I spaced out. They spacing out usually last for about 10 to 30 seconds and after I just can't focus whatsoever. Whatever people say just goes in one ear and out the other and I can't get my school work done even if I wanted to. If you could reply that would be great :) Have a great day and night :)

Submitted by Ray
Dear Ray 
 
Thank you for your question. Your symptoms sounds like a very confusing and disruptive thing to experience. 
 
As you are aware of these symptoms, if it is epilepsy, it could be some type of focal seizure https://www.epilepsy.org.uk/info/seizures/focal-partial

We know children with epilepsy can also have ADHD and children with ADHD can have epilepsy. But as a number of medical conditions can cause symptoms similar to epilepsy it would be best to get a medical diagnosis for your symptoms. 
 
If your doctor thinks it could be epilepsy, they should refer you to an epilepsy specialist for a diagnosis. This would usually be at to a neurologist. The ideal would be to someone with a specialist interest in epilepsy, as there are many different conditions, and neurologist tend to specialise in different ones.
 
Or if you see a specialist for your ADHD you could talk to them regarding your concerns. 
 
Here is a link to our information on diagnosing epilepsy Diagnosing epilepsy | Epilepsy Action
 
If we can be of any more help, please feel free to contact us again. You can contact our helpline team directly, either by email helpline@epilepsy.org.uk or the Epilepsy Action Helpline freephone 0808 800 5050. Our helpline is open Monday to Thursday 8.30am until 7.00pm, Friday 8.30am until 4.30pm and Saturday 10.00am until 4.00pm.
Regards
Diane


Submitted by Diane - Epileps...

Hi,

I was just wondering if jamais vu is still classed as TLE symptom? I didn't see it mentioned in the article.

Thanks,

Jo

Submitted by Jo Bergh
Hi Jo
 
Thank you for your question. Jamais vu can be associated with temporal lobe epilepsy. We have only listed some of the most common symptoms on our webpage. 
 
Regards
Diane
Helpline Team
Submitted by Diane - Epileps...

I read the information and I still aren’t sure what described seizures I get. My most common situation is sight problem. At times I will get unsteady sight. This can last for 15 minutes or over 2 hours. I can carry out most things but what I see always appears to me is things are in motion. I know the object is stationary but I interpret it to be in motion bobbing up and down.

Submitted by Alasdair Kelly

I have symptoms that have led to a diagnosis of grand mal seizures. These have been controlled using keppra and a recent switch after 6 years to Lamictal with no recurrence. However, before diagnosis 6 to 7 years ago I had what I believe to be Partial seizures or absence aware seizures, where I lose control of my body but am aware, I lose control of speech but understand others while not being able to speak back. Instead of words id slurr nonsensical speech. Other symptoms are completely losing my humanity acting instead like a lizard or robot, licking my lips, grunting, looking about on autopilot, while watching from behind my eyes with full awareness and no control of my body or automotisms.

I would have panic attacks and auras like sitting in a theater with the lights fading for the big show, a sense of falling into a dark tunnel out of my body, and waking up on the floor in a pool of my own blood, forgetting who I am, what year it is, thinking it was 12 years prior and I was in Japan in the military. I would slowly become aware of things in chronological order, and I would go from not identifying who people were or how they knew me or why they were looking or talking to me- to later responding like I never forgot who they were to begin with. It was like complete amnesia followed by less amnesia as though duh of course I remember that, followed by duh of course I remember everything... other than why I'm on the floor.

6 years later that doesn't happen anymore. Now what happens is I have absence seizures, where I'm in class, work, a movie, playing a game, I don't know when, where, why, or duration or recurrence but I'm conscious, then I stand or lean giggling to myself mischievously, poking people inappropriately with no memory, with them screaming at me or repeating my name to gain my attention. This when not addressed directly resolves itself without me ever being aware it happened or others notices something amiss. When addressed after about a minute I snap back feeling out of place, confused, often irritated out of shame or denial that it occurred. My doctor switched my medications which allowed me to feel emotional again, but the behavior continues - losing memory, acting weird, laughter.

It doesn't seem to happen while driving or doing complex things but I wouldn't know if it happened to begin with.

Submitted by Norman Kemp-Cameron

I’ve been “suffering” from Temporal Lobe seizures for probably 30 plus years. When I was younger it was seeing lights and patterns when I was tired. This grew into massive, intense and what I can only describe as profound Deja Vu “dreams” while I was in bed (sometimes at night, sometimes in the morning)…then I started having them when at work or socialising but I kept all this to myself for the longest time until I had a Grand Mal seizure that was so bad I dislocated my own shoulder. Finally told my doctor about all the other weird things I’d experienced all my life and got diagnosed with epilepsy…

Just wondering if anyone else actually misses having those temporal lobe seizures after being prescribed meds for them? It feels like a massive part of my life has ended! Not seeing patterns of light when laid in bed genuinely makes me a bit sad. The intense ‘waking seizures’… I found absolutely fascinating and loved to just sit back and let them happen…

Am I being stupid thinking like this?

Submitted by Joe

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