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Focal seizures

Seizure classification
Focal seizures

Todd’s paresis (sometimes called Todd’s paralysis)
Focal seizures that act as a warning of a generalised seizure

Seizure classification

The International League Against Epilepsy (ILAE), a world-wide organisation of epilepsy professionals, has put together a list of the names of different seizure types. This is called the ILAE seizure classification. The names and information given about different types of seizures in this booklet are based on this classification. The ILAE regularly looks at seizure classifications, so the names may change over time.

Some people use different words to describe seizures. But it is important for doctors to give seizures the right names. This is because specific medicines and treatments can help some seizure types but not others.

Seizure types

There are many different types of seizure. They can happen in any part of the brain. Some seizures are generalised, meaning they affect both halves of the brain. Others are focal, meaning they affect a small part of the brain. The brain is responsible for all the functions of our mind and body. What happens to someone during a seizure will depend on where in their brain the seizure is happening.

Focal (partial) seizures

In focal seizures, epileptic activity starts in just part of the person’s brain. You might be aware of what is going on around you in a focal seizure, or you might not. Different areas of the brain (lobes) are responsible for controlling all of our movements, body functions, feelings or reactions. So, focal seizures can cause many different symptoms. 

The structure of the brain

3D image showining different parts of the brain

 

Seizures can start in any of these lobes. What happens during a seizure will be different, depending on which lobe, and which part of the lobe, the seizure starts in. Each person will have their own experiences and symptoms during a focal seizure.

Temporal lobes

The temporal lobes are responsible for many functions, including hearing, speech, memory, emotions, and learning.

People who have temporal lobe seizures may stay partially conscious during a seizure. Or they may lose consciousness. They often don’t remember what happened to them during a seizure.

Temporal lobe seizures usually last between 30 seconds and two minutes. Some of the signs and symptoms of temporal lobe seizures include:

  • Feeling frightened
  • Having a deja-vu experience, that is a feeling that what’s happening has happened before
  • Having a strange taste, or smelling something that isn’t there
  • Having a rising sensation in the stomach
  • Staring
  • Lip smacking
  • Automatic behaviours such as staring, lip smacking, repeated swallowing, chewing or more complex tasks, such as dressing or undressing.

After a temporal lobe seizure, you might be confused and find it difficult to speak for a short time.

Frontal lobes

The frontal lobes are responsible for making decisions, solving problems, behaviour, consciousness, and emotions. If you have frontal lobe seizures, you may have unusual symptoms that can be mistaken for a mental health problem or a sleep disorder. Frontal lobe seizures usually last less than 30 seconds and often happen during sleep.

Signs and symptoms of frontal lobe seizures may include:

  • Moving your head or eyes to one side
  • Not being aware of your surroundings, or having difficulty speaking
  • Screaming, swearing or laughing
  • Having unusual body movements, such as stretching one arm, while bending the  other, as if you were posing like a fencer
  • Having repeated movements, such as rocking, pedalling or pelvic thrusting

Parietal lobes

Parietal lobes are involved with:

  • Processing information from the different senses in the body (seeing, hearing, touching, tasting and smelling)
  • Processing language
  • Writing
  • Maths skills

Parietal lobe seizures last between a few seconds and a few minutes. They affect about one in 20 people with epilepsy. 

Signs and symptoms of parietal lobe seizures may include:

  • Having feelings of numbness, tingling, heat, pressure, electricity and, rarely, pain
  • Having a ‘marching’ sensation that starts in your face, goes to your hand, then your arm, and down your leg (this is called a Jacksonian seizure)
  • Having sexual sensations
  • Feeling like your body is distorted, and that your arms or legs are in a weird position or are moving, when they are not
  • Feeling that a part of your body is missing or doesn’t belong to you
  • Feeling dizzy or as if you, or the area around you, is spinning
  • Seeing things that are not there, or seeing things differently from how they really are. For example objects might seem too close, too far away, too large, too small, slanted, moving or otherwise not right
  • Having difficulty understanding spoken words or language, difficulty reading or doing simple maths

Occipital lobes

The occipital lobes process information related to vision. They affect between one in five and one in 10 people with epilepsy.  They last for seconds.

Some of the signs and symptoms of occipital lobe seizures are:

  • Seeing things that are not there
  • Not seeing as well as usual, or not being able to see at all
  • Seeing an image that is replayed again and again
  • Feeling as if your eyes are moving
  • Having eye pain
  • Having sideways eye movements that you can’t control
  • Having rapid rhythmic eye movements where your eyes move quickly in one direction, and then slow down in the other direction. This is called nystagmus
  • Having fluttering eyelids

Todd’s paresis (sometimes called Todd’s paralysis)

Todd's paresis is a temporary weakness or paralysis in a hand, arm or leg. It affects some people after they have had a focal or generalised seizure.

Todd’s paresis affects the area of the body that was involved in the seizure. The weakness can be very mild, or it can completely paralyse that part of the body, or affect vision. Todd’s paresis usually occurs in just one side of the body. It can last from minutes to hours, before going away.

Focal seizures that act as a warning of a generalised seizure

The epileptic activity that causes a focal seizure can sometimes spread through the brain and develop into a generalised seizure. If this happens, the focal seizure acts as a warning of a generalised seizure and is sometimes called an aura. The aura is usually brief, lasting a few seconds or so, although in rare cases, auras can last for minutes, hours, or even days. Once the epileptic activity spreads to both halves of your brain, you quickly have a generalised seizure, usually a tonic-clonic, tonic or atonic seizure.

Warnings can be very useful. They might give you time to get to safe place or let someone else know that you are going to have a seizure. Sometimes, the epileptic activity spreads to both halves of your brain so quickly that you appear to go straight into a generalised seizure.

Epilepsy Action has more information about generalised seizures

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 Helpline by email at helpline@epilepsy.org.uk

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We can provide references and information on the source material we use to write our epilepsy advice and information pages. Please contact our Epilepsy Helpline by email at helpline@epilepsy.org.uk.
Code: 
B037.03

Epilepsy Action wishes to thank Dr John Paul Leach, consultant neurologist, Honorary Clinical Associate Professor, Glasgow, UK for reviewing this information.

This information has been produced under the terms of The Information Standard.

  • Updated July 2014
    To be reviewed July 2017

Comments: read the 17 comments or add yours

Comments

Recetly, I've been going to the doc's about a strange bout of 'episodes' where I go vacant, my limbs tingle, i feel sick (sometimes with actual vomitig) and my heart races. Often, I get visualizations of activities or places that I know is not real, such as my home being a hospital. Put on citalopram for anxiety but because mum fought, with a family history of epileptics and a great uncle who died from it, I'm now having a deep chat with the doc and hopefully finding out what is wrong.

If anyone has experienced something like this, it would be great to know I'm not alone, thank you.

Submitted by Charlotte on

Hi Charlotte

Epilepsy is very individual and can make itself felt in various ways. It all depends where in the brain the activity is coming from.

To hear from other people about their epilepsy, you may wish to post your question on facebook, twitter or our online forum.

If we can be of any more help, please feel free to contact us again, either by email helpline@epilepsy.org.uk or if you are in the UK, phone the Epilepsy Helpline freephone 0808 800 5050.

Yours sincerely

Diane

Submitted by Diane on

I halved it since I was 29 iam now 58 they still not control it . I have a lots of things that happen the taste,the feeling that things have happened before.uncontroable movement of arms and legs I have been in hospitol 3 times.had all the tests there is. I only know.that what I suffer and other people go.through .

Submitted by peter barrie taylor on

Hello Charlotte. I have only just read your message and I hope that you have found some help, somewhere. I too have feelings that you describe and have taken Citalopram for several months now. I'm not sure just how much it helps, if indeed it does. I also take Keppra & Zonisamide for my epilepsy. Have you had any more treatment?

Submitted by Rose on

Im going through a hard time. Epilespy is diagnosed but the cause unknowb. MRI is clear awaiting EEG results. Not allowed to work. I work for NHS any future employment will be untenable if they terminate my employment. At the mo im generalised seisures. What ever that means

Submitted by sue ward on

Hi Sue

This must be a very worrying time for you, especially as your employer is not allowing you to work. Your employer shouldn’t be keeping you off work unless it is absolutely essential.

Epilepsy is a condition that can develop at any age. For most people there isn’t an explanation or known cause for their epilepsy to develop.

Most jobs, even healthcare work, are possible for people with epilepsy. It all depends on your seizure type, seizure frequency and maybe some reasonable adjustments at work.

Because of your diagnosis of epilepsy, you are covered by the Equality Law. This means your employer must not discriminate against you and if necessary make any ‘reasonable adjustment’. This is to make sure that you are not put at a disadvantage to a non-disabled person, just because you have epilepsy. A risk assessment is generally carried out to look at possible problems within your job. From this assessment there may be some reasonable adjustments suggested. Your employer should do their best to make sure that you are not put at a disadvantage because of your epilepsy.

You should speak to your union or ACAS if you think your employer is keeping you off work needlessly.

The most common way epilepsy is treated is with epilepsy medicine. Epilepsy medicine doesn’t cure epilepsy, but for 70/80 per cent of people it can stop their seizures. This fact should be taken into account when talking to your employer.

If you or your employer would like more information, please feel free to contact us again, either by email helpline@epilepsy.org.uk or phone the Epilepsy Helpline freephone 0808 800 5050.

Yours sincerely

Diane

Regards

Diane Wallace

Advice and Information Team

Submitted by Cherry on

I have 3 questions. 1) Is it possible for someone's seizure type to change as they age? Example - Absence, Atonic, Myoclonic 2) Is it possible for tongue to tingle at the end of an Atonic seizure with near loss of consciousness? 3) Can a person have only a few seizures per year?

Submitted by PAMELA TULLIS on

Hi Pamela

It is possible that person may have more than one type of seizure, and this can change with age. Each person’s epilepsy is different, so it may be the tingling sensation you describe is related to epilepsy.  The frequency of seizures also varies greatly from person to person. There is no standard number of seizures people have, it really depends on their individual type of epilepsy and level of seizure control. With the right dose of the right drug, seven in 10 people with epilepsy could become seizure-free.

Sacha

Advice and Information Team

Submitted by Sacha on

hi im 33 yrs old,i have hydrocephalus (water on the brain) with 3 shunts and high blood pressure,i am known for epileptic seizures when one of my shunts go,my mum has witnessed me having my very 1st seizure April just gone,i was fully conscious but blank in the face and wasn't responding,i have collapsed in streets and at work also,i am now taking epilim which is controlling my symtoms but im still left in the dark to whether I am actually epileptic,im worried and dunno wot to do for the best really.

Submitted by deborah davies on

Hello Deborah

Thank you for your comment. Epilepsy can sometimes be related to hydrocephalus. Your shunts may be a factor, as people with hydrocephalus who have shunts sometimes develop focal seizures. Epilim can be an effective treatment for this, so it’s good to know it’s working well for you. If you talk to your doctor, they should be able to explain the specifics of your diagnosis to help you understand it, and your treatment.

Yours sincerely
Sacha, Epilepsy Advice & Information Team

Submitted by Sacha@Epilepsy ... on

My 8 year old son has a complex partial seizure this week. this involved being awake but vacant and unable to respond appropriately, staring off to the left hand side, a repetitive movement with his fingers, shaking of his arms, repetitive nonsensical speech and afterwards some visual hallucinations where he could see a 'spot' and a strange sensation in his head. It lasted approx 2-3 minutes. He also had a very strong feeling of fear. that lasted for approx 15 mins. He went to hospital and was monitored and discharged. Last night, 4 nights later, he went to bed and came down crying (this is not typical for him) and was again fearful and kept saying that he could hear voices in his head. He was really very scared. Could this second episode be a second seizure?

Submitted by Susan on

 

Hi Susan

It must be really difficult to see your son that upset.

It is possible this second episode was also a seizure. But it could have been an expression of his distress about the previous seizure. Or it could be linked to problems with sleep. Or something else entirely.

Also you don’t mention whether your son actually has a diagnosis of epilepsy. If he does and is taking epilepsy medicine, some of these medicines do list sleep disturbance as a possible side-effect.

Whatever it might be, it is always a good idea to record anything you think may possibly be related to seizure activity. We have a diary and an app, which you may find useful. This will provide really useful information for the consultant when you see them.

We also have some information on focal or partial seizures.

I hope you get some answers soon.

Cherry

Advice and Information Team

Submitted by Cherry-Epilepsy... on

Hi my 4 year old son was diagnosed with generalized myoclonic epilepsy at the age off 2 n half they managed to get his siezures under control with eperlim n keppra altho the last few weeks his siezures have became a problem again altho his meds have been upped there still not controlled is it possible for someones epilepsy to become worse over the years he had a tonic - clonic seizure on thursday it was his 1st 1 and very scary to watch is it possible he could go on to have more tonic - clonic siezures as im to scared to sleep i sit n watch him sleep to keep him safe

Submitted by marie carter on

my husband as demesha and took I'll he were just blank at first didn't respond at all just vacant when the paramedics came out and took him into the waiting room whitch was full of people and just left him there all of a sudden his hole body started jumping then his head went back stif he was grainding his teeth with so much pain and pulling at is chest then colaspet I was seeming for the doctors they said it was a fit he was having could this be true

Submitted by barbara Goldsbrough on

Dear Barbara

That certainly sounds like a fit or seizure. It can be really scary to watch someone you care about have a seizure.

Here is some information about epilepsy you might find useful.

If it would be easier to talk to someone on the phone, please feel free to contact us again, either by email or the Epilepsy Helpline freephone 0808 800 5050.

Cherry 
Epilepsy Action Advice and Information Team

Submitted by Cherry, Epileps... on

I have recently been diagnosed with todd seizures but i have not really been given much information on them other than they are rare and can sometimes come across as a stroke.
Can you loose memory with these as i feel like i am confussed and forget things after a seizure .

Submitted by jemma wright on

Hi Jemma

Apart from our information I also have struggled to find anything more than a few sentences on this.

But this definition might offer you just a little more:

A reversible unilateral weakness that occurs after a partial seizure involving the motor cortex. It can last minutes or hours, but is never prolonged beyond 24 hours (prolonged paralysis indicates that cortical damage has occurred, unrelated to epilepsy itself) The occurrence of Todd’s paralysis has reliable localising value, indicating that the epilepsy arises in the contralateral motor cortex.

This is taken from Simon Shorvon’s Handbook of Epilepsy Treatment.

We're not medically trained, but I think this means it is unlikely your memory problems are directly related to this. There are many reason why people with epilepsy have memory problems though, so you might find our information on this useful.

You could take the definition to your neurologist next time you see them and see if they can put it into plain English for you.

I hope this helps.

Cherry 

Epilepsy Action Advice and Information Team

Submitted by Cherry, Epileps... on