Focal seizures - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Focal seizures are the transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain originating within networks limited to one hemisphere.
Focal seizures can be caused by overt brain lesions (e.g., stroke, tumor), but neuroimaging studies often do not identify any underlying pathology.
History-taking is the most important aspect of diagnosis. Supportive tests, although helpful, need not be abnormal for a diagnosis of focal seizures.
Monotherapy with anticonvulsant medication is the initial and preferred treatment. Choice of medication should be tailored to the needs of the individual patient, taking into account factors such as age, sex, and comorbidities.
When at least two monotherapy trials fail to achieve seizure remission, dual therapy may be tried; use of drugs with different mechanisms of action should be considered to maximize efficacy and minimize toxicity.

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Definition

Epidemiology

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Citations

Key Articles

Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League Against Epilepsy: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017 Apr;58(4):522-30.[Abstract][Full Text]
Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017 Apr;58(4):512-21.[Abstract][Full Text]
Leone MA, Giussani G, Nevitt SJ, et al. Immediate antiepileptic drug treatment, versus placebo, deferred, or no treatment for first unprovoked seizure. Cochrane Database Syst Rev. 2021 May 4;(5):CD007144.[Abstract][Full Text]
Kanner AM, Ashman E, Gloss D, et al. Practice guideline update summary: efficacy and tolerability of the new antiepileptic drugs I: treatment of new-onset epilepsy. Report of the American Epilepsy Society and the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Epilepsy Curr. 2018 Jul-Aug;18(4):260-8.[Abstract][Full Text]
Kanner AM, Ashman E, Gloss D, et al. Practice guideline update summary: efficacy and tolerability of the new antiepileptic drugs II: treatment-resistant epilepsy. Report of the American Epilepsy Society and the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Epilepsy Curr. 2018 Jul-Aug;18(4):269-78.[Abstract][Full Text]
Royal College of Obstetricians and Gynaecologists. Epilepsy in pregnancy (Green-top Guideline No.68). Jun 2016 (updated May 2018) [internet publication].[Full Text]
Nevitt SJ, Sudell M, Weston J, et al. Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data. Cochrane Database Syst Rev. 2017 Dec 15;(12):CD011412.[Abstract][Full Text]
Boon P, De Cock E, Mertens A, et al. Neurostimulation for drug-resistant epilepsy: a systematic review of clinical evidence for efficacy, safety, contraindications and predictors for response. Curr Opin Neurol. 2018 Apr;31(2):198-210.[Abstract]

Other Online Resources

PROQOLID: Quality of Life in Epilepsy Inventory-10 (QOLIE-10)
Epilepsy Foundation: driver information by state
The North American AED (Antiepileptic Drug) Pregnancy Registry

Referenced Articles

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