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    Focal Aware Seizures, Once Called Simple Partial

    |7 min read
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    Dovy Paukstys

    Founder, Komori Care

    Abstract photograph for the Focal Aware Seizures, Once Called Simple Partial explainer
    Photo by Lorem Picsum on Unsplash

    Focal Aware Seizures, Once Called Simple Partial

    A focal aware seizure starts on one side of the brain. The person stays aware of themselves and the room.

    Important: This article is educational and is not medical advice. It does not diagnose, treat, prevent, or cure any condition. Komori is not a medical device, is not FDA-cleared, does not detect seizures, and is not intended for people with epilepsy. Talk with a neurologist or epileptologist about personal medical decisions. Households living with epilepsy should use clinically validated seizure-detection devices as directed by their care team.

    What "focal aware" means

    ILAE's 2017 classification replaced simple partial with focal aware. Focal means the seizure starts in networks limited to one hemisphere. Aware means the person knows who they are and what is happening around them during the event, even if they cannot move or speak easily.

    That last part matters. Awareness is not the same as being able to wave or answer a question. ILAE is explicit: retained awareness includes people who are immobile. What counts is knowledge of self and environment. Afterward, the person can usually confirm they knew what was going on.

    If awareness is impaired at any point, the seizure is named a focal impaired awareness seizure instead. The first 10 seconds do not get a separate type if the next 20 seconds are blank.

    CDC's public page uses the same split. Focal onset aware seizures do not cause a loss of awareness. A person can sometimes talk during them and remember them later. They used to be called simple partial seizures.

    What they can feel like

    Because the seizure stays in a limited network, the symptoms follow the job of that part of the brain.

    CDC lists a few common examples: a sense of deja vu, a funny feeling in the stomach, or abnormal movements.

    NINDS adds more of the range. The person may stay conscious and still have motor, sensory, or psychic feelings, including intense deja vu or sudden memories. They may feel unexplained joy, anger, sadness, or nausea. They may hear, smell, taste, see, or feel things that are not there. Movement may involve only one hand or one side of the face.

    ILAE groups those features under optional extra labels after "focal aware":

    • Motor: a brief stiffening, a rhythmic jerk, a twitch, or a forced head turn.
    • Sensory: tingling, a visual change, a smell, a taste, a sound, or a sense of movement.
    • Autonomic: flushing, a racing heart, goosebumps, or a rising epigastric wave.
    • Cognitive: deja vu, jamais vu, language trouble, or a forced thought.
    • Emotional: fear, anxiety, or a sudden unexplained joy.

    The earliest prominent feature names the subtype. A seizure that starts as fear and later includes a jerk of one arm is still a focal aware emotional seizure if awareness stays intact. The jerk can be added in the description.

    Aura is often this seizure

    Families hear "aura" and think of a warning before a bigger event. Clinically, an aura is a focal aware seizure. It may stay that small. It may also be the first chapter of a seizure that later impairs awareness or becomes a bilateral tonic-clonic convulsion.

    NINDS says some people with focal seizures experience auras, unusual sensations that warn of an impending seizure, and that a person's symptoms tend to be similar each time. Some people also describe a longer prodrome, a feeling that a seizure is coming, lasting hours or days. Prodrome is not the same as the ictal aura.

    If the same rising stomach feeling always comes before a convulsion, write that down. It is useful localization information. It is not a guarantee that the next event will stay small.

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    How long they last, and what comes after

    NINDS says these focal events usually last no more than a minute or two. Afterward, a person may have a headache or soreness in the muscles that tightened. Symptoms in the body part the seizure used can help a neurologist guess the starting region.

    Recovery is often fast compared with a focal impaired awareness seizure. The person can usually continue the conversation. That does not mean the event was trivial. A focal aware seizure can still be frightening, interrupt work or driving, and progress without warning.

    Todd's paralysis, a temporary weakness after a seizure, can follow focal motor activity. NINDS says it usually affects one side and can last from 30 minutes to 36 hours. It can look like a stroke. New one-sided weakness still needs urgent medical evaluation. Do not assume it is Todd's from the couch.

    What they can be mistaken for

    NINDS warns that focal seizure symptoms are easy to confuse with other disorders. Strange sensations and brief behavior changes can be taken for panic, migraine aura, faint, narcolepsy, or a psychiatric event. Several tests and careful monitoring may be needed.

    That cuts both ways. Not every wave of deja vu is a seizure. Not every unexplained smell is a seizure. Pattern, duration, stereotypy, and EEG are how clinicians sort it.

    Psychogenic nonepileptic events exist too. They are not electrical seizures. They still deserve care, just a different kind.

    First aid

    Care and comfort are usually enough. Stay with the person. Help them sit if they might fall. Move them away from a hot stove, a street, or the edge of a platform. Do not shake them. Do not argue them out of a hallucination. Time the event.

    If the seizure spreads, awareness drops, or a convulsion begins, switch to full Stay, Safe, Side first aid. Call 911 if the event lasts more than 5 minutes, if another starts before recovery, if there is injury, if this is a first seizure, or if breathing or waking is a problem.

    A focal aware seizure is not a reason to put anything in the mouth. It is not a reason to hold the person down.

    Why the name is worth using

    Simple partial sounded mild. For some people the event is a brief finger twitch. For others it is a wave of terror they cannot explain to a coworker. The 2017 name drops "simple" and says what is actually preserved: awareness.

    If you are describing this to a neurologist, skip the hunt for the perfect subtype. Say what you felt, what anyone else saw, how long it lasted, whether you could remember it, and whether it ever led to a larger seizure.

    FAQ

    Is a focal aware seizure the same as a simple partial seizure?

    Yes. Focal aware is the 2017 ILAE name. Simple partial is the older term. CDC still mentions the older name so families can map their charts.

    Can I talk during a focal aware seizure?

    Sometimes. CDC says a person can sometimes talk during these seizures and remember them afterward. Speech can also freeze even when awareness stays intact.

    Is an aura a separate kind of seizure?

    No. An aura is a focal aware seizure that the person can feel. It may remain the whole event, or it may be the start of a seizure that later impairs awareness or becomes convulsive.

    Can a focal aware seizure turn into a convulsion?

    Yes. If it spreads to both hemispheres, ILAE names that a focal to bilateral tonic-clonic seizure. First aid then follows the convulsive steps.

    Do these seizures mean I have epilepsy?

    One provoked focal event does not automatically mean epilepsy. ILAE diagnoses epilepsy after two unprovoked seizures more than 24 hours apart, after one unprovoked seizure with a high recurrence risk, or when an epilepsy syndrome is diagnosed. A neurologist applies those rules.

    Sources

    Related

    • types-of-seizures
    • focal-impaired-awareness-seizure
    • temporal-lobe-epilepsy

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