Focal impaired awareness seizures

Focal impaired awareness seizures start in one part of the brain but usually affect other parts of the brain that involve alertness and awareness. The symptoms of a focal impaired awareness seizure depend on which part of the brain is affected, but they usually involve impaired consciousness. A child who is experiencing a focal impaired awareness seizure may seem to be aware of their surroundings and may move or speak but will be confused or unaware of what is actually going on. 

What are other terms for focal impaired awareness seizures?

Other terms for focal impaired awareness seizures include:

• complex partial seizures
• psychomotor epilepsy
• temporal lobe epilepsy

How can you tell if your child has focal impaired awareness seizures?

Focal impaired awareness seizures appear different from person to person, depending on the affected area of the brain. However, an individual child will usually have the same seizure pattern every time.

It can be hard to identify focal impaired awareness seizures in a baby or a young child before the age of five or six years old, because their nervous systems are less developed than those of older children and adults. A child of this age may suddenly stop what they are doing and their hand or arm may jerk rhythmically, and holding the arm will not stop the jerking. They may raise one or both arms or move their head to one side. In rare cases, their eyes may look to one side.

Auras, such as a feeling of fear or nausea, are very common before focal impaired awareness seizures. If the child is not old enough to speak, they may run to their mother and cling to her.

A child may show behaviours called automatisms during a focal impaired seizure, such as:

• chewing, lip-smacking, gulping, swallowing or spitting
• eye blinking, head turning or raising one arm
• hand movements, including picking at the air or at their clothing, gestures, rapid “pill-rolling” movements, grasping at objects
• rubbing genitalia

The child may also have autonomic symptoms, such as vomiting or retching, drooling, rapid heartbeat or breathing, or going pale.

After the seizure, the child will be confused and may have no memory of events just before or after the seizure.

What causes focal impaired awareness seizures?

Focal impaired awareness seizures may start in any part of the brain and spread to other areas. They often result from head injuries, tumours or brain malformations. Focal impaired awareness seizures can also be due to an unknown cause or occur in some syndromes, such as BECTS or BECOS.

How many other children have focal impaired awareness seizures?

Focal impaired awareness seizures are one of the most common seizure types. Between 8% and 31% of children with epilepsy have this type of seizure.

How are focal impaired awareness seizures treated?

The treatment for focal impaired awareness seizures depends on the underlying cause. In some cases, such as a brain tumour, surgery will probably be advised as the first course of treatment. In other cases, the doctor will prescribe an anti-seizure medication.

If the child continues to have seizures while taking medication, it may be possible to surgically remove the affected area of the brain. This option depends on how close the seizure focus is to essential areas of the brain, such as the speech, language and motor areas.

What should I do when my child has a focal impaired awareness seizure?

What to do in this situation depends on the individual child. Let other people know what works for your child. Your child may wander around or perform automatisms (repetitive movements with no apparent purpose). They may react unpredictably if you speak to them or touch them. If your child is having a focal impaired awareness seizure:

• Try to be a barrier if they are walking or running around. Guide them gently away from hot or sharp objects and stairs, as they could hurt themselves or fall.
• Don’t restrain them unless it is absolutely necessary (if they are in an unsafe situation), as they may strike out or try to run away.
• Approach them cautiously from the side and speak to them so that they don’t feel threatened if you need to touch them.
• Quietly explain what happened and where they are. In some cases, once the seizure is over, they may be confused or tired. Give them time to rest and recover.

What is the outlook for a child with focal impaired awareness seizures?

The outlook for a child with focal impaired awareness seizures depends on the underlying cause of the seizures. They tend to be more resistant to treatment with medication than other types of seizures. and the chances of outgrowing this type of seizure are poorer. Some studies suggest that people with uncontrolled focal impaired awareness seizures have poor psychosocial outcomes. However, it is still possible for a child with these seizures to do well.