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Picture folding laundry, then letting your mind drift off to somewhere else entirely. Your hands keep moving, picking at the fabric in your grip, but you’re not really there. A minute later, you snap back, and the whole stretch of time is simply gone.
This is what a focal impaired awareness seizure can be like. It’s one of several seizure types that can happen with epilepsy, a brain condition that causes repeated seizures.
A focal impaired awareness seizure starts in one part of the brain and changes how aware you are of what’s happening around you. You can’t fully respond to people or remember the event afterward. Doctors used to call this a complex partial seizure, but the terms for seizures changed to make them easier to understand.
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This article covers the common symptoms of focal impaired awareness seizures, plus the treatments that can help bring them under control.
Focal impaired awareness seizures, sometimes still called complex partial seizures, don’t look the same in every person. What are focal impaired awareness seizures like in practice? Here’s what tends to happen, step-by-step.
Some people get a warning sign right before a focal impaired awareness seizure fully sets in. Doctors call this an aura. It’s actually the beginning of the seizure itself, even though awareness hasn’t been affected yet. By itself, it can be called a focal aware seizure.
During an aura, you might notice a strange smell, taste, or sound that isn’t really there. Some people feel a sudden rush of fear or a strange sense that a moment has already happened before. This feeling is called déjà vu.
Not everyone notices an aura. For some people, the first sign anyone else sees is a change in awareness itself, which makes it hard to predict exactly when a seizure will happen. That’s why doctors recommend planning ahead and taking safety precautions if you have this type of seizure.
As the seizure moves forward, awareness starts to fade. You might stare blankly into space and stop responding to the people around you.
Your body may keep moving even though you’re not fully aware of it. These automatic movements are called automatisms. Examples of automatisms include lip-smacking, chewing motions, picking at clothing, or rubbing your hands together.
If the seizure starts in the frontal lobe, the part of the brain right behind the forehead, you might bicycle your legs or thrust your pelvis instead.
Infrequently, a person having a focal impaired awareness seizure might repeat words or phrases, laugh, scream, or cry. Some people act in ways that can be unsafe or embarrassing without meaning to, like walking into traffic or removing their clothes. This is why planning ahead for safety matters so much.
A focal impaired awareness seizure typically lasts anywhere from several seconds to a few minutes.
Afterward, many people feel confused, tired, or foggy for a while. This stretch of time is called the postictal period.
Most people don’t remember the seizure itself, or even the moments right before it started.
Because these seizures cause staring and repetitive movements, they can look a lot like simple daydreaming or other types of seizures, such as absence seizures. For this reason, getting an accurate diagnosis from a neurologist, a doctor who specializes in the brain and nervous system, is very important.
If focal impaired awareness seizures are not well controlled with treatment, seeing a neurologist who specializes in epilepsy (called an epileptologist) can help you identify additional treatment options.
Focal impaired awareness seizures can happen to anyone. They’re sometimes linked to a past head injury, brain infection, stroke, or brain tumor. They can also come from genetic changes passed down in a family or from a difference in how the brain formed before birth.
Often, though, doctors never pin down an exact cause, even after performing an MRI to look for structural changes.
The good news is that focal impaired awareness seizures can usually be managed well. Your neurologist will help you find the right combination of treatments for your situation.
Medication is typically the first treatment tried. Several different anti-seizure medications can help prevent focal impaired awareness seizures from happening in the first place.
Finding the right medication can take some trial and error. Your neurologist will weigh how well a medication controls your seizures against any side effects you notice, and they may need to adjust your dose or try a different drug before landing on the best fit. This process takes patience and can involve more than one attempt before the right medication is found.
If two or more medications don’t fully control your seizures, your doctor may look at other options. These include surgery, devices, or changes to diet.
For some people, especially children whose seizures don’t respond well to medication, a special high-fat, low-carbohydrate eating plan called the ketogenic diet may help cut down on seizures. It’s prescribed by a doctor and closely monitored by a dietitian.
More than half of children who try the ketogenic diet see their seizures drop by 50 percent or more.
Neuromodulation devices are small implants that send gentle electrical pulses to calm down unusual brain activity. For many people, these devices lower how often seizures happen and how intense they are.
One example is vagus nerve stimulation, or VNS. It sends regular, mild pulses through the vagus nerve, which runs from the brain down through the neck and helps control automatic body functions like heart rate and breathing.
Research on VNS shows that roughly half of children who tried it had their seizures drop by 50 percent or more.
When medication, diet, and devices haven’t controlled seizures well enough, surgery may be considered.
Before recommending surgery, doctors use inpatient video EEG monitoring, a type of continuous electroencephalogram, to pinpoint where seizures begin in the brain. During this test, a person stays in the hospital while cameras and sensors record brain activity around the clock.
This hospital stay usually lasts anywhere from three to 10 days, though it can take longer for some people.
For people whose seizures come from the temporal lobe, the most common starting point for focal impaired awareness seizures, removing that small area can be very effective.
After this surgery, 60 to 70 out of every 100 people are free of seizures that affect their awareness. More than 85 percent see a significant improvement in seizure control overall.
You don’t have to manage epilepsy on your own. Before your appointment, keep a simple seizure log of when seizures happen, how long they last, and how you feel afterward. This can help your neurologist spot patterns.
Ask how well your treatment is working and whether other options may help. These could include a different medicine, diet changes, a device, or surgery.
If you’re a parent, ask how your child’s treatment may need to change as they grow.
Most importantly, tell your care team about all your symptoms, even those that seem unusual or hard to explain. Small details, such as a smell before a seizure or how long recovery takes, can help your care team better understand your seizures.
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On MyEpilepsyTeam, people share their experiences with focal impaired awareness seizures, get advice, and find support from others who understand.
What do you wish you’d known when you first learned you were having focal impaired awareness seizures? Let others know in the comments below.
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