Partial (focal) seizure

Alternative Names

Simple seizure; Jacksonian seizure; Seizure - partial (focal)

Treatment

Whenever someone has a seizure for the first time, he or she should be taken to an emergency room, as there may be a serious underlying medical condition which needs to be treated. First-aid measures should be performed as appropriate, including protecting the person from injury during the seizure, preventing him or her from inhaling vomit or mucus into the lungs, keeping the airway clear, and assistance with breathing.

Treatment of the causes may stop the seizures. This may include medication, surgical repair of tumors or brain lesions, and other treatments.

An isolated seizure with an obvious avoidable trigger, such as fever or toxic reactions, is treated by removing or treating the precipitating factor.

An isolated seizure may not require treatment. Findings on MRI or EEG may determine how likely recurrent seizures are and may help determine the need for ongoing treatment, such as anticonvulsants (anti-seizure medications). The response to these drugs varies, and medication and dosage may have to be adjusted repeatedly.

Multiple, repeated seizures are usually treated with anti-seizure drugs such as phenytoin or carbamazepine for preventive, long-term use. Follow-up includes review of the need for drugs and monitoring for side effects. Drugs may need to be continued indefinitely.

Some patients with seizures that are difficult to treat may respond to a vagal nerve stimulator -- a device that stimulates a nerve in the chest and reduces the number of seizures. Other patients may respond to surgery that removes the abnormal brain cells responsible for causing seizures.

Patients who have seizures that could result in loss of motor control or consciousness should be advised not to drive, swim alone, or engage in other activities during which a seizure could endanger themselves or others.

The patient might need to wear informational jewelry or cards (such as Medic-Alert) to aid in obtaining prompt medical treatment if a seizure occurs.

Outlook (Prognosis)

The outlook is largely determined by the underlying cause of the focal seizures. Patients who have recurrent seizures that are not due to a temporary condition (e.g., a drug side effect or infection) have a chronic condition called epilepsy.

Seizures that occur singly or in a closely associated group are commonly triggered by an acute condition such as brain injury and may occur as an isolated incident, or they may develop into a chronic seizure disorder. Seizures within the first 2 weeks of a brain injury do not necessarily mean that a chronic seizure disorder will develop. EEG and MRI findings may help determine whether the condition is likely to become chronic.

Death or permanent brain damage from seizures is rare, but either can occur if the seizure is prolonged or if many seizures occur in close proximity (status epilepticus).

Serious injury can occur if the seizure happens while the person is driving or operating dangerous equipment. These activities may be restricted for people with poorly controlled seizure disorders.

Infrequent seizures, however, need not severely restrict lifestyle. Work, school, and recreation do not necessarily need to be restricted, but precautions should be taken to reduce risks if a seizure should occur.

Possible Complications

• Generalized seizures
• Epilepsy (recurrent seizures)
• Prolonged or closely occurring seizures (status epilepticus)
• Injury from falls, bumps, biting self
• Injury caused by a seizure during driving or operating machinery
• Aspiration pneumonia
• Permanent brain damage (stroke or other damage)
• Side effects of medications (with or without observable symptoms)
• Complications of surgery
• Women who choose to get pregnant should inform their doctor in advance for appropriate adjustments in medications (many of the anti-epileptic medications can cause birth defects)

When to Contact a Medical Professional

Call your local emergency number (911) if this the first time a person has had a seizure or a seizure is occurring in someone without a medical ID bracelet (instructions explaining what to do). In the case of someone who has had seizures before, call the ambulance for any of these emergency situations:

• This is a longer seizure than the person normally has, or an unusual number of seizures for the person
• Repeated seizures over a few minutes
• Repeated seizures where consciousness or normal behavior is not regained between them (status epilepticus)

Call your health care provider if any new symptoms occur (including possible side effects of medications):

• Drowsiness, restlessness, confusion, sedation
• Nausea/vomiting
• Rash
• Loss of hair
• Tremors or abnormal movements
• Problems with coordination
• Fevers, infections

References

Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, Mo: WB Saunders; 2003.

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002.