• Start in a specific area, on one side of the brain

Level of awareness

• Focal aware (simple partial) -

  • no loss of consciousness
  • no post ictal confusion

• Focal impaired awareness (complex partial)

  • Altered consciousness during the episode (patient may seem fully aware)
  • Following the seizure, post ictal confusion

• awareness unknown

• Focal seizures can be described as being motor or non motor, and can be described as jacksonian if they travel across the cortex (usually distal to proximal muscles)

  • Focal aware motor (Jacksonian)
  • Focal aware sensory (Jacksonian)

Focal to bilateral tonic-clonic

• Start in one place - progress rapidly to the whole brain (or whole hemisphere) via large fasciculi or thalamus
• Patients may experience auras prior to generalised onset (warning signs)