What is the Best Treatment for Focal Seizures?

Treatment Options for Focal Seizures in Adults and Children

Focal seizures originate in a single area of the brain and may remain localised or extend to the adjacent areas. These seizures have characteristic, consistent pathways of propagation and exhibit unique clinical features—termed semiology—that provide an indication of their location.

They are classified as simple (i.e., no loss of awareness) or complex (i.e., impaired awareness). Whether you or a loved one is diagnosed with focal seizures, it is essential to know the best course of treatment.

Continue reading to learn about the features of focal seizures, as well as the best ways to treat and manage this condition.

How to Treat Focal Seizures?

Treatment of focal seizures focuses on symptom management, reducing their severity, and improving quality of life. Here are the best and most commonly used treatments for managing focal seizures:

• Anti-Seizure Medications (ASMs): These are still the first line of treatment for the majority of individuals with focal epilepsy. Medications stabilise electrical activity in the brain and are successful in most of the patients. The choice of medication is critical and depends on an accurate diagnosis. Common first-line options for focal seizures include lamotrigine, levetiracetam, lacosamide, and zonisamide. Carbamazepine and oxcarbazepine are also effective for focal seizures but must be used with caution as they can worsen other types of epilepsy. The selection is made by a neurologist based on the patient's specific seizure type, age, sex, and other health conditions.

These are either administered as daily pills or, in emergency situations, as intravenous therapy. Some of its side effects include rashes on the skin, weight changes, and liver or bone problems. Routine monitoring using blood tests and EEGs (electroencephalograms) is necessary to ensure the efficacy and safety of this approach.

• Epilepsy Surgery: For those with seizures not controlled by at least two suitable antiseizure drugs (drug-resistant epilepsy), surgical treatment might be considered. Surgery involves removing or disconnecting the specific area of the brain where seizures begin. The most common and successful procedure is an anterior temporal lobectomy. However, other techniques, such as lesionectomies or hemispheric procedures, are used depending on the precise location and cause of the seizures. 

In children, surgery is an option if medications do not work. Surgical assessment involves imaging, EEG monitoring, and cognitive testing to ensure that the removal of brain tissue will not compromise essential functions.

• Ketogenic Diet: This method is most useful for children with drug-resistant seizures. The ketogenic diet is a high-fat, low-carbohydrate diet that may sometimes lessen or even resolve seizures for them. It requires some planning and observation and typically begins with a hospital stay to initiate the diet safely.
• Neuromodulation Therapies: This therapy employs implanted medical devices to apply electrical stimulation to certain areas of the nervous system to interfere with abnormal brain activity, causing seizures. Vagus nerve stimulation (VNS) is a battery-operated device implanted in the chest that delivers electrical impulses to the vagus nerve, which transmits signals to the brain.

This procedure is specifically frequent in adults and older children with medication-resistant focal onset seizures. Patients also receive a magnet to trigger the device if a seizure is detected manually. Some notable side effects of this treatment include voice alteration, throat pain, and the need for battery replacement every few years.

• Adult and Paediatric Dietary Therapy: While more frequently encountered in the paediatric age group, adults can also benefit from dietary adjustments. Low glycaemic index or modified Atkins treatments are options for individuals who cannot adhere to a strict ketogenic diet but need seizure control.

These therapies are typically considered when standard treatments have not provided adequate improvement or when families are considering non-pharmacological interventions.

• Rescue Therapies and Emergency Procedures: In situations where breakthrough seizures happen even with continued treatment, patients, particularly children, may need emergency drugs called rescue therapies.

These are given as pills, sprays, or injections and work to resolve seizures rapidly. Emergency procedures are usually created in consultation with neurologists and play an essential role in minimising seizure length and avoiding complications.

• Monitoring and Long-Term Care: After treatment has begun, continuing care includes frequent visits with a neurologist, frequent EEG testing, and monitoring of cognitive or developmental milestones in children.

Medication or type of therapy may need to be changed as the child matures or when new symptoms arise. Supportive services, such as epilepsy education, seizure-response planning, and counselling, are also integral to ensuring long-term care.

What are the Features of a Focal Seizure?

Focal seizures develop in a specific region of the brain, but they can generalise and extend to other areas. Some clinical features of a focal seizure are as follows:

• The person's awareness during a focal seizure may be intact (focal aware seizures) or altered and foggy in some way (focal impaired awareness seizures).
• Movements during seizures may be jerking or twitching and will likely be involuntary, typically affecting only one side of the body.
• Some people may experience the onset of a seizure with an aura, a sensation that the person feels before the seizure occurs, such as a strange smell, taste, touch, or feeling.
• Focal seizures are most often associated with emotional changes (frustration, anger, joy), general amnesia, perceptual distortions, or hallucinations.
   

How Long Do Focal Seizures Last?

Most focal-aware seizures are short, usually lasting from a few seconds to two minutes. On the contrary, focal impaired awareness seizures typically last one to two minutes, though their time can fluctuate, being shorter or longer in different people.

Selecting the most effective treatment for focal seizures depends on many considerations, such as seizure type, location in the brain, medication response, and overall health. From new-generation antiepileptic drugs to innovative surgical and neuromodulation treatments, care is more tailored and effective than ever.