From the Guidelines
Neither focal seizures nor epilepsy itself is inherently more life-threatening than the other, as epilepsy is actually a condition characterized by recurrent seizures, which can be focal or generalized. However, certain seizure types can pose greater immediate risks. Focal seizures that remain localized to one area of the brain are generally less dangerous than those that progress to bilateral tonic-clonic seizures (formerly called grand mal seizures) 1. The most life-threatening seizure-related condition is status epilepticus, a prolonged seizure or series of seizures without recovery between them, which can occur with either focal or generalized seizures. This is a medical emergency requiring immediate treatment, typically with benzodiazepines like lorazepam (2-4 mg IV) or diazepam (5-10 mg IV), followed by anti-seizure medications such as fosphenytoin, valproate, or levetiracetam if seizures continue.
According to the most recent study 1, people with epilepsy also face risks from Sudden Unexpected Death in Epilepsy (SUDEP), which occurs more frequently in those with poorly controlled generalized tonic-clonic seizures. The best protection against life-threatening complications is proper seizure control through consistent medication adherence, regular neurologist follow-ups, and lifestyle management including adequate sleep and stress reduction. It's worth noting that approximately 30% of patients with epilepsy do not respond to two anti-seizure medications and are considered drug-resistant, with focal epilepsies being more likely to be drug-resistant 1. In such cases, epilepsy surgery may be a promising option, with approximately 65% of patients becoming seizure-free 1.
Key points to consider in managing epilepsy and reducing the risk of life-threatening complications include:
- Proper seizure control through consistent medication adherence
- Regular neurologist follow-ups
- Lifestyle management including adequate sleep and stress reduction
- Consideration of epilepsy surgery for drug-resistant cases
- Use of functional imaging tools such as PET or SPECT to localize the seizure onset for a tailored resection preserving motor, visual, language, or temporal lobe functions 1.
From the Research
Comparison of Focal Seizures and Epileptic Seizures
- Focal seizures are defined as seizures that originate within networks limited to one hemisphere, and are primarily subdivided into focal aware, focal impaired awareness, and focal to bilateral tonic-clonic seizures 2.
- Epileptic seizures, on the other hand, can be generalized or focal, and can have various etiologies, including genetic, structural, or metabolic causes 3, 2.
- In terms of life-threatening potential, both focal seizures and epileptic seizures can be dangerous, but the risk depends on various factors, such as the frequency and severity of seizures, the presence of underlying medical conditions, and the effectiveness of treatment 4.
Burden of Focal Seizures
- Focal seizures affect up to 61% of people with epilepsy, and are associated with an increased risk of injury and premature death compared to the general population 4.
- People with focal seizures also have high comorbidity, particularly depression, anxiety, and cognitive impairments, which can reduce quality of life (QoL) 4.
- The economic burden of focal seizures is also significant, with high individual costs, hospitalizations, and antiseizure medications (ASMs) being the leading cost drivers of inpatient management and indirect costs 4.
Treatment and Management
- The treatment and management of focal seizures and epileptic seizures depend on the underlying cause, severity, and frequency of seizures, as well as the presence of underlying medical conditions 5, 3, 2.
- Antiepileptic drugs (AEDs) are commonly used to treat both focal seizures and epileptic seizures, but the effectiveness of AEDs can vary depending on the individual and the type of seizure 3.
- In some cases, surgical intervention may be necessary to remove the epileptogenic zone and prevent further seizures 2.
- New treatments, such as targeted subcortical stimulation, are being investigated to enhance safety and psychosocial function for patients with focal seizures 6.