Understanding Focal Seizures
Focal Seizures with Impaired Consciousness
These seizures involve networks within one side of the brain and impair consciousness during some or all of the event. The person may look awake while being unable to respond normally or remember what happened.
Recognizing the older names
This page was previously called Focal Dyscognitive Seizures. Other names include “focal impaired awareness seizures,” “complex partial seizures” and “psychomotor seizures.”
ILAE’s 2025 classification uses consciousness, assessed through awareness and responsiveness. Impairment does not always mean the person falls down or becomes completely unresponsive.
About this information: This webpage is subject to continuous review by Epilepsy Ontario to help keep the information current. This material is for informational purposes only and should not be used for self-diagnosis or as a substitute for professional medical advice, diagnosis or treatment. Consult your healthcare provider about your own health and care.
Recognizing the Event
What Can Happen During the Seizure?
The features vary with the brain networks involved. Some people have similar events each time, but a symptom list cannot establish the diagnosis.
A pause or altered response
The person may stop an activity, stare, appear dazed or respond differently to questions. Their eyes may remain open.
Automatic movements
Repeated movements, called automatisms, may include chewing, lip-smacking, rubbing the hands or picking at clothing.
Walking or other behaviour
The person may move around, make sounds or continue an activity without fully understanding what is happening.
Incomplete memory
They may not remember some or all of the event. A witness’s description can therefore be useful during assessment.
Respond with calm and respect.
Seizure-related behaviour is involuntary. Do not assume the person is deliberately ignoring you or refusing to cooperate. Protect their safety and privacy.
Can it start with an aura?
Yes. Some seizures begin while consciousness is preserved and then develop to impair consciousness. The initial experience may be described as an aura.
Can it become convulsive?
Yes. Some focal seizures spread to involve both sides of the brain and develop into a focal-to-bilateral tonic-clonic seizure.
Follow the person’s action plan and the first aid guidance if the seizure changes.
Duration & Recovery
The seizure may last up to several minutes. Confusion, tiredness or memory difficulties can continue afterward, and recovery varies.
Time the active seizure and observe recovery separately. Do not assume prolonged confusion is harmless or wait for a routine appointment if emergency signs are present.
First Aid
How Can You Help?
Stay and protect.
- Stay calm and time the event.
- Move nearby hazards away.
- Gently guide the person away from traffic, stairs, water or heat.
- Speak simply and reassuringly.
- Give them space and protect their privacy.
Avoid restraint and rushing.
- Do not hold the person down or force their movements.
- Do not put objects or fingers in their mouth.
- Do not give food, drink or pills to swallow until fully alert and able to swallow safely.
- Stay through recovery and check for injury.
- Follow their seizure action plan.
When to Get Emergency Help
Call 911 for a first known seizure, a seizure lasting more than five minutes, repeated seizures without recovery, breathing difficulty or another emergency sign.
Get help for difficulty waking up or failure to return toward the person’s usual state. Read the full first aid page for additional emergency circumstances.
Use prescribed rescue medication or a VNS magnet only as instructed and trained. Do not delay emergency help while waiting for it to work.
Assessment & Treatment
Other conditions can resemble these events. Diagnosis requires clinical assessment; a normal EEG between episodes does not rule out epilepsy.
Describe the sequence, movements, responsiveness, duration and recovery to your healthcare provider. Treatment depends on the individual. Ask about specialist review if seizures continue or concerns remain.
Further reading:
ILAE: Seizure Classification (2025) ·
Epilepsy Foundation: Focal Impaired Consciousness Seizures.
