Symptomatic focal epilepsies

Symptomatic focal epilepsies account for about 40% of all epilepsies in children, and are defined according to seizure semiology pointing to a lobar location. However, the epileptogenic area itself can be associated with  multilobar networks. Seizures might include a single symptom or have complex symptomatology. The temporal sequence of events is related to the origin and propagation of the discharge. The very first manifestation of a seizure localises its onset. Alteration of consciousness has classically been considered the hallmark of complex partial seizures, with respect to simple partial seizures in which awareness is preserved. However, alteration of consciousness indicates extensive seizure spread but no origin or distribution. Postictal sleepness is frequent in children and has a major relevance for differential diagnosis. Scalp EEG can be misleading.
Attributing seizure origin to a specific area is difficult when neuroimaging is normal, unless a highly characteristic clustering of symptoms occurs.