Snapshot An 8-year-old girl is brought in by her parents after they noted her to have repeated episodes of uncontrolled arm "twitching." She does not lose consciousness during these episodes. Introduction Arise from a discrete regions in one cerebral hemisphere. Presentation Do not lead to a loss of conscious. Involve motor, sensory or autonomic without any alternation in conciousness. Postictally there may be focal neurologic deficits including Todd's paralysis. Todd's paralysis is hemiparalysis that lasts minutes to hours but resolves within 24 hours. Evaluation EEG is most important test in the seizure workup. Rule out alternative causes of seizure through extensive workup including metabolic panel, EEG, CT or MRI Treatment Treat underlying cause electrolytes, infection, toxic ingestion, trauma, azotemia, hypoxia, hypoglycemia, stroke/bleed. Medications for focal seizures include phenytoin phenobarbital valproate lamostrigine gabapentin