Snapshot An 8-year-old boy is brought to a neurologist because of episodes of impaired consciousness associated with repetitive, stereotyped arm movements. Introduction A complex (LOC), focal (discrete foci in one hemisphere) seizure. Often involve the temporal lobe. Presentation (70-80%) and are characterized by: impaired level of consciousness visual or auditory hallucinations automatism postictal confusion Evaluation EEG is most important test in the seizure workup. Rule out systemic causes through extensive workup including 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 lamotrigine gabapentin