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Focal Seizure with Impaired Awareness — RACP Adult Medicine MCQ

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EasyNeurologyFocal Seizure with Impaired AwarenessRACP Adult Medicine

A 30-year-old woman presents with a 6-month history of recurrent stereotyped episodes of an ascending epigastric sensation followed by lip-smacking and loss of awareness lasting 60–90 seconds. Witnesses report she appears confused for several minutes afterwards. EEG shows left temporal sharp waves. What type of seizure is this?

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Correct answer: C — Focal seizure with impaired awareness (previously complex partial seizure)

Stereotyped episodes with an aura (ascending epigastric sensation – mesial temporal origin), automatisms (lip-smacking), impaired awareness, and post-ictal confusion lasting minutes are characteristic of focal seizures with impaired awareness (previously termed complex partial seizures) originating from the temporal lobe. Left temporal sharp waves on EEG confirm the epileptiform focus. First-line AED options include lamotrigine, levetiracetam, or carbamazepine. Mesial temporal sclerosis should be sought on MRI.

Reference: eTG – 2025 – Neurology; ILAE – 2017 – Seizure Classification