What are the key clinical features that differentiate between focal and generalized seizures in adults?

Key clinical features differentiating focal and generalized seizures in adults:

• Focal seizures originate in one hemisphere of the brain and often present with localized symptoms such as unusual movements or behaviors, sensory disturbances, or wandering. They may or may not impair awareness during the event. After the seizure, the person typically recovers fully without confusion if awareness was preserved. Protection from injury involves removing harmful objects and observing until full recovery without giving food or drink during the event.
• Generalized seizures involve both hemispheres of the brain from the onset and commonly present as tonic-clonic seizures characterized by loss of consciousness, stiffening (tonic phase), followed by rhythmic jerking (clonic phase). These seizures usually last less than 5 minutes and require first aid measures such as cushioning the head and protecting from injury. Postictal confusion or drowsiness is common after generalized tonic-clonic seizures.
• Focal seizures may evolve to bilateral tonic-clonic seizures, but the initial focal onset distinguishes them clinically.
• Recognition of seizure type is important for management and prognosis, and detailed witness descriptions are crucial for diagnosis.

These distinctions guide first aid and treatment decisions, including when to arrange emergency admission or specialist review.

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