Focal seizures in children

A 13-year-old right-handed boy has been healthy until 1 year ago when he developed the onset of recurrent "spells". He comes for an evaluation with his parents who report that the spells have all looked the same when witnessed. He will initially feel a warning of a sudden "funny feeling" and have difficulty understanding what is being said. He is then seen to stare, be unresponsive to questioning, exhibit a behavioral arrest, and develop heavy breathing. The entire event lasts for less than a minute and afterwards his speech is altered. His parents notice that while his words are easily understood, there are prominent word substitutions and new words that do not make sense. He had a normal birth, labor, and delivery without perinatal complications, and his development was normal. There were no risk factors for epilepsy, including febrile seizures, meningitis or encephalitis, or head trauma. Additionally, there was no family history of seizures. Over the last year there has been a mild decline in his grades reflected by a slow deterioration in his test scores. His neurological examination was normal. A brain MRI was without abnormality. An EEG was obtained and demonstrated the following (see Fig. 8.1):