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Focal emotional seizures are characterized by alterations in mood or emotion, or the appearance of altered emotion without the subjective emotion, at seizure onset. These emotional seizures may occur with or without objective clinical signs of a seizure evident to the observer. Focal emotional seizures can be further described using the following descriptors:

  • Focal emotional seizure with fear/anxiety/panic - characterized by the presence of fear, worry, anxiety or panic as an expressed or observed emotion, at the outset of the seizure. Because of the unpleasant nature of these seizures, patients may also have anticipatory anxiety about having seizures. These seizures arise in mesial temporal networks, especially the amygdala. They can be distinguished from panic attacks, by the presence of impaired awareness, automatisms and other features of an epileptic seizure appearing in a stereotyped manner. They are also distinguished from a focal autonomic seizure with epigastric sensation, where the onset seizure feature is an autonomic epigastric sensation, and fear may be present as a secondary feature.
  • Focal emotional seizure with laughing (gelastic) - bursts of laughter or giggling, usually without appropriate related emotion of happiness, and described as 'mirthless'. This seizure type is characteristic of seizures arising in the hypothalamus (see hypothalamic hamartoma), but can occur in seizures arising in the frontal or temporal lobes.
  • Focal emotional seizure with crying (dacrystic) - characterized by the presence of stereotyped crying, this may be accompanied by lacrimation, sad facial expression and sobbing. The subjective emotion of sadness may or may not be present. These seizures often accompany focal emotional seizures with laughing in the setting of a hypothalamic hamartoma. They can also occur in seizures arising in frontal or temporal lobes. Crying is a rare feature of an epileptic seizure, and is more commonly a feature of a non-epileptic seizure.
  • Focal emotional seizure with pleasure - characterized by the presence of a positive emotional experience with pleasure, bliss, joy, enhanced personal well-being, heightened self-awareness or ecstasy. This is a rare seizure type, seen in seizures arising in the anterior insular cortex.
  • Focal emotional seizure with anger - characterized by the presence of anger, which may be accompanied by aggressive behaviour. This is a rare seizure type, anger and aggression, if present, are mostly seen in the post-ictal period. This seizure type localizes to prefrontal or mesial temporal regions of the brain. Focal emotional seizures with anger are distinguished from tantrums and rage reactions by the absence of organized, purposeful goal-directed aggressive behaviour, by their stereotyped evolution during each event, and by the presence of other epileptic seizure features as the seizure evolves.

NOTE If the focal seizure is not characterized by this feature at the very outset of the seizure, it is not used to classify the seizure, it is instead used as a seizure descriptor, after the seizure is classified according to its onset feature.

NOTE Focal emotional seizures are one type of epileptic 'aura'. An 'aura' is an subjective experience (which may be sensory, emotional, autonomic or cognitive) felt by the individual having a seizure. The 'aura' reflects the initial seizure discharge in the brain. It may be an isolated phenomenon or progress to a focal motor seizure, to a focal impaired awareness seizure or to a focal to bilateral tonic-clonic seizure. An aura is also known as a "warning".

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