Focal awareness seizures or auras?

right frontal lobe focal seizures. similar semiology to you. sEEG in Dec 2024 with ablation (4 months of seizure freedom). scheduled for resection in August 2025.
currently on 150mg Briviact BID, and 400mg Xcopri at night. I was on Keppra for a long time but my dose got to 4000mg XR daily and had horrible mood effects. no mood side effects since switching to Briviact. I have no proof, but I felt like Xcopri made the biggest difference in my seizures. Xcopri was a very slow taper up. I am tired all the time, but used to it after being on medication for so long.

Hi, @arkyjohn, and welcome to Mayo Clinic Connect. Hurray for the 4 months of seizure freedom and that the brivaracetam (Briviact) is helping with the mood effects you experienced on your previous seizure medication. Being tired all the time sounds rough. Glad you are at least getting used to it.

Are you planning on staying on the same medication, arkyjohn, or are you looking to switch to cenobamate (Xcopri) or something else?

I have focal aware seizures in my right temporl lobe. I have tried the following medications: Briviact, Carbamazepine, Lacosamide, Lamotrigine, Keppra, Aptiom, and Clonazepam. I am currently on 250 mg of Xcopri-Cenobamate. I tried to go up to 300 mg, but it made me extremely sleepy, and I didn't feel well. I also take .5mg of Clonazepam if I have several seizures in 1 day.
Has anyone had any success with a medication I haven't tried?

Hi, @lzbthtyler - I moved your post here so that you could chat with others talking about focal awareness seizures, such as @santosha @methel @kelspal @adoptivemother and others.

You mentioned upping your dose of cenobamate (Xcopri) but that it made you extremely sleepy and that you felt unwell. Is the 250 mg of helpful to you at all? When were you originally diagnosed?

Hi,
I was diagnosed in 2016. I feel better on the 250 mg of Xcopri. I usually have my seizures around the last week or 1st week of the month, so I don't know if the increase has helped yet. I'm scheduled to go in the EMU Sept 2nd.

Gabapentin

Hi, @murphymarg59 - welcome to Mayo Clinic Connect. Have you taken gabapentin for focal awareness seizures? If so, how is that going?

I’ve been in it 2 weeks
I am taking 100 mg in the morning. Started out with 100 mg at night. Made me anxious and couldn’t sleep.
Prescribed by my pcp.
So far no seizures. 🙏

I was diagnosed with Focal seizures at 78 years old! I had 5 of them in a year. Then put on Keppra 500 mg twice a day. I have never had another one and my Mayo Clinic Neurologist reduced the am one to 250 mg about 7 months ago. I still sense the Aura once in a while but never have had the 3 minute seizure. I am tired from the medication and going to ask the doctor when I see him next week if I can lower the Keppra at pm to 250mg.

Hi @lzbthtyler
I also have temporal lobe epilepsy, but on the left side of my brain. My seizures are mostly focal - either auras or impaired awareness seizures - though I've also had a few tonic-clonic ones.
I've tried many different medications that either didn't control my seizures or had terrible side effects: Lacosamide, Lamotrigine, Carbamazepine, Gabapentin, Oxcarbazepine, and full CBD. Later, I was diagnosed with mesial sclerosis in my temporal lobe, which is a type of temporal lobe epilepsy that's more resistant to medications - which explained my struggles with finding effective treatment. Surgery was even considered, but unlike you, who has already had LITT surgery, it was ruled out for me since the left side is my dominant brain hemisphere.
Today, I'm on Keppra and have been seizure-free for 7 months - the longest period since my diagnosis in 2019! I'm definitely celebrating that achievement! I started on 500 mg twice daily and experienced some very difficult side effects initially. However, through my doctor's careful dose adjustments and my own patience with the process, my side effects became manageable, and the benefits now far outweigh the drawbacks. Please don't lose hope - finding the right medication and dose can take time, but it's possible!
How long have you been on Xcopri, and how long at each dose (300 mg and 250 mg)?
Your mention of seizures occurring in the first or last week of each month is really interesting. Have you noticed any patterns or changes during those specific times? Many women experience catamenial seizures, which are triggered by hormonal fluctuations during their menstrual cycle.
Chris