Ictal memory and its clinical correlates in focal epilepsy.

OBJECTIVE: Altered consciousness during focal seizures adversely affects patients' quality of life, yet patients' memory of ictal events remains underexplored. METHODS: We prospectively assessed 114 focal seizures from 48 patients undergoing video-EEG monitoring between 2018 and 2024. Consciousness and ictal memory were evaluated using the Consciousness Seizure Scale, Ictal Consciousness Inventory, and Seizure Perception Survey. Clinical and electrographic variables, including epileptogenic zone, lateralization, and sleep-wake state, were analyzed. RESULTS: Ictal memory was preserved in 52.5% of seizures, with 70% of these occurring despite impaired consciousness. Aura recall strongly correlated with preserved ictal memory (p = 0.0001). Seizures originating from the left frontal lobe and during wakefulness were associated with memory preservation, whereas seizures in temporal lobe epilepsy (TLE) and sleep-related seizures were linked to ictal amnesia. CONCLUSIONS: Assessment of ictal memory provides valuable clinical insights beyond responsiveness measures and may improve patient confidence and seizure characterization in focal epilepsy.