Signs and Symptoms of Epilepsy

Epilepsy symptoms vary depending on the brain regions affected by abnormal electrical signaling. A tonic-clonic, or grand mal, seizure affects both sides of the brain and can cause a loss of consciousness and jerking movements.

Epilepsy is a seizure disorder that affects 1.2% of all people in the United States. The nerve cells in the brain (neurons) communicate t rough electrical signals to share information throughout the brain and the rest of the nervous system. A seizure is a burst of abnormal electrical activity in neurons. Symptoms can include jerking movements, unusual sensations, and a loss of consciousness. People with epilepsy experience recurring seizures.

There are many potential causes of epilepsy. These include damage to the brain due to stroke or physical trauma, infection, genetic mutations, and autoimmune disorders. These conditions cause the immune system to mistakenly attack healthy cells.  

Prodromal Symptoms

More than 20% of people with epilepsy experience prodromal symptoms. These symptoms occur days before the onset of the seizure itself. Prodromal symptoms can provide a warning about a coming seizure.

These symptoms include:

• A "funny feeling"
• Anxiety
• Confusion
• Headache
• Irritability
  

Generalized Seizure Symptoms

Epileptic seizures that affect both sides of the brain are called generalized seizures. These seizures often cause a person to lose consciousness or fall.

Different types of generalized seizures present a specific combination of symptoms, including:

• Absence seizures: Staring into space, sometimes with muscle twitching, for usually less than 10 seconds
• Atonic seizures: Loss of muscle tone leading to falling (drop attack)
• Clonic seizures: Repetitive jerking movements on one or both sides of the body, often accompanied by loss of consciousness
• Myoclonic seizures: Twitching movements of the upper body, arms, or legs that usually occur for a very short period of time (i.e., shorter than one second)
• Tonic-clonic (grand-mal) seizures: Body stiffening, repeated jerking of arms and legs, loss of consciousness
• Tonic seizures: Muscles stiffening in the back, legs, and arms for usually less than 20 seconds

The seizure can possibly begin as a partial (focal) seizure, affecting only part of the body. The seizure may progress to a generalized seizure, affecting the whole body.

Focal Seizure Symptoms

About 60% of people with epilepsy have focal seizures. These seizures affect only one specific part of the brain. The length of focal seizures can vary, lasting as long as a few minutes. Symptoms depend on their location.

Symptoms in the frontal lobe or medial temporal lobe of the brain include:

• A feeling of intense dejà vu
• A smell, taste, or feeling that isn't real (e.g., the smell of burnt toast when there is no toast nearby)
• Auditory or visual hallucinations
• Movements in one particular part of the body
• Repetitive behaviors like blinks, twitching, or mouth movements
• Unexplained feelings of joy, anger, sadness, or nausea
• Zoning out of consciousness into a dreamlike state

Focal seizures in the occipital lobe or parietal lobe of the brain are much more rare. Symptoms include:

• Cognitive difficulties (e.g., difficulty understanding language, reading, or writing)
• Experiencing rapid eye movements that are difficult or impossible to control
• Experiencing visual changes on one side of your visual field
• Feeling like a body part is missing or has changed in size
• Feeling like your body is floating
• Feeling numbness, tingling, prickling, or burning
• Repeated blinking
• Seeing "flashing" lights
• Seeing specific images (e.g., those of people, animals, or scenes)
• Unusual sexual sensations

Post-Seizure (Poctictal) Symptoms

Many people experience post-seizure (postictal) symptoms for several hours after a seizure ends. This is the result of the brain's electrical activity returning to normal.

These symptoms can last anywhere from a few minutes to days and include:

• Atypical mood for the affected person
• Motor weakness on one side of the body
• Psychosis or mania
• Repeated coughing, salivating, or nose-wiping
• Speech, motor, or memory problems, which can affect whether the person who had a seizure remembers having it at all

Symptoms in Children

Epilepsy is the most common childhood neurological disorder, affecting 0.6% of children in the United States. The onset of epilepsy usually occurs after age 5. Epilepsy in children may also result in learning difficulties in school.

Symptoms are usually aligned with a specific type:

• Absence (petit mal) seizure: Often characterized as simply staring spells, which can make them difficult to detect
• Generalized tonic-clonic (grand mal) seizure: Affects the entire body and includes aura, muscle rigidity, and loss of consciousness
• Partial (focal) seizure: Can involve any of the symptoms described above, varying based on what area of the brain is affected
  

When To Contact a Healthcare Provider

Call 911 and get medical attention if:

• A second seizure starts after the first one ends
• The person does not have a medical alert bracelet with further instructions
• The person has diabetes
• The person is injured during the seizure
• The person is pregnant
• The person is unconscious or behaving strangely after their seizure
• The seizure is different from the person's usual seizures
• The seizure lasts longer than five minutes
• The seizure occurs in water
• This is the first time someone is having a seizure

A Quick Review

Epilepsy is a neurological disorder involving multiple seizures. Epilepsy symptoms depend on the brain regions involved and the type of seizure. A tonic-clonic, or grand mal, seizure can cause stiffening, a loss of consciousness, and jerking movements. This type of seizure affects both sides of the brain.

It's important to get immediate medical attention if a person becomes unconscious, injured, or has a seizure that lasts longer than five minutes.