Symptoms of Epilepsy

Though seizures are the main symptom of all types of epilepsy, the full scope of one's epilepsy symptoms and signs can vary. Common symptoms of seizures include muscle jerking and contractions, loss of consciousness or awareness, weakness, anxiety, and staring, but the specific symptoms you have depend on your type of epilepsy. For instance, one type of seizure may cause a brief loss of consciousness, whereas another type may cause uncontrollable jerking of the entire body. Even though there are many different types of seizures, if you have epilepsy, your seizures will typically be similar each time they occur.

epilepsy symptoms
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Frequent Symptoms

There are a variety of symptoms you may have if you have epilepsy, and these may occur either before, during, or after a seizure. Not everyone has all of these symptoms, and the ones that you experience will depend on the type of seizures you're having.

While understanding the symptoms of your seizures is important, most people suffering from epilepsy don't remember their seizures or what was happening before they occurred. In this case, it's important to ask anyone who has seen one of your seizures how it presented and what was going on at the time. If you're comfortable doing so, you may also consider inviting that person to speak with your doctor directly.

The most common symptoms include:

  • Contraction and jerking of muscles: When people think of seizures, they usually think of the type in which multiple muscles in the body contract and jerk. However, involuntary muscle contractions can also occur in isolated areas of your body.
  • Loss of consciousness: Some seizures may cause a loss of consciousness or awareness that occurs suddenly and can last for a few seconds to hours. With some seizure types, this may be the only sign of a seizure that's visible to others. This may be associated with automatisms—purposeless and repetitive movements done without thought (see below).
  • Weakness: Weakness can occur in any area of your body. For instance, you may have weakness in one arm, one leg, or both. Usually, you will have weakness in the same part of the body with recurrent seizures. Weakness in one part of the body may look very much like a stroke, but it resolves when the seizure is over. This can be even more confusing since strokes can sometimes cause seizures.
  • Anxiety: Before a seizure, often a focal seizure, some people feel anxious. This can be its own symptom and/or a signal that a seizure is about to occur (see "Auras" below). Some people experience intense anxiety, fear, or a sense of impending doom.
  • Staring: Staring into space is a symptom when you have absence seizures. You may appear to be briefly daydreaming or lost in thought when, in fact, you're actually experiencing a seizure.

Automatisms

The type of automatism and the nature of it—whether it's complex or so simple that it may be missed—is highly variable. In epilepsy, automatisms may occur in focal impaired awareness seizures, as well as absence seizures (atypical ones, in particular). If you have an automatism, it tends to be the same for each seizure but isn't necessarily present in all of your seizures.

Some automatisms are more likely in certain types of seizures. For example, pelvic thrusting and bilateral leg automatisms, like pedaling or bicycling movements, are more common in frontal lobe epilepsy than temporal lobe epilepsy. Automatisms of the mouth and hands, on the other hand, are more common in temporal lobe epilepsy.

Automatisms can also provide clues for determining whether a seizure is occurring on the right or left side of your brain. For instance, automatisms that occur on one side of your body typically indicate that the seizure began on that same side of your brain.

Be sure to talk to your doctor about any automatisms you may be having (you will need an eyewitness to help you with this), since the presence or absence and type of automatisms may help determine the focus (location) and type of your seizures.

Aura

An epileptic aura is a distinct perception, either visual, motor, sensory, or psychological, that you feel around the time a seizure occurs. Although an aura may signal a seizure only seconds before it occurs, an aura and a seizure may be separated by as much as an hour.

Since auras often occur prior to a seizure in which you lose consciousness, they may be considered a form of a warning sign that a seizure is about to occur. They're most common when you have focal epilepsy and usually last for less than two minutes.

The type of aura you have can give clues as to the region of your brain in which your seizure begins. Sometimes auras occur alone and don't proceed on to anything more. In these cases, the aura was the seizure.

There are many different types of auras that you may experience either alone or before a seizure. These can be broken down into sensory auras, in which only a sensation is present, and experiential auras, which are more complex.

Auras vary considerably from person to person but are usually about the same from seizure to seizure. Some auras are easy for people to describe, such as seeing zig-zag lines, while others are much more difficult to explain, such as a feeling of being separated from your body.

Types of auras include:

  • Vision (visual): Visual auras can be simple, such as seeing bright flashes of light, dark spots, or tunnel vision, or they can be complex or experiential, such as blindness, visual hallucinations, illusions, and distorted scenery like macropsia, where everything surrounding you seems larger than normal.
  • Smell (olfactory): Certain smells, often unpleasant, may be experienced with an aura.
  • Hearing (auditory): Like visual auras, hearing auras can be simple, such as hearing a ringing or buzzing, or complex (experiential), like hearing distorted sounds or voices speaking.
  • Somatosensory: These auras involve sensation and can be quite varied, including tingling sensations, a feeling of moving even while you're sitting still, or a need to move.
  • Taste (gustatory): Abnormal tastes (e.g. metallic) or those that are present without eating food may occur.
  • Abdominal: Nausea or a feeling of stomach pressure or upset is a fairly common aura with temporal lobe seizures.
  • Motor: Repetitive movements of a limb or weakness may occur.
  • Autonomic: Auras involving cold shivers and goosebumps, for example, may occur.
  • Psychic: These auras can be very dramatic and may include a sudden sense of fear, a sense of impending doom, déjà vu experiences (the feeling that what's currently happening has happened in the past), and the like.

While these are the symptoms most frequently associated with epilepsy, there are a whole host of symptoms that may be due to abnormal neuronal firing in the brain, and some of them are especially difficult to differentiate from behavioral and other mental health disorders. From unusual thoughts to hearing and seeing things that aren't present to symptoms of repeated flatulence and vomiting (abdominal epilepsy), the sky is virtually the limit. That is why it's important to keep note of any symptoms noticed before, during, or after a seizure.

By Type

As noted earlier, the symptoms you experience depend on the type of seizures you have. Here are some of the common symptoms you may experience classified by type.

Generalized Seizures

Generalized seizures involve both sides of your brain. The symptoms associated with the six different kinds of generalized seizures include:

  • Absence seizures: Previously called petit mal seizures, absence seizures may not always be recognized as seizures at first and they're most common in children. When these seizures occur, you suddenly stop whatever you're doing and it may look like you're blankly staring into space. Absence seizures are sometimes accompanied by automatisms like lip smacking, chewing, or eye fluttering and usually last for about 10 seconds. When an absence seizure stops and starts gradually rather than suddenly and lasts longer than 10 seconds, it may be considered an atypical absence seizure. These seizures are more likely to result in falling. Automatisms that occur with atypical absence seizures can look like blinking or eyelid fluttering, lip smacking, chewing movements, rubbing your fingers together, or making other repetitive motions with your hands.
  • Tonic seizures: In tonic seizures, your muscles suddenly stiffen, usually in your arms, legs, and back, which can result in falling down if you're standing up when they occur. These seizures often happen while you're sleeping, typically last under 20 seconds, and usually result in a loss of consciousness if you're awake.
  • Atonic seizures: These seizures are the opposite of tonic seizures; when they occur, your muscles become limp, which can affect your whole body or just your head, neck, and trunk. If you're standing up while this happens, you'll collapse, which is why these seizures are nicknamed "drop seizures." The risk of injury is high because of the likelihood of falling, so protective gear may be needed for your head. Generally, you aren't fully aware during these seizures.
  • Myoclonic seizures: These seizures are sudden, short jerks of your arms or legs, typically on both sides of your body and lasting just a second or two. These can occur one after another in a short period of time or just here and there.
  • Clonic seizures: These seizures are just like myoclonic seizures except that the jerks are repetitive. They can involve the whole body or both sides and can last anywhere from a few seconds to a minute. Clonic seizures by themselves are rare and usually occur in infants.
  • Tonic-clonic seizures: These seizures, formerly called grand mal seizures, begin with loss of consciousness, which usually comes on quite suddenly. Next is the tonic phase, in which the muscles in your arms, legs, back, and chest become stiff, followed by the clonic phase, which involves the jerking and twitching of your muscles. The entire seizure can last for up to three minutes. As your body starts to relax, you may lose control of your bladder and/or your bowels as you begin to slowly regain consciousness. You may feel sleepy, confused, irritable, or depressed when you wake up.

    Focal Seizures

    Focal seizures are the most common type of seizures in epilepsy. They involve just one area or side of your brain. The symptoms associated with the two types of focal seizures include:

    • Focal aware seizures: This type of seizure is also commonly referred to as an aura. As the name indicates, you're awake and aware while these seizures are occurring, though you may not always be able to respond. They can involve muscle jerking, stiffening, limpness, or other symptoms and last from seconds up to a couple of minutes.
    • Focal impaired awareness seizures: During these seizures, you are either unaware or unconscious. These seizures are sometimes preceded by an aura or focal aware seizure, and usually, last for one or two minutes. The characteristics of a focal impaired awareness seizure, including the type of automatism, depend on the area of the brain where the abnormal electrical activity is occurring. Examples of automatisms that may occur in focal impaired awareness seizures are repetitive tapping, rapid blinking, repeating words or phrases, grunting, repetitive hand movements, picking or fumbling at clothes or objects, lip smacking, chewing, mumbling, swallowing, complex acts like shuffling cards, and dramatic acts like laughing, crying, screaming, or removing your clothes.

      Complications/Sub-Group Indications

      There are potential complications of seizures depending on when and where you have them. These can include:

      • Drowning: The risk of drowning while swimming or taking a bath is 15 to 19 times higher when you have epilepsy because of the potential of having a seizure while in the water. This risk goes down the longer you go between seizures.
      • Falls: Having a seizure can result in hitting your head, breaking a bone, or otherwise injuring yourself from falling.
      • Car accidents: Having a seizure while driving can cause a car accident, which is why many states have driving restrictions and time requirements related to how long you've been seizure-free. As with the risk of drowning, your risk of having a seizure while driving decreases as the amount of time between seizures increases.
      • Emotional issues: Anxiety, depression, and suicidal thoughts and behaviors are common in people with epilepsy. An estimated one out of every three people who have epilepsy will develop clinical depression at some point in their lives, which is often accompanied by an anxiety disorder. Treatment for these issues, however, can help.

        Life-threatening complications of epilepsy don't happen often, but include:

        • Status epilepticus: This is when you have a seizure that lasts for more than five minutes or you repeatedly have seizures without completely waking up in between. This condition can result in brain damage or death.
        • Sudden, unexpected death: This occurs in around 1 percent of people with epilepsy and no one knows the exact cause. You may be at higher risk of sudden unexpected death if your seizures aren't controlled by medications or you have frequent tonic-clonic seizures.

        Women With Epilepsy

        For women with epilepsy, there are some special considerations concerning menstruation, contraception, and pregnancy, since hormonal fluctuations can affect seizure activity. Specifically, physicians believe estrogen may heighten seizure activity, while progesterone seems to have the opposite effect.

        Menstruation: During puberty, the reproductive system matures and a woman's body makes estrogen and progesterone, which trigger the onset of menstruation along with breast development. Due to this increase in hormones, girls with epilepsy may also see an increase in the frequency of their seizures at this point in their development.

        Some women may also experience an increase in the frequency of their seizures around their menstrual period. Known as catamenial epilepsy, seizures occurring around a woman’s menstrual cycle may need additional management. Doctors believe that the effects of estrogen and progesterone on the brain lead to this increase in seizure frequency.

        Contraception: There are a variety of contraceptives available if you're a woman with epilepsy who wants to avoid pregnancy, but you'll need to take precautions, especially with oral contraceptives. Some epilepsy medications may counteract the effects of contraceptive pills, meaning you could get pregnant even if you're taking them. Conversely, oral contraceptive pills may decrease the effectiveness of your anti-seizure medication, which can cause breakthrough seizures. This is particularly true with Lamictal (lamotrigine). Talk to your doctor about your options.

        Pregnancy: Every woman with epilepsy's body responds to pregnancy differently. Most women have the same number of seizures during pregnancy as they did before, though some may have fewer or more. Seizures during pregnancy are dangerous for your baby and can lead to miscarriage, preterm labor, and premature birth, so it's important to keep them under as much control as possible. If you do have a seizure while you're pregnant, tell your doctor right away. You may need to have your medication adjusted.

        The anti-seizure medications you take may also affect your baby, so work with your doctor to find the safest medication and dosage to keep your seizures managed. It's best if you can do this before you get pregnant, but if you find out you're already pregnant, see your doctor as soon as possible. If you have been on medication for some time and haven't had any seizures, you may be able to taper off before you get pregnant, but don't ever discontinue your medication without your doctor's approval and supervision. Remember that uncontrolled seizures are far more harmful to your baby than any medication.

        Your doctor may also recommend that you take a high dose of folic acid, which helps prevent fetal brain and spinal cord abnormalities, several months before you plan to get pregnant since some anti-seizure medications can affect how your body metabolizes this vitamin.

        Seizures don't usually occur during labor, so you should be able to deliver your baby normally and without complications. If you do have a seizure while you're in labor, your doctor may try to stop it with an intravenous medication. For women who have frequent seizures during pregnancy, especially in the last trimester, a C-section may be recommended, but your doctor will go over the safest delivery methods for you.

        If you want to breastfeed your baby, talk to your doctor. Breastfeeding shouldn't be a problem, but your doctor may want to switch your medication or have you take it at a different time than you normally do.

        In general, the risk of a child developing epilepsy at some time in life is about 1 percent. If you have epilepsy, the risk of your child developing epilepsy increases a small amount to about 5 percent. If your epilepsy has a genetic or inherited component, the risk is higher. You can talk to a genetic counselor if you're worried about passing epilepsy on to your child.

        When to See a Doctor

        Experiencing a seizure for the first time means you need to see your doctor, even if you're not sure it was a seizure. He or she will need to determine the cause and rule out any underlying medical conditions, as well as potentially start you on anti-seizure medication.

        If you've already been diagnosed with epilepsy, you should see your doctor any time you have a change in your seizure patterns, frequency, or activity. The goal of treatment is to get your seizures under control with the least amount of medication possible, so you may need a dosage adjustment, another medication added on, a switch to another kind, or a different kind of treatment altogether.

        If you experience status epilepticus, you need emergency help, as it can be life-threatening. You also need emergency help if you have a seizure and you're pregnant; you have a seizure in water; you don't wake up after a seizure; you have another seizure right away; you have a high fever; you have diabetes or you've injured yourself during a seizure.

        Epilepsy: Causes and Risk Factors
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        Article Sources
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        • Mayo Clinic Staff. Epilepsy. Mayo Clinic. Updated March 10, 2018. https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093
        • Mayo Clinic Staff. Epilepsy and Pregnancy: What You Need to Know. Mayo Clinic. Updated July 13, 2017. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy/art-20048417
        • National Institute of Neurological Disorders and Stroke. The Epilepsies and Seizures: Hope Through Research: Pregnancy and Motherhood. NationalInstitutes of Health. Updated December 6, 2017. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Epilepsies-and-Seizures-Hope-Through#3109_38