Symptoms of Epilepsy

In This Article

Though seizures are the main symptom of all types of epilepsy, the full scope of epilepsy symptoms and signs varies. Common symptoms include muscle jerking and contractions, brief loss of consciousness or awareness, weakness, anxiety, and staring. However, the specific symptoms you have depend on your type of epilepsy. Even though there are many different types of seizures, yours will typically be similar each time they occur.

epilepsy symptoms
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Frequent Symptoms

If you have epilepsy, you may experience a variety of symptoms before, during, or after a seizure. Not everyone has all of these symptoms, and again, 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.

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.
  • 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. However, strokes can sometimes cause seizures, so it's not always possible to know the cause of this symptom right away.
  • 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 (i.e., aura). 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.

Some symptoms, including automatisms and aura, can help identify on which side of the brain the seizures originate and possibly even the type of epilepsy.

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). People tend to have the same automatism over and over, but it may not be present in all of their 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.

People who witness your seizures may have important observations, including what automatisms you may be having. The presence or absence and type of automatisms may help your doctor determine the location and type of your seizures.

Aura

An epileptic aura is a distinct perception—either visual, motor, sensory, or psychological—that you get around the time a seizure occurs. Sometimes, an aura may arise only seconds before the seizure, but it also can come as much as an hour before.

In people with focal epilepsy, auras may be an early warning sign because they often occur less than two minutes before seizures that cause loss of consciousness.

Sometimes, auras occur without any other seizure symptoms. In these cases, the aura is the seizure.

You may experience any of the many different types of auras, 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.

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, stomach upset, or stomach pressure is a fairly common aura with temporal lobe seizures.
  • Motor: Repetitive movements or 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, and the like.

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.

While these are the symptoms most frequently associated with epilepsy, a whole host of symptoms may be due to abnormal neuronal firing in the brain, and some of them are especially difficult to differentiate from behavioral and 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 in terms of symptoms. That is why it's important to note anything you notice before, during, or after a seizure.

Symptoms By Type: Generalized

Generalized seizures involve both sides of your brain. Six different kinds have been defined, and each includes its own set of symptoms.

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.

Symptoms, which last for about 10 seconds, include:

  • Sudden stopping of activity
  • Appearing to blankly stare into space
  • Automatisms like lip smacking, chewing, or eye fluttering

While less common, atypical absence seizures can happen. These seizures:

  • Last longer than 10 seconds
  • Start and stop gradually rather than abruptly
  • Are more likely to cause falling
  • May include automatisms such as blinking, eye fluttering, lip smacking, chewing movements, rubbing fingers together, or other repetitive hand motions

Tonic Seizures

Tonic seizures happen most often during sleep. Symptoms include:

  • Muscles in the arms, legs, and back suddenly stiffening
  • Typical duration of 20 seconds or less
  • Possible loss of consciousness and falling

Atonic Seizures

These seizures are nicknamed "drop seizures" and they're the opposite of tonic seizures. When they occur:

  • Muscles become limp.
  • The entire body or just the head, neck, and trunk may be affected.
  • You may collapse, if standing.
  • There may be some loss of awareness.

Because of the likelihood of falling, the injury risk is high with this type of epilepsy. You may need to wear protective gear for your head.

Myoclonic Seizures 

These can occur one after another in a short period of time or just here and there. These seizures:

  • Cause short jerks of your arms or legs
  • Are typically on both sides of your body
  • Last just a second or two

Clonic Seizures

Clonic seizures are similar to myoclonic seizures, though they can last from a few seconds to a minute. They involve:

  • Repetitive short jerks of your arms or legs
  • Both sides of the body (some cases)

Clonic seizures by themselves are rare and usually occur in infants.

Tonic-Clonic Seizures

These seizures, formerly called grand mal seizures, have a specific course of events. The can last up to three minutes and involve:

  • Loss of consciousness, which usually comes on quite suddenly
  • Tonic phase: muscles in arms, legs, back, and chest become stiff
  • Clonic phase: jerking and twitching muscles

As your body starts to relax and you slowly regain consciousness, you may lose control of your bladder and/or bowels. You may awaken feeling sleepy, confused, irritable, or depressed.

Symptoms By Type: Focal

Focal seizures are the most common type of epileptic seizure. They involve just one area or one side of your brain. They come in two forms.

Focal Aware Seizures

This type of seizure is also commonly referred to as an aura. During a focal aware seizure:

  • You're awake and aware.
  • You may not be able to respond.
  • You may have muscle jerking, stiffening, limpness, or other symptoms.

The duration can be just a few seconds to a couple of minutes.

Focal Impaired Awareness Seizures

This type of seizure involves numerous symptoms, which vary depending on the area of the brain where they occur. Symptoms, which can last a minute or two, may include:

  • Unawareness or loss of consciousness
  • Preceding aura or focal aware seizure (possible)
  • Automatisms including 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; dramatic acts like laughing, crying, screaming, or removing 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

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

    Menstruation

    During puberty, a woman's body makes estrogen and progesterone. Because of this increase in hormones, girls with epilepsy may 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 Use

    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).

    Pregnancy

    The body of every woman with epilepsy responds differently to pregnancy. 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 as controlled as possible. Speak to your doctor if you are or plan to be pregnant, as your medication may need to be adjusted both to curb seizures and protect your baby.

    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 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.

    If you have epilepsy, the risk of your child developing epilepsy increases a small amount, to about 5 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. Use our Doctor Discussion Guide below to help you start that conversation with your doctor.

    Epilepsy Doctor Discussion Guide

    Get our printable guide for your next doctor's appointment to help you ask the right questions.

    Doctor Discussion Guide Man

    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
    • Have a seizure in water
    • Don't wake up after a seizure
    • Have another seizure right away
    • Have a high fever
    • Have diabetes
    • Have injured yourself during a seizure

    Symptoms of epilepsy can disrupt your life, but you have a lot of treatment options that may help reduce the impact or eliminate it entirely. Keep the lines of communication with your doctor open so you can find the treatments that work best for keeping your epilepsy under control.

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    Article Sources

    • KiriakopoulosE, Shafer PO. Types of Seizures. Epilepsy Foundation. Published March 20, 2017. https://www.epilepsy.com/learn/types-seizures
    • 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