Signs and Symptoms of Epilepsy

Epilepsy is a seizure disorder that affects 1.2% of all people in the United States. The nerve cells in the brain, called neurons, communicate through 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. This can cause 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 conditions (conditions characterized by the immune system mistakenly attacking healthy cells). Generalized seizures affect both sides of the brain while focal seizures affect one small area. Sensations like strong scents or flashing lights may trigger a seizure. However, a seizure can also occur for no discernible reason. 

The symptoms of a seizure vary depending on the brain regions affected by abnormal electrical signaling. This activity can spread to healthy brain cells, increasing how often seizures occur and how severe they are.  

Prodromal Symptoms

More than 20% of people with epilepsy experience prodromal symptoms, which are symptoms that occur days before the onset of the seizure itself. It can provide a warning about a coming seizure. These symptoms include:

• A “funny feeling”
• Headache
• Confusion
• Anxiety
• Irritability

Symptoms of Generalized Seizures

Epileptic seizures that affect both sides of the brain are called generalized seizures. They often cause a person to lose consciousness and/or fall. Different types of generalized seizures present a specific combination of symptoms. These include (listed from most common to least common):

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

It is possible for the seizure to begin as a partial, or focal, seizure, affecting only part of the body. Then they may progress to a generalized seizure, affecting the whole body.

Symptoms of Focal Seizures

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

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

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

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

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

Post-Seizure (Poctictal) Symptoms

For several hours after a seizure ends, many people experience post-seizure, or postictal, symptoms. This is the result of the brain’s electrical activity returning to normal. These symptoms can last anywhere from a few minutes to days. They include:

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

Symptoms in Children

Epilepsy is the most common childhood neurological disorder, affecting 0.6% of children in the US. The onset of epilepsy usually occurs after age 5. Epilepsy in children may also result in learning difficulties in school. Like generalized seizures, the 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: Like tonic-clonic seizures in adults, these affect the entire body, including 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 See a Healthcare Provider

You should call 911 or contact an emergency provider if:

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