Symptoms of epilepsy
Since epilepsy is a spectrum of neurological disorders and seizures that can affect any region of the brain, symptoms vary widely depending on the type of seizure. Most people will experience the same type of seizure each time, so symptoms should be similar from one seizure to the next. However, it is possible for a person to have multiple seizure types.
There are many different kinds of seizures, but they can be classified into three main types:
These seizure types describe where in the brain the seizure starts, the level of awareness during the seizure, and whether or not the seizure involves movement. The wording in this article is based on a new classification system developed in 2017 by the International League Against Epilepsy. You may also encounter older classification systems.
Generalized onset seizures
Generalized onset seizures affect both sides of the brain – or the same groups of cells on both sides of the brain – at the same time, leading to a loss of consciousness and postictal (after the seizure) fatigue.
Generalized tonic-clonic (GTC) seizures were previously known as grand mal seizures. There are five distinct phases to this type of seizure, though not everyone will experience all five. During the tonic phase, the body, arms, and legs will flex, then straighten, then shake. In the clonic period, contraction and relaxation of the muscles follow. The seizure ends with the postictal period, during which fatigue, vision and speech problems, and head and body aches are common. GTC seizures may be proceeded by an aura, which is sometimes actually a focal onset aware seizure (see below). Tonic-clonic seizures may also cause vomiting and loss of bladder control.
Absence seizures, formerly referred to as petit mal, typically last less than 30 seconds. Absence seizures cause a short period of staring and altered consciousness. Most likely, the person will remain standing or sitting upright. The eyes may blink rapidly, or the face or mouth may twitch. After the seizure, they may not remember what just happened. Absence seizures may happen multiple times a day.
Atonic or akinetic seizures, also called drop attacks, cause a sudden loss of muscle tone. A person may suddenly drop their head or fall from a standing position. During the seizure, the body will be limp and unresponsive.
Myoclonic seizures often occur in clusters. Myoclonic seizures cause quick movements or the sudden jerking of muscles. Myoclonic seizures may happen multiple times a day or for multiple days in a row.
Clonic seizures cause jerking, rhythmic motions of the arms and legs, sometimes affecting the face and neck. Clonic seizures can occur on both sides of the body.
Tonic seizures cause the muscles to stiffen suddenly. Tonic seizures can last as long as 20 seconds. If a person is standing when a tonic seizure begins, they usually fall.
Focal onset seizures
Focal seizures affect only one part of the brain. In the past, focal onset seizures were referred to as partial seizures.
Focal onset aware seizures, previously called simple partial seizures, begin in one part or one group of cells of the brain. If a person is awake and aware during the seizure, it is called a focal onset aware seizure. Symptoms of a focal onset seizure vary depending on which part of the brain it affects, but may include visual disturbances, isolated muscle twitching, sweating, nausea, intense emotions, or unusual sensations. Focal onset aware seizures can sometimes precede a tonic-clonic seizure, leading some people to regard them as auras, warning signs, or premonitions of an oncoming generalized seizure.
During focal onset impaired awareness seizures, formerly referred to as complex partial seizures, a person may be confused, appear awake but be unresponsive, or become unconscious. Other behaviors during focal onset impaired awareness seizures may include chewing, gagging, laughing, crying, screaming, or running. Seizures last between 30 seconds to one minute. After the seizure, extreme fatigue is common.
Secondary generalized seizures begin in one part of the brain but then spread to both sides. A secondary generalized seizure is actually two seizures: a focal seizure followed by a generalized seizure.
Unknown onset seizures
In some cases, it is not known how or where the seizure begins. Seizures are considered unknown onset seizures if the seizure happens when a person is alone, when no one is present to witness the seizure. A doctor may be able to diagnose the seizure later as a focal or generalized seizure if more information is learned.
In some people with epilepsy, certain circumstances can trigger a seizure. Triggers vary from person to person, but among the most common are:
Identifying seizure triggers allows a person with epilepsy to avoid their triggers and hopefully to have fewer seizures. Keeping a seizure diary is a good way to identify triggers. When a seizure occurs, note the date and time, any special situations surrounding the seizure, and how it felt. There are many apps and websites that can help you track seizures and triggers.
Is it possible to have more than one seizure type?
Yes, a person with epilepsy can experience different types of seizures.
What are febrile seizures?
Febrile seizures are those triggered by high fevers. As many as 5 percent of children under the age of 6 experience febrile seizures. Febrile seizures are usually connected to viral or bacterial infection such as the flu, roseola, or tonsillitis. A child who has febrile seizures does not have epilepsy; however, children who experience febrile seizures do have an increased risk of developing epilepsy later in life.
If I have a seizure, do I have epilepsy?
It is possible to have seizures that are not caused by epilepsy. Nonepileptic seizures can look and feel like epileptic seizures, but they do not involve abnormal electrical activity in the brain. Nonepileptic seizures can have several different causes. Febrile seizures are one common example. Another type of nonepileptic seizure is the psychogenic seizure. Psychogenic seizures are caused by psychological stress, sometimes related to an anxiety disorder. Nonepileptic seizures can also be caused by heart problems and metabolic conditions such as diabetes. Women are at a higher risk for nonepileptic seizures. It is possible for someone who has epilepsy to experience one or more nonepileptic seizures.
What is status epilepticus?
Status epilepticus describes a prolonged seizure or a series of multiple seizures that occur too rapidly for recovery between each one. Most doctors today consider a seizure or seizure series of at least five minutes in duration to qualify as status epilepticus. In previous years, status epilepticus was pronounced at 20 minutes in duration. The longer a seizure lasts, the less likely it will end without medication. Prolonged seizures are dangerous and can raise the risk of death.
What is an aura?
Some people with epilepsy experience an unusual emotion or sensation, called an aura or warning, immediately before a seizure occurs. An aura may be a visual disturbance, such as colorful lights; an emotion, such as joy or fear; a physical sensation, such as tingling, twitching, or stiffness in a body part, or a sensation that is harder to describe, such as one arm feeling larger than the other, a wave going through the head, or déjà vu. An aura is actually a focal aware seizure, which in some people spreads into a generalized seizure. When a focal aware seizure spreads into a generalized seizure, it may be referred to as a secondary generalized seizure.
What are reflex epilepsies?
For some people with epilepsy, seizures consistently occur as a result of exposure to a certain situation or stimulus, as if the seizures are a reflex. This variety of epilepsy is known as reflex epilepsy, which is found in 4 to 7 percent of people with epilepsy.