Epilepsy, signs and symptoms

Epilepsy, signs and symptoms

Epilepsy is a disorder of the nervous system in which abnormal activity appears in the cerebral cortex, which causes sudden convulsions and loss of consciousness.

Many people with epilepsy have more than one type of attack and may also have other neurological symptoms.

Having epilepsy and having seizures can seriously affect personal safety, as well as relationships, social life, work, driving and much more.


  • 1 Causes of epilepsy
  • 2 Symptoms of epilepsy
  • 3 Generalized seizures, tonic-clonic or great evil
  • 4 Partial or focal crises
  • 5 The crisis of absence or petit mal
  • 6 Phases of seizures in epilepsy
  • 7 How to act during an epilepsy attack

Causes of epilepsy

The causes of epilepsy can be of various kinds, they can be related to a brain injury, they can be congenital or hereditary, but often the cause is completely unknown.

Hereditary causes

  • They are inherited genetically.

Congenital causes

  • Brain tumors.
  • Injuries of intrauterine development.
  • Vascular malformations
  • Neurocutaneous syndromes (neurofibromatosis, Sturge-Weber, tuberous sclerosis).
  • Chromosomal abnormalities (Down syndrome, Angelman syndrome).
  • Congenital metabolism disorders (aminoacidurias, leukodystrophies).
  • Congenital myopathies
  • Myoclonic epilepsy.

Acquired Causes

  • Trauma
  • Post-surgical injuries.
  • Post-infectious lesions (sequel of bacterial meningitis or viral encephalitis).
  • Infarction and cerebral hemorrhage.
  • Tumors (astrocytomas, meningiomas, oligodendrogliomas).
  • Sclerosis of the hippocampus (temporal lobe).
  • Toxic (alcohol and other drugs).
  • Degenerative diseases (dementias and others).
  • Acquired metabolic diseases.

The symptoms of epilepsy

The main symptom of epilepsy are the seizures, also calls seizures. But there are other less known epilepsy symptoms that are: dizziness, difficulty speaking, feeling disconnected from the environment, muscle stiffness, and so on.

Generalized seizures, tonic-clonic or great evil

In this type of seizures all areas of the cortex participate. They are also known as convulsions of great evil.

  • The person experiencing an attack of this type can scream or make some kind of sound, tense for several seconds and then present rhythmic movements of the arms and legs.
  • The eyes generally remain open.
  • The person may seem unable to breathe and their skin will turn blue. This can be followed by a period of deep and noisy breaths.
  • Consciousness returns gradually and the person may feel confused for some time, which may be minutes or hours.
  • The loss of urine is also common.

Partial or focal seizures

Here only a part of the brain is involved in the crisis, so only a part of the body is affected. Depending on the part of the brain that exhibits abnormal electrical activity, symptoms may vary.

  • If the part of the brain that controls the movement of a hand is the one involved, then only the hand can show rhythmic or sudden movements.
  • If other areas of the brain are involved, the symptoms could include strange sensations such as a feeling of fullness in the stomach or small repetitive movements such as touching clothes or making noise with the lips, for example.
  • Sometimes the person with a partial seizure looks stunned or confused. This may be a symptom of a complex partial seizure. The complex term is used by doctors to describe a person who is between complete and unconscious alertness.

The crisis of absence or petit mal

This type of crisis affecting about two out of every 1,000 people, the absence crisis (previously called "petit mal" seizures) are caused by abnormal and intense electrical activity in the brain.

Normally nerve cells in the brain or neurons communicate through tiny electrical signals. But with a seizure, these signals become abnormal. Seizures can affect an isolated part of the brain or may involve abnormal activity throughout the brain (called generalized seizures). Absence crises are a form of generalized seizure.

This type of seizure usually lasts between 10 and 30 seconds. The person, usually children between 5 and 15 years, abruptly stops what they are doing (walking, reading, etc.) and seems to "look into space." Absence seizures rarely cause a true seizure in which the person falls or shows sudden movements. Despite losing consciousness briefly, the person recovers completely, with no signs of confusion or other harmful effects. These "absences" can occur infrequently or several times in an hour. In children, absence crises can interfere with learning and are often misunderstood as daydreaming or lack of attention. A quarter of people who have absence attacks eventually develop generalized crises. The vast majority of children, however, overcome crises with age.

Phases of seizures in epilepsy

Seizures in a seizure have a beginning, a middle part and an end. Not all parts of a seizure can be visible or easy to separate from one another. Nor do all people go through the phases in the same way. But the symptoms during an attack are usually stereotypic (occurring in the same or similar way, every time), episodic (they come and go) and can be unpredictable.

Some people are aware of the beginning of an attack, but others may not be aware of the principle and therefore have no warning.


Some people can experience feelings, sensations or behavior changes A few hours or even a few days before an attack. These sensations are generally not part of the seizure, but they can warn the person that an attack may appear. Not everyone has these symptoms, but if they do, the signs can help the person make certain changes in their activity, be sure to take their medication, use rescue treatment etc.


An aura or warning It is the first symptom of an attack and is considered part of the seizure. Often, the aura is an indescribable sensation. Other times it is easy to recognize and can be a change in feeling, sensation, thought or behavior, and is similar every time a seizure occurs. Signs of the aura include:

Many people do not have this aura or warning phase and the seizure begins directly with loss of consciousness.

Common aura symptoms

  • Sudden and inexplicable feelings of fear, anger, sadness or happiness
  • Feeling of movement or fall
  • Experience of unusual sensations or feelings
  • Alteration of the senses of the ear, smell, taste, vision or touch (sensory hallucinations)
  • Feeling that the environment is not real (derealization) or detachment of the environment (depersonalization)
  • Sensation of spatial distortion (nearby objects are perceived as distant, micropsy or macropsy)
  • Deja vu (false sense of familiarity) or jamais vu (false sense of infamiliarity)
  • Difficulty or inability for spoken language

Physical changes

  • Dizziness or lightheadedness
  • Headache
  • Nausea or other stomach feelings (sensation that rises from the stomach to the throat)
  • Numbness or tingling in certain parts of the body

Ictal phase

The middle of an attack is called the ictal phase. It is the period of time that goes from the first symptoms (including an aura) to the end of the seizure activity. This correlates with electrical seizure activity in the brain. Sometimes visible symptoms last longer than seizure activity in a EEG.

Common symptoms during a seizure

  • Loss of consciousness and fainting
  • Confusion
  • Periods of forgetfulness or memory lapses
  • Feeling of daydreaming
  • Inability to hear
  • The sounds may seem strange or different
  • Unusual odors (often bad smells like burnt gum)
  • Unusual tastes
  • Loss of vision, blurred vision, sensation of seeing blinking lights, hallucinations (see objects or things that do not exist)
  • Numbness, tingling or sensation of electric shock in the body, arms or legs
  • Feeling of indifference
  • Deja vu (false sense of familiarity) or jamais vu (false sense of infamiliarity)
  • Body parts that feel or look different
  • Feeling of panic, fear, fear of imminent death (intense feeling that something bad is going to happen)
  • Pleasant sensations in general

Physical changes

  • Difficulty speaking (can stop talking, make meaningless or distorted sounds, keep talking with meaningless speech)
  • Unable to swallow, drooling
  • Repetitive blinking, eyes may move to one side or look up
  • Lack of movement or loss of muscle tone (inability to move, loss of strength in the neck, so the head may fall forward, loss of muscle tone in the body and the person may collapse or fall forward)
  • Trembling, shaking or sudden movements (it can occur on one or both sides of the face, arms, legs or the whole body; they can start in one area and then spread to other areas or remain in one place)
  • Tense or rigid muscles (part of the body or the whole body can be tightly tense and if the person is standing, it can fall "like a tree trunk")
  • Repeated unintended movements, called automatisms, involve the face, arms or legs, such as
    • chewing movements
    • repetitive hand movements, such as twisting, playing with buttons or objects in the hands
    • dress or undress
    • walk or run
  • Voluntary movements (person can continue the activity he was doing before the crisis)
  • Convulsion (person loses consciousness, the body becomes stiff or tense, jerking and then rapid movements occur)
  • Losing control of urine or feces unexpectedly
  • Perspiration
  • Change in skin color (pale, bluish or red)
  • Biting your tongue (for clenching your teeth when your muscles tense)
  • Difficult breathing
  • Tachycardia

Post-ictal phase

As the seizure ends, the post-ictal phase occurs, is the recovery period after the seizure. Some people recover immediately, while others may take minutes or even hours to feel in their usual state. The type of attack, as well as what part of the brain is affected in the seizure, will affect the recovery period.

The most common symptoms after a seizure

  • Slow response
  • Confusion
  • Drowsiness
  • Memory loss
  • Difficulty speaking or writing
  • Dizziness, feeling of turbidity
  • Feeling depressed, sad, upset
  • Feel scared and anxious
  • Frustration, shame

Physical changes

  • They may have lesions, such as bruises, cuts, fractures or head injuries, if they fell during the seizure
  • They may feel tired, exhausted or sleep for minutes or hours
  • Headache or other pains
  • Nausea and upset stomach
  • Thirst
  • General weakness or weakness in a part or side of the body
  • Urgency of going to the bathroom or losing control of the bowel or bladder

How to act during an epilepsy attack

In case of witnessing an epileptic attack, it is important to consider the following in order to help:

  • Do not move the person from the site.
  • Do not put anything in the mouth.
  • Avoid if it is possible to hit your head.
  • Only in specific cases is it necessary to go to the emergency room:
    • if she is a pregnant woman;
    • if there is a major trauma;
    • if it has several crises and between one and the other it does not recover consciousness or if a crisis lasts more than 5 minutes, both cases would be a epileptic status (a seizure that lasts more than 30 minutes or more than two seizures without regaining consciousness), which is very dangerous.

In the tonic phase of a crisis one does not breathe due to a contraction of all the muscles of the body. The oxygen in the body goes to the vital organs; for that reason the lips and ears can present cyanosis. This is not dangerous, as long as it is not an epileptic status.

Related tests
  • Depression test
  • Goldberg depression test
  • Self-knowledge test
  • how do others see you?
  • Sensitivity test (PAS)
  • Character test