Symptoms

Signs and Symptoms of Epilepsy

Signs and symptoms depend on the area of the brain in which seizure activity occurs and on the type of seizure.

Symptoms of Simple Partial Seizures

Symptoms may be motor, sensory, psychic (states of consciousness), and/or autonomic (involuntary activity controlled by the autonomic nervous system). There is no impairment of consciousness in simple partial seizures. While there is a wide range of potential signs and symptoms, for most patients symptoms are stereotypical.
Motor signs include the following:

• Alternating contraction and relaxation of muscle groups
• Eye movements and turning of the head to the same side
• Asymmetrical posturing of the limbs
• Speech arrest, vocalization

Sensory symptoms include the following:

• Seeing flashes of lights or colors, illusions and hallucinations
• Hearing humming, buzzing, hissing noises
• Experiencing unpleasant odors and tastes
• Dizziness, lightheadedness

Autonomic signs and symptoms include the following:

• Borborygmi (rumbling noises produced by gas in the intestines)
• Flushing
• Incontinence
• Nausea, vomiting
• Piloerection (goose bumps)
• Pupillary dilation
• Sweating
• Tachycardia (rapid heart rate)

Psychic symptoms include the following:

• Detachment, depersonalization
• Dreamy state
• Memory distortion: flashback, deja vu (feeling that one has seen something before), deja entendu (feeling that one has heard something before), jamais vu (feeling that one has never seen something that is familiar), jamais entendu (feeling that one has never heard something that is familiar), panoramic vision (rapid recall of past events)
• Time distortion
• Unprovoked emotion: fear, pleasure, displeasure, depression, anger, elation, eroticism

Symptoms of Complex Partial Seizures

Loss of consciousness distinguishes complex partial seizures from simple partial seizures. While unconscious, the patient may have "vacant" or "frightened" look and may have signs and symptoms of a simple partial seizure. Automatisms may occur during unconsciousness.
There are five types of automatisms:

• Alimentary: chewing, increased salivation, borborygmi (rumbling noises caused by gas in the intestines)
• Mimetic: facial expressions of fear, bewilderment, discomfort, tranquility, laughter, crying
• Gestural: repetitive movements of the hands, fingers, sexual gestures
• Ambulatory: wandering, running
• Verbal: repeated short phrases or swearing

Patients who have had complex partial seizures over a period of years may develop drop attacks. When this occurs, they lose postural tone and fall with the sudden onset of unconsciousness.

Symptoms of Tonic-Clonic (formerly called Grand Mal) Seizures

Generalized tonic-clonic seizures may begin as simple or complex partial seizures. They may begin with aura, but patients often do not remember this phase. The tonic phase consists of the following:

• Fall
• Loss of consciousness
• Yell or "tonic cry"
• Extension of arms, legs, and/or face
• Fingers and jaw clenched
• Autonomic symptoms: increased blood pressure and heart rate, increased bladder pressure, flushing, sweating, increased salivation, increased bronchial secretion, apnea (cessation of breathing)

During the clonic phase, muscles relax completely, then muscle tone returns. This produces rhythmic jerks of the body and head. In the postictal phase drooling; biting of the tongue, cheek, or lip; and urinary incontinence are common.
When the jerking movements stop, the patient may remain unconscious for a period of time. The seizure usually lasts 5 to 20 minutes. Patients often awaken confused and may sleep or pass directly into sleep without awakening, and may experience prolonged weakness after the event.

Symptoms of Absence (formerly called Petit Mal) Seizures

This type affects children. Absence seizures are generalized seizures that have a rapid onset and are characterized by the following:

• Automatisms (e.g., licking the lips, chewing, grimacing, scratching, fumbling with clothes)
• Blank staring
• Change in facial expression
• Lack of awareness, responsiveness, memory
• Jerking movements of the extremities
• Postictal confusion, sense of "lost" time

Symptoms of Myoclonic Seizures

These brief seizures cause a sudden onset of muscle contractions that may occur throughout the body or may be limited to certain areas of the body (e.g., face, one or more extremities, individual or groups of muscles). The seizure is so brief that it is not known if consciousness is lost. The onset may be so sudden that the patient falls to the ground, or so subtle that the seizure looks like a tremor.

Causes of Epilepsy & Seizures

Epilepsy is not associated with any particular disease. Many abnormalities of the nervous system can result in seizure activity. Seizures can also occur in the normal nervous system when its metabolic balance is disturbed. The etiology (cause) of epilepsy may be idiopathic (not clearly known) or related to a particular disease state. About 35% of all cases of epilepsy have no clearly definable cause.
The following summarizes some of the more common factors leading to seizure activity.
Genetic factors: It is now accepted that some persons may have a genetic predisposition to the development of seizures. There is also an increased incidence of epilepsy in relatives of those with a seizure disorder.
Head injury: Seizures may develop at or around the time of injury or years after (usually not more than two years later). They may occur with either an "open" or "closed" head injury.
Stroke/cerebrovascular disorders: Seizures can occur at the time of a stroke or many years later. They may occur with strokes that result in lack of blood flow to the brain or with those that involve bleeding into or around the brain.
Metabolic disturbances: This group of disorders changes levels of various metabolic substances in the body. These disease states sometimes result in seizures.

• Electrolyte disturbances (altered levels of sodium, calcium, or magnesium)
• Hypoglycemia (low blood sugar) or hyperglycemia (elevated blood sugar)
• Renal failure (kidney disease) with uremia (increased urea in the blood) or changes that occur around the time of kidney dialysis
• Hepatic failure (severe liver disease) and elevation of associated toxins
• Hypoxia (lowered oxygen delivery to the brain)

Toxic causes: The presence of certain drugs can cause seizure activity. In addition, abrupt withdrawal of some substances can lead to seizure activity. These substances that may induce seizures include the tricyclic antidepressants, lithium, antipsychotic medications, aminophylline, and high doses of penicillin.
Illicit drug use, particularly cocaine, heroine, amphetamines, and PCP, can cause seizures. Alcohol withdrawal can be associated with seizure activity. These seizures usually occur 12-24 hours after the last drink but can occur up until 48 hours or more after binge drinking.
Withdrawal from prescription drugs and agents such as barbiturates and narcotics can result in seizure activity.
Infections: Infections of the nervous system may result in a lowered seizure threshold. These may include meningitis (infections of the coverings of the brain and spinal fluid), encephalitis (infection of the brain itself), and HIV (human immunodeficiency virus), and related infections.
Tumors and space-occupying lesions: Brain tumors, both malignant (cancerous) and benign, may be associated with seizures. The anatomic location of the abnormality influences the likelihood of having seizures.
Degenerative disorders: There are many neurodegenerative disorders that are accompanied by seizures. These include tuberous sclerosis, neurofibromatosis, Tay-Sachs disease, phenylketonuria (PKU), and Sturge-Weber syndrome.

Brain damage in infancy: Cerebral palsy secondary to lack of oxygen, infection, or trauma is associated with epilepsy.
Febrile seizures: These are an age-associated form of epilepsy that may present as a single seizure or may be recurring. They are associated with a high fever in children 3 months to 4 years of age and occur in 3%–4% of children.