10 Warning Signs and Symptoms of Epilepsy You Should Never Ignore

Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures that affect the brain’s electrical activity. It affects approximately 50 million people worldwide, making it one of the most common neurological conditions. Understanding the symptoms of epilepsy is crucial for early detection and proper management of this condition.

An epileptic seizure occurs when there is a sudden, excessive electrical discharge in the brain cells, leading to temporary disruption in normal brain function. These seizures can vary significantly in their presentation, from brief lapses in attention to prolonged convulsions. While some people may experience obvious physical symptoms, others may have more subtle signs that can easily be overlooked.

Recognizing the warning signs of epilepsy is essential because early diagnosis and appropriate medical care can significantly improve quality of life. Here are the 10 most important symptoms and warning signs of epilepsy that you should be aware of:

1. Generalized Tonic-Clonic Seizures (Grand Mal Seizures)

This is perhaps the most recognizable type of epileptic seizure. Generalized tonic-clonic seizures involve two distinct phases that affect the entire brain and body.

During the tonic phase, which typically lasts 10-20 seconds, the person loses consciousness and their muscles suddenly stiffen. They may cry out as air is forced past the vocal cords, fall to the ground, and may bite their tongue or cheek. The body becomes rigid, and breathing may temporarily stop, causing the skin to take on a bluish tinge.

The clonic phase follows, lasting 1-2 minutes, during which the muscles contract and relax rapidly, causing rhythmic jerking movements. The person may lose control of their bladder or bowels. Breathing is typically irregular during this phase. After the seizure ends, the person usually experiences confusion, exhaustion, headache, and muscle soreness, a period known as the postictal state that can last from minutes to hours.

2. Absence Seizures (Petit Mal Seizures)

Absence seizures are brief episodes of impaired consciousness that primarily affect children, though they can occur in adults. These seizures are often so subtle that they may go unnoticed for extended periods.

During an absence seizure, the person appears to be staring blankly into space for typically 5-10 seconds. They become completely unaware of their surroundings and unresponsive to external stimuli. The person may stop speaking mid-sentence or cease their current activity abruptly. Subtle movements may accompany the staring spell, including:

• Rapid eye blinking or fluttering of the eyelids
• Slight upward rolling of the eyes
• Lip smacking or chewing movements
• Small hand movements or finger rubbing

These seizures begin and end abruptly, with the person immediately resuming normal activity afterward, often without realizing they’ve had a seizure. Children may experience dozens of these episodes daily, which can significantly impact their learning and academic performance if undiagnosed.

3. Focal Aware Seizures (Simple Partial Seizures)

Focal aware seizures originate in one specific area of the brain and the person remains conscious throughout the episode. These seizures can serve as important warning signs and may precede more severe seizures.

The symptoms depend on which part of the brain is affected and can include:

Motor symptoms: Jerking movements that typically start in one area, such as a finger, hand, or one side of the face, and may spread to other parts of that side of the body. The person may experience sudden weakness or inability to move a limb.

Sensory symptoms: Unusual sensations including tingling, numbness, or a “pins and needles” feeling. Visual disturbances such as seeing flashing lights, colors, or hallucinations. Auditory hallucinations including hearing buzzing, ringing, or voices. Olfactory hallucinations involving smelling odors that aren’t present, often unpleasant ones. Gustatory symptoms including unusual tastes in the mouth.

Autonomic symptoms: Changes in heart rate, blood pressure, sweating, or experiencing a “rising” sensation in the stomach similar to the feeling in an elevator.

Psychic symptoms: Intense feelings of fear, anxiety, déjà vu (feeling of having experienced something before), or jamais vu (feeling that familiar things are strange or unfamiliar).

4. Focal Impaired Awareness Seizures (Complex Partial Seizures)

These seizures also begin in one area of the brain but involve altered consciousness or awareness. The person appears awake but is not fully conscious of their surroundings and cannot respond appropriately to external stimuli.

During focal impaired awareness seizures, individuals often exhibit automatisms—repetitive, purposeless movements that may include:

• Lip smacking, chewing, or swallowing movements
• Picking at clothing or nearby objects
• Fumbling with hands or making hand-wringing gestures
• Walking aimlessly or wandering
• Repeating words or phrases inappropriately
• Making unusual sounds or grunting

The person typically has a blank, glassy-eyed stare and does not respond to questions or commands. These seizures usually last 1-2 minutes and are followed by confusion and disorientation that may persist for several minutes. The individual typically has no memory of what occurred during the seizure.

5. Myoclonic Seizures

Myoclonic seizures are characterized by sudden, brief, shock-like muscle jerks that typically last only a fraction of a second to a few seconds. These jerks can affect the entire body or specific muscle groups.

Common manifestations include:

Quick, involuntary twitching or jerking of the arms, legs, or upper body, often described as similar to the “jump” people experience when startled or falling asleep. The jerks are typically bilateral, meaning they affect both sides of the body simultaneously. They often occur in clusters, with multiple jerks happening in succession.

These seizures commonly occur shortly after waking up and may cause the person to drop objects they’re holding or suddenly fall if the leg muscles are involved. Consciousness is usually preserved during myoclonic seizures. While single myoclonic jerks are normal and can happen to anyone, frequent or clustered myoclonic seizures indicate epilepsy and require medical evaluation.

6. Atonic Seizures (Drop Attacks)

Atonic seizures involve a sudden loss of muscle tone, causing the person to go limp. These seizures are particularly dangerous because they occur without warning and can result in serious injuries from falls.

During an atonic seizure, which typically lasts less than 15 seconds, the person may experience:

• Sudden dropping of the head (head drop)
• Jaw dropping open
• Dropping objects from the hands
• Buckling of the knees or complete collapse to the ground

The person usually regains consciousness quickly after the muscle tone returns, but confusion may persist briefly. Because these seizures are so sudden and unpredictable, people with atonic seizures often need to wear protective headgear to prevent head injuries from falls.

7. Tonic Seizures

Tonic seizures cause sudden stiffening of the muscles, particularly affecting the back, arms, and legs. These seizures most commonly occur during sleep but can happen when awake.

Characteristics of tonic seizures include:

Sudden muscle rigidity that typically lasts 10-20 seconds. If standing, the person may fall backward due to the stiffening of the body. The eyes may roll upward, and breathing may be affected as the chest muscles tighten. Consciousness is usually lost or impaired during the episode.

When tonic seizures occur during sleep, the person may not be aware they’re having them. Family members might notice unusual stiffening movements, groaning sounds, or finding the person in an unusual position upon waking. These seizures can also cause injuries from falls or striking nearby objects.

8. Clonic Seizures

Clonic seizures are characterized by repeated, rhythmic jerking movements caused by muscle contractions and relaxations. While less common than other seizure types, they are an important symptom of epilepsy.

During a clonic seizure:

The jerking movements typically affect the face, neck, and arms, occurring on both sides of the body. The movements follow a rhythmic pattern with a consistent tempo. These seizures usually last several minutes and may be accompanied by loss of consciousness. The rhythmic jerking is slower than the brief jerks seen in myoclonic seizures and more sustained.

After the seizure ends, the person typically experiences confusion, fatigue, and sleepiness, which is part of the postictal recovery phase.

9. Aura (Warning Signs Before Seizures)

An aura is actually a type of focal aware seizure that serves as a warning sign that a larger seizure may be about to occur. Not everyone with epilepsy experiences auras, but for those who do, recognizing these symptoms can provide valuable time to get to a safe location.

Common aura symptoms include:

Sensory auras: Unusual smells (often unpleasant, like burning rubber or sulfur), strange tastes, visual disturbances such as seeing spots, flashing lights, or zigzag lines, hearing ringing, buzzing, or voices, tingling or numbness in parts of the body.

Emotional auras: Sudden, intense fear or panic without obvious cause, feelings of impending doom, unexplained happiness or sadness, sudden anger or irritability.

Physical auras: “Rising” sensation in the stomach (epigastric rising), feeling of pressure in the head, dizziness or lightheadedness, sudden racing heartbeat or palpitations, sweating or flushing.

Cognitive auras: Déjà vu or jamais vu experiences, feeling detached from one’s body or surroundings (depersonalization or derealization), difficulty thinking or forming thoughts.

Auras typically last from a few seconds to a couple of minutes before a larger seizure begins. Some people only experience the aura without progression to a larger seizure.

10. Postictal Symptoms (After-Seizure Signs)

The postictal state refers to the period immediately following a seizure, characterized by various symptoms as the brain recovers from the electrical disturbance. While not technically part of the seizure itself, these symptoms are important indicators of epilepsy.

Common postictal symptoms include:

Cognitive symptoms: Confusion and disorientation regarding time, place, or person, difficulty speaking or finding words (postictal aphasia), memory problems, particularly difficulty forming new memories, slowed thinking and responses.

Physical symptoms: Extreme fatigue and overwhelming need to sleep, headache ranging from mild to severe, muscle soreness and weakness, particularly after convulsive seizures, injuries such as tongue biting, bruises, or head injuries from falls.

Emotional symptoms: Depression or feelings of sadness, anxiety or fear, irritability or agitation, emotional sensitivity or crying.

Neurological symptoms: Temporary weakness or paralysis on one side of the body (Todd’s paralysis), visual disturbances, nausea or vomiting.

The postictal period can last from minutes to hours, or in some cases, even days, depending on the severity and type of seizure. During this time, the person needs rest and may require assistance with basic activities as they recover.

What Causes Epilepsy?

Understanding what causes epilepsy can help in recognizing risk factors and potentially preventing the condition. Epilepsy can develop at any age, and in many cases, the exact cause remains unknown (idiopathic epilepsy). However, several factors have been identified as causes or contributors:

Genetic factors: Some types of epilepsy run in families, suggesting genetic predisposition. Certain genetic mutations can affect brain development or the way neurons communicate, increasing seizure susceptibility.

Brain structural abnormalities: Brain tumors, both benign and malignant, can cause seizures. Abnormal blood vessels in the brain, such as arteriovenous malformations (AVMs) or cavernous malformations, can trigger epilepsy. Cortical dysplasia, where areas of the brain don’t develop properly, can lead to seizures.

Head trauma: Traumatic brain injuries from car accidents, falls, sports injuries, or violence are common causes of epilepsy, sometimes developing years after the initial injury. Penetrating head wounds carry a particularly high risk of post-traumatic epilepsy.

Stroke and vascular disease: Stroke is the leading cause of epilepsy in adults over 35. Reduced blood flow to the brain or bleeding in the brain can damage brain tissue and lead to seizures.

Infections: Brain infections such as meningitis, encephalitis, or brain abscesses can cause epilepsy. In developing countries, parasitic infections like neurocysticercosis (caused by pork tapeworm) are significant causes. HIV and other viral infections can increase epilepsy risk.

Prenatal and developmental factors: Oxygen deprivation during birth (perinatal asphyxia), maternal infections during pregnancy, poor nutrition during pregnancy, and brain malformations that occur during fetal development can all lead to epilepsy.

Metabolic and immune disorders: Certain autoimmune conditions where the immune system attacks brain cells, metabolic disorders affecting how the body processes nutrients, and electrolyte imbalances can trigger seizures.

Degenerative diseases: Alzheimer’s disease and other forms of dementia increase the risk of developing epilepsy. Progressive brain disorders can damage neural networks and lead to seizure activity.

Prevention of Epilepsy

While not all cases of epilepsy can be prevented, particularly those with genetic causes, there are several measures that can reduce the risk of developing the condition:

Prevent head injuries: Always wear seatbelts in vehicles and ensure children are in appropriate car seats. Use helmets when cycling, motorcycling, skating, or engaging in contact sports. Take measures to prevent falls, especially in elderly individuals, by removing tripping hazards and improving home lighting. Use appropriate safety equipment at work and during recreational activities.

Reduce stroke risk: Manage high blood pressure, cholesterol, and diabetes through regular medical check-ups and medication if prescribed. Maintain a healthy diet rich in fruits, vegetables, and whole grains while limiting saturated fats and sodium. Exercise regularly to improve cardiovascular health. Avoid smoking and limit alcohol consumption. Manage stress through relaxation techniques and adequate sleep.

Prenatal and perinatal care: Pregnant women should receive regular prenatal care to monitor both maternal and fetal health. Avoid infections during pregnancy through proper hygiene and avoiding contact with sick individuals. Ensure adequate nutrition during pregnancy with proper vitamins and supplements as recommended by healthcare providers. Access skilled medical care during delivery to minimize birth complications.

Prevent infections: Get vaccinated against diseases that can affect the brain, including measles, mumps, meningitis, and encephalitis. Practice food safety to avoid parasitic infections, particularly when traveling to areas where neurocysticercosis is common. Seek prompt treatment for infections to prevent them from spreading to the brain.

Manage underlying conditions: People with conditions that increase epilepsy risk should work closely with healthcare providers to manage these conditions effectively. This includes proper management of vascular diseases, metabolic disorders, and autoimmune conditions.

Avoid seizure triggers: For those already diagnosed with epilepsy, identifying and avoiding personal seizure triggers can prevent seizure occurrence. Common triggers include sleep deprivation, stress, flashing lights, alcohol consumption, and missing medications.

Frequently Asked Questions About Epilepsy

What is epilepsy?

Epilepsy is a chronic neurological disorder characterized by recurrent, unprovoked seizures caused by abnormal electrical activity in the brain. A person is typically diagnosed with epilepsy after experiencing two or more unprovoked seizures occurring more than 24 hours apart.

Is epilepsy the same as having a seizure?

No. A seizure is a single event of abnormal electrical activity in the brain, while epilepsy is a condition defined by the tendency to have recurrent, unprovoked seizures. Many people experience a single seizure in their lifetime without having epilepsy.

Can epilepsy be cured?

While there is currently no cure for epilepsy, many people can effectively manage their seizures with appropriate treatment. Some children with epilepsy outgrow the condition as they mature. In some cases, surgical intervention may eliminate seizures for individuals with focal epilepsy that doesn’t respond to medication.

Is epilepsy hereditary?

Some types of epilepsy have a genetic component and can run in families, but most cases of epilepsy are not directly inherited. Having a parent with epilepsy slightly increases a child’s risk, but the majority of children with a parent who has epilepsy will not develop the condition.

What should I do if I witness someone having a seizure?

Stay calm and stay with the person. For convulsive seizures, gently guide them to the floor, turn them on their side to help breathing, cushion their head, and time the seizure. Never put anything in their mouth or restrain them. Call emergency services if the seizure lasts more than 5 minutes, multiple seizures occur without recovery, the person is injured, pregnant, or has diabetes, or if it’s their first seizure.

Can stress cause epilepsy?

Stress does not cause epilepsy, but it is a common trigger that can provoke seizures in people who already have epilepsy. Managing stress through relaxation techniques, adequate sleep, and healthy lifestyle choices can help reduce seizure frequency.

Can people with epilepsy drive?

Driving regulations for people with epilepsy vary by country and state. Generally, individuals must be seizure-free for a specific period (often 3-12 months) before they can legally drive. It’s essential to follow local laws and medical advice regarding driving restrictions.

Are flashing lights dangerous for all people with epilepsy?

Only about 3-5% of people with epilepsy have photosensitive epilepsy, where seizures are triggered by flashing lights or certain visual patterns. Most people with epilepsy are not affected by flashing lights, though it’s wise to be cautious until photosensitivity has been ruled out through testing.

When should I see a doctor about possible epilepsy symptoms?

You should seek immediate medical attention if you experience a seizure for the first time, have a seizure lasting more than 5 minutes, or experience multiple seizures without regaining consciousness between them. Also consult a doctor if you notice recurring episodes of staring spells, unexplained jerking movements, temporary confusion, or any other symptoms that might indicate seizure activity.

References:

• World Health Organization – Epilepsy Fact Sheet
• Epilepsy Foundation – Seizure Types
• National Institute of Neurological Disorders and Stroke – Epilepsy Information
• Mayo Clinic – Epilepsy Symptoms and Causes
• Centers for Disease Control and Prevention – Epilepsy