Signs and symptoms of epilepsy 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)
- Nausea, vomiting
- Piloerection (goose bumps)
- Pupillary dilation
- 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:
- 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.