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Signs and Symptoms of Seizures

Mother comforting daughter in bed 

Signs and symptoms are not the same things. A sign is a clinical feature of a disease or condition that the doctor looks for. It is something that can be seen or measured. A symptom is something the patient feels or complains about, like fatigue or pain. Symptoms cannot be directly observed. Both signs and symptoms are assessed in order to make a diagnosis . 

Often, a child having a generalized seizure will not remember anything about it and cannot describe her symptoms. It is important to record what your child’s seizure looks like and any factors that may have triggered it. You and anyone who observed the seizure can give valuable information to help your child’s doctor reach a diagnosis.

By contrast, some children having partial seizures do not show any signs. It is only possible to find out about their seizures by asking them about their symptoms -- what they experienced during the seizure.

Your child is an expert about her own symptoms, so create opportunities to find out how she is feeling. Talk to her, use artwork to help her express her feelings, or use books about epilepsy to encourage discussion about what it is like to experience a seizure.

First seizure

Single, isolated seizures are not always a sign of epilepsy. Seizures can be triggered by illness, fever, medication, or injury. As well, some events look like seizures, but in fact are something else. However, a first seizure should always be evaluated by a doctor immediately. Record as much as you can remember about your child’s seizure, since this information will help your child’s doctor determine whether the event was a seizure and whether it is likely to recur.

Seizures come in many forms; your child’s seizure could look like one or a combination of any of the following.

Generalized absence seizures

What are possible signs of an absence seizure?

  • staring

  • the child suddenly stops what she is doing

  • a few seconds of unresponsiveness (usually less than 10 seconds, but it can be up to 20 seconds) that can be confused with daydreaming

  • no response when you touch your child

  • the child is alert immediately after the seizure

  • the child may have many seizures per day

Less common features include:

  • repetitive blinking

  • eyes rolling up

  • head bobbing

  • automatisms such as licking, swallowing, and hand movements

  • autonomic symptoms such as dilated pupils, flushing, pallor, rapid heartbeat, or salivation

Some of these less common features may result in the seizures being termed atypical absence seizures. Atypical absence seizures may be confused with complex partial seizures.

Generalized myoclonic seizures

What are possible signs and symptoms of a myoclonic seizure?

  • one or many brief jerks, which may involve the whole body or a single arm or leg

  • in juvenile myoclonic epilepsy, these jerks often occur upon waking

  • the child remains conscious

Generalized atonic seizures

What are possible signs and symptoms of an atonic seizure?

  • sudden loss of muscle tone

  • the child goes limp and falls straight to the ground

  • the child remains conscious or has a brief loss of consciousness

  • eyelids droop, head nods

  • jerking

  • the seizure usually lasts less than 15 seconds, although some may last several minutes

  • the child quickly becomes conscious and alert again after the seizure

Generalized tonic-clonic seizures

What are possible signs of a tonic-clonic seizure?

  • the child cries out or groans loudly

  • the child loses consciousness and falls down

  • in the tonic phase, the child is rigid, her teeth clench, her lips may turn blue because blood is being sent to protect her internal organs, and saliva or foam may drip from her mouth; she may appear to stop breathing because her muscles, including her breathing muscles, are stiff

  • heart rate and blood pressure rise

  • sweating

  • tremor​

  • in the clonic phase, the child resumes shallow breathing; her arms and legs jerk quickly and rhythmically; her pupils contract and dilate

  • at the end of the clonic phase, the child relaxes and may lose control of her bowel or bladder

  • following the seizure, the child regains consciousness slowly and may appear drowsy, confused, anxious, or depressed

In some cases, the seizure may not progress to a clonic phase.

Neonatal seizures

Neonatal seizures occur in babies who are less than 28 days old. Seizures in a newborn are often short and subtle; it can be difficult to tell whether a baby is actually having a seizure. Seizures in newborns can include any or all of the following:

  • repetitive facial movements, including sucking, chewing, or eye movements

  • unusual bicycling or pedalling movements

  • staring

  • apnea (stopping breathing)

  • clonic seizures, which are rhythmic jerking movements that may involve the muscles of the face, tongue, arms, legs, or other regions

  • tonic seizures, which are stiffening or tightening or muscle groups; the head or eyes may turn to one side, or the baby may bend or stretch one or more arms or legs

  • myoclonic seizures, which are quick, single jerks involving one arm or leg or the whole body

Infantile spasms

What are possible signs of infantile spasms?

  • usually begin within the first year of life, typically between the ages of three and seven months

  • slight head bobbing, which becomes more rapid over time, followed by flexor, extensor, or mixed spasms

  • with flexor spasms, the child’s neck, arms, and legs draw towards his chest; the child often bends at the waist in a “jackknife” motion

  • with extensor spasms, the child’s neck, arms, and legs stretch out

  • with mixed spasms, the child’s arms and body contract and his legs stretch out

  • spasms are usually symmetrical, although they may be stronger on one side

  • in most cases, the spasms occur in clusters; they repeat every five to 30 seconds, sometimes 10 to 40 times in a single attack; a child may have several such attacks per day

  • an attack usually continues for two to three minutes, and the spasms become less intense and farther apart as the cluster progresses

  • seizures rarely occur while a child is asleep, and often happen just after he wakes up

  • child may be quiet before and during the attack, or may cry between spasms

  • after a cluster of spasms, child may be exhausted or more alert

Simple partial seizures

Simple partial seizures appear different from person to person, depending on the seizure focus (the affected area of the brain). A common feature of simple partial seizures is that the child remains alert and can remember what happened.

Motor seizures

What are possible signs and symptoms of a focal motor seizure?

  • brief muscle contractions (twitching, jerking, or stiffening), often beginning in the face, finger, or toe on one side of the body

  • twitching or jerking spreads to other parts of the body on the same side near the initial site

  • other motor seizures may involve movement of the eye and head

  • the seizure begins the same way each time

  • the child remains conscious

Sensory seizures

What are possible symptoms of a sensory seizure?

  • seeing something that is not there, such as shapes or flashing lights, or seeing something as larger or smaller than usual

  • hearing or smelling something that is not there

  • feeling of pins and needles or numbness in part of the body

  • the child remains conscious

Autonomic seizures

What are possible signs of an autonomic seizure?

  • changes in heart rate

  • changes in breathing

  • sweating

  • goose bumps

  • flushing or pallor

  • the child remains conscious

What are possible symptoms of an autonomic seizure?

  • strange or unpleasant sensation in the stomach, chest, or head

  • changes in heart rate

  • changes in breathing

  • sweating

  • goose bumps

  • flushing or pallor

  • the child remains conscious

Psychic seizures

What are possible signs of a psychic seizure?

  • problems with memory

  • garbled speech

What are possible symptoms of a psychic seizure?

  • problems with memory

  • garbled speech

  • sudden emotions for no apparent reason, such as fear, depression, rage, or happiness

  • feeling as though she is outside her own body

  • feelings of déjà vu, jamais vu, or knowledge of the future

Secondarily generalized seizures

A secondarily generalized seizure begins as a simple partial seizure, then spreads to the whole brain to result in a generalized tonic-clonic or clonic seizure.

Complex partial seizures

What are possible symptoms of a complex partial seizure?

  • warning sign such as a feeling of fear or nausea

  • loss of awareness

  • confusion after the seizure

  • loss of memory about events just before or after the seizure

What are possible signs of a complex partial seizure?

  • loss of awareness

  • blank stare

  • walking or running

  • screaming, yelling, or thrashing, either from sleep or while awake

  • automatisms such as mouth movements, picking at air or clothing, repeating words or phrases

  • confusion after the seizure

  • loss of memory about events just before or after the seizure

Aura

Some children have auras before their seizures, which they can learn to recognize. An aura is a warning sign such as a feeling of fear or nausea. It is actually a simple partial seizure.

What isn’t a seizure?

Some episodes may look like seizures, but in fact do not originate in the brain. These include:

  • fainting

  • daydreaming

  • behavioural outbursts in certain situations

  • tics

  • some myoclonic jerks

  • breath-holding spells​

  • migraines

  • non-epileptic psychogenic seizures, which are a subconscious emotional reaction; these may look like a seizure, but there is no change in the brain’s activity

Your child’s doctor may want to rule out these possible causes when evaluating your child.

In some cases, seizures are not caused by epilepsy. These include non-epileptic psychogenic seizures and febrile seizures. Some children may have both epileptic and non-epileptic seizures.

Recording signs and symptoms

Keeping track of your child’s signs and symptoms is important for diagnosis. Information you can record includes:

  • the time of day the seizure occurred

  • what your child was doing before the seizure

  • if she is sick, tired, or stressed

  • if she is taking any medication

  • how the seizure began

  • if she felt any warning signs

  • what her movements (if any) looked like during the seizure

  • if the movements were on a particular side of her body

  • whether she was able to talk and respond during the seizure

  • whether she made any sounds

  • how long the seizure lasted

  • if she was confused, tired, or sore after the seizure

  • if she could speak normally after the seizure

Elizabeth J. Donner, MD, FRCPC​

2/4/2010




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