Signs and Symptoms of Seizures

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

What Does a Seizure Look Like?

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.

Absence 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

Myoclonic Seizures

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

Atonic Seizures

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.

Tonic, Clonic, and Tonic-Clonic Seizures

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

Neonatal Seizures

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

Infantile Spasms

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</