The symptoms of epilepsy usually vary on the basis of underlying pathology. Seizure is the only symptom which is present in all types of epilepsy. However, the associated symptoms may differ on the type of seizures.

Impairment or loss of consciousness is usually a feature of complex partial seizures. The level of consciousness is not affected in simple partial seizures. Atonic and tonic seizures often make the patient fall down.

• Unconsciousness

  At 14 years old, she experienced an aggravated seizure, manifesting as unconsciousness, hyperventilation, and urinary incontinence. [ncbi.nlm.nih.gov]

  The term "complex" is used by doctors to describe a person who is between being fully alert and unconscious. Absence or petit mal seizures: These are most common in childhood. [emedicinehealth.com]

  As patients are often unconscious or unaware during seizures, it's extremely important for the doctor to get an eye-witness description of attacks from another person. [netdoctor.co.uk]

  Once the seizure begins, you may remain conscious but your body will begin to twitch and display unconscious actions. You’ll make repetitive, uncontrollable movements such as lip smacking, swallowing, chewing, staring, or hand rubbing. [healthline.com]

• Abdominal Pain

  More severe liver injury can cause nausea, vomiting, abdominal pain, fatigue, anorexia, jaundice and/or dark urine. [fda.gov]

  Digestive system Seizures can affect the movement of food through the digestive system, causing symptoms such as: abdominal pain nausea and vomiting pauses in breathing indigestion loss of bowel control Epilepsy can have ripple effects on just about every [healthline.com]

  The individual may also experience intense fear, abdominal pain or discomfort, or an awareness of increased respiration rate or heartbeat. The form of the onset of a seizure is, in most cases, the same from attack to attack. [britannica.com]

  irritability, falls, sleepiness, nausea, vomiting, headache, weight gain, abdominal pain, and problems walking Phenobarbital Focal-onset seizures Generalized-onset tonic-clonic seizures Neonatal seizures Status epilepticus Drowsiness, abnormal eye movements [merckmanuals.com]

• Fecal Incontinence

  Bruno MK reported that the duration of attacks in his clinical criteria was short (less than one minute). 15 No unconsciousness or urinary and fecal incontinence were observed during the attack. [ncbi.nlm.nih.gov]

  Urinary and fecal incontinence, tongue biting, and frothing at the mouth sometimes occur. Seizures usually last 1 to 2 minutes. There is no aura. [merckmanuals.com]

• Dysgeusia

  Dysfunction Bilateral tonic posture Frontal lobe (supplementary motor cortex) Simple movements (eg, limb twitching, jacksonian march) Contralateral frontal lobe Head and eye deviation with posturing Supplementary motor cortex Abnormal taste sensation (dysgeusia [merckmanuals.com]

• Cyanosis

  In addition to the typical features of PTHS, the girl also had paroxysms of tachypnea followed by cyanosis and recurrent seizures. [ncbi.nlm.nih.gov]

• Flushing

  Focal-onset nonmotor seizures may be further classified based on the earliest prominent feature: Autonomic dysfunction (autonomic effects such as gastrointestinal (GI) sensations, a sense of heat or cold, flushing, sexual arousal, piloerection, and palpitations [merckmanuals.com]

• Muscle Twitch

  Symptoms of focal seizures might include: muscle twitching in one part of the body changes to smells, sounds, tastes and sight numbness difficulty talking abnormal behaviour and movements like picking at clothing or lip smacking. [raisingchildren.net.au]

  These seizures produce muscle twitches, convulsions and loss of consciousness. People with this type of epilepsy do not remember having a seizure. [faculty.washington.edu]

  Convulsions, during which the muscles twitch or jerk, are just one characteristic of seizures. Some seizures cause convulsions, but many do not. [northshore.org]

  They proposed a definition of the clinical syndrome as “clonic muscle twitching repeated at fairly short intervals in 1 part of the body for a period of days or weeks.” [medlink.com]

  Stronger seizures can cause spasms and uncontrollable muscle twitches, and can last a few seconds to several minutes. During a stronger seizure, some people become confused or lose consciousness. Afterward you may have no memory of it happening. [healthline.com]

• Visual Hallucination

  Types of auras include: Vision (visual): Visual auras can be simple, such as seeing bright flashes of light, dark spots, or tunnel vision, or they can be complex or experiential, such as blindness, visual hallucinations, illusions, and distorted scenery [verywell.com]

  The cortex is the outer layer of the brain, and seizure symptoms can vary from unusual sensations to visual hallucinations, emotional changes, or convulsions. [everydayhealth.com]

  hallucinations (formed images) Posterior temporal lobe or amygdala-hippocampus Localized sensory disturbances (eg, tingling or numbness of a limb or half the body) Parietal lobe (sensory cortex) Visual hallucinations (unformed images) Occipital lobe [merckmanuals.com]

  hallucinations, ictal blindness, vomiting and post-ictal headache; EEG typically shows interictal occipital spikes attenuated by eye opening an epilepsy syndrome with an age of onset of 3–10 years characterised by multiple seizure types (including atonic [pathways.nice.org.uk]

• Urinary Incontinence

  At 14 years old, she experienced an aggravated seizure, manifesting as unconsciousness, hyperventilation, and urinary incontinence. [ncbi.nlm.nih.gov]

  The tongue may be bitten during involuntary contraction of the jaw muscles, and urinary incontinence may occur. Usually, the entire generalized tonic-clonic seizure is over in less than five minutes. [britannica.com]

• Seizure

  Partial-onset seizures A partial seizure originates in a specific area of the brain. Partial seizures consist of abnormal sensations or movements, and a lapse of consciousness may occur. [britannica.com]

  Three categories of reflex seizures encountered clinically include pure reflex epilepsies, reflex seizures that occur in generalized or focal epilepsy syndromes that are also associated with spontaneous seizures, and isolated reflex seizures occurring [doi.org]

  […] causing seizures nonsyndromic epilepsy Seizure disorder The Sacred Disease Falling sickness Epilepsies Epileptiform Caducus morbus Morbus comitialis Seizure Disorder Intractable epilepsy in childhood Seizure syndrome Seizure prediction Mirgi Idiopathic [wikidata.org]

  The median age of onset of all seizures was 10 years, and 8 years for nodding seizures. PWE with nodding seizures presented with more cognitive disabilities. [ncbi.nlm.nih.gov]

• Confusion

  On 1-year follow-up, patient and family members did not report episodic confusion or any seizure-like activity. RAS constitute a particular entity of seizures and need careful interpretation and management. [ncbi.nlm.nih.gov]

  Epileptic seizures typically last one to two minutes but can be followed by weakness, confusion, or unresponsiveness. [britannica.com]

  Unfortunately, a great deal of misunderstanding and confusion about seizures still exists, so it is important that your child's friends and teachers become educated about her condition. [healthychildren.org]

  Often people will be confused briefly after a generalized seizure. Partial or focal seizures: Only part of the brain is involved, so only part of the body is affected. [emedicinehealth.com]

• Febrile Seizures

  CONCLUSIONS: Our study showed that being female, comorbid autism with febrile seizure and recurrent febrile seizure had an increased association with development of epilepsy. [ncbi.nlm.nih.gov]

  Febrile seizures and idiopathic epilepsy: a clinical and genetic study in a Finnish family. Epilepsia. 2006; 47 12 15 Scheffer I E, Berkovic S F. Generalized epilepsy with febrile seizures plus. [doi.org]

• Aura

  Here Prince Myshkin describes the onset of a seizure with an ecstatic aura. [charge.org.uk]

  The type of aura you have can give clues as to the region of your brain in which your seizure begins. Sometimes, auras occur without any other seizure symptoms. In these cases, the aura is the seizure. [verywell.com]

  After experiencing the aura, the individual becomes unresponsive but may examine objects closely or walk around. [britannica.com]

  Aura Stage For some types of seizures, an aura happens before a seizure and may alert a person that a seizure may occur. Auras typically begin seconds before the seizure. [uchospitals.edu]

  Her habitual seizures were described as sudden behavioral arrest, staring, unresponsiveness, and oral automatisms, with auras of fear and palpitation. [ncbi.nlm.nih.gov]

• Myoclonus

  SCARB2 gene should be analyzed in patients with progressive action myoclonus, epilepsy, peripheral neuropathy, without cognitive deterioration or renal failure. [ncbi.nlm.nih.gov]

Before the diagnosis of epilepsy is made, the following investigations are used to rule out infections or metabolic causes of seizures.

• Blood Chemistry Panel
• Serum urea, creatinine and electrolytes
• Random blood sugar
• Serum calcium and magnesium
• Liver function tests
• Lumbar puncture

Other investigations that will help diagnose epilepsy include the following.

• Electroencephalography: Electroencephalography may help establish and characterize the type of epilepsy by demonstrating abnormal electrical activity in the brain.
• Compuerized Tomography (CT) or Magnetic Resonance Imaging (MRI) scan: CT or MRI brain scanning is often useful in defining or excluding structural causes for seizures e.g. tumors and infections.
• Position Emission Tomography (PET) and Single Photon Emission Computed Tomography (SPECT): PET and SPECT are also used to evaluate certain patients of seizures who do not respond to medical therapy.

• Epileptiform Activity

  It remains unclear whether seizures and epileptiform activity on the EEG are causative or comorbid. It is also uncertain if focal epileptiform EEG abnormalities may be associated with stable cognitive impairment. [ncbi.nlm.nih.gov]

  Her EEG at 2 years was reported as showing frequent left central epileptiform activity. At 4 years, the EEG was more abnormal with the background predominantly comprising bilateral delta rhythms most prominent over the right central region. [brain.oxfordjournals.org]

• EEG Suppression

  Loparo, Automated Detection of Postictal Generalized EEG Suppression, IEEE Transactions on Biomedical Engineering, 65, 2, (371), (2018). [doi.org]

• Focal Epileptiform Discharges

  The cellular neurophysiologic correlate of an interictal focal epileptiform discharge in single cortical neurons is the paroxysmal depolarization shift (PDS). [emedicine.medscape.com]

  epileptiform discharges in focal-to-bilateral tonic-clonic seizures Spikes and slow-wave discharges occurring bilaterally at a rate of 3/second and usually normal background EEG activity in typical absence seizures Slow spike and wave discharges usually [merckmanuals.com]

• Spike-and-Slow-Waves

  Neuroimaging studies were unremarkable and electroencephalograms showed high voltage 200-400uV, 2-2.5 Hz generalized spike-and-waves and polyspikes with alternating frontal predominance, and multifocal spike-and-slow waves. [ncbi.nlm.nih.gov]

  […] and slow waves); (d) occurrence at any age in childhood and adulthood; (e) frequently demonstrable aetiology (tumor, vascular); and (f) no progressive evolution of the syndrome (clinical, electroencephalographic or psychological, except in relation to [medlink.com]

  EEG may detect epileptiform abnormalities (spikes, sharp waves, spike and slow-wave complexes, polyspike and slow-wave complexes). [merckmanuals.com]

  Cigdem Inan Akman, Nonconvulsive Status Epilepticus and Continuous Spike and Slow Wave of Sleep in Children, Seminars in Pediatric Neurology, 17, 3, (155), (2010). Bhaswati Ghosh, Partha S. Ghosh and Iftikhar U. [doi.org]

• Periodic Lateralized Epileptiform Discharges

  lateralized epileptiform discharges (PLEDs) with slow-wave activity. [ncbi.nlm.nih.gov]

Immediate care of seizures:

Little can be done for a person having a major seizure. Supportive treatment includes first aid, maintenance of airway, provision of oxygen and administration of intravenous anticonvulsants.

Anti-convulsant drug therapy:

If the cause of epilepsy is treatable promptly, drug therapy is not necessary. Drug therapy is required when the cause is not immediately treatable and and the patient is at a risk of having further seizures. There are various anticonvulsant drugs with different mechanism of actions. They can be divided into the following large groups [6]. 

• Sodium channels e.g. phenytoin, carbamazepine etc
• GABA-A receptor enhancers e.g. phenobarbital
• T-calcium channel blockers e.g. valproate
• Carbonic anhydrase inhibitors e.g. zonisamide
• Blockers of unique binding sites e.g. gabapentin

Surgical choices

The type of epilepsy surgery depends on the location in the brain causing the seizures. Anterior temporal lobectomy is the most common surgical choice in adults [7]. In children, the surgical choices include corpus callosotomy and hemispherectomy [8] [9].

If epilepsy is properly controlled via medications, the lifespan of the patients is completely normal.

Even without treatment, sudden death in the patients suffering from epilepsy is very uncommon. Those suffering from tonic-clonic seizures may suffer from accidents and traumas. Mortality is also higher in the patients whose seizures are associated with loss of consciousness.

The etiology of epilepsy varies with age group.

In neonates, developmental insufficiency or brain injury are the most common causes for the development of epilepsy.

In the infantile age group, the principal congenital malformations, perinatal injury and metabolic disorders are the principal causes of epilepsy.

In children and adolescents, epilepsy usually results from genetic causes.

In adults, in addition to genetic causes, cerebral neoplasms, drugs, alcohol withdrawal, brain trauma, stroke, infection and surgery are the predisposing conditions that lead to the development of epilepsy.

The genetic syndromes that cause seizures include Angelman syndrome, Rett syndrome, Pitt Hopkin’s syndrome, tuberous sclerosis, Prader Willi syndrome and Struge Weber syndrome [1][2].

The annual incidence of epilepsy in Minnesota was demonstrated by a study to be around a 100 cases per 100,000 persons aged between 0 to 1 years; 40 cases per 100,000 persons aged 38 to 40 years and 140 cases per 100,000 persons aged 79-80 years.

Overall, the total incidence of epilepsy is 3400 per 100,000 men (3.4%) and 2800 per 100,000 women (2.8%) by the age of 75 years [3].

Seizures result from a sudden imbalance between the excitatory and inhibitory mechanisms in the brain [4].

Partial seizures are those in which the seizure activity is restricted to one part of the cerebrum; i.e. the focus of increased electrical activity is in one hemisphere.

On the other hand, in generalized seizures, diffuse regions of both the hemispheres are involved simultaneously and sunchronously.

If any seizure remains for 60 minutes, irreversible brain damage occurs. Cell death occurs from excessively increased metabolic demands of the continuously discharging neurons.

Since the cause of epilepsy is not exactly known, it is not possible to prevent it. However, head injury being the most important cause, if avoided can prevent the development of epilepsy [10]. Wearing seat belts, following traffic rules and avoiding accidents is helpful in reducing the risk of head trauma.
Epileptics sensitive to alcohol must prevent alcohol intake.

A seizure or convulsion is a paroxysmal involuntary disturbance of brain function that may be manifested as an impairment or loss of consciousness, abnormal motor activity, behavioral abnormalities, sensory disturbances or autonomic dysfunction.
Epilepsy is defined as a brain disorder that is characterized by recurrent seizures unrelated to fever or to an acute cerebral etiology.

Epilepsy is a group of disorders characterized by seizures in association with loss of consciousness and psychic abnormalities. The patients of epilepsy may belong to any age group. Early diagnosis and proper management of the disease improves the outcome. Treatment may be done through anti-seizure drugs or brain surgery.

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