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]

  During a seizure, a person may: Fall down and start shaking Become unconscious or confused Usually after a few minutes, the nerve cells start to behave normally and the person returns to normal. [msdmanuals.com]

• Abdominal Pain

  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]

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

  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 [msdmanuals.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]

• 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. [msdmanuals.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 [msdmanuals.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]

• Muscle Twitch

  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]

  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]

  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]

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

  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]

• 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 [msdmanuals.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]

  Anteromedial temporal lobe Chewing movements, salivation, speech arrest Amygdala, opercular region Complex behavioral automatisms Temporal lobe Unusual behavior suggesting a psychiatric cause or sleep disorder Frontal lobe Visual hallucinations (formed [msdmanuals.com]

• Seizure

  However, non-epileptic seizures look like true seizures, which makes diagnosis more difficult. Normal EEG readings and lack of response to epileptic drugs are two clues they are not true epileptic seizures. [webmd.com]

  Seizures can be classified as being partial-onset seizures and generalized-onset seizures. 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. [symptoma.com]

  Two types of partial seizures are: Simple partial seizures (also called "Jacksonian" or "focal" seizures) - Short-lasting seizures without loss of consciousness. People with these kinds of seizures often see, hear or smell something strange. [faculty.washington.edu]

  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]

• 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]

  During a seizure, a person may: Fall down and start shaking Become unconscious or confused Usually after a few minutes, the nerve cells start to behave normally and the person returns to normal. [msdmanuals.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]

  Having a single seizure as the result of a high fever (called febrile seizure) or head injury does not necessarily mean that a person has epilepsy. Only when a person has had two or more seizures is he or she considered to have epilepsy. [ninds.nih.gov]

• Aura

  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]

  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]

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

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

  Other possible auras include hallucinations of sounds, voices, people, smells, and tastes. Not all people who experience temporal lobe seizures experience auras. Sometimes people do not remember experiencing an aura. [healthline.com]

• 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]

  Lafora disease is also known as Lafora progressive myoclonus epelepsy, which is an autosomal recessive inherited disorder involving reoccurrent seizures and degradation of mental capabilities. [diki.pl]

• 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]

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]

  activity – A-II-1 38 yrs, 6 mths 10 mths 14 yrs GTCS, FS Nil Normal – 2 yrs: L central epileptiform 4 yrs: diffuse slowing, more marked over R central region 5 yrs: bilateral parietal epileptiform 7 yrs: bilateral central and parietal epileptiform – [brain.oxfordjournals.org]

• EEG Suppression

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

  Kalitzin, Dynamics of convulsive seizure termination and postictal generalized EEG suppression, Brain, 10.1093/brain/aww322, (aww322), (2017). [oadoi.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]

  […] activity in primarily generalized tonic-clonic seizures Focal 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 [msdmanuals.com]

• Periodic Lateralized Epileptiform Discharges

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

• 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]

  The EEG background activity shows asymmetric and slow diffuse delta waves, with numerous ictal and interictal discharges that are not strictly limited to the Rolandic area. [medlink.com]

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

  Itsuo Kawai, Kazushige Shingu and Koichi Yamada, Epileptic Cases of Late Onset with the Diffuse Slow Spike‐Wave, Psychiatry and Clinical Neurosciences, 35, 2, (139-146), (2008). [doi.org]

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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