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Epilepsy: symptoms and types of seizures

An epileptic seizure can cause a wide variety of symptoms. Cramps, twitching or loss of consciousness do not always occur

Many people think of epilepsy as symptoms such as muscle twitching or cramped muscles. Such signs are actually seen in some seizures. But epileptic seizures can also look very different.

For example, some affected people fidget with an item of clothing for a few moments without motivation or swallow and smack their lips. Others suddenly have strange, inexplicable odor perceptions. Still others seem for a moment to be withdrawn. Numerous seizure symptoms are therefore conceivable. You can find an overview of important types of seizures below on this page.

Usually a single seizure does not last longer than a minute or two. Some seizures are associated with a reduction in consciousness or even loss of consciousness - the affected persons are therefore not accessible for a short time, react little, often slowly or not at all to their environment. Other seizures take place when consciousness is awake or slightly clouded.

Most of the time, someone has a specific type of seizure. So his seizures are similar every time. However, the form of the seizure can change as the disease progresses.

What is an aura?

Some epileptic seizures begin with what is known as an aura: those affected notice, for example, unusual sensory impressions such as tingling, visual disturbances, suffer from concentration disorders or hallucinations. Some feel strange sensations in their stomach (epigastric sensations) or they feel like they are floating. Dizziness or strange taste and smell impressions are also possible.

Some sufferers recognize from the aura that a major seizure event is imminent. But an aura can just as easily be and remain the only symptom of a seizure. Sometimes the aura symptoms allow conclusions to be drawn about the region of the brain in which the attack is occurring. This may help to track down the cause of epilepsy (see chapter causes). So an aura is a brief seizure that occurs in a very limited region of the brain.

The International League Against Epilepsy (ILAE) describes various types of seizures and epilepsies. Therapy is based on, among other things. On the one hand, the observed symptoms flow into the classification, on the other hand, results from examinations are also included:

  • Focal seizures: They start at a very specific point in the brain, for example in the area around a "brain scar" caused by a stroke. Such seizures are also called partial, partial, or focal seizures.
  • Secondary generalized seizures: They start like a partial seizure but then spread to the whole brain.
  • Generalized seizures: They seem to cover the entire brain from the start. With generalized seizures, there are usually also temporary disturbances of consciousness. A specific cause of epilepsy is less common in such seizures than in partial seizures. (More on this in the causes section).

These three types of seizures are broken down further. An overview of important subgroups:

1. Focal seizures

What is a single partial seizure?

A single-focal seizure takes place while fully conscious and can cause a wide variety of symptoms. For example, it can lead to abnormal movements such as twitching of a part of the body, involuntary body rotations or utterances. Or it is about unusual sensory perceptions such as tingling, flashing vision, auditory impressions, dizziness, smell or taste disorders. Other possible symptoms are speech disorders, hallucinations, feelings of fear or the impression of having experienced something before (déja vu). However, many people have dèja vu experiences. So there is more to diagnosing a seizure. The perceptual disorders are - as already described above - also summarized as aura.

What is a complex focal seizure?

This type of seizure can begin like a single focal seizure. In addition, the consciousness becomes cloudy. The patient can no longer be properly addressed. Affected people may behave strangely during a seizure: For example, they can smack their lips or grimace, stammer incomprehensible things or walk around aimlessly.

2. Generalized seizures

What are absences?

An absence (formerly also called petit mal) is a short pause in consciousness. Those affected typically stop moving all of a sudden, seem completely absent for a moment, and do not react to being spoken to. Most of the time, however, they do not fall. This mental absence usually lasts only a few seconds, rarely more than half a minute. In some cases, additional symptoms such as blinking, small mouth or head movements can be observed. Then the people abruptly continue with the activities they have started as if nothing had happened. They don't remember the little loss of consciousness.

This type of seizure occurs especially in childhood and adolescence epilepsy. Since the signs are very vague, they are not always noticed: Parents may only think of their child as unfocused or dreamy, a "Hans peep-in-the-air". Often absences accumulate when you are tired or immediately after waking up.

What are myoclonic seizures?

With this type of seizure, certain muscles or muscle groups start to twitch all of a sudden, for example in the hand, arm or trunk. Consciousness remains. The seizures usually only last a few seconds and then end again just as abruptly. Some sufferers only notice that they keep dropping things by accident - for example their coffee cup.

What are clonic seizures?

During such an attack, muscle groups - especially on the trunk - contract rhythmically. Those affected often fall and may injure themselves in the process. The seizures last for up to several minutes.

What are tonic seizures?

Here the muscles suddenly cramp without twitching. Those affected lose consciousness, fall and bend over, for example, or overstretch their heads. Such attacks usually only last a few moments. They can also occur from sleep.

What are tonic-clonic seizures?

The so-called great seizure (formerly: Grand Mal) is a generalized tonic-clonic seizure. It may be accompanied by an aura (see above) followed by a sudden loss of consciousness. The person affected may scream at the beginning of the seizure, usually falling.

Then there are cramps all over the body for about half a minute, followed by symmetrical twitching of the arms and legs as well as the head, which in turn can last about half a minute. During the seizure, foamy saliva may flow out of the mouth and urine may leak out. As breathing becomes sluggish, the skin gradually turns bluish as a sign of lack of oxygen. It happens that those affected involuntarily bite their cheek or tongue when they have cramps (tongue bite).

After the seizure, those affected are often drowsy and sleep for a while. When they wake up again, they may be confused or disoriented at first. You suffer from sore muscles. They usually do not remember the attack.

What are atonic (astatic) seizures?

With this type of seizure, the muscle tension in part of the muscles suddenly decreases. Depending on which muscles are affected, for example the chin suddenly falls on the chest or the legs bend. Or the person affected literally slumps down. Some sufferers remain motionless for a short time and are momentarily unconscious.

Epileptic seizure - what are the complications?

Depending on the type of attack, those affected may be injured - by objects in their vicinity, falls or accidents, for example in traffic or during sports (swimming, climbing). Strong involuntary muscle contractions sometimes even cause vertebral body fractures or bite injuries to the tongue or cheek.

Dangerous: the status epilepticus

Status epilepticus is what doctors call a seizure that lasts longer than ten minutes - or a series of seizures between which there is no full recovery and that lasts longer than half an hour. The status epilepticus is a threatening situation because it can damage the brain. Therefore: In this case, notify the emergency doctor immediately! More about first aid in the corresponding chapter.