Many people believe that epilepsy symptoms are limited to sudden falls, convulsions, and loss of consciousness, but in reality epilepsy seizures can appear in different ways, and some are brief and easy to miss, such as staring blankly, a sudden feeling of fear, or temporary changes in sensation.

Epilepsy is a common neurological disorder that can affect people of all ages. Knowing the epilepsy symptoms helps you recognize possible warning signs, respond correctly when a seizure occurs, and seek medical evaluation in time.

What is epilepsy?

Epilepsy is a non-contagious neurological disorder in which the brain has a tendency to produce recurrent seizures caused by abnormal electrical activity in brain cells. These seizures can affect consciousness, movement, sensation, or behavior, depending on the area where the abnormal activity starts and how far it spreads.

The World Health Organization states that around 50 million people worldwide live with epilepsy, and that up to 70% of them can live seizure-free if they receive proper diagnosis and treatment. It is important to know that a single seizure does not necessarily mean a person has epilepsy; seizures can occur for various reasons, and the doctor determines the nature of the condition based on the medical history and the necessary tests.

What are the symptoms of epilepsy?

Epilepsy symptoms vary from person to person, and not every sign appears in every patient. The type of seizure and the area of the brain affected also determine the nature and duration of the symptoms. The most prominent signs that may appear during seizures include:

1. Convulsions and involuntary movements

Involuntary muscle movements are a well-known sign of some epileptic seizures, and may include:

• Repeated shaking of the arms or legs.
• Sudden muscle stiffness.
• Convulsive movements in parts of the body or the whole body.
• Sudden falling due to loss of muscle control or consciousness.

However, not everyone with epilepsy has obvious convulsions; seizures may appear with less noticeable symptoms.

2. Loss of consciousness or reduced responsiveness

A person may temporarily lose consciousness during a seizure, or become unable to respond to those around them. In some cases, the person may appear awake but cannot interact normally with speech or their surroundings.

3. Sudden staring into space

Some seizures cause a brief pause in activity with staring into space and no response for a few seconds.

This may be accompanied by rapid eye blinking or simple movements of the mouth or hands. These seizures can go unnoticed, especially in children, and some may think the child is not paying attention or is daydreaming.

If these episodes recur, it is important to seek medical evaluation rather than assuming they are merely a lack of attention.

4. Sudden fear or anxiety

Some people may feel sudden fear or an unfamiliar sensation for no clear reason, which may be accompanied by a strange feeling in the stomach or a sudden change in sensation. These feelings may be part of a focal seizure in some patients, but they do not by themselves mean epilepsy, as they can also occur for other reasons.

5. Temporary changes in the senses

• Sensory symptoms during some seizures may include:
• A tingling or numb feeling in part of the body.
• Seeing unusual lights or shapes.
• Hearing sounds or perceiving things differently.
• Smelling or tasting something unfamiliar with no clear source.

These symptoms vary depending on the area of the brain affected.

6. Unusual movements or behaviors

During a seizure, a person may make repeated, unintentional movements, such as moving the hands, smacking the lips, or walking without full awareness of what they are doing. They may appear confused or unable to answer questions normally. It is therefore important to note how often these behaviors recur, how long they last, and the circumstances in which they occur.

7. Loss of bladder control

Involuntary urination may occur during some seizures, especially those accompanied by loss of consciousness and convulsions. However, this sign is not present in every case and is not enough on its own to diagnose epilepsy.

8. Confusion and fatigue after a seizure

After some seizures end, a person may feel tired, sleepy, or have a headache, and may experience temporary confusion or difficulty remembering what happened. Recovery time varies from one person to another and from one seizure to another.

What are the types of epileptic seizures?

Seizures differ depending on where they begin in the brain and how they affect consciousness, movement, and sensation. The main types include:

First: Focal seizures

Focal seizures begin in one area of the brain and may affect movement, the senses, emotions, or behavior.

The person may remain aware of what is happening around them, or their awareness may be partially or completely affected. Examples include a sudden tingling sensation, involuntary movements in part of the body, or temporary changes in perception.

Second: Generalized seizures

Generalized seizures affect wide networks on both sides of the brain from the start of the seizure, and may appear in different forms, including:

• Tonic-clonic seizures: May be accompanied by loss of consciousness, muscle stiffening, and then repeated convulsive movements.
• Absence seizures: Involve a brief interruption in consciousness or responsiveness, and may appear as sudden staring.
• Other types of generalized seizures: May cause sudden muscle jerks or changes in muscle tone without all of them involving traditional convulsions.

The type of seizure cannot be determined from a general description alone; the doctor needs to evaluate the symptoms and the details of how they occur, and may request additional tests.

What causes epilepsy?

Epilepsy may be linked to various factors that affect the structure of the brain or its electrical function. In some cases, doctors cannot identify a clear cause. Possible causes include:

• Genetic factors and certain genetic changes.
• Severe brain injuries.
• Strokes and some blood vessel diseases.
• Certain infections that affect the brain or central nervous system.
• Certain structural abnormalities or disorders in the brain.
• Certain complications before, during, or after birth.

Having one of these factors does not mean a person will inevitably develop epilepsy. Likewise, there is a difference between epilepsy and seizures that may occur as a result of an acute medical problem, such as low blood sugar, electrolyte disturbances, or certain types of poisoning. A first-time seizure requires medical evaluation to determine the cause.

How is epilepsy diagnosed?

Diagnosing epilepsy relies on a comprehensive medical evaluation and cannot be confirmed from symptoms alone.

The evaluation may include:

1. Medical history: The doctor asks about the nature and duration of the seizure, what happened before, during, and after it, and whether it has happened again.
2. Witness description: Observations from someone who saw the seizure, or a safe video recording of it if possible without delaying first aid, can help clarify its nature.
3. Electroencephalogram (EEG): Helps record the electrical activity of the brain and look for patterns that support the diagnosis.
4. Magnetic resonance imaging (MRI): May be used to detect structural changes in the brain.
5. Additional tests: The doctor may request blood tests or other tests to rule out different causes of the seizure.

The results of some tests may be normal even when epilepsy is present, so the doctor interprets the results based on the symptoms and the full medical history.

How is epilepsy treated?

Treatment depends on the type of seizures, their cause, and the patient’s age and health, and aims to control seizures and reduce their impact on daily life.

1. Anti-seizure medications

Anti-seizure medications are used to control abnormal brain activity. The doctor determines the appropriate medication and dose according to the type of seizures and other factors.

It is essential to follow the prescribed doses and not to stop the medication or change its dose without consulting the doctor, because sudden discontinuation may cause seizures to return or increase the risk of having them.

2. Surgery in some cases

Surgery may be discussed for some patients whose seizures do not respond to appropriate medications, after a specialized evaluation to determine whether it is suitable.

3. Other treatment options

Some patients may benefit from other options, such as neurostimulation or the ketogenic diet under the supervision of a specialized medical team, depending on the case. The World Health Organization notes that up to 70% of people with epilepsy can live seizure-free with proper diagnosis and treatment.

What should you do if you see someone having an epileptic seizure?

The right response during a seizure helps protect the person from injury. If you see someone having a convulsive seizure, follow these steps:

• Stay calm and stay next to the person.
• Move furniture and sharp or hard objects away from them.
• Place something soft under their head if they are on the floor.
• Loosen tight clothing around the neck if you can do so safely.
• Time the seizure.
• After the convulsions stop, help them lie on their side if they are breathing, and stay with them until they fully regain consciousness.

Avoid completely:

• Restraining the person’s movements by force.
• Putting anything in their mouth, including fingers, water, or medication.
• Trying to give them food or drink before they have fully regained consciousness.

When should you call an ambulance?

Call an ambulance immediately if it is the person’s first seizure, if the seizure lasts five minutes or longer, if seizures recur without the person regaining consciousness in between, or if the person has difficulty breathing or suffers a serious injury. The person may also need urgent medical help if the seizure occurs in water or if they do not return to their usual state after it ends.

If the person has been diagnosed with epilepsy and has an emergency plan set by their doctor, follow it if you know how to apply it, without delaying the call for an ambulance when danger signs appear.

Can people live with epilepsy normally?

Yes, many people with epilepsy can study, work, and carry out their daily activities, especially when their seizures are under control and they receive appropriate care. Managing the condition includes adhering to treatment, following up with the doctor, knowing the signs that may precede seizures in some patients, and paying attention to regular sleep and avoiding known personal triggers.

Family and community support and awareness of the condition also help reduce the social stigma and misunderstanding associated with epilepsy. A diagnosis of epilepsy should not be a reason for isolation or discrimination; a medical condition does not define a person’s abilities or worth.

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