Epilepsy: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate epilepsy:

Symptoms of focal seizures

  • Motor symptoms such as.
    • Tonic cramping or muscle twitching in individual regions of the body
    • Turning movements of the head or eyes, respectively
    • Simultaneous bending and stretching movements of the arms
  • Sensory symptoms such as.
    • Hallucinations
    • Tingling
    • Numbness
    • Photopsia (flashes of light; flashes)
  • Vegetative symptoms such as.
    • Paleness
    • Sweating
    • Blushing
    • Piloerection (goose bumps)
    • Mydriasis (pupil dilation)
  • Mental symptoms such as.
    • Aphasia (speech disorder)
    • Dysmnesia – memory disorder such as déjà vu.
    • Cognitive disorders – disorders affecting the memory
    • Affective disorders such as anxiety
    • Illusions or hallucinations

Symptoms of generalized seizures

Non-convulsive seizures (petit mal seizures).

  • Impaired consciousness lasting only a few seconds
  • Amnesia – the affected person can not remember the seizure afterwards
  • Motor and vegetative accompanying symptoms are possible

Convulsive (convulsive) seizures

  • Tonic spasms – strong and prolonged contractions (continuous spasms) of single muscles or muscle groups.
  • Clonic spasms – rapid successive, rhythmic muscle twitches of antagonistic (oppositely acting) muscles with intervening flaccid spasms
  • Tonic-clonic convulsions (also called grand mal seizures) – muscle spasms of long duration are replaced by twitching muscle contractions during the course of the seizure

Atonic seizures

  • Sudden brief loss of muscle tone, causing the affected person to sink to the ground

Myoclonic seizure

  • Brief muscle contractions that can affect the entire body

Duration of epileptic seizures: Usually only a few seconds to about 3 minutes and rarely longer than 5 minutes.

Phases or symptoms of generalized tonic-clonic seizure (GTKA):

  • Seizure onset
    • Possibly aura (perceptions in the run-up to an epileptic seizure: e.g., acoustic, visual, vegetative) and/or involuntary vocalizations (initial cry)
    • Falling down (tonic, “stiff as a board”) (frequent).
  • Generalized tonic-clonic seizure (approx. 1-2 min).
  • Postictal symptoms (“symptoms following an epileptic seizure”; 5-30 min; longer if preexisting brain disease):
    • Twilight state (disorientation, psychomotor agitation and agitation, impaired consciousness) or terminal sleep (patient can be awakened only by strong stimuli).
    • In focal seizures: Todd paresis or aphasia

Other symptoms

  • Face color: bluish (sometimes)
  • Eyes: open, fixed; hearth look.
  • Tongue bite: often lateral tongue bite.
  • Wetting (frequent)

Duration of GTKA: 0.5-3 minutes

Important notes on senile epilepsy!

  • Almost always focal (rarely also generalized).
  • Frequently atypical symptomatology: unclear mental changes, confusion, memory impairment, syncope (momentary loss of consciousness) or vertigo (dizziness)
  • Episode of disturbed consciousness and fixed gaze followed by minutes of persistent confusion (may be the only clinical sign)!
  • Seizure precursors (auras) are rare.

Status epilepticus

According to Lowenstein et al, status epilepticus is defined as follows:

  1. Epileptic seizure that exceeds >5 minutes in duration for generalized tonic-clonic seizures and >20 minutes for focal seizures or absences (earlier definition >30 min); or
  2. Sequence of single epileptic seizures (of above duration) between which complete restitution (recovery) does not occur clinically or electroencephalographically.