- Depending on the origin of the epileptiform discharge and the type of the seizure, various temporary motor, sensory, autonomic, or psychological symptoms may occur.
- However, the most frequent clinical presentation involves rhythmic twitching and loss of consciousness (tonic-clonic seizure). Other features include
- Temporary confusion
- A staring spell
- Uncontrollable jerking movements of the arms and legs
- Loss of consciousness or awareness
- Disturbance in mood and cognition
- Psychic symptoms such as fear, anxiety or deja vu
- Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend to have the same type of seizure each time, hence the symptoms will be similar from episode to episode.
- Types of seizures
- Focal Seizures – Abnormal activity of one area of the brain causing seizure
- Focal seizures with intact consciousness –
Ictal Phase – Auras are present, clonic, involuntary repetitive movements of the contralateral limbs or facial muscles, Hallucinations, Parasthesias, vertigo etc
Post Ictal Phase: Residual neurological defects, Todd's paralysis
- Focal seizures with impaired consciousness – Often from temporal lobe
Ictal Phase: Auras, Sensory and Psychic symptoms, dejavu, hallucinations, sudden behavioural arrest, Automatisms
Post Ictal Phase: Confusion, Anterograde amnesia, Aphasia
- Generalized Seizures - Seizures that appear to involve all areas of the brain are called generalized seizures. Subtypes are;
- Absence seizures – Characterized by abrupt loss of consciousness, a vacant look and behavioural arrest. The person can maintain posture but may have 3 per second eyelid myoclonia.
- Generalised Tonic-Clonic seizures - begins with a tonic phase characterized by loss of consciousness and tonic contraction of facial, axial and limb muscles leading to a loud cry, rolling up of eyes, rigid posturing of the extremities and Apnoea. The clonic phase that follows is characterized by rhythmic jerking of limbs as in a clonus. The tongue may be bitten. There may be papillary constriction or incontinence.
- Myoclonic seizures - Characterized by a sudden brief shock-like contractions of agonist and antagonist muscle leading to a brief jerk
- Tonic seizures- are very brief (lasting few seconds) but longer than myoclonic. Characterized by sudden spasms of the muscles particularly the axial muscles that throw the subject forcibly down the floor, resulting in deep cuts on the head or face.
- Atonic seizures – sudden lapses in muscle tone resulting in lapses in posture or falls.
Phases of Seizure:
- Prodromal phase - About 20% of individuals with epilepsy experience a prodromal phase – a subjective feeling or sensation that can occur several hours or even days before the actual seizure
- Early Ictal (aura) phase – not seen in all. Some common symptoms are Blurred vision, strange smells, numbness, deja vu etc.
- Ictal Phase - It's the period from the first symptoms (including an aura) to the end of the seizure Some common symptoms are tremors, drooling, stiff limbs, strange sounds, memory lapse etc.
- Postictal Phase – recovery period following the seizure. Some common symptoms are headache/migraine drowsiness, confusion, nausea, general malaise, memory loss, residual neurological symptoms (Todd’s Paralysis )etc.
EPILEPSY – TYPES
- Infantile Spasm (West syndrome) – manifests between 4-6 months of age. Tuberous sclerosis, malformations of cortical developments, Trisomy 21, birth asphyxia, CNS infections and inborn errors of metabolism are the common etiological factors. Seizures are similar to myoclonus but are slower in evolution.
- Lennox –Gastaut syndrome: Epileptic encephalopathy that typically starts around 3 years of age. Characterised by multiple seizures
- Benign Epilepsy with Centrotemporal Spikes (BECT) – Most common epilepsy in childhood. Starts after 3 years of age and remit by adolescence. Partial seizures are typical and involve focal twitching of facial muscles, speech arrest and sialorrhea that occurs during sleep
- Juvenile Myoclonic Epilepsy – Adolescent onset of myoclonus and generalised tonic-clonic seizures without any aura. Seizures are specifically provoked by sleep deprivation
- Differential Diagnosis
- Psychological disorders:
- Pseudoseizures: paroxysmal events that may clinically resemble epileptic seizures but have a psychiatric origin
- Panic attacks
- Psychogenic hyperventilation
- Vasovagal syncope
- Stokes-Adams attack
- Carotid sinus syndrome
- Cardiac failure
- Stroke (including transient ischemic attack )
- Sleep disorders
- REM sleep behavior disorder