Signs and symptoms are not the same thing. A sign is a clinical feature of a disease or condition that a doctor can look for and measure. A symptom is something the patient feels or complains about, such as pain, but cannot be directly observed. Signs and symptoms are both assessed when considering a diagnosis of epilepsy.
Often, a child having a generalized seizure will not remember anything about it and cannot describe their symptoms. It is important to record what your child’s seizure looks like and any factors that may have triggered it. You and anyone who observed the seizure can give valuable information to help your child’s doctor reach a diagnosis.
By contrast, some children having partial seizures do not show any signs. It is only possible to find out about their seizures by asking them about their symptoms - what they experienced during the seizure.
Your child is an expert about their own symptoms, so create opportunities to find out how they are feeling. Talk to them, use artwork to help them express their feelings or use books about epilepsy to encourage discussion about what it is like to experience a seizure.
First seizure
Single, isolated seizures are not always a sign of epilepsy. Seizures can be triggered by illness, fever, medication or injury. As well, some events look like seizures, but in fact are something else. However, a first seizure should always be evaluated by a doctor immediately. Record as much as you can remember about your child’s seizure, since this information will help your child’s doctor determine whether the event was a seizure and whether it is likely to recur.
Seizures come in many forms; your child’s seizure could look like one or a combination of any of the following.
Generalized absence seizures
What are possible signs of an
absence seizure?
- Staring
- the child suddenly stops what they are doing
- A few seconds of unresponsiveness (usually less than 10 seconds, but it can be up to 20 seconds) that can be confused with daydreaming
- Lack of response when you touch your child
- Immediate alertness after the seizure
- Many seizures per day
Less common features include:
- Repetitive blinking
- Eyes rolling up
- Head bobbing
- Automatisms such as licking, swallowing and hand movements
- Autonomic symptoms such as dilated pupils, flushing, pallor (paleness), rapid heartbeat or salivation
Some of these less common features may result in the seizures being termed atypical absence seizures. Atypical absence seizures may be confused with complex partial seizures.
Generalized myoclonic seizures
What are possible signs and symptoms of a
myoclonic seizure?
- One or many brief jerks, which may involve the whole body or a single arm or leg (in juvenile myoclonic epilepsy, these jerks often occur upon waking)
- Remaining conscious
Generalized atonic seizures
What are possible signs and symptoms of an atonic seizure?
- Sudden loss of muscle tone
- Going limp and falling straight to the ground
- Remaining conscious or having only a brief loss of consciousness
- Drooping eyelids, head nodding
- Jerking
- Seizures usually lasting less than 15 seconds, although some may last several minutes
- Rapid return to consciousness and alertness after the seizure
Generalized tonic-clonic seizures
What are possible signs of a tonic-clonic seizure?
- Crying out or groaning loudly
- Loss of consciousness and falling down
- Increased heart rate and blood pressure
- Sweating
- Tremor
- In the tonic phase, the child is rigid, their teeth clench, their lips may turn blue because blood is being sent to protect their internal organs, and saliva or foam may drip from their mouth; they may appear to stop breathing because their muscles, including their breathing muscles, are stiff.
- In the clonic phase, the child resumes shallow breathing; their arms and legs jerk quickly and rhythmically; their pupils contract and dilate.
- At the end of the clonic phase, the child relaxes and may lose control of their bowel or bladder.
- Following the seizure, the child regains consciousness slowly and may appear drowsy, confused, anxious or depressed.
In some cases, the seizure may not progress to a clonic phase.
Neonatal seizures
Neonatal seizures occur in babies who are less than 28 days old. Seizures in a newborn are often short and subtle; it can be difficult to tell whether a baby is actually having a seizure. Seizures in newborns can include:
- repetitive facial movements, including sucking, chewing, or eye movements
- unusual bicycling or pedalling movements
- staring
- apnea (stopping breathing)
- clonic seizures, which are rhythmic jerking movements that may involve the muscles of the face, tongue, arms, legs, or other regions
- tonic seizures, which are stiffening or tightening or muscle groups; the head or eyes may turn to one side, or the baby may bend or stretch one or more arms or legs
- myoclonic seizures, which are quick, single jerks involving one arm or leg or the whole body.
Infantile spasms
What are possible signs of infantile spasms?
- Usually begin within the first year of life, typically between the ages of three and seven months
- Slight head bobbing, which becomes more rapid over time, followed by flexor, extensor or mixed spasms
- With flexor spasms, the child’s neck, arms, and legs draw towards their chest; the child often bends at the waist in a “jackknife” motion.
- With extensor spasms, the child’s neck, arms, and legs stretch out.
- With mixed spasms, the child’s arms and body contract and their legs stretch out.
- Spasms are usually symmetrical, although they may be stronger on one side.
- In most cases, the spasms occur in clusters; they repeat every five to 30 seconds, sometimes 10 to 40 times in a single attack; a child may have several such attacks per day.
- An attack usually continues for two to three minutes, and the spasms become less intense and farther apart as the cluster progresses.
- Seizures rarely occur while a child is asleep, and often happen just after they wake up.
- A child may be quiet before and during the attack, or may cry between spasms.
- After a cluster of spasms, child may be exhausted or more alert.
Simple partial seizures
Simple partial seizures appear different from person to person, depending on the seizure focus (the affected area of the brain). A common feature of simple partial seizures is that the child remains alert and can remember what happened.
Motor seizures
What are possible signs and symptoms of a focal motor seizure?
- Brief muscle contractions (twitching, jerking, or stiffening), often beginning in the face, finger or toe on one side of the body
- Twitching or jerking spreading to other parts of the body on the same side near the initial site
- Sometimes, movement of the eye and head
- Consistent start to seizure each time
- Remaining conscious
Sensory seizures
What are possible symptoms of a sensory seizure?
- Seeing something that is not there, such as shapes or flashing lights or seeing something as larger or smaller than usual
- Hearing or smelling something that is not there
- Feeling of pins and needles or numbness in part of the body
- The child remains conscious
Autonomic seizures
What are possible signs and symptoms of an autonomic seizure?
- Changes in heart rate
- Changes in breathing
- Sweating
- Goose bumps
- Flushing or pallor (going pale)
- Remaining conscious
- Strange or unpleasant sensation in the stomach, chest or head
Psychic seizures
What are possible signs and symptoms of a psychic seizure?
- Problems with memory
- Garbled speech
- Sudden emotions for no apparent reason, such as fear, depression, rage or happiness
- Feeling like they are outside their own body
- Feelings of déjà vu, jamais vu or knowledge of the future
Secondarily generalized seizures
A secondarily generalized seizure begins as a simple partial seizure, then spreads to the whole brain to result in a generalized tonic-clonic or clonic seizure.
Complex partial seizures
What are possible signs and symptoms of a complex partial seizure?
- Warning sign such as a feeling of fear or nausea
- Loss of awareness
- Blank stare
- Walking or running
- Screaming, yelling or thrashing, either from sleep or while awake
- Automatisms such as mouth movements, picking at air or clothing, repeating words or phrases
- Loss of memory about events just before or after the seizure
- Confusion after a seizure
Aura
Some children have auras before their seizures, which they can learn to recognize. An aura is a warning sign such as a feeling of fear or nausea. It is actually a simple partial seizure.
What is not a seizure?
Some episodes may look like seizures, but in fact do not originate in the brain. These include:
- fainting
- daydreaming
- behavioural outbursts in certain situations
- tics
- some myoclonic jerks
- breath-holding spells
- migraines
- non-epileptic psychogenic seizures, which are a subconscious emotional reaction; these may look like a seizure, but there is no change in the brain’s activity.
Your child’s doctor may want to rule out these possible causes when evaluating your child.
In some cases, seizures are not caused by epilepsy. These include non-epileptic psychogenic seizures and febrile seizures. Some children may have both epileptic and non-epileptic seizures.
Recording signs and symptoms
Keeping track of your child’s signs and symptoms is important for diagnosis. Information you can record includes:
- the time of day the seizure occurred
- what your child was doing before the seizure
- if they are sick, tired, or stressed
- if they are taking any medication
- how the seizure began
- if they felt any warning signs
- what their movements (if any) looked like during the seizure
- if the movements were on a particular side of their body
- whether they were able to talk and respond during the seizure
- whether they made any sounds
- how long the seizure lasted
- if they were confused, tired, or sore after the seizure
- if they could speak normally after the seizure
To guide you in recording your child's seizures, please see the following resource:
Are seizures painful?
Some children experience pain as part of a simple or complex partial seizure. Ask your child if their seizures are painful.
While a child is having a tonic-clonic seizure, they may cry out, fall to the ground and convulse. This is frightening to watch, but they are not aware of it.
When the seizure is over, some children say that their head or stomach hurts or their muscles ache. If a child hits their head or bites their tongue during a seizure, this can hurt as well.
You can ask your child’s doctor or nurse if it is okay to give your child
acetaminophen or
ibuprofen after a seizure for any aches and pains.
