Epilepsy Symptoms, Risk Factors, Diagnosis and Treatment | Narayana Health

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Symptoms, Causes, Risk Factors, Diagnosis & Treatment



What is Epilepsy?

Epilepsy meaning - Epilepsy, commonly known as fits disease, is a disorder of the central nervous system in which the brain shows abnormal behavior that results in recurrent and unprovoked epileptic seizures. This neurological disorder is chronic and it’s identified as seizures occurring without any indication of a known or reversible medical condition like alcohol withdrawal or low blood sugar. Having a series of two unprovoked seizures is considered to be symptoms of epilepsy in which case a doctor should be consulted immediately.

Anyone can develop epileptic fits. But epilepsy disease is generally seen in people who have gone through a brain injury or have inherited it from their family. The right cause of epilepsy is often not exactly known.

Epilepsy is the result of chronic neurological conditions but it is fairly common among all types of neurological disorders with over 65 million people being affected worldwide. One of the most common neurological disorders, epilepsy in children is seen more than that in adults. Moreover, males have more chances of being affected by epilepsy seizures than females.



What is a Seizure?

A seizure by definition refers to the sudden rush of electrical activity in the brain. Seizures symptoms can vary greatly but many people who face any epileptic attack may have more than one type of seizure. Mild seizures may even be difficult to recognize as the only symptom is a lack of awareness for a few seconds. Stronger seizures lead to muscle spasms and untrollable twists in the muscle. They also cause confusion and patients may lose consciousness with no memory of the incident later.

Seizure Vs Epilepsy

Epilepsy and seizure are by definition not the same. Seizures refer to a single occurrence of fits whereas epilepsy definition is the recurrent and unpredictable incidents of seizures.



Symptoms of Epilepsy

Epilepsy Symptoms

Unpredictable seizures are the main epilepsy symptoms. But symptoms of fits can vary on a case-by-case basis depending on the particular type of fits. The different types of epilepsy along with their respective symptoms are given below:

There is change in the classification of epilepsy recently in 2017 and as per ILAE

Seizures are classified as

Focal when seizures begin one area of brain and remain in one side of the brain.The term Focal has replaced the previous term Partial. Focal onset seizures are subdivided into those with retained and impaired awareness. Focal aware seizures correspond to the old classification as ‘’simple partial seizures” and focal impaired awareness seizures to the previous designation “complex partial seizure. Awareness means consciousness in new definition. Focal onset seizures further classified as motor versus non-motor. A seizure that starts focally and then spreads to bilateral tonic clonic movement is called a focal to bilateral tonic-clonic seizure, corresponding to the old phrase “secondarily generalized tonic-clonic seizure”

Focal Seizures or Partial Seizures

Focal epilepsy is the type of seizure when the abnormal activity originates from only one area of the brain. Further classification of seizures that occur partially are:

Simple partial seizures: Focal seizures that do not involve loss of consciousness are referred to as simple partial seizures. Signs and symptoms of epilepsy generate in only one part of the brain are:

  • These epilepsy types lead to alteration of emotions and other physical sensations like smell, taste or sound, among others
  • Involuntary jerking of body parts such as arms and legs occurs along with spontaneous seizure disorder symptoms like feelings of dizziness, unusual tingling and twitching of limbs and flashing lights in front of the eyes

Complex partial seizures: Originating in one part of the brain, focal seizures that lead to fits disease symptoms such as complete lack of consciousness or awareness of the surroundings are called complex partial seizures. Neurological problem symptoms associated with this condition are:

  • Patients tend to stare at space or at a certain point blankly for a long period of time
  • Epilepsy patients who faced a complex epilepsy attack do not respond normally to their environment
  • Instances of patients performing repetitive movements such as chewing, walking around in circles, hand rubbing and swallowing have been seen.

Generalized Seizures

when the clinical or EEG findings suggest onset in both hemispheresof brain . Generalized onset seizures are categorized as motor and non-motor (absence) seizures. The generalized onset tonic clonic seizure, colloquially referred to as “grand mal,” has retained its place in new classification. There are six main types of seizures disease:

Absence seizures: One of the most common types of seizures in children, absence seizures were previously known as petit mal seizures. Fits in children caused by this disorder often occur in clusters and show the following symptoms:

  • Blankly staring into space
  • Lack of awareness
  • Random and subtle body movements such as lip-smacking and eye blinking

Tonic seizures: This type of seizures cause stiffness of the muscles. This generally affects the muscles at your arms, legs, and back. These epilepsy fits are so strong that they may cause the patient to fall down due to a lack of muscle movement.

Atonic seizures: Atonic seizures show fits disease symptoms in adults in which case, there occurs a complete loss of muscle control leading to the patient suddenly collapsing and falling down.

Clonic seizures: Such types of seizures are associated with repetitive or rhythmic jerking movements of the body muscles. This generally affects the neck, face, and arms.

Myoclonic seizures: Myoclonic epilepsy usually occurs with sudden brief jerks of the body muscles that cause unpredictable and involuntary twitching in the arms and legs.

Tonic-clonic seizures: One of the most dramatic types of epileptic seizures, various unprovoked incidences can take place on its occurrence. Previously known as grand mal seizures, the symptoms include:

  • Abrupt and random loss of consciousness
  • Extreme stiffening of muscles
  • Involuntary shaking of the body
  • Loss of urinary bladder and bowel control
  • Random acts like tongue biting



Triggers of Epilepsy

Certain environmental factors have been known to trigger epilepsy. Such triggers are often not easy to identify. The most commonly reported triggers that are known to cause fits in children and adults are:

  • Lack of sleep or insomnia
  • Excessive stress
  • Fever and illness
  • Bright flashing lights with certain distinguished patterns
  • Intake of too much caffeine, alcohol, drugs or medicines
  • The habit of skipping meals or overeating
  • Certain food ingredients

A single incident does not always mean that it is a seizure trigger. It is often a combination of numerous factors. The best way to find out is by keeping a seizure journal and noting down important points about the environment and conditions that lead to fits every time. The points that one should note in the journal are as follows:

  • The day and time of seizure
  • The activity that the patient was involved in at the time of the attack
  • The environmental situation around the patient at the time
  • Unusual sights, smells and sounds
  • Level of fatigue
  • If the patient has had proper sleep the night before
  • Unusual stress factors



What Causes Epilepsy?

It is considered that for more than half of the people with epilepsy, the actual cause of the disease cannot be identified. The several most common epilepsy causes that have been known are:

  • Genetic factors and heredity: One of the main causes of epilepsy is genetics. Epilepsy research has indicated that specific genes of the human genome make the patients more susceptible to environmental triggers that cause fits. But for most of the affected population, genes are only a part of the cause.
  • Trauma in the head: Any traumatic injury in the brain or skull due to an accident or other factors can lead to epilepsy. This leads to the scarring of the brain.
  • Condition of the brain: Another primary fits disease causes is brain health. Brain tumors or a history of brain stroke is a major cause of epileptic fits in adults over the age of 35.
  • Infectious diseases: Diseases such as meningitis, HIV AIDS and viral encephalitis can also be reasons for epilepsy.
  • Prenatal brain injury: Fetuses in the mother’s womb are extra sensitive to brain damage. If the mother’s health is poor, such as the presence of infections or nutrition and oxygen deficiencies can lead to severe prenatal brain injury in the baby. This ultimately causes seizure disorder meaning fits or cerebral palsy.
  • Developmental disorders: Disorders such as autism and other growth defects can lead to the development of epileptic seizures.
  • Presence of brain tumors or cysts in the brain.



Risk Factors of Epilepsy

The exact cause or trigger of epilepsy has not yet been understood by doctors, but there are certain factors that increase the risks of epilepsy. They are:

  • Age - Epilepsy is seen most commonly in children and older adults but it can happen to patients of any age
  • Family history - Family genetic history of epilepsy leads to an increased risk of epileptic seizures in patients due to the presence of specific genes
  • Head injury or trauma due to an accident
  • Seizures in childhood
  • Brain diseases - Certain brain conditions such as Dementia and Alzheimer’s disease can increase the risk in cases of older adults
  • Brain infections - Viral infections such as encephalitis, AIDS or meningitis which causes inflammation in the brain or spinal cord lead to epilepsy
  • Stroke and other vascular diseases - Such conditions cause brain damage which may, in turn, lead to occurrences of seizures and acute epilepsy



Steps to Prevent Epilepsy

Total prevention of epilepsy is not possible but certain habits can help reduce the incidences of epileptic seizures. They include:

  • Patients should learn stress management and relaxation techniques by taking up yoga and meditation
  • Follow a proper sleep schedule
  • Maintain a healthy diet as prescribed by the doctor
  • Avoid excessive exposure to TV, computer and video games
  • Avoid consumption of alcohol and drugs
  • Consume only prescribed medications
  • Avoid bright and flashing lights or other forms of visual stimuli
  • Pregnant mothers with epilepsy disorder running in their families should take extra care of their health



Diagnosis of Epilepsy

Epilepsy Diagnosis

To determine the cause of seizures, the doctor may recommend certain tests in order to help patients with an accurate treatment and management plan:

The most common tests involve:

  • Neurological examination - A complete pathophysiology of epilepsy is determined by studying motor abilities, overall behavior and mental function. This is done to find out the region of the brain that is causing the repetitive seizures.
  • Blood tests - This is done to check for infections and genetic conditions that may be the cause of epilepsy.

Tests to detect abnormalities in the brain include:

  • Electroencephalogram (EEG) - During this test, doctors attach electrodes to the skull that measures the electrical activity in the brain. Often, epileptic seizures meaning is that the brain shows abnormal patterns of waves or electrical activity which can help doctors determine the region that is causing the seizures.
  • High-density EEG - Similar to normal EEG but in this case, the electrodes are placed to close to each other. This helps doctors determine the precise location of the origin of epilepsy in the patient.
  • Computed Tomography (CT) Scan - Provides cross-sectional images of the brain to reveal the presence of abnormalities.
  • MRI - MRI uses radio waves and magnets to create a detailed view of the brain that can help to locate and identify abnormalities and lesions in the brain.
  • Functional MRI - Functional MRI or fMRI identifies the changes in the blood flow in the brain which usually happens when certain parts of the brain are not working normally.
  • Positron Emission Tomography (PET) - PET scan uses small amounts of radioactive traces that is injected into the veins to help doctors see the active areas of the brain with abnormalities
  • Single Photon Emission Computerized Tomography (SPECT) - SPECT is performed when MRI and PET fail to precisely locate the exact origin of the epileptic seizures.
  • Neuropsychological tests - Types of epilepsy pathophysiology tests, this includes the assessment of thinking, memory and speech skills to identify the part of the brain that has been affected.



Stages of Epileptic Seizures

There are three phases of a seizure known as Aura, Ictus and Postictal

  • Aura - The 1st stage of a seizure, in this phase, patients experience vision loss, numbness, tingling of muscles and buzzing sounds, flickering lights and hallucinations and dark spots among other similar experiences.
  • Ictus - The ictus phase or peak stage manifests in different ways for different people depending on whether the seizure is focal or generalized. Common occurrences are confused looks, blackouts, loss of awareness and consciousness, repetitive blinking and sudden collapse.
  • Postictal - This is the recovery phase of the seizure when people still tend to experience certain side-effects. They involve dizziness, hypertension, difficulty walking or talking, lack of bladder control and headaches.



Treatment and Management


Epilepsy symptoms and treatment may vary on a case-by-case basis. Doctors generally begin the first line of treatment with medications. These are generally available in tablet, liquid, and injectable forms that travel to the bloodstream and affect neurotransmitters that regulate the electrical activity in the brain.

Antiepileptic medications include the following drugs:

  • Levetiracetam
  • Lamotrigine
  • Topiramate
  • Valproic acid
  • Carbamazepine
  • Ethosuximide

Antiepileptic meaning is that these medicines help act against seizures in the brain. But they also have certain side-effects. Such problems involve:

  • Fatigue and dizziness
  • Loss of coordination and balance
  • Memory problems
  • Skin rashes

More severe side-effects have also been seen which include depression, suicidal thoughts, and inflammation of vital organs of the body. More than half of the population affected by epileptic seizures tend to become seizure-free after the first dosage of prescribed medications.


Surgery is another means of fits disease cure. In cases where medications fail to provide a cure for seizures, doctors may recommend surgeries.

Resection - The procedure involves the removal of the part of the brain that causes seizures. This is only performed when:

  • The epileptic seizure originates in a very small area of the brain
  • When doctors are sure that the surgery will not affect vital functions of the body like speech, vision, sense of smell and sound, language and motor capabilities.

Multiple Subpial Transection or Disconnection - This is done when the affected area of the brain is large. In this procedure, the doctor makes cuts in the brain to interrupt the nerve pathway that can help stop the spread to seizures in the brain.

Side-effects of epilepsy surgery may involve permanent damage to cognitive abilities and hence it is only performed in rare cases.


Apart from medications and surgical procedures, certain therapies are also available as an alternative option for the treatment of epilepsy. Such therapies include:

  • Vagus nerve stimulation - In this procedure, the doctor implants a device underneath the skin of the chest which has wires connected to the vagus nerve of the neck. This battery-powered device sends bursts of electrical activities to the brain which helps reduce seizures by 20 to 40 percent.
  • Deep brain stimulation - In this case, surgeons implant electrodes inside the specific parts of the brain, usually the thalamus. These electrodes are connected to the generator implanted in the chest or skull that sends electrical signals to the brain which reduces seizures.



Road to Recovery and Aftercare

Patients who have faced depression and anxiety issues may continue to face such problems even after surgery. Post-surgical symptoms such as headaches, swelling of the forehead, fatigue and upset stomach are normal. Most patients go back to near-normal life within 4-6 weeks of surgery. Some coping mechanisms include:

  • Diet - There are certain dietary restrictions that patients should follow in the recovery stage. A ketogenic diet is recommended for children with epilepsy. This diet is low in carbohydrates and high in fats. This helps in reducing seizures in children. For adults with epilepsy, an alternate form of diet called the Atkins diet is recommended by doctors. This too has high-fat content but a balanced amount of carbohydrates.
  • Keeping handy a seizure diary that records the incidents and environmental changes that triggers epilepsy
  • Wearing a medical alert bracelet to let family and friends know in the event of a seizure
  • Seeking professional help when symptoms of depression and anxiety start to show



Epilepsy FAQs: All your concerns addressed

Q.  What is the meaning of epilepsy?

  1. Epilepsy means the occurrence of more than one unpredictable and unprovoked seizures that happens due to abnormal activities in one or more regions of the brain.

Q.  What is meant by epileptic fits?

  1. The term epileptic meaning is that it is associated with incidences of epilepsy. Epileptic fits meaning is the recurrent seizures that lead to lack of vision and other sensations and causes random, involuntary jerking of the muscles of the body.

Q.  What is the neurology definition?

  1. Neurology means the branch of medicine or biology that deals with the anatomy, functions, and disorders of the nerves and the central nervous system as a whole.

Q.  What is the difference between Seizure and Epilepsy?

  1. The primary difference between epilepsy and seizure is that the latter is a single occurrence whereas the former is a proper neurological disorder characterized by two or more episodes of seizures.

Q.  Is epilepsy fatal?

  1. The risk of sudden death in epilepsy is very rare and it is only seen happening in 1% of the population affected by neurological disease.

Q.  Is epilepsy hereditary?

  1. Certain research links specific genes to epilepsy. But in many cases, it is seen that parents with epilepsy do not always have children with the same fits disorder. If pregnant mothers suffer from epilepsy, then antiepileptic medications can affect the unborn baby and cause prenatal damage to their brain.

Q.  Is there a cure for epilepsy?

  1. There is no exact cure for epilepsy but early identification, treatment, and management can help affected individuals live near-normal life. Antiepileptic medicines help control the occurrences of seizures to a great extent but they have severe side-effects. Two types of surgeries are also performed in which the defective area of the brain is removed that can permanently eliminate events of epilepsy.

Q.  What is the recovery period of surgery for epilepsy?

  1. It is found that almost 81 percent of people who underwent surgery for epilepsy have been seizure-free after six months of the procedure. After 10 years, 72 percent of such population still live seizure-free, almost normal lives.

Q.  What are the main causes of epilepsy?

  1. For up to 70% of the epilepsy cases among children and adults, no cause can be discovered. The Epileptic condition may be traced to various factors, including:
  • Low oxygen during birth
  • Head injuries during birth or from accidents
  • Brain tumours
  • Genetic influence from family
  • Abnormal level of sodium or blood sugar which results in a chemical imbalance
  • Certain toxic chemicals or drugs of abuse
  • Alcohol withdrawal
  • Developmental disorders, such as autism and neurofibromatosis
  • Infectious diseases, like AIDS, viral encephalitis, meningitis, encephalitis can cause epilepsy.
  • Brain conditions like Alzheimer’s disease can also cause seizures

Q.  What does having epilepsy mean for your everyday life?

  1. Epilepsy is a medical condition in which a person has recurrent seizures. A seizure is an abnormal, disorderly discharging of the brain's nerve cells, resulting in a temporary disturbance of motor, sensory, or mental function. This hampers life skills such as driving and swimming due to the high risk if a seizure happens during this time.

Q.  What are the first signs of a seizure?

  1. Some warning signs of possible seizures may include:
  • Odd feelings, often indescribable
  • Unusual smells, tastes, or feelings
  • Unusual experiences – "out-of-body" sensations; feeling detached; situations or people look unexpectedly familiar or strange body looks or feels different
  • Feeling spacey, fuzzy
  • Temporary confusion
  • Periods of forgetfulness or memory lapses
  • Psychic symptoms such as fear, anxiety or deja vu
  • Daydreaming episodes
  • Jerking movements of an arm, leg, or body
  • Falling
  • Sudden loss of consciousness or awareness
  • Tingling, numbness, or feelings of electricity in part of the body
  • Headaches
  • Unexplained sleepiness, weakness
  • Losing control of urine or stool unexpectedly

Q.  Can you feel a seizure coming on?

  1. Often termed as aura, the warning or the first symptom of seizure is an indescribable feeling. The aura can also occur as a focal onset aware seizure, which is a partial seizure without much change in awareness. In most epilepsy cases, people do not feel any aura or warning; the seizure starts with a loss of consciousness or awareness.

Q.  What are the different types of seizures?

  1. It is found that almost 81 percent of people who underwent surgery for epilepsy have been seizure-free after six months of the procedure. After 10 years, 72 percent of such population still live seizure-free, almost normal lives.
  2. Focal (or partial) seizures occur in a limited part of the brain hemisphere. There is a specific site or a focus where the seizure begins. There are two types of focal seizures:

  • Focal seizures with retained awareness
  • Focal seizures with a loss of awareness

Generalized seizures are a widespread seizure activity in the left and right hemispheres of the brain. The different types of generalized seizures are:

  • absence seizures
  • tonic-clonic or convulsive seizures
  • atonic seizures
  • clonic seizures
  • tonic seizures
  • myoclonic seizures

Infantile Spasms is an epileptic seizure which is neither focal nor generalized seizure. It starts at an early stage of life, usually around three to seven months of age.

Psychogenic non-epileptic seizures are not exactly due to epilepsy but may look very similar to an epilepsy seizure.

Q.  Can epilepsy kill you?

  1. Epilepsy can be fatal but its completely undetectable or unpredictable. After a seizure, one might die in sleep. The condition is called SUDEP - sudden unexpected death in epilepsy. There's a condition called status epilepticus, where the patient can have single or multiple seizures that lasts more than five minutes. 30% of such patients die within 30 days.

    Also, Epileptic patients are 5 times more likely to take their own lives than the general population. Most deaths in epilepsy are accidents rather than a medical condition. Seizure during drowning, car accidents, falls, burns or cardiovascular problems can be fatal.

Q.  If I have Seizure, does that mean I have epilepsy?

  1. Not really. Seizures disorder may also occur when you have other medical conditions such as:
    • A high fever.
    • Low blood sugar.
    • Alcohol or drug withdrawal

Q.  How is epilepsy disease diagnosed?

  1. A person who has a seizure for the first time should talk to a primary health care provider. Your healthcare provider would look into what happened and the underlying cause of it. People who have seizures may need to undergo tests like brain scans for a closer look.

Q.  Who gives epilepsy treatment?

  1. If you have epilepsy, you may need to consult a physician who can make a diagnosis of epilepsy and later on you may be referred to a neurologist or epileptologist. Neurology is a branch of medicine that deals with disorders related to the brain and nervous system. An epileptologist is also a neurologist who specializes in epilepsy. In case of seizures that are difficult to control or need advanced care, you may be shifted to an epilepsy centre. The healthcare team would comprise of:
    • Epileptologists and neurologists.
    • Nurses.
    • Psychologists



Living with Epilepsy

This chronic neurological disorder affects many walks of life other than the health factor. Since a seizure is unpredictable and can occur at any moment, common activities like driving and crossing a busy road are often dangerous. This ultimately leads to a loss of independence. Other than these social issues, there are other health complications that might occur. These include:

  • Status epilepticus - Severe seizures that last more than five minutes pose the risk of permanent brain damage or death. This also includes a series of recurring seizures without gaining consciousness in between.
  • In very rare cases, sudden unexplained death has also been seen.

People suffering should follow a proper, doctor-recommended recovery plan to cure epileptic seizures permanently.