Signs and symptoms are not the same thing. A sign is a clinical feature of a disease or condition that a health-care provider 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 health-care provider reach a diagnosis.
By contrast, some children who have focal 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 repeat.
Seizures come in many forms; your child’s seizure could look like one or a combination of any of the following.
Sample videos can be viewed at Epilepsydiagnosis.org website of the International League Against Epilepsy (ILAA).
Generalized seizures:
Absence seizures
Absence seizures are a type of generalized seizure. They involve short periods of unresponsiveness, often many times a day. A full description of absence seizures can be found here.
Myoclonic seizures
Myoclonic seizures usually involve one or multiple brief jerks, which may involve the whole body or a single arm or leg (in juvenile myoclonic epilepsy, these jerks often occur upon waking).
A full description of myoclonic seizures can be found here.
Atonic seizures
Atonic seizures involve a sudden loss of muscle tone, making a child go limp and fall to the ground. A full description of atonic seizures can be found here.
Tonic, clonic and tonic-clonic seizures
Tonic,clonic and tonic-clonic seizures involve different combinations of sudden muscle stiffening and contraction, and rhythmic twitching or jerking. A full description of tonic, clonic and tonic-clonic seizures can be found here.
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. A full description of neonatal seizures can be found here.
Infantile spasms
Infantile spasms usually begin within the first year of life, typically between the ages of three and seven months.
Focal seizures
Focal aware seizures
Focal aware seizures appear different from person to person, depending on the seizure focus (the affected area of the brain). A common feature of focal aware seizures is that the child remains alert and can remember what happened. A full description of focal aware seizures can be found here.
Focal seizures with impaired awareness
Focal seizures with impaired awareness start in one part of the brain but usually affect other parts of the brain that involve alertness and awareness. The symptoms of a complex partial seizure depend on which part of the brain is affected. A full description of focal seizures with impaired awareness can be found here.
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 that occurs before a bigger seizure. The aura is actually a focal aware seizure.
What is not considered 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, especially brief jerks occurring during sleep
- breath-holding spells
- migraines
- psychogenic non-epileptic seizure s, which are caused by a subconscious emotional reaction to stress or anxiety; these may look like a seizure, but these are not caused by abnormal electrical activity in the brain
Your child’s health-care provider may want to rule out these possible causes when evaluating your child.
In some cases, seizures are not caused by epilepsy. These include children with provoked seizures such as febrile seizures and children having abnormal movements mimicking seizures such as syncope (fainting) and psychogenic non-epileptic 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
Are seizures painful?
Some children experience pain as part of a focal aware or impaired awareness 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.
Ask your child’s health-care provider if it is okay to give your child acetaminophen or ibuprofen after a seizure for any aches and pains.