Causes and Symptoms of Epilepsy

Epilepsy is a chronic neurological disorder characterised by recurrent seizures caused by temporary, excessive and irregular electrical activity in the brain’s nerve cells. During a seizure, a person’s consciousness, movements, senses, behaviour or communication with their surroundings may be temporarily affected.

Epileptic seizures do not look the same in every person. Some people may stare blankly for a few seconds, while others may experience muscle contractions, falls, shaking or loss of consciousness. The appearance of a seizure depends on where the abnormal electrical activity begins in the brain and how far it spreads.

Having a single seizure does not always mean that a person has epilepsy. During the diagnostic process, the cause of the seizure, whether it has occurred more than once, the person’s medical history and test results are evaluated together. The World Health Organization generally defines epilepsy as a disorder characterised by two or more unprovoked seizures.

What Is an Epileptic Seizure?

An epileptic seizure occurs when a group of nerve cells in the brain produces excessive electrical discharges at the same time, temporarily affecting brain function.

One or more of the following functions may change during a seizure:

• Consciousness and awareness

• Muscle movements

• Vision, hearing, taste and smell

• Speech

• Memory

• Emotions

• Behaviour

• Communication with the environment

Not every epileptic seizure causes full-body convulsions. Some seizures may appear only as brief staring episodes, an expressionless gaze, repetitive hand movements or a short change in awareness.

What Causes Epilepsy?

Epilepsy is caused by temporary disruption of the brain’s electrical communication. However, there is no single cause behind this disruption. The World Health Organization classifies the causes of epilepsy as structural, genetic, infectious, metabolic, immune-related and unknown.

In a significant proportion of cases, the exact cause of epilepsy cannot be identified. An unknown cause does not mean that the person’s symptoms are unimportant or that a diagnosis cannot be made.

Genetic Factors

Genetic predisposition may play a role in certain types of epilepsy. Having a family history of epilepsy can increase the risk, but not everyone with an affected family member develops the condition.

Certain genetic changes may affect how nerve cells function and influence the seizure threshold. Genetic factors may act alone or together with environmental and developmental influences.

Brain Injury Before or During Birth

A lack of oxygen during pregnancy or childbirth, certain congenital abnormalities and birth trauma may affect brain tissue.

These conditions may be associated with some forms of epilepsy that begin during childhood. However, not every birth complication leads to epilepsy.

Head Injuries

Severe head injuries may cause permanent changes in brain tissue or in the connections between nerve cells.

Seizures may occur immediately after trauma or begin months or years later. Epilepsy does not develop after every head injury. The risk depends on the severity of the injury and the brain area affected.

Stroke and Cerebrovascular Disorders

Stroke, which interrupts blood flow to the brain or causes bleeding, may be an important cause of epilepsy, particularly when it begins later in life.

Arteriovenous malformations and brain haemorrhages may also interfere with normal electrical activity.

Brain Tumours and Structural Abnormalities

Brain tumours, cysts, congenital brain development abnormalities and certain vascular disorders may cause seizures.

In these conditions, seizures may occur when a structural change affects electrical communication in the brain. Brain imaging methods may be used to investigate the cause.

Central Nervous System Infections

Meningitis, encephalitis and other infections affecting brain tissue may cause seizures.

A seizure may occur during the infection, or epilepsy may develop later because of damage left in the brain tissue.

Metabolic and Immune-Related Causes

Certain conditions that affect blood glucose, electrolyte balance or metabolism may cause seizures. However, a seizure occurring during a metabolic disorder does not always mean that the person has epilepsy.

Some neurological conditions in which the immune system affects brain tissue may also be associated with epilepsy. The differential diagnosis of such conditions should be made by a neurologist.

What Are the Symptoms of Epilepsy?

Epilepsy symptoms vary according to the area of the brain in which the seizure begins and how far the abnormal electrical activity spreads. Symptoms may range from a few seconds of reduced awareness to prolonged muscle contractions.

Symptoms occurring before, during or after a seizure may differ from person to person.

Changes in Consciousness and Awareness

During a seizure, a person may completely or partially lose contact with their surroundings. They may not respond to questions, may stare at one point or may suddenly stop what they are doing.

After the seizure, the person may not remember what happened. Temporary drowsiness, sleepiness or confusion may also occur.

Muscle Contractions, Shaking and Jerking

Involuntary movements may affect one part of the body or the whole body.

These movements may include:

• Repetitive jerking of an arm or leg

• Sudden muscle stiffening

• Rhythmic contraction and relaxation

• Turning of the head or eyes to one side

• Sudden falls

• Brief loss of muscle tone

Not every contraction or episode of shaking is caused by epilepsy. Fainting, sleep disorders, movement disorders and psychogenic non-epileptic seizures may sometimes appear similar.

Staring and Blank Episodes

In certain seizure types, a person may stare blankly for a few seconds. During this time, they may not respond to speech and may stop what they are doing.

Because these episodes are brief, they may sometimes be mistaken for inattention or daydreaming. Recurrent staring episodes should be assessed by a neurologist.

Sensory Changes

Temporary changes in vision, hearing, taste, smell and touch may occur before or during a seizure.

A person may report:

• Smelling an odour that is not present

• Experiencing an unusual taste

• Seeing flashing lights or shapes

• Numbness or tingling

• Hearing unusual sounds

• Feeling that familiar surroundings are strange or that unfamiliar surroundings are familiar

• Sudden fear or anxiety

In some people, these symptoms may occur as an aura that signals the beginning of a seizure.

Automatisms and Repetitive Movements

Automatisms are purposeless or repetitive movements performed without awareness.

During a seizure, the following behaviours may occur:

• Lip smacking

• Chewing or swallowing movements

• Rubbing the hands

• Pulling at clothing

• Repeatedly touching an object

• Walking aimlessly

• Repeating the same word or sound

The person may not remember performing these movements after the seizure.

Confusion After a Seizure

After a seizure ends, the brain may need time to return to normal function. This period is called the postictal phase.

The following symptoms may occur:

• Fatigue

• Sleepiness

• Headache

• Muscle pain

• Difficulty speaking

• Memory loss

• Confusion

• Temporary weakness

• Difficulty understanding where one is

Recovery time after a seizure varies between individuals. Some people return to normal immediately, while others may need minutes or hours.

What Are the Types of Epileptic Seizures?

Epileptic seizures are generally classified as focal-onset seizures, which begin in one area of the brain, and generalised-onset seizures, which affect both sides of the brain at the same time.

Correctly identifying the seizure type is important for diagnosis and treatment planning.

Focal-Onset Seizures

Focal seizures begin in a specific area of the brain. Awareness may be preserved or impaired.

Symptoms may vary depending on the area in which the seizure begins:

• Contraction of an arm or leg

• Numbness and tingling

• Unusual smell or taste

• Sudden fear

• Difficulty speaking

• Staring

• Repetitive, purposeless movements

A seizure that begins focally may later spread to both sides of the brain and affect the entire body.

Generalised-Onset Seizures

In generalised-onset seizures, abnormal electrical activity begins on both sides of the brain at the same time or within a very short period.

This group may include:

• Brief staring seizures

• Tonic seizures involving sudden muscle stiffening

• Clonic seizures involving rhythmic contractions

• Myoclonic seizures involving brief, sudden jerks

• Atonic seizures involving loss of muscle tone

• Tonic-clonic seizures involving loss of consciousness and full-body convulsions

What Can Trigger an Epileptic Seizure?

A seizure trigger is not the same as the cause of epilepsy. Triggers do not necessarily cause epilepsy, but they may increase the likelihood of a seizure in people with epilepsy or a predisposition to seizures.

Triggers may differ from person to person.

Common triggers include:

• Lack of sleep

• Severe stress

• Missing medication doses

• Alcohol use or sudden alcohol withdrawal

• Prolonged fasting

• Dehydration

• High fever

• Flashing lights in some individuals

• Hormonal changes related to the menstrual cycle

• Starting or stopping medication without medical supervision

• High doses of certain medications or substances

Anti-seizure medications should not be reduced or stopped without medical advice. Medication changes should be made under the supervision of a neurologist because they may increase seizure risk.

Can Hormonal Changes Affect Epileptic Seizures?

In some women, changes in hormone levels during the menstrual cycle may be associated with an increase in seizure frequency. This condition is known as catamenial epilepsy.

Pregnancy, the postpartum period and menopause may also affect hormone levels, sleep patterns and the concentration of medications in the body. People with epilepsy who are planning a pregnancy should not stop their medication independently and should plan the process together with a neurologist and obstetrician.

How Is Epilepsy Diagnosed?

Epilepsy diagnosis is not based on a single test. A neurologist evaluates the person’s seizure history, how the episode began, how long it lasted, what happened afterwards and whether there were any possible triggers.

Because awareness may be affected during a seizure, information from witnesses is valuable. A safely recorded video may also help the physician.

Medical History and Seizure Description

The following questions may be considered during diagnosis:

• Was there an unusual sensation before the seizure?

• How did the seizure begin?

• Was there loss of consciousness?

• Which part of the body was affected?

• Did the head or eyes turn to one side?

• How long did the seizure last?

• Was there drowsiness or confusion afterwards?

• Has a similar episode happened before?

• Are there any medications or existing medical conditions?

• Is there a family history of epilepsy?

EEG

Electroencephalography is a painless examination that records the brain’s electrical activity using electrodes placed on the scalp.

Electrical changes consistent with epilepsy may be seen on EEG. However, a normal EEG does not rule out epilepsy on its own. Some patients may require sleep EEG, prolonged EEG or video EEG monitoring.

MRI and Brain Imaging

Magnetic resonance imaging may be used to evaluate structural changes in the brain that could cause seizures.

It can help identify brain tumours, previous stroke, trauma-related damage, developmental abnormalities or vascular disorders. Computed tomography may also be used in emergency situations.

Blood Tests

Blood tests may help identify conditions that could cause or mimic seizures.

Blood glucose, electrolytes, liver and kidney function, signs of infection and medication levels may be assessed.

Does Having One Seizure Mean Epilepsy?

Having a single seizure does not always mean that a person has epilepsy. Temporary seizures may occur because of high fever, low blood glucose, electrolyte imbalance, poisoning, alcohol withdrawal, infection or acute brain injury.

When diagnosing epilepsy, physicians consider whether the seizure occurred without a clear trigger, the risk of recurrence and the findings of diagnostic tests. Anyone experiencing a first seizure should be medically evaluated, even if the symptoms have ended.

What Should Be Done During an Epileptic Seizure?

The main goal during a seizure is to protect the person and prevent injury.

The following steps may be taken:

• Stay calm and note the time the seizure begins.

• Remove hard, sharp or dangerous objects from the area.

• Help the person lie safely on the ground if they are falling.

• Place a soft item such as a folded jacket or towel under the head.

• Loosen tight clothing around the neck.

• Do not restrain the person or try to stop the movements.

• Do not place fingers, spoons, cloths or other objects in the mouth.

• Do not give water, food or medication during the seizure.

• When appropriate, gently turn the person onto their side.

• Stay with them until they fully regain consciousness.

• After the seizure, calmly explain what happened.

A person cannot swallow their tongue during a seizure. Placing an object in the mouth may cause injury to the teeth, jaw or airway.

When Should Emergency Help Be Called During a Seizure?

An ambulance may not be required for every seizure in a person with known epilepsy. If the person has a seizure action plan prepared by their physician, that plan should be followed.

However, emergency services should be called in the following situations:

• It is the person’s first seizure.

• The seizure lasts longer than five minutes.

• Another seizure begins before the person recovers from the first one.

• The person has difficulty breathing after the seizure.

• Consciousness does not return as expected.

• A serious injury occurs.

• The seizure happens in water.

• The person is pregnant.

• The seizure is different from the person’s usual seizures.

Prolonged or repeated seizures may require urgent medical treatment.

How Is Epilepsy Treatment Planned?

Epilepsy treatment is individually planned according to seizure type, the cause of epilepsy, the person’s age, accompanying conditions and lifestyle.

Anti-seizure medications are the most commonly used treatment. The medication and dose should be selected by a neurologist. In some patients whose seizures cannot be controlled with medication, epilepsy surgery, neuromodulation methods or specific dietary approaches may be considered.

According to the World Health Organization, a significant proportion of people with epilepsy can live without seizures when they receive an accurate diagnosis and appropriate treatment. However, treatment response varies and regular specialist follow-up is necessary.

What Should People With Epilepsy Consider in Daily Life?

Treatment adherence and recognising personal triggers are important when living with epilepsy.

The following points may be considered:

• Taking medication at the recommended time and dose

• Not stopping medication without medical supervision

• Maintaining regular and adequate sleep

• Avoiding skipped meals

• Drinking enough fluids

• Consulting a physician about alcohol use

• Keeping a seizure diary

• Recording known triggers

• Informing close contacts about seizure first aid

• Avoiding swimming or water activities alone

• Taking safety precautions when working at heights or with dangerous machinery

Driving, occupational safety, pregnancy planning and sports should be assessed together with a physician according to seizure control and applicable regulations.

When Should a Neurologist Be Consulted?

People who experience a first seizure, recurrent staring episodes or unexplained changes in consciousness should consult a neurologist.

The following symptoms should be evaluated:

• Recurrent loss of consciousness

• Frequent staring or blank episodes

• Unexplained falls

• Recurrent contractions or jerking

• Temporary speech difficulties

• Unexplained memory gaps

• Episodes beginning with unusual smell or taste

• Repetitive unusual movements during sleep

• Seizures continuing despite treatment

• Changes in seizure pattern or frequency

These symptoms are not always caused by epilepsy. Neurological assessment and appropriate tests are important for an accurate diagnosis.

Plan an Online Neurologist Consultation With Happ Health

Recurrent staring episodes, changes in consciousness, involuntary contractions, shaking or suspected seizures may affect a person’s daily life and safety. Although these symptoms do not always indicate epilepsy, they should be evaluated by a neurologist.

Through Happ Health, you can plan an Online Neurologist consultation and share your symptoms, seizure history and existing test results with a specialist. An online consultation may support the initial assessment and follow-up plan; however, a physical examination, EEG, MRI, blood tests or face-to-face evaluation may be required for a definitive diagnosis.

If a person experiences a seizure for the first time, if the seizure lasts longer than five minutes, if seizures occur repeatedly or if the person has difficulty breathing, emergency services should be contacted without waiting for an online consultation.