What can an epileptic seizure look like?

At a glance

• Convulsive seizures are only one of many seizure types.
• What happens afterwards is also important.
• Not every seizure-like episode is epileptic: functional seizures also occur.

Tonic-clonic seizures

The best-known presentation is loss of consciousness, stiffening and then convulsions on both sides of the body. Bluish skin colour, salivation, tongue biting and loss of bladder control may occur.

After the convulsions, the person may remain confused, not know where they are, respond inappropriately, feel very tired, have a headache or fall asleep. Postictal confusion is an important clue when distinguishing epilepsy from other causes of loss of consciousness.

Seizures without convulsions

Temporal lobe seizures may involve repeated déjà vu, unusual smells or tastes, a difficult-to-describe sensation in the upper abdomen, sudden fear, staring with impaired responsiveness, or automatic movements of the mouth or hands, followed by no memory of the event.

Frontal lobe seizures can be brief and abrupt, often occurring in clusters or during sleep. They may include sudden stiffening, unusual limb postures, head turning, vocalisation or complex unusual movements.

Functional (dissociative) seizures

These were previously called psychogenic non-epileptic seizures. Functional or dissociative terminology avoids suggesting a single cause and can be less stigmatising.

The symptoms are real and involuntary, not faked. They are not caused by epileptic discharges in the brain and need a different approach, often involving a psychologist or psychiatrist. Stress, difficult experiences or anxiety may play a role, but a single cause cannot always be identified.

Functional and epileptic seizures can coexist. Recording a typical episode during video-EEG can help clarify the diagnosis by comparing behaviour with the EEG recording.

A functional seizure diagnosis does not mean that nothing is wrong. It means the symptoms have a different mechanism and require different treatment.

Repeated unexplained episodes?

• Clarifying what the episodes are is essential for treatment.
• Bring a phone recording: it can provide valuable diagnostic information.
• If possible, attend with someone who has witnessed an episode.