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Focal seizure signs and symptoms that manifest during an acute event depend on the part of the brain involved. The terms for these features correlate with the names of the different focal seizure types at their various levels of classification in the ILAE 2017 naming system. They are not classifiers in and of themselves. Yet, they are useful descriptors that can help doctors define and classify seizures if they are aware of them.
Categorizing focal seizure signs and symptoms according to their various levels of classification helps in recalling them and using them to describe what happened. The intent is not to make diagnosticians out of patients. Rather, it is to make patients and observers of their seizures better describers.
Listed below are some of the more common focal seizure signs and symptoms that patients or observers of seizures need to be able to convey to doctors. Many are words that people outside of the medical community recognize but perhaps have not linked with seizures.
The seizer – person having a seizure – is usually not able to describe any signs and symptoms of a focal impaired awareness seizure because of the lack of knowledge of self and environment during the event. Therefore clinicians have to depend on observations reported by witnesses. Sometimes though, the seizer might report loss of awareness as “blacking out.”
Focal seizure motor signs and symptoms might be in the form of abnormal muscle tone, an increased amount of muscle activity, or automatisms. Dystonia is the term for abnormal muscle tone. Hyperkinesia is the term for an excessive amount of muscle activity.
Focal dystonic and hyperkinetic Seizure Signs and Symptoms
Focal seizure signs and symptoms in this category apply to the following classifiers: atonic; clonic; myoclonic; tonic; epileptic spasms, and hyperkinetic. The motor expressions usually start in one limb of the body opposite the side of the brain where the seizure electrical discharge begins. In the case of a focal to bilateral tonic-clonic seizure though, the dystonia starts on the side of the body opposite the seizure focus in the brain and then spreads to both sides. There are various descriptors for signs and symptoms of focal seizures of this category. Common ones are as follows:
- Jerking (rhythmic or arrhythmic), twitches, tremors, and rigidness or tightening of muscles, depending on the seizure type
- Flaccidness (limpness) in the case of an atonic seizure; it might result in a fall.
- Spasms – sudden involuntary muscle contractions; in the case of an epileptic spasms seizure they involve the trunk and proximal limb muscles.
- Excessive simple and/or complex movements such as bicycle pedaling and pelvic thrusting (simulating the movements of human intercourse) when hyperkinesia is the main motor feature
Other motor signs and symptoms that might occur are the following:
- Violent vocalization with some hyperkinetic seizures
- Abnormal posturing due to the dystonia
- Head or eye deviation (turning aside)
- Todd’s paralysis – transient muscle weakness or paralysis present at the end of some seizures. It usually subsides within 48 hours.
Focal Automatisms Seizure Signs and Symptoms
Some of the more common automatic and purposeless behaviors that characterize focal seizures of this type are the following:
- Various mouth movements such as lip smacking, chewing, spitting, or mumbling
- Rapid eye blinking
- Head nodding
- Perseveration – the repetitive utterance of words or phrases without a stimulus
- Repetitive grunting
- Dramatic vocal acts such as laughing, crying and screaming
- Hand movements such as clapping, fumbling, fidgeting, grasping, clothes picking
- Pelvic thrusting
Focal Nonmotor Seizure Signs and Symptoms
Descriptors of focal nonmotor seizure signs and symptoms relate to action(s) of the autonomic nervous system; pauses in behavior; or experiences during the seizure. The experiences can be in the realm of cognition, emotion, or sensation.
Focal Autonomic Seizure Signs and Symptoms
During this type of focal seizure an action(s) of the autonomic nervous system is increased or not appropriate for the circumstances. Some of the more common ones are as follows:
- Piloerection – goosebumps
- Dilation (widening) of the pupils
- Constriction (narrowing) of the pupils
- Pallor (paleness)
- Altered breathing – could be hypoventilation, hyperventilation, or a change in breathing pattern
- Tachycardia or bradycardia
- Nausea and/or vomiting
- Abdominal pain
- Borborygmus – a gurgling or rumbling sound in the abdomen due to the movement of gas through the intestines
- Flatus – the passage through the rectum of excessive gas that builds up in the stomach and intestines
- Fecal incontinence – uncontrolled defecation
- Urinary incontinence – uncontrolled urination
Focal Behavior arrest Seizure Signs and Symptoms
This is a new seizure class as of 2017. The seizer or a witness might use the following terminology to describe it:
- A temporary pause in one’s activities; movement freezing
Focal Cognitive Seizure Signs and Symptoms
Experiences involving cognition that one might have during a focal seizure can be any of the following:
- Attention impairment – inattentiveness; difficulty mentally concentrating or staying focused on an issue or circumstance at hand
- Confusion – often described as feeling spaciness or disoriented
- Déjà vu – the illusion of a new experience being the repeat of a prior one; an example is an eerie feeling of having been to a place before even though it is the first time being there.
- Dissociation – The sense of a dreamlike state or unreal place in which the mind seems to be detached from the emotional state or even the body; there might be poor memory of the specific events.
- Hallucination – the perception of objects or other sensory experiences as reality, even though they are not; it is the result of dysfunction of the nervous system.
- Illusion – a misperception of reality
- Jamais vu – the illusion that what should be familiar is one’s initial encounter even though it is not; it is the opposite of déjà vu.
- Memory impairment – periods of forgetfulness or memory lapses during the event
- Responsiveness impairment – decreased or absent reaction in the form of movement or speech to a verbal or other type of stimulus
Focal Emotional Seizure Signs and Symptoms
The various emotions one might experience during a focal emotional seizure are the following:
One might also display signs of an emotion whether or not the emotion is actually experienced. The most notable descriptors for seizures of this type are:
- Dacrystic – bursts of crying with or without accompanying sadness
- Gelastic – inappropriate bursts of giggling or laughter without an emotional state to match it
Focal Sensory Seizure Symptoms
A focal seizure might cause the experiencing of certain sensations, depending on the part of the sensory nervous system it stimulates. They might be any of the following:
- Auditory – pertaining to hearing; actual symptoms might include altered hearing, tinnitus and/or illusory sounds or voices.
- Gustatory – pertaining to taste; the actual symptoms might be a sudden abnormal taste(s) and/or an altered sense of taste.
- Olfactory – pertaining to the since of smell; the actual symptom might be a strange smell(s) or an altered sense of smell.
- Somatosensory – involving stimulation of the skin or internal organs; possible symptoms include altered sense of touch, hot or cold feelings, numbness, and tingling.
- Visual – having to do with seeing; altered vision and a visual hallucination are the possible symptoms.
- Vestibular – pertaining to the function of the central vestibular system; vertigo might occur infrequently on this basis during a focal seizure.
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