Everything You Must Know About Lesser-Known Seizure Symptoms

Many aren't able to spot certain signs of seizures including laughter and quick blinking, as indicated by a recent survey.

Seizures since 2017 have been classified based on their brain location, the individual’s knowledge of their symptoms, and whether or not the symptoms are typical motor symptoms like jerkiness and trembling.

The recent survey, conducted by Ipsos for Orlando Health the previous month, sought to establish if individuals in the United States could identify some of the less common seizure symptoms.

“We must boost awareness about epilepsy and seizures to prevent sudden unexpected death in epilepsy (SUDEP) and lessen the stigma linked to the diagnosis,” Dr. Dipali Nemade, MD, MPH, an epileptologist (a neurologist specializing in epilepsy) at Orlando Health Neuroscience Institute, told Health.

Below are the subtle seizure signs to watch for and directions on how to spot and respond to a seizure.

The recent survey gathered data from 1,024 adults aged 18 years and above. Fewer than half could identify the following as seizure indicators:

According to Nemade, determination of seizure signs depends on the seizure association with awareness level, as well as if you or someone else is the one with the symptoms.

“Seizure symptoms related to awareness loss will be noticed by people around or family/loved ones,” he stated. “But if seizure symptoms have no association with awareness loss, patients are more likely to notice.”

These symptoms include rising sensation in one's stomach or déjà vu (familiarity sensation), olfactory aura (pleasant or unpleasant odor), and visual or auditory hallucination, as explained by Nemade.

“Generally, if the seizure isn't associated with an awareness loss, patients are more likely to notice it and vice versa,” he added.

Clifford Segil, DO, a neurologist at Providence Saint John’s Health Center in Santa Monica, California agrees with this, stating that caregivers and loved ones can easily observe seizures involving shaking.

“A usual seizure involves shaking for 60 to 90 seconds followed by stiffness period and then a time of confusion,” Segil mentioned.

He noted that a twitchy hand or facial twitch, although more subtle, are also outward signs of a seizure.

Seizures that don't have visible signs of mental change, confusion, speech issues, or shaking are simply less noticeable, making it easier for both the person having a seizure and loved ones to miss.

“Small seizures lead to minor symptoms while big seizures cause major symptoms like tongue biting, shaking, and bladder incontinence,” he stated. “Small symptoms do indicate a minor seizure.”

Not recognizing subtle seizure signs means seizures are going undiagnosed, not reported, and untreated, resulting in increased health risks such as sudden and unexpected death.

Nemade explained that not being able to identify subtle signs or symptoms that are less recognizable of seizures could result in increased injury risk if the seizures are associated with awareness loss.

For instance, “a behavior arrest, staring into space, awareness loss for a few seconds whilst driving can lead to major car accidents,” he described.

Similarly, if the person is swimming, it may lead to drowning. During cooking and working with fire, it can lead to burns, and so on.

“An atonic (body tone loss) seizure can lead to dangerous falls,” he noted.

Moreover, these subtle seizure signs can lead to cognitive issues that can be difficult to quickly detect and treat.

“A subtle seizure can cause temporary confusion,” Nemade noted. “Thus, it can affect daily activities and quality of life because patients are aware something is wrong but can't explain.”

The unpredictable nature of these seizures can result in anxiety, depression, and negatively impact a person's mental health.

“People with epilepsy may express changes in behavior at times,” Nemade pointed out. “They may also display symptoms of psychosis.”

While failing to catch subtle seizure symptoms can negatively impact a person's life quality, early symptom recognition can have the opposite effect.

“Diagnosing early can result in early treatment,” Nemade stressed. “This will aid patients to improve their personal life quality and they will be capable of functioning as productive society members.”

Segil explained that not knowing if you’re experiencing a seizure leads to poor management of seizures.

“Younger adults may be more prone to ignore such episodes,” Pooja S. Patel, MD, the director of the Epilepsy Monitoring Unit at Marcus Neuroscience Institute, part of Baptist Health South Florida at Boca Raton Regional Hospital, told Health.

“They could dismiss these episodes as falling asleep, daydreaming or just being inattentive for few seconds and delay in seeking medical attention for it,” she said.

Segil explained that being able to accurately report a seizure to a healthcare provider helps professionals best treat seizures, as well as lower seizure frequency. This is just as important for small seizures as it is for bigger, more obvious episodes.

“Often it takes a big convulsive event that gets patients or family,” Patel said.

If a patient or family member can properly identify a seizure, they can take advantage of resources that are in place to help patients with seizures—no matter the size.

According to Segil, taking anti-seizure medication promptly is very important to avoid prolonged seizures which can be life-threatening.

Patel added that “if medicine does not help with symptoms, we may recommend neurosurgery or neurostimulation treatment via minimally invasive surgical techniques.”

In a 2017 survey, few U.S. adults reported feeling knowledgeable about epilepsy, with 20% reporting having the confidence to help someone having a seizure with appropriate seizure first aid.

According to the Centers for Disease Control and Prevention, not all seizures are emergencies, but people should call 911 if a seizure lasts more than 5 minutes or if the person gets injured during the seizure.

“In case of any warning of a seizure, get to a safe place low on the ground to prevent injury,” said Patel.

Segil advises his patients to video record any event concerning a possible seizure so a trained neurologist can look at an episode and reverse engineer which part of a person’s brain not working would cause this type of seizure.

“If someone is concerned they have had a seizure, I would also advise them to video themselves in a mirror or with their phone to show their treating doctor what occurred during the episode concerning a seizure,” he said.

If you believe that you or a loved one are experiencing a seizure, seek medical attention immediately.