While many people think of epilepsy as one syndrome, it is actually an umbrella term for a range of different seizure disorders. The signs and symptoms of epilepsy can differ from person to person and are also affected by the type of epilepsy.

Are There Warning Signs of Epilepsy?

Doctors usually don’t make a diagnosis of epilepsy unless a person has had at least 2 “unprovoked” seizures that occur greater than 24 hours apart. Unprovoked seizures are those that don’t have a clear cause. Clear causes may include a high fever, an acute brain injury or head trauma within the last week, or alcohol or drug withdrawal.

If someone has had 2 or more seizures that occurred more than a day apart, and that are unprovoked, they meet clinical criteria for a diagnosis of epilepsy. Epilepsy can begin anytime, but most often starts in childhood or in older adulthood (above age 65).

Febrile seizures — or seizures that result from a high fever — are usually not a sign of epilepsy. However, children who have prolonged (30 minutes or more) seizures are at a higher risk of developing epilepsy.

Beyond actual seizures, there are no early warning signs of epilepsy. However, some factors can put children or adults at a higher risk of epilepsy. These include:

  • A family history of epilepsy.
  • Previous damage to the brain, such as from an injury, stroke, or cancer.
  • Personal history of meningitis or encephalitis.
  • Some developmental disorders.
  • Dementia.
  • Premature birth.
  • Developmental delay.
  • Intellectual disability.

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Are There Warning Signs a Seizure Is About to Occur?

If you or your child have experienced a seizure due to epilepsy, you may worry about having another one. You may fear having a seizure in public, for example.

Some people have no warning signs that a seizure is about to happen, while others do. These warning signs may occur either before or during the beginning of a seizure.

The prodromal phase: Before a seizure

Most people don’t experience what’s called the “prodromal phase.” However, 20% of people with epilepsy notice signs and symptoms minutes, hours, or even a few days, before a seizure begins.

The signs and symptoms that a seizure is coming can include:

  • Mood or behavior changes.
  • A “funny feeling.”
  • Confusion.
  • Anxiety.
  • Insomnia.
  • Difficulty staying focused.
  • Headache.

If a person experiences a prodromal phase, they can take actions to avoid injury due to involuntary movements of a seizure. They should avoid swimming, traveling, or cooking over heat without supervision, for example.

Aura: The first part of a seizure

For more than half of people with epilepsy, their seizure starts while their awareness is maintained, and this can produce symptoms they remember. Some people refer to this as the “aura” or the early stage of a seizure. (Focal, or partial, seizures can also happen on their own, without progression to loss of awareness or a generalized seizure.)

This focal seizure, or “aura,” may occur just prior to progression with impaired consciousness. The person may be able to tell someone they are having a seizure, or lie or sit down. In other words, an aura can be a warning sign that can prevent someone from being injured during their seizure.

For people with epilepsy, signs and symptoms of an “aura,” or focal seizure, include:

  • Strong feelings of fear, joy, sadness or anger.
  • Sudden, intense feelings of anxiety.
  • Twitching or jerking movements on only one side of the body.
  • Confusion.
  • Nausea.
  • A change in heart rate or blood pressure.
  • Hallucinations, which may mean seeing, smelling or hearing things that aren’t present.
  • Tingling or numbness.
  • A strong sense of déjà vu (the feeling that something has happened before).

The warning signs of a seizure differ from person to person. The good news is that if people with epilepsy have warning signs, they usually experience the same ones each time. Paying attention to emotional and physical symptoms can help you recognize the signs of a seizure.

Life with Epilepsy

A good source of information for people living with epilepsy is the Epilepsy Foundation. This organization provides educational options, support services, and other resource lists (including transportation services information, help understanding health coverage, information about camps for kids with epilepsy, financial assistance, and more).

If you need a second opinion or more information on how to live your best life with epilepsy, contact the UPMC Comprehensive Epilepsy Center.

Sources

Dr. Frank Besag and Dr. Michael Vasey. Prodrome in epilepsy. Link

Febrile Seizures. National Institute of Neurological Disorders and Stroke. Link

Dr. Stephen Huff and Dr. Najib Murr. Seizure. StatPearls. Link

Warning Signs of Seizure. Epilepsy Foundation. Link

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