Differences Between Seizures and Epileptic Spasms

When it comes to epilepsy, we typically tend to associate the disorder with seizures. While seizures are common symptoms experienced by people with epilepsy, there are other ways that the condition manifests itself, such as epileptic spasms. 

What are epileptic spasms?

Epileptic spasms are a symptom of epilepsy that results in patients briefly jerking or tensing. These spasms are short, typically lasting for no longer than 2 seconds at a time. The most common time for babies to experience epileptic spasms is when they wake from sleep. 

Epileptic spasms tend to repeat in a cluster fashion, with 1 to 2-second spasms repeating every 5 seconds or so for some time. Children with this condition can experience hundreds of seizures per day. 

Epileptic spasms are also sometimes referred to as infantile spasms because they typically affect babies under one year. 

Common symptoms of epileptic spasms include:

• Stiffened and tensed muscles

• Jackknife seizures (with the child’s body bending forward and knees pulling up, the head thrown back, and arms moving out to the side)

• Reduced alertness

• Eyes rolling up

• Nodding of the head

• Grimacing

• Movement of the chin 

What causes epileptic spasms?

There are multiple reasons why a baby might develop epileptic spasms. Unfortunately, though, sometimes the cause cannot be identified. The possible causes of epileptic spasms that we do know include the following:

Brain injury and infection

Injury to the brain can result in the development of epileptic spasms. Injuries that result in a child’s brain not getting enough oxygen or blood, meningitis, and a specific type of fetal stroke during pregnancy, called perinatal stroke, can all contribute to the onset of spasms. 

Developmental issues

Fetal development of the brain and spinal cord is key to healthy functioning. When that development goes wrong, it can cause issues like epileptic spasms. These malformations can include cortical dysplasia, lissencephaly, Aicardi syndrome, and holoprosencephaly. 

Gene mutation

We now know that certain genetic mutations can lead to the development of epileptic spasms. Genetic conditions leading to spasms include Miller-Dieker syndrome, CDKL5 deficiency disorder, Down syndrome (trisomy 21), and tuberous sclerosis. 

Metabolic issues

Your metabolism turns the food that you consume into energy. But when your metabolism goes haywire, it can result in the development of severe nutrition issues. Problems with your metabolism can, in some cases, lead to a vitamin B6 deficiency that causes epileptic spasms. 

Treatment options for epileptic spasms

Standard anticonvulsant drugs (AEDs) are ineffective against epileptic spasms, so it can be challenging to manage the symptoms of this condition. Treatment options for epileptic spasms include: 

• Steroid medications

• Vigabatrin, a medication used in epilepsy management

• Adrenocorticotropic hormone (ACTH), a hormone that is effective in reducing epileptic spasms¹

It’s important to note that researchers have a contentious debate about appropriate epileptic spasm treatment protocol. 

And while current treatments show positive indications, robust data is lacking, and randomized and comparative trials are needed to understand their effectiveness further. 

Outcomes for patients with epileptic spasms 

Treatment can effectively help to manage epileptic spasms, but there is no evidence that it can alter long-term outcomes. 

Unfortunately, the underlying issues that are often behind the development of epileptic spasms predispose patients to poor development outcomes, such as the following: 

• Up to 50% of patients with epileptic spasms also suffer from epilepsy

• 15%–33% of patients with epileptic spasms also have autism

• Up to 70% of patients with epileptic spasms also have tuberous sclerosis

• Normal development occurs in only 15%–25% of patients with epileptic spasms 

Better outcomes are seen in patients without an identified cause for their spasms. Even better developmental outcomes are seen in patients treated with hormonal therapy (ACTH) rather than vigabatrin. 

Common symptoms of seizures 

Seizures result from electrical disturbances in the brain, resulting in the uncontrolled movements and behaviors we see in seizure patients. Seizures can affect patients of any age. 

There are two main types of seizure classifications:

Partial (focal) seizures

Partial seizures occur in only one hemisphere of your brain and can happen while conscious or unconscious.

The common symptoms of this type of seizure include involuntary twitching and muscle tensing, hallucinations, sweating, drooling, skin color change, and changes to the emotional state. Some patients also experience an aura before a partial seizure. 

Generalized seizures

Generalized seizures occur in both hemispheres of the brain and can be classified into various types, including tonic, atonic, absence, and myoclonic seizures. 

Treatment options for seizures 

The treatment options for seizures will depend on the type of seizure a patient is experiencing and how often they occur. Treatment options for seizures include: 

Medication 

Medication options for patients experiencing seizures include anti-epileptic drugs (AEDs) such as carbamazepine, lacosamide, phenytoin, and oxcarbazepine. More recently approved medication options include the cannabinoid product Epidiolex. 

Surgery

Surgery can be effective in helping to manage seizures in patients who aren’t responding to medication. Surgery for seizures involves severing connections in the area of the brain where misfiring electrical activity is occurring. 

Diet

You might be surprised to learn that diet can help manage seizures. The ketogenic, low glycemic index, and modified Atkins diets have all shown promise in reducing seizures.²

Electrical stimulation

Implanting electrodes into certain brain areas and the vagus nerve (located in the neck) can help block seizures. 

Differences between epileptic spasms and seizures

The main differences between epileptic spasms and seizures are:

Age of onset

Epileptic spasms typically occur within the first year of life, while seizures can develop at any age.

Symptoms

Epileptic spasms cause 2-second spasms that repeat every 5 seconds for some time. Seizures can result in symptoms ranging from violent jerking to small hand movements, staring spells, loss of consciousness, and many more. 

Treatment

The first-line treatment option for epilepsy is AEDs. Successful treatment options for epileptic spasms include hormone and steroid medications. 

The lowdown 

While seizures and epileptic spasms can share some visual similarities—both can produce jerking movements, muscle tension, and loss of focus—they are very different conditions. 

People also ask 

What do epileptic spasms look like?

An epileptic spasm looks like a brief jerking movement that lasts no longer than 2 seconds and typically repeats after 5 seconds for a short cluster. Children with epileptic spasms also tend to lose focus, roll their eyes up, grimace, throw their heads back, bend forward, pull their knees up, and move their arms out to the side. 

When do epileptic/infantile spasms begin?

Children are most likely to experience an epileptic/infantile spasm for the first time between the ages of 4 and 7 months. However, spasms can begin to show at any time during the child’s first few years. Most patients with epileptic spasms will be diagnosed within the first year of life. 

Do epileptic spasms go away?

Epileptic spasms tend to stop in patients by age 2 to 4 years old. 

What is the difference between spasm and seizure?

A spasm is a 2-second repeated jerking movement that typically affects infants just as they wake. Seizures are movements or behaviors (without pause) that occur due to electrical disturbances in the brain and can affect patients of any age.