Crying is a natural, physiological response to intense emotional distress. While crying alone does not cause the underlying brain condition known as epilepsy, the intense physical and emotional stress associated with vigorous crying can act as a trigger for a sudden neurological event in a susceptible individual. Understanding the difference between a trigger and a cause is fundamental to addressing this concern.
Crying as a Trigger Versus Cause
Crying is not the neurological cause of a seizure, which is defined by abnormal, excessive electrical discharges in the brain. Epilepsy is primarily caused by a permanent change in brain structure or function that predisposes an individual to seizures. Emotional stress, however, is a well-documented seizure trigger that can temporarily lower the seizure threshold in susceptible individuals. In most cases where crying is followed by a seizure-like event, particularly in young children, the episode is a different, usually benign, physiological reaction rather than a true epileptic seizure.
Breath-Holding Spells: The Non-Epileptic Event Often Confused with Seizures
The most common non-epileptic event following intense crying, especially in children between six months and six years old, is a breath-holding spell. These spells are involuntary, reflexive events triggered by pain, fear, or, most frequently, extreme emotional upset like a tantrum. The episode begins with intense crying, followed by the child holding their breath and then losing consciousness briefly.
These spells are categorized into two main types based on the child’s appearance. The cyanotic spell is the most common, resulting from prolonged breath-holding after a vigorous cry, which causes the child’s lips and face to turn blue due to a lack of oxygen. The less common pallid spell occurs in response to a sudden fright or minor injury and is characterized by the child turning very pale due to a temporary slowing of the heart rate. Both types can involve brief body stiffening or twitching, which is why they are often mistaken for true seizures, but they typically last less than a minute and resolve spontaneously.
How Hyperventilation and Stress Affect Brain Activity
Intense crying often involves vigorous, rapid breathing, which leads to hyperventilation and a condition called hypocapnia, or abnormally low levels of carbon dioxide (CO2) in the blood. This sudden drop in CO2 causes cerebral vasoconstriction, constricting blood vessels in the brain and temporarily reducing blood flow and oxygen delivery to the tissue. The resulting change in blood chemistry, including an increase in blood pH (respiratory alkalosis), increases the excitability of brain cells.
This combination of reduced blood flow and an altered electrical environment effectively lowers the seizure threshold. Controlled hyperventilation is a standard diagnostic tool used during electroencephalogram (EEG) testing to intentionally provoke abnormal brain activity in individuals with suspected epilepsy. Therefore, while crying is an emotional act, the subsequent changes in blood gas levels are the physical driver that can make a seizure more likely.
Recognizing a True Seizure and When to Seek Medical Attention
Distinguishing a true epileptic seizure from a breath-holding spell centers on the sequence of events and the recovery phase. A breath-holding spell involves loss of consciousness or convulsive movement occurring after intense crying and color change. A true seizure, conversely, is an uncontrolled electrical discharge that typically starts abruptly, with any vocalization being part of the seizure itself. Following a true seizure, the individual enters a post-ictal phase characterized by confusion, drowsiness, or unresponsiveness that can last minutes to hours, whereas recovery from a breath-holding spell is almost immediate.
Medical attention is warranted for any first-time event involving loss of consciousness or convulsive movements. A medical evaluation is particularly necessary if the event lasts longer than a minute, is not preceded by a clear emotional trigger, or is followed by a prolonged period of confusion or deep sleep. While many events related to crying are benign, a specialist must confirm the diagnosis to rule out serious underlying conditions.