Most Common Types of Seizures
Epilepsy Symptoms: Not All Seizures Look Alike
The primary symptom of epilepsy is seizures, but not all seizures look or feel the same. The extent of the seizure activity usually reflects the extent of the brain involvement.
For example, seizure symptoms on only one side of the body (unilateral) tend to indicate that the seizure is only on one side of the brain. A unilateral seizure can indicate that the seizure is a “focal” seizure, meaning it originates in one part of the brain and stays in that part of the brain.
Seizures that arise from both sides of the brain (called “generalized” seizures) may lead to symptoms occurring on both sides of the body (bilateral).
A seizure is also sometimes classified as “unknown” if it was not observed by another person, or if it is unclear when the seizure started.
What Happens During a Seizure?
For both generalized and focal seizures, symptoms are subdivided into motor (movement) and nonmotor (nonmovement) symptoms. (1,2)
The following are considered motor symptoms:
- Clonic symptoms, when the muscles twitch repeatedly and rhythmically
- Tonic symptoms, when the muscles stiffen
- Tonic-clonic symptoms, when there is both muscle stiffening and twitching. When tonic-clonic symptoms are generalized, the result is convulsions. Generalized tonic-clonic seizures used to be called “grand mal” seizures. A generalized tonic-clonic seizure that lasts more than five minutes is a medical emergency.
- Myoclonic symptoms, when muscles twitch briefly. The twitch can almost seem like a tic. In a generalized seizure, myoclonus can present as the eyelids fluttering. With a focal seizure, myoclonic symptoms can appear to simply be an extra movement. As with all seizure symptoms, the movement is involuntary.
- Atonic symptoms, in which muscles become flaccid or weak. If a person has a generalized atonic seizure, this is sometimes called a “drop attack.”
- Automatisms are uncontrolled movements that sometimes happen with focal seizures. Automatisms can include a wide array of movements including chewing or lip-smacking, hand rubbing or clapping, pelvic thrusting, undressing, or even running.
Nonmotor seizure symptoms can include the following:
- Absence, when the person stares as if there’s “nobody home.” This kind of seizure used to be called a “petit mal” seizure, and it is a generalized seizure affecting both sides of the brain.
- Behavior arrest, in which the person stops what they are doing for a moment
- Changes in thinking or feelings, sometimes resulting in paranoia or aggression
- Autonomic nervous system symptoms, in which bodily changes, such as goose bumps, skin flushing, or erections, which normally happen automatically in response to stimuli seem to occur spontaneously.
- Other signs that may be observed in people having a generalized tonic-clonic seizure include crying out, cyanosis (skin and lips turning blue), frothy salivation, loss of bowel or bladder control, and biting of the cheeks or tongue.
Level of Awareness in Focal Seizures
People having a generalized seizure tend not to be aware of their surroundings.
People with focal seizures, on the other hand, may or may not have awareness during their seizures. Focal seizures are therefore further classified by level of awareness: aware or impaired awareness.
- Focal Onset Aware Seizure The person is aware of what is happening during the seizure, but they may be unable to respond to others. These used to be called “simple partial seizures.”
- Focal Seizure With Impaired Awareness The person may be confused during the focal seizure, or they may be unaware. The person may have limited memory of the event. These seizures used to be called “complex partial seizures.”
Auras: Warnings of Upcoming Seizures
Some people have symptoms before a seizure that warn them that a seizure is coming. This is called an “aura,” and researchers believe that auras are also focal aware seizures.
Some auras can be vague, like a sense of fear or of déjà vu. Some people experience a rising feeling in their stomach, as if they're on a roller coaster. Aura symptoms can also include physical movements, unusual behaviors, and cognitive changes, such as the following:
- Foot stomping
- Hand waving
- Chewing movements
- Oversensitivity to stimuli
- Memory loss
- Distortions of the sense of time, or the size of the body
- Tongue biting or drooling
- Electric-shock feelings
- Psychic experiences
Auras are more common among people with focal seizures. Researchers believe that highly specific auras (like smelling a certain smell) are good predictors that the seizure disorder is focal.
Symptoms After Seizures (Postictal Symptoms)
The period after a seizure is called the postictal period.
With some seizures, people feel pretty much back to normal after the seizure is over. With other seizures, the person may experience postictal symptoms for minutes or hours afterward.
Some of the symptoms people may experience after seizures include:
- Headache, confusion, or difficulty talking
- Exhaustion or sleepiness
- Sore muscles
- Fear or embarrassment or depression
- Nausea or pain
- Memory loss
- Perceptual alterations
Postictal symptoms can occur after both generalized and focal seizures.
Status epilepticus is when a person has an extended seizure, or when they have multiple seizures in a row without a break in between. These kinds of seizures are less likely to stop on their own.
Particularly with generalized tonic-clonic seizures, stopping a seizure before it goes on too long can be important. Most seizures last only 2 to 3 minutes, at most. Seizures over 5 minutes are considered to need medical intervention.
If you observe someone having what appears to be a tonic-clonic seizure, make sure that they are safe and make note of the time. If the seizure lasts more than 5 minutes, call 911.
During a tonic-clonic seizure, multiple body systems can be impacted, including the person’s breathing and heart rate and metabolism. The risk of neurological damage from the seizure increases substantially after more than 30 minutes. (3)
Seizure First Aid
First aid for someone having a seizure is usually aimed at keeping the person safe and as comfortable as possible. To those ends, there are a few basic things to remember (4):
- Realize that most seizures last only a few seconds to a few minutes and are not life-threatening. Stay calm, and speak reassuringly to the person having a seizure, both during the seizure and afterward.
- If a person has a generalized tonic-clonic (“grand mal”) seizure, first make sure they are safe. Prevent injury to the person by removing any sharp objects from the area or items that could be pulled down on top of the person during a seizure. If the person seizing is at risk for falling, help guide them to the ground or to a comfortable chair. Protect their head from hitting the floor by placing a folded-up piece of clothing beneath it.
- Make note of the time. If the seizure is more severe than usual, the person is injured or choking, or the seizure goes on for more than 5 minutes, call 911. (See “Status Epilepticus” above.)
- Don’t try to hold a person down during a seizure. This won’t stop the convulsions, and you risk injury to yourself and to them if you try to restrain them.
- If the person is walking during a seizure, help to guide them away from dangers like traffic, heights, or the edges of subway or train platforms.
- Do not put anything in the mouth of someone having a seizure! Doing so increases the risk of choking. To help prevent choking on saliva during a tonic-clonic seizure, roll the person onto their side so their mouth is pointed toward the ground.
- After a seizure, stay with the person until they feel normal or feel able to contact someone else who can help them.
- If you have epilepsy, help the people in your life understand how to help you during a seizure. If you have any fast-acting emergency medications, instruct the people close to you on how and when to use them. Wear some form of medical ID to help strangers or first responders understand what’s likely going on.
You can find more information about seizure first aid at the Epilepsy Foundation website.
Death From Epilepsy
Most people with epilepsy live full lives, and they do not usually die from their illness.
About 1 in 1,000 people with epilepsies die each year from sudden unexpected death in epilepsy, or SUDEP. The cause is not understood, but some research points to genetic differences in the heart or in respiratory function. Research is ongoing.
For some people, epilepsy symptoms may go away over time or respond well to medication.
Video: Psychogenic Seizures — What are They, How Can They be Diagnosed and Treated?
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