Seizures are complicated, so describing all the potential ways they might look is a very difficult task. Keep in mind that any person who is suddenly unconscious for no apparent reason with no medical history to explain it deserves a call to 911. Seizure treatment consists of mostly supportive care and calling for help if necessary.
In patients with a chronic history of seizures, having a single seizure does not always warrant a trip to the hospital. On the other hand, it's important to note that status seizures (see below) and first time seizures are always medical emergencies.
There are two basic types of seizures: generalized and partial. A generalized seizure involves the whole body while a partial seizure might only involve one arm, one leg, just the face, or any other area of the body while leaving the rest of the body alone. Partial seizures are often called local seizures or focal seizures.
There are many more types of seizures and ways they can look, but the purpose of this article is to teach you how to recognize the most common types of seizures. There is a list of types of seizures from our Epilepsy site.
Let's start with generalized seizures, which are the most likely to get your attention -- as a patient and as a bystander.
Generalized seizures are commonly called grand mal seizures. These are full body seizures and more importantly should be called full brain seizures. Abnormal impulses firing throughout the brain can cause muscles to twitch or contract.
Generalized seizures have a common pattern consisting of three phases: pre-ictal, ictal and post-ictal.
- Pre-Ictal: People who have a history of seizures might be able to tell when they are about to have one. This is most often called an aura and isn't always obvious. In some cases, family members can recognize when a seizure is going to occur. Some seizure patients have service dogs that can predict when the patient will have a seizure and can notify the patient or family members.
- Ictal: This is the seizure. In most full body seizures, the patient is completely unresponsive. Their eyes may remain open or be closed; often, they will be blinking rhythmically. Most seizures start with tonic muscle contractions. There isn't any shaking at that point, just a whole lot of muscles are contracting at once. During the tonic portion, patients may feel stiff or hard to the touch. The tonic part is followed by clonic movements, the medical term for convulsions. Clonic movements are what most of us think of when we think of seizures. Often in medical circles, a full body seizure like this is referred to as a tonic-clonic seizure.
- Post-Ictal: After the seizure stops, the patient will be completely unresponsive -- like he or she is sleeping and won't wake up -- gradually becoming fully awake. It may take minutes to hours for the patient to begin to recover, and often can take hours to recover completely.
Partial seizures are harder to describe because there are so many ways they can develop. A partial seizure happens for the same reason as a generalized seizure -- there are random impulses firing in the brain. In the case of a partial seizure, however, the impulses are in an isolated area of the brain and therefore only affect an isolated area of the body.
Clonic movements, just like those in a generalized seizure, can be seen in a partial seizure. The two big differences are that the patient won't necessarily be unconcious during a partial seizure, and the convulsions will only be in a certain area: one arm or one side of the face, for instance.
The brain is divided into two halves, right and left. The right side of the brain mostly controls the left side of the body and vice versa. A hallmark of partial seizures is that only one side of the body will be affected. In other words, you would not expect to see both arms in clonic movements while the rest of the body is unaffected. Instead, you will see one arm or one leg, or maybe one whole side of the body is shaking but the other side is not.
There are some conditions that might cause a partial seizure at first, which then progresses into a full body generalized seizure.
Status seizures, also known as status epilepticus, is a serious medical emergency. There are two definitions of status seizures:
- A prolonged seizure, usually lasting more than 10 minutes (different doctors will have different timelines, but 10 minutes is the most common).
- More than one seizure without fully recovering from the post-ictal state in between. In other words, if a patient has a seizure and is still unconscious or groggy and has another one, it's considered status seizures.