Recognising stages of seizures
Many people think seizures are all pretty much the same. In fact, there are many different types of seizures and even some seizure types, although they have the same name – such as focal seizures – can vary enormously.
A seizure is a temporary disruption of the electrical activity in the brain and can present in many ways including changes to sensation, awareness, behaviour, or movement. Some seizures are very brief and others can last longer. Not all seizures involve jerking or convulsions and not all seizures are diagnosed as epilepsy.
To better understand what is happening in the brain when a seizure occurs, it is helpful to understand the stages of a seizure. There can be up to four stages of a seizure and each stage is different, occurs at different times and the symptoms experienced are different.
It is important to note that not everyone will have all four stages of a seizure.
The four stages of a seizure are:
-
- Prodrome (before seizure)
- The Aura (early seizure)
- Ictal (seizure)
- Postictal (after seizure)
Before the seizure: the prodrome
The prodromal stage is usually a feeling or sensation that can happen several hours or even days before the seizure. Some people report symptoms consistently happening hours ahead of a seizure, while others may not be fully aware of this happening, but people close to them may have pick up on subtle changes.
The most common symptoms of a prodrome include confusion, anxiety, irritability, headache, tremor, and anger or other mood disturbances.
A prodrome is different from aura. It is not considered part of the actual seizure.
For those who experience it, once recognised, a prodrome may serve as a warning sign of an impending seizure.
During the seizure: early ictal and ictal stage
Ictal means a seizure. The ictal stage includes the time between the beginning (aura, if present) and the end of the seizure.
The aura (early ictal stage)
Some people with epilepsy experience what they call an “aura” which has traditionally been thought of as a warning a seizure is about to happen. The aura is actually the beginning or onset of a seizure.1
Auras are common, but not everyone with epilepsy has one. An aura typically happens a few seconds before main symptoms of a seizure or, it can happen in isolation. At this stage, the person has awareness of what is happening and can describe the symptoms.
The symptoms of the aura depend on where the seizure is starting in the brain, so they can vary greatly. Symptoms may include feelings of fear, déjà vu, sensations in the stomach such as nausea, heartburn or butterflies, dreamlike or outer body experiences, unusual smells or tastes, and hallucinations. The aura is usually remembered (but not always), and person can recall the happenings during this stage well enough.
Another term for aura is a focal aware seizure.
The seizure activity that causes an aura may stay confined to one small area of the brain and remain as an aura (focal aware seizure) in isolation.
The aura may progress to other areas of the brain and cause the person’s awareness to become impaired, which is then called a focal impaired awareness seizure.
The aura can also spread widely to both hemispheres of the brain, which will then become a convulsive (tonic clonic) seizure which is termed a focal to bilateral tonic clonic seizure when it spreads in this manner.
The seizure (ictal stage)
This is the stage of the seizure that most people are familiar with and would identify as a seizure. This stage is where you can usually clearly see signs such as changes in behaviour, consciousness or movement.
Seizures present in many different ways for each person with epilepsy. A person may experience very few, or many noticeable symptoms. Some of these can include:
- Change in consciousness, confusion, vagueness
- Unresponsiveness or inappropriate responses
- Unable to move or speak
- Stiffening and/or jerking of the limbs
- Eye or head jerking movements
- Chewing or lip-smacking
- Speaking gibberish or vocalising
- Fidgeting
- Wandering
- Drooling
- Loss of bladder and/or bowel control
- Pale or flushed skin
- Dilated pupils
- Sweating
- Increased heart rate
After the seizure (post-ictal stage)
The time after a seizure is called the post-ictal period. With some seizures, people have an immediate recovery, such as absence seizures, while others may take the person several minutes to return to baseline. For more severe seizures such as tonic clonic seizures, some people can feel dreadful for hours, even days afterward.
The length of the post-ictal stage depends on the seizure type, severity, and region of the brain affected.
Many people need a rest or sleep after a seizure, even if it appears mild. Typical symptoms that happen after a seizure include:
- Headache or migraine
- Confusion, memory loss
- Difficulty with speech or finding names or words
- Body soreness
- Tiredness, drowsiness, lethargy
- Nausea
- Feeling sad
Symptoms difficult to describe
So much surrounding a seizure can be difficult to articulate, especially when the person has memory loss for all or part of the seizure. For instance, unusual feelings or sensations, déjà vu, an aura that is like an outer body feeling, hallucinations or strange smells or tastes.
Not everyone has four stages with their seizures. Some will have less, depending on their seizure type. Still, one of the most disabling aspects of epilepsy is that seizures are usually unpredictable. If someone with epilepsy can have more awareness of their seizure stages, especially the prodrome, then they may be able to recognise symptoms much earlier and have more of a forewarning and be able to take themselves to a safe place or alert a loved one before a seizure happens.
For more about seizure types, see our:
Seizure Classification Factsheet
