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Phases of Seizures

Epilepsy is a debilitating neurological disorder characterized by repeated seizures of various types and severity.

Painting, three circles in gradient lighting.

“Illusion” by Vincent Buchinsky presented at the 1:26 The Art of Epilepsy exhibition in Boston, MA. Vincent suffers from focal seizures with impaired awareness (complex partial) and, in this work, he explores how he experiences auras. He says his paintings give him a sense of calmness.

There are two broad categories of seizures; generalized and focal. If the seizure starts at a single location in one hemisphere (or side) of the brain, it’s a focal seizure, and if it starts in both hemispheres simultaneously, it’s generalized. If you have additional questions about different types of seizures and how they are classified, check out our free webinar The New Way to Describe Your Seizure Type.

Different forms of epilepsy affect people in different ways, and not every seizure has the same symptoms or progression. Because of this, not every individual experiences all of the seizure phases and symptoms we describe below.

A seizure can be composed of four distinct phases: prodromal, early ictal (aura), ictal, and post-ictal.

Before the Seizure

About 20% of individuals with epilepsy experience a prodromal phase – a subjective feeling or sensation that can occur several hours or even days before the actual seizure (Besag & Vasey, 2018). The most common symptoms of a prodrome include confusion, anxiety, irritability, headache, tremor, and anger or other mood disturbances (Besag & Vasey, 2018). The prodromal period may serve as a warning sign of seizure onset for those who experience it, but, unlike an aura (see below), this phase is not part of the seizure.

During the Seizure

“Passenger” by Linda Sudlesky presented at the 1:26 The Art of Epilepsy exhibition in Boston, MA. Linda compared her seizures to the angst-provoking experience of speeding through a tunnel as a passenger in a car, feeling helpless to control what happened to her.

For many people with epilepsy, the earliest sign of seizure activity is an aura. Although it has traditionally been thought of as a warning of an on-coming seizure, an aura is actually the earliest sign of seizure activity and the beginning of the ictal phase. (Besag & Vasey, 2018). The ictal phase includes the time between the beginning (aura, if present) and the end of the seizure.

Like the prodrome (mentioned above), not everyone with epilepsy has auras. For those who do, the specific symptoms vary depending on the seizure type, severity and affected brain region. Some common symptoms include the following:

  • Vision loss or blurring
  • Flickering vision
  • Hallucinations
  • Déja vu (feeling of familiarity with a person, place, or thing without having experienced it)
  • Jamais vu (feeling of unfamiliarity with a person, place, or thing despite having already experienced it)
  • Ringing or buzzing sounds
  • Strange, offensive smells
  • Bitter, acidic taste
  • Out-of-body sensation
  • Nausea/stomachache
  • Numbness
  • Tingling
  • Dizziness
  • Head, arm, or leg pain
  • Subtle arm or leg twitching
  • Strong feelings of joy, sadness, fear, or anger

An aura can remain localized or progress to other areas of the brain with the person’s awareness becoming impaired to varying degrees. The aura can also spread to both hemispheres of the brain, becoming a secondarily generalized seizure within seconds to minutes after onset (Falco-Walter et al., 2018).

The ictal phase manifests in different ways for every person with epilepsy. They may experience a variety of symptoms, including but not limited to:

  • Confusion
  • Memory lapses
  • Distractedness
  • Sense of detachment
  • Eye or head twitching movement in one direction
  • Inability to move or speak
  • Loss of bladder and/or bowel control
  • Pale/flushed skin
  • Hearing loss
  • Strange sounds
  • Vision loss, blurring, flashing vision
  • Chewing or lip-smacking
  • Unusual physical activity such as dressing/undressing
  • Walking/running
  • Pupil dilation
  • Difficulty breathing
  • Racing heart
  • Sweating
  • Tremors
  • Twitching
  • Arm or leg stiffening
  • Numbness
  • Drooling

 

After the Seizure Ends

Nathan Plung 1 in 26

“Winston Churchill” by Nathan Plung presented at the 1:26 The Art of Epilepsy exhibition in Boston, MA. Nathan explains that his artwork (fiber art/cross-stitch) allows him to express himself without words and to enter a “zen” or meditative state.

Following a seizure, there is a recovery period called the post-ictal phase. Some people recover immediately, while others require minutes to days to feel like they’re back at their baseline. The length of the post-ictal phase depends directly on the seizure type, severity, and region of the brain affected. Typical symptoms include the following:

  • Drowsiness
  • Confusion
  • Memory loss
  • Nausea
  • General malaise
  • Body soreness
  • Difficulty finding names or words
  • Headaches/migraines
  • Thirst
  • Arm or leg weakness
  • Hypertension
  • Feelings of fear, embarrassment, or sadness

Reviewed by CURE Scientific Advisory Council Members Daniel Lowenstein, MD and Jaideep Kapur, MD/PhD on Thursday, January 16, 2020.

References

Besag, F.M.C. and Vasey, M.J. (2018) Prodrome in epilepsy. Epilepsy & Behav. 83: 219-233

Falco-Walter, J.J., Scheffer, I.E., and Fisher, R.S. (2018) The new definition and classification of

seizures and epilepsy. Epilepsy Res. 139: 73-79.

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