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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.

A seizure is an electrical disturbance that interferes with normal brain function – they occur when abnormal electric signals from the brain change the way the body functions. A focal seizure starts in a single location in one hemisphere (or side) of the brain, whereas a generalized seizure starts in both hemispheres simultaneously.

In addition to these categorizations, there are four distinct phases of seizures: prodromal, early ictal (the “aura”), ictal, and post-ictal.

Please note: different forms of epilepsy affect people differently, and not every seizure has the same symptoms or even the same progression. Because of this, individual experiences with seizures may vary, meaning some people will not experience all of the stages or symptoms described below.

 

Before the Seizure: Prodromal Phase

The prodromal phase is a subjective feeling or sensation that can occur several hours or even days before the actual seizure. The most common symptoms of a prodrome include confusion, anxiety, irritability, headache, tremor, and anger or other mood disturbances (Besag & Vasey, 2018).

About 20% of individuals with epilepsy experience this stage (Besag & Vasey, 2018), which may serve as a warning sign of seizure onset for those who experience it. Unlike an aura, though, this stage is not part of the seizure.

During the Seizure: Early Ictal and Ictal Phases

“Passenger” by Linda Sudlesky. Linda compares 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.

 

Early Ictal (The Aura)

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

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

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).

 

Ictal Phase

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

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

 

After the Seizure Ends: Post-Ictal Phase

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.

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

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

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 & Behav83: 219-233

Falco-Walter, J.J., Scheffer, I.E., and Fisher, R.S. (2018) The new definition and classification of seizures and epilepsy. Epilepsy Res139: 73-79.

 

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