Phases of Seizures
Discover the signs, symptoms, and progression of a seizure.
Epilepsy is a debilitating neurological disorder characterized by repeated seizures of various types and severity.
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.
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.
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:
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:
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:
Reviewed by CURE Scientific Advisory Council Members Daniel Lowenstein, MD and Jaideep Kapur, MD/PhD on Thursday, January 16, 2020.
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.