Seizures can be scary events, both for the person experiencing them and for observers. Understanding what happens in the brain and body during a seizure can help remove some of the fear and mystery surrounding seizures.
What is a seizure?
A seizure is a sudden, uncontrolled electrical disturbance in the brain. It results in changes in behavior, movements, sensations, or states of awareness. Seizures are caused by intense bursts of electrical activity in the brain, which can be triggered by a number of factors.
There are many different types of seizures. The main types include:
- Focal (partial) seizures – Seizures that start in one area of the brain.
- Generalized seizures – Seizures that involve the entire brain at once.
- Absence (petit mal) seizures – Brief lapses of consciousness.
- Tonic-clonic (grand mal) seizures – Entire body stiffens and shakes.
- Atonic seizures – Loss of muscle control.
- Myoclonic seizures – Sudden muscle jerks.
Seizures vary widely in how they look and feel to the person having them. But there are some common themes in what happens in the brain and body during a seizure event.
Before the seizure
In the moments leading up to a seizure, many people experience warning signs known as auras or premonitions. These can include:
- A strange feeling in the stomach
- A change in emotions
- Seeing or smelling something that’s not there
- A feeling of fear or anxiety
- Experiencing déjà vu
- Having blurred or tunnel vision
- Uncontrolled body movements or muscle twitches
These auras are actually simple focal seizures that can progress into more pronounced seizures. Paying attention to auras when they occur can sometimes allow a person to get to a safe place before a bigger seizure happens.
Start of the seizure
When the seizure itself begins, the electrical misfiring occurs and starts to take over normal brain function. What happens next depends on the type of seizure:
- Focal onset seizure – One area of the brain is affected first. This can lead to muscle twitching, sensory changes, or emotional and cognitive effects limited to one side of the body or mind.
- Generalized onset seizure – Both sides of the brain are involved from the beginning. This causes loss of consciousness and leads to convulsions, muscle stiffening, jerking, or staring.
- Unknown onset – The starting point of the seizure in the brain can’t be identified.
In a generalized tonic-clonic seizure, the most pronounced type, the person will suddenly lose consciousness. Their body will become stiff and fall to the ground. Jerking, convulsing movements begin that affect the entire body.
During the seizure
While in the midst of having a seizure, a number of changes take place in the body:
- Loss of awareness and consciousness (with generalized seizures)
- Drooling or frothing at the mouth
- Chewing motions
- Random vocalizations
- Stiffening and jerking of muscles
- Loss of bladder or bowel control
- Impaired breathing
- Blue tint to skin (cyanosis)
- Rolling back of the eyes
These effects occur because normal neural communication is disrupted and muscles contract uncontrollably. The longer the seizure lasts, the greater the risk of prolonged oxygen deprivation or physical injury.
Duration of seizures
Seizures typically last from 30 seconds up to 2-3 minutes. Prolonged seizures over 5 minutes require emergency medical care.
| Seizure Duration | Level of Concern |
|---|---|
| Less than 1 minute | Minimal concern |
| 1-3 minutes | Seek medical care after for evaluation |
| 3-5 minutes | Call 911 if seizure continues past 5 minutes |
| Over 5 minutes | Medical emergency, call 911 immediately |
Injuries during seizures
The uncontrolled muscle contractions of a seizure can lead to injuries such as:
- Head trauma from falling
- Bitten tongue or cheek
- Broken bones
- Damage to teeth and mouth
- Burns or bruises if near heat or hard objects
- Car accidents if seizure happens while driving
Staying in an open area and away from hazards can help reduce risk of injury. Putting soft padding around hard edges helps make the environment safer.
After the seizure
Once seizure activity stops, the recovery phase begins as the brain returns to normal function:
- Awareness and alertness start to return
- Confusion is common right after seizure ends
- Fatigue, weakness, and lethargy set in
- Bad headache may occur afterwards
- Period of altered consciousness before full wakefulness
Some people experience temporary paralysis on one side of their body after a seizure. This is called Todd’s paralysis and indicates that one area of the brain was more affected than others.
Recovery time varies from minutes up to several hours or days depending on seizure severity. Proper rest and nutrition can help speed post-seizure recovery.
Warning signs of seizure complications
Seeking emergency care is recommended if any of the following danger signs occur after a seizure:
- Seizure repeats without full recovery between episodes
- Confusion, drowsiness, or weakness lasts more than one hour
- Fever over 101 F degrees
- Severe headache or stiffness in neck
- Vomiting more than once after seizure
- Breathing difficulties
- No return to consciousness after 30 minutes
- Seizure lasting longer than 5 minutes
These may indicate an underlying problem like status epilepticus, meningitis, pulmonary edema, or brain injury from the seizure. Seeking prompt medical care can prevent further health complications.
Summary of the stages of a seizure
While seizures can appear frightening to onlookers, knowing what to expect can help reduce fear and uncertainty. Here are the basic stages of a seizure:
- Pre-seizure aura or warning signs
- Sudden onset of seizure activity in the brain
- Altered awareness and involuntary muscle contractions
- Gradual ending of convulsions and jerking motions
- Post-seizure drowsiness and confusion
- Recovery period until normal consciousness returns
Understanding seizures involves more than just observing their physical effects. It also requires appreciating what the person with epilepsy experiences as their brain activity becomes disrupted.
Perspective from inside a seizure
To understand what a seizure feels like, it helps to hear direct experiences from those who live with them.
Here are some first-hand accounts of what it’s like to have a seizure:
“At first it feels like a wave of anxiety washing over me. Things begin looking distorted, then I lose awareness of what’s going on.”
“My seizures are like being plunged into a dream then pulled out just as fast. When I come to, I have no memory of the seizure itself.”
“Losing control during a seizure is the worst feeling. I try to fight it but can’t stop my body from convulsing.”
“After a seizure I’m completely disoriented. I know I should recognize people and places, but my brain needs time to reset.”
Gaining this lived perspective is key to appreciating what seizures truly involve beyond just physical signs. The loss of control and awareness they cause can be distressing.
Caring for someone during or after a seizure
If you witness someone having a seizure, these tips can help you provide safe, effective care:
- Remain calm and track timing of the seizure
- Protect their head by placing something soft beneath it
- Turn them on their side if vomiting occurs
- Avoid restraining or putting anything in their mouth
- Stay with them until consciousness returns
- Be reassuring and orienting when they wake up
Getting proper training in first aid for seizures empowers you to know the right things to do if someone needs assistance. Staying with the person until they recover fully lets them know they are not alone.
Conclusion
Witnessing seizures can be worrying for family and friends. Learning what happens inside the brain reduces fear and stigma. Being aware of seizure stages guides proper response and care.
While seizures may seem bizarre to onlookers, having awareness makes them more comprehensible. Staying calm and knowing what to expect during and after a seizure allows you to provide the best care and reduce anxiety. With understanding and compassion, seizures can become less daunting over time.