Seizure

A seizure is a surge of abnormal electrical activity in the brain that can cause temporary changes in awareness, muscle control, behavior, and senses. Anyone can experience a seizure at any age, and understanding the different types, causes, and treatments can help you or your loved ones manage this condition more effectively.

Table of contents

• What is a seizure?
• Types of seizures
• Symptoms of a seizure
• What causes seizures?
• How is a seizure diagnosed?
• Treatment options
• First aid for seizures
• Living with seizures
• Can seizures be prevented?

What is a seizure?

A seizure happens when there are sudden and uncontrolled changes to electrical signals in the brain^[1]. The flow of electrical signals in your brain is disrupted, causing a temporary change in brain activity^[2]. This disruption can lead to changes in awareness, muscle control, behavior, and feelings^[3].

Not all seizures look the same. Some seizures are very noticeable, causing loss of consciousness and uncontrollable movements called convulsions (violent shaking movements)^[1]. However, other seizures can be so subtle that they may not even be recognized—you might simply stop what you’re doing and stare off into space for a few seconds, or you might jerk your arm or feel your muscles twitch^[1].

Up to 10% of people around the world will have at least one seizure during their lifetimes^[1]. About 1 in 10 people in the United States may have a seizure in their lifetime^[16]. Your experience with seizures can be very different from someone else’s—you might have only one seizure in your life or experience multiple seizures per day^[1].

Having a seizure does not automatically mean you have epilepsy (a condition of recurrent unprovoked seizures)^[5]. Seizures can be provoked by certain factors like abnormal blood sugar levels or medication side effects. They may also be unprovoked, meaning they occur without a definitive cause^[5]. Epilepsy is specifically diagnosed after a person has experienced two or more unprovoked seizures at some point in their life, or after a single seizure if medical evaluation indicates an increased risk for more seizures^[5].

Types of seizures

There are two main types of seizures, named based on where the seizure starts in the brain^[4]:

Focal seizures

Focal seizures, also called “focal onset seizures,” begin on one side of the brain^[4]. They start in one small area of your brain (the “focus”) and can spread to other areas^[3]. These used to be known as partial seizures^[3].

Focal seizures may cause changes in awareness, behavior, or sensation, or abnormal movements usually on just one side of the body^[4]. It is possible for this type of seizure to spread to both sides of the brain, which can cause a loss of consciousness and movements on both sides of the body^[4].

There are two main types of focal seizures:

• Focal onset aware seizures (previously called “simple partial seizures”): You are fully aware of what’s happening during the seizure and able to remember it afterward^[1]. You can sometimes talk during these seizures^[5].
• Focal impaired awareness seizures (previously called “complex partial seizures”): You lose awareness and experience confusion when the seizure happens and can’t remember it^[1]. These may make you confused or dazed, cause you to pick at your clothes or smack your lips, or leave you unable to respond to questions or directions for a few minutes^[4].

Generalized seizures

Generalized seizures, also called “generalized onset seizures,” begin on both sides of the brain at the same time^[4]. Electrical activity starts on both sides of your brain at the same time^[1]. They usually cause a loss of consciousness or awareness and may also cause abnormal movements on both sides of the body^[4].

The types of generalized seizures include:

• Absence seizures (previously called “petit mal”): You stop what you’re doing and have a blank stare^[1]. These cause short, sudden lapses of consciousness and may include rapid eye blinking or chewing movements^[4].
• Atonic seizures (drop seizures): You lose muscle control and drop to the ground suddenly^[1].
• Clonic seizures: You’ll shake both sides of your body and may pass out, or shake one side without passing out^[1].
• Myoclonic seizures: These involve a quick jerk or twitch that affects one muscle or a group of connected muscles^[1].
• Tonic-clonic seizures (previously called “grand mal”): Your muscles stiffen, you lose consciousness and have convulsions^[1]. This is the type many people think of when they hear of a seizure. These cause muscle stiffness and rhythmic jerking, usually last a few minutes, and may cause confusion and tiredness afterwards^[4].
• Tonic seizures: You pass out and your muscles tighten up but you don’t have convulsions^[1].

Unknown onset seizures

Unknown onset seizures are those where it is not clear where in your brain they started^[3]. Your unknown onset seizure type might change with more testing or information^[3].

A person with epilepsy can have more than one type of seizure^[4].

Febrile seizures

Febrile seizures, or febrile convulsions, are seizures that happen in children when their body temperature rises due to a fever^[3]. About 1 in 30 children will have a febrile seizure and usually only once^[3]. They usually happen between 6 months and 6 years old^[3]. Even though it can be scary to watch, your child usually won’t have any ongoing problems from a febrile seizure^[3].

Symptoms of a seizure

Seizure symptoms vary based on the type and severity^[1]. Some seizures may cause symptoms that are very obvious to the person having the seizure or observers. However, some seizures can be subtle and go unrecognized by both the person having the seizure and those witnessing it^[5].

Seizure symptoms may include:

• Loss of consciousness^[1]
• Uncontrollable movements (convulsions, muscle spasms, jerking)^[1]
• Staring^[1]
• Sudden emotional changes (confusion, fear, joy, anxiety)^[1]
• Teeth clenching^[1]
• Drooling^[1]
• Abnormal eye movements^[1]
• Sudden stiffening or jerking of arms and legs^[3]
• Changes in awareness or feelings^[3]
• Numbness, impaired speech, or sudden confusion^[5]

The type of seizure you have depends on the part of the brain the seizure starts in, if you are aware during the seizure, and if there is a change in your movements during the seizure^[3].

Most seizures last just a few minutes, and some can last a few seconds^[16]. A seizure usually lasts a few seconds or minutes and stops by itself^[3].

What causes seizures?

There are many possible causes of seizures because a lot of things can interfere with your brain’s typical electrical patterns^[1]. These range from changes to your blood sugar levels to an illness, injury, or underlying condition^[1].

You can have two types of seizures based on their cause^[7]:

• Provoked seizure: This type is triggered by something that irritates your brain. For instance, an infection, high or low blood sugar, a reaction to a drug, alcohol withdrawal, not getting enough sleep, and bright flashing lights can cause seizures^[7].
• Unprovoked seizure: You can also have a seizure for reasons that are unclear^[7].

Some people have epilepsy as a symptom of pre-existing conditions such as stroke, brain tumors, or moderate to severe traumatic head injury, though often there is no apparent cause^[6]. It can also be caused by a head trauma, infection, tumor, or injury that happened before birth^[6]. Some developmental issues, like autism, can also raise your risk of epilepsy^[6].

Epilepsy and seizures can develop at any point in your lifetime. New cases are most common with younger children, particularly in their first year of life. However, cases also increase after age 55, as you are more likely to develop brain injuries, such as stroke, brain tumors, and Alzheimer’s disease^[5].

How is a seizure diagnosed?

After a seizure, your healthcare professional reviews your symptoms and medical history and does a physical exam^[8]. You may have tests to find the cause of your seizure. Tests also may show how likely it is that you’ll have another seizure^[8].

Tests may include:

• A neurological exam: This is to look at your behavior, motor abilities and how your brain works^[8].
• Blood tests: A blood sample can show blood sugar levels and look for signs of infections or gene conditions. A health professional also may check the levels of salts in the body^[8].
• Electroencephalogram (EEG): This test records the electrical activity of the brain through electrodes put on the scalp. EEG results show changes in brain activity that may help diagnose brain conditions such as epilepsy and other seizure conditions^[8].
• Brain imaging tests: These may include CT scans or MRI scans to look for abnormalities in the brain^[8].

If you or your child have had a seizure, you’ll need to see a specialist doctor. They’ll check what caused it and whether you might have epilepsy^[3]. If seizures are frequent or interfere with daily activities despite taking medications as prescribed, it may be time to see a seizure specialist^[17]. An epileptologist is a neurologist with specific training in the diagnosis and treatment of seizures^[17].

Treatment options

Medications

The most common treatment for epilepsy is medicine to prevent seizures, called anti-seizure or anti-epileptic medicine^[10]. Anti-seizure medicines limit the spread of seizures in the brain^[10]. There are more than two dozen drugs that can lower the level of electrical activity in the brain, helping to prevent or reduce the number of seizures^[15].

It may take time to find the right medicine. Sometimes you’ll need a combination of medicines^[10]. It’s very important to take your medicine as prescribed^[10]. Medicines work for about 2 in 3 people with epilepsy^[10]. While drugs won’t cure epilepsy, they allow an estimated 70% of people with the condition to manage it to the point where it barely interferes with their daily life^[15].

Medicines can cause side effects like tiredness or trouble thinking. Let your health care provider know if you’re having any side effects, so they can adjust the medicine if needed^[10]. You should not skip or stop taking your seizure medicine without talking to your provider. Suddenly stopping your medicine might cause withdrawal symptoms, including life-threatening seizures^[10].

Surgery

When seizures come from a single area of the brain (focal seizures), surgery might be helpful^[10]. Removing the affected area may stop future seizures or make them easier to control with medicine^[10]. Brain surgery techniques have been advancing, which has meant a revolution for those with epilepsy that doesn’t respond well to medication^[15].

Seizure devices

Several devices can help manage seizures:

• Vagus nerve stimulation: An electrical device is placed under the skin on the upper chest. It sends energy pulses to the brain through the vagus nerve, which can stop seizures^[10].
• Responsive nerve stimulation: An electrical device is placed in the brain to find the area where seizures are coming from. It then sends energy pulses to that area to prevent seizures^[10].

Diet

If medicine doesn’t work and surgery isn’t an option, there are other treatments that might help. Your doctor may suggest a ketogenic diet: This is a strict, high-fat, low-carbohydrate diet. It’s typically used in children whose seizures won’t stop. It’s prescribed by a health care provider and monitored by a dietician^[10]. Some people find that low-carbohydrate diets can help reduce seizures, but always discuss dietary changes with your healthcare provider^[21].

The most important thing you can do to prevent seizures is to take your medicine as prescribed^[10]. Taking your medicine is the most important thing you can do to prevent seizures^[10].

First aid for seizures

If you are with someone having a seizure, there are important steps to follow to keep them safe^[16]:

• Keep yourself and others calm^[16]
• Stay with the person^[16]
• Remove anything near them that can cause an injury^[16]
• Check to see if they are wearing a medical bracelet for information about any medical conditions, medicines, and emergency contacts^[16]
• If the person is lying down, turn them gently on their side, with their mouth pointing to the ground. This will keep their airway clear^[16]
• Time the seizure to track if it lasts more than 5 minutes. If it does, seek immediate medical attention or call emergency services^[16]
• When the seizure is over, help them sit in a safe place to recover^[16]
• Once they are alert, comfort them and explain what happened^[16]

What not to do during a seizure:

• Don’t hold the person down or stop their movements. This could injure you or them^[16]
• Don’t put anything in their mouth. This can hurt their teeth or jaw^[16]
• Don’t give mouth-to-mouth breaths during the seizure. People usually start breathing again on their own after a seizure^[16]
• Don’t offer water or food until they are fully alert. This is not necessary and could cause them to choke^[16]

When to call emergency services

You should call emergency services if one or more of these things happen^[16]:

• The seizure lasts longer than 5 minutes^[16]
• They have another seizure soon after the first one^[16]
• They have trouble breathing or waking up after the seizure^[16]
• They are injured during the seizure^[16]
• The seizure happens in water^[16]
• The person has never had a seizure before^[16]
• The person has diabetes and loses consciousness^[16]
• The person is pregnant^[16]

If you or your child are experiencing frequent seizures despite treatment, it’s essential to consult a neurologist^[23].

Living with seizures

As with many chronic medical conditions, lifestyle adjustments can be an important part of seizure management^[22]. Self-care for individuals with epilepsy is crucial to managing their condition and overall well-being and can contribute to a healthier and more fulfilling life^[21].

Understand your triggers

Every patient may have different seizure triggers. Common factors include lack of sleep, missed medications, dehydration, flashing lights, or high stress^[23]. By keeping a seizure diary, patients can track activities, diet, emotions, and sleep patterns that might contribute to seizures^[23]. Recognizing these patterns makes it easier to adjust daily routines and avoid preventable episodes^[23].

Healthy lifestyle choices

Lifestyle modifications can include^[22]:

• Adequate sleep: Fatigue is one of the most common seizure triggers, and disrupted sleep can make the brain more vulnerable to misfiring^[22]. Prioritize good sleep hygiene and aim for consistent sleep patterns, as lack of sleep can trigger seizures in some individuals^[21]. Establishing a routine bedtime, creating a calming sleep environment, and avoiding stimulants like caffeine in the evening can significantly reduce seizure risks^[23].
• Healthy diet: A healthy diet is an essential aspect of self-care. Maintain a balanced diet with regular meals^[21].
• Regular exercise: Engage in regular physical activity, which can help reduce stress and improve overall well-being^[21]. Daily aerobic exercise can improve your mood, health and overall self-esteem, and may reduce the number of seizures you experience^[17]. However, avoid activities with a high risk of injury if seizures are not well-controlled^[21].
• Avoiding drugs and alcohol: These can be triggers for seizures in patients with epilepsy. Even one or two drinks can provoke seizures^[22]. Limit alcohol, avoid recreational drugs, and stay well-hydrated^[23].

Stress management

Stress management counseling is important, as stress is often cited as a trigger for seizures. It can also lead to sleep deprivation, another common trigger^[22]. High stress and anxiety can affect brain activity and increase seizure likelihood^[23].

Practice relaxation techniques like deep breathing, meditation, or yoga to reduce stress^[21]. Relaxation strategies such as mindfulness, yoga, and breathing exercises can help reduce stress^[23].

Safety precautions

There are many ways to make your home safer in the event you have a seizure^[17]. Wear a medical alert bracelet or necklace to alert others of your condition in case of emergency^[21]. Inform close contacts, such as family, friends, and coworkers, about your epilepsy and what to do if you have a seizure^[21].

Depending on your type of seizures, certain activities such as swimming, rock climbing and contact sports should be avoided as they could place you in a dangerous situation should you have a seizure^[17]. Never swim alone^[18].

Emotional and social support

Make time for activities you enjoy, such as hobbies or relaxing with loved ones^[21]. Community support is a critical part of managing epilepsy and is beneficial for mental health. Connecting with others who have epilepsy can provide emotional support as well as practical tips for managing the condition^[21].

Depression and anxiety commonly occur with epilepsy. Symptoms may be subtle, and depression can accompany other conditions, such as anxiety. Depression and anxiety are very treatable conditions that can have a major effect on quality of life^[22].

Can seizures be prevented?

While not all seizures can be entirely prevented, there are practical steps that can help individuals manage triggers, lower risks, and improve quality of life^[23].

The most effective ways to prevent seizures include:

• Taking medication as prescribed: One of the most effective ways to prevent seizures is to take prescribed medications consistently. Missing even a single dose can increase the risk of breakthrough seizures^[23].
• Getting adequate sleep: Poor or inconsistent sleep is a well-known seizure trigger^[23].
• Managing stress: High stress can increase seizure likelihood^[23].
• Avoiding known triggers: These may include flashing lights, alcohol, certain medications, or lack of sleep^[23].
• Maintaining healthy lifestyle choices: This includes regular exercise, a balanced diet, and staying well-hydrated^[23].

Lifestyle changes such as better sleep, stress management, and avoiding known triggers can help, but they usually work best in combination with prescribed seizure treatment from a neurologist^[23].