Jennifer DeWolfe, D.O.Epilepsy is a common neurological condition that causes seizures and affects millions worldwide. Though seizures are a commonly recognized symptom of epilepsy, the disease can present differently depending on the patient.

“It’s all about the brain,” said Jennifer DeWolfe, D.O., professor in the UAB Department of Neurology. “Seizure manifestations are stereotyped, so the same symptoms occur with each seizure that involves that region of the brain in that person.”

Generalized vs focal seizures

Before examining seizure symptoms in more detail, it is essential to note that symptoms depend on the area of the brain involved during the seizure. Seizures can be classified as either generalized or focal, depending on the part of the brain involved. Seizures can affect a single area of the brain or the whole brain simultaneously at the onset of the seizure.

Focal seizures involve one area of the brain. These seizures can include preserved and impaired consciousness depending on the brain region involved. A focal seizure can begin with preserved awareness and progress to impaired awareness if the seizure spreads to a brain region that affects consciousness. Focal seizures can be easily confused with other conditions such as migraines, narcolepsy, or mental illness.

Generalized seizures, unlike focal seizures, involve all areas of the brain. Generalized seizures typically involve a loss of awareness or consciousness. These seizures typically involve abnormal movements on both sides of the body.

Seizure symptoms: What to look for

When most people think of epilepsy, they think of intense seizures with stiff jerking movements and a noticeable loss of consciousness. These symptoms describe a type of seizure, specifically tonic-clonic seizures, but symptoms of epilepsy can present in several even more subtle ways. Seizures can affect different regions of the body depending on the area of the brain involved. Read about six common seizure symptoms that can be associated with epilepsy.

Short-term confusion

Seizures can cause short-term confusion due to their impact on the brain’s ability to process information. This confusion may persist during the seizure and continue after the event.

A staring spell

During a seizure, a person may experience staring spells. This can look like a “blank stare,” and the person may not respond when prompted and may not recall the events that occurred during the seizure once it is over. Staring spells may occur with or without movement of the body.

Stiff muscles

Sudden muscle stiffness can occur during a seizure. Stiffness can occur in the arms, legs, or trunk, on one or both sides, and can cause the person to fall if they are standing or upright when a seizure occurs. The location and severity of stiffness depend on the area of the brain involved during the seizure.

Jerking movements of the arms and legs

Seizures involved different types of jerking movements. Repeated jerking movements can occur on one or both sides of the body during a seizure. These are uncontrolled movements that can happen when someone is both conscious and unconscious.

Loss of consciousness

Some seizures can begin or lead to loss of consciousness or awareness. Levels of consciousness depend on the location of the brain region involved during the seizure. Some may never lose consciousness, while others will have no recollection of the event.

Psychological symptoms such as fear, anxiety, or déjà vu

Seizures can elicit a psychological response. This can be felt as a sudden and intense fear or anxiety at the start of a seizure. Some may even experience a phenomenon known as déjà vu, where they have a sense that something is very familiar.

Warning signs of a seizure

Sometimes, a person may experience something called an aura. Auras are most common with focal seizures. An aura is a seizure occurring in one region of the brain before it spreads to another area of the brain.

“People often have the misperception that the aura is not a seizure,” DeWolfe said. An aura may be considered a warning because it can indicate that seizure activity may spread to another region of the brain. Warning signs can include a feeling in the stomach, feelings of anxiety and fear, specific tastes or smells, visual signs such as flashing lights or colors, hallucinations, and dizziness or loss of balance. These auras are actually seizures in that region of the brain. The “seizure” that begins after the “aura” represents the seizure activity spreading to another brain region. 

Seizure first aid

Anyone can help when a seizure occurs. Following these steps and educating yourself about seizures and epilepsy can make a difference when a medical event occurs. The number one goal of seizure first aid is to keep the person safe.