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Do You Know the Subtle Signs of Seizures?

January 16, 2024

Doctor examining scan of human brain

A seizure is an electrical disturbance that disrupts normal brain function. According to the Centers for Disease Control and Prevention, about one in 10 Americans will have a seizure in their lifetime. But as Stefan Gillen, DO, a neurologist at Atlantic Health System points out, there are several types of seizures that have distinct features. He explains that some signs and symptoms of seizures can go unrecognized, and how to help in an emergency.

What is a seizure?

A seizure is abnormal electrical activity in the brain that causes neurologic manifestations. Most seizures last several seconds to a couple of minutes, and they generally fall into one of two categories: focal-onset or general-onset. Focal-onset seizures start in a specific area of the brain and either remain there or spread to other regions of the brain. Generalized seizures begin globally throughout the brain.

Traditionally, when people think of a seizure, they envision someone falling to the ground, unresponsive, shaking, and possibly foaming at the mouth. While some of these features can be seen with generalized seizures or focal-onset seizures, they do not represent all seizure symptoms.

What are the obvious signs of a seizure?

Clinical manifestations of seizures vary depending on the brain regions involved. Generalized seizures typically last one to two minutes and begin with impaired awareness followed by rigidity and rhythmic shaking and ending in confusion. Focal-onset seizures can produce varying symptoms. Some people may retain awareness while others have impaired awareness. Other symptoms can include rising stomach sensations, foul smells, bitter tastes, sudden feelings of doom, visual disturbances, autoscopy where someone visualizes their double, and simple or complex motor behaviors.

What are the lesser-known signs?

In some cases, people may appear confused or have difficulty with speech and comprehension. In exceptionally rare circumstances, some seizures can cause the heart to stop beating. Still others can cause unprovoked laughter or crying sounds, or subtle facial signs like pouting. It is also common to see simple or complex motor behaviors that can appear stereotyped, like posturing your arm to resemble a fencer, picking at a shirt button, or shaking a limb. Even bicycling leg movements at nighttime can signify a seizure.

If the symptoms appear milder, does that mean the seizure is milder?

Not necessarily. Even a mild seizure can leave the person exhausted and disoriented with long-term adverse effects. A mild seizure for one person may be debilitating for another. Suppose a seizure causes your arm to suddenly posture briefly. For some it is a mild annoyance, but for a professional musician or athlete it is a significant deficit.

What should you do if you suspect someone is having a seizure?

Make sure their environment is safe and remove potential hazards when you’re able to do it safely. If they are lying down, keeping them on their side can help prevent choking and allow their saliva to drain out of their mouth, but it is advisable not to restrain them to prevent injuries. If there are any worrisome complications like injuries or respiratory distress, call the paramedics. Following a seizure, the person may be disoriented, confused, aggressive, or even emotional.

When is it time to get emergency help?

First and foremost, if someone seizes longer than five minutes, it is a medical emergency and they’re at risk of brain damage. With any suspicion of a seizure, evaluation by an epileptologist or neurologist is essential. An electroencephalogram (EEG) will study brain wave activity and epilepsy testing by an epileptologist or seizure specialist can help better understand why the seizure occurred.

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  • Brain Health