Warning Signs Of A Seizure You Shouldn’t Miss

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What is a seizure?

A seizure occurs when there is abnormal electrical activity in the brain. Generally, there is an increase in electrical activity during a seizure. The electrical activity decreases afterward, which is the brain’s way of recovering. 

It is reported that approximately 10%¹ of people will have at least one seizure in their lifetime. It is most common in children and the elderly. If you have more than one unprovoked seizure, you will likely be diagnosed with epilepsy.

Epilepsy is a medical disorder where someone is prone to seizures for any reason. It is relatively common. The Centers for Disease Control and Prevention estimates that 1.2%² of Americans have active epilepsy, which is defined as someone that has had one or more seizures in the past year and/or is taking antiepileptic medication.

What are the symptoms of a seizure?

Many different symptoms present with a seizure. It varies between individuals, but also by the type of seizure. They include:

  • Reduced or loss of consciousness, e.g., not feeling quite there, blacking out

  • Uncontrollable movements of one or more limbs 

  • Changes in your sensations, e.g., smell, vision, etc.

  • A feeling of impending doom 

  • Jerking movements

  • Urinary incontinence

  • Tongue biting 

To get a more extensive list of symptoms, click this link.

What are the four stages of a seizure?

A seizure can be separated into four stages: prodromal, aura, ictal, and postictal. It is important to note that although these stages occur consecutively, people might not experience the prodromal or early ictal phase.  

1. Prodromal

This occurs days to hours before the seizure. Not everyone will feel these symptoms. A review study³ reported that 21.9% of people experienced the prodrome phase. And of those, 10.4% reported feeling funny, 9% felt confused, 8.6% were anxious, and 7.7% were irritable. 

2. Aura

 This occurs minutes to seconds before the seizure. The term ‘aura’ refers to the indescribable feeling that precedes a seizure. This phase varies largely between individuals and may not even occur in some people.

In an interview-based study,⁴ approximately 800 people who had experienced generalized seizures were asked if they felt an aura. It found that 21.3% of participants reported an aura without any prompting, which increased to 64.3% on further questioning. 

This symptom occurs when the temporal lobe is affected. This lobe has many functions: memory, hearing, smell, language, and emotion. It is implicated in both generalized and focal seizures.

3. Ictal

This refers to the period of the seizure where the brain has increased electrical activity. When the entire brain is affected, it is classified as a generalized seizure. It is called a focal seizure when it is restricted to only one area. 

The symptoms you might experience depend on which area of the brain is affected. Generally speaking, seizures cause changes in consciousness, cognition, movement, and sensation.

4. Postictal

This refers to the period after the seizure when the brain reduces its electrical activity to recover. Typically, people will feel very tired and confused. 

Everyone is different, but there is a period of time needed for the individual to return to their normal baseline. This is typically between 5 and 30 minutes. 

Are there any warning signs before a seizure?

Everyone is different, but studies have compiled the most common warning signs that precede a seizure. They can be separated into early and late signs, which come from the prodromal and aura phases, respectively. 

Early warning signs include:

  • Behavioral changes

  • Mood changes

  • Fogginess 

  • Zoning out  

  • Inability to concentrate

  • Problems with sleeping

Late warning signs include:

  • Feelings of déjà vu 

  • Strange smells, tastes, and sounds

  • Problems with vision

  • Nausea and vomiting

  • Numbness restricted to one part of the body

  • An ‘aura’ 

Being aware of these warning signs can give you better control of your seizures. It allows you time to go somewhere you feel safe and makes sure you are supported. 

What are the four most common warning signs?

1. Aura

Aura can present in many different ways but can be described as an out-of-body feeling, increased sensations, or feelings of detachment from the environment.

It is relatively common to experience this minutes to seconds before a seizure. While it is thought to occur mainly in focal seizures, it can also precede generalized seizures. One study⁵ suggests that approximately 70% of people with generalized epilepsy will experience some form of aura.

The temporal lobe of the brain has been implicated in this process. This lobe controls many functions, including memory, hearing, smell, language, and emotion. 

2. Mood changes

Mood changes have been reported hours to days before a seizure, and Epilepsy Society UK⁶ reports heightened feelings of sadness, irritability, and aggression. This may stem from underlying feelings of fear and anxiety about the upcoming seizure. 

An article published in the European Journal of Epilepsy⁷ reported the occurrence of emotional changes before a seizure. They stated that approximately half of their participants reported changes in their mood leading up to their seizures.

3. Alteration of consciousness

In some cases, the individual may experience a strange out-of-body experience or alteration of consciousness just before or during the start of a seizure. This may also lead to hallucinations or illusions of a visual or auditory nature. 

4. Headache

Headaches have been reported in some studies. One study⁸ investigated the frequency of headaches preictal, ictal, and postictal. They included 100 participants with epilepsy, and they found that 5% had preictal headaches. 

What to do if you are about to have a seizure?

The most important thing to do is remove yourself from any dangerous situations. The best option would be to notify someone about what you think will happen and then move to a quieter and safer place. 

Seizures generally do not cause harm due to their brief duration. Often, the harm done is the indirect consequence of losing consciousness or muscle tone. Experiencing a seizure while engaged in some activities, such as driving, may result in serious harm.

What to do after a seizure?

After a seizure, the brain typically responds by decreasing its electrical activity for a period of time in order to recover. Typically, this occurs minutes or hours afterward, but symptoms, particularly changes in mood, can persist for days.

Commonly reported symptoms to include unresponsiveness, headaches, fatigue, and feeling not quite yourself. This is completely normal.

A study⁹ published in Neurology, 2016 found that 72% of people with epilepsy and 50% of people with non-epileptic seizures (e.g., first time having a seizure) experienced some level of cognitive behavioral impairment.

This period is necessary for recovery, so you should be patient and give the brain some time to return to its baseline. Lying down and relaxing as much as possible is recommended. When you return to a feeling of normality, this is your sign that you can get back to your normal routine without any risk. 

What are ways to prevent future seizures?

Epilepsy cannot be cured, but it can be managed successfully – seven out of ten people¹⁰ with epilepsy control their seizures by taking medication. 

There are several different types of anti-epileptic medications, but they all act to reduce the 'excitability' in the brain. Asking your doctor about these medications is important if you think you could be having seizure activity. They will be able to take your full history and complete an examination to rule out any other causes of your symptoms.

Another prevention strategy is to stay away from any triggers. There are numerous triggers, and different ones will affect different people. If you are aware of any triggers for you, such as flashing lights, minimizing your exposure to them will help.

The lowdown

Seizures occur due to excessive electrical activity in the brain and can be separated into four stages: prodromal, aura, ictal, and postictal. In the first two phases, there are several warning signs that you might be able to feel. 

Being aware of these symptoms is crucial, as it will allow you time to manage your seizure as safely as possible.

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