2025 Guide: Types of Seizures, Symptoms & Identification | Free Resource

Seizures can manifest in various ways beyond the typical shaking and jerking movements that most people recognize. Some seizures might cause a person to suddenly fall or become motionless, making it challenging to identify without proper knowledge.

Neurons are nerve cells responsible for transmitting information from the brain to the body through electrical impulses. When this electrical activity becomes excessive and disorganized, it triggers a seizure, leading to temporary, uncontrollable symptoms.

Understanding the different types of seizures and their symptoms is crucial for timely recognition and response. This guide explains seizure classifications, common signs, and essential steps to take during a seizure.

Seizure Classifications

Seizures vary widely and are categorized based on the brain regions affected. They fall into two main types: focal seizures and generalized seizures.

• Focal seizures: Begin in a specific area of one hemisphere of the brain. Previously known as partial seizures.
• Generalized seizures: Involve both sides of the brain from the onset. Occasionally, focal seizures can evolve into generalized seizures.

Focal Seizure Varieties

Focal seizures affect roughly 60% of individuals diagnosed with epilepsy and typically involve only one side of the brain.

• Focal aware seizures
• Focal impaired awareness seizures
• Focal to bilateral tonic-clonic seizures
• Gelastic and dacrystic seizures

Focal Aware Seizures

Formerly called simple focal seizures, these do not cause loss of consciousness. Individuals remain fully aware but may experience symptoms such as:

• Unusual eye or head movements
• Dilated pupils
• Muscle tension
• Numbness or tingling sensations
• Hallucinations
• Nausea or sweating
• Facial flushing or vision changes
• Speech difficulties or déjà vu feelings

Duration typically ranges from a few seconds up to 2 minutes.

Focal Impaired Awareness Seizures

Previously known as complex focal seizures, these cause partial or complete loss of awareness. The person may appear awake but unresponsive, exhibiting behaviors like:

• Blank staring or daydreaming
• Lip smacking or repetitive movements
• Involuntary jerking or rigidity
• Emotional outbursts such as crying or laughing

These seizures usually last 1 to 2 minutes, followed by confusion or drowsiness.

Focal to Bilateral Tonic-Clonic Seizures

This occurs when a focal impaired awareness seizure spreads to both brain hemispheres, causing intense muscle stiffening and jerking. Symptoms may include:

• Loss of consciousness
• Falling down
• Facial twitching
• Incontinence
• Breathing difficulties

Seizure duration ranges from 30 seconds to 3 minutes.

Gelastic and Dacrystic Seizures

Originating in the hypothalamus, gelastic seizures cause uncontrollable laughter, while dacrystic seizures trigger involuntary crying. Consciousness is usually maintained.

Generalized Seizure Types

Generalized seizures affect both sides of the brain simultaneously and include:

• Generalized tonic-clonic seizures (GTC)
• Tonic seizures
• Clonic seizures
• Absence seizures
• Myoclonic seizures
• Atonic seizures
• Infantile or epileptic spasms

Generalized Tonic-Clonic Seizures (GTC)

Also known as grand mal seizures, GTC seizures start in both brain hemispheres simultaneously and involve two phases:

• Tonic phase: Muscle stiffening, loss of consciousness, falling, possible crying or groaning.
• Clonic phase: Rapid, rhythmic jerking of muscles, facial twitching, and loss of bladder or bowel control.

These seizures typically last 1 to 3 minutes.

Tonic Seizures

Characterized by muscle stiffening, tonic seizures often happen during sleep and affect the back, legs, or arms. They may cause falls if standing.

Clonic Seizures

These involve repetitive jerking movements without muscle stiffening.

Absence Seizures

Commonly mistaken for daydreaming, absence seizures cause brief lapses in awareness. They are divided into:

• Typical absence: Sudden blank stare and eyelid fluttering lasting less than 10 seconds.
• Atypical absence: Gradual onset with additional symptoms like blinking and hand movements, lasting 20 seconds or more.

More prevalent in children than adults.

Myoclonic Seizures

Brief, sudden muscle jerks affecting both sides of the body without loss of consciousness. These often occur multiple times daily.

Atonic Seizures

Also called drop attacks, these cause sudden loss of muscle tone, leading to falls or head drops.

Infantile or Epileptic Spasms

Brief flexing or extending movements of limbs or head, primarily affecting children under 2 years old. These spasms can occur repeatedly over short periods.

Conditions Mimicking Seizures

Some disorders resemble epileptic seizures but require different treatments.

Febrile Seizures

Triggered by fever in children aged 6 months to 5 years, febrile seizures are classified as:

• Simple: Last less than 15 minutes, occurring once in 24 hours.
• Complex: Last more than 15 minutes or occur multiple times within 24 hours.

Nonepileptic Events (NEE)

Also called pseudoseizures, NEE are linked to psychological stress and disorders rather than brain electrical activity abnormalities. They may mimic generalized seizures but have distinct muscle movement patterns.

Tics

Involuntary, repetitive movements or vocalizations occurring consciously, often affecting the face or neck. Examples include Tourette syndrome and chronic motor tic disorder.

Seizure Types by Age Group

Adults commonly experience focal aware, focal impaired awareness, focal to bilateral tonic-clonic, gelastic, dacrystic, generalized tonic-clonic, tonic, clonic, absence, myoclonic, atonic seizures, and nonepileptic events. Children and infants are more prone to febrile and absence seizures.

Common Causes of Seizures

Seizures may result from various factors disrupting brain function, such as:

• Neurological disorders
• Birth trauma in infants
• Congenital brain abnormalities
• Brain infections like meningitis
• Fever
• Stroke
• Brain tumors
• Head injuries
• Substance misuse
• Blood sugar imbalances
• Electrolyte disturbances
• Medication side effects

Sometimes, the cause remains unidentified.

Risks and Complications of Seizures

Seizures can lead to injuries and serious complications, including:

• Falls and accidents
• Injuries from biting the tongue
• Pregnancy-related complications
• Drowning during water exposure
• Motor vehicle accidents
• Sudden unexpected death in epilepsy (SUDEP)

What to Do If You Feel a Seizure Coming

Some seizures present warning signs such as déjà vu, confusion, or involuntary facial or limb movements. If you notice these, take precautions:

• Move to a safe area free of hazards.
• Loosen tight clothing, especially around the neck.
• Inform someone nearby.
• If driving, safely pull over.
• Avoid water and heat sources.
• Follow your personalized seizure action plan.
• Consider sitting or lying down.

How to Assist Someone Having a Seizure

Remain calm and ensure the person's safety by:

• Clearing sharp or hard objects away.
• Helping them gently to the floor if standing.
• Turning them onto their left side to maintain airway.
• Removing eyeglasses.
• Placing something soft under their head.
• Loosening tight clothing around the neck.
• Not restraining their movements.
• Not placing anything in their mouth.
• Waiting until fully alert before offering food or drink.
• Speaking calmly as they regain consciousness.

Time the seizure duration carefully.

Emergency Alert: Call 911 if a seizure lasts longer than 3 minutes, if it is the first seizure, if multiple seizures occur consecutively, if breathing difficulties persist post-seizure, if the person does not regain consciousness, if pregnant, or if there are underlying medical conditions.

When to Seek Medical Advice

Prompt medical evaluation is essential for seizures lasting over 3 minutes or for first-time seizures. Consult a healthcare provider if seizures continue, result from injury, occur during pregnancy, or are accompanied by new neurological symptoms.

Summary

Seizure symptoms differ significantly depending on the type, ranging from jerking movements and muscle stiffness to blank stares and involuntary emotional expressions. Immediate safety measures and appropriate first aid can prevent injury during a seizure. If seizures persist or last longer than a few minutes, seek emergency medical attention.

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