When most people think of seizures, they picture someone falling to the ground with violent shaking, the dramatic scenes we’ve seen in movies and television. While these tonic-clonic seizures (previously known as grand mal seizures) do occur, the reality is that many seizures look nothing like what Hollywood portrays. They are often subtle, easily missed, and can be mistaken for daydreaming or unusual behavior.
More than 3 million Americans have active epilepsy and approximately 150,000 Americans develop epilepsy each year. This can happen to anyone and at any age. They are not something to be embarrassed about and with proper treatment, whether medication or surgical intervention, many people with epilepsy live full, active lives. Recognizing when someone has a seizure is the first step in getting them the help they need.
Seizures are due to abnormal electrical activity in the brain. What a seizure looks like depends on where the electrical activity is starting and spreading. Here are some seizure types that one can look out for.
Absence seizures (staring spells)
Focal aware seizures
The person experiences unusual sensations, emotions, or movements they cannot control. They remain conscious and are aware of their surroundings during these episodes. The stereotyped nature of the episodes and the aura occurring before bigger seizures is often a clue that these are small seizures (not causing loss of awareness because of limited spread of the electrical activity).
Focal impaired awareness seizures
Similar to absence seizures, some people may suddenly stop what they are doing, stare off, and become unresponsive. They may have repetitive movements such as chewing, lip smacking, and fidgeting of the hands. Others can wander, answer questions, and even do certain activities but appear confused and have no recollection of these events (impaired awareness).
Generalized tonic-clonic seizures
These are the seizures portrayed in media; the person loses consciousness, falls, and has full body stiffening and shaking. The person may have symptoms of the other types of seizure beforehand. They may let out a groan or yell (ictal cry) as their body starts to stiffen. The most important thing to do is to make sure the patient is safe and follow the steps outlined below.
Atonic seizures (“drop attacks”)
These seizures usually start in childhood. The person suddenly loses muscle tone and collapses or drops their head. These happen without warning and can result in injuries from falling.