Understanding Seizure Phases: Key Points to Note
In the complex world of epilepsy, understanding the phases of a seizure is crucial. These phases occur in a sequence: prodrome, aura, ictal stage, and post-ictal stage.
The prodrome is the preliminary stage, marked by non-specific warning signs or triggers that may occur before the seizure. Symptoms can include dizziness, greying of vision, tinnitus (ringing in ears), pallor, and sweating. These signs may develop over several seconds to a minute.
The aura, or early ictal stage, includes the first symptoms of an impending seizure. It is characterized by specific sensory or experiential symptoms such as out-of-body sensations, deja vu, hallucinations, vision changes, nausea, pain or twitching in the arms or legs, changes in taste and smell, numbness and tingling, dizziness, headache, panic, intense feelings of fear, anger, joy, or sadness, jamais vu, hearing ringing or buzzing sounds, and difficulty speaking or moving.
The ictal stage is the main seizure event. For generalized onset tonic-clonic seizures, symptoms include loss of consciousness, convulsions (tonic rigidity followed by clonic jerking), autonomic symptoms, and possible incontinence or tongue biting.
The post-ictal stage happens after the seizure has ended and is the recovery period. It is characterized by confusion, lethargy, disorientation, headache, and sometimes neurological deficits such as weakness. Recovery time varies but often includes transient cognitive and neurological impairments lasting minutes to hours. Post-ictal headache is common in epilepsy.
To summarize key distinguishing features in each stage:
| Seizure Stage | Common Symptoms | Differentiating Features | |------------------|-----------------------------------------------------|-------------------------------------------------------| | Prodromal | Dizziness, visual graying, tinnitus, pallor, sweating | Gradual onset before seizure, non-specific, often autonomic| | Aura | Visual or auditory hallucinations, sensory changes | Focal neurological/ sensory symptoms signaling seizure start | | Ictal | Loss of consciousness, tonic-clonic convulsions, autonomic signs | Full seizure activity with convulsions and unconsciousness | | Post-ictal | Confusion, headache, disorientation, weakness | Recovery phase with neurological and cognitive slowing |
These stages represent a typical progression in generalized tonic-clonic seizures but may vary with seizure type. Not everyone who has seizures experiences the prodrome or aura stages.
Recovery from a seizure may depend on the type of seizure, seizure severity, and the area of the brain where it took place. The recovery period may last for hours or days before people feel back to normal. Symptoms of the post-ictal stage may include weakness in the arms or legs, fatigue, malaise, headache, sore muscles, confusion, drowsiness, memory difficulties, feelings of fear, anxiety, shame, frustration, embarrassment, or sadness, nausea, thirst, high blood pressure, loss of bladder or bowel control, lack of consciousness, injury, temporary paralysis after a focal onset seizure (Todd's paralysis), and soreness in the muscles.
It is essential to remember that if people have any serious injuries from a seizure, they will need to seek medical help straight away. The ictal stage is when a person displays seizure symptoms, such as involuntary movements and reduced awareness. It may last for up to a few minutes, and when it lasts longer than 30 minutes, it is considered status epilepticus, which requires immediate medical attention.
Focal onset seizures begin in one side of the brain, and there are three main types of seizures: focal onset seizures, generalized onset seizures, and unknown onset seizures. People may need to allow themselves time to rest after a seizure.
[1] Epilepsy Foundation. (2021). Seizure Types. Retrieved from https://www.epilepsy.com/learn/types-seizures
[2] Epilepsy Foundation. (2021). Post-Seizure Care. Retrieved from https://www.epilepsy.com/learn/seizures-and-episodes/post-seizure-care
[3] Mayo Clinic. (2021). Tonic-clonic seizure. Retrieved from https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20371726
[4] Epilepsy Society. (2021). Prodrome. Retrieved from https://www.epilepsysociety.org.uk/information/about-epilepsy/what-happens-during-a-seizure/prodrome
[5] Epilepsy Action. (2021). Autonomic seizures. Retrieved from https://www.epilepsy.org.uk/information/about-epilepsy/types-seizures/autonomic-seizures
