types of epileptic and non-epileptic seizures: recognizing the signs and symptoms
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being able to recognize the signs of a seizure and respond quickly can make all the difference, ensuring the person gets the help they need and potentially saving a life.
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when most people think of the term seizure, they tend to picture the hollywood version of someone falling unexpectedly to the ground, losing consciousness, and shaking and jerking uncontrollably. while these signs are present in one form of seizure, many other types do not present with these well-known characterizations.
because of the high number of seizure types and the differing signs and symptoms, being able to spot a seizure that isn’t as obvious as a cinematic dramatization isn’t easy for many people to do. since first aid is imperative for people who suffer from seizures, knowing the signs is a great way to stay informed and potentially help someone with a seizure disorder recover from their experience.
the categories of seizures
a seizure can occur for many reasons. in epileptic seizures, neurons in the brain send simultaneous signals at an accelerated rate. the increase in electrical activity in the brain drives movements, sensations, emotions, or behaviours because these signals control all aspects of the body and brain.
the seizure is the result of this overactivity, much like a motor may fail to work when being fed too much electricity at once. the brain, like an engine, temporarily shuts down due to the inner electrical storm.
seizures come in two main types, both of which are characterized by where in the brain they originate from. generalized seizures affect both sides of the brain, whereas the second type, focal seizures, occur in just one area of the brain.
then, there’s a third type that has nothing to do with the brain at all: non-epileptic seizures. these are driven by things outside the brain, such as psychological or physical stress.
these categories are designed to break down the different types of seizures, all of which will present differently.
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generalized seizures and their signs
generalized seizures are a grouping of many types that present in various ways.
absence seizures
these types of seizures will not cause the typical symptoms. instead, a person will seemingly stare into space when their brain activity goes into overdrive. there may also be slight muscle twitches, but that isn’t always present.
tonic seizures
a tonic seizure presents with muscle stiffening, typically affecting the back, legs, and arms. during an attack, people may fall backwards without warning, and their limbs and neck may stretch out. their eyes may be wide open and roll upwards into their heads. in some cases, a person may cry out or stop breathing during a tonic seizure.
clonic seizures
people experiencing a clonic seizure may fall, lose consciousness, urinate, bite their tongue, and engage in uncontrollable jerking movements of the face, arms, and legs. when a person has this type of seizure and a tonic seizure simultaneously, it is known as a tonic-clonic or grand mal seizure. this type is the most recognized.
myoclonic seizures
a myoclonic seizure presents as a fast jerk or spasm of a specific muscle in the body or a specific muscle group. it will appear as if the person was just shocked by something. they will remain conscious during these types of seizures, and the contraction will last a few seconds or less.
atonic seizures
atonic seizures, also referred to as drop seizures or drop attacks, present with limpness that causes a person to fall to the ground. in many cases, the person will be conscious during these attacks, but they can lose consciousness briefly. in some cases, this type of seizure may be milder, leading to the person’s head dropping for a moment before the muscle tone returns.
focal seizures and their signs
focal seizures are characterized differently. because they affect only a partial brain area, they are typically considered less dangerous than generalized types. there are three main types of focal seizures.
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- focal awareness: this is called simple focal or simple partial seizures. when focal awareness types occur, a person is aware of them happening.
- focal impaired awareness: these are often called complex partial or complex focal seizures. people lose some awareness when they occur but do not typically lose consciousness.
- focal to bilateral tonic-clonic: this type of focal seizure involves the typical signs of a tonic-clonic seizure, such as full-body muscle convulsions and movements.
focal seizures are a bit more challenging to recognize because they affect various bodily processes, including motor, sensory, autonomic and cognitive. the symptoms that develop are often referred to as auras and can act like warning signs before a seizure attack or be present during the seizure itself, especially if a person has focal awareness.
focal seizure with motor symptoms
these present with involuntary movements of the face, hands, or toes, such as blinking, tapping a hand or finger, or smacking lips repetitively. they may also move around the body from their starting point. for example, if a person’s involuntary movements begin in the hands, they may move around to the limbs or face. paralysis can also occur in people with focal motor seizures.
focal sensory seizures
these types affect a person’s senses, including sight, hearing, smell, taste, and touch. they may hear non-specific noises or sounds or see bright lights or flashes. objects can also become distorted to appear larger or smaller than their actual size. in some cases, a person may catch a sudden and unexpected smell of something that isn’t there or a taste that isn’t related to anything they’re eating or recently consumed. feelings or sensations beneath the skin that can resemble tingling, crawling, heat, pain, or pins and needles can also occur suddenly.
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focal autonomic seizures
people who experience these types will first develop sweating, drooling or making too much saliva, going pale or flushing, and feeling a rise in the belly area (gastric uprising).
focal cognitive seizures
these types of seizures will drive emotional state changes that could include increased feelings of fear, anxiety, agitation, anger, joy, excitement, or uncontrollable laughter. people may also experience a disconnection from reality and feel like they are in a dream or in the middle of a flashback of their lives. the feeling of déjà vu is also present in these types of seizures and jamais vu, which is when a familiar experience feels new.
in some cases, a person may engage in activities that seem purposeful, but they are doing them involuntarily. for example, if a person was washing their dishes before the seizure, they may continue to do it, but the actions will be more repetitive and incorrect. in some people with focal seizures, the aura they experience lasts for hours or days before a seizure occurs, almost like they’re able to have a premonition about their impending seizure. this is called a prodrome.
because these symptoms are unlike other types of seizures and can present in other disorders, focal seizures are challenging to diagnose and spot. many people may experience diagnoses of mental illness, fainting, or narcolepsy instead of focal seizures.
non-epileptic seizures and their signs
non-epileptic seizures resemble various types of other epileptic seizures in terms of signs and symptoms, but they are not driven by impulses in the brain. they are set off by psychiatric or physical disorders, including mental illnesses and trauma, metabolic disorders, cardiovascular disorders, or medication withdrawal or toxicity.
the only way to tell if non-epileptic seizures are not caused by brain signals is by getting accurate testing based on the signs seen during the attack.
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knowing the signs of seizures can make all the difference if you are ever in the presence of someone who has one, making it safer for people with both epileptic and non-epileptic seizures to find the proper care following an attack.
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