Epilepsy is a neurological (brain) disease that causes people to have seizures. With epilepsy, brain cells called neurons create too many electrical signals, too quickly. Some doctors describe this as an “electrical storm” in the brain. This storm interferes with normal brain function and causes seizures.
Seizures may take many forms. Each seizure may have 4 stages:1,2
- Prodromal (pre-seizure)
- Early ictal or aura (early)
- Ictal (middle)
- Postictal (ending, recovery)
People with epilepsy may or may not experience all 4 stages, or in this order. Some people’s seizures may follow the same stages each time. Others have seizures that change.
Prodromal phase
The prodromal phase may happen minutes, hours, or even days before the seizure. Most people describe it as a funny feeling or sense of confusion, anxiety, irritability, headache, tremor, anger, or other mood change. About 2 out of 10 people with epilepsy experience this stage. For those who do, this can be a warning to get somewhere safe.3
This phase most often lasts 30 minutes to 1 day. But it may be as short as 10 minutes and as long as 3 days. The symptoms last until the seizure begins.3
Early ictal (aura)
An aura in epilepsy is a change in feelings or sensations that appear just before the rest of a seizure takes place. But an aura can also occur by itself. It is actually considered the earliest part of the ictal phase. Like the prodromal phase, not everyone experiences an aura. But for those who do, aura can be a warning to get somewhere safe.4
An aura is actually a type of focal seizure. Studies show up to 6 out of 10 people with generalized seizures have auras.5,6
Aura symptoms depend on which part of the brain is affected by a seizure. The aura can start in 1 part of the brain and spread to other areas, so symptoms can change over time. The person may feel emotional, sensory, or physical changes, including:7
- Smells, sounds, tastes, or vision
- “Strange” feelings
- Fear, panic, or racing thoughts
- Lightheaded or dizziness
- Headache
- Nausea or a rising feeling in the stomach
- Numbness or tingling
- Fidgeting
- Memories
These sensations last a varying amount of time, from seconds to hours. Sometimes an aura occurs by itself, other times it occurs before another seizure takes place.7
Ictal phase
The ictal phase can be different for every person with epilepsy. It depends on the part of the brain in which the seizure occurs. Symptoms may even change from seizure to seizure in the same person. Symptoms may include:1,8
- Loss of consciousness
- Confusion
- Muscle spasms, tremors, or twitching
- Loss of muscle tone
- Changes in senses and emotions
- Inability to move or speak
- Sudden stillness
- Staring
- Loss of bladder or bowel control
- Racing heart
- Sweating
- Repetitive movements like lip smacking, chewing, or dressing and undressing
Postictal phase
After a seizure ends, the person enters what is called the postictal phase. This is a recovery period that may last from a few minutes to a few days. How long this phase lasts depends on the type of seizure, its severity, and the area of the brain affected. Postictal symptoms may include:1,8
- Weakness in the arms or legs
- Soreness
- Confusion
- Problems finding words
- Drowsiness or fatigue
- Headache
- Nausea
- Thirst
It is also common for people to feel fearful, embarrassed, or sad after a seizure. If epilepsy involves episodes of losing consciousness, it may prevent someone from driving or living alone. This can greatly impact quality of life because it interferes with independence.
If you know someone with epilepsy, you can help by learning seizure first aid and the person’s seizure action plan.