Loss of Consciousness and Confusion in People with Epilepsy

Epilepsy is a brain (neurological) disease in which nerve cells in the brain do not properly work. When the nerve cells do not work, it can cause a seizure. Different types of symptoms result when nerves in the brain misfire.1

Three of the most common symptoms are loss of consciousness, lack of awareness, and confusion.

What causes this?

Full loss of consciousness is most common in generalized tonic-clonic seizures. Generalized seizures happen on both sides of the brain. The seizure may also start on 1 side of the brain and spread to the whole brain. After these seizures, the person may be sleepy or confused for minutes to hours.2

Absence seizures are another type of generalized seizure. With these types of seizures, the person may seem to be "absent." They may stare blankly for a few seconds and then return to normal.3

People with focal seizures may also seem "out of it" or lose awareness for short times. These are the symptoms of focal seizures with impaired awareness. These are also called complex partial seizures.4

Other things to know

It is easy to recognize when someone loses consciousness. Depending on the type of seizure, they may fall to the ground, slump over, or black out. Or, they may appear to be asleep, except that they are in the middle of muscle spasms or stiffness. Most of the time, these people will not remember their seizures.1,5

Lack of awareness and confusion may be harder to recognize as a seizure. Children with absence seizures may seem to be daydreaming or ignoring an adult’s request. Adults may seem spacey, forgetful, or hesitant. Some people cannot speak during a seizure, so you may think they are unconscious when they are not.1,5

Some people are partially aware that they are having a seizure. Others do not remember, even if they seemed to be awake.5

After a seizure, the person may be sleepy, confused, have trouble talking, or be slow to respond. Some people feel tired or sleep for minutes to hours after a seizure.1

How are these symptoms diagnosed?

Generalized and focal seizures are diagnosed using a test called an EEG (electroencephalogram). An EEG checks electrical activity in the brain.7

It is also important to keep a seizure journal. Loved ones should make videos of seizures when they occur. This record of when seizures happen, what seems to trigger them, and what they look like will help your doctor create your treatment plan.7

How are these seizures treated?

Safety is important if someone loses consciousness or is confused during and after a seizure. The basic steps of seizure safety include:5,6

  • Stay with the person until they are awake and alert
  • Turn them on their side if they are not awake
  • Put something soft under their head
  • Do not put anything in their mouth or restrain them
  • Do not let them run or wander off
  • Do not assume they can talk or hear you
  • Time the seizure
  • Call 911 if the seizure lasts more than 5 minutes, if they are injured, or if they do not return to their usual state

Epilepsy is treated in a variety of ways. There are 3 goals to treating all epilepsy: controlling seizures, avoiding side effects, and improving quality of life. Treatments include:7

  • Anti-seizure drugs
  • Surgery
  • Lifestyle changes
  • Diet and nutrition
  • Supportive devices such as a smartwatch
  • An epilepsy service dog

Doctors believe 7 out of 10 people with epilepsy can become seizure-free with treatment. Some people can eventually stop taking anti-seizure medicines.8

A safety note

People who lose consciousness are not able to drive. If they are seizure-free for a certain time they may regain driving privileges. The timing varies by state, and regulations can change. Your doctor will help decide your ability to safely drive and submit reports to the state. The Epilepsy Foundation keeps a database of U.S. driving laws by state.

Losing consciousness is just 1 possible symptom of epilepsy. Other potential signs of epilepsy include:

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Written by: Jessica Johns Pool | Last reviewed: November 2021