Seizures don’t always look like what you see in movies. The dramatic, full-body convulsions are just one type. Others can be as subtle as a blank stare lasting a few seconds or someone fumbling with their clothes without realizing it. Knowing the full range of signs helps you recognize what’s happening and respond quickly.
The Seizure Most People Recognize
The tonic-clonic seizure (sometimes called a grand mal seizure) is the most visible type. It happens in two distinct phases you can watch for. First, the person’s muscles suddenly stiffen, often causing them to fall. They may let out a groan or yell as air is forced past their vocal cords. They lose consciousness. This stiffening phase typically lasts 10 to 20 seconds.
Then the jerking starts. The arms and legs contract and relax rhythmically, usually for one to two minutes. You may also notice drooling, tongue biting, random eye movements, or loss of bladder or bowel control. After the convulsions stop, the person won’t snap back to normal right away. They may remain unresponsive for several minutes.
Subtler Seizures That Are Easy to Miss
Not every seizure involves falling and convulsing. Focal seizures with impaired awareness affect only part of the brain, and the signs can look strange rather than alarming. The person may smack their lips, chew on nothing, rub their hands together, or pick at their clothing, all without any awareness of what they’re doing. Some people walk around aimlessly or perform other purposeless actions. Because the symptoms are subtle, bystanders often think the person is daydreaming or just acting oddly.
When focal seizures affect the frontal lobes, the movements can be more unusual: bicycling motions of the legs, pelvic thrusting, or other complex repetitive actions. The key giveaway is that the person is unresponsive during these episodes. They won’t answer you or seem to register your presence, even though their eyes may be open.
Absence Seizures
These are the easiest to overlook entirely. The person suddenly stops what they’re doing, stares blankly, and appears to “check out.” You might notice slight eyelid fluttering or gentle head nodding. The whole episode lasts between 3 and 15 seconds, starts without warning, and ends just as abruptly. They’re most common in children, and teachers or parents sometimes mistake them for inattention or zoning out. If someone frequently freezes mid-sentence or mid-step for a few seconds, then carries on as if nothing happened, that pattern is worth noting.
Warning Signs Before a Seizure
Some people experience a warning phase called an aura in the moments before a seizure begins. These auras are actually small focal seizures themselves, and the person experiencing one may describe a rising sensation in their stomach, sudden intense fear or anxiety, or a strong feeling of déjà vu. Things may suddenly look, smell, taste, or sound different. A metallic taste in the mouth is commonly reported. If someone tells you they’re having these sensations, take it seriously. It may mean a larger seizure is coming, and you can help them get to a safe position before it starts.
Seizure or Fainting?
Fainting (syncope) can look similar to a seizure at first glance, since both involve losing consciousness and sometimes brief jerking movements. But there are reliable differences. Fainting episodes typically last less than a minute, while seizures usually last longer. A person who faints often looks pale or clammy beforehand, with cold sweats or nausea. A person having a seizure is more likely to show tongue biting, drooling, lip smacking, sustained convulsions, random eye movements, or loss of bladder control. Recovery time is another clue: someone who fainted tends to come around quickly once they’re lying flat, while someone who had a seizure often remains confused or unresponsive for minutes afterward.
What Happens After a Seizure
The recovery period, called the postictal state, can last anywhere from a few minutes to a few days depending on the severity of the seizure. Common symptoms include confusion, extreme fatigue, headache or migraine, muscle soreness, memory loss, and difficulty speaking. The person may not remember the seizure at all. Emotional changes are also normal during recovery. Some people feel anxious, agitated, or embarrassed. After more severe seizures, some people experience hallucinations, delirium, or an abnormal heartbeat.
This recovery phase is a normal part of the process, not a sign that something has gone additionally wrong. The person needs time, patience, and a calm environment. Once they’re alert, explain what happened, since they likely have no memory of it.
How to Help During a Seizure
If someone is having a tonic-clonic seizure, ease them to the ground if they’re falling. Clear the area around them so they can’t hit furniture, sharp objects, or anything hard. Place something soft and flat under their head, like a folded jacket. Remove their eyeglasses and loosen anything around their neck that could restrict breathing. Gently turn them onto their side with their mouth pointing toward the ground to keep the airway clear. Start timing the seizure from the moment it begins.
For subtler seizures where the person is wandering or performing repetitive movements, stay with them and gently guide them away from hazards like traffic, stairs, or sharp objects. Don’t restrain them. Speak calmly and wait for the episode to pass.
Check for a medical bracelet on their wrist or neck. It may list their condition, medications, and emergency contacts.
What Not to Do
- Don’t put anything in their mouth. People don’t swallow their tongues during seizures, and forcing something between their teeth can break teeth or injure their jaw.
- Don’t hold them down or try to stop their movements. This can injure both of you and won’t shorten the seizure.
- Don’t attempt mouth-to-mouth breathing. People typically start breathing on their own after a seizure ends.
- Don’t offer food or water until they’re fully alert. They could choke.
When It Becomes an Emergency
Call 911 if the seizure lasts longer than 5 minutes. That threshold matters because prolonged seizures can cause brain injury and require medical intervention to stop. Also call for emergency help if the person doesn’t regain consciousness after the convulsions end, if they have a second seizure shortly after the first, if they’re injured during the seizure, or if you know (or suspect) this is their first seizure ever. For someone with a known seizure disorder who recovers normally afterward, a single seizure under 5 minutes may not require an ambulance, but the 5-minute rule is always worth watching closely.