A seizure is a sudden, abnormal surge of electrical activity within the brain, temporarily disrupting normal function. This disturbance can manifest in various ways, from subtle staring spells to full-body convulsions. Recognizing these distinct phases is important for safety and preparation, allowing individuals to take precautions and helping observers respond properly during and after the event.
The Prodromal Phase
The prodromal phase is the earliest indication that a seizure may be impending, occurring hours or even days before the main event. This stage is a pre-seizure state of the brain, not the seizure itself. Because the symptoms are subtle and non-specific, it is often the least recognized phase, and not all individuals who experience seizures will have a prodrome.
Symptoms in this stage are typically psychological or behavioral, reflecting a general feeling of being “off.” Common signs include unexplained mood changes, such as irritability, anxiety, or depression. Physical complaints like headache, fatigue, difficulty concentrating, or trouble sleeping are also reported. This phase can last anywhere from 30 minutes up to three days before the seizure begins.
The Aura Phase
The aura phase is a specific, immediate warning sign that occurs seconds or minutes before the seizure fully manifests. Though experienced as a warning, an aura is classified as a focal aware seizure, meaning it is the actual beginning of the seizure activity. The symptoms experienced are highly individualized but tend to be the same for a particular person each time.
These symptoms often involve sensory, psychic, or emotional disturbances. People may report visual changes, such as flashing lights, or experiencing unusual smells or tastes. Common experiences include feelings of déjà vu, fear, panic, a rising sensation in the stomach, or tingling and numbness in a limb. The aura gives the person a brief window to seek safety before the subsequent phases begin.
The Ictal Phase
The ictal phase is the period of the actual seizure, lasting from the first abnormal electrical discharge until the activity ceases. This is when the most visible physical manifestations occur, varying widely depending on the region of the brain affected. Symptoms can include loss of consciousness, uncontrolled muscle movements like jerking or stiffening, or simply a blank stare and inability to respond.
Most seizures are brief, resolving spontaneously within one to two minutes. During this phase, the observer’s role is to ensure safety by removing nearby hazards and cushioning the head. Timing the seizure is also helpful, as a duration exceeding five minutes requires immediate medical assistance. Avoid restraining the person or placing anything in their mouth, as these actions can cause harm.
The Postictal Phase
The postictal phase is the recovery period immediately following the cessation of seizure activity. The brain’s neurons, intensely active during the ictal phase, are now attempting to reset, leading to temporary neurological deficits. The duration is highly variable, often lasting between 5 and 30 minutes, though it can extend for hours or, rarely, a few days, depending on the seizure type and severity.
Common temporary symptoms include disorientation, confusion, fatigue, or drowsiness. The individual may also experience a headache, nausea, or temporary weakness in a limb, known as Todd’s paresis. Monitoring the person during this time provides reassurance and allows them to rest until they return to their baseline level of awareness.