Seizures are sudden, uncontrolled electrical disturbances in the brain that manifest in diverse ways in adults. Understanding these varied appearances is important for personal awareness and assisting others. Signs can range from subtle changes in awareness to dramatic physical convulsions.
Recognizing Generalized Seizures
Generalized seizures originate from both sides of the brain, leading to more widespread physical signs. Tonic-clonic seizures, previously grand mal seizures, are perhaps the most recognized. They involve two phases: the tonic phase, where muscles stiffen, consciousness is lost, and the person may fall, often emitting a cry. This is followed by the clonic phase, characterized by rhythmic jerking of the limbs, which can include tongue biting, frothing at the mouth, and loss of bladder or bowel control.
Absence seizures, once called petit mal seizures, present as brief staring or unresponsiveness, often mistaken for daydreaming. Subtle movements like eye fluttering or lip smacking may occur, with the person typically recovering quickly and having no memory of the event.
Myoclonic seizures involve sudden, brief, shock-like jerks or twitches of a muscle group, usually too short to affect consciousness. While minor, a forceful jerk could cause a person to drop an object or fall.
Atonic seizures, or “drop attacks,” cause a sudden loss of muscle tone, leading to a fall or collapse. The body becomes limp, and if standing, the person falls. These brief episodes last less than 15 seconds, and consciousness may or may not be fully lost.
Identifying Focal Seizures
Focal seizures begin in one part of the brain, resulting in a broader, sometimes subtle range of symptoms. These can be challenging to recognize.
Focal aware seizures, previously simple partial seizures, occur when consciousness is maintained, and the person remains awake and alert. Signs include sudden, uncontrolled jerking of a limb or one side of the face, sensory disturbances like unusual smells, tastes, or visual distortions. Tingling sensations or sudden emotional changes such as fear or déjà vu may also occur.
Focal impaired awareness seizures, formerly complex partial seizures, involve a change or loss of awareness. The person may stare blankly, appear confused, and be unresponsive. Common signs include automatisms: repetitive, non-purposeful movements such as lip smacking, fiddling with clothes, mumbling, or aimless walking. The person may not respond normally or remember the event, and their awareness may be only partially impaired.
The Post-Seizure Experience
The period immediately following a seizure is the postictal phase. After a seizure, confusion and disorientation are common. The person may also feel significant fatigue or a strong urge to sleep. Headaches or muscle soreness are frequently reported, particularly after tonic-clonic seizures.
A temporary weakness in a limb or one side of the body, known as Todd’s paralysis, can occur. This weakness ranges from mild to complete paralysis and typically resolves within 48 hours.
Emotional changes such as irritability, sadness, or anxiety may be present. The individual may also have no memory of the seizure or the immediate postictal period.
Immediate Actions During a Seizure
If you witness an adult having a seizure, remain calm. Prioritize the person’s safety by moving harmful objects away and placing something soft, like a jacket or pillow, under their head. Loosening tight clothing around their neck can also help with breathing.
Time the seizure from start to finish. This information is useful for medical professionals.
Do not physically restrain the person or attempt to stop movements. This can cause injury to both the individual and helper.
Never put anything into their mouth. A person cannot swallow their tongue during a seizure, and inserting an object can cause dental injuries or block the airway.
Once jerking stops, gently roll the person onto their side. This helps keep their airway clear and prevents choking.
Stay with the person until they are fully conscious and aware.
Call for emergency medical help (e.g., 911) if the seizure lasts longer than 5 minutes, if one occurs immediately after another without full recovery, or if the person has difficulty breathing after it stops. Other situations warranting immediate medical attention include a first-time seizure, an injury sustained during the seizure, or a seizure occurring in water.