Seizures look different depending on the type, and many don’t involve the dramatic full-body convulsions most people picture. Some seizures cause a person to stare blankly for ten seconds. Others involve subtle repetitive movements like lip smacking or picking at clothing. The classic shaking-and-falling episode is just one form, and recognizing the less obvious types matters just as much.
Tonic-Clonic Seizures: The Most Recognizable Type
This is what most people think of when they hear “seizure.” It happens in two distinct phases. During the tonic phase, every muscle in the body stiffens at once. The person loses consciousness, falls to the ground, and their body goes rigid. Their jaw clenches, and they may let out a cry or groan as air is forced past tense vocal cords. Breathing can become irregular or pause briefly, and their lips or face may turn bluish.
The clonic phase follows within seconds. The stiffness gives way to rhythmic jerking movements of the arms, legs, and sometimes the face. These jerks are symmetrical and follow a pattern, starting fast and gradually slowing down. The person may bite their tongue, drool, or lose bladder control. The whole episode typically lasts one to three minutes. Afterward, the jerking stops, and the person enters a recovery phase where they’re confused, exhausted, and may not remember what happened.
Absence Seizures: Easy to Miss
Absence seizures look nothing like convulsions. A person suddenly stops what they’re doing and stares vacantly into space, almost as if they’ve mentally checked out mid-sentence. These episodes last about 10 seconds on average, though they can stretch to 30 seconds. During the stare, you might notice eyelid fluttering, subtle chewing motions, lip smacking, or small movements of both hands like finger rubbing.
The person doesn’t fall. They don’t shake. They simply freeze in place, then snap back to normal as if nothing happened. These seizures are most common in children and are frequently mistaken for daydreaming or not paying attention. A key difference from ordinary zoning out: you can’t get the person’s attention during an absence seizure by calling their name or touching their shoulder. They’re completely unresponsive for those few seconds.
Focal Seizures: Odd Behaviors and Automatisms
Focal seizures start in one area of the brain, and what they look like depends on which area is involved. In milder forms where the person stays aware, you might see twitching or jerking in just one arm, one leg, or one side of the face. The person may report strange sensations like tingling, a metallic taste, or a rising feeling in their stomach, but outwardly appear mostly normal.
When a focal seizure impairs consciousness, the signs become more visible but still look unusual rather than alarming. The person appears dazed or “not all there” and begins performing repetitive, purposeless movements called automatisms. Common ones include smacking the lips, chewing when there’s no food, picking at clothing, rubbing the hands together, or fumbling with nearby objects. Some people walk aimlessly, repeat words or phrases, or laugh, scream, or cry without reason. Seizures involving the frontal lobes can produce stranger movements like bicycling of the legs or pelvic thrusting.
These episodes last anywhere from 30 seconds to a couple of minutes. Afterward, the person is typically confused and has no memory of what they did during the seizure. From a bystander’s perspective, a focal seizure can look like someone is drunk, on drugs, or behaving erratically, which is one reason they’re often misidentified.
Atonic Seizures: A Sudden Collapse
Atonic seizures are the opposite of the stiffening seen in tonic seizures. Instead of muscles tightening, they go completely limp. Imagine a puppet whose strings are suddenly cut. The person’s head may drop forward, they may release whatever they’re holding, and if standing, they collapse to the ground. These seizures are brief, often just a few seconds, but the sudden fall can cause serious injuries to the face, head, or body. There’s no shaking or jerking involved. The person simply loses all muscle tone and then regains it almost immediately.
Warning Signs Before a Seizure
Some people experience an aura in the minutes or seconds before a seizure begins. This is actually a small focal seizure itself, and it can serve as a warning that a larger one is coming. Auras are highly individual, but common experiences include a strong sense of déjà vu, seeing sparkling lights or dark spots, hearing a ringing or buzzing that no one else hears, smelling something odd like burning rubber, or feeling a sudden wave of fear or anxiety that comes out of nowhere.
Physical warning signs can also appear: sudden sweating, flushing of the skin, drooling, or a fluttering sensation rising from the stomach. Some people exhibit brief behavioral changes like abruptly walking away mid-conversation, blurting out something unrelated, or becoming momentarily agitated or confused. These signs are subtle and easy to dismiss, but people who recognize their own aura pattern can sometimes get to a safe position before the seizure progresses.
What Happens After a Seizure
The recovery period after a seizure is called the postictal state, and it can be almost as disorienting to witness as the seizure itself. The person may appear deeply confused, unable to speak clearly, or unable to recognize where they are or who they’re with. Fatigue hits hard, and many people feel an overwhelming need to sleep. Headaches, muscle soreness, and memory gaps are common. Some people experience mood changes like agitation, anxiety, embarrassment, or even brief depression.
This recovery window typically lasts between 5 and 30 minutes, though it can stretch to hours or even days after a severe seizure. During this time, the person may say things that don’t make sense or struggle to form words. They gradually return to baseline, but the fog can linger.
How to Help Someone Having a Seizure
If you see someone having a convulsive seizure, the most important thing is to protect them from injury without restraining them. Ease them to the ground if they’re not already down, and place something soft like a folded jacket under their head. Gently roll them onto their side with their mouth pointing toward the ground so saliva or vomit can drain and their airway stays clear.
Three things to avoid: don’t hold the person down or try to stop their movements, don’t put anything in their mouth (this includes wallets, spoons, and fingers), and don’t offer food or water until they’re fully alert. The old idea of preventing someone from swallowing their tongue is a myth. Restraining them risks injuring both of you.
Time the seizure from the moment it starts. A convulsive seizure lasting longer than five minutes is a medical emergency. At the five-minute mark, the seizure has moved past the window where it’s likely to stop on its own, and the risk of serious complications rises sharply. Continuous seizure activity lasting 30 minutes or more carries a high mortality rate. Call emergency services if the seizure passes five minutes, if the person doesn’t regain consciousness between repeated seizures, if they’re injured during the fall, or if you know it’s their first seizure.
When a Seizure Isn’t Epilepsy
Not all events that look like seizures are caused by abnormal electrical activity in the brain. Psychogenic non-epileptic seizures (sometimes called functional seizures) can closely resemble epileptic ones but have different underlying causes, often related to psychological stress or trauma. There are some visual differences that even bystanders may notice.
During an epileptic convulsion, the person’s eyes are almost always open. In non-epileptic events, the eyes are closed about two-thirds of the time, and they may stay closed for 20 seconds or longer compared to roughly 2 seconds in epileptic seizures. Non-epileptic episodes also tend to involve movements that wax and wane, stop and start, or change direction and rhythm mid-episode. Epileptic seizures follow a more predictable progression: stiffening, then rhythmic jerking that gradually slows. Other clues include crying or weeping during the event, stuttering, side-to-side thrashing, and whispering after the episode ends. None of these differences are absolute, though, and only monitoring with an EEG during an episode can confirm the diagnosis.