Epilepsy Talk
The Four Stages of Seizures – Prodromal, Auras, Ictal and Postictal | October 5, 2021
Welcome to the world of ictals and postictals. A world you’re probably familiar with.
Seizure Phases
A seizure often has four distinct phases: Prodromal Symptoms, Auras, Ictal and Postictal Stages.
The first phase — the prodromal stage — involves mostly emotional signals.
In an aura, alterations in activity, emotions, hearing, smell, taste, visual perception are involved.
The seizure itself is the ictus.
There are two major types of seizure: partial and generalized.
What happens to the person during the seizure depends on where in the brain the disruption of neural activity occurs.
Following a seizure, the person enters into the postictal state.
Drowsiness and confusion are commonly experienced during this phase.
Let’s start at the very beginning…
PRODROMAL SYMPTOMS
This prodromal group of symptoms occurs days or hours before a seizure ensues.
It’s different from aura in that it includes symptoms like:
Affection
Depression
Difficulty concentrating.
Ecstatic feelings
Headache
Increased agitation
Insomnia
Irritability
Lightheadedness
Mood changes
AURAS
Auras are actually a small partial seizure that is often followed by a larger event.
They usually come a few seconds to a few minutes before the actual seizure.
It’s the beginning of the seizure and is seen mostly in partial seizures.
The feelings of the aura are often vague and many patients are unable to describe their features.
There may be:
Biting of tongue (from teeth clenching when muscles tighten)
Blinking of eyes, eyes may move to one side or look upward, or staring
Convulsion (person loses consciousness, body becomes rigid or tense, then fast jerking movements occur)
Change in skin color (looks pale or flushed)
Difficulty talking (may stop talking, make nonsense or garbled sounds, keep talking or speech may not make sense)
Difficulty breathing
Dreamlike experiences
Dressing or undressing
Drooling
Feelings of extreme fear
Hallucinations
Heart racing
Inability to swallow
Lack of movement or muscle tone (unable to move, loss of tone in neck and head may drop forward, loss of muscle tone in body and person may slump or fall forward)
Losing control of urine or stool unexpectedly
Movements of hands, like wringing, playing with buttons or objects in hands, waving
Non-purposeful movements, called automatisms, involve the face, arms or legs, such as lip smacking or chewing movements
Pupils may dilate or appear larger than normal
Repeated purposeful movements (person may continue activity that was going on before the seizure)
Rigid or tense muscles (part of the body or whole body may feel very tight or tense and if standing, may fall “like a tree trunk”)
Sensations in the stomach
Sweating
Tremors, twitching or jerking movements (may occur on one or both sides of face, arms, legs or whole body; may start in one area then spread to other areas or stay in one place)
Unpleasant smells
Walking or running
This is the actual phase of the seizure.
Generalized seizures occur if the abnormal electrical activity affects all or most of the brain.
This affects most of the body.
A tonic-clonic seizure is the most common type of generalized seizure.
The whole body stiffens (tonic phase) and the person loses consciousness and falls.
This is followed by a violent uncontrollable shaking (clonic phase).
Absence seizure is another type of generalized seizure.
The person may lose consciousness or awareness. This is common in children.
ICTAL PHASE
The middle of a seizure is called the ictal phase.
It’s the period of time from the first symptoms (including an aura) to the end of the seizure activity, which correlates with the electrical seizure activity in the brain.
Sometimes, the visible symptoms last longer than the seizure activity on an EEG.
That’s because some of the visible symptoms may be after-effects of a seizure or not related to seizure activity at all.
Common symptoms during a seizure include:
Awareness, sensory, emotional or thought change
Biting of tongue (from teeth clenching when muscles tighten)
Blinking of eyes, eyes may move to one side or look upward, or staring
Body parts feels or looks different
Blurry vision
Change in skin color (looks pale or flushed)
Confused, feeling spacey
Convulsion — person loses consciousness, body becomes rigid or tense, then fast jerking movements occur
Déjà vu (feeling of being there before but never have)
Difficulty breathing
Difficulty talking (may stop talking, make nonsense or garbled sounds, keep talking or speech may not make sense)
Distracted, daydreaming
Dressing or undressing
Euphoric feelings
Feeling detached
Feeling of panic, fear, impending doom — intense feeling that something bad is going to happen
Flashing lights
Formed visual hallucinations — objects or things are seen that aren’t really there
Heart racing
Inability to hear
Inability to swallow, drooling
Jamais vu (feeling that something is very familiar but it isn’t)
Lack of movement or muscle tone (unable to move, loss of tone in neck and head may drop forward)
Loss of awareness (often called “black out”)
Loss of consciousness, unconscious, or “pass out”
Losing control of urine or stool unexpectedly
Loss of muscle tone in body –person may slump or fall forward
Loss of vision or inability to see
Movements of hands, like wringing, playing with buttons or objects in hands, waving
Non-purposeful movements, called automatisms, involve the face, arms or legs, such as lip smacking or chewing movements
Numbness, tingling, or electric shock like feeling in body, arm or leg
Out of body sensations
Periods of forgetfulness or memory lapses
Pupils may dilate or appear larger than normal
Repeated purposeful movements (person may continue activity that was going on before the seizure)
Rigid or tense muscles (part of the body or whole body may feel very tight or tense and if standing, may fall “like a tree trunk”)
Sounds may be strange or different
Sweating
Tremors, twitching or jerking movements (may occur on one or both sides of face, arms, legs or whole body; may start in one area then spread to other areas or stay in one place)
Unusual smells (often bad smells like burning rubber)
Unusual tastes
Walking or running
POSTICTAL STAGE
The postictal stage occurs after the ictus or active stage of the seizure.
As the seizure ends, the postictal phase occurs. This is the recovery period after the seizure.
Some people recover immediately, while others may take minutes to hours to feel like their usual self.
The type of seizure, as well as what part of the brain the seizure impacts, affects the recovery period — how long it may last and what may occur during it.
Common symptoms after a seizure include:
Anxiety
Confusion
Depression, sadness, upset
Difficulty talking or writing
Embarrassment
Emotional behavior
Exhaustion
Fear
Feeling fuzzy, light headed or dizzy
Frustration
General weakness or weak in one part or side of the body
Headache
Lack of awareness
Memory loss
Nausea or upset stomach
Physical changes
Sensory changes
Shame
Sleepiness
Slow response or not able to respond right away
Thirst
Thought changes
Urge to go to the bathroom or lose control of bowel or bladder
They also may suffer such injuries as:
Broken bones
Bruising
Cuts
Head injuries
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Resources:
http://www.epilepsy.com/learn/epilepsy-101/what-happens-during-seizure
http://www.uchospitals.edu/specialties/neurosciences/epilepsy/seizure/stages.html
http://www.news-medical.net/health/Epilepsy-Seizure-Types.aspx
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I thought the dejavu was part of the aura? Prior to the two tonic clonic’s I have had I had several weeks of dejavu experiences. They began just happening occasionally and got increasingly more frequent and intense… leading to the tonic clonic.
These were about twenty-five years ago and I no longer take medication. (Did for about 10 years) However, some of the things you described in the list for prodromal state is me! Kind of unsettling to read.
I do not have dejavu as frequently as I used to…now it happens rarely and is so fleeting I always wonder if it’s my imagination.
I question now if I should find a new neurologist…the one I saw those years ago has retired. I just don’t know. I guess I fear being told “it’s all in my head”.
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Comment by Jodi Wilson Kosary — October 5, 2021 @ 11:08 AM
Well, it’s all in your head…literally! 😉
I also used to get deja vu before a seizure. And as my seizures subsided, so did they.
Part of the brain’s circuitry I suppose.
If you’re looking for a new doc, here’s a 2021 Patient Recommendation List for TOP Neurologists…Epileptologists…Neurosurgeons…and Pediatric Doctors
The list is based on members who have had positive personal experiences with docs over the years.
I think it might be helpful for anyone looking for a good Neurologist…Epileptologist…Neurosurgeon…or Pediatric Doctor.
NOTE: The National Association of Epilepsy Centers (NAEC) provides a directory of specialized epilepsy centers in the U.S. along with other useful information about epilepsy. http://www.naec-epilepsy.org/
Another good resource for finding an epileptologist or neurologist is the American Epilepsy Society (AES). They also have a “finder” where you put in your zip code or state. http://www.aesnet.org.
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Comment by Phylis Feiner Johnson — October 5, 2021 @ 11:39 AM
Seeing how the Aura phase is just small seizures then anything during the ictus phase can occur during the aura. For me the aura is made up of tingling, numbness and pins and needles feeling in right finger tips slowly moving up my hand. When the thumping and uncontrolled movements starts i know the seizure is on. Normally mine go up my arm in a Jacksonian march, then will stop at the shoulders or sometimes goes to the side of my face, as long as i hold my hand still. If i let go of my hand things can get violent.
Now with the grand mall seizures i have, those do not give me any auras of there coming.
I haven’t had a seizure in 10 months, that’s the longest i’ve been without one. Although the last 3 i had really beat me up, to the point where i can’t move my right hand higher then my head. Only other change i did was go from capsule Gabapentin to the pill form. Woohoo, miracles do happen sometimes. 🙂
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Comment by Zolt — October 5, 2021 @ 7:10 PM
Love your descriptions!
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Comment by Toni Robison — October 6, 2021 @ 7:25 AM
Zolt, ten months seizure-free sounds like a miracle. And a relief.
But what a price you pay. Let’s hear it for Gabapentin and hope it continues to do its job!
With prayers…
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Comment by Phylis Feiner Johnson — October 6, 2021 @ 8:35 AM
Is a perfect line up of how these symptoms or feelings or actions can happen. But also shows me something because using ” prodromal group of symptoms” is a term I have never used or linked together with this?
add hyper-actvity to that list and it pretty much describes my life!
I took note of you saying those feelings og postictal are often the hardest for others to put a word to or even discuss because they may not know the word or even fear telling the “normal” person about will be seen as “different” (nice way to say crazy)
The different stages of all of this is why or how I came to put it into prose,poetry,it seems a lot of postictal feelings have come out that way
I would hesitate saying it any where else but the reason I began writing those raw emotions down was because they felt “good” or euphoric and with short term memory problems I did not want to forget them,now I might have also had a broken bone or two and feel like I was hit by a train but something in my head also felt good
Personally I have found more people who have had or do have a even a small number of those feelings in all those lists automatically disassociate it or never try to truly accept them,is a lot more to that idea and another subject in itself.I guess my word of the day is now “prodromal” 🙂 great imfo as always thanks. Rick
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Comment by wichitarick — October 22, 2021 @ 1:20 AM
WRITING! What a wonderful way to capture your actions and reactions!
Of course I’m a little prejudiced! 😉
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Comment by Phylis Feiner Johnson — October 22, 2021 @ 10:01 AM
This was the lat poem I did on having a sz. or more dealing with “postictal” feelings,I have been injured pretty bad about 6 times since Jan. so these feeling hang around longer than in the past. thank you Peace Rick
Collections Of A Scattered Mind
Awoke in daylight barely on the edge of twilight, before feet hit the floor suddenly forced to count the score
Days without sleep the price now obvious but steep, began routine while slowly realizing a change has been made
Too often has been played off bright blush part of the bluff, I know now was simply hiding what was truly in store
First signs slowly coming out, so used to vertigo the floor was tilted and I did not know, morning mingling familiar cranium tingling, hints come in pieces slowly showing how the body or mind has decayed
Morning motions coming around unaware if something was lost so often surprised when it is found, done many times before at least the countdown not starting from a floor
Flowing moments floating on an edge felt deeply as if a member of a secret club, many others search for hidden clues and wonder if their dues have been paid
Begin a checklist while lost in the foggy mist, reflections come as voids or in triplicate
listless and lost, images mixed liked work sock in the top drawer
Views narrow but as my mind widens come in bursts that truly hurt, not a major concern as I have learned, still checking the list for new issues to be displayed
Realize as I analyze simple motions become a hard notion, thickness of time part of the illness
mind and body wading through waters waiting to come ashore
My mind like a broken chain, scattered links come together slowly form bringing strength,
as it grows longer my brain is stronger, only time ends this mindless charade
Making better connection with what is now a concoction or collection of my scattered mind,
my brain is empty waiting for the river of knowledge to refill the reservoir
Now aware this day will be played but on ever changing stage, not to regress like taking a familiar test, best to take things light without fright as my minds brings down another barricade
R.C.
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Comment by wichitarick — October 22, 2021 @ 1:26 AM
FABULOUS revelation. Now I know how and why your talent takes you through.
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Comment by Phylis Feiner Johnson — October 22, 2021 @ 10:10 AM
Body Part Twitching
Deja Vu
and
Aura Colors
All are related to Spiritual Awakening … ❤ ❤
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Comment by Master Mind — October 23, 2021 @ 7:18 AM
Well, you’ve certainly described seizure stages to a tee. Thank you. It’s WONDERFUL!!!
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Comment by Phylis Feiner Johnson — October 23, 2021 @ 11:21 AM
I have seizures in this house so much and I hope that this helps somebody else or more people because it was a real big help for us….
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Comment by Shawna — May 7, 2022 @ 1:20 PM
My son has a concussion. Believe is now having seizures. Affects his speech and response timing. Multiple seizures daily.
(Seizure #), ( Speech ), ( responce )
1. Slow. Slow
2. Normal. Normal
3. Mumbles Normal
Can’t form words
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Comment by Nelson Reynolds — November 12, 2022 @ 12:17 AM
Nelson, perhaps these two articles will help clarify things:
Have You Had A Concussion? https://epilepsytalk.com/2014/03/30/have-you-had-a-concussion/
Concussions: Helping Your Brain Heal… https://epilepsytalk.com/2020/01/27/concussions-helping-your-brain-heal/
I hope this helps.
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Comment by Phylis Feiner Johnson — November 12, 2022 @ 9:52 AM