Epilepsy Talk

The 4 Stages of Seizures – Prodromal, Auras, Ictal and Postictal  | March 25, 2025

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

What are your experiences? How do you deal with them? We’d love to know.

To subscribe to Epilepsy Talk and get the latest articles, simply go to the bottom box of the right column, enter your email address and click on “Follow”

Resources:

https://www.webmd.com/epilepsy/stages-seizures

https://epilepsydisease.com/seizure-stages

http://www.epilepsy.com/learn/epilepsy-101/what-happens-during-seizure

---