What Is a Seizure? Your Doctor Explains

It’s one of those calls no one wants to make, or receive. “Mom, something happened. I… I think I had a seizure.” Your heart drops. Or maybe you were the one on the floor, confused, with a worried face peering down at you. It’s a frightening experience, no doubt about it. That sudden loss of control, the strange sensations, the blank period. What just happened?

Let’s talk about it, just you and me.

Understanding What a Seizure Is

So, what exactly is a seizure? Think of your brain as a super-complex electrical grid. Normally, tiny electrical signals zip around, telling your body what to do – move your arm, blink, think. But sometimes, there’s a sudden, uncontrolled burst of electrical activity, like a power surge in one or more parts of that grid. That’s a seizure.

The most dramatic image people have is often someone falling, shaking uncontrollably (convulsions), and losing consciousness. And yes, that can happen. But not all seizures look like that. Sometimes it’s much quieter. You might just stare blankly for a few moments, or perhaps an arm or leg might jerk a bit. You could feel a muscle twitch. It’s a wide spectrum, really. Some folks have just one in their lifetime; others might experience them more often. Everyone’s experience can be quite different.

There isn’t just one single cause, either. So many things can disrupt the brain’s usual electrical rhythm – from a dip in your blood sugar to an illness, a head injury, or an underlying medical condition we need to uncover.

The Main Types of Seizures We See

We generally group seizures into two main categories, based on where that electrical surge starts in the brain:

1. Generalized Seizures: This is when the abnormal electrical activity kicks off on both sides of your brain at roughly the same time. You might see shaking on both sides of the body, or just one side, or sometimes it’s that blank stare. These often start in childhood or young adulthood, but honestly, they can pop up at any age.

1. Focal Seizures: Here, the electrical hiccup begins in a specific area, or “focus,” on one side of your brain. Symptoms usually affect one side of your body. A key thing here is whether you’re aware during it.

It’s worth knowing that up to 10% of people worldwide might have at least one seizure in their lives. So, you’re not alone in wondering about this.

What Does a Seizure Feel and Look Like?

The signs can really vary, but some common ones include:

• A temporary loss of consciousness.
• Uncontrollable movements, like convulsions, muscle spasms, or jerking limbs.
• Just staring off into space.

Other things you or someone else might notice:

• Sudden emotional shifts – feeling confused, scared, unusually happy, or anxious for no clear reason.
• Clenching the teeth.
• Drooling.
• Eyes moving in an unusual way.
• Losing control of bladder or bowels (this can happen).
• Making sounds like grunts or snorts.

These symptoms are usually temporary, lasting from a few seconds to a couple of minutes.

The Journey of a Seizure: Stages

Sometimes, a seizure has a bit of a lead-up, almost like stages, though not everyone experiences all of them:

1. Prodrome phase: Days, or even hours, before, you might notice subtle changes. Mood swings, feeling lightheaded, trouble focusing, or difficulty sleeping.
2. Aura phase: This is right before the main event. You might see flashing lights, have a headache, feel dizzy or nauseous, or experience sudden anxiety or fear. Your senses can play tricks – strange tastes, sounds, smells, or feelings on your skin.
3. Ictal phase: This is the seizure itself, when the actual symptoms are happening.
4. Postictal phase: Right after it ends. It’s common to feel wiped out, confused, sore, or have really strong emotions.

Many seizures can come on without any warning, especially that aura phase. So don’t worry if you didn’t notice anything beforehand.

Any Warning Signs to Watch For?

If there are warnings (that aura we talked about), they might include:

• Sensory changes: Seeing bright lights or things looking distorted, hearing odd sounds, sudden metallic or bitter tastes, strange smells, or a pins-and-needles feeling.
• Emotional shifts: A sudden wave of fear or joy, that weird feeling of “déjà vu” (like you’ve been there before) or “jamais vu” (when something familiar feels new).
• Autonomic symptoms: Things your body does automatically can go a bit haywire – like sweating, producing too much saliva (drooling), an upset stomach, or looking pale.

Again, not everyone gets these.

What’s Behind a Seizure? Pinpointing the Cause

At its core, a seizure is that surge of electrical activity. Your brain cells, called neurons, chat with each other using electrical signals. During a seizure, some cells go into overdrive, firing signals uncontrollably. This overload causes the symptoms.

We tend to think about causes in two broad ways:

• Provoked seizures (nonepileptic): Something specific triggers these. It could be a temporary issue or certain circumstances.
• Unprovoked seizures (epileptic): These seem to happen out of the blue, sometimes repeatedly. This is what we see with epilepsy, where seizures are the main symptom.

Sometimes, we just can’t find a clear cause. We call those idiopathic seizures.

Common Seizure Triggers

Life throws us curveballs, and some can act as triggers:

• Blood sugar levels going way too low or too high.
• Certain medications (for example, bupropion, often known as Wellbutrin®).
• Flashing or flickering lights (this is a big one for some).
• Getting seriously overheated (heat illness).
• A high fever, especially in little ones.
• Not getting enough sleep (sleep deprivation).
• Major stress.
• Substance use, including alcohol withdrawal.

Triggers are very individual. If seizures become a pattern, keeping a diary of what was happening beforehand can sometimes help us spot them.

Medical Conditions That Can Lead to Seizures

A whole host of medical issues can, unfortunately, bring on a seizure. Things like:

• Brain aneurysms (a bulge in a blood vessel).
• Brain tumors.
• Cerebral hypoxia (when the brain doesn’t get enough oxygen).
• Cerebrovascular disease (problems with blood vessels in the brain).
• Diabetes.
• A severe concussion or traumatic brain injury (TBI), especially if there was loss of consciousness.
• Degenerative brain diseases like Alzheimer’s disease or frontotemporal dementia.
• Eclampsia (a serious condition in pregnancy).
• Electrolyte imbalances – particularly low sodium (hyponatremia), calcium, or magnesium.
• Epilepsy itself.
• Some genetic conditions.
• Hormonal changes.
• Infections, especially those affecting the brain like encephalitis or meningitis, or severe body-wide infections like sepsis.
• Inflammation from autoimmune conditions.
• Sometimes, mental health conditions can lead to what we call psychogenic seizures (seen in conditions like conversion disorder).
• Problems with how the brain developed before birth (congenital brain abnormalities).
• Strokes.
• Exposure to toxins or poisons, like carbon monoxide poisoning.
• Even venomous bites or stings in rare cases.

Anyone can have a seizure, but you might be at a slightly higher risk if you have an underlying medical condition, a family history of seizures, if you’re a child, or if you’re over 50.

Potential Complications

The biggest immediate worry with a seizure is injury. If you lose consciousness and fall, or if it happens while you’re driving or operating machinery, that’s obviously dangerous. The convulsions themselves can cause bumps, bruises, or even broken bones.

There’s a serious situation called status epilepticus. This is when a seizure lasts longer than five minutes, or if you have several seizures back-to-back without fully recovering in between. This is a medical emergency because it can lead to brain damage or, in the worst cases, be fatal. It needs immediate medical help.

And it’s not just physical. Seizures can take a real toll on your mental health. It’s very common to feel anxious or depressed. You might worry constantly about when the next one will happen, avoid social situations, or feel embarrassed. These are all perfectly normal reactions to something so unpredictable. Talking to a mental health professional can be incredibly helpful.

Figuring It Out: How We Diagnose a Seizure

If you’ve had what you think might be a seizure, the first step is a thorough check-up. Usually, this involves seeing a neurologist, a doctor who specializes in the brain and nervous system. We’ll do a physical exam and a neurological exam, ask lots of questions about your symptoms, your medical history, and your family’s health history.

It’s often really helpful if someone who saw the event can come with you to the appointment. You might not remember everything, so their description can be invaluable.

Tests We Might Suggest

To confirm if it was a seizure and to try and find a cause, we have several tests:

• Blood tests: To check for things like blood sugar issues, electrolyte imbalances, or signs of infection.
• Computed tomography (CT) scan or Magnetic resonance imaging (MRI): These are like detailed pictures of your brain, looking for any structural issues like a tumor or damage from a stroke.
• Electroencephalogram (EEG): This is a key test. It records the electrical activity in your brain. We’re often looking for a “focal point” – a specific area where seizures might be starting. This can really guide treatment.
• Genetic tests: Sometimes, there’s a genetic link.
• Positron emission tomography (PET) scan: Another imaging test that can show brain activity.
• Spinal tap (lumbar puncture): If we suspect an infection like meningitis, we might need to take a small sample of spinal fluid.

We’ll always talk you through why we’re recommending a particular test.

Getting a Handle on Seizures: Treatment Options

How we treat a seizure really depends on the type, how severe it is, and what’s causing it. Our approach might include:

1. Treating the underlying cause: If we find something specific, like low blood sugar or an infection, treating that condition is the first priority. This might stop future seizures.
2. Antiseizure medications: There are many good medications that can help prevent seizures or at least make them happen less often.
3. Surgery: In some cases, especially if seizures start in a very specific, identifiable part of the brain (that focal point we talked about), surgery to address that area might be an option to reduce how often or how badly seizures occur.
4. Brain stimulation: This is a bit more specialized. A surgeon can implant a small device, a bit like a pacemaker for the brain, that sends mild electrical currents to try and interrupt or stop abnormal electrical activity. Vagus nerve stimulation is one type.
5. Dietary changes: For some people, especially if medications aren’t working well, a very specific diet, like a ketogenic diet (which is very low in carbohydrates), might help reduce seizures. Research is still ongoing here.

Medications for Seizures

The goal of medication is usually to:

• Stop a seizure if it’s happening.
• Prevent future ones.
• Make seizures less severe if they do occur.
• Reduce how frequently they happen.

Some common medications we use include benzodiazepines (like diazepam), carbamazepine, gabapentin, lamotrigine, oxcarbazepine, phenytoin, pregabalin, and valproic acid. There are many others, too.

Finding the right medication and the right dose can take a bit of trial and error. It’s a partnership between you and your doctor. We’ll need regular follow-ups to see how you’re doing. It’s so important to keep taking your medication as prescribed, even if you start feeling better. Stopping suddenly can sometimes trigger more seizures.

Studies suggest about a third of people find their seizures stop completely with medication, and another third see a big reduction in how often they happen.

Can We Prevent Seizures?

Because seizures can be so unpredictable, we can’t completely prevent them all. The best strategy is to manage any known causes or triggers. That means things like keeping your blood sugar stable if you have diabetes, or taking steps to protect yourself from head injuries or serious illnesses.

Living with Seizures: What to Expect

If you’ve had one unprovoked seizure, there’s a less than 50% chance you’ll have another. If a second one does happen, that’s often when we’ll start talking more seriously about antiseizure medications. If a seizure was provoked (meaning it had a clear, temporary cause), your risk of another one depends on whether that cause is treatable or likely to happen again.

Medications can be very effective. But as I said, it can take time to find the best fit. For more challenging situations, surgery or dietary approaches might be considered.

If seizures happen often, we’ll talk about safety. Wearing a medical ID bracelet or carrying a card can be a lifesaver, letting others know what’s happening and how to help if you have a seizure in public.

A seizure itself usually lasts from a few seconds to a few minutes, maybe up to 15 minutes. If it goes on longer, or you have several in a row, that’s status epilepticus, and that’s an emergency.

Your own outlook really depends on your specific situation – the cause, the type of seizure, how severe it was, whether it was your first, any underlying conditions, and how well treatments work for you. We’ll navigate all of this together.

When to Reach Out for Medical Help

You should head to the emergency room if you have a seizure for the very first time, or if you have any event where you pass out and don’t know why. If you’re alone and think you’ve had a first-time seizure, please call your doctor or get checked out right away.

If you’ve had a seizure before, and then you have a second one, it’s really important to see your doctor as soon as you can. Each seizure can potentially make it a bit easier for another one to happen, so getting on top of it early with diagnosis and treatment is key.

If someone has regular seizures and a known diagnosis, calling an ambulance every time might not be necessary. However, even if you know why it happened, there’s always a chance of injury that might need medical attention.

Questions for Your Doctor

If you’ve had a seizure, here are some good questions to ask:

• What do you think caused my seizure?
• Are there specific triggers I should try to avoid?
• What kind of treatment do you recommend for me?
• What are the possible side effects of that treatment?
• Is it likely I’ll have another seizure?
• What can I do to keep myself safe?

What About Seizures in Children?

Kids can have seizures too, often for similar reasons as adults. Some common types we see in children include absence seizures (sometimes called childhood absence epilepsy), febrile seizures (caused by high fever), infantile spasms, juvenile myoclonic epilepsy, and Lennox-Gastaut syndrome. Of course, tonic-clonic seizures can happen in children as well. If your child has a seizure, it’s a different kind of worry, and we’ll approach it with extra care.

Seizures and Pregnancy: Is It Safe?

Yes, it’s definitely possible to have a safe pregnancy even if you have a history of seizures. We’ll likely want to see you for more frequent checkups to keep a close eye on both you and your baby. Some antiseizure medications aren’t recommended during pregnancy, but there are often safer alternatives we can use to help manage your symptoms. That’s a conversation we absolutely need to have if you’re planning a family or find out you’re pregnant.

Take-Home Message: Key Things to Remember About Seizures

Living with or worrying about a seizure can be tough. Here are a few key points:

• A seizure is a sudden, abnormal electrical discharge in the brain.
• Symptoms vary widely, from dramatic convulsions to subtle staring spells.
• There are many potential causes, including underlying conditions, injuries, or specific triggers.
• Diagnosis involves a careful history, exam, and often tests like an EEG or brain imaging.
• Treatment aims to control seizures, often with medication, but sometimes surgery or dietary changes are considered.
• If a seizure lasts more than 5 minutes (status epilepticus), it’s a medical emergency.
• Understanding your specific type of seizure and its triggers is important for management.

A Final Thought

Dealing with a seizure, whether it’s your own or a loved one’s, can feel overwhelming. Please know that you’re not alone in this. We have many ways to understand and manage seizures today. Reach out, ask questions, and let’s work through it together.