The phases of a seizure may occur in a sequence, with the prodrome and aura at the beginning, the ictal stage usually in the middle, and the post-ictal stage after the seizure has ended.
Seizures can occur in different stages, although not everyone experiences every stage with each seizure. Recognizing these stages may help you notice early warning signs, giving you time to adjust your activity, move to a safer place, or take medication if prescribed.
Each stage may involve certain symptoms, but these can vary from person to person and depending on the type of seizure.
This article explains the different stages of a seizure and the typical symptoms that may occur during each.
Each stage has certain symptoms, although these may vary for each person, depending on the type of seizure.
This article looks at the different seizure stages and typical symptoms for each.
Phase 1 of a seizure may include the prodromal stage and early ictal, or aura, stage.
These stages may warn people that a seizure is about to happen.
Not everyone who has seizures will experience a prodrome or aura.
Prodromal stage
A prodrome is a sensation or particular feeling that people may experience before having a seizure.
The prodromal stage may occurs hours or days before the seizure occurs.
Symptoms of the prodromal stage may include:
- changes in mood and behavior
- anxiety
- confusion
- irritability
- anger
- difficulty focusing
- headache
- feeling lightheaded
- trouble sleeping
- tremor
The prodromal stage spans from the onset of these early symptoms to when symptoms of the seizure itself begin.
The prodromal stage may not occur with every seizure. Around 20% of people with epilepsy may experience the prodromal stage.
If you begin to recognize a pattern of prodromal symptoms before your seizures, consider discussing a plan with your neurologist.
This may include instructions about when to take medication, if prescribed, and when to stop activities that could become dangerous during a seizure, such as driving, swimming, climbing, or other activities that may increase the risk of a fall or injury.
Aura
In many cases, the aura, or early ictal stage, is the first stage of a seizure.
People are conscious and aware during the aura. It can last for minutes or longer, but it might not occur at all.
According to Cure Epilepsy, around 65% of people with epilepsy may experience aura as part of their seizures.
Symptoms of aura may include:
- out-of-body sensations
- deja vu
- hallucinations
- vision changes
- nausea
- pain or twitching in the arms or legs
- changes in taste and smell
- numbness and tingling
- dizziness
- headache
- panic
- intense feelings of fear, anger, joy, or sadness
- jamais vu, a feeling of seeing something familiar for the first time
- hearing ringing or buzzing sounds
An aura may or may not progress to a prolonged or more severe seizure.
Because an aura can occur shortly before changes in awareness or involuntary movements, recognizing it may give you time to get to a safer place.
Recognizing an aura may give you a brief warning before other seizure symptoms begin, allowing you to sit or lie down somewhere safe and alert someone nearby if needed.
The ictal stage of a seizure is when a person displays seizure symptoms, such as involuntary movements and reduced awareness.
Intense abnormal electrical activity in the brain occurs during this stage.
It may last for up to a few minutes. When the ictal stage lasts for more than
Status epilepticus is dangerous and requires immediate medical attention.
During a seizure, the priority is to prevent injury and get medical help when needed. Seek prompt medical attention if a seizure lasts 5 minutes or longer, is different from a person’s usual seizures, or results in an injury.
Symptoms of the ictal stage vary with the type of seizure, but may include:
- loss of awareness
- loss of muscle control
- stiffening of arms and legs
- confusion
- distractedness or sense of detachment
- chewing
- lip-smacking
- repetitive movements
- drooling
- sweating
- tremors
- numbness
- difficulty speaking or moving
- lapses in memory
- unusual physical activity
- dilated pupils
- loss of bladder or bowel control
- twitching movements
- increased heart rate
- changes in vision or hearing
- changes in taste or smell
- difficulty breathing
- convulsions
The post-ictal stage happens after the seizure has ended. It is the recovery period in which people will feel the after-effects of a seizure.
Symptoms of the post-ictal stage may include:
- weakness in the arms or legs
- fatigue
- malaise, or a general feeling of discomfort or illness
- headache
- sore muscles
- confusion
- drowsiness
- memory difficulties
- feelings of fear, anxiety, shame, frustration, embarrassment, or sadness
- nausea
- thirst
- high blood pressure
- loss of bladder or bowel control
- lack of consciousness
- injury, such as cuts, broken bones, or head injury
Sometimes, there can be temporary paralysis after a focal onset seizure. Experts refer to this as Todd’s paralysis.
Todd’s paralysis usually occurs on one side of the body. It can last from
After a seizure, give yourself time to rest and recover. If the seizure was unusual for you, your recovery symptoms are concerning, or something seems different from your typical pattern, contact your neurologist to discuss whether your treatment plan needs to be adjusted.
Recovery from a seizure may depend on the type of seizure a person had, seizure severity, and the area of the brain where it took place.
People may or may not remember having a seizure once it is over, or they may only remember parts of it.
People may experience the ending stage very briefly following a seizure. In other cases, the recovery period may last for hours or days before people feel back to normal.
People may need to allow themselves time to rest after a seizure. If people have any serious injuries from a seizure, they will need to seek medical help straight away.
This section answers some frequently asked questions about seizures and seizure stages.
What are the three main types of seizures?
The three main types of seizures are:
- Focal onset seizures: Focal seizures begin in one side of the brain. Focal onset seizures include focal onset aware seizures, in which a person remains aware during a seizure, and focal onset impaired awareness seizures, in which a person experiences a change in awareness during a seizure.
- Generalized onset seizures: Generalized seizures begin in both hemispheres of the brain at the same time. Generalized seizures include seizures such as tonic-clonic, atonic, and absence seizures.
- Unknown-onset seizures: If it is not clear where in the brain a seizure begins, it is an unknown-onset seizure.
What are the three signs of a seizure?
The signs of a seizure vary depending on the type of seizure, but may include:
- changes in movement, such as shaking, falling, or muscle spasms
- changes in awareness, such as confusion, staring into space, or loss of consciousness
- changes in mood and sensation, such as feelings of fear, sensory changes, or deja vu
A seizure causes abnormal activity in the brain and consists of different stages, each with its own symptoms.
There are four main stages of a seizure:
- prodromal stage
- aura, or early ictal stage
- ictal stage
- post-ictal stage
People may experience each stage differently depending on the type and severity of the seizure and which area of the brain it affects. Some people may not experience the prodromal or aura stages.