Like other neurological conditions, seizures don’t impact patients the same way. They vary depending on where they start in the brain and how they affect awareness and behavior. Doctors classify them into types, and knowing your type helps guide treatment.

There are three main types of seizures.

‍

1. Focal seizures

This type starts in one part of the brain and stays localized, affecting only that area. You might experience strange sensations, emotions, or movements depending on which areas are involved, but the disturbance does not spread to your whole brain. It is further broken down into two categories.

a. Focal aware seizures are limited to one region of the brain, and consciousness is preserved. Symptoms may include sudden emotions like fear, joy, or déjà vu, unusual tastes or smells, tingling or numbness in part of the body, localized muscle twitching, or changes in vision such as flashing lights. These seizures usually last 30 seconds to 2 minutes.

b. Focal impaired awareness seizures start in one region of the brain but spread to areas that affect consciousness. Symptoms may include staring blankly, repetitive movements, or automatisms such as lip smacking, picking at clothing, and difficulty communicating. These seizures last 1 to 3 minutes.

‍

2. Generalized seizures

This type involves abnormal electrical activity from both sides of the brain at onset. These seizures typically affect your consciousness and often involve your whole body. There are several types of generalized seizures.

a. Tonic-clonic seizures (grand mal) affect both sides of the brain and happen in two phases that last 1-3 minutes. During the tonic phase, the body goes rigid, and the person may cry out or fall. This is followed by the clonic phase, where the arms and legs jerk rhythmically.

Patients lose consciousness, may sometimes bite their tongue, or lose bladder control. After the seizure, there is a postictal period during which the patient remains disoriented or confused for a short time. In the ER, this lingering confusion helps doctors figure out what happened. If someone is found unconscious, it can be hard to tell if they fainted or had a seizure, but prolonged postictal confusion is specific to tonic-clonic seizures.

b. Absence seizures (petit mal) are brief disruptions of signaling across both brain hemispheres. Symptoms may include sudden staring spells or blank expressions, where the patient is conscious but unresponsive. These seizures may involve subtle lip smacking or eye blinking and last 5 to 30 seconds. Patients have no memory of the event itself and can often resume normal activity immediately. In school or work, absence seizures can be mistaken for daydreaming.

c. Myoclonic seizures are sudden, brief electrical discharges involving both hemispheres, often from the motor cortex. Patients have sudden, brief muscle jerks in the arms, shoulders, or upper body with consciousness preserved. These jerks last a few seconds, and patients may drop objects as a result. These are not the same as the jerking sensations felt when falling asleep, which are hypnic jerks and not epilepsy.

d. Atonic seizures (drop attacks) are generalized seizures with a sudden loss of muscle tone. The whole body may fall, or just the head may drop forward. Consciousness is lost for up to 15 seconds.

e. Tonic seizures, unlike tonic-clonic seizures, involve a sudden increase in muscle tone or stiffening of the arms, legs, or back, lasting up to 20 seconds with a brief loss of consciousness.

‍

3. Unknown onset seizures

This is a placeholder category used when doctors can't determine the origin of a seizure based on the available information because:

• No one saw the seizure begin, so there's no description of the initial symptoms.
• The person was alone at the time of the s.
• The EEG didn't capture the start of the seizure.
• The person doesn't remember how it started (which is common)
• Video monitoring was unavailable, or it didn't capture the onset.

This is not usually a permanent diagnosis. As doctors gather more information through additional EEGs, longer monitoring, witness accounts of future seizures, or imaging studies, they can often reclassify the seizure as focal or generalized. It may take longer to receive a more specific diagnosis.

‍

Treatment options for seizures

Since each seizure type originates from different brain regions and presents with distinct symptoms, treatments vary accordingly.

Medications

• Unknown onset seizures: Doctors usually start with broad-spectrum anti-seizure medications that work for multiple seizure types until they can identify the specific type. Once they know if it is focal or generalized, they can fine-tune the treatment.
• Focal seizures: Often respond to drugs like carbamazepine, levetiracetam, or lamotrigine.
• Generalized tonic-clonic: May use valproic acid, phenytoin, or newer medications.
• Absence seizures: Often treated with ethosuximide or valproic acid.
• Myoclonic seizures: May respond to valproic acid or levetiracetam.

Beyond medications

• Vagus nerve stimulation (VNS): A device implanted to help with seizures that do not respond to medications.
• Responsive neurostimulation (RNS): A brain implant that can detect seizures starting and stop them.
• Deep brain stimulation (DBS): Electrodes placed in targeted brain areas.
• Surgery: Removing the part of the brain where seizures originate (mainly an option for focal seizures).
• Dietary approaches: The ketogenic diet works well for certain childhood epilepsies.

‍

What to do when someone has a seizure

Your response depends on the type of seizure you are experiencing.

For focal seizures: Stay calm and stay with them. Keep them away from anything dangerous, but do not physically restrain them. Time the seizure if you can, and speak to them in a reassuring voice.

For generalized seizures: This is more urgent. Protect their head right away because jerking movements can be violent. Once the seizure stops, roll them onto their side to keep their airway clear and open. Never hold them down or put anything in their mouth. Timing the seizure helps medical staff later.

‍

When to call 911

Not every seizure is an emergency. If someone has a known seizure disorder, the seizure is brief and typical for them, and they return to normal afterward, a call to their neurologist is usually enough.

But call 911 if:

• The seizure lasts longer than 5 minutes.
• They don't wake up between seizures.
• They get injured during the seizure.
• The seizure happens in water.
• They have diabetes, heart disease, or are pregnant.
• It's their first seizure ever.

‍

Preparing for your visit

Figuring out your seizure type is the foundation of your treatment plan.

A neurologist can make more informed decisions during the first appointment when patients come prepared with relevant information. If anyone witnessed your seizure, get every detail you can: body movements, whether you were conscious, how long it lasted, everything.

Your neurologist will probably order an EEG to confirm their suspicions, but a detailed account of what happened is valuable. Bring an up-to-date medication list, including any medications you have recently started or stopped, and write down your questions ahead of time.

Key questions to ask your doctor

1. What specific type of seizures do I have?
2. What triggers should I avoid?
3. How will you monitor the effectiveness of my treatment?
4. What side effects should I be aware of with my medications?
5. When should I seek emergency care?
6. Are there activities I should avoid?
7. How often do I need follow-up appointments?

If you're dealing with seizures and need guidance, we're here to help. Book a video visit to see a specialist in a few days.