What are the phases of an Epileptic Seizure?

December 8, 2022

Seizures are a common symptom of epilepsy, a condition caused by abnormal electrical signals from the brain’s neurons. There are several types of seizures, and most patients experience them differently, but those who have this disorder can often tell when they’re about to have one.

Approximately 3 million adults and 500,000 children have epilepsy in the USA. While 70% of people can manage their disease without medication, it can still directly affect their day-to-day life.

A common question asked by patients after their diagnosis is “what is epilepsy?” This is a very broad subject and in this article we have focused specifically on the phases of a seizure. More information on epilepsy in general can be found here.

It’s important that patients and doctors are familiar with the early signs of an epileptic seizure, as they can then ensure they are in a safe environment where they are unlikely to come to serious harm.

Phases of a seizure

The prodrome and aura stage marks the beginnings of a seizure, whereas the ictal stage marks the active part of the seizure.

Prodrome Phase

The prodromal phase can last anywhere from 10 minutes to several days. However, some people won’t experience this stage.

Some common signs and symptoms of seizures in the prodrome stage include:

  • Anxiety
  • Mood changes
  • Difficulty sleeping
  • Feeling lightheaded
  • Focus issues
  • Behavioural changes

Patients may just feel different or “off.” Friends and relatives may notice behaviours that seem uncharacteristic. Confusion, irritability, and headaches are also common.

Aura Phase

The aura stage generally signals the start of a seizure. The International League Against Epilepsy (ILAE) seizure classification system classifies auras as focal aware seizure.

Fortunately, people who experience these auras generally have the same symptoms every time, making them easier to predict.

Some common signs and symptoms of seizures in the aura stage include:

  • A feeling of déjà vu
  • Feelings of jamais vu
  • Odd sounds, tastes, or smells
  • Vision difficulties
  • Dizziness
  • Changes in blood pressure
  • Intense fear or anxiety
  • Numbness or “pins and needles”
  • Confusion and headaches
  • Muscle jerking or twitches

During the aura, relatives may notice that the patient stares into the distance, stops talking, or seems confused.

Ictal Phase

This is the main phase of the seizure where there is the most intense electrical activity within the brain. This stage manifests differently for each individual with epilepsy. Patients may experience a variety of symptoms including:

  • Drooling
  • Memory issues
  • Confusions
  • Problems hearing
  • Unusual smells or tastes
  • Difficulty speaking or saying strange words
  • Twitching
  • Loss of muscle control
  • Repeated movements (such as lip smacking or chewing)
  • Body convulsions
  • Pale/flushed skin
  • Strange sounds

Be aware that partial seizures can turn into generalised tonic-clonic seizures (characterised by extreme muscle jerking and stiffness).

Post-Ictal Phase

This is the final phase of the seizure and is considered the recovery stage. The type of seizure, severity and region of the brain involved will determine how long this phase lasts for. Some people recover immediately, whereas some people can take days to recover.

Common symptoms include:

  • Confusion
  • Fatigue
  • Headache
  • Fear and anxiety
  • Shame or embarrassment
  • Thirst
  • Nausea
  • Sore muscles
  • Weakness in parts of the body