Understanding The Stages Of A Seizure

Among all the different types of seizure, there is only one denominator that can be observed – seizure happens in stages.

There are, in general, three physical stages of a seizure. The fourth stage, the prodromal symptom period, which is often an overlook stage, begins in a period preceding the onset of the seizure.

Prodromal Symptoms
This premonitory group of symptoms occurs days or hours before a seizure ensues. This includes symptoms like mood changes, lightheadedness, sleep disturbances, irritability, an ecstatic feeling, usually one that is associated with affection, and difficulty concentrating. Less common prodromal symptoms include facial pallor, headache, and abdominal pain.

People with repetitive seizure may or may not experience any prodomal symptoms. Even for those patients of possibly the worst type of seizure, generalized tonic-clonic seizure, prodomal symptoms are extremely rare. Having said that, seizure is typically only divided into three stages – aura, ictal period, and post-ictal period.

Aura
Prior to the onset of a seizure, epileptic patients experience physical sensations that could warn them of an impending seizure episode. This is actually a less severe type of seizure called simple partial seizure. The sensations differ from one case to another, although there are general symptoms that may give away the fact that a seizure will soon occur. These include a feeling of restlessness, nervousness, tension, anxiety, depression, heaviness, and a general feeling that something is not quite right with the body.

The above mentioned sensations are accompanied with:
- Trembling,
- Salivation,
- Tingling sensation,
- Unusual smell or taste,
- Visual and auditory disturbances or hallucinations, and
- Déjà vu

Basically, aura is a period wherein mood and behavioral changes can be experienced.

Ictal Period
Each type of seizure produces different symptoms. Absence seizure, for example, may not appear like a seizure at all because of the absence of violent movements of the body. Apilepsia partialis continua, an extremely rare type of seizure, may appear like a seizure of a localized area of the body that continues for an extended period of time. Tonic-clonic seizure or grand mal, on the other hand, produces an entire spectrum of familiar seizure symptoms.

In tonic-clonic seizure, symptoms may be divided into two stages – the tonic phase and the clonic phase.

The tonic phase involves either myclonic jerks or a type of transient muscle jerks, or rarely, absences followed by a significant tension in the muscles. This period last anywhere from 10 to 20 seconds.

The clonic phase is the period when convulsive movements occur. In this phase, the tensed muscles relax for a brief period then symptoms progress to a generalized tremor. The clonic phase often lasts for about 2 minutes with worse bouts of seizure lasting up to 5 minutes or more.

Post-Ictal Period
Again, depending on the type of seizure, the transition between the ictal period to a normal period called post-ictal period may involve a variety of symptoms. As the body recovers, the brain may 'shut down', bringing about a prolonged period of unconsciousness which may last from hours to days at a time. This may be followed by sleep or a period of stupor, and in rare cases, a period of prolonged generalized weakness. This condition is called Todd's paralysis.