Seizures: Causes, Symptoms, Types, and How to Manage Them

What is a seizure?

Our brains are specialized in sending electrical impulses to signal and communicate. Brain cells, called neurons, allow us to think, feel, and move. Some people experience a “short circuit” that temporarily disrupts the brain’s communication system. This is known as a seizure: a brief window of time when the brain’s neurons fire signals in an uncoordinated and unintentional way, like an electrical storm. Depending on where the seizure is happening, it might cause a person to lose consciousness, experience muscle spasms, or simply appear to be daydreaming. 

A seizure is considered a symptom of an underlying issue, not a disease in itself. While a seizure is a one-time event, epilepsy is the neurological disorder diagnosed when a person has recurrent, frequent, or unprovoked seizures over time. Essentially, a seizure is the individual occurrence, whereas epilepsy is the ongoing condition that indicates those events are likely to happen again.

What are the types of seizures?

Not all seizures look like the dramatic shaking we may have seen on TV. Many seizure types are so subtle they go undiagnosed for long periods of time. Seizure types are typically grouped into categories based on their location in the brain.

Focal Onset Seizures

These seizures start in one specific area or on one side of the brain. A person might remain fully awake and aware, perhaps experiencing a strange taste in their mouth or a sudden twitch in an arm. Sometimes, awareness is impaired, and the person might look confused or perform repetitive movements like tugging at their shirt.

Generalized Onset Seizures

These involve both sides of the brain at once. Because the whole brain is affected, awareness is almost always lost.

• Tonic-Clonic Seizures: These are what most people imagine when they hear "seizure." The body stiffens (tonic phase) and then moves into rhythmic jerking (clonic phase).
• Absence Seizures: These are common in children and often look like "staring spells." The person stops moving and stares into space for a few seconds before returning to normal, usually with no memory of the lapse.
• Atonic Seizures: Also called "drop attacks," these involve a sudden loss of muscle tone. A person’s head might suddenly drop, or their whole body might go limp, leading to a fall.

What are symptoms of seizures?

Seizure symptoms are as diverse as the people who experience them. Because the brain controls every function of the body, a disruption in its electrical flow can manifest in many different ways.

Beyond the obvious physical shaking, families should watch for:

• Autonomic changes: Sudden changes in heart rate, breathing, or skin color (turning pale or blue).
• Behavioral "arrest": A person suddenly stops what they are doing and becomes unresponsive to their name.
• Sensory hallucinations: Smelling burnt toast, seeing flashing lights, or hearing sounds that aren't there.
• Motor tics: Repeated lip-smacking, eye-blinking, or "cycling" movements with the legs.
• Psychological shifts: A sudden wave of intense fear, anxiety, or a sense of déjà vu.

What are the stages of a seizure?

Understanding the timeline of a seizure helps prepare for what comes after the event. Most seizures follow a three-part structure.

The Aura (The Warning)

Some people experience a "prodrome" hours or even days before a seizure, characterized by irritability or sleep changes. The "aura" itself is actually the very beginning of the seizure. It might feel like a "pit in the stomach" or a specific smell. If a person is old enough to communicate this, it provides a vital window to get them to a safe position.

The Ictal Phase (The Event)

This is the period from the first symptom to the end of the seizure activity. This is the time to stay calm, track the duration, and ensure the person is safe.

The Postictal Phase (The Recovery)

The brain needs time to recover after the electrical storm. This phase can last minutes or hours. This may cause someone to be extremely sleepy, confused, or even temporarily combative. They might have a significant headache or feel physically sore. This is a time for quiet, rest, and reassurance.

What causes seizures?

Seizures happen for many reasons. Sometimes they are "provoked" by an outside factor. Common triggers include high fevers (especially in young children), lack of sleep, flashing lights, or extreme stress.

However, "unprovoked" seizures usually stem from a structural or genetic cause. In these cases, the brain's threshold for electrical activity is naturally lower, making seizures more likely to occur spontaneously. 

Seizures in NGLY1 Deficiency

While every NGLY1 patient is different, about half develop epilepsy, often starting in early childhood. The seizures in NGLY1 can be complex. They may range from subtle "myoclonic jerks" (quick, involuntary muscle twitches) to more significant generalized seizures. Because NGLY1 also affects movement and coordination, it can sometimes be difficult for parents to distinguish between a seizure and a movement disorder. This makes close collaboration with a dedicated neurology team essential. Fortunately, many NGLY1 families have success in managing seizures through use of one or more anticonvulsant medications. Despite only half of patients experiencing seizures events, all patients with NGLY1 Deficiency have EEG evaluations that show abnormal brainwave patterns.

How are seizures diagnosed?

If you suspect your child has had a seizure, the first step is a thorough evaluation by a doctor. Capturing a seizure episode on video and sharing it with your neurologist can be a helpful piece of evidence for the right diagnosis.

The primary medical test is the EEG (electroencephalogram). This involves placing small sensors on the scalp to monitor brain waves. A "normal" EEG doesn't always rule out epilepsy, as the brain might only show abnormal activity during the seizure itself. Doctors may also use MRI or CT scans to look at the physical structure of the brain and blood tests to check for metabolic triggers or genetic markers.

How are seizures treated?

The goal of treatment is always to find a balance between stopping seizures and maintaining a high quality of life.

Medication

Anti-epileptic drugs (AEDs) are the frontline treatment. There is no single "best" drug; rather, neurologists look for the medication that best fits the specific seizure type.

Rescue Medications

For children prone to long-lasting seizures (status epilepticus), doctors prescribe rescue medications like diazepam or midazolam. These are administered at home to stop a seizure quickly and prevent a trip to the emergency room.

Living with and managing seizures

Managing epilepsy requires a team approach where patients, caregivers, and medical professionals work together to improve quality of life. Whether you are navigating this journey for a child or managing it as an adult, advocacy is your most powerful tool. This means working with your neurology team to create a formal Seizure Action Plan, asking direct questions about how medications impact long term cognitive health, and educating those in your daily circle. Having a strong support network ensures that no one has to face the challenges of epilepsy alone.

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References

1. Huff, J. S. (2021). Seizures. Emergency Medical Services, 163–170.
2. Tong, S., Ventola, P., Frater, C. H., Klotz, J., Phillips, J. M., Muppidi, S., Dwight, S. S., Mueller, W. F., Beahm, B. J., Wilsey, M., & Lee, K. J. (2023). NGLY1 deficiency: a prospective natural history study. Human Molecular Genetics, 32(18), 2787–2796.
3. Epilepsy Foundation. (2024). Types of Seizures and Safety Preparedness. 
4. National Institute of Neurological Disorders and Stroke (NINDS). (2024). The Epilepsies and Seizures: Hope Through Research.

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