The Stages of a Seizure

Although a seizure may feel like it comes on all of a sudden, it often happens in stages. Hours or even days before a seizure starts, some people may begin to notice symptoms.

Understanding these stages can help first aiders respond calmly, recognise what may be happening, and support the person through recovery.

Beginning phase (prodrome)

Hours or even days before a seizure starts, some people may begin to notice changes.

Trouble sleeping
Mood changes
Feeling anxious
Trouble paying attention
Feeling light-headed

Early ictal phase (aura)

An aura is like a warning sign from the brain that a seizure has begun. Not everyone has an aura, and an aura does not always progress into a seizure.

Odd smells, sounds, or tastes
Feeling dizzy
Changes in eyesight, such as blurry or flickering vision
Pins and needles feelings in parts of the body
Arm or leg pain or twitching
Ringing or buzzing sounds
An out-of-body sensation
Feelings of intense fear, panic, deja vu, or jamais vu
Nausea or headache

Middle phase (ictal)

The period between the very first symptom and the end of a seizure is called the ictal stage. These symptoms are what many people think of when they picture a seizure.

Stiff arms and/or legs
Uncontrollable lip smacking or chewing
Vision changes and/or dilated pupils
Racing heart, sweating, or drooling
Finding it hard to breathe
Feeling confused or distracted
Hearing strange sounds
Flushed or pale skin
Twitching, tremors, or feeling unable to move or talk
Acting oddly, such as taking off clothes or suddenly running
Incontinence

Ending phase (post-ictal)

Some people recover right away after a seizure, while others may take days before they feel like themselves again. The length of this phase depends on the type and severity of the seizure.

Weakness in parts of the body
Soreness or body aches
Low energy or feeling sleepy
Increased thirst
High blood pressure
Headaches or migraines
Nausea
Feeling confused, forgetful, embarrassed, scared, or sad
Finding it hard to hold urine or bowel movements

First aid reminder

Stay with the person through the recovery phase. Speak calmly, check for injuries, protect their dignity, and call 999 if you are concerned about their breathing, awareness, injury, or seizure duration.