What does an epileptic seizure look like and what happens in the brain during it?

From the perspective of a witness, an epileptic seizure can be terrifying. A fall, foam from the mouth, convulsions, and the lack of response from the person – all of this evokes fear and anxiety. However, not every seizure looks the same, nor does every seizure have the same intensity or visible external symptoms.

Can an epileptic seizure be predicted?

For most patients, similar signals appear before a seizure, and individuals with prior experience can recognize them. However, these signals are individual to each patient. Some become more nervous or agitated, while others experience strange smells or hear things that others cannot confirm. Patients often describe a feeling of warmth rising from the stomach or paresthesia – “tingling” or “electric currents” running through the body, especially unilaterally in the limbs. A frequent sensation is déjà vu – the feeling that “this has already happened.” All of these are sensory symptoms associated with the senses. The brain still registers them; we are aware of them and analyze them, says Dr. Maria Maliszewska in an interview with Medonet.

There is very little time to react, as these symptoms can appear days before the seizure or mere minutes beforehand. What should you do in such a situation? Move to a safe place. It’s best to lean against some furniture, sit down, or even lie on the floor. It’s also helpful to inform people nearby that a seizure is imminent. Our clinic offers free silicone bracelets with the inscription "I have epilepsy," which inform those around the patient that what is happening is a seizure.

An epileptic seizure cannot be stopped because the process has already started in the brain, and the cells have already sent an electrical impulse. It is crucial to know how to act. It’s also good to inform close friends, colleagues, or coworkers about the steps they should take during a seizure to help and not harm. For an uninformed observer, a seizure may appear traumatic. The patient usually collapses to the ground, loses consciousness, experiences convulsions, and often involuntarily urinates. Learn how to help a person during a seizure.

Is the person conscious during a seizure and aware of what is happening?

It all depends on the type of seizure. If we’re dealing with a simple focal seizure, there is no loss of consciousness. We can clearly see and feel that, for example, one limb (usually the upper) is twitching or shaking, speech is distorted, electrical sensations run through the body, or there is tingling in the face. This lasts briefly, but we cannot control it. We feel it, but there’s no pain – rather, it’s a type of discomfort.

During seizures with impaired consciousness, particularly generalized tonic-clonic seizures, we have no idea what’s happening to us. We “black out,” and our consciousness is beyond us. The brain does not register pain, but pain appears later, albeit with a delay. After the seizure, headaches and fatigue/sleepiness often follow, and the next day, we feel as if we’ve run a marathon or done intensive exercise without a proper warm-up, leading to muscle soreness – says Dr. Maliszewska.

Do seizures lower IQ and cause brain damage?

Not every seizure is that severe. Short seizures do not have the power to cause this. The problem lies in prolonged seizures lasting more than 4 minutes. During such seizures, some cells die due to a lack of oxygen supply to neurons. The more severe the seizure, the higher the risk of micro-injuries. The greater the number of seizures, the more new lesions appear in the brain.

The more seizures a person experiences and the longer they live with them, the higher the likelihood of significant cognitive impairments, such as poorer memory, slower learning, or trouble concentrating.

However, these are individual parameters and, again, everything depends on the type of epilepsy, seizures, their duration, and when the disease first appeared.

Can a seizure cause death?

In extreme cases, yes. This is referred to as SUDEP, or sudden unexpected death in epileptic patients. The patient experiences breathing difficulties and heart rhythm disturbances. Both result from the fact that the brain, as the central organ, mismanages the centers responsible for breathing and heart function. This leads to a disconnect between these centers, resulting in cardiac arrest and death – explains Dr. Maliszewska in an interview with Medonet.

So yes, in extreme cases, death can occur, but most seizures are not that harmful. It’s essential to observe your body and recognize the signs of an impending seizure. Inform those around you about the possibility of such an event so they can prepare to assist.