You May Not Know These Subtle Signs of a Seizure

Key Takeaways

• A new survey found that most Americans can’t identify the more subtle signs of a seizure, including numbness or tingling, blinking rapidly, screaming, and laughing.
• Focal seizures—which occur as a result of abnormal electrical firing in a particular brain region—are the most common in adults with epilepsy. However, they're hard to identify.
• If you suspect someone may be having a focal seizure, there’s not much you can do in that moment, though it’s helpful for you to keep an eye on them. Bring them to the hospital if the seizure lasts more than four or five minutes.

The classic symptoms of a convulsive seizure—falling to the ground, shaking, convulsing, and foaming at the mouth—are easily identifiable. However, most Americans are unaware of the more subtle signs of a seizure, according to a new national survey by Orlando Health.

The survey found that less than half of Americans know that numbness or tingling, blinking rapidly, crying out or screaming, and laughing are signs of a seizure as well.

While a convulsive seizure is a more concerning type of seizure, it’s not the most common one, according to Parshaw Dorriz, MD, a board-certified neurologist with a specialty in epilepsy at Providence Mission Hospital.

Dorriz said that focal seizure, which happens as a result of abnormal electrical firing in a particular region of the brain, is the most common type of seizure in adults with epilepsy. However, they tend to be the most insidious and difficult to identify.

“Someone may be in the middle of a conversation and they may stop responding, or they may start doing funny things with their hands or making abnormal movements with their mouth as if they’re chewing something,” Dorriz said. “They may also start blinking and staring unresponsively to questions that may be directed towards them.”

Some other less-known seizures cause unprovoked laughter, called gelastic seizures, or crying sounds, called dacrystic seizures, said Stefan Gillen, DO, a board-certified neurologist at Atlantic Health System.

There are other subtle physical signs like pouting, atypical posturing (such as raising your arms to resemble a fencer), and legs making bicycling-like movements at nighttime. In some severe forms of epilepsy, individuals may have head drop seizures where they lose muscle support in the head and neck, and their arms often raise upward.

Some people may also experience one-sided facial twitching. In exceptionally rare circumstances, some seizures can cause hearts to stop beating.

Do Milder Symptoms Mean a Milder Seizure?

The symptoms of a seizure merely reflect the parts of the brain involved and how the abnormal electrical activity behaves, Gillen said. Milder symptoms can signal a milder seizure, but even brief seizures that simply cause unpleasant sensations can have long-term adverse effects, he added. And a mild seizure to one individual may be debilitating to another.

“Suppose your seizures cause your arm to suddenly posture briefly,” Gillen said. “Some may consider this a mild annoyance, but this could cause significant debility to a professional musician, athlete, or chef.”

Even what appears to be a “mild” seizure can cause someone to feel exhausted, confused, disoriented, and generally wiped out afterward, according to Dorriz.

“But suffice to say, it’s far less taxing or burdensome on the body than the other types of seizures,” Dorriz said.

What Can You Do If Someone Has a Seizure?

If you suspect someone may be having a focal seizure, there’s not much you can do in that moment to get them out of it, Dorriz said, though it’s helpful for you to simply be there with them.

The biggest concern in a focal seizure is not so much the seizure itself, because they’re unaware in the moment, but the aftermath. After a focal onset seizure, someone may become disoriented, confused, erratic, aggressive, scared, or emotional.

“It’s involving the limbic system, and there’s some disinhibition,” Dorriz said. “And so you may have to kind of babysit them as they come back around.”

When it comes to a convulsive seizure, Dorriz said there are many misconceptions about what to do. He’s heard patients say they put a doorstop, a wallet, or a finger in a person’s mouth when they were having a seizure to prevent them from biting their tongue.

“I cannot emphasize how important it is that you don’t do that because you may harm yourself, or you may do more harm to the patient who’s having the seizure,” he said.

Instead, you should make sure the person is lying on their side and on a solid surface that they can’t fall off of. Make sure you support them, but don’t hold them down because you could unintentionally suffocate or smother them. Keep an eye on the clock, and if it lasts longer than four or five minutes, then they should be going to the hospital.

With any suspicion of a seizure, a neurologic evaluation by an epileptologist or neurologist is essential, Gillen said.

“If a patient seizes and continues to seize, they’re at risk of having brain damage if it’s not stopped,” Dorriz added.

“So it is a medical emergency,” he said. “If the body doesn’t get enough oxygen, they can have brain damage. They can cause themselves significant bodily harm if they’re not cared for properly... There needs to be better awareness of it.”

What This Means For You

If you're familiar with the many symptoms of seizures, you can recognize when someone has a seizure onset and provide support in the moment and after the fact. While seizures can present in many different ways, they should be considered a medical emergency, and a neurologic evaluation by an epileptologist or neurologist is essential.

 Source: verywellhealth.com, Mira Miller