Seizures come in many forms, and while some may look similar on the surface, they can vary significantly depending on the type. Knowing how to differentiate between types of seizures is essential to providing the right kind of care. For those unfamiliar, seeing someone have a seizure can be alarming. However, each type of seizure requires a specific approach to ensure the person remains safe during and after the episode.
Before we start, I just want to make it clear that I have Non-Epileptic Attack Disorder. Non-Epileptic Attack Disorder is a condition in which a person experiences episodes that resemble epileptic seizures but are not caused by abnormal electrical activity in the brain.
When you witness someone having a seizure, it can be frightening or confusing if you don’t know how to respond. Whether the person is experiencing an epileptic seizure or a non-epileptic one, your approach to helping them should be the same.
I personally only have tonic clonic seizures and dissociative seizures, but some people may have only one type, and some people may have multiple. It’s different for everyone.
Types of Seizures
Tonic-Clonic Seizures (Grand Mal Seizures)
Tonic-clonic seizures are one of the most well-known types of seizures associated with epilepsy. They are characterised by a loss of consciousness and violent muscle contractions.
This type of seizure has two phases:
- Tonic phase: The person's muscles stiffen, and they may fall to the ground. The body becomes rigid, and breathing may stop momentarily, causing the person to turn blue or pale.
- Clonic phase: The muscles contract and relax rapidly, causing convulsions. The person may jerk or twitch uncontrollably, and they could also lose control of their bladder or bowels.
How to Respond:
• Gently lower the person to the ground if they’re standing. Move any sharp or hard objects away to prevent injury.
• Time the seizure. Most tonic-clonic seizures last between 1 to 3 minutes. If it lasts longer than 5 minutes, it’s a medical emergency.
• Let the seizure run its course, but do not try to hold the person down or stop their movements.
• Place something soft, like a jacket or cushion, under their head to prevent injury.
• Once the convulsions stop, gently turn the person onto their side (recovery position) to help keep their airway clear and prevent choking.
• Despite the myth, people having a seizure cannot swallow their tongue, and trying to insert an object into their mouth can cause injury or choking.
• After the seizure ends, they may be confused, disoriented, or tired. Stay with them until they are fully aware of their surroundings and can recover safely.
In addition to the well-known tonic-clonic seizures, there are also tonic seizures and clonic seizures, which involve only one phase of the tonic-clonic pattern. Understanding these types of seizures, how they differ, and how to assist someone experiencing one is crucial for providing the appropriate care.
Tonic Seizures
Tonic seizures are characterised by a sudden stiffening of the muscles, especially in the arms, legs, and back. During a tonic seizure, the person’s muscles contract, causing them to become rigid. These seizures can occur while the person is awake or asleep, and they are typically brief, lasting less than 20 seconds.
Signs of a Tonic Seizure:
- Muscle stiffening: The person’s body becomes rigid, and they may lose balance and fall if standing. The arms and legs may stiffen, and the back might arch.
- Falling: Because of the sudden muscle stiffness, the person is likely to fall to the ground. They may fall backward or forward, depending on how the stiffness affects their body.
- Brief duration: Tonic seizures are short, usually lasting only a few seconds. They often end as abruptly as they begin.
How to Respond:
• If the person falls during the seizure, try to cushion their fall or guide them to the ground if you can. Move away any nearby objects that could cause injury, such as sharp or hard objects.
• After the person falls, ensure they are in a safe position and won’t hit their head or other body parts on the ground or surrounding objects.
• As with other types of seizures, do not attempt to restrain the person. Allow the seizure to run its course.
• Tonic seizures are short, but the person may be confused or disoriented afterward. Stay with them until they regain full awareness and can safely move on their own.
• If this is the first time the person has had a seizure, or if they were injured during the fall, seek medical help.
Clonic Seizures
Clonic seizures involve rhythmic, jerking movements of the muscles. During these seizures, the person’s muscles rapidly contract and relax, leading to repetitive jerking movements. The jerking movements are usually symmetrical, involving both sides of the body.
Signs of a Clonic Seizure:
- Rhythmic jerking: The person’s muscles, typically in the arms, legs, and sometimes the face, will jerk rhythmically. The movements may be quick and repetitive.
- Loss of consciousness: Unlike tonic seizures, clonic seizures are often accompanied by a loss of consciousness, though this isn’t always the case.
- Variable duration: Clonic seizures can last longer than tonic seizures, typically from a few seconds to a minute.
How to Respond:
• Make sure there is nothing near the person that could harm them during the jerking movements. Clear away objects that might injure them as their limbs move.
• As with all seizure types, do not attempt to hold or restrain the person. Allow the seizure to happen naturally.
• If they are on the ground, place something soft, like a jacket or pillow, under their head to prevent head injury from the jerking.
• Time the seizure if possible. If the jerking lasts more than 5 minutes, call for emergency medical assistance.
• Once the seizure ends, place the person on their side in the recovery position to help keep their airway clear and prevent choking if they vomit or have difficulty breathing.
• After the seizure, the person may be disoriented, confused, or very tired. Stay with them until they fully regain awareness.
Absence Seizures (Petit Mal Seizures)
Absence seizures are brief episodes where the person "zones out" or stares blankly for a few seconds. They typically don't involve convulsions or muscle jerks and are most common in children.
Signs of an Absence Seizure:
- Sudden staring, often with fluttering eyelids or slight head movements.
- The person may not respond to their name or surroundings for a few seconds.
- After the seizure, they resume normal activity as though nothing happened.
How to Respond:
• Stay calm. These seizures are usually very brief and not dangerous.
• If the person is walking or in a situation where they could hurt themselves (like crossing the street), guide them gently to a safe spot.
• Once the seizure ends, they will quickly return to normal activity. You do not need to do anything beyond ensuring their safety.
Focal Seizures (Partial Seizures)
Focal seizures begin in one part of the brain and can either remain localised or spread. They can affect different functions depending on the part of the brain involved. There are two types:
- Focal aware seizures: The person remains conscious but may experience strange sensations, such as tingling, a sense of déjà vu, or a sudden emotional change.
- Focal impaired awareness seizures: The person may lose awareness or become confused. They might make repetitive movements, such as lip-smacking, hand-rubbing, or picking at clothes, without realising it.
How to Respond:
• Ensure their safety by guiding them away from potentially dangerous situations, like busy roads or sharp objects.
• Let the seizure run its course. If they are making repetitive movements or seem disoriented, do not try to restrain them or forcibly stop the actions. Let the seizure play out while ensuring they are not in danger.
• Speak softly and reassure them. They may feel confused or frightened during or after the seizure, so gentle communication can help.
• If the person seems unaware of their surroundings, gently steer them to a safe location to prevent injury.
Atonic Seizures (Drop Seizures)
Atonic seizures are characterised by a sudden loss of muscle tone. The person may go limp and fall to the ground abruptly. These seizures are brief, typically lasting just a few seconds, but can result in injuries due to the sudden loss of control over the body.
How to Respond:
• Since the fall is often sudden and unexpected, it’s important to make sure the person doesn’t hit their head or fall into something sharp or hard. If you see them about to collapse, try to catch them gently or guide them to the ground.
• The seizure itself is usually over very quickly, so it’s important to focus on making sure the person is safe and then assist them afterward if they are confused or disoriented.
• Atonic seizures are brief, and the person may quickly recover. However, due to the risk of injury from falls, they may need assistance standing back up or may need medical attention if they have hurt themselves.
Myoclonic Seizures
Myoclonic seizures involve brief, shock-like jerks of a muscle or a group of muscles. These jerks are sudden and often happen in clusters, usually lasting only a few seconds. The person may remain fully aware during these seizures, but the sudden movements can cause them to drop objects or lose balance.
How to Respond:
• Since myoclonic seizures involve quick jerks, make sure the person is in a safe position where they won’t fall or be hurt if they suddenly jerk.
• Myoclonic seizures are usually short and don’t require any specific first aid. However, if they happen frequently or in clusters, medical advice may be needed to adjust treatment.
Dissociative Seizures (Psychogenic Non-Epileptic Seizures)
Dissociative seizures are often seen in people with Non-Epileptic Attack Disorder (NEAD) like myself. Unlike epileptic seizures, these are not caused by abnormal electrical activity in the brain but rather are a response to emotional or psychological distress. They can look very similar to epileptic seizures but have different characteristics:
- Gradual onset: Dissociative seizures often begin more slowly than epileptic seizures, with the person appearing distressed or agitated beforehand.
- No convulsive movements: While some people with dissociative seizures may exhibit shaking, they often don’t have the violent convulsions typical of a tonic-clonic seizure. Movements may be less rhythmic and more varied.
- No postictal confusion: After the seizure, the person typically does not experience the same level of confusion or drowsiness that someone with epilepsy might. They may, however, feel emotionally drained or upset.
How to Respond:
• Dissociative seizures are often triggered by emotional distress, so a calm and supportive approach can help. Speak gently and offer reassurance.
• Unlike tonic-clonic seizures, where the person might need protection from injury, dissociative seizures rarely cause the kind of intense physical movements that require restraint. Simply ensure they are safe and wait for the seizure to pass.
• The person may be emotionally drained after a dissociative seizure, so offer comfort and, if they wish, help them seek a safe space to rest.
It's really important to note, however, that not everyone non-epileptic will have these types of seizures. You can have non-epileptic seizures and only [insert seizure of choice].
Recognising the Differences Between Tonic-Clonic and Dissociative Seizures
While tonic-clonic and dissociative seizures can appear similar, there are key differences:
- Onset: Tonic-clonic seizures typically start abruptly, without warning, while dissociative seizures may build more gradually.
- Movements: Tonic-clonic seizures involve intense, rhythmic convulsions, whereas dissociative seizures often have less structured, irregular movements.
- Duration and Recovery: A tonic-clonic seizure is generally shorter but more intense, followed by a period of confusion and fatigue. In contrast, dissociative seizures can last longer but tend to end with less confusion or disorientation.
How to Care for Someone With Different Seizure Types
Be Prepared: If you know someone who has seizures, learn about their specific type of seizure so you can offer the best support. This will also help you remain calm during the event and take appropriate action.
Respect the Person’s Dignity: Seizures can be disorienting and embarrassing for the person experiencing them. Offering quiet reassurance and protecting their dignity, such as covering them if they’ve lost control of their bladder, can go a long way in making them feel safe.
Know When to Call for Help: Always call emergency services if the seizure lasts longer than 5 minutes, if the person has multiple seizures in a row without recovering in between, if they are injured during the seizure, or if it’s their first seizure.
Post-Seizure Support: Regardless of the type, seizures can leave a person feeling exhausted, disoriented, or emotionally upset. After the seizure has passed, help them find a safe and comfortable place to rest and ensure they feel supported emotionally as well as physically.
Being prepared, educating yourself, and knowing how to respond can make a tremendous difference in the well-being of someone experiencing a seizure, regardless of its type. By understanding the specific needs of people with epilepsy, NEAD, or other seizure disorders, we can help reduce stigma and provide the care they deserve.