Seizures occur when changes in the brain’s electrical activity cause sudden changes in movement, sensation, awareness, thought, or behavior. Depending on the part of the brain involved, they are categorized into three main types – focal onset seizures, generalized onset seizures, and unknown onset seizures. Although seizures may present themselves differently and with varying intensities, recognizing their early signs is crucial for timely support and intervention. Some of the most commonly reported signs of a seizure include:

Aura
People who experience seizures often describe feeling an aura beforehand. This sensation can include a variety of feelings, such as visual, auditory, or olfactory sensations, pain, numbness, or headaches. Some examples of aura symptoms include a wave-like sensation that travels through the head, twitching or stiffening of the arm or hand, a feeling of falling or riding a roller coaster in the stomach, an unusual taste or smell, hearing unexplained sounds or music, experiencing sudden, intense emotions like fear, happiness, or anxiety, tingling or numbness, hallucinations, or seeing colored or flashing lights.

According to research, around 65 percent of people with generalized epilepsy experience seizures. Auras can be a warning sign of an oncoming seizure, signaling that it may be time to seek assistance and move to a safer place.

Changes in mood or behavior
Another common early sign of a seizure is changes in one’s mood or behavior. This may include sudden feelings of fear, anxiety, or experiencing Déjà vu (a sense that something has happened before when it hasn’t) or Jamais vu (feeling like one is experiencing something for the first time, even though they know it well).

These changes are typically seen in the prodromal (beginning) stage, making them an indicator of an oncoming seizure.

Muscle twitching or jerking
In the ictal (middle) stage of a seizure, one may also experience motor or movement symptoms. These may include stiffening movements (tonic phase; movements may be severe enough to cause a person to fall), jerking movements (clonic phase), alternative stiffening or jerking (also called tonic-clonic), tremors, shaking, or floppiness and loss of muscle tone (known as atonic). This activity may be intense, rhythmic, and uncontrollable.

If one notices someone else undergoing these symptoms, it is important to stay with them for support and safety. Move any dangerous or sharp objects out of their way, and avoid suppressing or controlling these movements, as they may lead to injury.

Sensory changes
Another common symptom of seizures includes sensory changes, such as numbness or tingling in the limbs. Some people may also experience a pins and needles sensation. In rare cases, people have also reported pain and thermal sensations. In case of a focal seizure, one may also experience hearing problems, hallucinations, olfactory, and other distortions.

Automatisms
Many people also experience automatisms during a seizure. These are non-purposeful and repetitive movements, such as lip-smacking, blinking, grunting, gulping, fidgeting, picking at clothing, or shouting. These movements may often be subtle and go unnoticed by the person experiencing the seizure.

Loss of awareness
The onset of certain types of seizures may also lead to loss of awareness. For instance, the focal onset impaired awareness seizure may impact the area of the brain that controls awareness and alertness. This can lead to loss of awareness, causing one to stare blankly and fail to respond to external stimuli.

Altered speech
Seizures may also impact one’s ability to respond or communicate with others. Individuals experiencing seizures may slur their words or have difficulty forming sentences, leading to altered speech. Some may also experience a brief loss of the ability to speak, read, or comprehend speech.

Cognitive disturbances
Towards the end of a seizure (post-ictal phase), one may experience cognitive disturbances such as confusion, memory lapse, or difficulty concentrating.

Other symptoms in the post-ictal phase also include lack of consciousness, tiredness or fatigue, headache, loss of bladder or bowel control, fear or anxiety, frustration, shame or embarrassment, thirst, nausea, sore muscles, weakness, or even injury.

How to help someone having a seizure
Being equipped with the right knowledge to provide first aid is crucial, especially in case of seizures. Here are some things to practice when one notices another person having a seizure:

Never hold the person down or try to stop their movements during a seizure.
Do not put anything in their mouth. This can increase the risk of injury.
Do not offer any food or water until the person is fully alert.
Keep other people out of the way.
Take note of how long the seizure lasted and the symptoms exhibited. In case one experiences multiple seizures, note down the time between the seizures as well.
Stay with the person until the seizure ends. After the seizure, help them sit in a safe place. Contact their trusted person to ensure they reach home safely.
Check if the person is wearing a medical or emergency bracelet. Take action accordingly.

It is important to note that not all seizures require emergency medical help. Call for help if:

The person is pregnant or diabetic
The seizure happened in the water
The seizure lasted longer than five minutes
The person did not regain consciousness after the seizure
The person has a high fever
The person has difficulty breathing or walking after the episode
The person injures themselves during the seizure
This is the first seizure the person has ever experienced

In case of a generalized tonic-clonic (grand mal) seizure:

Ease the person to the floor
Turn them gently to one side to encourage breathing
Clear any hazardous objects in the area
Cushion their head
Remove their eyeglasses
Time the seizure. Call 911 if the seizure lasts longer than 5 minutes.

Most seizures end in 30 seconds to 3 minutes. In case of a prolonged episode, others must remain alert and take action immediately. Awareness and timely intervention is crucial.