Meaning of seizures (fits)

Normal functioning of the brain

Our brain is divided up into many different parts. These different brain parts have varied functions.

For example:

  • The brain parts in the front do most of the thinking.
  • The brain parts behind the ears store memories.
  • The brain parts just above the ears help us to move our hands and legs.
  • The brain parts at the very back help us to see things.

And so on…

These parts communicate with each other using minute electrical currents.

This electricity is strictly regulated. Our hand only moves when we want it to move. We remember something only when it is relevant, or we try to remember it. We see something only when our eyes send a electrical current to the brain parts in the back.

Thus, usually these things happen for a reason.

Patients with seizures can get olfactory (smell) hallucinations.

What causes a seizure?

A seizure is caused by a sudden uncontrolled surge of electricity in the brain.

If wires connecting two brain parts are not properly connected, electricity in that area can become un-regulated. This may occasionally cause cause a sudden surges of electricity. Frequently, this electrical surge is suppressed by our brain.

But sometimes, this local electrical surge becomes uncontrollable. It may spread to other areas of the brain, like an electrical storm.

A seizure is like an electrical storm inside our head.

When the electrical storm involves different brain parts, you experience symptoms related to that brain part. For example:

  1. If the electrical surge involves the brain part behind the ears, you may get a sudden surge of memories.
  2. If it involves the brain part above the ears, your hand may cramp up or start shaking
  3. If it involves the back of the brain, you may see things

and so on…

If the electrical storm spreads over the entire brain, your entire body shakes violently and you lose consciousness. At this stage, the electrical storm is called a “Generalized convulsion” or “Generalized Tonic-Clonic seizure”.

When the electrical storm spreads over the entire brain, the entire body may start shaking.

What happens during a seizure?

The symptoms during a seizure depend on which brain part is involved.

A few examples are given above.

Our brain produces ALL our experiences. Therefore, you can get any kind of experience during a seizure.

But some parts of the brain have seizures more frequently than others. Therefore, some symptoms are more common during seizures.

Each part of our brain has a specific, unique function.
Common symptoms which happen during a seizure
  1. A bad odor. It may be disgusting (for example of garbage) or sickeningly sweet.
  2. A bad taste. A metallic taste, or a bitter taste is very common. Some patients report tasting blood.
  3. Extreme fear or anxiety.
  4. A Deja-Vu feeling: An intense feeling of “This has happened to me before”.
  5. Difficulty in talking or understanding other people.
  6. Visual hallucinations: Seeing things that are not really in front of you.
  7. Tingling or numbness in the face, arm or legs
  8. Cramping or shaking of a hand, leg or the entire body.
  9. Involuntarily passing urine or stool.
  10. Blanking out and staring off into space

As noted, any experience can happen with a seizure. Here are some experiences/symptoms that occur with seizures, but less commonly.

Less common symptoms during a seizure
  1. Extreme anger
  2. Extreme happiness or sadness
  3. A feeling of floating away from your body and looking towards it from above (Autoscopy)
  4. A feeling of being one with nature, or with the surroundings (Depersonalization)
  5. Sudden nausea or urge to vomit
  6. Sudden urge to urinate
  7. Dizziness
  8. Hearing strange sounds such as ringing bells or people talking
  9. Repetitive eye blinking

In addition to these symptoms that happen during a seizure, there may be some complications due to a seizure:

  1. You may bite your tongue.
  2. In generalized convulsions (see above), some people may dislocate their shoulder.
  3. In generalized convulsions,  some people may get other injuries – such as bruises or head injuries.
  4. After a seizure, you may have trouble speaking, using a body part or thinking for some time.
You may bite your tongue during a seizure.

Warning signs of a seizure (Aura)

An Aura is the beginning of a seizure. Many patients interpret this as a warning sign of a seizure.

Auras are usually seen with Focal seizures (see below)

When the seizure is small, it produces minimal symptoms. It may produce a bad smell, or some memories, or some problems with eyesight. Later, when the seizure spreads over the entire brain, the patient gets a big seizure.

For example, a patient may smell something bad, and then get a large seizure with violent shaking of the entire body.

An aura is a small seizure that produces subtle symptoms.

When this keeps happening repeatedly the patient recognizes that the bad smell is a warning. This warning is called an “Aura”.

Auras in Primary Generalized Seizures:

Primary generalized seizures (see below) usually don’t produce an aura. The occur without warning. This is because they occur over the entire brain at once.

However, newer research has show that even in these kind of seizures, some patients get a warning. This warning is felt before the big seizure. How this happens is not known.

Auras also occur in primary generalized seizures, but they may be difficut to describe.

Types of seizures

There are two main types of seizures. Focal seizures and Primary Generalized seizures.

Focal seizures:

Partial seizures start in one part of the brain’s surface.

Sometimes, a focal seizure may not spread and produce limited symptoms. At other times,  it may then spread to the entire brain and produce dramatic symptoms.

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Generalized seizures & Focal seizures

Primary Generalized seizures:

Generalized seizures start all over the brain, at once.

It is unclear where they start from. Many researchers believe that they start deep within the brain. These deep-seated brain parts are called the “Basal-Ganglia” & “Thalamus”.

These seizures had different names earlier. For example, focal seizures used to be called “Partial seizures”.

Even more confusingly, each one of these seizures is divided further into many types! Here is the current classification from the ILAE (International League Against Epilepsy):

ilae 2017 classification expanded 0 e1618815599205

How should you keep track of your seizures?

It is very easy to get confused by this complex and ever-changing terminology.

Therefore, I always insist that patients use their own words to describe and label their seizures.

It is easy to get confused by medical terms. It is better to describe seizures in your own words, and name them yourself – for example – “Only bad smell” seizures.

For example, a patient who gets 4 different types of seizures may describe them as below:

  1. “Only Bad smell” seizures
  2. “Right arm Cramping” seizures
  3. “Big whole body shaking” seizures
  4. “Blank staring” seizures

By labeling the seizures simply, it becomes easy to count them.

You can use a paper calendar, diary or your smartphone to record your seizures. There are are many apps.

A nice printable diary is available from the UK Epilepsy society:

Keeping a detailed log of your seizures helps immensely in titrating your medications.
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For apps – I like the free “Epilepsy Journal” app for Android, and the free “My Seizure diary” app which is available both for Android and Apple.

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Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor's permission.
Dr. Siddharth Kharkar

Dr. Siddharth Kharkar

Dr. Siddharth Kharkar has been recognized as one of the best neurologists in Mumbai by Outlook India magazine and India today Magazine. He is a board certified (American Board of Psychiatry & Neurology certified) Neurologist.

Dr. Siddharth Kharkar is a Epilepsy specialist in Mumbai & Parkinson's specialist in Mumbai, Maharashtra, India.

He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

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