The Different Types of Seizures and What They Look Like

Epilepsy can look very different from person to person. When many people hear the word “seizure,” they picture someone falling to the ground and convulsing. In reality, seizures range from brief lapses of attention or muscle jerks to full-body convulsions. Not all seizures involve convulsions, and some can be so subtle they’re easily missed. In this post, we’ll explore the main types of seizures – what they are and how they might appear in everyday situations – to show how epilepsy can look different for everyone

Focal Onset Seizures (Partial Seizures)

Focal onset seizures start in one area (one “focus”) on one side of the brain. (They were once called partial seizures.) Because they begin in a specific part of the brain, the symptoms often affect just one region or function of the body. Focal seizures fall into a couple of categories based on the person’s awareness during the event:

• Focal Onset Aware Seizures: In these seizures, the person remains conscious and aware. They might experience odd sensations or emotions without losing awareness. For example, someone could suddenly feel a wave of déjà vu or a “funny” feeling in their stomach during a focal aware seizure. They might perceive a strange taste or smell, or one arm could start twitching. Because the person stays alert, they may even be able to speak (though they might be “frozen” and not respond until it ends). This type was previously called a simple partial seizure.

  
  

• Focal Onset Impaired Awareness Seizures: In these, awareness is affected or lost. The person might appear confused or dazed and may not respond to people around them. Often, they stare blankly and perform involuntary movements called automatisms – for instance, fidgeting with or picking at their clothes, rubbing their hands, or smacking their lips. It may look like the person is awake but “nobody’s home,” as they won’t remember or be aware of what happened during the seizure. These typically last a minute or two. Afterward the person may be confused for a short time as they recover. This type used to be known as a complex partial seizure.

  
  

Focal onset seizures do not always look dramatic. A focal seizure could be as subtle as a momentary hand twitch or a sudden sense of fear, with the person fully aware the whole time. Or it could involve a few minutes of confusion and automatic movements. Because the signs can be mild or resemble daydreaming, focal seizures (especially focal impaired awareness seizures) are sometimes mistaken for other things. It’s important to remember that what happens depends on which part of the brain is involved. One person’s focal seizure might cause an arm jerk, while another person’s might cause an odd smell sensation; it varies for each individual.

Absence Seizures (Petit Mal)

Absence seizures are a form of generalized seizure that causes a very brief loss of awareness. An absence seizure often looks like the person has suddenly “checked out” for a few seconds. They might stop what they’re doing, stare into space with a blank look, and not respond to their name.

These episodes are typically very short (usually under 10 seconds) and start and end abruptly. After the seizure, the person quickly returns to whatever they were doing, with no confusion or lingering effects in most cases. In fact, absence seizures are so brief that they can easily be missed – observers may just think the person is daydreaming or not paying attention.

During an absence seizure, there may be subtle physical signs as well. The person’s eyes might flutter or blink rapidly, or they might make small chewing or lip movements. However, they won’t typically fall or jerk dramatically – it’s more like a pause or “glitch” in awareness. Because the person is unaware during it, they won’t respond if you try to get their attention. For example, a student in class might suddenly stop talking mid-sentence and gaze blankly ahead for a few seconds. Then they’ll pick up right where they left off, not realizing they had a seizure.

Absence seizures (previously often called “petit mal” seizures) are more common in children and teens, but they can occur in adults too. A young adult with absence seizures may have dozens of these tiny episodes a day without others noticing, which can make it hard to follow conversations or lectures. The key thing to remember is that although absence seizures are generalized seizures (involving both sides of the brain), they do not look like the convulsive seizures most people think of. Instead, they’re brief, subtle, and easy to misinterpret. If you notice someone having frequent “spacing out” moments like this, encourage them to seek medical advice – it could be absence seizures rather than simple daydreaming.

Tonic-Clonic Seizures (Grand Mal)

Tonic-clonic seizures are the type of seizure most people picture when they think of epilepsy. (The older term for these is “grand mal”.) This seizure has two phases. First comes the tonic phase, in which the person loses consciousness and all their muscles stiffen up. They may let out a cry or groan as the air is forced out of their lungs. Their body becomes rigid and, if standing, they will collapse to the ground (which can cause injury). Next comes the clonic phase, which is the classic convulsions: the arms and legs jerk rhythmically as the muscles alternately contract and relax. The person’s face might look flushed or a bit blue during the seizure, and they can sometimes lose bladder control or bite their tongue due to the intense muscle contractions.

A tonic-clonic seizure usually lasts one to three minutes. To an observer, it’s a frightening, intense event – the person is unconscious, convulsing, and clearly in a medical emergency. After the jerking stops, the person enters a recovery period often called the post-ictal phase. They will slowly regain consciousness, but they’ll likely be confused, disoriented, tired, or groggy for minutes to hours afterward. Many people fall into a deep sleep for a short time after a tonic-clonic seizure, as it is exhausting for the brain and body. They may also have a headache, sore muscles, or a bitten tongue once they’re awake. It’s normal for someone to not remember the seizure itself.

In everyday life, a tonic-clonic seizure is a clear sign to those around that a seizure is happening. For example, if a young adult is at a coffee shop and suddenly cries out and falls off their chair, stiffening and then shaking on the floor, bystanders will recognize this as a convulsive seizure and (hopefully) call for help. This is the kind of seizure that requires first aid – making sure the person is safe from injury, rolled on their side for breathing, and getting medical help if it lasts too long. A tonic-clonic seizure is an unmistakable event, but it’s important to remember it’s just one type of seizure. Many people with epilepsy never have tonic-clonic convulsions, and those who do may have other seizure types as well.

Myoclonic Seizures

Myoclonic seizures involve brief, shock-like

jerks of muscles or muscle groups. The word “myoclonic” literally comes from "myo" (muscle) and "clonus" (jerk), and that’s exactly what happens; sudden jerking movements. These seizures are extremely brief, often lasting just a fraction of a second or a second or two. They often happen in clusters or series; a person might have several myoclonic jerks in a row or within a short time. To an observer, a myoclonic seizure might look like a sudden jump or sudden twitch.

For instance, imagine you’re sitting with a friend and you both reach for your coffee – then your friend’s arms suddenly jolt and perhaps they drop what they were holding. It’s over as soon as it started, and your friend is still awake and aware the whole time. They might just shake it off and say “Oops, sorry, my arm just jerked.” In fact, people often continue whatever they were doing immediately after a myoclonic seizure, because there’s no loss of consciousness. No first aid is needed for the seizure itself, as the person is alert and resumes activity on their own.

Myoclonic jerks can be subtle or dramatic. Sometimes it’s just a single abrupt twitch of the shoulders or arms; other times it might be a bigger jerk that can make a person spill their drink or stumble. These seizures often happen on both sides of the body simultaneously (for example, both arms jerk together). They are commonly seen in specific epilepsy syndromes (like juvenile myoclonic epilepsy, which often starts in the teens), often occurring shortly after waking up. It’s worth noting that even people without epilepsy can experience occasional myoclonic jerks (like those “sleep start” jerks when you’re falling asleep), but in epilepsy, these jerks are due to abnormal brain activity and tend to recur.

Because myoclonic seizures are so brief, they can be easily overlooked or mistaken for clumsiness or tics. If someone frequently has these sudden jerks, especially in the morning or when tired, it could be a sign of myoclonic epilepsy. The person might describe it as “my arms just jerk for no reason” or “I feel like I got shocked for a split second.” If you notice patterns like this, it’s something to bring up with a doctor. The important thing to remember is that myoclonic seizures do not cause the person to black out or lose control, apart from the instant of the muscle jerk. They’re quick “lightning” seizures that a person often experiences as a brief shock or jolt in their body.

Atonic Seizures (Drop Attacks)

Atonic seizures cause a sudden loss of muscle tone. (“Atonic” literally means “without tone.”) In an atonic seizure, the muscles abruptly become limp and weak. Depending on which muscles are affected, an atonic seizure can range from a head nodding forward (if neck muscles briefly lose strength) to the entire body going slack and collapsing. You might hear atonic seizures referred to as “drop attacks” or “drop seizures,” because they often cause a person to drop to the ground without warning.

Imagine someone just suddenly goes rag-doll limp – that’s what an atonic seizure looks like. If the person is standing or walking, they will crumple to the floor like a puppet whose strings were cut. If they’re sitting, you might see their head suddenly slump forward and maybe their arms drop for a moment. These seizures are typically very brief, usually lasting only a few seconds (often under 15 seconds). Consciousness is usually impaired during those seconds, so the person is not aware of what’s happening in the moment. However, recovery can be quick – they might stand up and be fine right after, aside from any injuries from the fall.

Because atonic seizures can cause abrupt falls, injuries are a big concern. People who have frequent atonic drop attacks often wear helmets or protective gear to prevent head injury. If you see someone suddenly collapse and then get up confused, an atonic seizure could be a possible cause. For example, a young adult with atonic epilepsy might be walking in the hallway when they suddenly crash to the ground. A few seconds later, they regain muscle strength and try to get back up, perhaps a bit dazed. Onlookers might think the person simply fainted. In reality, the brain momentarily shut off muscle control.

It’s important not to try to grab or hold someone up if they have an atonic seizure – let them fall in a safe way if possible, then check for injuries. Usually, the person will be able to get up again very soon. Safety management (like keeping environments free of sharp corners, using helmets, etc.) is key for those with this seizure type, since the seizures themselves are short and not typically harmful to the brain, but the falls can be harmful to the body.

Epilepsy Looks Different for Everyone

As you can see, seizures come in many forms. Epilepsy is a condition that affects people of all ages and walks of life, and each person’s seizures may look and feel different. Some people with epilepsy experience only one type of seizure, while others might have several different types. For instance, one young adult with epilepsy might have only absence seizures that look like daydreaming spells, whereas another might have an occasional tonic-clonic seizure and some focal impaired-awareness seizures. There is no single way a seizure should look – any brief, abnormal interruption in awareness, movement, or behavior could be a seizure if it’s caused by those sudden electrical discharges in the brain.

It’s also important to remember that not all seizures are dramatic. Many are brief and subtle. This is why understanding the different seizure types is so important – for people with epilepsy, it can help with self-awareness and explaining to friends or teachers what to watch for. For friends and family, it builds empathy and the ability to support someone during a seizure. If you have epilepsy, your seizures are unique to you. Tracking what your seizures look like and how you feel can help your doctors tailor your treatment and safety plans.

No matter the type of seizure, compassion and understanding go a long way. If you see someone “blank out” for a few seconds, gently check if they’re okay – they might have had an absence seizure. If a friend tells you they have focal seizures that make them zone out or fidget, remember they can’t help it – it’s not rudeness or inattentiveness. And if you witness a convulsive tonic-clonic seizure, stay calm and follow first aid steps (protect their head, roll to side, call for help if it lasts too long). By knowing about the many faces of seizures, you’re helping create a more understanding and safe environment for people with epilepsy.

Resources

• Epilepsy Foundation – Types of Seizures: Comprehensive overview of seizure classifications, symptoms, and what different seizures look like. (Epilepsy.com)

• Centers for Disease Control and Prevention (CDC) – Types of Seizures: Succinct, user-friendly explanation of focal vs. generalized seizures and their key characteristics, plus general epilepsy information. (CDC.gov)

• World Health Organization (WHO) – Epilepsy Fact Sheet: Global perspective on epilepsy (affecting 50 million people worldwide) and description of how seizures can vary from brief lapses to prolonged convulsions. (WHO.int)