Seizures 101: not all seizures look like TV

 

And no, staying conscious doesn’t make it fake.

Quick myth-busters

• “If you don’t pass out, it’s not a seizure.” Wrong. Many epileptic seizures happen with full awareness. They’re called focal aware seizures. ILAEEpilepsy Foundation

• “All seizures are big body convulsions.” Also wrong. Seizures can be motor or non-motor, affecting sensation, stomach, breathing, vision, emotion, or speech. ILAE

• “Sleep protects you from seizures.” Nocturnal seizures are a thing, and they often wake people from sleep or hit at wake-up. Epilepsy Foundation

What counts as epilepsy

Epilepsy means recurrent, unprovoked seizures due to abnormal electrical activity in the brain. The pattern of symptoms depends on where that storm starts and how far it spreads. Awareness can be preserved, altered, or lost; none of those states make it “more real” or “less real.” The standard for classifying what you’re seeing is set by the International League Against Epilepsy (ILAE). ILAE

How neurologists classify seizures (the short version)

Per the ILAE’s modern system:

• Focal onset: starts in one region of one hemisphere.

  • Focal aware: you’re awake and aware during it.

  • Focal impaired awareness: awareness is affected.

  • Any focal seizure can spread and become focal to bilateral tonic-clonic. ILAE

• Generalized onset: starts across networks on both sides at once (e.g., absence, myoclonic, tonic, atonic, tonic-clonic). ILAE

• Unknown onset: when the start isn’t witnessed or recorded. ILAE

What seizures can actually look like

• Focal aware (simple partial): you remain conscious. May include jerking in one body part, sensory changes, speech arrest, or intense emotions. People often recall the whole thing. Usually brief. Epilepsy Foundation

• Focal impaired awareness (complex partial): staring, confusion, or automatisms (lip-smacking, hand movements). You may not remember it well. Epilepsy Foundation

• Autonomic/“abdominal” seizures: rising, tight, churning, or painful sensations from the upper abdomen that can shoot up toward the chest or throat; nausea or vomiting; flushing, pallor, heart-rate changes. Frequently linked to temporal-lobe networks. These can stay focal or evolve into other seizure types. Being awake doesn’t negate them. Epilepsy Diagnosis

• Generalized seizures:

  • Absence: brief staring spells.

  • Myoclonic: quick muscle jerks.

  • Tonic/atonic: stiffening or sudden loss of muscle tone.

  • Tonic-clonic: the classic convulsion. Not the only real seizure, just the most obvious one. CDC

Nighttime and wake-up seizures

Seizures often cluster around sleep transitions. Some people have syndromes where events occur as they wake or during sleep, including patterns like sleep-related hypermotor seizures that involve dramatic movements without loss of awareness. If you’re waking up in a seizure, that’s a known, documented pattern and not some internet conspiracy. Epilepsy Foundation+1

Triggers vs causes

• Triggers like heat, stress, sleep loss, alcohol, or missed meds make seizures more likely; they are not the root cause.

• The cause is the brain’s abnormal electrical activity pattern. Classification helps doctors target treatment. ILAE

How doctors confirm it

• EEG records brainwaves and can capture abnormal discharges. Yield improves with sleep-deprived or prolonged/ambulatory EEG, especially when events occur at night or after naps. If routine EEG is normal but your history screams seizures, sleep-stage or sleep-deprived EEG is standard. NCBIJAMA Network

• MRI may be used to look for structural causes, depending on history and exam. (Work-up specifics vary by patient; talk to your clinician.)

Safety and first aid that bystanders should know

What actually helps during a visible convulsive seizure:

1. Time it. Over 5 minutes is an emergency.

2. Protect from injury. Ease down, turn on one side, clear nearby hazards, put something soft under the head, loosen tight neckwear, remove glasses.

3. Do not hold the person down, put anything in the mouth, or give food/drink/meds during the event.

4. Call 911 if it lasts longer than 5 minutes, repeats, there’s breathing trouble or injury, the person is pregnant, in water, or it’s a first seizure. CDC+1

Tracking helps you win

A simple log makes treatment smarter: date/time, what you were doing (heat, stress, sleep), what it felt like (e.g., abdominal rise to head, muscle jerks), duration, awareness, and after-effects (head “electric shocks,” fatigue, confusion). Bring that to your PCP or neuro.

Hard truth: risk exists, so control matters

SUDEP (sudden unexpected death in epilepsy) is rare, but better seizure control reduces risk. That’s not fear-mongering; it’s what the data show. Medication adherence and minimizing triggers aren’t optional if you want the odds on your side. CDC+1

---

Receipts: authoritative resources

• ILAE (International League Against Epilepsy): the gold-standard classification your doctor uses. ILAE

• Epilepsy Foundation — seizure types and sleep: accessible breakdowns of focal aware vs impaired, nocturnal patterns, and specific syndromes. Epilepsy Foundation+2Epilepsy Foundation+2

• CDC — types, first aid, and when to call 911: clear public guidance that shuts down myth and panic. CDC+1

• Autonomic/abdominal seizures: clinical overview of epigastric rising and other autonomic features, typically temporal-lobe in origin. Epilepsy Diagnosis

• EEG done right: why sleep-stage or sleep-deprived EEG is ordered when routine tests miss nocturnal events. NCBIJAMA Network

• SUDEP facts: what it is, how rare it is, and why seizure control matters. CDC

---

Bottom line

Seizures are electrical events, not theater. Awareness during a seizure doesn’t make it fake; it makes it focal. Abdominal onset, sleep-linked timing, head “electric shocks” after the fact, partial response to medication, sensitivity to heat and stress — all of that is recognized in the literature and in clinics every day. The trolls can keep guessing; the science isn’t guessing.