Seizures are often portrayed in films as sudden medical emergencies in which a person collapses, shakes uncontrollably and loses consciousness. While this is one possible presentation, it represents only a part of the picture. In reality, seizures can take many forms, and some may be so subtle that they go unnoticed by those around the individual.
From a neurological perspective, understanding the different ways seizures present is essential for timely recognition, appropriate first aid and access to medical care. Misconceptions can delay diagnosis, create unnecessary fear and leave people living with epilepsy feeling misunderstood. Recognising the facts can help families respond with confidence rather than panic.
Myth 1: Every seizure involves violent shaking
A seizure does not always involve falling to the ground or shaking uncontrollably. Although these are recognised features of a generalised tonic-clonic seizure, other seizures may cause a person to stare blankly, stop responding briefly, experience unusual sensations or make repetitive movements.
For instance, during an absence seizure, a person may appear to switch off for a few seconds before returning to normal activity. Focal seizures can cause sudden changes in awareness, emotions, memory or sensation, depending on the area of the brain involved.
These less obvious episodes can be mistaken for daydreaming, distraction or behavioural problems. Families should seek medical advice if someone repeatedly experiences unexplained episodes of altered awareness or unusual behaviour.
Myth 2: A person must lose consciousness during a seizure
Not all seizures cause a loss of consciousness. Some people remain fully aware of what is happening around them, even when they experience involuntary movements or unusual sensations. Others may have difficulty responding or remembering the episode afterwards.
A person experiencing a focal aware seizure, for example, may remain conscious while experiencing tingling, sudden fear, an unusual smell or involuntary movements in one part of the body.
Recognising these differences matters because an individual who does not collapse may still be experiencing a seizure. A detailed description of the episode, including its duration, associated symptoms and recovery, can help a neurologist determine whether further investigation is needed.
Myth 3: Seizures always mean a person has epilepsy
A seizure is an event, whereas epilepsy is a neurological condition characterised by an enduring tendency to experience recurrent unprovoked seizures. Not every seizure automatically indicates epilepsy.
Seizures may occur in association with certain acute medical conditions, including low blood glucose, significant electrolyte disturbances, infections affecting the brain or head injuries. Some seizures may also be triggered by specific circumstances in susceptible individuals.
A neurological assessment helps establish the possible cause and determine whether further tests, treatment or monitoring are required. Families should avoid concluding a single episode without a proper medical evaluation.
Myth 4: Nothing can be done during a seizure
Although a seizure cannot usually be stopped by someone nearby, appropriate first aid can prevent injury and provide reassurance.
If a person experiences a convulsive seizure, those present should remain calm, move nearby hazardous objects away, cushion the person's head and loosen tight clothing around the neck. They should time the seizure and, once convulsions stop, turn the person onto their side if possible and check their breathing.
A person should never be restrained or have anything placed in their mouth. Food, water and oral medication should not be given until they are fully alert.
Emergency medical assistance is necessary if a seizure lasts five minutes or longer, another seizure begins before the person recovers, breathing becomes difficult afterwards, or the individual is injured or experiencing their first known seizure.
Myth 5: People recover immediately and can resume normal activities
Films often show characters recovering from a seizure within seconds. In reality, recovery can take considerably longer. Some individuals experience confusion, headache, muscle soreness, exhaustion or temporary memory difficulties afterwards. This period is known as the postictal phase.
The time needed to recover varies according to the type and duration of the seizure and the individual. Families should allow the person to rest, offer reassurance and remain with them until they are sufficiently alert and safe.
Repeated or prolonged confusion, new weakness or difficulty breathing requires urgent medical assessment.
Replacing fear with understanding
Seizures are neurological events, not a reflection of a person's intelligence, character or emotional strength. When families understand how differently they can present, they are better equipped to recognise warning signs, provide appropriate first aid and seek timely medical attention.
A neurologist's role extends beyond diagnosing and treating seizures. It also involves educating patients and their families, addressing concerns and helping them distinguish between common misconceptions and medical facts.
Greater awareness can make a meaningful difference. By looking beyond dramatic portrayals on screen, families can replace fear with informed action and offer people living with epilepsy the understanding and support they deserve.
The author is the director of Neurosurgery at the CK Birla Hospital®, Delhi.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
