Types of Seizures: Focal and Generalized, and When to Call 911

The main points

• There are two main types of seizure — focal and generalized — named for where in the brain they start, which shapes how they affect a person.
• A person with epilepsy can have more than one type.
• Call 911 if any seizure lasts more than 5 minutes, or if the person doesn't fully wake up between seizures.

Focal and generalized

A focal seizure can spread to both sides of the brain, and then cause loss of consciousness and movements on both sides of the body.

Words for seizure movements that health care providers may use:

• Tonic — muscles stiffen.
• Atonic — a sudden, unexpected loss of muscle strength or tone.
• Myoclonic — brief, lightning-quick jerks.
• Clonic — spells of rhythmic shaking or jerking.

Focal seizures

They're divided by whether the person loses awareness.

• Focal onset aware seizures (once called simple partial seizures): the person stays aware, can sometimes talk, and remembers the seizure. They may feel déjà vu or an odd feeling in the stomach, or have unusual movements.
• Focal impaired awareness seizures (once called complex partial seizures): the person loses awareness, with or without unusual movements. They may seem confused or dazed, pick at their clothes, smack their lips, or be unable to respond to questions or directions for a few minutes.

Generalized seizures

There are many kinds, told apart mainly by their effects on awareness and movement.

• Generalized motor seizures: the person loses awareness and muscles may stiffen, relax, jerk, spasm or shake, alone or in combination. They may cry out, lose consciousness, fall, or have jerks or spasms. The best-known kind is the tonic-clonic seizure (once called grand mal) — stiffening and rhythmic jerking, usually for a few minutes, often followed by confusion and tiredness.
• Generalized nonmotor seizures, or absence seizures (once called petit mal): short, sudden lapses of consciousness that often go unnoticed. The person may stare into space, blink rapidly, or make chewing or hand movements.

When to call 911

Call 911 if:

• the seizure lasts longer than 5 minutes;
• another seizure starts soon after the first;
• the person has trouble breathing or waking up afterward;
• the person is injured during the seizure;
• the seizure happens in water;
• the person has never had a seizure before;
• the person has diabetes and loses consciousness;
• the person is pregnant.

Sources

Based on "Types of Seizures," Epilepsy, Centers for Disease Control and Prevention; a work of the United States government in the public domain. Its stock photographs are not reproduced.