What are the different types of auras

Experiencing different types of seizures

An epileptic seizure occurs when normal nerve activity in the brain is suddenly interrupted. There are many different types of seizures, and an affected person can have more than one type of seizure. (for more details see IZE).

There are very many different terms for the seizures, and since the introduction of a new classification system in 2010, the medical community is currently using different terms from the old and the new system. (see information and links)

For practical communication, we use terms that are currently widely used by patients and doctors.

Epileptic seizures can be divided into two broad groups: partial seizures and generalized seizures. Focal seizures arise in a specific area in the brain and only take place in that part. In the case of generalized seizures, the seizure spreads very quickly throughout the brain, where consciousness is always impaired. A partial seizure can also develop into a generalized seizure.

Just focal seizures and auras

In simple partial seizures, the affected person consciously experiences the seizure. Either the motor skills can be affected, so that, for example, a part of the body suddenly cramps up for a short time. Or it is sensory perception, such as a sudden tingling sensation in a part of the body.

With Sven Franke, the tongue tensed up again and again for a few seconds in a simple focal seizure.

Some people with epilepsy describe having an aura, a premonition, before a seizure. An aura is actually a simple focal seizure where the person has a strange feeling that only they can perceive and that sometimes occurs just before a major seizure starts.

Some narrators describe their auras as a feeling of nausea rising from the stomach. Others have the feeling of a déja vue, i.e. they have the feeling that they have already experienced the situation. Still others feel a tingling sensation, a strange taste, or a feeling of fear. And some feel something that cannot be put into words.

Katharina Sommer sometimes feels a strange gut feeling before the attack.

As a child, Anna Blum did not know what the weird Déja-Vue meant.

Auras can appear as an early warning of an attack, but they can also occur individually without an attack following. Not all people with seizures have auras.

For many who have auras, it is good to know that they still have a few seconds to get to safety and, for example, to sit on the floor before a major seizure begins.

Martin Krüger's aura is difficult to put into words.

Anton Huber experiences his auras as a feeling as if an alien will intervenes.

Complex partial seizures

In complex focal seizures, a specific region of the brain is affected. Depending on what these brain areas are responsible for, different functions are affected by the attack. Since those affected do not simply faint, but are still capable of actions that can no longer control arbitrarily, it is often very difficult for outsiders to recognize the attack as such.

Some interviewees say that they have brief "dropouts" during the seizures. From the descriptions of their fellow human beings, they know that they stare in front of themselves, do not react, appear absent, let things drop. Some narrators do not even notice it themselves, others experience it, but can no longer speak or react, for example.

Alexandra Ludwig sees almost everything in her seizures, but cannot speak.

Some narrators report that they fidget, smack or swallow or wet themselves on their clothes during a seizure.

Others say that when they have a seizure, they walk around doing nonsensical things or are disoriented.

Thomas Kern sometimes finds it unbelievable what he does in a fit.

When she had an attack, Monika Schulz no longer knew how to get home.

Stefan Köhler found out afterwards from the nurse what he had done during one night in the clinic when he had an attack.

Some narrators report that afterwards they were very embarrassed about their seizures, for example because they had undressed from others or had hidden things during the seizure.

Complex-focal seizures can also include motor changes such as walking forward with the upper body, making sounds, twitching one leg.

Cornelia Schmitt partially notices how her body behaves, but cannot influence it.

Secondary generalized seizures

Sometimes a simple-focal or complex-focal seizure also spreads to the brain and becomes a generalized seizure that then affects the whole body.

Sven Franke experienced a couple of times how the seizure began with the spasm of the tongue and this spasm slowly spread over his whole body until he lost consciousness and had a tonic-clonic seizure.

Generalized seizures

Generalized seizures that affect the whole brain also come in different forms.

Tonic-clonic seizures

Tonic-clonic seizures were formerly known as "grand mal" or "major seizures". Most people think of these seizures after hearing about epilepsy. The affected person loses consciousness, often falls to the ground, the whole body first becomes stiff and then there are twitching movements of the arms and legs. Sometimes she bites her tongue and saliva often comes out of her mouth. After 2-3 minutes the seizure will be over and the person will slowly come to.

Claudia Hartmann tells how a tonic-clonic seizure works for her

Some narrators have regular tonic-clonic seizures. Others only had it once or twice at the beginning of the disease until they were given medication. Since then, they have only had minor seizures.

After a tonic-clonic seizure, the affected person is often exhausted and needs to rest or sleep. Our interview partners report very different experiences after a tonic-clonic seizure: Some sleep all day and need 1-2 days to feel fit again. Some complain of severe headaches and sore muscles throughout the body. Others get back on their feet very quickly and can go about their business as normal. For some, it takes longer until they are fully oriented or can speak again.

Katharina Sommer cannot speak for a while after an attack. It's a strange feeling.

After accumulating seizures, Andreas Bergmann often has a changed perception of his environment for some time.

In rare cases a seizure does not stop on its own or other seizures keep following one another. This is called status epilepticus or a series. In this case, it is imperative to call an emergency doctor, as in this case the seizure can become dangerous.

Tonic and atonic seizures

In the case of tonic or atonic seizures, the tension in the affected person's muscles changes in one fell swoop, which often leads to a fall. During tonic seizures, the whole body becomes rigid and the person falls like a felled tree. Atonic attacks make the person slump.

Some of our narrators had seizures like this for a while.

Absence

Absences are also generalized seizures in which the person concerned is absent for a few seconds. At this moment they do not notice anything of their surroundings and only notice in retrospect that they are missing “a bit”.

From the outside, the absences are sometimes barely noticeable, those affected stare for a moment, but are again conscious so quickly that the absences are not necessarily noticed by outsiders.

Sarah Schneider tried to cover up her absences during her studies, which was very exhausting for her.

Less common types of seizures

In addition to the types of seizure described, there are plenty of other types of seizures that cannot all be listed here.

One interviewee suffers from epilepsia partialis continua, a focal myoclonic status. Since the onset of the disease a few years ago, she has had myoclonus, small muscle twitches in her right arm that persist continuously. Depending on the medication she's taking, the twitches are sometimes stronger or sometimes weaker, but they never go away completely.

Renate Lang almost always has a muscle twitch in her right arm.

Beate Pohl has had many different types of seizures in the course of her life. For a while she also had fits of laughter, so-called elastic fits, in which those affected involuntarily and without being able to control it, have to laugh during the fit. After about two years, this type of seizure disappeared again with Beate Pohl.

How often the seizures occur and at what times varies greatly among our narrators. For some it is an improvement that they only have one seizure a day, others have only had 2-4 seizures in their life over many years.

When the seizures occur is also very different: some interviewees only have sleep-related seizures that occur at night.

Julia Brandt only has sleep-related seizures, which makes some things easier.

For others, the seizures can occur at any time of the day or night (see also the topic text “Seizure triggers and controllability”). With some of the narrators, the seizures always occur more frequently, in so-called clusters, after which there is rest for some time.

Many of our interviewees find it very strange that they themselves do not notice anything or only little of their seizures, even though it does happen to them.

Martin Vogt describes this with the sentence: “I'm never there and I'm there”.

Some report that they rely entirely on the descriptions of those around them to know if they have had seizures and what they look like. Some report that at first they had a hard time believing they were really having a seizure.

Timo Lindner believed as a child that his family only wanted to annoy him with the descriptions of the attacks.

Many narrators with complex focal seizures report that they suddenly have a memory gap. they are missing “a bit”, time has passed or they suddenly find themselves in a different place and do not know how they got there.

Martin Vogt notices his seizures because he is missing a few minutes.

Others who have, for example, nocturnal tonic-clonic seizures, report that the next day they bite their tongue or sore muscles that they had another seizure.

Psychogenic seizures

In addition to the described epileptic seizures, which are triggered by changes in the nervous activity of the brain, there are also seizures that arise from psychological causes. These can look so similar to epileptic seizures that even doctors cannot tell the two forms apart. They can be clearly diagnosed if an EEG is taken during a seizure.

Some of our interviewees have both types of seizures. They have epilepsy, and in addition to that, at some point over time they also had psychogenic seizures

In addition to epileptic seizures, Martin Krüger also has psychogenic seizures.

Shortly before the interview, an interviewee found out that she did not have epileptic seizures, as she had thought for years, but only psychogenic seizures.

Finding a cause for the psychogenic seizures is difficult for Silke Fuchs.

Silke Fuchs explains how psychogenic seizures occur.