Main Author: Dr. Evelyn Chau Yi Wen. Lecturer and emergency physician. Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM); Committee of Malaysian Sepsis Alliance (MySepsis)
Co-authors:
- Dr Khaizurin Tajul Arifin, Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Committee of Malaysian Sepsis Alliance (MySepsis);
- Associate Professor Dr. Tan Toh Leong, Consultant Emergency Physician, Department of Emergency Medicine, Faculty of Medicine, UKM, Founder and President, Malaysian Sepsis Alliance (MySepsis)
Weekend afternoons are busy times at the mall.Families stroll between shops and children squealed over ice cream. Suddenly, there was a commotion- a small crowd gathered in front of a restaurant. An elderly woman had collapsed on the floor. Her body stiffened, limbs jerked rhythmically, and eyes rolled upward. Someone shouted for water. Another tried to shake her awake. One person even frantically searched for a spoon to place in her mouth. Everyone went into panic mode. One thing was clear – most people didn't know what was happening, let alone how to help. What the women had experienced was a generalised tonic-clonic seizure – the most recognised type. It is usually marked by loss of consciousness, body stiffening and rhythmic jerky muscles. Sometimes, bladder or bowel control may be lost, making an already distressing scene even more embarrassing.
What is a seizure?
A seizure is a burst of uncontrolled electrical activity in the brain like an “electrical storm”. It disrupts normal communication between brain cells, causing temporary abnormalities in movements, behaviours, sensations or awareness – almost like the brain’s wiring momentarily short-circuiting. In fact, up to 10% of people worldwide will experience at least one seizure in their lifetime (Epilepsy).
There are two main types of seizures (Types of Seizures):
- Generalised seizures begin on both sides of the brain at once. They often cause loss of consciousness or awareness and abnormal movements involving the whole body.
- Focal or partial seizures begin on one side of the brain. These can cause changes in awareness, behaviour, or sensation, and usually affect one part or one side of the body.
Different kinds of seizures
Not all seizures look dramatic. Some are silent, almost invisible– like absence seizures. In these instances, a person suddenly pauses mid-conversation or activity, stares blankly into space for a few seconds, and then resumes as if nothing had happened. There’s no collapse, no jerking — just a brief, quiet lapse. Subtle signs such as eye blinking, lip-smacking, or chewing motions may occur. These episodes are so brief that it’s often mistaken for daydreaming or “zoning out.” Most people with absence seizures are unaware it even happened — only those around them notice.
While these seizures involve a loss of awareness, other types — known as focal seizures, may preserve consciousness. In focal seizures, abnormal electrical activity starts in one part of the brain, leading to symptoms limited to only one side or area of the body. A person might experience unusual sensations, jerking of one limb, or odd tastes or smells, all while remaining awake and aware.
Sometimes, focal seizures can spread to both sides of the brain, evolving into a generalised tonic-clonic episode.At the severe end of the spectrum lies status epilepticus, a life-threatening form of seizure, where a seizure lasts five minutes or longer, or when multiple seizures happen without the person regaining consciousness in between (1). The longer the seizure persists, the poorer the outcome. Therefore, early recognition and prompt treatment are absolutely critical in managing status epilepticus.
When do seizures become epilepsy?
Seizures can happen to anyone, sometimes triggered by high fever, infection, or metabolic disturbances. However, when seizures occur repeatedly without a clear cause, it points toward a condition known as epilepsy.
Epilepsy is not a single disease, but rather a group of disorders characterised by one defining feature — a tendency for recurrent, unprovoked seizures. It is estimated that at any given time, between 4 and 10 out of every 1,000 people worldwide are living with active epilepsy (Epilepsy). The lifetime risk for sudden unexpected death in epilepsy is estimated to be between 7%-12%, highlighting the importance of early diagnosis and proper management (2).
Epilepsy is usually diagnosed when (Types of Seizures):
- At least two unprovoked seizures occurring more than 24 hours apart, or
- One unprovoked seizure with high risk (60% or more) of recurrence — for example, history of stroke, brain infection, or traumatic brain injury.
What to do when someone has a seizure (Types of Seizures):
- Lay the person on a safe, flat surface
- Move any nearby objects that can cause harm
- Loosen tight clothing, especially around the neck
- Turn the person to the left lateral position to prevent choking on saliva or vomit
- Do not put any objects in their mouth
- Stay with the person until he/she fully awake
- Seek medical help if:
- This is their first seizure
- The seizures last more than 5 minutes
- They have repeated seizures without recovery
- They do not regain consciousness after 30 minutes
- Or if they are injured or pregnant
Diagnosis and management
Diagnosing epilepsy begins with understanding the story behind each seizure.
Doctors will ask about what happened before, during, and after the episode. Sometimes, a short video recorded by a bystander can be incredibly helpful. To support the diagnosis, tests such as an EEG (electroencephalogram) are used to detect abnormal electrical activity in the brain, while MRI or CT scans help identify possible causes like stroke, scarring, or tumours. Blood tests are done to rule out metabolic or infectious triggers. In certain cases, genetic testing and antibody screening may be indicated (2).
Once confirmed, the goal of treatment is to control seizures and maintain quality of life. Anti-seizure medications are the mainstay of therapy and help stabilise brain activity. Most patients achieve good control with a single medication, though some may need adjustments or combination therapy.
Lifestyle habits also play an important role in seizure control. Getting adequate sleep, managing stress, taking medication regularly, and avoiding known triggers can make a big difference. Family members and friends should also know basic seizure first aid, so they can help calmly and safely during an episode.
For safety reasons, people with newly diagnosed or uncontrolled epilepsy may need to make some lifestyle adjustments — especially when it comes to driving, taking high-risk jobs such as operating machinery, working with chemicals, or flying aeroplanes, and participating in activities like swimming (1). With proper diagnosis, treatment, and support, up to 70% of people with epilepsy can live seizure-free, continuing their studies, work, and daily activities just like anyone else (Epilepsy).
Final takeaway
Seizures don’t always look like what we see in movies. Some are loud and visible; others are silent and subtle. What matters most is how we respond.Knowledge replaces fear, and calm action saves lives. The next time someone collapses with jerking movements or stares blankly into space, you know that your calm presence and simple actions can make all the difference.
References
- Malaysian Society of Neurosciences Epilepsy Council. (2017). Guideline on the management of epilepsy (3rd ed.). https://www.neuro.org.my/assets/guideline/2017Epilepsy.pdf
- National Institute for Health and Care Excellence. (2025, January 30). Epilepsies in children, young people and adults. NICE guideline [NG217]. https://www.nice.org.uk/guidance/ng
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