There are a few more aspects of epileptic seizures that require explanation.

Some people may have a warning of seizure. The first type of warning is a vague feeling of an impending seizure, particularly before a tonic-clonic (grand mal) seizure. This prodrome may last several hours. It has no obvious physiological explanation, but it is remarked upon too often by people to be lightly dismissed as due to imaginary reconstruction of events. The prodrome is usually unpleasant—a feeling of mental heaviness or depression. Less commonly, elation and energetic activity may herald a seizure. The second type of warning, known as an aura, is not really a warning at all, but the initial symptom of the seizure itself. Examples of such auras include the epigastric sensation of partial seizures arising in one part of the temporal lobe, or the brief tingling in one hand which precedes a partial seizure arising in the parietal lobe which rapidly generalizes to a grand mal seizure.

Another phrase requiring definition is post-ictal paresis. An ictus is another older synonym for a seizure. Post-ictal paresis indicates weakness of left or right limbs following a convulsion primarily affecting those limbs. Sometimes known as Todd’s paresis, after the neurologist who first described it, it indicates some structural problem in the hemisphere on the side opposite to the weak limbs. The weakness may last from a few minutes up to 48 hours. Post-ictal amnesia, post-ictal confusion, post-ictal sleep, and post-ictal headache have already been described.

Post-ictal automatism is the phenomenon in which a person can undertake some fairly complex act, such as undressing and putting themselves to bed, of which they have no subsequent memory. Status epilepticus is a phrase used to indicate seizures occurring so close together that one seizure runs into another, without recovery of normal cerebral function between seizures. This may happen with any type of seizure, so that a neurologist speaks of absence status, partial status, or tonic-clonic (grand mal) status. In the first two types, the diagnosis may be difficult to reach unless the subject is already known to the doctor. The person may be found in the street or at home confused and inaccessible to conversation because of continuing seizure discharges.

Grand mal status epilepticus, in which the person does not recover consciousness between generalized tonic-clonic convulsions, is a medical emergency. The lack of normal respiratory movements, in association with the extreme muscular contractions during the seizures, throw a considerable stress upon the cardiovascular system.

Finally, a partial seizure in which the seizure discharge continues but remains confined to one part of the motor cortex results in continuous twitching of muscles in one part of a limb on the opposite side of the body. For example, the index finger and thumb may continue to twitch for days or even weeks, without any spread of seizure discharge to other muscles, and with no disturbance of consciousness. This is known as epilepsia partialis continua.

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