SeizureSafe™ – Seizure Recognition

Seizures in dementia are often subtle, easily overlooked, and rarely resemble the dramatic convulsions most people imagine. These missed events lead to preventable harm, unnecessary hospitalizations, and costly survey citations. This section trains your team to identify early warning signs, recognize individuals at risk, and enhance observation and reporting accuracy.

Module 1: Identifying Seizure Activity

Most seizures in dementia residents look like everyday behaviors, brief unresponsiveness, staring spells, or repetitive movements, and can be mistaken for confusion or typical dementia symptoms. This module teaches staff how to spot subtle seizure patterns, understand which residents are most vulnerable, and document warning signs that might otherwise go unnoticed.

Lesson 1.1: Recognizing Seizures in Dementia: What Every Caregiver Should Know

Why Seizure Recognition Matters

Seizures in dementia are rarely dramatic, but that’s precisely what makes them dangerous. When seizures are missed, mislabeled as behaviors, or left undocumented, residents face increased harm and facilities face operational risks. Early recognition prevents unnecessary falls, ER transfers, and family complaints while improving overall care quality.

What Happens When Seizures Are Missed
  • Preventable falls and injuries
  • Avoidable ER transfers or hospitalizations
  • Missed or delayed diagnoses
  • Inaccurate documentation of incidents or behaviors
  • Family complaints and loss of trust
  • Survey citations or legal exposure

Unrecognized episodes can occur repeatedly before anyone connects the dots. Facilities that train staff to recognize subtle signs experience fewer emergencies and achieve stronger compliance outcomes.

What You’ll Learn in This Lesson:
  • Why seizures happen more frequently in dementia residents
  • What common seizure presentations look like in long-term care
  • Why they are often overlooked or misinterpreted
  • How to recognize and document seizure activity during daily care

You can prevent harm and improve safety if your team can identify even the subtle signs.

Quick-Check: Top 5 Subtle Seizure Signs
  • Sudden staring or “blank” episodes
  • Unusual repetitive movements (lip smacking, chewing motions, hand wringing)
  • Sudden confusion or behavior changes that resolve quickly
  • Brief muscle jerks or twitching (myoclonic jerks)
  • Unexplained falls or near-falls without environmental triggers.

Tip: Document the time, duration, and the resident’s activity before and after each episode. Refer to the Seizure Documentation module for best practices on recording and communicating these observations.

Observation in Action

The Seizure Observation Checklist highlights real-world behaviors documented during suspected seizure episodes. This tool is designed for use during daily care and team huddles to improve recognition and reporting.

Think About This

Have you witnessed a resident staring blankly, suddenly becoming unresponsive, or making unusual repetitive movements and not known what it meant? Would you feel confident reporting it next time?

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Lesson 1.2: Common Signs to Watch For

What Most People Picture

When most people think of seizures, they picture dramatic, full-body convulsions. But in dementia care, seizures are often subtle and can look like ordinary behaviors. These quiet episodes are easily missed without the proper training.

What Seizures Look Like in Dementia Care

Common signs include:

  • Sudden Staring or “Zoning Out”
    Resident stops mid-task, stares blankly, shows no response, then resumes as if nothing happened.
  • Repetitive, Unusual Movements
    Lip-smacking, hand rubbing, shirt tugging, picking motions, or repeating words without an apparent reason.
  • Sudden Drop in Alertness
    Resident appears unusually tired, disengaged, or slumped, often during routine care.
  • Quick Jerking Movements
    Brief, sudden jerks of the arm, hand, or shoulder (often mistaken for tremors or startle reflexes).
  • Unexplained Falls or Injuries
    Resident falls or nearly falls without a trip hazard; may later say they felt “off” or confused.
  • Other Subtle Indicators
    Sudden fear or panic without a cause, trouble speaking mid-conversation, fixed or intense gaze, new patterns of wandering, or uncharacteristic silence.
Why These Signs Get Missed
  • Episodes are brief and nondramatic, often lasting just seconds.
  • Behaviors mimic symptoms of dementia, such as confusion, wandering, or fatigue.
  • Staff may be unsure what to report or how to describe what they saw.
  • Documentation often uses vague terms like “confused” or “acted out,” which don’t indicate possible seizure activity.
What to Do When Something Feels Off

You don’t need to diagnose a seizure. Your role is to notice, document, and report what you observe. When behaviors seem unusual:

  • Pause and watch carefully
  • Ask yourself: Could this be seizure activity?
  • Document and report exactly what you saw, including the time and what the resident was doing before and after the event. Refer to the Seizure Documentation module for guidance on recording these details.
Quick Reference
Clinical References
  • Vossel, K. A., Tartaglia, M. C., et al. (2017). Epileptic activity in Alzheimer’s disease: Causes and clinical relevance. Lancet Neurology, 16(4), 311-322.
  • Hauser, W. A., & Beghi, E. (2018). Focal seizures and automatisms in elderly patients. Neurology, 90(16), 745-754.
  • Horvath, A., Szucs, A., et al. (2021). Seizures and epilepsy in Alzheimer’s disease: A review. Frontiers in Neurology, 12, 764.
  • Wang, Y., Wu, H., et al. (2024). Clinical and EEG characteristics of mesial temporal seizures in dementia. Journal of Clinical Medicine, 13(13), 3879.
  • Alzheimer’s Society. (2023). What is the link between seizures and dementia? alzheimers.org.uk/blog.
Think About This

Have you seen zoning out or odd movements and assumed it was confusion? Would you recognize it differently now?

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Lesson 1.3: Who’s at Risk for Seizure Activity?

Why This Matters

Not every resident will experience seizures, but specific individuals face a higher risk. Recognizing these risk factors enables staff to remain vigilant, escalate concerns, and assist clinical teams in making informed and timely decisions.

Who’s Most at Risk
  • Moderate to Severe Dementia: Alzheimer’s and mixed dementias are strongly associated with unrecognized seizures.
  • History of Brain Injury or Stroke: Residents with prior strokes or traumatic brain injury often have lower seizure thresholds.
  • Sudden Changes in Cognition or Behavior: Increased confusion, sudden agitation, or episodes of unresponsiveness can be early warning signs.
  • Unexplained Episodes or Prior Seizures: Even one unexplained event warrants observation and reporting.
  • Medication Changes: Certain antibiotics (e.g., some fluoroquinolones), antipsychotics, and antidepressants have been associated with a reduced seizure threshold. Staff should document any unusual behavior that occurs after changes to medication.
  • Underlying Health Issues: Infections, dehydration, or metabolic imbalances (such as low sodium levels) can trigger seizure activity in vulnerable residents.
What to Watch For During Daily Care
  • Staring spells, disengagement, or sudden pauses during routine tasks
  • Repetitive, unusual movements (lip smacking, hand wringing)
  • Sudden “blank” episodes or uncharacteristic verbal repetition
  • Unexplained falls or near-falls during transfers or ambulation
Why Certain Times Matter
  • Overnight and Early Morning Hours: Low stimulation and fatigue make subtle seizures harder to recognize.
  • Shift Handoffs: Events may be missed if not documented or communicated clearly.
  • After Medication Administration: Be alert to sudden changes following new or adjusted medications.
Assisted Living vs Skilled Nursing
  • ALF: Seizures may show up as sudden falls, wandering, or refusal of care.
  • SNF: Seizure signs are often misinterpreted as confusion or typical dementia behaviors, especially in medically complex residents.
Risk Awareness, Not Diagnosis

Your role is to notice and report—never diagnose or treat. If you observe these patterns, document the time, behavior, and any related changes, then communicate your observations to the nurse or care team.

Think About This

Which residents under your care have risk factors? Would you recognize and report unusual behaviors that might signal seizure activity?

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Module 1 Wrap-Up

What You Learned:
  • Why seizures occur more frequently in dementia.
  • The most common and subtle signs of seizure.
  • Risk factors that increase seizure likelihood.
  • Why documenting and communicating observations is critical.
Key Takeaway

You’re not diagnosing. Your role is to observe, document, and escalate any issues that don’t seem right.

Next Steps:

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