By Nowshin Yeasmin Nishat
Photo Credit: The Defeating Epilepsy Foundation
Introduction
When most people picture a seizure, they picture someone falling, shaking, maybe losing consciousness. But a lot of seizures don’t look like that at all. Some are quiet. Easy to miss. Easy to mistake for something else entirely.
Automatisms fall into that second category. They’re repetitive, almost purposeful-looking movements: lip smacking, chewing, hand rubbing, fumbling with a shirt button that happen during certain seizures, often without the person having any idea it’s happening. Watch someone experience one, and you might not think “seizure” at all. You might think they’re distracted, or being weird, or just not listening to you.
That gap between what’s actually going on and what it looks like from the outside is exactly why this matters. If you’re a parent, a teacher, a partner, or just someone who spends time around a person with epilepsy, knowing what an automatism is can change how you react in the moment and it can spare someone a lot of unfair judgment.
So what exactly is an automatism?
At its core, an automatism is a coordinated, repeated movement that happens during a seizure, outside the person’s conscious control. They show up most often with focal seizures, particularly ones involving the parts of the brain tied to awareness and behavior (Fisher et al., 2017).
Some automatisms are tiny, such as a lip smack, a blink, fingers rubbing together. Others look more involved: picking at clothes, wandering a few steps, handling an object nearby. What ties them together isn’t complexity; it’s the fact that the person doing them usually isn’t choosing to. That’s the part people find hardest to wrap their heads around. Someone can look like they’re interacting with the world, touching things, moving around while their awareness is somewhere else entirely. It’s no wonder these episodes get misread so often by people who’ve never seen one before.
Why does this even happen?
Seizures involve abnormal electrical activity spreading through the brain, and where that activity starts and where it travels shapes what the seizure actually looks like (Engel, 2013).
Temporal lobe seizures in particular tend to bring on automatisms like chewing, swallowing, or repetitive hand movements, often alongside a kind of blank, unresponsive quality. The person might not answer when spoken to. They might not remember any of it once it’s over. Worth repeating: none of this is a conscious choice. It can look deliberate from a few feet away and be completely involuntary up close.
What automatisms tend to look like
They show up in a few recognizable flavors:
Oral ones are probably the most common lip smacking, chewing, swallowing, that sort of repetitive mouth movement. Manual automatisms involve the hands: rubbing them together, picking at clothing, fidgeting with something nearby.
Some are more gestural adjusting a piece of clothing, handling an object in a way that looks almost intentional. And then there are ambulatory automatisms, where a person actually gets up and walks around, still with no real awareness of what they’re doing or where they’re going. No two people experience this identically, which is part of why it helps so much to actually watch and remember what happened during an episode; that detail is genuinely useful when it comes time to talk to a doctor.
What’s it like from the inside?
Probably nothing. That’s the strange part. During a focal seizure with impaired awareness, a person can look awake, eyes open, moving around while being essentially unreachable. They might stare, repeat a movement, and then come back with no memory of any of it (Fisher et al., 2017).
To everyone else in the room, that’s confusing. A parent might think their kid is tuning them out. A teacher might chalk it up to a distracted student. A friend might just think something’s off. None of those readings are unreasonable; they’re just wrong, because what’s actually happening is neurological, not behavioral.
Is any of this dangerous?
The movement itself, usually not. It’s the surroundings that can turn risky.
Someone wandering during a seizure doesn’t know they’re near a staircase, a road, or a pool; they’re not tracking any of that. Someone fumbling with an object could hurt themselves without meaning to. The safest thing you can do is stay close, steer them gently away from anything hazardous, and resist the urge to grab or restrain them.
If you’re with someone having one
A few things that actually help:
- Stay calm; your steadiness matters more than you’d think.
- Don’t leave them alone.
- Clear away anything nearby that could cause harm.
- If they’re heading somewhere unsafe, guide them gently in another direction.
- Don’t hold them down unless there’s real, immediate danger.
- Never put anything in their mouth.
- Keep track of how long it lasts.
- Once it’s over, reassure them and fill in what happened if they don’t remember.
If there’s already a seizure action plan in place, follow it.
When it’s time to call for help
Call emergency services if a seizure runs past five minutes, if seizures start stacking one after another without recovery in between, if breathing becomes difficult, if there’s a serious injury, or if it’s someone’s very first seizure (Epilepsy Foundation, 2025). And if automatisms are already a known part of someone’s epilepsy, any noticeable change in longer episodes, new patterns, increased frequency is worth flagging to their doctor.
Why this is worth knowing
Epilepsy has a reputation built around its most dramatic moments: the falling, the shaking. But a huge amount of it is quieter than that, and quieter doesn’t mean less real. The social cost of that mismatch is easy to underestimate. Someone whose seizures show up as automatisms can spend years being labeled inattentive, odd, or difficult by people who simply don’t know what they’re looking at. That’s not a small thing. Which is really the whole point of talking about this openly. Once people understand that these behaviors can be completely involuntary, the way they respond as teachers, coworkers, friends, and family tends to shift from judgment to support.
Conclusion
Automatisms are repetitive, seizure-driven behaviors such as lip smacking, chewing, hand movements, and wandering that mostly show up during focal seizures involving impaired awareness. They can look deceptively normal, even purposeful, while actually reflecting a burst of abnormal electrical activity in the brain. Learning to recognize them isn’t just a piece of medical trivia. It’s the difference between someone getting help and someone getting misunderstood.
References
Engel, J. (2013). Seizures and epilepsy. Oxford University Press.
Epilepsy Foundation. (2025). Seizure first aid. https://www.epilepsy.com/recognition/seizure-first-aid
Fisher, R. S., Cross, J. H., French, J. A., et al. (2017). Operational classification of seizure types by the International League Against Epilepsy: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia, 58(4), 522–530.
