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Overview

What Is Epilepsy?

Epilepsy is a neurological disorder that causes repeated, unprovoked seizures. Seizures happen when there are sudden bursts of abnormal electrical activity in the brain, which can temporarily affect movement, awareness, sensations, or behavior. Epilepsy can begin at any age and may affect children, adults, and older people. The type of seizure, possible cause, and treatment needs vary from person to person.

Emergency Warning Signs

Emergency Warning Signs

Call emergency services

When a seizure is an emergency

Call emergency services for a first seizure, a seizure lasting 5 minutes or longer, repeated seizures without recovery, breathing difficulty, serious injury, a seizure during pregnancy, or a seizure in water. These situations may indicate status epilepticus or another life-threatening problem. Do not restrain the person or put anything in their mouth.

  • Stay with the person and remain calm.
  • Move hard or sharp objects away from them.
  • Cushion their head with something soft.
  • Turn them gently onto their side when possible.
  • Time the seizure from start to finish.
  • Do not restrain them or place anything in their mouth.

Symptoms

Epilepsy Symptoms

Epilepsy symptoms vary depending on which area of the brain is involved. A seizure may change movement, awareness, sensations, emotions, or behavior, and not every seizure causes shaking. The symptoms may also differ between epilepsy types, including focal epilepsy that begins in one area or lobe of the brain.

  • Staring blankly for a short period.
  • Brief loss of awareness or responsiveness.
  • Muscle stiffening (tonic activity).
  • Rhythmic jerking of the arms or legs (clonic activity).
  • Sudden loss of muscle control (atonic seizure).
  • Unusual smells, tastes, visual changes, or tingling sensations.
  • Sudden feelings of fear, déjà vu, or a rising sensation in the stomach.
  • Confusion or sleepiness after a seizure (postictal state).

Causes

What Causes Epilepsy?

Epilepsy develops when the brain has an enduring tendency to produce abnormal electrical activity and recurrent seizures. A single seizure does not always mean that a person has epilepsy; clinicians consider the event, medical history, examination, and risk of future seizures. Causes may be genetic, structural, infectious, immune-related, metabolic, or unknown.

  • Genetic factors can increase the brain’s tendency to produce seizures.
  • Differences in brain development can contribute to epilepsy.
  • Stroke and other blood-vessel conditions can injure seizure-prone brain tissue.
  • Traumatic brain injury can cause lasting changes that lead to seizures.
  • Brain tumors and other structural abnormalities can trigger seizures.
  • Central nervous system infections can damage or inflame the brain.
  • Immune or metabolic disorders can disrupt normal brain activity.
  • In many people, no specific cause is identified.

Risk Factors

Risk Factors for Epilepsy

Nonmodifiable and early-life risk factors

  • A family history of epilepsy can increase risk.
  • Certain genetic or developmental conditions are associated with epilepsy.
  • Brain injury or oxygen deprivation before or around birth can increase risk.
  • Older age increases the likelihood of stroke-related epilepsy.
  • A history of serious brain infection or neurological disease can increase risk.

Potentially modifiable risk factors

  • Preventing head injuries may reduce the risk of epilepsy after trauma.
  • Vaccination and prompt treatment of serious infections may help prevent infection-related brain injury.
  • Managing conditions that increase stroke risk may reduce one possible cause of epilepsy.

Complications

Epilepsy Complications

  • Seizures can cause falls, burns, drowning, or other injuries.
  • Status epilepticus can cause lasting brain injury and requires emergency treatment.
  • Sudden unexpected death in epilepsy (SUDEP) is rare but serious.
  • Frequent seizures can affect attention, learning, or memory.
  • Depression and anxiety are more common in people with epilepsy.
  • Seizures may affect driving, work, school, and independent living.
  • Stigma and social isolation can affect quality of life.

Diagnosis

How Epilepsy Is Diagnosed

Diagnosis is based on what happened during the event, the person’s medical history, and a physical and neurological examination. A clinician may ask someone who witnessed the episode to describe it or review a safe video of the event. Testing helps identify the epilepsy type, rule out other causes, and look for changes that may explain the seizures.

  • A neurological examination checks movement, reflexes, sensation, memory, and alertness.
  • An electroencephalogram (EEG) records electrical activity in the brain.
  • Video EEG may match brain-wave changes with observed symptoms.
  • MRI or CT scans look for structural causes such as a tumor, scar, or stroke.
  • Blood tests can help identify metabolic, infectious, or medication-related contributors.
  • Genetic or other specialized testing may be considered when the history suggests a specific cause.

Treatment & Management

Epilepsy Treatment and Management

Epilepsy treatment is individualized according to seizure type, cause, age, overall health, pregnancy considerations, and personal goals. Antiseizure medicine is commonly used first, but some people need additional approaches when seizures continue. A neurologist can help choose a treatment plan and adjust it over time.

  • Antiseizure medicines are the most common first treatment.
  • Rescue medicines may be prescribed for prolonged or clustered seizures.
  • A medically supervised ketogenic or modified diet may help some drug-resistant cases.
  • Epilepsy surgery may be considered when seizures start in an area that can be safely treated.
  • Vagus nerve stimulation or other implanted devices may reduce seizures for some people.
  • Treating an underlying tumor, infection, stroke-related problem, or metabolic disorder may improve seizure control.

Prevention

Can Epilepsy Be Prevented?

Many cases of epilepsy cannot be prevented, especially when genetic or developmental factors are involved. However, preventing brain injury, certain infections, stroke, and complications around birth may lower the risk of some forms of epilepsy. For people already diagnosed, safety planning can help prevent injuries during seizures.

  • Use seat belts, helmets, and other safety equipment to reduce head injuries.
  • Follow recommended vaccinations and seek prompt care for serious infections.
  • Obtain regular prenatal care to reduce some pregnancy and birth-related risks.
  • Manage blood pressure, diabetes, cholesterol, and tobacco use to reduce stroke risk.
  • Follow an individualized safety plan to reduce injury if seizures occur.

Outlook and Prognosis

Outlook and Prognosis for Epilepsy

The outlook depends on the cause, seizure type, age when seizures begin, response to treatment, and other health conditions. Many people achieve good seizure control and maintain active lives, while others may need lifelong treatment and support. Persistent, changing, or worsening seizures require review by a specialist.

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