Epilepsy

Epilepsy can sound like a frightening word, especially if you or someone close to you has just had a seizure. The aim of this page is to explain epilepsy in clear, simple language: what it is, why it happens, how it is diagnosed, what symptoms to look for, and how it is treated. It is for education only and does not replace advice from your own doctor.

What Is Epilepsy?

Epilepsy is a condition in which a person has a tendency to have repeated seizures. A seizure happens when there is a sudden burst of abnormal electrical activity in the brain, which temporarily changes how the brain works.

Not everyone who has a single seizure has epilepsy. Sometimes a seizure can be caused by a high fever, low blood sugar, an infection, or alcohol withdrawal. In those cases, once the cause is treated, the seizure may never happen again. Doctors usually call it epilepsy when someone has had two or more unprovoked seizures, or one seizure with a high risk of having more in the future.

Epilepsy is common. It affects people of all ages, from children to older adults. According to international health organisations, tens of millions of people worldwide live with epilepsy, and many live full, active lives with the right treatment.

Why Does Epilepsy Happen?

In most people, the brain’s electrical signals are well organised. In epilepsy, some brain cells suddenly fire in an abnormal way. This can temporarily disturb movement, awareness, feeling, behaviour, or consciousness.

Sometimes doctors can clearly find the cause. Sometimes they cannot, even after detailed tests. Common known causes include a previous head injury, stroke or reduced blood flow to part of the brain, brain infections such as meningitis or encephalitis, problems during birth or early development, brain tumours or structural changes in the brain, and certain genetic (inherited) conditions.

In many people, especially children and young adults, no clear cause is found even after proper testing. This is called “unknown” or “idiopathic” epilepsy, and it can still be well controlled with treatment.

In countries like India, infections of the brain and past birth complications are important causes of epilepsy, especially in younger people, while stroke becomes a more common cause in older adults.

What Do Seizures Look Like? (Symptoms of Epilepsy)

Seizures do not all look the same. Some are dramatic, with shaking of the whole body. Others are very subtle and easy to miss. Because epilepsy begins in the brain, seizures can affect many different functions: awareness, movement, feelings, emotions, or senses like vision, smell, or taste.

Some people suddenly “blank out” or stare into space for a few seconds and do not respond. Others feel strange sensations such as tingling, unusual smells or tastes, odd feelings in the stomach, or a sudden wave of fear or déjà vu. Many experience short episodes of confusion and cannot remember what happened for a few minutes. Some make repetitive movements such as lip smacking, blinking, rubbing hands, or walking in circles without being fully aware. In more dramatic cases, people suddenly fall to the ground with stiffening followed by jerking movements of the arms and legs, sometimes with loss of bladder control or biting of the tongue.

Doctors often group seizures based on where they start in the brain. Some begin in one small area (often called “focal” seizures), while others affect both sides of the brain from the beginning (often called “generalised” seizures). You do not need to remember these terms, but it helps to know that seizures can be very different from person to person.

Certain things can trigger seizures in people with epilepsy, such as missing medicines, lack of sleep, severe stress, flashing lights (for a small number of people), fever, or heavy alcohol use. Not every seizure has an obvious trigger, but understanding your own pattern helps in controlling them.

How Is Epilepsy Diagnosed?

Epilepsy is usually diagnosed by a doctor, often a neurologist, after a detailed assessment. The goal is to confirm that what happened was truly a seizure, to understand what type of seizure it was, and to look for a possible cause.

Diagnosis typically involves several steps. First, the doctor asks what exactly happened before, during, and after the episode. Because people often do not remember the seizure itself, it is very helpful if a family member or witness can describe what they saw. This detailed history of events is often the most valuable clue.

Second, the doctor performs a physical and neurological examination, checking your strength, reflexes, balance, coordination, and how you speak, think, and respond. An Electroencephalogram (EEG) is a safe test that records the electrical activity of your brain using small sensors placed on the scalp. Certain patterns on EEG can support a diagnosis of epilepsy and help decide what type of seizures you have.

Third, your doctor may order brain imaging such as MRI or CT scans to look for structural causes such as old injuries, stroke, tumours, scars, or developmental problems. MRI is more detailed and is often recommended when available.

Finally, blood tests help to rule out infections, low sugar, electrolyte problems, or other medical conditions that might have caused the seizure. The combination of history, examination, EEG, imaging, and blood tests usually gives doctors a clear picture of what is happening.

Why and When Is Diagnosis Necessary?

Some people ignore a first seizure, hoping it was “just a one-time thing.” This can be dangerous. A seizure can be a sign of a serious underlying problem such as infection, bleeding in the brain, stroke, or a metabolic issue that needs urgent treatment.

Early diagnosis is important for many reasons. It helps find and treat any serious underlying cause. It allows the doctor to start anti-seizure medicines if needed, which reduce the risk of further seizures. Repeated uncontrolled seizures can make future seizures more likely; early treatment reduces this risk. Seizures can cause injuries from falls, accidents, or drowning. Some seizures are life-threatening if they last too long (more than 5 minutes) or occur in clusters. You can also receive proper guidance about driving, swimming, working at heights, and other safety issues.

International guidelines recommend that anyone who has had a first suspected seizure should be seen by a doctor promptly, and ideally by an epilepsy specialist within a short time.

How Is Epilepsy Treated?

The main goal of epilepsy treatment is simple: to stop seizures or reduce them as much as possible, with the fewest side effects. For many people, seizures can be completely controlled with medication. For others, seizures become less frequent and less severe. Treatment plans are personalised. What works for one person may not be best for another.

Most people with epilepsy are treated with daily anti-seizure medicines (often called anti-epileptic drugs). There are many different options available. Your doctor will choose a medicine based on your age, type of seizures, other health conditions, and possible side effects. Taking medicine regularly, at the same time every day, is very important. Missing doses is one of the most common reasons for breakthrough seizures.

Simple daily habits can make a big difference in seizure control. Getting enough sleep, taking medicines exactly as prescribed, avoiding heavy alcohol use or recreational drugs, managing stress as much as possible, treating fevers or infections early, and knowing your personal triggers are all important parts of managing epilepsy. Stress is one of the most commonly reported seizure triggers in people with epilepsy, so stress management is an important part of care.

Some people continue to have seizures despite trying several medicines. In such cases, doctors may discuss additional options such as epilepsy surgery (removing or disconnecting the part of the brain where seizures start), special implanted devices (like vagus nerve stimulation or responsive neurostimulation), or specific diets in selected children. These advanced treatments are considered only after a thorough evaluation at a specialised epilepsy centre.

Why Is It Important to See a Neurologist for Seizures?

Seizures are a sign that something is happening in the brain. A neurologist is a doctor who specialises in brain and nerve conditions and is best trained to evaluate and manage seizures and epilepsy.

You should see a neurologist if you have had even one suspected seizure, have repeated episodes of blackouts, staring spells, or unexplained confusion, have sudden falls or loss of awareness without a clear cause, are already diagnosed with epilepsy but seizures are not well controlled, or are experiencing side effects from anti-seizure medicines.

A neurologist can confirm whether what you experienced was truly a seizure. Many other conditions mimic seizures, such as fainting, heart rhythm problems, panic attacks, or movement disorders, and only an experienced doctor can tell the difference. A neurologist can order the correct tests (EEG, MRI, blood tests), choose and adjust medicines to suit your needs, discuss whether you might benefit from advanced treatments, and guide you on driving, work, pregnancy, sports, and safety.

Articles from major hospitals emphasise that untreated seizures can become more frequent, last longer, and increase the risk of injury, so early evaluation by a specialist is strongly recommended.

Living With Epilepsy and Seizure First Aid

With proper treatment, many people with epilepsy study, work, marry, have children, and live independent, fulfilling lives. Understanding some basic safety and first aid can further reduce risks.

If you see someone having a seizure, basic first aid usually includes staying calm, keeping them safe from injury (for example, moving sharp objects away), gently turning them on their side once the jerking stops, and timing how long the seizure lasts. Do not put anything in their mouth and do not try to hold them down.

You should call emergency services if a seizure lasts more than 5 minutes, another seizure follows immediately, the person has trouble breathing or does not wake up after the seizure, it is the person’s first known seizure, the seizure happens in water, the person is pregnant or injured, or you are simply unsure what to do. Clear step-by-step seizure first aid advice is available from the CDC and epilepsy organisations worldwide.