Epilepsy is a brain condition that causes repeated seizures

Epilepsy is a neurological disorder—meaning it affects how the brain works—that makes a person have seizures over and over. A seizure happens when there is a sudden burst of electrical activity in the brain that disrupts normal brain function. During a seizure, a person might lose consciousness, their body might shake uncontrollably, or they might stare blankly and be unaware of what is happening around them.

Not everyone who has one seizure has epilepsy. Doctors diagnose epilepsy when a person has had two or more unprovoked seizures, or when they have had one seizure and tests show they are likely to have more. An unprovoked seizure is one that happens without an obvious trigger like a high fever, a head injury, or low blood sugar.

Epilepsy can start at any age, though it is most common in children under 18 and in adults over 55. It affects roughly 1 in 26 people at some point in their lives, though the exact number varies depending on where you live and what medical care is available.

Key Takeaways

  • Epilepsy is diagnosed when a person has two or more unprovoked seizures, or one seizure plus test results showing they are likely to have more.
  • Seizures happen because of sudden, abnormal electrical activity in the brain and can look very different from person to person.
  • Doctors use an EEG (electroencephalogram) test to record brain waves and often order an MRI or CT scan to look for physical causes.
  • Many people with epilepsy can control their seizures with medication, and some may become seizure-free over time.
  • Epilepsy is a long-term condition, but it does not mean a person cannot work, go to school, or live independently.

Different types of seizures look and feel different

Seizures are not all the same. The type of seizure a person has depends on which part of the brain the abnormal electrical activity starts in and how far it spreads.

Generalized seizures involve both sides of the brain from the start. A tonic-clonic seizure (also called a grand mal seizure) is what many people picture: the person loses consciousness, their muscles go stiff, then they shake rhythmically. This usually lasts a few seconds to a couple of minutes. An absence seizure (also called a petit mal seizure) is much quieter—the person stares blankly for a few seconds and does not respond, then it stops. They may not remember it happened.

Focal seizures start in one area of the brain. During a focal seizure, a person might twitch in one arm or leg, feel tingling, or experience strange smells or tastes. They may or may not stay conscious. Some focal seizures spread to both sides of the brain and become generalized seizures.

A person with epilepsy usually has the same type of seizure each time, though some people have more than one type. Knowing what type of seizure a person has helps doctors choose the right treatment.

How doctors figure out if someone has epilepsy

Diagnosing epilepsy starts with a detailed conversation. A neurologist—a doctor who specializes in brain and nervous system disorders—will ask about what happened during the seizure, how long it lasted, whether the person remembers it, and what they were doing when it started. They will also ask about family history, past head injuries, infections, or other medical conditions.

The main test for epilepsy is an EEG (electroencephalogram). This test records the electrical activity of the brain using small metal discs called electrodes that stick to the scalp. The test is painless and usually takes 20 to 30 minutes. An EEG can show abnormal brain wave patterns that suggest epilepsy, even when the person is not having a seizure at that moment. Some people wear a portable EEG monitor for a day or longer to capture brain activity over time.

Doctors often order an MRI (magnetic resonance imaging) or CT (computed tomography) scan to take detailed pictures of the brain. These scans can show if there is a physical reason for the seizures, such as a scar, a tumor, or an area of abnormal brain development. Not everyone needs both tests—the neurologist will decide based on the person's age, medical history, and what the EEG shows.

Blood tests may also be done to rule out other causes of seizures, such as infections, low blood sugar, or problems with liver or kidney function.

What causes epilepsy varies widely

In about half of people with epilepsy, doctors never find a specific cause. This is called idiopathic epilepsy. In the other half, there is usually something that triggered it.

Common causes include a head injury, a stroke, a brain infection like meningitis, a brain tumor, or abnormal brain development that was present from birth. Some people develop epilepsy after a high fever in childhood. In older adults, stroke is the most common cause. Genetics also plays a role—if a parent or sibling has epilepsy, the risk is higher, though it does not mean a person will definitely develop it.

Certain conditions increase seizure risk. These include autism, cerebral palsy, Down syndrome, and Alzheimer's disease. Some medications and drugs can also lower the seizure threshold, meaning they make seizures more likely to happen.

Medication is the first treatment most people try

Once epilepsy is diagnosed, the goal is to stop seizures from happening. Antiepileptic drugs (AEDs)—also called seizure medications—are the first-line treatment. These medications work by calming down the abnormal electrical activity in the brain.

There are many different AEDs available, and they work in different ways. A neurologist will choose one based on the type of seizure, the person's age, other medical conditions, and other medications they are taking. Common medications include levetiracetam, valproic acid, lamotrigine, and phenytoin, though there are many others.

Finding the right medication and dose sometimes takes time. A person might start on a low dose and have it increased gradually until seizures stop. If one medication does not work, the doctor may try a different one or combine two medications. About 70 percent of people with newly diagnosed epilepsy become seizure-free with the first or second medication they try.

Medications do have side effects, which can include drowsiness, dizziness, weight gain, or mood changes. Most side effects are mild, but it is important to tell the neurologist about any problems so they can adjust the dose or try a different medication.

Other treatments when medication is not enough

For people whose seizures do not stop with medication alone, other options exist. Brain surgery can be considered if tests show that seizures are coming from a specific area of the brain that can be safely removed. Surgery is most successful when there is a clear abnormality like a scar or a tumor in that area.

Vagus nerve stimulation (VNS) is a procedure where a small device similar to a pacemaker is implanted under the skin near the collarbone. The device sends regular electrical pulses to the vagus nerve, which helps reduce seizure frequency. This does not stop all seizures but can reduce how often they happen.

Ketogenic diet is a high-fat, low-carbohydrate diet that has been shown to reduce seizures in some people, especially children. It requires close supervision by a dietitian and is usually tried when medications have not worked.

Responsive neurostimulation (RNS) is a newer device that detects abnormal brain activity and sends a small electrical pulse to stop a seizure before it starts. Like VNS, it is implanted under the skin and is used when medication has not controlled seizures.

Living with epilepsy and managing daily life

With proper treatment, many people with epilepsy have few or no seizures. Some people become seizure-free and may eventually be able to stop taking medication under a doctor's supervision. Others need to take medication long-term to keep seizures under control.

People with epilepsy can usually work, go to school, drive (once seizures are controlled), and participate in most activities. However, there are some safety considerations. During a seizure, a person cannot control their body, so activities like swimming alone or working at heights may need to be modified. Seizure action plans—written instructions for what to do if a seizure happens—are helpful for family members, coworkers, and teachers.

Stress, lack of sleep, missed medications, and certain foods or drinks can trigger seizures in some people. Keeping a seizure diary—writing down when seizures happen and what happened before them—can help identify personal triggers and patterns.

It is important to take medication exactly as prescribed, keep appointments with the neurologist, and report any new symptoms or side effects. Regular follow-up helps the doctor make sure the treatment is working and adjust it if needed.

Frequently Asked Questions

Can epilepsy go away on its own?

Some people, especially children, may outgrow epilepsy and eventually stop having seizures. Others need lifelong treatment. A neurologist can discuss the likelihood based on the type of epilepsy and how well it responds to medication. Some people become seizure-free and can gradually stop medication under medical supervision, but this should never be done without a doctor's guidance.

Is epilepsy the same as a seizure disorder?

Epilepsy and seizure disorder are often used interchangeably, though seizure disorder is a broader term. Epilepsy specifically means a tendency to have repeated, unprovoked seizures. Someone can have a single seizure without having epilepsy, but epilepsy means the person is at high risk for more seizures in the future.

What should I do if someone is having a seizure?

Stay calm and keep the person safe. Move dangerous objects away, place something soft under their head, and turn them on their side if possible to keep their airway clear. Do not put anything in their mouth or try to hold them down. Most seizures stop on their own within a few minutes. Call emergency services if the seizure lasts longer than five minutes, if another seizure starts right after, or if the person does not wake up afterward.

Can stress cause epilepsy?

Stress does not cause epilepsy, but it can trigger seizures in people who already have the condition. Other common triggers include lack of sleep, missed medications, flashing lights, and hormonal changes. Identifying and managing personal triggers can help reduce how often seizures happen.

Will medication affect my ability to have children?

Some antiepileptic medications can affect pregnancy, but many are considered safe. A person taking seizure medication who is planning to become pregnant should talk with their neurologist and obstetrician before conception. The doctor may adjust medications to find the safest option. Stopping medication without medical guidance is dangerous and can lead to uncontrolled seizures during pregnancy.