Parkinson's disease does not typically cause seizures, but people with Parkinson's have a higher seizure risk than the general population

Seizures are not a direct symptom of Parkinson's disease itself. The core features of Parkinson's—tremor, rigidity, slowness of movement, and balance problems—arise from loss of dopamine-producing neurons in a specific brain region called the substantia nigra. Seizures involve abnormal electrical activity across broader areas of the brain and stem from different causes.

However, people with Parkinson's do experience seizures more often than people without it. Research suggests the risk is roughly two to three times higher, though estimates vary depending on disease duration and severity. This increased risk comes from several sources: the underlying brain changes in Parkinson's itself, the medications used to treat it, and other conditions that can develop alongside Parkinson's.

Key Takeaways

  • Seizures are not a symptom caused by Parkinson's disease, but people with Parkinson's have a higher seizure risk than the general population.
  • Levodopa and other dopamine medications can lower the seizure threshold, making seizures more likely in some people, especially at higher doses.
  • Brain changes from Parkinson's, cognitive decline, and stroke risk all contribute to increased seizure likelihood independent of medication.
  • A first seizure in someone with Parkinson's warrants evaluation to rule out stroke, infection, or medication interaction before assuming it is Parkinson's-related.
  • Seizure medications and Parkinson's medications can interact, so any seizure treatment must be coordinated with your neurologist.

How Parkinson's medications can increase seizure risk

The medications that treat Parkinson's motor symptoms can paradoxically raise the risk of seizures. Levodopa, the most effective and widely used Parkinson's medication, lowers the brain's seizure threshold—the point at which abnormal electrical activity becomes a seizure. This effect appears dose-dependent: higher doses carry greater risk. The risk is not universal; most people on levodopa never have a seizure, but the medication shifts the odds.

Other dopamine agonists—medications like pramipexole and ropinirole that mimic dopamine—carry similar but generally lower risk. Amantadine, an older medication sometimes used for Parkinson's, has been associated with seizures in some patients, particularly those with kidney problems or at higher doses. The longer someone takes these medications and the higher the dose, the more the seizure risk accumulates.

This creates a clinical dilemma: the medications that best control Parkinson's symptoms are the same ones that increase seizure risk. Your neurologist weighs this trade-off when choosing doses and combinations, monitoring for early warning signs.

Brain changes in Parkinson's that raise seizure risk

Beyond medication, Parkinson's disease itself alters the brain in ways that make seizures more likely. The same neurodegeneration that causes motor symptoms—loss of dopamine neurons and accumulation of abnormal protein—affects broader brain networks. Over time, people with Parkinson's often develop cognitive changes, including mild cognitive impairment or dementia. Cognitive decline is itself associated with higher seizure risk, independent of any medication.

Parkinson's also increases the risk of stroke, which is a common seizure trigger. People with Parkinson's have higher rates of atrial fibrillation (irregular heartbeat), which can lead to blood clots and stroke. A stroke damages brain tissue and can create a scar that generates seizures weeks or months later. Additionally, Parkinson's can affect swallowing and increase aspiration risk, which can lead to pneumonia and secondary complications that lower seizure threshold.

The longer someone has Parkinson's, the more these cumulative brain changes accumulate, which partly explains why seizure risk rises with disease duration.

When a seizure occurs: what to do and what to investigate

If you or someone with Parkinson's experiences a first seizure, seek immediate medical attention. A seizure is a medical emergency, and the first step is ensuring the person is safe—on their side if possible, away from hazards, and monitored until emergency services arrive if the seizure lasts more than five minutes or if multiple seizures occur.

Once the immediate event is over, the neurologist will investigate the cause. A first seizure in someone with Parkinson's is not automatically assumed to be Parkinson's-related. The evaluation typically includes brain imaging (usually an MRI) to look for stroke, tumor, or other structural problems; blood tests to check medication levels, kidney and liver function, and electrolytes; and sometimes an EEG (electroencephalogram) to record brain electrical activity. Recent medication changes, infections, or missed doses of Parkinson's medications can all trigger seizures and must be ruled out.

This investigation is essential because the cause determines treatment. A seizure from a stroke requires stroke management. A seizure from medication toxicity requires dose adjustment. A seizure from an infection requires treating the infection. Only after other causes are excluded does the neurologist consider whether Parkinson's disease itself or its medications are the primary driver.

Seizure medications and Parkinson's drug interactions

If seizures do occur and seizure medication is needed, the choice becomes complicated because many seizure drugs interact with Parkinson's medications. Phenytoin, an older seizure medication, can worsen Parkinson's symptoms and is generally avoided. Levetiracetam and lamotrigine are often preferred because they have fewer interactions with dopamine medications, though lamotrigine requires slow dose escalation.

Newer seizure medications like lacosamide and perampanel may also be options depending on the individual case. The key is that your neurologist and the doctor prescribing seizure medication must communicate. Parkinson's medications can affect how seizure drugs are metabolized, and seizure drugs can affect how Parkinson's medications work. Dose adjustments on either side may be necessary.

Some people with Parkinson's and seizures benefit from adjusting Parkinson's medication doses downward if seizures are frequent, though this must be balanced against worsening motor symptoms. This is a conversation that requires close monitoring and frequent follow-up.

Seizure risk by Parkinson's stage and type

Seizure risk is not uniform across all people with Parkinson's. People with longer disease duration face higher risk than those newly diagnosed. People with Parkinson's dementia have substantially higher seizure risk than those with normal cognition. People with atypical Parkinson's syndromes—such as progressive supranuclear palsy or multiple system atrophy—may have different seizure risks than those with typical Parkinson's disease, though research on this is limited.

Age also matters. Older people have higher baseline seizure risk from other causes (prior stroke, brain atrophy), so the added risk from Parkinson's compounds existing vulnerability. A person diagnosed with Parkinson's at age 50 faces different seizure risk than someone diagnosed at 75, even if disease duration is the same.

Your neurologist considers these factors when assessing your individual risk and deciding whether preventive measures or closer monitoring are warranted. This is not a one-size-fits-all calculation.

What to monitor and when to contact your neurologist

If you have Parkinson's, you do not need to live in fear of seizures—most people with Parkinson's never have one. But knowing the warning signs allows you to seek help quickly if they occur. Seizures can present as loss of consciousness and convulsions, but they can also be subtle: staring spells, lip smacking, repetitive hand movements, or brief confusion. Some people have a warning sign called an aura—a strange smell, taste, or feeling—seconds before a seizure begins.

Contact your neurologist if you experience any of these, or if someone observes unusual behavior that might be a seizure. Also report any new or worsening tremor, confusion, or falls, as these can sometimes precede seizures. If you are on a high dose of levodopa or have recently increased your dose, mention this to your neurologist, as dose escalation can increase seizure risk.

Keep a record of any suspected seizures—when they happened, how long they lasted, what you remember, and what you were doing beforehand. This information helps your neurologist determine whether the events are actually seizures and what might have triggered them.

Frequently Asked Questions

Is a seizure a sign that my Parkinson's is getting worse?

Not necessarily. A seizure can occur for many reasons unrelated to Parkinson's progression—medication side effects, infection, stroke, or electrolyte imbalance. However, seizures can indicate that Parkinson's has progressed to involve cognitive changes or that medication doses have become high enough to lower seizure threshold. Your neurologist will investigate to determine the cause.

Can I prevent seizures if I have Parkinson's?

There is no proven way to prevent seizures in Parkinson's, but your neurologist may recommend avoiding triggers like missed medication doses, sleep deprivation, or alcohol. If you have had one seizure, preventive seizure medication may be recommended. Keeping Parkinson's symptoms well-controlled and maintaining overall health—managing blood pressure, treating sleep apnea, staying hydrated—may reduce risk indirectly.

Will seizure medication make my Parkinson's worse?

Some seizure medications can worsen Parkinson's symptoms, but many do not. Levetiracetam and lamotrigine are generally well-tolerated alongside Parkinson's medications. Your neurologist will choose a seizure medication with this in mind and monitor you closely for any worsening of tremor, rigidity, or slowness.

What should I do if I have a seizure while alone?

If possible, call emergency services (911 in the US) before a seizure starts if you feel warning signs. If you cannot call, consider wearing a medical alert bracelet that identifies you as having Parkinson's and seizures. Some people use seizure alert devices that detect seizures and alert caregivers. Talk to your neurologist about options that fit your situation.

Does everyone with Parkinson's eventually have seizures?

No. Most people with Parkinson's never experience a seizure. Seizure risk is higher than in the general population, but it remains uncommon. Risk increases with disease duration and cognitive decline, but many people live with Parkinson's for decades without seizures.