What is epilepsy?
Epilepsy is one of the most common brain conditions in the world, yet it is still widely misunderstood. If you or someone you love has just been diagnosed, learning the basics can make the condition feel far less frightening. This guide explains what epilepsy is, what happens during a seizure, and what most people can expect over time.
What epilepsy is
Epilepsy is a condition of the brain in which a person has a lasting tendency to have recurring seizures. A seizure is a sudden burst of abnormal electrical activity in the brain that briefly changes how a person moves, feels, or behaves.
Having a single seizure does not always mean a person has epilepsy. Seizures can be provoked by a temporary cause, such as a very high fever, low blood sugar, or alcohol withdrawal. Doctors usually diagnose epilepsy when a person has had two or more unprovoked seizures, meaning seizures that happen without a clear one-time trigger.
How common it is
Epilepsy is far more common than many people realize. According to the World Health Organization, about 50 million people around the world live with epilepsy, making it one of the most common neurological conditions.
It can begin at any age, from newborn babies to older adults. It affects people of every background, gender, and culture. For some people, epilepsy starts after a clear event such as a head injury, a stroke, or an infection that affects the brain. For many others, no specific cause is ever found, and this is completely normal.
What happens in the brain during a seizure
The brain works by sending tiny electrical signals between billions of nerve cells, called neurons. Normally these signals are steady and organized. During a seizure, a group of neurons fires all at once in a sudden, uncontrolled way, like a temporary electrical storm.
What this looks like depends on which part of the brain is involved. Some seizures affect only a small area. A person might notice an unusual smell or taste, a wave of fear, a feeling of déjà vu, or twitching in one hand. A warning feeling like this before a larger seizure is called an aura, which is itself a type of seizure.
Other seizures involve a wide area of the brain. These can cause a person to lose awareness, stare blankly, or fall to the ground with stiffening and jerking of the body. Most seizures stop on their own within a few minutes, and the person gradually recovers.
How epilepsy is diagnosed
There is no single test that confirms epilepsy on its own. Instead, doctors put together a picture from several sources.
The most important part is the history. The doctor will ask detailed questions about what happened before, during, and after the event. A description from someone who witnessed the seizure is often very helpful, since the person having a seizure may not remember it.
An EEG, short for electroencephalogram, is a painless test that records the electrical activity of the brain using small sensors placed on the scalp. It can pick up unusual patterns that point to epilepsy. Brain imaging, such as an MRI scan, takes detailed pictures of the brain and can look for a physical cause, such as scarring or a difference in how the brain formed. Blood tests may also be done to rule out other causes.
The outlook
A diagnosis of epilepsy can feel overwhelming, but the outlook for most people is encouraging. With the right anti-seizure medication, meaning medicines that reduce the chance of seizures, about 2 in 3 people with epilepsy become free of seizures.
Finding the right treatment can take time and patience, and it may involve trying more than one medicine. Many people go on to lead full, active lives, including working, studying, driving once their seizures are controlled and local rules allow, and raising families. For seizures that do not respond to medication, other options exist, such as different medicines, dietary therapy, or surgery in selected cases.
When to talk to your doctor
Always speak with your doctor if you or someone you care for has had a possible seizure for the first time, or if seizures change in how they feel, how long they last, or how often they happen. Never stop or change anti-seizure medication on your own, because this can trigger more seizures.
Call emergency services if a seizure lasts longer than 5 minutes, if one seizure follows another without the person recovering in between, if the person is injured or has trouble breathing, or if it is their first ever seizure. During a seizure, gently move the person onto their side, cushion their head, remove nearby hazards, and never put anything in their mouth. Stay with them until they are fully recovered.