Quick answer

What is epilepsy?

Epilepsy is tendency to have recurrent unprovoked seizures — sudden bursts of electrical activity in the brain causing convulsions, staring spells, or unusual sensations. One seizure does not always mean epilepsy — diagnosis usually requires two or more. Anti-seizure medicines control seizures in about 70% of people. Phone 999 for seizure lasting over 5 minutes, repeated seizures, or first seizure with injury or pregnancy.

Epilepsy — recurrent seizures explained

Epilepsy is diagnosed when a person has a tendency to recurrent unprovoked seizures — sudden disruptive electrical discharges in the brain.

Seizure ≠ epilepsy always — one seizure from acute cause (hypoglycaemia, hangover withdrawal, high fever in child) needs workup but may not label epilepsy.

UK prevalence: ~600,000 people — 1 in 100.

What happens during a seizure

Neurons fire abnormally — synchronously — symptoms depend on where in brain and spread.

Generalised tonic-clonic (grand mal)

  • cry at start (air forced out)
  • stiffening (tonic) then jerking (clonic)
  • loss of consciousness
  • ** tongue biting**, incontinence
  • post-ictal confusion — minutes to hours

Absence (petit mal) — mainly children

  • brief blank stare — 5 to 10 seconds
  • ** eyelid flutter**
  • no post-ictal confusion — dozens daily possible — affects school

Focal (partial) seizures

  • aware or impaired awareness
  • automatisms — lip smacking, picking clothes
  • auras — déjà vu, strange smell, rising epigastric sensation
  • may generalise to tonic-clonic

Causes and triggers

Structural:

  • stroke, tumour, head trauma, infection, ** cortical malformation**

Genetic — many idiopathic generalised epilepsies

Triggers (in known epilepsy):

  • ** missed medicines** — commonest avoidable cause
  • sleep deprivation
  • alcohol excess and withdrawal
  • flashing lights — photosensitive epilepsy (minority)
  • menstruation (catamenial)

First seizure assessment

A&E or same-day GP:

  • glucose, electrolytes
  • ECG if cardiac syncope suspected
  • CT/MRI brain if indicated
  • EEG — outpatient
  • refer neurology

Syncope vs seizure:

  • syncope — pale, brief jerks, rapid recovery
  • seizure — cyanosis, prolonged confusion, tongue lateral bite

Treatment

Anti-seizure medications (ASMs)

First-line depends on seizure type:

  • lamotrigine, levetiracetam, sodium valproate (not in women of childbearing potential without Pregnancy Prevention Programme)
  • carbamazepine, phenytoin — focal
  • ethosuximide — absence

Monotherapy preferred — add second if needed.

70% become seizure-free on first or second drug.

Non-drug

  • ketogenic diet — children, refractory adults — specialist
  • surgery — resect focal lesion — curative potential
  • VNS — vagus nerve stimulator

First aid — tonic-clonic

DO:

  • stay calm, time seizure
  • protect head, move hazards
  • recovery position when jerking stops
  • 999 if >5 min or injury/pregnancy/first seizure

DON’T:

  • restrain
  • put objects in mouth
  • give food/drink until fully alert

Driving and lifestyle

DVLA notification mandatory — 6-month seizure-free rule typical for Group 1.

Swimming, heights, baths — risk assessment.

Sudden unexplained death in epilepsy (SUDEP) — rare — medicine adherence reduces risk.

Status epilepticus — emergency

Seizure ≥5 minutes or cluster without recovery — 999 — benzodiazepines (buccal midazolam, rectal diazepam) if rescue plan.

Epilepsy is common, stigmatised, and treatable — one seizure needs neurology, not assumption it will never recur.

Common questions

What causes epilepsy?
Often no identified cause — genetic predisposition common. Known causes include brain injury, stroke, tumour, infection, birth injury, and developmental malformations. A single seizure from alcohol withdrawal or high fever is not epilepsy — recurrent unprovoked seizures define epilepsy.
What are the signs of a seizure?
Tonic-clonic — body stiffens, jerking limbs, loss of consciousness, may bite tongue, incontinence, confusion after. Absence — brief blank stare, eyelid fluttering in children. Focal — strange smell, déjà vu, involuntary movement one body part — may spread. Not all seizures involve full convulsions.
How is epilepsy diagnosed?
Clinical history from witness essential — EEG records brain electrical activity — may be normal between seizures. MRI brain excludes structural cause. Diagnosis usually after two unprovoked seizures or one with high recurrence risk on EEG/MRI.
Can epilepsy be cured?
Medicines control seizures in about 70% — taken long term. Some become seizure-free and taper medicines under specialist supervision. Epilepsy surgery cures selected focal epilepsies. Vagus nerve stimulation and ketogenic diet for refractory cases — specialist centres.
What should you do if someone has a seizure?
Protect from injury — cushion head, clear space, do not restrain or put anything in mouth. Time seizure — call 999 if over 5 minutes or first known seizure with injury. After tonic-clonic ends, recovery position, stay until alert. Note time and features for doctor.
Can you drive with epilepsy?
Must notify DVLA after unprovoked seizure — Group 1 (car/motorcycle) usually cannot drive for 6 months seizure-free off medicines or 6 months on stable treatment depending on circumstances. Stricter for HGV/bus. Failure to notify invalidates insurance.

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