Epilepsy: Causes, Symptoms, Seizure First Aid, Treatment and How to Live Well

Epilepsy is a neurological condition that can affect people of any age. Although many people associate epilepsy only with dramatic shaking or falling to the ground, seizures can take many different forms. Some people may stare blankly for a few seconds, become confused, make unusual movements or temporarily lose awareness.

Understanding epilepsy is important because knowing what to do during a seizure can help prevent injuries and may even save a life.

According to the World Health Organization (WHO), around 50 million people worldwide live with epilepsy. Nearly 80% of people with epilepsy live in low- and middle-income countries. WHO also estimates that up to 70% of people with epilepsy could become seizure-free when they receive appropriate diagnosis and treatment.

Despite this, epilepsy remains surrounded by fear, misinformation and stigma in many communities.

This article explains what epilepsy is, what causes it, the symptoms to look for, what to do when someone has a seizure, available treatments and how people living with epilepsy can protect their health and maintain a fulfilling life.

What Is Epilepsy?

Epilepsy is a chronic disorder of the brain characterized by a tendency to have recurrent seizures.

A seizure occurs when there is a sudden burst of abnormal electrical activity in the brain. Depending on where the abnormal activity begins and how it spreads, a seizure can affect movement, awareness, sensation, emotions, behaviour or other brain functions.

Having one seizure does not automatically mean that a person has epilepsy. WHO notes that epilepsy is generally associated with recurrent unprovoked seizures, while a single seizure can occur in people who do not have epilepsy.

Epilepsy is not contagious. You cannot catch epilepsy by touching, hugging, sharing food or living with someone who has the condition.

What Causes Epilepsy?

There is no single cause of epilepsy.

WHO groups possible causes into several categories, including structural, genetic, infectious, metabolic, immune and unknown causes. In many people, however, doctors cannot identify one specific cause.

Possible causes include:

1. Brain injury

A serious head injury can damage the brain and increase the risk of seizures.

Road traffic accidents, falls, sports injuries and other forms of trauma can sometimes result in brain damage associated with epilepsy.

2. Stroke

A stroke can damage brain tissue and may lead to seizures, particularly in older adults.

3. Brain infections

Certain infections affecting the brain, including meningitis and encephalitis, can contribute to epilepsy.

In some parts of the world, parasitic infections such as neurocysticercosis can also be associated with epilepsy.

4. Problems before or around birth

Brain injury occurring before or during birth can sometimes contribute to epilepsy.

Examples include reduced oxygen supply to the brain and certain complications associated with pregnancy or childbirth.

5. Genetic factors

Some forms of epilepsy are associated with genetic conditions. Having a family history does not necessarily mean that a person will develop epilepsy, but genetics can play a role in some cases.

6. Brain abnormalities or tumours

Structural abnormalities of the brain and certain brain tumours may cause seizures.

7. Unknown causes

Sometimes extensive medical evaluation cannot identify why a person has epilepsy.

This does not mean the seizures are imaginary or that the person is responsible for the condition.

What Are the Symptoms of Epilepsy?

Epilepsy symptoms can vary considerably from one person to another.

A seizure may involve:

Sudden loss of awareness
Staring blankly
Confusion
Uncontrolled shaking or jerking
Sudden muscle stiffness
Repeated movements
Temporary inability to respond
Strange sensations or feelings
Changes in vision, hearing, smell or taste
Temporary loss of consciousness
Falling suddenly
Confusion or extreme tiredness after the seizure

Some seizures are obvious, while others can be subtle and may initially be mistaken for daydreaming, behavioural problems or ordinary confusion.

Different Types of Seizures

There are many types of seizures, but they are broadly classified according to where they begin in the brain.

Focal seizures

Focal seizures begin in one area of the brain.

They can affect awareness, movement, emotions, sensations or behaviour.

A person may remain conscious but experience unusual sensations or movements. In other cases, awareness may become impaired.

A focal seizure can sometimes spread and affect both sides of the brain.

Generalized seizures

Generalized seizures involve both sides of the brain from the beginning.

One well-known type is a tonic-clonic seizure, which can cause the person to become unconscious, fall and experience muscle stiffening followed by rhythmic jerking.

Afterwards, the person may be tired, confused or need time to recover.

Absence seizures

Absence seizures can cause brief periods of reduced awareness.

The person may suddenly stare into space and appear unresponsive for a short period.

These seizures can be particularly difficult to recognize in children because they may look like ordinary daydreaming.

What Should You Do When Someone Has a Seizure?

Knowing seizure first aid is extremely important.

If you see someone having a seizure, stay calm and stay with the person.

Step 1: Protect the person from injury

Move nearby dangerous objects away.

If the person is falling, help them reach the ground safely if you can do so without putting yourself at risk.

Step 2: Cushion the head

Place something soft and flat under the person's head if possible.

Remove glasses and loosen tight clothing around the neck.

Step 3: Turn the person onto their side

If the person is lying down, gently turn them onto their side when possible. This can help keep the airway clear.

Step 4: Time the seizure

Use a watch or phone to determine how long the seizure lasts.

This information can be extremely important for medical professionals.

Step 5: Stay with them

Remain nearby until the seizure ends and the person becomes alert.

After the seizure, they may be confused, frightened or exhausted. Reassure them and explain calmly what happened.

These steps are consistent with CDC seizure first-aid guidance.

What You Should NEVER Do During a Seizure

There are several dangerous myths about seizures.

Do not put anything in the person's mouth

Do not put a spoon, finger, cloth, food, medicine or any other object into the person's mouth.

This can cause injury or choking.

Do not hold the person down

Trying to physically restrain someone during a seizure can cause injuries.

Instead, clear dangerous objects away and allow the seizure to run its course.

Do not give food or water during the seizure

Wait until the person is fully alert before offering food, drink or oral medication.

Do not panic

A seizure can look frightening, but staying calm allows you to provide better assistance.

When Is a Seizure an Emergency?

Most seizures do not require emergency medical attention, but certain situations require urgent help.

Seek emergency medical assistance if:

The seizure lasts longer than five minutes.
Another seizure begins soon after the first.
The person has difficulty breathing after the seizure.
The person does not regain consciousness or awareness as expected.
The person is seriously injured.
The seizure happens in water.
It is the person's first known seizure.
The person is pregnant.
The person has diabetes and loses consciousness.

These are among the emergency situations identified by the CDC.

How Is Epilepsy Diagnosed?

A healthcare professional will usually begin by taking a detailed medical history.

Doctors may want to know:

What happened before the seizure?
What did the person's body do during the episode?
How long did it last?
Was the person conscious?
What happened immediately afterwards?
Has this happened before?
Are there possible triggers?
Is there a family history of seizures?

A doctor may also use tests such as an electroencephalogram (EEG), which records electrical activity in the brain.

Other investigations may be needed depending on the person's symptoms and suspected cause.

WHO notes that epilepsy can often be diagnosed and treated at the primary healthcare level, although some people require specialist assessment.

How Is Epilepsy Treated?

Treatment depends on the type of seizure, the underlying cause, the person's age, overall health and other individual factors.

Anti-seizure medicines

Anti-seizure medicines are commonly used to control seizures.

Finding the most appropriate medication and dose can sometimes take time.

A person should take prescribed medication exactly as directed by their healthcare professional.

Do not stop epilepsy medication suddenly without medical advice.

Suddenly stopping some seizure medicines can cause serious or potentially life-threatening seizures.

Surgery

For some people whose seizures are difficult to control with medication, surgery may be considered.

This is particularly relevant when doctors can identify a specific area of the brain where seizures begin.

Medical devices

Certain implanted or specialized devices may be used in selected patients whose seizures remain difficult to control.

Special diets

In some situations, particularly for certain children with difficult-to-control epilepsy, a ketogenic diet may be recommended under professional medical supervision.

It should not be started casually without guidance from a qualified healthcare professional and dietitian.

Can Epilepsy Be Cured?

There is no single answer because epilepsy has many different causes and forms.

However, epilepsy can often be effectively controlled.

WHO estimates that up to 70% of people living with epilepsy could become seizure-free with appropriate diagnosis and treatment.

Some people may eventually be able to stop medication under medical supervision after a sustained period without seizures.

That decision must be made with a healthcare professional. A person should never stop medication simply because they have been seizure-free for a while.

Can Someone With Epilepsy Live a Normal Life?

Yes.

Many people with epilepsy attend school, work, have families, pursue careers and participate in everyday activities.

However, people may need to make safety adjustments depending on their seizure pattern and medical advice.

Helpful habits can include:

Taking medication as prescribed
Getting adequate sleep
Attending medical appointments
Learning personal seizure triggers
Avoiding known triggers where possible
Following medical advice about driving
Taking appropriate precautions around water and heights
Informing trusted people about seizure first aid

CDC guidance emphasizes medication adherence and self-management as important parts of living well with epilepsy.

Common Seizure Triggers

Triggers vary from person to person.

Possible triggers can include:

Lack of sleep
Missing prescribed medication
Stress
Alcohol
Illness or fever
Certain flashing or rapidly changing lights in some people
Hormonal changes in some individuals

Not everyone with epilepsy has identifiable triggers.

Keeping a seizure diary can help a person and their healthcare provider identify patterns.

Epilepsy and Children

Epilepsy can occur during childhood.

Parents, teachers and caregivers should understand that seizures do not always involve dramatic shaking.

A child may instead stare into space, suddenly become unresponsive, behave unusually or experience brief repeated episodes.

If a child repeatedly has unexplained episodes of staring, unusual movements, loss of awareness or other concerning symptoms, parents or guardians should seek medical evaluation.

Early assessment can help identify the cause and determine whether treatment is necessary.

Epilepsy and Stigma

One of the biggest challenges facing people with epilepsy is not always the seizure itself.

It can be the reaction of other people.

Some communities still associate epilepsy with myths, curses, spiritual punishment or supernatural causes.

These beliefs can lead to discrimination and prevent people from seeking appropriate medical care.

Epilepsy is a neurological medical condition. It is not contagious, and a person having a seizure should be treated with dignity and compassion.

WHO specifically identifies stigma and discrimination as ongoing problems for people with epilepsy and their families.

Education is one of the best ways to challenge these misconceptions.

What Family Members Should Know

If someone in your family has epilepsy, learn their seizure first-aid plan.

Family members should know:

What the person's seizures normally look like
How long their seizures usually last
What medication they take
When emergency medical help should be called
What their doctor has advised
How to keep them safe during and after a seizure

People who regularly care for someone with epilepsy can benefit from learning formal seizure first aid.

Epilepsy Is Not a Reason to Give Up

An epilepsy diagnosis can be frightening.

Some people worry about school, employment, relationships, marriage, pregnancy, driving or their future.

But epilepsy does not automatically prevent someone from having a productive and meaningful life.

The most important steps are proper medical assessment, appropriate treatment, safety planning and support.

People with epilepsy should be encouraged to discuss their individual circumstances with qualified healthcare professionals rather than allowing fear or misinformation to determine their choices.

When Should You See a Doctor?

Seek medical attention if you or someone around you experiences a possible first seizure.

A medical evaluation is especially important if there is:

Loss of consciousness
Repeated unexplained episodes
Uncontrolled shaking
Sudden unexplained confusion
Repeated staring episodes
Unusual movements
Seizures following a head injury
Seizures associated with fever or illness

A first seizure should not simply be dismissed as stress, tiredness or spiritual activity without proper medical assessment.

The Bottom Line

Epilepsy is a neurological condition that can affect anyone, regardless of age, background or social status.

A seizure does not always look like violent shaking. Some seizures may appear as staring, confusion, unusual movements or temporary loss of awareness.

The good news is that epilepsy can often be controlled effectively. With appropriate diagnosis and treatment, many people can become seizure-free and live active, productive lives.

Perhaps the most important thing everyone should learn is seizure first aid:

Keep the person safe. Clear dangerous objects away. Turn them gently onto their side when appropriate. Time the seizure. Stay with them. Never put anything in their mouth and never restrain them.

And remember: if a seizure lasts more than five minutes, another seizure follows immediately, the person has difficulty breathing or waking up, suffers an injury, or the seizure occurs in other emergency circumstances, seek urgent medical assistance.

Most importantly, epilepsy should not be surrounded by shame.

Knowledge can replace fear, and compassion can replace stigma.

Medical Disclaimer

This article is intended for general educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. If you or someone you know is experiencing seizures or symptoms that could indicate epilepsy, consult a qualified healthcare professional. In an emergency, seek immediate medical assistance.