What is the difference between a seizure and epilepsy?

A seizure is a single episode of abnormal electrical activity in the brain. Epilepsy is a neurological condition defined by a tendency to have recurrent seizures — typically diagnosed after two unprovoked seizures, or after one seizure when the risk of recurrence is considered high (e.g., due to a brain lesion or abnormal EEG). Not everyone who has a seizure has epilepsy.

Can epilepsy go away?

Some forms of epilepsy, particularly certain childhood epilepsy syndromes, do go into remission. Many people with epilepsy achieve long-term seizure freedom on medication and may, under specialist guidance, be able to eventually trial withdrawal. For others, epilepsy is a lifelong condition requiring ongoing treatment. This depends heavily on epilepsy type and individual factors.

Are all seizures convulsions?

No. Convulsions (tonic-clonic seizures with jerking movements and loss of consciousness) are one type of seizure and the most widely recognised. Many seizures involve no convulsions — they may present as brief blank staring (absence seizures), repetitive automatisms (lip-smacking, hand-rubbing), sudden muscle tone loss, or a feeling of déjà vu or unreality with maintained consciousness.

What should I do if someone is having a seizure?

Stay calm. Protect the person from injury by moving hard objects away. Do not restrain them or put anything in their mouth. Roll them onto their side (recovery position) once convulsive movements stop. Time the seizure. Call an ambulance if the seizure lasts more than 5 minutes, if they do not regain consciousness, if another seizure follows, if they are injured, or if this is their first known seizure.

Can people with epilepsy drive?

Driving regulations for people with epilepsy vary by country. In most jurisdictions, people with uncontrolled seizures are not permitted to drive. After a period of seizure freedom (typically 12 months in many countries, or 6 months after the first unprovoked seizure in some), driving may be permitted subject to medical clearance. Your neurologist and licensing authority are the appropriate sources for current guidance specific to your location.

SUDEP stands for Sudden Unexpected Death in Epilepsy. It is a rare but real complication — defined as the sudden, unexpected, non-traumatic, non-drowning death of a person with epilepsy. The annual risk is approximately 1 in 1,000 people with epilepsy. Risk is higher in those with uncontrolled convulsive seizures, nocturnal seizures, and certain high-risk profiles. Good seizure control — through medication, lifestyle, and regular specialist care — substantially reduces SUDEP risk.

Epilepsy: Seizures, Diagnosis, Treatment, and Living Safely

Intro

Epilepsy is one of the world’s most common neurological conditions, affecting approximately 50 million people globally. It is characterised by a tendency to have recurrent, unprovoked seizures — episodes of abnormal electrical activity in the brain that temporarily disrupt normal function.

Epilepsy is not a single disease. It is a spectrum of conditions with different seizure types, causes, severities, and outcomes. Many people with epilepsy achieve excellent seizure control and live full, active lives. Understanding the condition — including how to manage it, what to avoid, and how to stay safe — is central to living well.

Key Points

Epilepsy affects approximately 50 million people worldwide; about 1 in 26 people will develop it at some point in their life
Seizures vary enormously — from brief blank stares to generalised convulsions
Diagnosis requires clinical assessment, EEG, and often brain MRI
Most people achieve seizure control with one or two antiseizure medications
Seizure triggers (sleep deprivation, alcohol, stress, illness) should be identified and managed
Driving restrictions apply in most countries during periods of uncontrolled seizures
SUDEP — sudden unexpected death in epilepsy — is rare but can be reduced by optimising seizure control

Background: What Causes Seizures?

The brain communicates via electrical signals. A seizure occurs when abnormal, excessive, or hypersynchronous electrical activity disrupts normal function — either in one brain region or across the whole brain.

Causes of epilepsy include

Structural: brain lesions from stroke, tumour, traumatic brain injury, cortical malformations
Genetic: many epilepsy syndromes have identified genetic mutations (ion channel genes, etc.)
Metabolic: low sodium, low glucose, low calcium, thyroid disorders
Autoimmune: autoimmune encephalitis (anti-NMDA receptor, LGI1, CASPR2 antibodies)
Infectious: meningitis, encephalitis, cerebral abscess
Unknown (cryptogenic): no identifiable cause despite investigation — the most common category in adults

Types of Seizures

The ILAE (International League Against Epilepsy) classifies seizures by how they begin:

Focal-onset seizures (arising from one brain region)

Focal aware (previously “simple partial”): person remains conscious; may experience tingling, visual disturbances, déjà vu, rising stomach sensation, fear, or abnormal movements confined to one body part
Focal impaired awareness (previously “complex partial”): consciousness is altered; may involve automatisms — repetitive semi-purposeful movements like lip-smacking, chewing, hand-rubbing; person may appear confused or dazed
Focal to bilateral tonic-clonic: a focal seizure that spreads to become a generalised convulsion

Generalised-onset seizures (involving both hemispheres simultaneously)

Tonic-clonic (“grand mal”): loss of consciousness, stiffening (tonic phase), followed by rhythmic jerking (clonic phase); usually 1–3 minutes, followed by postictal confusion and fatigue
Absence (“petit mal”): brief (5–30 second) blank staring, unresponsiveness; may involve eye blinking or subtle automatisms; common in childhood epilepsy syndromes
Myoclonic: sudden, brief muscle jerks — often affect arms; can cause objects to fly from hands; common on awakening
Tonic: sudden muscle stiffening, may cause falls
Atonic (“drop attacks”): sudden loss of muscle tone causing falls
Clonic: rhythmic jerking without preceding tonic phase

Unknown onset

Some seizures cannot be classified due to limited information about onset.

Diagnosis

Clinical history

The most important diagnostic tool is a detailed account of what happened — ideally from a witness as well as the patient. Neurologists assess: what the person was doing before, early sensations (aura), what the seizure looked like, duration, recovery time, and any incontinence or tongue biting.

Electroencephalogram (EEG)

An EEG records electrical brain activity via scalp electrodes. EEG can:

Identify abnormal epileptiform discharges (spikes, sharp waves) that support an epilepsy diagnosis
Help classify seizure type and epilepsy syndrome
Guide medication selection

A normal EEG does not exclude epilepsy — EEG has significant limitations. Prolonged EEG monitoring and video-EEG (simultaneous EEG and video recording of a seizure) improve diagnostic yield.

Brain MRI

Standard investigation for newly diagnosed epilepsy. Identifies structural causes (tumour, mesial temporal sclerosis, cortical dysplasia, vascular lesions). High-resolution epilepsy-protocol MRI is preferred.

Blood tests

Glucose, electrolytes, calcium, liver and kidney function, full blood count — to exclude metabolic causes of acute seizures and baseline values before medication.

Additional tests when indicated

Video-EEG telemetry: inpatient recording of actual seizures with simultaneous EEG — the gold standard for diagnosis and pre-surgical evaluation
Autoimmune encephalitis panel: if autoimmune cause suspected
Genetic testing: in unexplained epilepsy, particularly in children or with a family history

Antiseizure Medications (ASMs)

The goal of antiseizure medication is seizure freedom with acceptable side effects. About 70% of people with epilepsy achieve seizure control with medication.

Starting treatment

Treatment is generally started after two unprovoked seizures, or after one seizure when recurrence risk is high. The first medication chosen depends on seizure type, epilepsy syndrome, age, sex, and other medical factors.

Commonly used medications

Medication	Common uses	Key considerations
Levetiracetam	Focal, generalised	Widely used; can cause irritability/mood change
Lamotrigine	Focal, generalised	Requires slow titration; preferred in women of childbearing age
Valproate	Generalised (especially absence, JME)	Highly effective; significant teratogen — avoid in women who may become pregnant
Carbamazepine	Focal	Effective; multiple drug interactions
Lacosamide	Focal	Well tolerated; fewer interactions
Ethosuximide	Absence seizures only	First-line for pure absence
Zonisamide	Focal, generalised	Once-daily dosing; weight neutral
Topiramate	Focal, generalised	Cognitive side effects; causes weight loss
Brivaracetam	Focal	Fewer behavioural side effects than levetiracetam
Perampanel	Focal, generalised tonic-clonic	Once daily; aggression/mood risk

Drug-resistant epilepsy

Defined as failure of two appropriately chosen and tolerated ASMs. Approximately 30% of people with epilepsy do not achieve seizure freedom with medication. These patients should be referred to an epilepsy specialist or comprehensive epilepsy programme for further evaluation, including consideration of surgery.

Epilepsy Surgery

For carefully selected patients with drug-resistant focal epilepsy, surgery can be curative or substantially improve seizure control.

Temporal lobectomy (for mesial temporal lobe epilepsy): seizure freedom in 60–70% of carefully selected patients
Lesionectomy: removal of a structural lesion causing seizures
Laser ablation (LITT): minimally invasive thermal ablation of seizure focus
Corpus callosotomy: reduces spread of seizures; used for drop attacks
Vagus nerve stimulation (VNS): implantable device that reduces seizure frequency in drug-resistant epilepsy; not curative but adjunctive
Responsive neurostimulation (RNS): closed-loop brain stimulation device that detects and interrupts seizure activity

Seizure Triggers

Identifying and managing personal triggers can significantly reduce seizure frequency:

Sleep deprivation — one of the most consistent triggers across epilepsy types; prioritise sufficient, regular sleep
Alcohol — lowers seizure threshold; binge drinking is particularly high-risk
Missed medication — the most common preventable cause of breakthrough seizures
Fever and illness — particularly in febrile-prone epilepsy syndromes
Stress — indirect trigger through sleep disruption and physiological arousal
Hormonal changes — some women experience catamenial epilepsy (seizure clustering around menstruation)
Flashing lights (photosensitive epilepsy) — affects ~3% of people with epilepsy; generalised epilepsies most commonly

A seizure diary helps identify personal patterns.

Safety Considerations

What to do during a seizure (for bystanders)

Stay calm; note the time the seizure starts
Protect from injury — move hard objects away; cushion the head
Do not restrain movements
Do not put anything in the person’s mouth — there is no risk of “swallowing the tongue”
Once convulsive movements stop, roll into the recovery position (on their side)
Stay with the person until fully recovered

Call an ambulance if:

The seizure lasts more than 5 minutes (or longer than their usual seizures)
Another seizure follows without full recovery
The person is injured or not breathing after the seizure
This is the person’s first known seizure
You are uncertain whether recovery is complete

Home safety

Showering rather than bathing (drowning risk)
Padding sharp furniture corners
Cooking on back hob rings
Avoiding working at heights or near open water without safeguards

Work and activity

Most people with well-controlled epilepsy can work across a wide range of occupations. High-risk roles (working at heights, operating heavy machinery, certain transport roles) require specific assessment.

Driving

Driving with uncontrolled epilepsy poses significant safety risk. Most countries have laws that restrict driving:

Most jurisdictions require a seizure-free period (commonly 6 or 12 months) before a licence can be held or regained
Rules vary for different licence types (car, heavy vehicle, motorcycle)
Reporting obligations vary — check your local licensing authority and seek specialist advice

Your treating neurologist can advise on current guidelines applicable to your situation.

SUDEP: Sudden Unexpected Death in Epilepsy

SUDEP is a rare complication in which a person with epilepsy dies suddenly and unexpectedly without an identified cause. It is most commonly associated with uncontrolled convulsive seizures and nocturnal seizures.

The annual risk is approximately 1 in 1,000 people with epilepsy — placing it in perspective as rare, but not negligible. Risk is substantially lower in those with well-controlled seizures.

Risk reduction strategies:

Optimise seizure control — medication adherence, specialist review, considering surgery if appropriate
Avoid seizure triggers — particularly sleep deprivation and alcohol
Nocturnal monitoring — for those with nocturnal seizures, listening monitors or specialist seizure detection devices may be discussed with a neurologist
Not sleeping alone when seizure risk is high — particularly for high-risk individuals

SUDEP should be discussed openly between patients, families, and clinicians — awareness enables risk reduction without creating unnecessary fear.

Women and Epilepsy

Women with epilepsy require additional consideration in several areas:

Contraception: some ASMs (enzyme-inducing drugs like carbamazepine, phenytoin) reduce the effectiveness of hormonal contraception; specialist advice is essential
Pregnancy: most women with epilepsy have healthy pregnancies; folate supplementation is recommended before conception; valproate is teratogenic and must not be used in women who may become pregnant without compelling specialist justification
Catamenial epilepsy: seizure clustering with the menstrual cycle; may respond to hormonal or medication strategies

Mental Health and Epilepsy

Depression and anxiety are approximately two to three times more common in people with epilepsy than the general population. This is partly biological (shared brain mechanisms), partly due to the burden of living with an unpredictable condition.

Mental health should be actively assessed and treated — not accepted as inevitable. See Depression and Anxiety for evidence-based management options.