Epilepsy
A chronic neurological disorder defined by recurrent unprovoked seizures.
Overview
Epilepsy is a condition in which a person has a lasting predisposition to seizures, defined by ≥2 unprovoked seizures more than 24 hours apart, or one seizure with high recurrence risk. Most people achieve seizure freedom with medication.
Symptoms
- • Focal seizures: limb jerking, sensory changes, déjà vu, automatisms
- • Generalised tonic-clonic seizures: loss of consciousness, stiffening then jerking
- • Absence seizures: brief blank staring (especially children)
- • Post-ictal confusion, tongue biting, incontinence
- • Auras (warning sensations) before some seizures
Risk factors
- • Family history of epilepsy
- • Previous head injury, stroke or CNS infection
- • Developmental brain abnormalities
- • Older age (stroke-related) and very young age
Causes
- • Genetic (most generalised epilepsies)
- • Structural: stroke, tumour, trauma, cortical malformation
- • Infections: meningitis, encephalitis, neurocysticercosis
- • Metabolic and autoimmune causes
- • Unknown in around 30%
🚨 Red flags — seek urgent care
- • First-ever seizure — emergency assessment
- • Seizure lasting >5 minutes or repeated without recovery (status epilepticus) — call emergency services
- • Seizure with fever, neck stiffness or persistent confusion
- • Injury, drowning risk, or pregnancy seizure
When to seek care
- • Any new seizure
- • Change in seizure pattern or frequency
- • Side effects from anti-seizure medication
Diagnosis
- • Detailed eye-witness account is the cornerstone
- • EEG to support classification (normal EEG does not exclude epilepsy)
- • MRI brain to identify structural cause
- • Blood tests, ECG and toxicology to exclude mimics
Treatment
- • Anti-seizure medication chosen by seizure type — lamotrigine, levetiracetam, valproate (avoid in females of childbearing potential)
- • Aim for monotherapy at the lowest effective dose
- • Surgery for drug-resistant focal epilepsy
- • Vagus nerve stimulation, ketogenic diet in selected cases
- • Driving, lifestyle and pregnancy counselling
Prevention
- • Helmet use and injury prevention
- • Stroke prevention and vaccination against CNS infections
- • Medication adherence and trigger avoidance (sleep deprivation, alcohol)
Complications
- • Injury, drowning, burns
- • Status epilepticus
- • Sudden Unexpected Death in Epilepsy (SUDEP)
- • Depression, anxiety and cognitive effects of seizures and drugs
Prognosis
Around 70% of people become seizure-free on medication. Drug-resistant epilepsy affects ~30% and may benefit from surgery or device therapy.
Education & self-care
Epilepsy is highly treatable. Most people achieve full seizure control and normal life with the right medication and adherence.
Frequently asked questions
Can I drive with epilepsy?
Driving rules vary by country and seizure type. Most jurisdictions require a seizure-free period (often 12 months) before driving resumes.
Is epilepsy lifelong?
Some childhood epilepsies remit; many adults need long-term treatment, but seizure freedom is achievable for most.
Can I drive with epilepsy?
In the UK, drivers must be seizure-free for 12 months (Group 1) or 10 years (Group 2) before regaining a licence, and must inform the DVLA. Rules vary internationally.
Will I always need medication?
About 70% of people achieve good seizure control on a single anti-seizure medication. After several years of being seizure-free, some can taper off treatment under specialist supervision.
Are pregnancy and epilepsy compatible?
Yes, with planning. Specialist preconception advice is essential because some anti-seizure medications (especially sodium valproate) carry significant risks to the developing baby.