Overview
A brief blank stare that lasts a few seconds, or a sudden convulsion that lasts minutes, both can be a seizure, and epilepsy is the tendency to have them more than once, unprovoked. It is one of the most common neurological conditions in the world, and one of the most treatable, yet in many parts of Africa, most people living with it never receive the medication that could make it manageable.
Disease Summary
- Category
- Non-Communicable Disease
- Cause
- Abnormal electrical activity in the brain, arising from many possible causes including brain injury, infection, or stroke, though in many cases no clear cause is found
- Transmission
- Not applicable; epilepsy is a non-communicable neurological condition and cannot be spread between people
- Body System
- Nervous System
- Preventable
- Yes
- Curable
- No
Symptoms
Common Symptoms
Seizures can look very different from person to person, and even from one seizure to the next in the same person.
Convulsive Seizures
Involve stiffening and rhythmic jerking of the body, often with a loss of consciousness. This is the presentation most people associate with epilepsy.
Staring Spells or Brief Confusion
Non-convulsive seizures can look like a blank stare, brief confusion, or a short period of not responding, and are easy to miss or misinterpret.
Unusual Sensations Before a Seizure
Some people notice a warning sign, sometimes called an aura, such as a strange smell, taste, or feeling, shortly before a seizure begins.
Temporary Confusion After a Seizure
A period of tiredness or confusion, sometimes lasting minutes to hours, commonly follows a seizure.
Repetitive Movements
Unusual, repeated movements such as blinking, chewing, or hand movements can occur during some types of seizures.
Danger Signs
Seek emergency medical attention immediately if any of the following occur.
A Seizure Lasting Longer Than Five Minutes
Needs emergency care, since prolonged seizures can cause lasting harm.
A Second Seizure Without Full Recovery
Back-to-back seizures without regaining consciousness in between is a medical emergency.
Difficulty Breathing or Persistent Blue Lips
Needs immediate emergency attention after a seizure.
A Seizure After Head Injury, High Fever, or During Pregnancy
Each of these situations needs prompt medical evaluation.
Diagnosis
Detailed Clinical History
A description of the seizure, ideally from someone who witnessed it, is often the most important piece of information for diagnosis.
Electroencephalogram (EEG)
Records the brain’s electrical activity and can help identify patterns associated with epilepsy.
Brain Imaging (MRI or CT)
Looks for a structural cause, such as scarring, a tumour, or damage from a past injury or infection.
Laboratory Tests
Electroencephalogram (EEG)
Records electrical activity in the brain and can reveal patterns associated with epilepsy, even between seizures.
MRI or CT Brain Imaging
Looks for a structural cause in the brain, such as scarring, a tumour, or past injury.
Blood Tests
Help rule out other causes of seizure-like symptoms, such as low blood sugar or an electrolyte imbalance.
Testing for Underlying Infections
In endemic regions, testing for conditions like neurocysticercosis or onchocerciasis may be considered if there is reason to suspect them.
Treatment
Antiseizure Medication
The main treatment for epilepsy, and often highly effective. Up to 70 percent of people become seizure-free with appropriate use.
Surgery
Considered for some people whose seizures do not respond well to medication, particularly when a specific area of the brain is identified as the source.
Prevention
Support good prenatal and birth care
Reduces the risk of the birth-related brain injury that is a significant cause of epilepsy in some regions.
Prevent and promptly treat brain infections
Conditions like meningitis and encephalitis are preventable and treatable causes of epilepsy.
Reduce exposure to neurocysticercosis
Good sanitation and thoroughly cooking pork reduce the risk of this parasitic infection, a significant preventable cause of epilepsy in some regions.
Prevent head injuries
Using seatbelts, helmets, and general road safety reduces the risk of traumatic brain injury, a known cause of epilepsy.
Risk Factors
Higher Risk
These factors are linked to a higher chance of developing epilepsy.
- Brain injury during birth, including low birth weight or oxygen loss
- A family history of epilepsy or a genetic condition affecting the brain
- Traumatic head injury
Infections Linked to Epilepsy
These conditions, more common in some regions, are recognised causes of epilepsy.
- Brain infections such as meningitis or encephalitis
- Neurocysticercosis, a parasitic infection from pork tapeworm
- Onchocerciasis, in areas with poorly controlled transmission
- Severe malaria affecting the brain
Other Contributing Factors
Additional recognised causes of epilepsy.
- Stroke, particularly in older adults
- Brain tumours
Complications
Status Epilepticus
A prolonged or repeated seizure without recovery in between, a medical emergency that can cause lasting harm if not treated promptly.
Injury During a Seizure
Falls, burns, and drowning are among the most common preventable causes of harm and death related to epilepsy.
Sudden Unexpected Death in Epilepsy (SUDEP)
A rare but serious risk, more common in people with poorly controlled seizures.
When to Seek Medical Care
A Seizure Lasting Longer Than Five Minutes
Needs emergency care immediately.
A First-Ever Seizure
Should always be evaluated by a healthcare provider, even if it resolves on its own.
Seizures Becoming More Frequent or Severe
Suggests treatment may need to be adjusted and should be discussed with a healthcare provider.
Injury During or After a Seizure
Should be assessed, particularly after a fall or head injury.
Prognosis
Highly Controllable With Treatment
Up to 70 percent of people with epilepsy can become seizure-free with appropriate medication.
Outcomes Depend Heavily on Access to Care
The treatment gap in some low-income countries reaches as high as 90 percent, meaning most people who could be seizure-free are not receiving treatment.
Many Underlying Causes Are Preventable
Reducing birth-related injury and preventable infections could significantly lower the overall burden of epilepsy.
Differential Diagnosis
Fainting (Syncope)
Can involve a brief loss of consciousness similar to a seizure, but is usually triggered by a drop in blood flow to the brain rather than abnormal electrical activity.
Febrile Seizures in Children
Seizures triggered by high fever in young children are common and usually do not indicate epilepsy on their own.
Bacterial Meningitis
Can cause seizures during the acute illness, though this differs from the recurring, unprovoked pattern seen in epilepsy.
References
World Health Organization (WHO)
World Health Organization fact sheet on epilepsy causes, symptoms, treatment, and the global treatment gap.
Epilepsy in the WHO African Region: Bridging the Gap
WHO regional report on the burden, causes, and treatment gap for epilepsy across Africa.
PAHO/WHO: Epilepsy
Regional clinical and public health guidance on epilepsy diagnosis and management.
Frequently Asked Questions
Is epilepsy contagious?
No. Epilepsy is a non-communicable neurological condition and cannot be spread through contact with someone who has it.
Can epilepsy be cured?
There is no guaranteed cure, but up to 70 percent of people with epilepsy can become seizure-free with appropriate medication. After several years without a seizure, some people are able to stop medication under medical guidance.
Does having a seizure mean I have epilepsy?
Not necessarily. A single seizure can have many causes, including high fever, low blood sugar, or a head injury. Epilepsy is diagnosed when someone has a tendency toward recurrent, unprovoked seizures.
What should I do if someone is having a seizure?
Protect them from injury by clearing the area around them, gently turn them onto their side if possible, and time the seizure. Do not put anything in their mouth. Seek emergency care if the seizure lasts longer than five minutes or if a second seizure begins before they recover.