1. What is a seizure?

A seizure happens when a sudden and sustained burst of electrical activity interrupts the brain’s normal signals.

• Some are considered provoked, meaning they have an identifiable cause, such as abnormal blood sugar levels or medication side effects. These factors can cause seizures even in people without a predisposition to seizures.
• Others are unprovoked, meaning there is no definitive cause. However, they can sometimes occur with triggers, such as sleep deprivation or stress. These factors may make a seizure more likely in someone who is already prone to seizures, but they do not usually cause seizures on their own.

Seizures are remarkably common. Roughly 10% of people worldwide have one during their lifetime. Symptoms are sometimes obvious to the person or to observers. In other cases, they’re subtle and go unrecognized by everyone involved. They can even occur during sleep.

Working with your healthcare team to understand your seizure type can help you recognize a seizure and get the help you need.

2. What is epilepsy?

Epilepsy is a neurological disorder that causes recurring seizures. It is often treated with antiseizure medication to lower the risk of future seizures.

“The term ‘epileptic’ has historically been used to refer to someone who has epilepsy, but it is not appropriate,” says Dr. Gururangan. “Abnormal brain activity can be defined as ‘epileptic,’ but people should not be defined by a medical condition. Use ‘person with epilepsy’ instead, just as you would say, ‘person with diabetes’ or ‘person with asthma.’” 

3. If I have a seizure, does that mean I have epilepsy?

Not necessarily.

“If someone has a provoked seizure, the risk for recurrent seizures is not typically increased, as long as the circumstances that caused the first seizure do not repeat,” says Dr. Gururangan. “As a result, provoked seizures do not lead to a diagnosis of epilepsy.”

Epilepsy is a specific diagnosis that may be given after a person has experienced two or more unprovoked episodes at some point in their life. It can also be diagnosed after a single unprovoked seizure if testing shows an increased risk of more, such as abnormalities found on brain imaging or an electroencephalogram (EEG).

This is because the risk for further unprovoked seizures increases with each occurrence. After one unprovoked seizure, the risk for a second unprovoked seizure increases to about 30%. After two unprovoked seizures, the risk for a third unprovoked seizure increases to about 60%.

“Neurologists have traditionally used this 60% recurrence risk as the threshold for diagnosing epilepsy, so it is not common to start antiseizure medications after a first seizure in a person’s life,” says Dr. Gururangan. “However, I recommend doing a diagnostic evaluation after the first seizure. If brain imaging or an EEG show certain abnormalities, the risk of another seizure may rise from 30% to over 60%. This allows for an earlier diagnosis of epilepsy and earlier establishment of an appropriate treatment plan.”

If you’ve had a seizure, work with your doctor to identify which tests you need, evaluate your risk of another seizure, and determine whether medication could help prevent future seizures.

4. Does age matter with epilepsy and seizures?

Epilepsy and seizures can develop at any age. New cases are most common with young children, particularly in their first year of life.

However, cases also increase after age 55, as you are more likely to develop other conditions, such as strokes, brain tumors or Alzheimer’s disease. These conditions raise your risk for seizures, which is why any new symptom in this age group is worth getting checked out.

5. Are there different types of seizures?

Yes, and it is important to recognize that not all seizures present with intense shaking. Symptoms can vary widely from person to person, and may include numbness or weakness, sudden confusion or impaired speech, staring spells, or stiffening or jerking.

“Some seizures last only a few seconds, while others may go on for several minutes,” says Dr. Gururangan. “Some can occur just as auras, which are symptoms that are felt only by the person having the seizure without producing signs visible to others, and some can progress to bigger seizures, such as convulsions.”

There are three main types of seizures, based on where in the brain they start, how far they spread or how much they impair your consciousness (your ability to respond or remember during the event):

• Focal onset seizures begin in a limited area of the brain, so they may cause just one symptom or affect only one part of the body.
• During focal preserved consciousness seizures (previously called simple partial seizures or focal aware seizures), you remain awake and aware.
• During focal impaired consciousness seizures (previously called complex partial seizures or focal impaired awareness seizures), you become confused or lose consciousness.
• Initial aura symptoms can include déjà vu, panic or fear, a rising sensation in the stomach, nausea, numbness or tingling.
• Visible seizure signs can include unusual, purposeless, or repetitive mouth or limb movements.
• Focal onset seizures can sometimes spread and become a bilateral tonic-clonic seizure.

• Generalized onset seizures affect both sides of the brain immediately.
• Generalized tonic-clonic seizures (previously called grand mal seizures) move through three stages: You become unresponsive, your limbs stiffen and then they jerk. Recovery can take minutes to hours, and you may feel confused afterward.
• Myoclonic seizures are very brief jerks of the arms or body that often occur in the morning or when you are sleep deprived.
• Absence seizures (previously called petit mal seizures) cause brief unresponsiveness and a blank stare, sometimes with eyelid flutter. They last only seconds and are the most common type in children age 14 and younger.
• Atonic seizures or drop attacks cause your muscles to suddenly go limp.

• Unknown onset seizures are those that could be either focal or generalized in onset. With time, testing and observation, your care team may be able to reclassify them as focal or generalized.

6. How do I provide first aid to someone having a seizure?

While you cannot stop a seizure, you can help keep the person safe. Most stop on their own within a few minutes, though people may feel confused or fatigued afterward.

Call 911 or seek emergency care if:

• It is the person’s first known seizure.
• It lasts longer than five minutes.
• Another begins before the person fully regains consciousness.
• It happens when the person is in water (such as a pool or bathtub), because they may have inhaled water.
• The person is injured.
• The person is pregnant.
• The person has trouble breathing or does not regain consciousness afterward.

Do:

• Stay calm and stay with them until they are fully alert.
• Gently turn them onto their side and put something soft under their head.
• Loosen anything around their neck and move objects that could cause injury.
• Time the seizure.
• Check for a medical ID bracelet or seizure action plan and follow any instructions.

Don’t:

• Put anything in their mouth, including your fingers. This can cause choking or serious injury.
• Move them unless they’re in immediate danger.
• Hold them down or restrain their movements.

7. How can epilepsy be managed?

Most people with epilepsy can manage seizures with medication. Finding the right dose may take time. Even after you start a medication, your care team may need to adjust the dose to determine what works best for you. During that process, you may continue to experience seizures.

“Our goal is your goal: Minimize both seizures and medication side effects,” says Dr. Gururangan.

In addition to medication, lifestyle changes can help reduce the risk of seizures. These include:

• Getting enough sleep: Fatigue is a common trigger. When your sleep is off, your brain is more susceptible to abnormal electrical activity. Managing stress can also help promote quality sleep.
• Avoiding alcohol and other recreational drugs: Alcohol and illicit drug use can be triggers. “Even marijuana and kratom products obtained legally have been associated with a lowered seizure threshold,” says Dr. Gururangan.
• Taking medications as prescribed: Missing a dose of antiseizure medication is a common trigger that can be avoided. Use a phone reminder, pillbox or another routine that helps you take each dose on time.
• Checking before taking a new medication or supplement: Some prescription and over-the-counter medications and supplements can increase seizure risk or interact with antiseizure medication. Talk with your doctor before starting a new medication or supplement.  
• Avoiding triggers: For some people, this may include flashing lights, stress or dehydration.
• Keeping a seizure diary: Record when episodes occur, how long they last, symptoms you experience and any possible triggers. This can help you and your care team identify patterns, evaluate treatment and make informed decisions about your care. There are several online tools and apps available to track your seizures, including the Epilepsy Foundation’s My Seizure Event Diary.

Some wearable devices and smart watch apps can help detect seizures at home, including those during sleep that might otherwise go unnoticed. Detecting nighttime seizures may be especially important because they can increase the risk of sudden unexpected death in epilepsy (SUDEP).

“These are the most helpful for detecting seizures that cause increased movement, but false detections are possible,” says Dr. Gururangan. “You should discuss with your doctor whether such a device would be beneficial for your specific seizure types.”

Some people may also benefit from dietary changes. Learn about epilepsy and the keto diet.

8. What if medication and lifestyle modifications do not help manage seizures?

If seizures persist despite taking antiseizure medications and making lifestyle changes, surgery may be the best option.

“Resection, or removal of brain tissue responsible for generating seizures (called the seizure onset zone), can be significantly more successful at reducing seizures compared to additional trials of antiseizure medications,” says Dr. Gururangan. “However, this is only feasible when the seizure onset zone can be identified and is limited to a brain area that is safe to remove.”

Some people who previously were not considered candidates for epilepsy surgery may be helped through minimally invasive techniques, such as:

• Stereoelectroencephalography (stereo EEG or SEEG), which involves the placement of thin electrode wires into the brain through small holes in the skull. This allows doctors to better pinpoint where seizures begin and determine whether removing this area would be safe.
• Laser interstitial thermal therapy (LITT or laser ablation), which uses heat to destroy a small area of brain tissue where seizures begin. It may be an option for some people without requiring a large opening in the skull.

Another advancement in epilepsy care is the use of neuromodulation devices. Three types are currently used:

• Vagus nerve stimulation (VNS): VNS uses a device implanted in the chest to send electrical impulses to the vagus nerve in the neck. The vagus nerve carries the impulses to the brainstem, changing activity in the brain.
• Deep brain stimulation (DBS): DBS uses a battery implanted in the chest and small electrodes placed in the thalamus, an area of the brain that connects with many other regions. The device sends electrical impulses to help regulate abnormal brain activity. “VNS and DBS act like pacemakers, firing on and off according to how your doctors program them to keep the brain from firing abnormally,” says Dr. Gururangan.
• Responsive neurostimulation (RNS): RNS works more like a defibrillator, recording activity from electrodes placed where seizures are likely to start. The electrodes deliver electrical charge when abnormal activity is detected from a battery placed under the scalp and on the skull. Over time, this treatment may help reduce how often seizures happen and how severe they are.

9. Can people with epilepsy have healthy babies?

Yes, many people with epilepsy can have healthy pregnancies and healthy babies. If you are thinking about becoming pregnant, plan ahead so you and your care team can review which antiseizure medications and vitamins are safest for you and minimize complications for you and your baby.

Keep taking your medication as prescribed unless your doctor tells you otherwise. Stopping suddenly can trigger seizures, which carry their own risks during pregnancy. Try not to miss doses, know your seizure triggers, and stay in close contact with your care team before, during and after pregnancy.

10. Can you drive after a seizure?

Depending on the laws in your state and the cause of your seizure, you may not be able to drive for a period of time. Talk with your doctor about restrictions that may apply to driving, operating machinery or other activities that could pose a safety risk to you or others.