Understanding Epilepsy: What It Is, What Causes It, and What You Need to Know

When most people think of epilepsy, they picture someone falling to the ground and shaking uncontrollably. That image — the dramatic, full-body seizure — is real, but it represents just one type of seizure among many. Epilepsy is far more varied, far more common, and far more manageable than popular perception suggests.

It is one of the most prevalent neurological conditions in the world, affecting people of every age, background, and walk of life. And yet, stigma and misinformation continue to delay diagnosis, discourage treatment, and isolate those living with it.

"Epilepsy is not a single disease — it is a spectrum of conditions defined by recurring, unprovoked seizures. Understanding that spectrum is the first step toward better care." — National Institute of Neurological Disorders and Stroke (NINDS)

EPILEPSY IN AMERICA

3.4 million Americans are currently living with epilepsy. 456,000 U.S. children under 17 have active epilepsy. 200,000 new cases are diagnosed each year in the U.S. 1 in 10 Americans will have a seizure in their lifetime.

Despite these numbers, nearly 1.5 million adults with active epilepsy continue to experience uncontrolled seizures — a gap that reflects barriers in access to care, treatment adherence, and awareness.

WHAT IS EPILEPSY?

Epilepsy is a chronic neurological disorder characterized by recurrent, unprovoked seizures. A seizure occurs when a sudden surge of abnormal electrical activity disrupts the brain's normal function. The type of seizure — and its symptoms — depends on which part of the brain is affected and how far that disruption spreads.

A single seizure does not constitute epilepsy. The condition is typically diagnosed after a person experiences two or more unprovoked seizures, or after one seizure with a high likelihood of recurrence based on brain imaging or other testing.

Epilepsy vs. seizure disorder: These terms are often used interchangeably, but epilepsy specifically refers to a brain condition that predisposes someone to recurring seizures. Not every seizure is caused by epilepsy — fevers, low blood sugar, and head injuries can all trigger one-time seizures in people who don't have the condition.

TYPES OF SEIZURES

Seizures fall into two broad categories depending on where in the brain they originate:

• Focal onset aware seizures — Start in one area of the brain. The person remains conscious and aware, and may experience unusual sensations, emotions, or involuntary movements.

• Focal impaired awareness seizures — Also start in one area, but affect consciousness. The person may stare blankly, make repetitive movements, or appear confused. These are the most common seizure type overall.

• Tonic-clonic seizures — The "classic" seizure involving loss of consciousness, muscle stiffness (tonic phase), and rhythmic shaking (clonic phase). Formerly called grand mal seizures.

• Absence seizures — Brief lapses in awareness, often lasting only seconds. The person may stare into space or blink rapidly. Common in children and frequently mistaken for daydreaming.

• Atonic seizures — A sudden loss of muscle tone that can cause the person to collapse or drop suddenly. Sometimes called "drop attacks."

• Myoclonic seizures — Brief, lightning-quick jerking movements of the arms, legs, or body. Often occur in clusters, particularly upon waking.

WHAT CAUSES EPILEPSY?

In fewer than half of all newly diagnosed cases, doctors can identify a specific cause. The rest are classified as having unknown or idiopathic origins. When a cause is identified, it typically falls into one of these categories:

• Traumatic brain injury — Head trauma from accidents, falls, or sports injuries is a leading preventable cause of epilepsy. • Stroke or vascular disease — Disruptions to blood flow in the brain, particularly in adults over 35, are a common trigger for late-onset epilepsy. • Infections — Meningitis, encephalitis, and neurocysticercosis can damage brain tissue and set off recurring seizures. • Genetic factors — Some forms of epilepsy are inherited. Certain genetic mutations affect how neurons fire, increasing seizure susceptibility. • Brain tumors or structural abnormalities — Growths or developmental differences in brain structure can create areas of abnormal electrical activity. • Prenatal injury or developmental disorders — Brain damage before birth, oxygen deprivation, or conditions like cerebral palsy can contribute to epilepsy from an early age.

TREATMENT AND MANAGEMENT

Epilepsy is a manageable condition for the majority of people who have it. Anti-seizure medications are the most common first-line treatment and are effective for approximately two out of three people with epilepsy. Finding the right medication — or combination of medications — often takes time and close collaboration with a neurologist.

For those whose seizures don't respond to medication, other options exist: surgical removal of the seizure-causing area of the brain, implanted nerve stimulation devices, and specialized diets such as the ketogenic diet have all shown meaningful results in select patients.

If you or someone you know has been diagnosed with epilepsy and is still experiencing seizures while on medication, ask your doctor for a referral to a neurologist or epileptologist — a neurologist who specializes specifically in epilepsy. Specialty care significantly improves outcomes.

SEIZURE FIRST AID: WHAT TO DO

Because 1 in 10 Americans will have a seizure at some point in their lives, knowing basic seizure first aid is a practical, potentially life-saving skill. Most seizures end on their own within a few minutes and do not require emergency intervention.

1. Stay calm, and stay with the person throughout the seizure.
2. Gently guide them to the floor and cushion their head if possible.
3. Turn them onto their side to keep their airway clear.
4. Remove any nearby objects that could cause injury.
5. Do NOT hold them down, put anything in their mouth, or give water.
6. Time the seizure. Note when it started and how long it lasts.
7. Speak calmly and reassure them as they recover.

Call 911 if: the seizure lasts more than 5 minutes, another seizure begins immediately after, the person doesn't regain consciousness, they're injured, the seizure happens in water, or it's their first known seizure.

LIVING WELL WITH EPILEPSY

A diagnosis of epilepsy is not a life sentence. Millions of people with epilepsy work, raise families, travel, and live full and active lives. Seizure control, mental health support, medication adherence, and access to specialty care are all factors that meaningfully shape outcomes — and all are within reach with the right support system.

This article is for informational purposes only and does not constitute medical advice. Consult a licensed neurologist or healthcare provider for diagnosis and treatment. Sources: CDC, NIH/NINDS, Nationwide Children's Hospital, Epilepsy Foundation, SingleCare, The Global Statistics.