Seizures / Epilepsy
Symptoms, Causes & Treatment
Epilepsy affects around 600,000 people in the UK and is one of the most common serious neurological conditions. With the right medication, around 70% of people achieve complete seizure control. A first seizure always requires urgent medical assessment.
What are Seizures & Epilepsy?
Epilepsy is defined by two or more unprovoked seizures, or a single seizure with a high risk of recurrence. Seizures can be focal (starting in one area) or generalised (involving both hemispheres from the outset). Correct classification determines the most appropriate antiseizure medication. A first seizure must be assessed urgently to exclude metabolic, cardiac, and structural causes.
Symptoms of Seizures & Epilepsy
Seizure type, onset pattern, post-ictal features, and associated symptoms guide classification and investigation.
Tonic-clonic (grand mal): loss of consciousness, rhythmic jerking, post-ictal confusion · Absence: brief staring episodes · Focal aware: unusual sensations or movements without LOC · Focal unaware: confusion, automatisms · Post-ictal drowsiness and fatigue
Seizure lasting more than 5 minutes (status epilepticus — call 999) · First ever seizure · Seizure with no recovery of consciousness between episodes · Seizure in pregnancy · Head injury following a seizure · Seizure in a known epileptic with new pattern
First ever seizure · Seizure lasting more than 5 minutes · Seizure without recovery of consciousness · Seizure in pregnancy — call 999 immediately.
What Causes Seizures & Epilepsy?
Epilepsy and seizures arise from abnormal electrical activity in the brain. Understanding seizure classification and triggers guides appropriate antiseizure medication choice.
Generalised epilepsy involves synchronised electrical discharge across both hemispheres. Focal epilepsy begins in a localised area and may or may not spread. Correct classification determines appropriate antiseizure medication choice.
A first unprovoked seizure requires urgent investigation including MRI brain, EEG, and blood tests. It does not automatically lead to an epilepsy diagnosis (two unprovoked seizures at least 24 hours apart are required). DVLA must be notified — the patient cannot drive for 6 months.
Status epilepticus is a seizure lasting more than 5 minutes or recurrent seizures without regaining consciousness. It is a life-threatening emergency treated with IV lorazepam, followed by levetiracetam or phenytoin if no response.
Common triggers for seizures include sleep deprivation, alcohol, flashing lights (photosensitive epilepsy), missed medication, fever, and hypoglycaemia. Identifying and avoiding personal triggers significantly reduces seizure frequency.
Women with epilepsy require specialist preconception counselling. Sodium valproate is highly teratogenic and must never be prescribed to women of childbearing potential without the Pregnancy Prevention Programme. Folate 5mg daily should be started before conception.
SUDEP (sudden unexpected death in epilepsy) affects approximately 1 in 1,000 people with epilepsy per year, rising to 1 in 150 in those with poorly controlled seizures. Optimal medication compliance, avoiding alcohol, and sleeping safely reduce risk.
Key Risk Factors
Diagnosing Seizures & Epilepsy
EEG and MRI brain are the two essential investigations for epilepsy diagnosis and classification. Blood tests exclude metabolic causes after a first seizure.
Treatment for Seizures & Epilepsy
Antiseizure medication is the cornerstone of epilepsy treatment. Drug choice depends on seizure type, patient characteristics, and comorbidities.
Supportive Measures
Wear a medical alert bracelet. Ensure family and colleagues know seizure first aid. Avoid known triggers. Keep a seizure diary. Do not swim or bathe alone. Take showers rather than baths. Never stop antiepileptic medication without specialist advice.
Long-Term Epilepsy Management
Epilepsy is a lifelong condition requiring specialist oversight. Annual neurology reviews assess seizure control, medication side effects, and driving status. Drug-resistant epilepsy (seizures despite two appropriate medications) should be referred to a tertiary epilepsy centre for consideration of surgery or vagus nerve stimulation.
When to Seek Help
First ever seizure · Seizure lasting more than 5 minutes (status epilepticus) · Seizure without regaining consciousness · Seizure in pregnancy · Seizure with head injury — call 999 immediately.
Any first unprovoked seizure requires same-day or next-day GP assessment and urgent neurology referral. You must inform the DVLA and stop driving immediately after a first seizure.
Preventing Seizures
For people with epilepsy, seizure prevention focuses on consistent medication compliance, trigger avoidance, and lifestyle management.
Take antiepileptic medications exactly as prescribed. Missing doses is the most common cause of breakthrough seizures. Use pill dispensers, reminders, or phone alarms. Never stop antiepileptic medication abruptly without specialist advice.
Prioritise 7–9 hours of sleep per night. Sleep deprivation is the most common and potent seizure trigger. Shift work and jet lag significantly increase seizure risk in people with epilepsy.
Avoid alcohol. Alcohol both directly lowers the seizure threshold and causes sleep deprivation, significantly increasing seizure risk. People with epilepsy should avoid or very strictly limit alcohol.
Identify and avoid personal triggers including flashing lights (use sunglasses), video games with flash settings disabled, and emotional stress. Keep a seizure diary to identify consistent personal triggers.
People with epilepsy should not drive until a period of seizure freedom has been achieved (6 months for a first seizure; 12 months for established epilepsy with a change in seizure type). Inform the DVLA.
Aim for 7–9 hours of quality sleep per night. Maintain a consistent sleep schedule, avoid alcohol before bed, and create a dark, cool, quiet sleep environment. Limit screen use in the hour before bed.
Getting Treatment
After a first seizure, a GP will arrange urgent neurology referral, perform an ECG, arrange blood tests, and advise on driving restrictions and DVLA notification. All subsequent epilepsy medication management should involve a specialist.
Expert clinical advice, when you need it.
Seizures & Epilepsy — Frequently Asked Questions
You cannot drive for 6 months after a first unprovoked seizure. You must inform the DVLA immediately. After 6 months seizure-free, driving can be considered. For established epilepsy, 12 months seizure-free is required (or 3 years for heavy vehicles). Failure to notify DVLA invalidates your insurance.
Most people with epilepsy can live full, independent lives with well-controlled seizures. Work, travel, and exercise are all possible with appropriate precautions. Seizure diaries, medication compliance, avoiding triggers, and annual specialist reviews are central to optimal management.
Sodium valproate is highly effective for generalised epilepsy but is teratogenic — it increases the risk of neural tube defects, autism, and developmental delay by 2–3 times. It must never be prescribed to women of childbearing potential without the Pregnancy Prevention Programme. Lamotrigine is the preferred alternative in women.
If you witness a seizure: stay calm, protect from injury (cushion the head, clear space), time the seizure, place in recovery position when convulsing stops, and stay with the person until they fully recover. Call 999 if the seizure lasts more than 5 minutes or the person does not regain consciousness.
Status epilepticus is a seizure lasting more than 5 minutes, or repeated seizures without recovery in between. It is a medical emergency. Call 999 immediately. Administer buccal midazolam if prescribed. IV lorazepam is the first-line hospital treatment.
Epilepsy is one of the most common conditions in pregnancy. Most women with epilepsy have healthy pregnancies. Key risks include medication teratogenicity (especially valproate), seizure in pregnancy, and fetal hypoxia during prolonged seizures. Pre-pregnancy counselling with a neurologist and obstetrician is essential.
SUDEP (sudden unexpected death in epilepsy) is a rare but real risk affecting about 1 in 1,000 people with epilepsy per year. Risk is highest in those with uncontrolled seizures. Taking medication consistently, avoiding alcohol and sleep deprivation, and sleeping safely reduce the risk.
A GP can arrange an urgent neurology referral after a first seizure, review existing epilepsy medications, manage side effects, issue repeat prescriptions, and provide emergency buccal midazolam. Specialist epilepsy nurses also provide ongoing support between clinic appointments.