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One free scan finds every outdated or missing driver and matches the right update for your exact hardware.Free scan · exact hardware matchEpilepsy is a brain disease that creates an ongoing tendency to have unprovoked seizures. Its causes include structural brain injury, genetic or congenital conditions, infections, metabolic or immune disorders, and— in about half of cases worldwide—no cause that can be identified. Doctors diagnose it from the event history and examination, then use tests such as EEG and MRI to support the diagnosis, classify seizures and look for an underlying cause. Antiseizure medicines are the usual first treatment; surgery, implanted devices or a supervised ketogenic diet may help selected people whose seizures remain uncontrolled.
A single seizure does not automatically mean epilepsy. The International League Against Epilepsy (ILAE) defines epilepsy by recurrent unprovoked seizures, a sufficiently high risk of recurrence after one unprovoked seizure, or a recognized epilepsy syndrome. Diagnosis and treatment therefore depend on the individual’s seizure pattern, test results, health, risks and preferences.
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Epilepsy, seizures and the one-seizure question
A seizure is a temporary episode of abnormal electrical activity in the brain. It can cause shaking or stiffening, a brief loss of awareness, unusual sensations, staring, confusion or other changes in movement, behavior or consciousness. Epilepsy is the underlying disease: a continuing predisposition to unprovoked seizures.
That distinction matters after a first event. The World Health Organization (WHO) notes that as many as 10% of people worldwide have one seizure during their lifetime, and one seizure alone does not signify epilepsy. A seizure triggered by an immediate problem—such as a metabolic disturbance—may not establish an epilepsy diagnosis once the trigger is corrected.
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Under the ILAE practical definition, clinicians can diagnose epilepsy when one of these applies:
- At least two unprovoked seizures occurring more than 24 hours apart.
- One unprovoked seizure plus a predicted risk of further seizures comparable to the risk after two unprovoked seizures.
- A diagnosis of an epilepsy syndrome, even if the person has not met the first two pathways.
The word “unprovoked” means that the seizure was not caused by a short-lived, immediately reversible circumstance. Doctors still have to determine whether an apparent seizure was epileptic or was another event that can look similar, such as fainting or a heart-rhythm problem.
What causes epilepsy?
WHO groups causes into six broad categories. A person can have more than one relevant factor, and finding a cause does not always predict how seizures will respond to treatment.
Structural causes
Structural epilepsy results from an abnormality or injury in the brain. Examples include brain damage before or around birth, congenital brain malformations, severe head injury, stroke and brain tumors. MRI is often used to look for these changes. A visible lesion does not by itself prove that every subsequent episode is epileptic; clinicians match the scan with the history, examination and electrical findings.
Genetic causes
Some epilepsies are linked to inherited or newly occurring genetic changes. A genetic cause can also be associated with a broader epilepsy syndrome or with a congenital brain abnormality. “Genetic” does not necessarily mean that a parent passed the condition on, and it does not mean every relative will develop seizures. The relevance of genetic testing depends on the seizure pattern, age at onset, examination and suspected syndrome.
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Infectious causes
Infections affecting the brain can damage tissue or provoke seizures. WHO lists meningitis, encephalitis and neurocysticercosis among examples. Whether an infection is the immediate trigger, a lasting cause of structural injury or unrelated to a later seizure is a clinical judgment based on timing, symptoms and investigations.
Metabolic causes
Metabolic disturbances can trigger a seizure and may also contribute to an epilepsy condition. Low blood sugar is one example that NICE asks clinicians to consider after a suspected first seizure. Correcting an acute metabolic problem is different from treating an enduring tendency to have unprovoked seizures, so the distinction affects diagnosis and follow-up.
Immune causes
In some people, an abnormal immune response affecting the brain contributes to seizures. The possibility is considered alongside the person’s symptoms, examination and other evidence; it is not established by a routine EEG alone.
Unknown cause
Despite modern imaging and testing, the cause remains unknown in about 50% of epilepsy cases globally, according to the WHO’s 7 February 2024 fact sheet. “Unknown” means that no cause has been established—not that the seizures are imaginary, contagious or untreatable. A cause may become clearer later, or it may remain unidentified.
How doctors diagnose epilepsy
There is no single test that independently confirms every case. Diagnosis starts with a careful reconstruction of what happened and then uses tests to support or challenge the clinical impression.
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1. History, examination and eyewitness evidence
NICE recommends a detailed account from the person who had the event and, when appropriate, relatives or carers. A witness may have noticed movements, breathing changes, eye position, responsiveness, speech, duration and recovery that the person cannot recall. A safely recorded phone video can also help a specialist evaluate the episode.
The clinician asks about previous events, injuries, illness, sleep, medications, substance exposure and any immediate trigger. The physical and neurological examination looks for signs of an underlying disorder and for clues that the event may have been something other than an epileptic seizure.
2. ECG and metabolic assessment
NICE recommends a 12-lead electrocardiogram (ECG) after a suspected first seizure because some heart conditions can cause loss of consciousness and movements that resemble an epileptic seizure. Clinicians also consider metabolic disturbances, including low blood sugar. These checks address potentially reversible causes and important mimics; they do not replace the seizure history.
3. EEG: useful support, not a rule-out test
An electroencephalogram (EEG) records electrical activity from the scalp. It can support a suspected diagnosis and provide information about seizure type or an epilepsy syndrome. NICE says not to use EEG to exclude epilepsy: a normal routine recording does not rule the disease out.
If an EEG is requested after a first seizure, NICE recommends performing it as soon as possible, ideally within 72 hours. When a routine EEG is normal but uncertainty remains, the guideline says clinicians may consider a sleep-deprived EEG. If uncertainty continues, ambulatory EEG recording for up to 48 hours may capture abnormalities that a short routine test misses. The result is interpreted with the event history, not in isolation.
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4. MRI and, when necessary, CT
NICE recommends offering magnetic resonance imaging (MRI) to children, young people and adults diagnosed with epilepsy, except for specified syndromes including idiopathic generalized epilepsy and self-limited epilepsy with centrotemporal spikes. MRI looks for structural abnormalities that may explain the seizures or affect treatment planning.
Computed tomography (CT) may be considered when MRI is contraindicated. The choice of scan and the meaning of its findings depend on the clinical situation. A normal scan does not disprove epilepsy, because many epilepsies do not produce a visible structural lesion.
What the tests can and cannot establish
| Assessment | Main purpose | Important limitation |
|---|---|---|
| History, examination and witness or video account | Establish what happened, identify seizure features and assess alternative explanations | Descriptions may be incomplete, especially when no witness was present |
| 12-lead ECG | Look for cardiac conditions that can mimic a seizure | It does not diagnose epilepsy |
| Metabolic assessment | Find contributing or reversible problems such as low blood sugar | Correcting a disturbance does not by itself determine long-term seizure risk |
| Routine, sleep-deprived or ambulatory EEG | Support diagnosis and help classify seizure type or syndrome | A normal EEG cannot exclude epilepsy |
| MRI (or CT when MRI is contraindicated) | Identify structural abnormalities | A normal scan does not rule out epilepsy |
How epilepsy is treated
Treatment is chosen after clinicians consider seizure type or syndrome, suspected cause, previous response to medicines, potential adverse effects, other health conditions and the person’s circumstances. Surgery, devices and dietary therapy are not interchangeable alternatives or universal next steps.
Antiseizure medicines
Antiseizure medication is the most common treatment. The aim is to prevent seizures while causing as few unwanted effects as possible. CDC notes that finding the right medicine can take time; some people need a change of drug, a dose adjustment or a combination of medicines.
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1Fix the driver behind crashes, sound loss and screen glitches2Repair Windows errors before they cause bigger problems3Scan for outdated or missing drivers - takes under a minuteWHO estimates that up to 70% of people with epilepsy could become seizure-free with appropriate use of antiseizure medicines. This is a population estimate, not a guarantee for an individual. Seizure control depends on the diagnosis, cause, medicine choice, adherence, interactions and other factors. A person should not stop or reduce medication without the prescribing clinician’s direction.
When medication does not control seizures
Continuing seizures despite treatment warrants specialist review. The team may revisit the diagnosis, confirm the seizure type, look for an untreated cause, review adherence and interactions, and assess whether another treatment path is appropriate.
| Option | When it may be considered | What determines suitability |
|---|---|---|
| Epilepsy surgery | Seizures arise from a brain region that can potentially be treated safely | Seizure focus, structural findings, expected benefit and surgical risk |
| Vagus nerve stimulation | Selected people whose seizures remain uncontrolled with medicines | Seizure pattern, prior treatment response and specialist assessment |
| Responsive nerve stimulation | Selected drug-resistant epilepsies | Where and how seizures begin, device candidacy and specialist evaluation |
| Ketogenic diet | Selected cases under medical supervision | Age, health, seizure syndrome, nutrition needs and ability to follow a strict plan |
CDC describes the ketogenic diet as strict and requiring oversight from health professionals and a dietitian. It should not be started independently, because nutrition, medication, growth and other medical factors need monitoring.
Reducing or stopping medication
Whether treatment can be reduced or discontinued is a clinician-led decision. WHO says discontinuation may be considered after two seizure-free years, but seizure history, recurrence risk and relevant social and personal factors must be weighed. A seizure-free interval does not make unsupervised stopping safe.
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How clinicians choose among treatment paths
During follow-up, the decision is usually built around several questions:
- What type of seizure or epilepsy syndrome is present?
- Is there a structural, genetic, infectious, metabolic, immune or unknown cause?
- How often do seizures occur, and how dangerous are they for this person?
- What happened with each medicine tried, including benefits and adverse effects?
- Would surgery, a device or dietary treatment offer a reasonable balance of likely seizure control and risk?
- How do work, school, driving rules, pregnancy plans, other illnesses and daily support affect the plan?
These questions explain why two people with apparently similar seizures may receive different treatment. A specialist may also order prolonged monitoring or additional evaluation when the diagnosis remains uncertain or when seizures continue despite medication.
What to expect after a suspected first seizure
- Document the event. Write down what happened before, during and after it, how long each phase lasted, injuries, recovery time and any possible trigger. Ask witnesses for their observations; preserve a safe video if one exists.
- Arrange medical assessment. The clinician will take a detailed history, perform an examination and consider an ECG and metabolic causes, including low blood sugar.
- Complete indicated testing. If EEG is requested, NICE recommends doing it as soon as possible, ideally within 72 hours. A normal result may lead to sleep-deprived or up-to-48-hour ambulatory EEG when uncertainty persists.
- Discuss imaging. MRI is generally offered after an epilepsy diagnosis, with specified syndrome exceptions; CT may be used when MRI cannot be performed.
- Agree on follow-up and treatment. The clinician determines whether the event meets epilepsy criteria, whether medication is warranted and when specialist review is needed.
Seek urgent medical help for an event that is prolonged, repeats without recovery, causes serious injury, occurs in water or involves another immediate danger. Emergency decisions depend on the circumstances, so local medical services should guide the response.
Key figures and guidance dates
- WHO estimated that around 50 million people worldwide had epilepsy in 2024.
- WHO reported that the cause is unknown in about 50% of epilepsy cases globally.
- WHO estimated that up to 70% of people could become seizure-free with appropriate antiseizure medicines.
- NICE guideline NG217 was published on 27 April 2022 and last updated on 30 January 2025.
These are population-level estimates and guidance statements, not an individual prognosis. Medication choices, diagnostic practice and local referral pathways can change, so a person’s own clinician should interpret current recommendations for their country and circumstances.
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