Epilepsy
What is epilepsy?
Epilepsy is a chronic neurological condition in which recurrent epileptic seizures occur. These seizures result from a temporary, uncontrolled electrical discharge of nerve cells in the brain. About 0.5–1% of the population is affected.
A single epileptic seizure does not yet mean epilepsy. The diagnosis is made when at least two unprovoked seizures have occurred or when there is an increased risk of recurrence after a single seizure.
Symptoms
Epileptic seizures can look very different depending on which brain region is affected:
Focal seizures (originating from one brain region)
- Twitching of one side of the body or individual limbs
- Sensory disturbances (tingling, numbness)
- Visual disturbances, olfactory or gustatory hallucinations
- Altered consciousness with automatisms (e.g. lip smacking, fumbling hand movements)
- Déjà-vu experiences or rising nausea (epigastric aura)
Generalized seizures (affecting the entire brain)
- Tonic-clonic seizure (grand mal): loss of consciousness, stiffening of the body, rhythmic twitching, possibly tongue biting and incontinence
- Absence seizures: brief pauses in consciousness (5–30 seconds), often in childhood
- Myoclonic seizures: sudden, brief muscle jerks
Causes
- Genetic predisposition – familial forms of epilepsy
- Structural brain changes – after stroke, traumatic brain injury, brain tumor
- Inflammatory diseases – meningitis, encephalitis
- Metabolic disorders – electrolyte imbalances, low blood sugar
- Unknown cause – in a considerable proportion of patients the cause remains unclear (cryptogenic epilepsy)
Diagnostics
The EEG (electroencephalography) is the most important diagnostic procedure for epilepsy. It can detect epilepsy-typical potentials and helps classify the type of epilepsy.
Further diagnostics:
- Detailed medical history – seizure description (ideally by eyewitnesses), pre-existing conditions, family history
- Neurological examination – clinical neurological findings
- Laboratory tests – blood count, electrolytes, liver and kidney values, medication levels
- Imaging – MRI of the head to rule out structural causes (referral)
Treatment
Drug therapy (anticonvulsants)
The goal is complete freedom from seizures with as few side effects as possible. Commonly used medications:
- Levetiracetam – broad spectrum of action, well tolerated
- Lamotrigine – especially for focal epilepsies and for women of childbearing age
- Valproate – effective for generalized epilepsies (not for women of childbearing age)
- Lacosamide – for focal epilepsies
- Oxcarbazepine – for focal epilepsies
The choice of medication depends on the type of epilepsy, age, comorbidities, and individual tolerability.
Disease monitoring
- Regular EEG check-ups
- Measurement of medication levels in the blood
- Seizure diary for documentation
- Adjustment of medication as needed
Lifestyle
- Sufficient sleep (sleep deprivation is a common seizure trigger)
- Moderate alcohol consumption or abstinence
- Regular medication intake
- Information on fitness to drive and career choice
Last updated: 2026-07-04