Epilepsy 101
Empowering Epilepsy Conference
October 13, 2026
Today
What is a seizure?
- A sudden, brief change in how the brain works
- Caused by a burst of abnormal electrical activity in a group of brain cells
- Brain cells normally “talk” in an organized way. During a seizure, many fire all at once
- Most seizures stop on their own within 1 to 3 minutes
Three phases of a seizure
- An aura is the very start of a focal seizure. It can be a useful warning to get somewhere safe
- Recovery can take minutes to hours. Confusion and sleepiness afterwards are expected
Provoked or unprovoked?
A febrile seizure in a toddler is frightening to watch, and is usually not epilepsy.
When is it epilepsy?
A person has epilepsy if any one of these is true:
One seizure does not always mean epilepsy. Some people have a single seizure and never have another.
Fisher et al., Epilepsia 2014
Things that can look like seizures
Getting the diagnosis right comes first. A phone video of the event is one of the most helpful things you can bring to an appointment.
Types of seizures
Older names you may still hear: grand mal (tonic-clonic), petit mal (absence), complex partial (focal impaired awareness).
What causes epilepsy?
Six broad groups:
- Structural: scar, stroke, tumour, malformation
- Genetic: often new, with no family history
- Infectious, metabolic, immune
- Unknown: still about half of people
In older adults, stroke and dementia are common causes.
How is it diagnosed?
- The story of what happened, from witnesses too
- Video of the event
- EEG to look at the brain’s electrical activity
- MRI to look at the brain’s structure
- Sometimes blood and genetic tests
The next talk, Testing in Epilepsy, covers all of this in detail.
Treatment: Anti-Seizure Medicines
No seizures, no side effects, on the simplest treatment possible.
About 2 in 3 people become seizure-free with medication.
Taking medication well
- Same time every day. Pillboxes and phone alarms help
- Start low, go slow
- Never stop suddenly without talking to your team
- Report side effects. There are usually other options
- Ask about cost. Assistance programs exist
- Keep an up-to-date medication list with you
When medications are not enough
- After two well-chosen medications have not worked, the chance that a third alone will work is low
- This is called drug-resistant epilepsy (about 1 in 3 people)
- First, double-check the diagnosis and the dose
- Then ask about a comprehensive epilepsy center. Options include:
- Epilepsy surgery or laser ablation
- Devices: VNS, RNS, DBS
- Dietary therapy (ketogenic diet)
- Newer and targeted medications
Know your triggers
Common triggers:
- Missed medication
- Poor or short sleep
- Alcohol, or withdrawal from it
- Illness and fever
- Stress
- Menstrual cycle
- Flashing lights (a small group of people)
A seizure diary helps you and your team spot patterns.
Seizure first aid
Time it. Stay calm and stay with the person.
When to call 911
- Nothing in the mouth. A person cannot swallow their tongue
- If a rescue medication has been prescribed, follow the seizure action plan
- A one-page seizure action plan for school, work and family is worth asking for
Safety at home
- Water is the biggest risk: showers over baths, never swim alone
- Care with heights, ladders and hot stoves
- Bathroom doors unlocked
- Padding on sharp corners if falls are common
- The right level of caution depends on how well seizures are controlled
Driving and work
- Rules differ by state. Your neurologist will tailor advice to your seizures
- Pause driving during medication changes
- Jobs with driving, heights, water or heavy machinery may need adjustments. Many accommodations are possible
Tolchin et al. (AAN/AES/Epilepsy Foundation), 2025. State-by-state rules: epilepsy.com
Everyday life
- Medical ID bracelet or phone medical ID
- Pack extra medication in your carry-on
- Keep doses on schedule across time zones
SUDEP
Sudden Unexpected Death in Epilepsy
- About 1 in 1,000 adults with epilepsy each year. Lower in children
- Biggest risk: frequent tonic-clonic seizures, especially in sleep
What lowers the risk
- Take medication every day
- Push for better seizure control
- Nighttime supervision or alert devices for those with night seizures
Harden et al., Neurology 2017
More than seizures
- About 1 in 3 people with epilepsy will have depression or anxiety at some point
- Memory, attention and learning difficulties are common, and help is available
- Children may need school supports
- Sleep matters for mood and for seizures
Mood and memory are part of epilepsy care. Bring them up at every visit.
Take-home points
- A seizure is a brief electrical storm. Epilepsy is an ongoing tendency to have them
- Most people become seizure-free with medication
- If two medications have not worked, ask about an epilepsy center
- Know seizure first aid, and when to call 911
- Sleep, medication routine and a seizure diary go a long way
- You are part of the care team
Thank you
Questions?