Epilepsy: Its Meaning, Causes, Symptoms, Diagnosis, and Care

Epilepsy is one of the most common neurological disorders and affects millions of people throughout the world. Many people believe that epilepsy always causes a person to lose consciousness, fall to the ground, and shake violently. Although this can happen during certain types of seizures, epilepsy is much broader than this common description.

Not everyone with epilepsy falls unconscious or develops whole-body convulsions. Some people may briefly lose awareness while remaining seated or standing. They may stare blankly, stop speaking, fail to respond to people around them, or become unaware of their surroundings for several seconds or minutes. In other cases, only one part of the body, such as a hand, arm, leg, or one side of the face, may jerk or become stiff.

Therefore, epilepsy may cause loss of awareness without necessarily causing a person to collapse. A person may remain physically upright while temporarily losing normal awareness, memory, speech, or control over part of the body.

Epilepsy is not a psychiatric illness, and it is not an infectious disease. It does not spread from one person to another through physical contact, food, air, blood, bacteria, or viruses. It is a disorder associated with abnormal electrical activity within the brain and nervous system.

What Is Epilepsy?

Epilepsy is a long-term neurological condition in which a person has an ongoing tendency to experience recurrent seizures. A seizure occurs when groups of brain cells suddenly produce abnormal, excessive, or poorly coordinated electrical signals. This temporary disturbance may affect awareness, movement, sensation, speech, memory, emotions, or behaviour.

A seizure may last only a few seconds or continue for several minutes. Its appearance depends on the part of the brain in which the abnormal activity begins and how widely that activity spreads. Some seizures involve a small area of the brain, while others rapidly affect larger areas and may cause loss of consciousness and whole-body convulsions.

A person should not automatically be diagnosed with epilepsy simply because they collapsed or had a single seizure. The diagnosis requires careful consideration of the event, the person’s medical history, the possibility of temporary provoking factors, and the findings of appropriate clinical investigations.

How Does a Seizure Develop in the Brain?

The human brain contains billions of nerve cells known as neurons. These cells communicate through carefully regulated electrical and chemical signals. This communication allows the brain to control thought, speech, memory, emotion, movement, vision, hearing, sensation, breathing, and many other essential functions.

During a seizure, the normal balance of this electrical communication becomes disturbed. A group of neurons may suddenly discharge an unusually large amount of electrical activity, fire at the wrong time, or begin firing together in an uncontrolled manner. The abnormal signals may remain within one area of the brain or spread rapidly to other regions.

When this happens, normal brain function is temporarily interrupted. Depending on the area involved, the person may stop speaking, lose awareness, stare blankly, experience unusual sensations, develop involuntary movements, become stiff, shake, lose memory of the event, or collapse unconscious.

For example, abnormal activity involving an area that controls movement may cause jerking or stiffness of a hand, leg, face, or one side of the body. Activity involving areas responsible for awareness and memory may cause the person to become confused, unresponsive, or unable to remember what happened. If the electrical disturbance spreads widely through the brain, the person may lose consciousness, fall, become rigid, and develop rhythmic whole-body jerking.

Warning Symptoms Before a Seizure

Some people experience a brief warning sensation before a more noticeable seizure begins. This warning is commonly called an aura. An aura may itself represent the early stage of a seizure beginning in one part of the brain.

The person may notice a strange smell that is not actually present, an unusual taste, flashing lights, changes in vision, dizziness, sudden fear, a rising sensation in the abdomen, numbness, tingling, a feeling that the surroundings are unfamiliar, or a strong sense that something is about to happen.

A person who recognises such warning symptoms should move away from fire, traffic, water, heights, sharp objects, and other dangerous surroundings. They should sit or lie down in a safe place whenever possible and inform someone nearby.

The Difference Between a Seizure and Epilepsy

A seizure is a temporary event caused by abnormal electrical activity in the brain. Epilepsy, however, is a neurological condition in which the brain has a persistent tendency to produce recurrent seizures.

A person may have a seizure because of a temporary and identifiable problem such as very low blood sugar, a severe fever, a major electrolyte disturbance, a recent brain injury, poisoning, an infection affecting the brain, severe oxygen deprivation, or the sudden withdrawal of heavy alcohol use. When the underlying temporary cause is corrected, the seizure may not occur again.

Such an event does not automatically mean that the person has epilepsy. Epilepsy is considered when seizures recur without an immediate temporary cause, when the risk of recurrence is clinically high, or when the person’s history and examination are consistent with an established epileptic condition.

For this reason, a person who has lost consciousness or convulsed should receive a proper medical assessment rather than being labelled immediately as having epilepsy.

Who Can Develop Epilepsy?

Epilepsy can affect people of any age, from newborn babies and young children to adults and older people. It is often identified during childhood, but new cases can also develop later in life, particularly among people with a history of stroke, head injury, brain infection, reduced oxygen supply to the brain, or other neurological conditions.

The condition is not contagious. A person with epilepsy can study, work, marry, raise a family, participate in the community, and live a productive life. However, appropriate evaluation, regular follow-up, safety awareness, and consistent care are important.

Epilepsy does not always continue throughout a person’s entire lifetime. Some childhood forms may disappear as the child grows. In other people, seizures can be controlled for long periods. The outcome varies according to the cause, the pattern of seizures, the person’s overall health, and how the condition responds to care.

Symptoms of Epilepsy

The symptoms of epilepsy differ greatly from one person to another. They depend on the location of the abnormal electrical activity, the extent to which it spreads, and the brain functions affected during the event.

Loss of Consciousness, Falling, and Whole-Body Convulsions

A person may suddenly lose consciousness and fall. The body may first become rigid, followed by repeated rhythmic jerking of the arms and legs. Saliva or froth may appear around the mouth, the tongue may be bitten, breathing may temporarily become irregular, and urine may be passed involuntarily.

After the seizure ends, the person may remain confused, exhausted, sleepy, weak, or unaware of what happened. Headache and muscle pain may also occur. This recovery period can last from a few minutes to several hours.

Brief Staring and Loss of Awareness

Some people do not fall or shake. Instead, they suddenly stop what they are doing, stare into space, stop speaking, and fail to respond for a short time. They may then return to normal activity without realising that anything happened. In children, these episodes may be mistaken for daydreaming, poor attention, or lack of interest in school.

Unusual Repetitive Behaviour

During some seizures, a person may appear awake but remain unaware of the surroundings. They may repeatedly chew, move their lips, rub their hands, pull at their clothes, walk without purpose, repeat words, or fail to respond to instructions. Afterward, they may have no memory of the event.

Movement or Sensory Symptoms Affecting One Part of the Body

A seizure may cause only one hand, one leg, one side of the face, or one side of the body to jerk, stiffen, or become numb. The person may remain fully conscious while this happens. Other people may experience unusual smells, tastes, sounds, visual changes, fear, abdominal sensations, tingling, or a feeling that familiar places have suddenly become strange.

The absence of falling or violent shaking does not rule out epilepsy. Repeated episodes of unexplained staring, temporary unresponsiveness, unusual sensations, memory gaps, or involuntary movements require proper evaluation.

What Causes Epilepsy?

In many people, the exact cause cannot be identified. However, several conditions are known to damage brain tissue, alter its development, or disturb electrical communication between nerve cells.

Brain Injury

A severe fall, road traffic accident, blow to the head, penetrating injury, or other trauma may damage brain tissue. Scar tissue can later interfere with normal electrical signalling and become a source of recurrent seizures. The first seizure may occur immediately after the injury or months or years later.

Reduced Oxygen Supply Around Birth

When a baby experiences severe breathing difficulty or inadequate oxygen during labour and delivery, areas of the brain may be injured. Depending on the severity and location of the injury, this may later increase the risk of epilepsy, developmental difficulties, or movement problems.

Infections Affecting the Brain

Conditions such as meningitis, encephalitis, cerebral malaria, brain abscesses, and certain parasitic infections can inflame or damage brain tissue. Even after the infection has resolved, the remaining scar or structural damage may continue to produce seizures.

Stroke and Disorders of the Brain’s Blood Supply

A stroke occurs when a blood vessel supplying the brain becomes blocked or when bleeding occurs inside or around the brain. The affected brain tissue may be damaged or destroyed. The injured area may later generate abnormal electrical activity and recurrent seizures, especially in older adults.

Genetic Susceptibility

Some forms of epilepsy are associated with inherited or newly developed genetic changes that affect how brain cells communicate. Having a relative with epilepsy may increase a person’s risk, but it does not mean that every family member will develop the condition.

Structural and Metabolic Causes

Abnormal brain development, brain tumours, damage caused by previous infections, disorders of the brain’s blood vessels, severe metabolic disturbances, advanced neurological diseases, and prolonged oxygen deprivation may also contribute to epilepsy.

In a large proportion of people, no single definite cause is found even after appropriate investigation. This does not mean that the seizures are imaginary or that the person is pretending. It means that the available history and investigations have not identified a visible or measurable cause.

How Is Epilepsy Evaluated?

Epilepsy cannot usually be confirmed by one blood test, one brain scan, or one brief examination. A careful diagnosis combines the person’s medical history, the account of someone who witnessed the event, a neurological examination, and a limited number of relevant investigations.

Clinical History and Witness Description

The first and most important part of the assessment is a detailed description of what happened before, during, and after the event. The clinician may ask whether the episode occurred suddenly, whether the person experienced a warning sensation, whether the eyes were open or closed, whether the head or eyes turned to one side, whether the body became stiff, whether shaking followed, and how long the event lasted.

It is also important to know whether the person bit the tongue, passed urine involuntarily, developed frothing around the mouth, had difficulty breathing, remained confused afterward, slept for an unusually long period, experienced weakness, or remembered what had happened.

Information from a person who directly witnessed the episode can be extremely valuable because the affected person may not remember it. When it can be recorded safely, a short mobile-phone video of the event may also help the clinician understand the pattern. However, protecting the person from injury and providing first aid must always take priority over recording.

Neurological Examination

The clinician may examine awareness, speech, memory, eye movement, muscle strength, sensation, reflexes, balance, coordination, walking, and other neurological functions. A normal examination does not exclude epilepsy because many people appear completely normal between seizures.

EEG

An electroencephalogram, commonly called an EEG, records the brain’s electrical activity through small sensors placed on the scalp. It can help identify abnormal electrical patterns and may provide information about whether a seizure begins in one area or involves broader regions of the brain.

An abnormal EEG can support a diagnosis of epilepsy, but it must be interpreted together with the person’s symptoms and history. A normal EEG does not rule out epilepsy because abnormal electrical activity may not occur during the short period in which the test is recorded.

Brain Imaging

A brain scan such as MRI or, in selected circumstances, CT may be used to look for structural changes such as an old injury, stroke, abnormal brain development, infection-related damage, bleeding, or a mass. A normal scan does not necessarily mean that epilepsy is absent because many forms of epilepsy do not produce visible structural changes.

Basic Laboratory Assessment

Selected blood tests may be used to identify temporary conditions that can provoke a seizure, such as low blood sugar, disturbances in sodium or calcium, serious infection, or significant kidney or liver dysfunction. These tests do not independently confirm epilepsy, but they help distinguish recurrent epilepsy from a seizure caused by a temporary medical problem.

Normal investigation results do not automatically exclude epilepsy. The diagnosis is made by interpreting the test results together with the person’s clinical history, symptoms, witness account, and neurological findings.

What Should Be Done During a Seizure?

When a person develops a seizure, those nearby should remain calm and focus on preventing injury. Move sharp, hot, or dangerous objects away from the person. If the person is falling, guide them gently to the ground. Place something soft beneath the head, loosen tight clothing around the neck, and record the time the seizure began.

Do not hold the person down or attempt to stop the movements by force. Do not put a spoon, stick, cloth, fingers, medicine, water, or any other object into the person’s mouth. A person cannot swallow their tongue, and placing objects in the mouth may break the teeth, injure the jaw, block breathing, or harm the person providing assistance.

When the jerking stops, turn the person onto one side if it is safe to do so. This position can help keep the airway clear and allow saliva or vomit to drain. Remain with the person until awareness returns and provide calm reassurance.

When Is Emergency Assistance Required?

Urgent medical assistance is required when a seizure continues for five minutes or longer, another seizure begins before the person recovers, breathing does not return normally, the person remains unconscious, the seizure occurs in water, a serious injury occurs, the person is pregnant, or the event is the person’s first known seizure.

A prolonged or repeatedly recurring seizure can become life-threatening and should not be managed only at home.

Can People With Epilepsy Improve?

The course of epilepsy differs among individuals. Some children experience forms of epilepsy that become less active or disappear as they grow. Many adults and children can achieve long periods without seizures when the condition is properly evaluated and consistently managed. Others may require longer follow-up and more individualised support.

No responsible health service should promise that every person with epilepsy will be permanently cured, because the outcome depends on the underlying cause, the pattern and frequency of seizures, the person’s age, overall health, and individual response to care.

The main objectives of care are to reduce or stop seizures, address possible contributing factors, protect the person from injury, support neurological and general health, improve sleep and daily functioning, and help the individual participate safely in family, educational, occupational, and social life.

Common Misunderstandings About Epilepsy

Epilepsy is not contagious, and a person cannot acquire it by touching, helping, eating with, or living with someone who has the condition. A person with epilepsy is not necessarily mentally ill, intellectually disabled, or unable to live independently.

A seizure should not automatically be attributed to a curse, wrongdoing, or supernatural punishment. Such beliefs can delay proper evaluation, expose the person to harmful practices, and increase discrimination.

Pouring water on the face, forcing the mouth open, placing strong-smelling substances under the nose, restraining the body, or inserting objects into the mouth does not stop the abnormal electrical activity causing a seizure and may produce serious injury.

People with epilepsy deserve protection, dignity, appropriate care, education, employment opportunities, family support, and equal participation in society.

Our Epilepsy Care Service

Our centre provides consultation, assessment, supportive care, and an individualised treatment service for children and adults experiencing epilepsy, recurrent seizures, unexplained loss of consciousness, staring episodes, abnormal movements, and related neurological complaints.

The care plan is developed after reviewing the person’s symptoms, the pattern and frequency of the episodes, previous medical history, available investigation results, existing health conditions, and other relevant information. Patients who already have EEG, MRI, CT, laboratory, or previous medical reports are encouraged to bring or send clear copies for review.

Treatment is not identical for every patient. The type and duration of care depend on the person’s condition, the suspected cause, age, severity, seizure pattern, previous treatment history, and response during follow-up.

People who cannot visit the centre in person may contact us from within Ethiopia or abroad and provide a written description of the condition together with available reports. Initial guidance and information may be provided remotely. However, remote communication cannot replace emergency care, direct physical examination, or hospital investigation when these are required.

Contact Numbers for Epilepsy Care and General Consultation

You may contact our professionals through a telephone call, WhatsApp, Telegram, or a written SMS message. When contacting us, clearly describe the patient’s age, when the episodes began, how often they occur, what happens before and during the episode, how long the event lasts, and what the person experiences after regaining awareness.

Contact for Liver Conditions

For consultation concerning liver conditions, including Hepatitis B, fatty liver disease, and related health concerns, contact:

Conclusion

Epilepsy is a neurological condition caused by recurrent disturbances of electrical activity in the brain. It does not always cause violent convulsions or collapse. Some people may remain standing or seated while briefly losing awareness, staring, stopping speech, performing repetitive movements, experiencing unusual sensations, or developing jerking in only one part of the body.

A single seizure does not always mean that a person has epilepsy. Severe fever, low blood sugar, electrolyte disturbances, brain infections, head injury, poisoning, stroke, alcohol withdrawal, and other temporary conditions may provoke a seizure. For this reason, the person’s history, symptoms, witness description, neurological examination, EEG, appropriate brain imaging, and selected laboratory investigations should be considered together.

Epilepsy is not contagious, and people affected by it should not be isolated, blamed, or denied opportunities. With accurate understanding, careful evaluation, appropriate treatment, safety precautions, and consistent follow-up, many people with epilepsy can achieve significant improvement and live active and productive lives.