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Epilepsia
Repeated seizures without an acute cause — and the description from outside is worth more than any examination.
Also known as: epilepsy · seizure disorder
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
An epileptic seizure is a short, excessive electrical discharge in the brain. One speaks of epilepsy only when seizures occur repeatedly and without an acute cause. A single seizure with fever, after a sleepless night, with a very low sodium or with low blood sugar is something else and is treated differently. Seizures look very different: besides the familiar picture with a fall and stiffening, there are those in which someone only pauses briefly, stares, chews or fiddles with their clothing and afterwards does not know what happened in that minute. For classifying them, the description from outside is often worth more than any examination — anyone who was there should come along, and a recording on the phone says more than any account. During the seizure itself little applies, but that little exactly: nothing in the mouth, do not hold the person down, cushion the head, look at the clock and afterwards turn them on their side. If it lasts longer than five minutes or a second seizure follows at once, it is an emergency. With medicines a large share of people become seizure-free. Regular taking and sleep are decisive — and two subjects belong discussed early, uncomfortable as they are: driving and, with a wish for children, the choice of medicine. If the disturbance of consciousness lasts unusually long after a seizure with a fall, or a new deficit appears on one side of the body, the head is imaged the same day.
If someone is there and it is safely possible: let the phone run. Half a minute of recording often clarifies more than a week of investigation — and note the time and the duration.
Do not hold the person down, clear away dangerous things, cushion the head, then turn them on their side. Nothing between the teeth — it injures and prevents nothing.
If a seizure lasts longer than five minutes or a second follows without the person becoming responsive in between, call the emergency number 144. Anyone who has a rescue medicine gives it as agreed.
The commonest cause of a new seizure under well-adjusted treatment is a missed dose. A weekly pill box, a fixed time and a reserve when travelling work better than memory.
Regular times, dark and cool, and particular care after sleepless nights. Lack of sleep and alcohol together are the riskiest combination.
After a seizure binding waiting periods apply to driving, and they depend on the type of seizure. Clearing this up early and honestly prevents much worse trouble — the same goes for work on ladders, at machines and in water.
Some active substances are unfavourable in pregnancy, and a switch needs months of lead time. Folic acid belongs to it — but the planning starts before the pregnancy, not after the test.
If the seizures persist despite two well-used medicines and an operation is not an option, there is a third road: an electrode on the vagus nerve in the neck. It works slowly over months, clearly reduces seizures in some people and makes almost nobody seizure-free — that belongs said beforehand.
Worldwide a cyst of the pork tapeworm in the brain is one of the commonest causes of seizures that begin newly in adulthood — in Latin America, parts of Africa and South Asia. With a fitting life history that belongs in the imaging and is treatable.
Worldwide the most common preventable cause of a first adult seizure. Imaging shows it and it can be treated — rare in central Europe, but worth thinking of with the matching history.
The seizures come from the larva in the brain, not the worm in the gut. Anyone harbouring the adult worm can infect themselves and others — which is why the household is checked too.
An organism that has lain silently in the tissue for years in one person in three can become active in the brain when defences are strongly weakened and trigger seizures. It is treatable.
Antiepileptic drugs damp the over-excitability of nerve cells — depending on the agent through sodium channels or by strengthening GABA. They prevent seizures for as long as they are taken; the cause in the tissue remains. After two to five seizure-free years, a trial of stopping is discussed.
About one person in a hundred has epilepsy. In roughly two out of three, the first or second medicine achieves freedom from seizures. A single seizure in a lifetime is not epilepsy — about one in ten people has one and never has another.
Someone who knows their aura can sit down and avoid the fall. It is therefore more than a forewarning — it is the most useful minute of the whole seizure.
About half of the people with a first seizure never have a second. So after the first time a cause is looked for rather than starting lifelong treatment at once.
Seconds to a minute without responding, often with chewing, fiddling or a fixed stare, then a gap in the memory. This is long taken for inattention or daydreaming.
A rising feeling in the stomach, a smell, a déjà-vu or a twitch of one hand. These warnings say a lot about where in the brain the seizure begins — they belong described precisely.
Lack of sleep is the strongest trigger of all, often together with alcohol and the day after. In some forms the seizure typically comes shortly after waking.
A bite on the side of the tongue, aching muscles all over, wet clothing and a slowing that lasts minutes to hours speak for a true seizure and separate it from a faint, after which one is quickly clear again.
A very low sodium triggers seizures without any epilepsy being present. Often from water tablets, certain antidepressants or drinking very large amounts.
Low blood sugar can look like a seizure and is immediately correctable. So it is measured with every first seizure, best of all on the spot.
A very low calcium causes cramping and seizures. It is among the few values that can supply an entirely different explanation.
A pronounced shortage lowers the threshold for seizures and occurs above all with heavy drinking and after prolonged diarrhoea.
With catamenial epilepsy seizures cluster around the period and around ovulation. The reason is the ratio: oestrogen lowers the seizure threshold, progesterone raises it — when the ratio tips, the threshold tips with it. A seizure calendar over three cycles shows it.
Several older seizure medicines drive the liver, and this transport protein rises with it. The freely available share of testosterone and estradiol falls — that explains loss of libido and cycle disturbances on treatment, although the total values look normal.
The same medicines break vitamin D down faster. Over years that costs bone — which is why vitamin D and bone density belong in the long-term care, in young people too.
A low blood sugar can trigger a seizure without epilepsy being present. With a first seizure the sugar value therefore belongs among the very first measurements — it is the most quickly fixable cause.
In children with hard-to-treat seizures the ketogenic diet halves seizure frequency in about a third. It is strict, needs supervision and is judged over 3 months — not for self-experiment.
Skipping meals, lack of sleep and alcohol withdrawal are among the most common seizure triggers. Not the alcohol itself but the withdrawal the next day is the critical phase.
The ketogenic diet is a recognised treatment in hard-to-treat childhood epilepsy — about a third then have half as many seizures. It is strict, needs supervision and is not for self-experiment.
Lack of sleep is among the most common seizure triggers of all. Fixed times are not a side recommendation here but part of the treatment.
Here as a warning: ginkgo can lower the seizure threshold and is not recommended in epilepsy. St John’s wort also interferes with the breakdown of many anti-epileptic drugs.
AWMF 030-041 · S2k · 2023-09 — in force
Erster epileptischer Anfall und Epilepsien im Erwachsenenalter
checked 2026-09