A first seizure: is it epilepsy?

At a glance

• One seizure does not always mean epilepsy.
• Seizures do not always involve convulsions.
• A detailed account of the episode, including a witness account, is essential.

Epilepsy is one of the most common chronic neurological conditions. It can begin at any age.

A seizure is not the same as epilepsy

The International League Against Epilepsy (ILAE) defines epilepsy as including any of the following:

• At least two unprovoked seizures more than 24 hours apart.
• One unprovoked seizure with a high risk of further seizures, similar to the risk after two seizures: at least 60% over the next 10 years.
• A diagnosis of an epilepsy syndrome.

After a first seizure, the question is not only “Is this epilepsy?” but also “What happened, and why?”

Seizures without convulsions

An episode may last only a few seconds and be barely noticeable: a brief lapse of awareness, déjà vu, sudden fear, an unusual sensation or automatic movements. It may also involve loss of consciousness, a fall, stiffening and convulsions. Diagnosis should not depend solely on whether convulsions occurred.

Does epilepsy mean restrictions?

Extra caution is needed when a sudden loss of awareness could endanger you or others: driving, working at heights or with dangerous machinery, and swimming alone. Driving is also subject to separate legal requirements.

An epilepsy diagnosis does not rule out an active life, work, travel or sport. Advice is tailored to seizure type, seizure control and your circumstances.

When to call 112

• A seizure lasts more than 5 minutes.
• Another seizure starts before the person regains consciousness.
• The person does not regain consciousness, has breathing difficulties or is injured.
• The seizure occurs in water or during pregnancy.
• This is the person’s first seizure.

What to bring

• An account of the event, ideally including a witness description.
• A phone recording if episodes recur.
• EEG, CT or MRI, ECG and blood test results, and discharge summaries.
• A list of your medicines.