At a glance
What it is
A tendency to have seizures — episodes of involuntary muscle contractions, altered awareness, or unusual sensations caused by abnormal electrical discharge in the brain.
Typical signs
Sudden loss of consciousness with stiffening and jerking (tonic-clonic); or absences (brief lapses where the person stares blankly); or focal awareness with hand automatisms.
How we treat it
First-line is anti-seizure medication (AEDs). When drugs fail or cause intolerable side effects, surgery to remove or disconnect the seizure-generating zone offers seizure freedom.
What epilepsy is
Epilepsy is a disorder of recurrent, unprovoked seizures. A single seizure does not make epilepsy — the defining feature is tendency to recur. In most patients the seizures are generalised (affecting both brain hemispheres) or focal (starting in one region and sometimes spreading).
The causes vary widely. Many cases are genetic or developmental. Others arise from head trauma, stroke, brain tumour, or infection. In many cases the cause remains unknown even after investigation.
Generalised vs focal seizures
The seizure type guides investigation and treatment choice. Some patients have both.
Type A
Generalised seizures
- Affect both hemispheres from onset (or within seconds).
- Loss of consciousness is typical.
- Tonic-clonic (stiffening and shaking), absence (blank stares), or atonic (sudden falls) patterns.
- EEG abnormality is bilateral and diffuse.
Type B
Focal seizures
- Start in one brain region, may or may not spread.
- Awareness can be preserved (focal aware) or lost (focal impaired awareness).
- Hand movements, lip smacking, or automatisms are common.
- EEG abnormality is localised.
What we see in clinic
1%
Of the population has active epilepsy at any given time
70%
Of new-onset seizures respond to a single anti-seizure drug
30%
Are drug-resistant and may benefit from surgery
Key facts
How it is treated
Anti-seizure medication is first-line. Surgery is the next step for drug-resistant epilepsy.
Anti-seizure medication
First-line for all new-onset seizures
- Monotherapy (one drug) tried first — leveteracetam, sodium valproate, lamotrigine, or lacosamide depending on seizure type
- If monotherapy fails, a second drug is added (polytherapy)
- Frequent blood tests and EEGs to assess control and side effects
Ketogenic diet
Adjunctive for focal or generalised seizures
- High-fat, low-carbohydrate diet used for decades in paediatric epilepsy
- Works for adults too — about 30% achieve significant seizure reduction
- Requires dietitian supervision and monitoring
Surgery
Drug-resistant epilepsy (failure of two or more AEDs)
- Resection: removal of the seizure-generating zone if focal and surgically accessible
- Disconnection: callosotomy or functional hemispherectomy to prevent spread
- Neuromodulation: vagus nerve stimulation or responsive neurostimulation (RNS) for multifocal or diffuse seizure zones
Counselling
Ongoing support throughout treatment
- Psychoeducation about seizure triggers and lifestyle
- Driving and work implications
- Pregnancy planning (some AEDs carry teratogenic risk)
Seizure freedom is the goal, but some patients settle for a significant reduction if complete freedom is not achievable.
Related reading
Stroke
A medical emergency where blood flow to part of the brain stops, and every minute counts. We handle recovery and preventing another stroke.
Head injury
A blow to the head, from mild concussion to major injury. The key question: is there bleeding that needs surgery, swelling to monitor, or neither?
Book a consultation
The secretary schedules first appointments during clinic hours; please have prior imaging, operative notes and a current medication list available at the time of the call.
This page provides general information about epilepsy and is not a substitute for individual medical assessment. If your symptoms are severe or worsening, contact a clinician promptly.