Epilepsy and Seizures: Understanding Types, Triggers, and Medications

When someone has a seizure, it can be terrifying-not just for the person experiencing it, but for anyone watching. You might see them stiffen, shake, stare blankly, or lose awareness. But not all seizures look the same. And not every seizure means epilepsy. The difference matters-because how we classify seizures directly affects what treatment works.

What Really Counts as Epilepsy?

Epilepsy isn’t just having one seizure. The International League Against Epilepsy (ILAE) defines it as a brain condition where you’re likely to have more seizures without a clear trigger-like a head injury, high fever, or alcohol withdrawal. To be diagnosed, you typically need either two unprovoked seizures more than 24 hours apart, or one seizure with a 60% or higher chance of having another based on tests like EEG or brain scans.

That’s important because many people have a single seizure in their life and never have another. But if your brain has a pattern that makes seizures likely to return, that’s epilepsy. About 50 million people worldwide live with it. In the U.S., that’s 3.4 million people-roughly 1 in 83. And every year, 5 million more are diagnosed.

The New Way to Classify Seizures (2025 Update)

In 2025, the ILAE updated its seizure classification system to make it simpler and more useful for doctors and patients. They cut the number of named seizure types from 63 down to 21. Why? Because too many labels confused even trained clinicians.

Now, seizures are grouped into four main types:

• Focal seizures - start in one part of the brain
• Generalized seizures - affect both sides of the brain at once
• Unknown onset - you don’t know where it started
• Unclassified - not enough info to say

Focal seizures are the most common, making up about 60% of all epilepsy cases. They used to be called “partial” or “complex partial,” but now they’re split by awareness:

• Aware focal seizures - you’re fully conscious. You might feel a strange smell, see flashing lights, or have a rising sensation in your stomach. These used to be called “simple partial.”
• Impaired awareness focal seizures - you lose awareness. You might stare blankly, fumble with your clothes, or repeat words without knowing. These were once called “complex partial.” About 75% of focal seizures fall into this category.

Generalized seizures happen when both brain hemispheres fire at once. Common types include:

• Absence seizures - brief staring spells, often in children. Lasts 5-10 seconds. Sometimes mistaken for daydreaming.
• Myoclonic seizures - sudden jerks in arms or legs. Often happens right after waking up.
• Tonic-clonic seizures - the classic “grand mal.” Body stiffens, then jerks. Often followed by confusion or sleep.
• Atonic seizures - sudden loss of muscle tone. Can cause falls. Sometimes called “drop attacks.”

A key change in the 2025 system? They replaced “motor” and “non-motor” with “observable” and “non-observable.” Why? Because not all seizures involve movement. Some just change how you feel inside-like a sudden wave of fear, déjà vu, or numbness. These were hard to classify before. Now, they’re recognized as real seizure types.

What Triggers Seizures?

Not all seizures happen randomly. Many people have triggers-things that make their brain more likely to fire off a seizure. Common ones include:

• Sleep deprivation - one of the biggest triggers. Skipping sleep or changing your schedule can set off seizures, even in people who are otherwise controlled.
• Stress - emotional or physical stress increases brain activity in ways that can push someone over the edge.
• Flashing lights - affects about 3% of people with epilepsy. It’s rare, but real. Video games, strobe lights, or even sunlight flickering through trees can trigger them.
• Alcohol and drugs - heavy drinking or withdrawal can cause seizures. Even moderate drinking can interfere with medication.
• Missed medication - this is the number one cause of breakthrough seizures. Skipping even one dose can be enough.
• Hormonal changes - many women with epilepsy have more seizures around their period. This is called catamenial epilepsy.
• Illness or fever - especially in children. Infections can lower the seizure threshold.

Keeping a seizure diary helps spot patterns. Write down what happened before the seizure-what you ate, how much you slept, if you were stressed. Over time, you’ll see what’s consistent.

Antiepileptic Medications: What Works and What Doesn’t

There are more than 25 antiepileptic drugs (AEDs) available today. The goal isn’t to cure epilepsy-it’s to stop seizures with the fewest side effects. The right drug depends on your seizure type, age, gender, and other health conditions.

For focal seizures, common first-line drugs include:

• Lamotrigine - good for most focal seizures, less sedating than older drugs.
• Levetiracetam - often used in kids and adults. Few drug interactions.
• Carbamazepine - effective but can cause skin reactions in some people, especially those of Asian descent.
• Brivaracetam - newer, similar to levetiracetam but faster acting.

For generalized seizures, especially absence or myoclonic:

• Valproate - very effective for multiple seizure types, but not for women of childbearing age due to birth defect risks.
• ethosuximide - first choice for absence seizures in children.
• Topiramate - works for both focal and generalized seizures, but can cause brain fog or weight loss.

For tonic-clonic seizures, common choices include:

• Lamotrigine
• Levetiracetam
• Phenytoin - older drug, needs blood monitoring, but still used when others fail.

Side effects vary. Some people feel tired, dizzy, or have trouble concentrating. Others gain weight, lose it, or get rashes. If a drug isn’t working or causes bad side effects, don’t stop it cold. Talk to your doctor. Tapering off too fast can cause status epilepticus-a life-threatening seizure that won’t stop.

Medication isn’t always enough. About 30% of people with epilepsy don’t respond to drugs. For them, options include surgery, nerve stimulation (like VNS or RNS), or the ketogenic diet-a high-fat, low-carb diet that changes how the brain uses energy.

Why Getting the Diagnosis Right Matters

Here’s the hard truth: 15-20% of people are misdiagnosed at first. Some are told they have epilepsy when they don’t. Others have epilepsy but are told it’s anxiety, migraines, or fainting.

One common mix-up is psychogenic non-epileptic seizures (PNES). These look like epileptic seizures but aren’t caused by abnormal brain electricity. They’re real-they just come from psychological stress, not brain misfires. About 20-30% of people sent to epilepsy monitoring units turn out to have PNES. Treating PNES with antiepileptic drugs doesn’t help. Therapy does.

Another big problem? Temporal lobe epilepsy is often mistaken for generalized epilepsy. That leads to wrong meds, longer delays in treatment, and more seizures. A 2023 study found that when classification was done correctly, medication adherence jumped 34%. People understood their condition better-and stuck with their treatment.

What’s Next for Epilepsy Care?

The ILAE is working on a digital tool that uses AI to help doctors classify seizures based on video recordings. Early tests show it boosts accuracy by 18% for non-specialists. In places without EEG machines or neurologists, this could be life-changing.

Genetics is also becoming more important. We now know that some epilepsy syndromes are caused by single gene mutations. Testing for these is becoming more common, especially in kids with early-onset seizures. In the next few years, we’ll likely see treatment choices guided not just by seizure type, but by genetic profile.

For now, the best thing you can do is get accurate diagnosis, track your triggers, and take your meds as prescribed. Epilepsy isn’t a life sentence. With the right care, most people live full, active lives.

Common Questions About Epilepsy and Seizures

Final Thoughts

Epilepsy isn’t one thing. It’s many things-different causes, different seizure types, different triggers, different treatments. The 2025 classification system helps make sense of that complexity. But the real breakthrough isn’t in the labels-it’s in understanding that each person’s epilepsy is unique. What works for one person might not work for another. The goal isn’t perfection. It’s control. And with the right approach, most people with epilepsy can live without fear of the next seizure.