When Should I Worry About...

Are Epilepsy and Seizures the Same Thing?

Feb. 12, 2024 - Kim Rivera Huston-Weber

Misconceptions abound about epilepsy, which is often called seizure disorder — or even seizure disorders or "the epilepsies." Why? Because the causes and types of epilepsy are diverse.

One in 26 people will develop epilepsy at some point in their lifetime, according to the Epilepsy Foundation — and what triggers seizures in one person may not trigger seizures in another. We're breaking down the differences in what causes epilepsy, and what triggers the seizures that can lead to an epilepsy diagnosis.

So what's the difference between seizures and epilepsy?

Seizures start when nerve cells in the brain, called neurons, send incorrect signals. Many neurons will suddenly send signals at the same time during a seizure, causing a temporary surge of electrical activity in the brain. This surge can cause anything from involuntary movement or sensations to changes in feelings and behavior. People experiencing a seizure may even lose consciousness.

About one in 10 people will experience a seizure in their lifetime, according to the CDC — but having a seizure doesn't mean a person has or will develop epilepsy.

"There are other reasons you can have a seizure that doesn't mean your brain is susceptible to having these come back over and over again," says Dr. Omotola A. Hope, a neurologist and epileptologist at Houston Methodist. "If you have diabetes, for example, and your blood sugar drops way too low, then that could be an explanation for a seizure. And it doesn't necessarily mean that you have epilepsy."

Seizures can be classified as either provoked or unprovoked. Provoked seizures have an identifiable cause, whether it's having low blood sugar, a very high fever or withdrawal from substances such as alcohol or drugs. Events such as brain injury or strokes can also "provoke" or trigger seizures in the immediate aftermath of the event — often within the first week, for example.

Unprovoked seizures, however, can't be pinned to any medical condition or event. They occur simply because the person's brain has the structure or wiring that makes it easier to create these unprovoked seizures. Recurrent unprovoked seizures is epilepsy. Seizures caused by events such as brain injuries and strokes are considered unprovoked if the seizure occurs a long time after the event.

For example, Dr. Hope says if you had a TBI while you were in the Army three years ago, and you have seizures now, then these seizures are most likely epilepsy.

Following a seizure, Dr. Hope says that patients are evaluated extensively through blood work, checking electrolyte levels and other tests to discern whether the seizure was provoked or unprovoked. If a seizure is provoked, the underlying cause is treated.

But to be diagnosed with epilepsy, Dr. Hope says that a person will need to have two or more unprovoked seizures that cannot be explained.

"Epilepsy means that you have a vulnerability to seizures," Dr. Hope says. "It's easier for your brain to be triggered into a seizure. It would take multiple nights of sleep deprivation, lots of drugs, and lots of things to trigger a single seizure in someone without epilepsy. It's just so much easier to get to that threshold when someone has epilepsy."

What causes epilepsy — and who develops it

"The problem with epilepsy is it's not one disease," Dr. Hope says. "Epilepsy is epilepsies, and the only thing that the diseases all share is the fact that you have recurrent seizures."

Epilepsy is one of the most common neurological conditions, according to Dr. Hope. Anyone can develop epilepsy at any age. Epilepsy can develop early in life, as there is a genetic and hereditary element to the condition.

There may be as many as 500 genes associated with epilepsy — and while the condition does run in families, it's possible for genetic epilepsy to spontaneously occur. A parent or sibling with epilepsy increases the risk of developing the condition, but it's still possible to carry genes related to epilepsy and not develop it. Individuals with certain movement disorders and developmental disorders, including autism, Down syndrome and neurofibromatosis, may experience epilepsy as well.

"So it can be genetic, and it can be acquired," Dr. Hope says. "Any brain disease can put you at risk for epilepsy, including traumatic brain injury, dementia and stroke. About 10% of people that have had a stroke will develop epilepsy. And we know that larger size and several other factors can increase that risk, but we still don't fully understand why someone with the same stroke might have seizures and someone else with the same stroke will not. That's why it can get complicated."

People can also develop epilepsy after experiencing viral or bacterial infections, such as encephalitis and meningitis. And while it's still being studied, Dr. Hope says that when people have uncontrolled chronic conditions, including vascular issues, high blood pressure, and diabetes there can be an increased cumulative risk for developing epilepsy.

Types of seizures that people with epilepsy experience

The type of epilepsy a person has is often classified by the type of seizures they experience. The seizure type symptoms are defined by where in the brain the electrical storm surge occurs.

"Broadly, we put them in two big buckets: focal epilepsies and generalized epilepsies," Dr. Hope says. "Focal is a microstructural or structural problem that we can often see, and generalized is more of a wiring problem and the whole brain is wired in a way that makes it more excitable."

Both hemispheres, or sides, of the brain are affected during a generalized seizure — and the symptoms are what people stereotypically imagine when they think about a seizure. A person may lose consciousness, fall to the ground, and have muscle spasms that cause their limbs to move in a jerking motion. But generalized seizures can also look like someone staring off into the distance or experiencing rapid blinking.

Focal seizures usually affect either the right or left side of the brain — but can move locations from one hemisphere to the other as electrical activity intensifies. This type of seizure can have more vague symptoms — everything from your senses of smell, sight, taste or sound can be affected, and your emotions can feel intensified.

Some may feel a sense of déjà vu or a tingling sensation, see flashing lights or feel dizzy. There can also be repetitive movements, including blinking the eyes, lip-smacking, rubbing the hands or hand motions. The arm and leg muscles can jerk uncontrollably. People can be aware during focal seizures but can lose awareness as the electrical surge moves hemispheres.

"There can be a delay in diagnosis for people that have focal seizures since people just don't recognize these funny episodes as seizures," Dr. Hope says. "If you have these events recur, and whenever they occur, it's the same type of event, I would discuss it with your doctor and suggest seeing a neurologist yourself if your doctor is not that impressed with the symptoms. Because the fact that it occurs the same way every time is often what is helpful in making the diagnosis."

Generalized seizures are more commonly associated with genetic epilepsy, according to Dr. Hope. Focal seizures are most common in those who experience a brain injury, certain infections, strokes, and brain tumors. As we age and experience chronic conditions, the chance of experiencing epilepsy increases. We're most at risk after age 60.

What triggers a seizure in someone with epilepsy?

For people with epilepsy, seizures can follow a certain pattern or may happen based on what's going on with their bodies. Common seizure triggers for people with epilepsy can include:

  • Alcohol
  • Being sick (with or without fever)
  • Certain foods
  • Dehydration
  • Drug use, such as ecstasy and cocaine
  • Inadequate sleep, poor
  • Flashing lights or bright lights
  • Hormonal changes
  • Low blood sugar
  • Menstrual cycle
  • Missing medications
  • Over-the-counter allergy and cold medicines
  • Skipping meals
  • Stress
  • Vitamin and mineral deficiencies


Dr. Hope emphasizes that while avoiding triggers may help some people with epilepsy control the number of seizures they experience, but that it's no substitute for working with a neurologist to manage your epilepsy.

"Stress is certainly a common trigger," Dr. Hope says. "But it's not the cause of your epilepsy. That's not why you're having epilepsy. People can have the same stress and not have a seizure. You have stress as a trigger, but it's not the cause.

"I usually try to differentiate between the two," adds Dr. Hope. "And not that we know the cause of every single case, but those triggers are important to control. Still, they're not the end-all be-all — some people say, 'Oh, if I control my triggers, I don't have to take medication.' Well, no, you're still going to be susceptible, and maybe you still need to be on medication."

Epilepsy can be controlled

"Most people with epilepsy will, no matter what, will be on medications — but the big message with treatment is that 70% of people will do great, meaning that you try the first or second drug, and it's well-controlled," Dr. Hope says.

Newer epilepsy medications, including Keppra, Lamotrigine and Topiramate, are broad-spectrum, meaning they can be used for focal or generalized seizures. While most people with epilepsy will find relief with medication, Dr. Hope says 20% to 30% of people with epilepsy will have refractory, or drug-resistant, epilepsy.

Focal epilepsies may be harder to control for some. Epilepsy is considered refractory when a person has tried two or more medication regimens and have not been able to attain seizure freedom. Also, some people have intolerable side effects with seizure medications that make it difficult to treat.

"There are several treatment options for those with difficult-to-treat epilepsy, such as surgical resection, laser ablation and devices for neuromodulating the brain," Dr. Hope says.

Laser ablation is a treatment that allows neurosurgeons to remove the cells that lead a person to have seizures. Resection surgery is when the section of the brain causing seizures is removed. And more and more, neuromodulation medical devices are being used to treat epilepsy.

These types of procedures can include vagal nerve stimulation, responsive neurostimulation called NeuroPace, and deep brain stimulation. In a vagal nerve stimulation procedure, a device is inserted that causes the vagal nerve to be sent regular pulses of electricity to control seizure activity in the brain.

For the NeuroPace device, a device is placed or inserted in or around the affected area of the brain. The device delivers personalized treatment to respond to a person's unique electrical brain activity.

For people with epilepsy, there are now more ways to manage seizures than ever before.

"We are in an era where we have a lot of great medications and procedures," Dr. Hope says. "The genetics of it is expanding every day as we're learning more and more about what causes some of these epilepsies. So it's very interesting."

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