Epilepsy and Seizures: Understanding Types, Triggers, and Medications

When someone has a seizure, it’s not just a momentary loss of control-it’s a signal that something deeper is happening in the brain. Epilepsy isn’t one condition. It’s a group of neurological disorders tied to recurring, unprovoked seizures. And how we classify those seizures has changed dramatically in the last few years. The old terms like "partial" or "complex" are gone. Now, doctors use focal and generalized to describe where seizures start. This shift isn’t just semantics-it changes how treatment works, what medications are chosen, and even whether a patient gets the right care at all.

What Really Counts as Epilepsy?

Having one seizure doesn’t mean you have epilepsy. The International League Against Epilepsy (ILAE) says you need either two unprovoked seizures more than 24 hours apart, or one seizure with a high chance-60% or more-of having another. That’s because isolated seizures can be caused by things like low blood sugar, alcohol withdrawal, or a head injury. Epilepsy is when the brain develops a lasting tendency to spark seizures without an obvious trigger.

Worldwide, about 50 million people live with epilepsy. In the U.S., that’s 3.4 million. Every year, 5 million new cases are diagnosed. Yet, nearly 8 out of 10 patients report being misdiagnosed at least once. Why? Because seizures don’t always look like the dramatic convulsions shown on TV. Many are subtle-staring blankly, blinking rapidly, or suddenly losing awareness for a few seconds. These are often mistaken for daydreaming, panic attacks, or even ADHD in children.

The New Seizure Classification: Simpler, Clearer

In 2025, the ILAE updated its seizure classification system, cutting the number of named seizure types from 63 down to just 21. The goal? Make it easier for doctors-especially those without specialist training-to get it right the first time.

Seizures are now grouped into four main types:

• Focal seizures-start in one area 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 data to say

Focal seizures are split into two categories based on consciousness:

• Aware (formerly "simple partial")-you’re fully awake during the seizure. You might feel a strange smell, see flashing lights, or have a tingling in your hand. You remember it all.
• Impaired awareness (formerly "complex partial")-you lose awareness. You might stare, chew without meaning to, or wander around. Afterward, you have no memory of it. This is the most common type of focal seizure, making up about 75% of cases.

Generalized seizures include:

• Absence-brief staring spells, often in kids. Lasts 5-10 seconds. May happen dozens of times a day.
• Myoclonic-sudden jerks in arms or legs. Often happens right after waking up.
• Tonic-muscles stiffen. Person may fall backward.
• Clonic-repeated jerking movements.
• Tonic-clonic-the classic "grand mal" seizure. Stiffening, then shaking. Often followed by confusion or sleep.
• Atonic-sudden loss of muscle tone. Person drops like a puppet with cut strings.

One big change: doctors now focus on "observable" and "non-observable" signs instead of "motor" vs. "non-motor." That’s because seizures can involve changes in thought, emotion, or autonomic function-like sweating, heart racing, or nausea-without any visible movement. These were often missed before.

What Triggers Seizures? It’s Not Just Stress

Triggers vary from person to person. But some are common enough to watch for:

• Sleep deprivation-the #1 trigger for most people. Even one night of poor sleep can lower your seizure threshold.
• Alcohol and drugs-binge drinking or withdrawal can spark seizures. Some recreational drugs, like cocaine or MDMA, are high-risk.
• Flashing lights-only affects about 3% of people with epilepsy. Still, it’s real. Video games, strobe lights, or even sunlight flickering through trees can trigger some.
• Hormonal changes-many women with epilepsy have more seizures around their period. This is called catamenial epilepsy.
• Missed medications-not taking your drug on time is the most preventable cause of breakthrough seizures.
• Illness and fever-especially in kids. High fevers can cause febrile seizures, which are different from epilepsy but can increase future risk.

What doesn’t trigger seizures? Most people think stress or emotions cause them. While stress can make seizures more likely, it’s rarely the direct cause. The brain’s electrical activity is the real driver. That’s why tracking your seizures with a journal-timing, symptoms, sleep, meds, meals-can reveal your personal pattern.

Antiepileptic Medications: What Works and What Doesn’t

There are over 30 FDA-approved antiepileptic drugs (AEDs). The goal isn’t to cure epilepsy-it’s to stop seizures without causing side effects that make life worse.

First-line medications depend on seizure type:

• Focal seizures: Lamotrigine, levetiracetam, carbamazepine, oxcarbazepine
• Generalized seizures: Valproate, lamotrigine, ethosuximide (for absence), topiramate
• Combined focal and generalized: Lamotrigine, valproate, topiramate

Valproate is highly effective for generalized seizures-but it’s not safe for women of childbearing age due to high risk of birth defects. Lamotrigine is often preferred here because it’s safer and still works well.

Levetiracetam is popular because it has fewer drug interactions and is well-tolerated. But some people report mood changes-irritability, depression-so it’s not for everyone.

Carbamazepine works great for focal seizures, but it can cause skin rashes in people with the HLA-B*1502 gene, common in Asian populations. Genetic testing is now recommended before starting it in high-risk groups.

Medication success rates vary. About 70% of people become seizure-free with the first or second drug. The rest have drug-resistant epilepsy. For them, options include surgery, nerve stimulation (like VNS or RNS), or dietary therapies like the ketogenic diet.

Side effects matter. Dizziness, fatigue, weight gain, memory fog, and mood shifts are common. Many patients stop taking meds not because they don’t work-but because they feel worse on them. That’s why doctors now talk about "quality of life" as a key outcome, not just "seizure freedom."

Why Classification Matters for Treatment

Getting the seizure type wrong leads to the wrong drug. A 2023 study found that 27% of people were prescribed medications that didn’t match their seizure type. For example, giving ethosuximide (for absence seizures) to someone with focal seizures? Useless. Giving carbamazepine to someone with myoclonic seizures? Can make them worse.

Combined focal and generalized epilepsy-a category added in 2017-is especially tricky. About 5-8% of people have this. Many are initially labeled as having only focal seizures. They get the wrong meds. Their seizures keep happening. It takes months-or years-to reclassify them. That’s why accurate diagnosis isn’t just paperwork-it’s life-changing.

One patient, a 12-year-old girl with daily staring spells, was diagnosed with ADHD for two years. Her teacher said she was "inattentive." Only after a video EEG showed 3Hz spike-and-wave patterns did she get the right diagnosis: childhood absence epilepsy. Within weeks on ethosuximide, her seizures stopped. Her grades improved. Her confidence returned.

What’s Next for Epilepsy Care?

AI tools are coming. The ILAE is testing a digital assistant that helps doctors classify seizures using video clips and EEG data. Early results show it boosts accuracy by 18% for non-specialists. That’s huge for rural clinics or countries without neurologists.

Genetics is changing the game too. We now know that over 500 genes are linked to epilepsy. In the next few years, genetic testing may help predict which drugs will work best-and which could cause dangerous side effects-before a patient even takes one pill.

But the biggest barrier isn’t technology. It’s access. In low-income countries, more than 75% of people with epilepsy don’t get diagnosed. In the U.S., only 58% of rural patients get an EEG within the recommended 72 hours. Without proper testing, classification fails. Treatment fails. Lives are put on hold.

What You Can Do

If you or someone you know has seizures:

• Keep a seizure diary: note date, time, duration, symptoms, possible triggers
• Record videos if possible-eyewitness accounts are gold
• Ask your doctor: "What type of seizure is this?" and "What’s the evidence?"
• Don’t accept "it’s just stress" as an answer if seizures keep happening
• Stick to your meds-even if you feel fine
• Get enough sleep. It’s not optional.

Episodes of confusion, staring, or sudden jerks aren’t normal. They’re signals. And with the right classification, the right treatment, and the right support, most people with epilepsy can live full, active lives.

If you’re living with epilepsy, know this: you’re not alone. The tools to manage it are better than ever. The key is getting the right diagnosis-and sticking with a plan that works for your life.