Skip to main content

Health condition · Clinically reviewed

Epilepsy, seizure types, EEG and MRI, medicines that work and what comes next.

Around 600,000 people in the UK live with epilepsy. With the right diagnosis and the right medicine, most become seizure-free. When medicines are not enough, modern surgery, neurostimulation and the ketogenic diet all have a place.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE NG217, the ILAE 2017 classification and MHRA safety updates you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including the valproate Pregnancy Prevention Programme, cannabidiol (Epidyolex) and epilepsy surgery pathways.

Key facts

Epilepsy at a glance.

The essentials, in plain English: what it is, who it affects, how the ILAE classifies seizures and how it is treated in the UK today.

  • What it is

    A neurological condition of recurrent unprovoked seizures caused by abnormal, synchronised electrical activity in the brain.

  • How common

    Around 600,000 people live with epilepsy in the UK, roughly 1 in 100. It can start at any age, from infancy to later life.

  • Diagnostic threshold

    Two or more unprovoked seizures at least 24 hours apart, or one seizure with a high (around 60%) recurrence risk.

  • Classification

    ILAE 2017 groups seizures by onset (focal, generalised or unknown), by awareness and by motor or non-motor features.

  • First-line treatment

    Antiseizure medication chosen for the seizure type, syndrome and reproductive potential. Around two thirds of people become seizure-free.

  • When medicines fail

    Drug-resistant epilepsy (failure of two appropriate medicines) warrants specialist review for surgery, neurostimulation or ketogenic diet.

Why this guide matters

A precise diagnosis, then a precise plan.

Epilepsy is a family of conditions, not one disease. The three points below shape the diagnostic pathway and everything that follows on this page.

  • Seizure type drives treatment

    The ILAE 2017 classification splits seizures into focal, generalised or unknown onset. The right medicine is chosen for the right type - one size does not fit all.

  • Reproductive potential matters

    Sodium valproate is highly effective for generalised epilepsies but contraindicated in girls and women of childbearing potential unless the Pregnancy Prevention Programme is met.

  • Drug-resistance is not the end

    Failure of two appropriate medicines meets the ILAE definition of drug-resistant epilepsy and triggers a tertiary referral for surgery, VNS, DBS or the ketogenic diet.

How the diagnosis is made

From first seizure to a clear syndromic diagnosis.

The steps a UK first-seizure clinic or neurologist will normally follow, in order, so you know what to expect and why.

  1. 01

    Assessing

    Detailed history and eyewitness account

    Semiology, aura, duration, awareness, post-ictal confusion, tongue biting, incontinence. A mobile phone video from a witness is genuinely invaluable.

  2. 02

    Assessing

    Neurological examination

    A full exam looking for focal signs, cognitive change and syndromic features that point towards an underlying cause.

  3. 03

    Assessing

    Blood tests

    FBC, U&Es, LFT, glucose, calcium, magnesium, prolactin, toxicology and, where relevant, antiseizure drug levels to exclude provoked causes.

  4. 04

    Confirming

    EEG

    Interictal, sleep-deprived, ambulatory or video-EEG telemetry (the gold standard) helps confirm epilepsy type and localise the focus.

  5. 05

    Confirming

    MRI brain with epilepsy protocol

    3 Tesla imaging looks for mesial temporal sclerosis, focal cortical dysplasia, tumours, malformations and vascular lesions.

  6. 06

    Planning

    Specialist epilepsy review

    Nurse-led epilepsy services and neurology confirm the syndrome, choose the first medicine and plan safety advice, DVLA and pregnancy counselling.

  7. 07

    Planning

    Tertiary referral if drug-resistant

    Failure of two appropriate medicines triggers referral to a specialist commissioned centre for surgical work-up, VNS, DBS or ketogenic diet.

Typical timeline: a first-seizure clinic within 2 weeks, EEG and MRI within a few weeks, medicine started when the diagnosis is confirmed.

Symptoms

What seizures actually look like.

Semiology varies enormously: from staring spells that last seconds to whole-body convulsions. The features below help clinicians classify seizures and pick the right medicine.

  • Focal aware seizures

    Formerly simple partial. Awareness preserved, with sensory, motor, autonomic or psychic symptoms lasting seconds to minutes.

  • Focal impaired awareness

    Formerly complex partial. Blank staring, automatisms (lip smacking, picking), often from the temporal lobe.

  • Tonic-clonic (grand mal)

    Generalised stiffening then rhythmic jerking, tongue biting, incontinence and prolonged post-ictal confusion.

  • Absence (petit mal)

    Brief blank spells of 5 to 20 seconds, common in childhood absence epilepsy and juvenile myoclonic epilepsy.

  • Myoclonic and atonic

    Sudden brief jerks (myoclonic) or sudden loss of tone with drop attacks (atonic) seen in JME and Lennox-Gastaut.

  • Aura

    A focal seizure at the start: rising epigastric sensation, deja vu, olfactory or gustatory hallucinations, fear or visual change.

  • Post-ictal state

    Confusion, headache, fatigue, transient weakness (Todd’s paresis) and amnesia for the event, sometimes lasting hours.

  • Red flag - status epilepticus

    A seizure lasting more than 5 minutes, or repeated seizures without recovery, is a medical emergency. Call 999.

Treatment

How epilepsy is treated in the UK.

Medicine first, chosen for the seizure type and reproductive potential. When two appropriate medicines fail, surgery, neurostimulation and the ketogenic diet come into view.

  • Lamotrigine

    A broad-spectrum first-line option for focal and generalised tonic-clonic seizures. Well tolerated and preferred in pregnancy.

  • Levetiracetam

    Broad-spectrum, quick to titrate, no significant interactions. First-line for many focal and generalised epilepsies including in pregnancy.

  • Sodium valproate

    Highly effective for generalised epilepsies but contraindicated in girls and women of childbearing potential unless the Pregnancy Prevention Programme is met.

  • Carbamazepine / oxcarbazepine

    Established options for focal epilepsy. Use is declining in favour of lamotrigine and levetiracetam because of interactions and side effects.

  • Ethosuximide

    First-line for childhood absence epilepsy when absences are the only seizure type. Not effective for tonic-clonic seizures.

  • Newer antiseizure medicines

    Lacosamide, brivaracetam, perampanel, cenobamate, zonisamide and rufinamide for focal or refractory epilepsy, chosen by a specialist.

  • Cannabidiol and fenfluramine

    Cannabidiol (Epidyolex) is NICE-approved for Lennox-Gastaut, Dravet and tuberous sclerosis. Fenfluramine (Fintepla) adds an option for Dravet.

  • Surgery, neurostimulation and diet

    Resective surgery, VNS, RNS, DBS and the ketogenic diet are the options when two appropriate medicines have failed.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, ILAE classification and MHRA safety updates, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your neurologist and epilepsy nurse know your history and can tell you which parts apply to you. If a seizure lasts more than 5 minutes, call 999.

  • NICE. Epilepsies in children, young people and adults (NG217).

  • ILAE. Operational classification of seizure types (2017) and classification of the epilepsies.

  • MHRA. Valproate use in women and girls of childbearing potential - Pregnancy Prevention Programme.

  • DVLA. Assessing fitness to drive: epilepsy and seizures guidance for medical professionals.

  • Epilepsy Action, Epilepsy Society, Young Epilepsy and SUDEP Action - patient information and support.

Red flags

When epilepsy needs urgent attention.

Most seizures self-terminate and most people with epilepsy do well. These are the situations where routine care is not enough.

  • Status epilepticus

    A seizure lasting over 5 minutes, or seizures repeating without recovery, is a medical emergency. Call 999 and give buccal midazolam if prescribed.

  • First seizure

    A first unprovoked seizure needs urgent assessment (within 2 weeks) in a first-seizure clinic. Do not drive until reviewed.

  • SUDEP risk

    Sudden unexpected death in epilepsy is rare but real. Poorly controlled generalised tonic-clonic seizures at night are the main risk factor.

  • Valproate exposure in pregnancy

    Valproate carries a high risk of birth defects and neurodevelopmental problems. Any suspected exposure needs immediate specialist review.

  • New focal neurology or headache

    Progressive focal signs, personality change or new persistent headache with seizures needs urgent imaging to exclude a structural cause.

  • Post-ictal Todd’s paresis

    Transient focal weakness after a seizure can mimic stroke. If in doubt, treat as stroke until imaging clarifies.

  • Mental health crisis

    Depression, anxiety and suicidal thoughts are more common in epilepsy. Some medicines can worsen mood. Ask for help early.

  • Driving after a seizure

    You must notify the DVLA and stop driving. Cars and motorcycles: at least 12 months seizure-free. HGV and PCV: much longer, off medication.

  • Non-epileptic attacks

    Dissociative (psychogenic) non-epileptic seizures can coexist with epilepsy. Video-EEG and specialist psychology clarify the diagnosis.

Living with it

A manageable condition, with the right plan.

Four things that make the biggest difference day to day: knowing your triggers, small safety changes, understanding the DVLA rules and planning any pregnancy early.

A quiet reminder

Sleep, adherence and honesty about triggers do most of the work.

Missed doses, poor sleep and alcohol are the three most common reasons for a breakthrough seizure. Get those right and everything else gets easier.

  1. 01 Triggers

    Know your triggers

    Sleep deprivation, alcohol, missed doses, illness, stress and, in a small subgroup, flashing lights are the common ones. Track them.

  2. 02 Safety

    Small changes, big protection

    Shower rather than bathe, avoid swimming alone, be careful around cooking and heights, and consider a medical alert.

  3. 03 Driving

    The DVLA rules

    You must tell the DVLA and stop driving after a seizure. Rules on the seizure-free period depend on the licence type and seizure pattern.

  4. 04 Pregnancy

    Plan pregnancies early

    Talk to your specialist before conceiving. Avoid valproate, prefer lamotrigine or levetiracetam, take 5 mg folic acid and join the UK Epilepsy and Pregnancy Register.

Frequently asked

Everything we get asked about epilepsy.

Quick answers on seizure types, EEG and MRI, medicines, surgery, driving and pregnancy.

  • What is epilepsy?

    Epilepsy is a neurological condition defined by a lasting tendency to have unprovoked seizures. In practice that means two or more unprovoked seizures more than 24 hours apart, or one seizure with a high risk of recurrence (around 60%) because of an underlying cause on imaging or EEG. It is not a single disease but a family of conditions with many causes.

  • What causes epilepsy?

    Causes fall into six ILAE groups: genetic (for example SCN1A in Dravet syndrome), structural (stroke, traumatic brain injury, tumour, malformation, mesial temporal sclerosis), metabolic, immune (Rasmussen, LGI1, anti-NMDAR, GAD65 encephalitis), infectious (post-encephalitis, meningitis, neurocysticercosis worldwide) and unknown. In many people no single cause is ever found and the epilepsy is called idiopathic or of unknown cause.

  • What tests will I have?

    The core work-up is a careful history with a witness account, an EEG (interictal, sleep-deprived, ambulatory or video-EEG) and an MRI brain with a dedicated epilepsy protocol at 3 Tesla. Blood tests exclude reversible triggers and check for organ function before medicines are started. Some people need FDG-PET, MEG, Wada testing or intracranial EEG at a tertiary centre.

  • Which medicine will I be offered?

    The choice depends on the seizure type, the syndrome, other conditions and, importantly, reproductive potential. Lamotrigine and levetiracetam are common first-line options. Ethosuximide is used for absence seizures. Sodium valproate is very effective for generalised epilepsies but is contraindicated in girls and women of childbearing potential unless the strict Pregnancy Prevention Programme is met.

  • What happens if medicines do not work?

    About one in three people has drug-resistant epilepsy, defined by the ILAE as failure of two appropriate, tolerated antiseizure medicines. That triggers referral to a specialist commissioned tertiary centre for detailed video-EEG monitoring, advanced imaging and assessment for epilepsy surgery, vagus nerve stimulation, deep brain stimulation, responsive neurostimulation or a ketogenic diet.

  • Is epilepsy life-limiting?

    For most people, no. With the right treatment the majority become seizure-free and live full lives. There is a small but real risk of sudden unexpected death in epilepsy (SUDEP), particularly with poorly controlled generalised tonic-clonic seizures at night. Openly discussing SUDEP with a specialist nurse, optimising treatment and paying attention to safety and sleep all reduce that risk.

Related content

Keep reading.

Pulse Healthcare concierge

Send us your enquiry

A concierge service for UK private healthcare. We match you with the best vetted clinics and consultants in our network - they then contact you directly.

So we can match you to the right clinician close to you.

We reply to every enquiry within 24 hours (Mon–Fri). Confidential - your details are never shared outside our vetted consultant network.