Epilepsy

Epilepsy is a tendency to have repeated, unprovoked seizures — sudden bursts of abnormal electrical activity in the brain that briefly change how the brain works.

A single seizure is not the same as epilepsy. The diagnosis is made when a person has had two or more unprovoked seizures, or one unprovoked seizure with a high risk of further seizures based on investigations such as an EEGEEGElectroencephalogram — a non-invasive recording of the brain's electrical activity using electrodes placed on the scalp. The most important test in epilepsy diagnosis. or MRI.

Epilepsy can begin at any age — it is most common in children and in adults over 60. It is not contagious, it is not a mental illness, and (importantly) it is not a personality flaw. It is a neurological condition, and in Australia it affects approximately 250,000 people — about 1 in 100 (Epilepsy Action Australia, accessed April 2026).

Seizures are grouped by where in the brain they begin. Knowing the type decides the right medication and the right tests.

Focal seizures — starting in one area of the brain

Focal seizuresfocal seizureA seizure that begins in one specific area on one side of the brain. The most common seizure type in adults. Older terms: 'partial seizure', 'simple partial', 'complex partial'. start in one specific area of the brain — the most common seizure type in adults.

• Focal aware — you stay conscious but feel unusual sensations, movements, or emotions (older term: simple partial)
• Focal impaired awareness — your awareness is altered and you may have no memory of the event afterwards (older term: complex partial)
• Focal to bilateral tonic-clonic — a focal seizure that spreads across both sides of the brain and becomes a convulsive seizure

Generalised seizures — involving both sides from the start

Generalised seizuresgeneralised seizureA seizure that involves both sides of the brain from the moment it begins. Includes tonic-clonic, absence, myoclonic, atonic and tonic seizures. involve both sides of the brain from the very start.

• Absenceabsence seizureA brief generalised seizure causing a few seconds of staring or unresponsiveness, often with subtle eyelid flutter. Most common in children — a paediatric pattern that adults rarely develop de novo. — brief staring or blanking out lasting seconds; usually a childhood pattern
• Tonic-clonictonic-clonic seizureA convulsive seizure with a stiffening (tonic) phase followed by rhythmic jerking (clonic) phase, usually with loss of consciousness. Older term: grand mal. — the body stiffens, then jerks rhythmically; usually with loss of consciousness
• Myoclonic — sudden brief muscle jerks, often in the arms on waking
• Atonic — sudden loss of muscle tone causing a fall (“drop attack”)
• Tonic — the body suddenly stiffens without the rhythmic jerking phase

In about half of adult cases, no specific cause is found — this is sometimes labelled idiopathic or unknown-cause epilepsy. Identified causes include:

• Genetic factors — epilepsy can run in families, and some single-gene conditions raise seizure risk
• Brain injury — head trauma, stroke, meningitis, encephalitis, or brain tumour
• Vascular conditions — stroke is the leading cause of new-onset epilepsy in people over 60
• Prenatal injury — brain injury before birth from infection, oxygen deprivation, or major nutritional problems

Some neurodevelopmental conditions — including cerebral palsy and autism spectrum disorder — are more commonly seen alongside epilepsy, reflecting shared underlying brain biology rather than directly causing it.

1. We start by listening

Diagnosis begins with a careful history of what happened — what you remember, what witnesses saw, how long it lasted, what came before and after. Witness video is genuinely useful. We then examine you neurologically and review medications and medical conditions that can cause or mimic seizures.

2. EEG — on-site at Drummoyne

An EEG records the electrical activity of your brain through small electrodes placed on the scalp. It is the single most important test in epilepsy diagnosis. We offer all three EEG types on-site at our Drummoyne clinic:

• Routine EEG — a 20–40 minute recording in clinic, usually the first study performed
• Ambulatory EEGambulatory EEGA 3-day take-home EEG that records continuously while you go about your normal life. Best for capturing seizures or abnormalities that don't show up in a short clinic recording. — a portable 3-day recording you wear at home, ideal for capturing infrequent or sleep-related events
• Sleep-deprived EEGsleep-deprived EEGAn EEG performed after deliberately staying awake overnight. Sleep deprivation lowers seizure threshold, making abnormal patterns easier to capture. — performed after staying awake overnight, which raises the chance of capturing abnormal activity

3. MRI brain

An MRI looks for structural causes of seizures — old scarring, vascular malformations, tumours, hippocampal sclerosis. A dedicated epilepsy-protocol MRI is more sensitive than a standard scan and we’ll specify the protocol when we refer you.

4. Blood tests

Blood tests rule out conditions that mimic or trigger seizures — sodium and calcium disturbance, thyroid problems, infections, alcohol or drug effects, and medication interactions.

The goal is reliable seizure control with as few side effects as possible. Most adults with epilepsy reach that goal with a single well-chosen anti-seizure medication.

Anti-seizure medications

Anti-seizure medicationsanti-seizure medicationAnti-seizure medications (ASMs, formerly anti-epileptic drugs or AEDs) are the first-line treatment for epilepsy. The right choice depends on seizure type, age, sex, other medical conditions, and pregnancy plans. (ASMs — older term: anti-epileptic drugs or AEDs) are the first-line treatment. We choose based on your seizure type, age, sex, other medical conditions, plans for pregnancy, and how the medication interacts with anything else you take. ASMs commonly prescribed in Australia include:

• Levetiracetam (Keppra) — broad-spectrum, often a starting choice for both focal and generalised seizures
• Lamotrigine (Lamictal) — broad-spectrum; among the preferred choices in pregnancy
• Lacosamide (Vimpat) — widely used for focal seizures; increasingly chosen earlier in the treatment sequence
• Carbamazepine (Tegretol) — long-established agent for focal seizures. Per TGA guidance, we screen patients of Asian ancestry — particularly Han Chinese, Thai, Malay, Filipino, Indonesian, and South Asian populations — for the HLA-B*1502 allele before starting carbamazepine or oxcarbazepine, because of the risk of Stevens-Johnson syndrome in carriers.
• Topiramate (Topamax)
• Sodium valproate (Epilim) — effective for generalised seizures, but with significant pregnancy considerations (see below)

The five long-established ASMs above are all listed on the Pharmaceutical Benefits Scheme (PBS) and have generic versions widely available. Newer ASMs (lacosamide, brivaracetam, perampanel, cenobamate) have varying PBS access arrangements — your neurologist will discuss what applies to your situation.

When the first medication doesn’t work

Approximately 30% of people with epilepsy continue to have seizures despite a first ASM (Kwan & Brodie, NEJM 2000). The International League Against Epilepsy (ILAE, 2010 consensus) defines drug-resistant (refractory) epilepsydrug-resistant epilepsyDefined by the ILAE 2010 consensus as failure of two adequately trialled, tolerated, and appropriately chosen anti-seizure medications to achieve sustained seizure freedom. Also called refractory epilepsy. as failure of two adequately trialled, tolerated, appropriately chosen ASMs.

When that happens, the next step is specialist multidisciplinary review — revisiting the diagnosis, adjusting or combining medications, and considering whether referral to a tertiary epilepsy centre is appropriate. We coordinate that referral when it is the right step.

Driving rules for people with epilepsy in Australia are set by Austroads in the document Assessing Fitness to Drive. Every state and territory licensing authority applies the same standard. The thresholds below summarise the diagnosed-epilepsy pathway as verified at the date of this review (see the byline above); we check the live document at every assessment. Austroads also publishes a separate pathway for a single unprovoked seizure with normal investigations, and additional nuance for sleep-only, medication-withdrawal and provoked seizures — your neurologist will work through your individual situation against the current edition.

Private (car) licence — diagnosed epilepsy

• Unconditional private licence: 12 months seizure-free is the headline threshold under the current Austroads standard for diagnosed epilepsy
• Conditional private licence: a shorter seizure-free period may be possible in defined circumstances and is subject to individual specialist assessment
• Any change in medication can temporarily affect your driving eligibility — please discuss before making changes

After a single unprovoked seizure (no epilepsy diagnosis yet)

A separate Austroads pathway applies to a single unprovoked seizure with normal investigations. Under that pathway, a 6-month non-driving period followed by neurologist assessment is typical for return to private driving on a conditional licence; the exact criteria, including the investigations required, are set by the current Austroads edition and are confirmed at your assessment.

Commercial vehicle licence — diagnosed epilepsy

Commercial licences (heavy vehicles, buses, taxis, rideshare) are held to a substantially stricter standard. Under the current Austroads commercial pathway for diagnosed epilepsy, the typical criteria are:

• 10 years seizure-free from the most recent seizure
• 5 years off all anti-seizure medication
• Specialist neurologist assessment and clearance

Licensing-authority discretion applies, and a separate single-seizure commercial pathway exists. Thresholds occasionally shift between Austroads editions — please confirm with your neurologist before making employment decisions. CURA completes the Austroads commercial-vehicle assessment paperwork where the medical criteria are met.

Your responsibilities

• You are legally required to report your epilepsy to your state or territory licensing authority. In New South Wales this is Transport for NSW — phone 13 22 13 or visit nsw.gov.au
• If you have a seizure, stop driving immediately and notify the licensing authority
• Driving against medical advice or without reporting your condition has legal and insurance consequences

At CURA, our neurologists complete Austroads fitness-to-drive assessments as a routine part of epilepsy care, including the medical certification paperwork your licensing authority requires.

SUDEP — what it is and how to lower the risk

SUDEP — Sudden Unexpected Death in EpilepsySUDEPSudden Unexpected Death in Epilepsy. A rare but real risk, mostly seen in people with poorly controlled tonic-clonic seizures. Risk is lowered by good seizure control, medication adherence, and limiting alcohol. is rare but real, and we discuss it openly rather than leave it to be discovered online. The dominant risk factor is uncontrolled tonic-clonic seizures (especially at night); the other modifiable contributors that the evidence consistently points to are missed anti-seizure medication doses and heavy alcohol use.

The biggest risk-reduction levers are:

• Take medication consistently — same time each day, never skip a dose
• Treat night-time tonic-clonic seizures aggressively — tell us if they are happening
• Limit alcohol; avoid sleep deprivation
• Stay engaged with neurology follow-up — don’t fall out of care

Seizure first aid — for family, friends, colleagues

Knowing what to do during a seizure is one of the most valuable things a household can have ready. Adapted from Epilepsy Action Australia:

1. Stay calm. Stay with the person.
2. Time the seizure. Call 000 if it lasts longer than 5 minutes.
3. Move hard or sharp objects away. Cushion the head. Do not restrain.
4. Once the jerking stops, place them on their side (recovery position).
5. Do not put anything in their mouth.
6. Stay with them until they are fully alert.
7. Call 000 if there is injury, a second seizure begins, the person is pregnant, has diabetes, or this is their first-ever seizure.

Work and discrimination

Most people with epilepsy work in a wide range of roles. Australian anti-discrimination law protects you from being dismissed or refused employment because of epilepsy. Some roles with safety requirements — commercial driving, working at heights, operating heavy machinery — require a medical assessment under the relevant industry standard.

Mental health

Depression and anxiety are more common in people with epilepsy than in the general population — partly biological, partly the adjustment of living with the condition. If your mood is struggling, tell your neurologist. Treatment is effective and some antidepressants are well-suited to people with epilepsy.

Medicare and NDIS

Specialist neurology consultations and EEG studies attract Medicare rebates with a current GP referral. Most ASMs are subsidised under the PBS. If your epilepsy meaningfully affects your everyday function or capacity to work, you may be eligible for support through the National Disability Insurance Scheme (NDIS).

Pregnancy — plan ahead

If you are planning pregnancy and take an anti-seizure medication, make a neurology appointment before you start trying. Some medications (sodium valproate especially) carry meaningful teratogenic risk and benefit from a planned switch over months. Folate supplementation is started before conception. Never stop ASMs abruptly — that risks status epilepticus.

• Epilepsy Action Australia — epilepsy.org.au (national patient advocacy and education organisation)
• Epilepsy Foundation (Australia) — epilepsyfoundation.org.au (community programs and seizure-management training)
• Austroads — Assessing Fitness to Drive — austroads.com.au (the national medical-fitness-to-drive standard)
• International League Against Epilepsy (ILAE) — ilae.org (international classification, refractory-epilepsy definition, clinical guidelines)
• HealthDirect Australia — Epilepsy — healthdirect.gov.au
• TGA — Valproate use in pregnancy — tga.gov.au (Australian regulatory guidance on valproate in people of childbearing potential)
• MBS Online — Services Australia — mbsonline.gov.au (current item descriptors and rebates)