Can You Have Epilepsy Without Seizures?

Epilepsy is commonly understood as a condition involving recurrent seizures caused by abnormal electrical activity in the brain. Given this, many people wonder whether it is possible to have epilepsy without experiencing seizures. The straightforward answer is that seizures are central to an epilepsy diagnosis; however, the experience of seizures can vary widely, and some types of epilepsy may present with subtle or unusual seizure activity that is not immediately recognised. This article explores the relationship between epilepsy and seizures, explains how epilepsy can sometimes be overlooked, and clarifies what it means to have epilepsy.

Seizures Are Essential for an Epilepsy Diagnosis

By definition, epilepsy involves having at least two unprovoked seizures occurring more than 24 hours apart. Seizures are the hallmark symptom of epilepsy and the main reason people seek medical advice. Without seizures, epilepsy is not diagnosed because the condition fundamentally involves abnormal brain activity that manifests as seizures.

Subtle or Unrecognised Seizures

While seizures are essential for diagnosis, not all seizures look dramatic or involve convulsions. Some seizures, such as absence seizures, focal aware seizures, or sensory seizures, may be very brief or subtle, leading to unrecognised or misinterpreted symptoms. For example, a person may experience brief lapses in awareness, strange sensations, or brief muscle twitches that go unnoticed or are mistaken for other issues. In such cases, epilepsy can exist but appear as if seizures are absent.

Non-Epileptic Seizures

It is important to distinguish epilepsy seizures from non-epileptic seizures or other conditions that mimic seizures, such as fainting, panic attacks, or psychogenic non-epileptic seizures (PNES). These events do not involve the abnormal electrical brain activity seen in epilepsy.

Epilepsy with Rare or Atypical Seizures

Some people with epilepsy may have seizures that occur infrequently or under specific triggers, making them less obvious. Others may experience only one seizure in a lifetime and still be diagnosed with epilepsy if the risk of further seizures is high.

Diagnostic Challenges

Diagnosing epilepsy when seizures are subtle or rare requires careful clinical assessment, witness accounts, EEG testing, and sometimes prolonged monitoring. Misdiagnosis or delayed diagnosis can occur if seizures are mistaken for other conditions or overlooked.

Living with Epilepsy

Once diagnosed, epilepsy management focuses on controlling seizures through medication and lifestyle measures. Understanding the variety of seizure types helps people recognise symptoms and seek help early.

Final Thought

Epilepsy cannot exist without seizures by definition, but seizures may be subtle or unrecognised in some cases. Awareness of different seizure types and thorough medical evaluation ensure accurate diagnosis and effective management.