Why treating epilepsy isn't just about stopping seizures

Analysis: Epilepsy was viewed for a long time as a disorder of sudden electrical disruption, but we now know the story is more complex

By Sujithra Srinivas, UCD

For decades, the central goal of epilepsy treatment has been straightforward: stop the seizures. Modern anti-seizure medicines have transformed the lives of many people. For thousands in Ireland, they reduce attacks and allow people to work, study, drive and live more independently.

But seizures are only part of the story. Around 45,000 people in Ireland live with epilepsy, and about one in three continue to have seizures despite trying several medications. Even when medication does control seizures, most people must stay on them for many years, sometimes for life.

This raises an important question: what if epilepsy treatments could do more than suppress seizures, and instead target the changes in the brain that allow them to happen in the first place?

Looking beneath the surface

To understand this, it helps to know what a seizure actually is. A seizure happens when groups of brain cells or neurons suddenly fire in fast, intense bursts. Normally, brain cells communicate in a balanced, organised way. During a seizure, that balance collapses, and signals become overwhelming.

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Most epilepsy mediations work by calming this activity. They slow down neuron firing or reduce the chances that these bursts happen. For many people, this works extremely well. But there's a catch: these mostly address the symptom, not the root cause. Think of it like a leaking roof during heavy rain. Buckets on the floor stop the water from soaking the house, but they don’t fix the hole.

Anti-seizure medications catch the water. But for people whose seizures continue despite treatment or who need lifelong medication, the "leak" itself remains a problem.

More than "too much electricity"

For years, epilepsy was often described simply as "too much electrical activity" in the brain, but research over the past two decades has shown it’s more complex. In some people, epilepsy starts after an event such as a head injury, stroke, infection, or a long seizure. After this, the brain can begin to change.

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Neurons may connect differently, some signals grow stronger while others weaken, and networks of cells can gradually become more sensitive more likely to fire in bursts. These changes can take years to develop. So, epilepsy is not always just a sudden electrical storm. Sometimes it’s the result of slow, underlying changes in the brain.

And that opens a new possibility: instead of reacting to seizures after they appear, could future treatments make the brain less likely to produce them in the first place?

Tiny switches in our cells

One area scientists are exploring is how our cells decide which instructions to follow. Every cell in the body carries the same set of genetic instructions, but they aren’t used all at once. Cells turn certain instructions on or off depending on what they need.

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Think of it like a dimmer switch for a light: the instructions don’t change, but the brightness can. In epilepsy, some of these switches may stop working properly. Certain instructions may stay turned up for too long, while others remain too low. If this balance stays disturbed for a long time, the brain can remain in a state where seizures are more likely.

Scientists are now asking: could we gently reset these switches and restore balance in the brain?

Messages inside brain cells

Inside every cell there’s also a constant stream of messages that help turn instructions into action. These messages tell the cell which proteins to make. Proteins are the cell’s working parts they build structures, send signals, and keep everything running smoothly.

Cells carefully control how long messages last and how strongly they’re used. Some disappear quickly, while others stay for longer, allowing the cell to make more of a particular protein. In epilepsy, growing evidence suggests this system can become unbalanced. Messages that stay too long or appear too often can cause brain cells to produce proteins that make them more excitable. Over time, this may contribute to unstable brain activity.

At University College Dublin, as part of the FutureNeuro Research Ireland Centre, my research focuses on these changes and how they might influence seizure risk over the long term.

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Why this matters

For people living with epilepsy and their families this way of thinking could make a real difference in the future. Today’s medicines are life-changing for many, but they mainly act after epilepsy has already developed.

Future treatments might go a step further. Instead of only calming seizures once they occur, they could reduce the brain’s tendency to produce them in the first place. This could lower the risk of seizures returning, help people whose epilepsy doesn’t respond to current medicines, or even prevent epilepsy after certain brain injuries.

The research is still at an early stage, and there’s much more to learn. But advances in neuroscience are helping scientists understand the slow changes that happen in epilepsy and uncover ways these changes might be reversed.

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Rethinking how we treat epilepsy

For a long time, epilepsy was seen mainly as a disorder of sudden electrical disruption. We now know the story is more complex. Alongside seizures, slow changes inside brain cells can affect how they behave over time.

This doesn’t replace the importance of current treatments. But it does open new possibilities. One day, seizure-controlling medications could be combined with treatments that target these deeper changes in the brain.

We’re not there yet, but the direction of research is shifting. By looking beyond seizures and exploring what’s happening inside brain cells, scientists are beginning to uncover ways to change the processes that make seizures possible.

If successful, epilepsy care could move from simply managing seizures to reducing the chance they occur at all, a meaningful step forward for the tens of thousands of people living with epilepsy across Ireland.

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Sujithra Srinivas is a researcher in the UCD Conway Institute of Biomolecular and Biomedical Research at University College Dublin and the FutureNeuro Research Ireland Centre for Translational Brain Science.

The views expressed here are those of the author and do not represent or reflect the views of RTÉ