“A convulsive seizure by itself rarely poses a threat to life. The circumstances in which it occurs are much more dangerous”

Expert Profile

Olga Anatolyevna Pylaeva is a neurologist-epileptologist, editor of the IDNE website, scientific editor of the Russian Journal of Pediatric Neurology, and author and co-author of numerous scientific articles and books on epileptology.

Education and Qualifications

1998 – Pediatric Faculty, Russian State Medical University (RSMU).

1998–2000 – Clinical residency at the Department of Nervous Diseases, Pediatric Faculty, RSMU.

2000–2003 – Postgraduate studies at the Department of Nervous Diseases, Pediatric Faculty, RSMU.

2020 – Specialist certificate (psychiatry).

2025 – Specialist certificate (neurology).

2025 – Advanced training in "Neurology."

Work Experience

More than 20 years of experience.

2016–present – St. Luke's Institute of Pediatric and Adult Neurology and Epilepsy.

Areas of focus: diagnosis and treatment of various forms of epilepsy in children and adults; special area of interest—adverse effects of antiepileptic drugs, including the impact of medications on learning, behavior, and mood.

Professional Skills: Management of adverse effects of antiepileptic therapy, correction of hyperactive behavior in children with epilepsy, interpretation of genetic studies in patients with epilepsy, Panayiotopoulos syndrome, various forms of epilepsy, both focal and generalized, including genetic epilepsies.

"Epilepsy doesn't always look like a 'movie' seizure"

– What does the epidemiological picture of epilepsy in Russia look like today: how many patients are there, and in which groups—children, adults, elderly—is this disease most common?

– Approximately 0.5–1% of the population has epilepsy, meaning on average one person in a hundred. This makes epilepsy one of the most common chronic neurological diseases, comparable in prevalence to other widespread neurological diagnoses.

Epilepsy most often debuts at two age "peaks"—in childhood and in old age; first seizures occur significantly less frequently in middle-aged people. In children, the prevalence of epilepsy reaches 1%, and febrile seizures (seizures with high fever) occur at least once in approximately 5% of children. So in pediatrics, this is one of the most common chronic neurological problems—it occurs even more frequently than, for example, bronchial asthma or tuberculosis.

In two-thirds of patients, the first epileptic seizures occur before age 20, predominantly in the first three years of life or during puberty. A child's brain is more vulnerable to a range of external and internal influences and often responds to them with increased seizure susceptibility.

Seizures triggered by high fever are especially common in young children; only in some children does chronic epilepsy develop against this background, while in most cases febrile seizures disappear with maturation, usually by school age. At the same time, the developmental features of the child's brain create conditions for the emergence of a whole range of age-dependent, hereditary forms of epilepsy specifically during childhood.

In adults, and especially in elderly patients, the epidemiological picture of epilepsy changes: symptomatic (structural) forms associated with other brain diseases come to the forefront. The most common causes are consequences of stroke, traumatic brain injuries, brain tumors, and less frequently metabolic or degenerative processes. Genetically determined forms start much less frequently at this age, and if seizures appear for the first time in a person aged 60+, we almost always look for a structural cause in the brain.

– To what extent does epilepsy remain underdiagnosed: are there estimates of "hidden" cases, and how much time on average passes from the first seizure to diagnosis?

– Epilepsy is a nervous system disease, a human brain disorder associated with structural or functional abnormalities of the brain that can be detected using specific diagnostic methods. Epileptic seizures are based on pathological excessive electrical discharges of nerve cells in the cerebral cortex.

The causes of such discharges are more often brain structural abnormalities, genetic disorders (specific mutations in genes and chromosomes or complex interactions between genes determining genetic predisposition to developing epileptic seizures). The primary diagnostic method is EEG (electroencephalography) and prolonged EEG study—video-EEG monitoring. In cases where the cause of epilepsy is brain structural abnormalities, MRI provides significant help in diagnosing brain damage. 

Since epilepsy doesn't always manifest as a "movie-style" generalized seizure with falling, convulsions, and complete loss of consciousness, many of its forms can remain unrecognized for years. Some patients experience only brief episodes of strange sensations, "freezing," automatic movements, memory lapses, or twitching that others attribute to fatigue, stress, or "personality traits." In such cases, the diagnosis must be differentiated from syncope (including in cardiovascular diseases and diabetes), migraine, psychiatric disorders, and a number of other conditions.

How quickly the correct diagnosis can be made and effective treatment initiated largely depends on where the patient ends up. If they seek help early at a specialized center and are examined by an epileptologist, the path to the correct diagnosis is usually shorter. However, if a person is followed for years by specialists who lack sufficient experience in epileptology, the epileptic nature of seizures may remain unnoticed for a long time.

This is precisely why, when recurring, stereotypical episodes of unusual behavior or sensations appear that a person cannot control or explain, limb twitching, or any episodes with impaired consciousness, it's important to undergo high-quality video-EEG monitoring with sleep at a specialized epilepsy center and receive a consultation from an experienced epileptologist as soon as possible. This approach allows either confirmation of epilepsy and selection of therapy, or convincing exclusion of it and searching for other causes of symptoms.

"There has been a breakthrough in understanding the genetic basis of epilepsy"

– What changes in epilepsy patient care pathways have occurred over the past 5–10 years (registries, reference centers, first-seizure protocols)?

– Over the past 5–10 years, much more has changed in working with epilepsy patients than may appear if we only look at the familiar routes of "clinic—hospital—ongoing care."

First and foremost, the very "language" of epileptology has been seriously updated: two key international classifications have been revised—epileptic seizures and epileptic syndromes—definitions of many forms have been refined, and new syndromes have been described. This isn't just an academic exercise: the precise name of a seizure and syndrome directly affects therapy choice and prognosis.

In parallel, there has been a breakthrough in understanding the genetic basis of epilepsy. Today, when a hereditary form is suspected, we routinely refer the patient for genetic testing, often identify a specific genetic defect, and on this basis can more accurately assess prognosis, select therapy, and give parents meaningful recommendations for planning future pregnancies.

For structural forms of epilepsy associated with brain structural changes, standardized epilepsy-focused high-resolution MRI protocols with slice thickness less than 1 mm have appeared—10–15 years ago such studies were unavailable or rare. This has radically improved the detection of small cortical dysplasias, tumors, and other causes that simply weren't "seen" before. Surgical approaches to epilepsy treatment are also developing, which also changes patient routing—they are now referred more frequently and earlier for consideration of surgery.

Regarding the pathway after the first seizure, the principle remains surprisingly simple and has essentially not changed over these years: the faster a patient after a first seizure gets not into "general" neurology but into a specialized epilepsy center to an experienced epileptologist, the higher the chances of rapid diagnosis verification, correct treatment selection, and prevention of disease progression.

Therefore, our recommendation remains the same: don't waste months on chaotic consultations, but build a pathway through a specialized center with access to video-EEG monitoring, high-precision MRI, and a team of highly qualified specialists as early as possible.

"Complaints of frequent distractibility and learning difficulties can lead to an incorrect ADHD diagnosis"

– When we talk about epilepsy, often people picture seizures and convulsions. Are seizures always like this, and what symptoms does epilepsy actually have?

– An epileptic seizure is a brief episode of pathological excessive electrical discharges of nerve cells in the cerebral cortex, causing a state noticeable to the person having the seizure or to people around them. Sometimes patients can forget their seizures and not notice them. Likewise, in some cases, epileptic seizures in patients may be unnoticeable to others.

Epilepsy doesn't always have classic, familiar manifestations—seizures with falling, convulsions, and impaired consciousness—so cases of epilepsy with less noticeable and dramatic manifestations can remain unrecognized for a long time.

Clinical manifestations of seizures are very diverse in different patients and reflect the functions of those cortical areas where the pathological discharge originates and spreads. Motor, sensory, or mental disturbances, autonomic disorders, and neurological deficit symptoms (such as speech cessation or loss of muscle tone) can occur in isolation or in combination. Epileptic seizures often have a sudden onset and usually stop spontaneously.

They are usually brief, lasting from several seconds to several minutes, and are often accompanied by a period of drowsiness or confusion. Seizures can occur during wakefulness and sleep.

Some types of seizures are characteristic of early childhood (for example, epileptic spasms—rhythmic flexion or extension movements of the arms and legs combined with head nodding, occurring in clusters).

It's precisely because of this diversity of manifestations that epilepsy is easily missed. Therefore, when recurring, brief, and stereotypical episodes of unusual behavior or sensations appear that a person cannot control or explain, limb twitching, "lapses" in consciousness, or other strange states, it makes sense to undergo quality video-EEG monitoring with sleep at a specialized epilepsy center and receive an epileptologist consultation as early as possible. This allows either confirmation of the epileptic nature of seizures and initiation of treatment, or convincing exclusion of it.

– There are such subtle symptoms that aren't always recognizable. Theoretically, could it be that a person has epilepsy and doesn't even know about it?

– This is indeed possible. There is an extreme variant—so-called "phantom seizures"—that neither the person nor their surroundings notice: epileptic activity is recorded only on video-EEG monitoring, which was initially ordered for another reason, for example due to headaches or episodes of loss of concentration.

A separate story is brief absences: seizures in the form of second-long "freezing" and brief consciousness disconnection with a characteristic EEG pattern. From the outside, this often looks like ordinary absent-mindedness or "daydreaming," especially in a child. In such cases, complaints of frequent distractibility and learning difficulties can lead to an incorrect ADHD diagnosis, when in fact epileptic activity underlies it.

There are many such situations: with very mild, subtle manifestations, epilepsy remains unrecognized for years, and the diagnosis is made only after the first "major" convulsive seizure, although in reality the person has been ill for a long time.

– Are there any identified risk groups for epilepsy, who can develop it?

– Several groups can be identified where the risk of epilepsy is known to be higher than the population average. These include people who have suffered severe traumatic brain injury, children with severe perinatal nervous system damage, and patients with confirmed genetic diseases for which epilepsy is a common manifestation.

In children with already detected epileptiform activity on EEG, the probability of developing seizures is also above average. But in most such cases, this is not a reason to immediately start treatment: observation by an epileptologist and periodic video-EEG monitoring with sleep are sufficient. We usually don't prescribe preventive therapy before the first seizure. The exception is situations where epileptiform activity is so pronounced that it negatively affects the child's development—then treatment is required even in the absence of clinical seizures.

"A convulsive seizure with loss of consciousness does not pose a serious threat to life. The circumstances in which it occurs are much more dangerous"

– When a person has an epileptic seizure, what happens in their head at that moment? This is usually described as brain abnormalities or abnormal neuron behavior, but what does that mean?

– When a person has an epileptic seizure, the system of coordinated neuron function "breaks down" in their brain for a short time.

An epileptic seizure is an episode of excessively strong and abnormally synchronous discharges in a group of nerve cells in the cerebral cortex. These cells begin to work differently than usual, as if "firing in volleys," and this is precisely what gives external manifestations: convulsions, "freezing," consciousness lapse, unusual sensations—depending on which cortical zone the discharge originates in.

It's important to understand: the underlying cause lies deeper and is constantly present—this could be a brain structural change (for example, a scar after trauma, tumor, congenital anomaly) or a genetic "mutation." But the pathological discharges themselves, which turn into a clinical seizure, occur episodically: most of the time the brain functions relatively normally, and then for seconds or minutes "breaks down" into this abnormal mode of neuron operation.

– Can a person die from an epileptic seizure?

– Yes, such danger exists, but in reality this occurs much less frequently than commonly imagined.

A convulsive seizure with loss of consciousness looks very dramatic, however in most cases it lasts mere seconds or minutes, ends spontaneously, and in itself does not pose a serious threat to life. The circumstances in which the seizure occurs are much more dangerous: if it catches a person in water, behind the wheel, at height, on stairs, or on a roadway—trauma itself can cause severe consequences.

There are two truly life-threatening situations.

The first is status epilepticus: a prolonged convulsive seizure that doesn't stop on its own and isn't controlled by standard emergency medications, requiring intensive therapy in an ICU.

The second is SUDEP (Sudden Unexpected Death in Epilepsy). It occurs more often in patients with uncontrolled disease, when frequent convulsive seizures persist and the person is not receiving effective treatment or not following therapy recommendations. It's important to emphasize that SUDEP is an extremely rare phenomenon relative to the total number of patients, especially with properly selected treatment and seizure control.

"Everyone should know the basic rules of first aid during a convulsive seizure"

– How can you help a person during an epileptic seizure?

– It's necessary to know first aid measures when a convulsive seizure with loss of consciousness occurs. In these cases, you need to turn the person and their head to the side (so they don't choke on saliva and vomit), protect the patient from injury (place something soft under their head), don't try to put a spoon or other objects in their mouth, note the time when convulsions started, call emergency services.

Don't leave the patient alone after the seizure until they come to. If a convulsive seizure with impaired consciousness lasts more than 5–7 minutes, the emergency physician administers a special drug to stop the seizure. In some cases, it becomes necessary to hospitalize the patient in an ICU.

– Does a person always need medical help after a seizure? Could it be that there was a seizure, and the person got up and went about their business?

– After an epileptic seizure, scenarios can be very different.

After a generalized convulsive seizure with loss of consciousness, a person doesn't always "get up and go about their business": often the episode ends with deep sleep, severe weakness, disorientation, or headache. In such a situation, at least minimal organization of help is needed—make sure breathing is free, there are no injuries, wait until the person fully comes to.

During a seizure in a public place, hospitalization or at least accompaniment home is often required, rather than independent travel by car (this is absolutely contraindicated in all cases).

However, if the seizure was short, passed on its own, the person quickly and fully recovered, and there were no injuries, emergency hospitalization isn't always mandatory. During many "minor" seizures, after which the patient immediately returns to their normal state, it's sufficient to ensure their safety at the moment of the episode and organize a scheduled consultation with a neurologist or epileptologist as soon as possible to clarify the diagnosis and select treatment.

– If a person is diagnosed with "epilepsy," do they have to take medications for their entire life?

– Medications need to be taken daily, regularly, at the same time of day, for at least 3-4 years after complete cessation of seizures. It's important to remember that irregular medication intake or even a single missed pill can lead to seizure recurrence.

Subsequently, with very good treatment results, the question of possible very gradual medication withdrawal under video-EEG monitoring control is decided. The risk of relapse during treatment withdrawal depends on the specific situation, and this question is decided individually.

– What is your attitude toward using AI in epileptology: in diagnostics (EEG/MRI analysis), seizure prediction, therapy selection?

– Epileptology is a specialized narrow field of knowledge in which, from our point of view, the practical experience of an expert physician is most valuable, which AI cannot fully replace.

– If you had the opportunity to improve the lives of people with epilepsy through one change in the healthcare system, what would you change: routing changes, access to medications, rehabilitation, patient education?

– If we're talking about one priority change, I would put rapid and real accessibility of accurate epilepsy diagnostics in the first place. Today, quality video-EEG monitoring, high-resolution MRI according to a specialized epilepsy protocol, and modern genetic studies in most cases are either available only for a fee, or formally included in insurance but with multi-month wait times and often lower quality execution.

It is precisely these methods that allow accurate diagnosis, differentiation of epilepsy forms, understanding of the cause, and selection of the correct treatment approach. And already at the next stage, access to needed medications comes to the forefront: it often happens that the optimal medication is either completely absent from the market or costs too much for the patient, which directly affects seizure control and quality of life.

– What, in your opinion, should everyone know about epilepsy?

– It's important for everyone to know that epilepsy is not a "mysterious disease" or a death sentence, but a nervous system disease associated with structural or functional abnormalities of the brain, which in many cases can be detected using MRI and EEG and effectively treated. Epilepsy is treated with special antiepileptic drugs selected by a neurologist-epileptologist. They are taken regularly, for years, and with properly selected therapy many patients live without seizures or with minimal manifestations.

People with epilepsy are ordinary people who, outside of seizures, often don't differ from others and can realize themselves in their profession, family, and creative pursuits. Approximately one-third of patients have the disease accompanied by additional neurological disorders—motor or cognitive—but this is not epilepsy itself, but a consequence of the underlying brain damage that caused it.

At the same time, there are objective limitations associated with injury risk during a sudden seizure: such patients, as a rule, cannot drive a car, work with moving machinery, or be in water or at height without reliable supervision.

And finally, everyone should know the basic rules of first aid during a convulsive seizure: turn the person on their side, remove nearby hard and sharp objects, protect the head, don't forcibly open the jaws and don't put any objects in the mouth, record the time when convulsions started and call emergency services, and after the seizure ends, don't leave the person alone until they fully come to.