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According to the World Health Organization, epilepsy is one of the world's oldest recognized conditions, with written records dating back to 4000 BC. Fear, misunderstanding, discrimination, and social stigma have surrounded it for centuries — and that stigma continues in many countries today, affecting the quality of life of people with the condition and their families.

It's a chronic, noncommunicable disease of the brain that affects around 50 million people worldwide. It's characterized by recurrent seizures — brief episodes of involuntary movement that may involve part of the body (partial) or the entire body (generalized), sometimes with loss of consciousness or control of bowel or bladder function.

Seizures happen when there's excessive electrical activity in a group of brain cells. They can range from the briefest lapse of attention or a muscle jerk to severe, prolonged convulsions, and can vary in frequency from less than once a year to several times a day.

One seizure does not mean epilepsy — up to 10% of people worldwide have a seizure at some point in their life. Epilepsy is defined specifically as having two or more unprovoked seizures.

According to WebMD, there are four major types of epilepsy:

1. Generalized epilepsy has two basic kinds of seizures. Generalized motor seizures (formerly "grand mal") cause the body to move in ways you can't control — muscles stiffen and jerk, and consciousness is lost. Generalized non-motor (absence) seizures look like stopping mid-task and staring into space, sometimes with repeated small movements like lip-smacking — it can look like the person "isn't really there."

2. Focal epilepsy (formerly "partial seizures") develops in one area or network of brain cells on one side of the brain. There are four categories: focal aware seizures (you know what's happening), focal impaired awareness seizures (confusion or no memory of it), focal motor seizures (twitching, spasms, or movement), and focal non-motor seizures (no movement, but changes in feeling or thought — intense emotion, a racing heart, goosebumps, or waves of heat or cold).

3. Generalized and focal epilepsy — some people experience both types.

4. Unknown if generalized or focal — sometimes doctors are certain it's epilepsy but can't yet tell which type, often because no one witnessed the seizure or test results aren't conclusive.

• Some forms of epilepsy have no identifiable cause — seizures simply start.
• Head injuries, such as from an accident or a fight.
• Diseases like cerebral malaria, meningitis, and measles, which can cause brain damage.
• Growths in the brain, such as a tumor.
• Substance abuse, including cocaine, alcohol, and bhang.
• Prolonged lack of oxygen, which can occur during a long or difficult labour and birth.

Witnessing a seizure for the first time can be frightening — the most important thing is to stay calm. Each type of seizure is different, so the right response varies, but keeping the person safe is a shared responsibility between anyone nearby and the person themselves.

For a Grand Mal seizure (the most common type):

1. Don't run away — stay calm and stay with the person.
2. Clear away anything that could cause harm: stones, hot water, buckets, furniture.
3. Do not restrain the person, and never put anything in their mouth — this can cause choking, which can be life-threatening.
4. Protect their head with something soft, like a folded jacket or pillow. If a tie or top button is tight at the neck, loosen it gently.
5. Once the seizure stops, check their breathing, and if it's okay, turn them onto their side.
6. Once they respond, help them sit up comfortably and calmly explain what happened. If you don't know them, gently ask for details so you can contact someone close to them.

Call for emergency help if:

• They're not breathing, or breathing is laboured
• They've been injured
• The seizure lasts more than five minutes
• It's their first seizure
• They take more than 10 minutes to respond afterward
• Seizures repeat one after another
• They have an underlying condition like heart disease, diabetes, or are pregnant

If you feel a seizure coming on yourself (an "aura"): sit or lie down somewhere safe, loosen any tight clothing, and let someone nearby know what's happening.

Prevention — the old adage holds true here: prevention is better than cure.

• Take medication faithfully, and never stop without a doctor's guidance.
• Avoid unprescribed or illegal drugs — talk to your doctor if substance use is a challenge.
• Avoid alcohol.
• Get enough sleep, and manage stress.
• Exercise faithfully, and take time to relax.
• Keep a consistent meal schedule, especially important for those managing diabetes too.
• Avoid flashing lights if you have photosensitive epilepsy.
• Protect against head injury — e.g. wearing a helmet on a motorbike or bicycle.
• For young children, manage fevers promptly.

Treatment — always guided by a medical professional:

• See a doctor after more than one seizure — ideally a neurologist. In Kenya, organizations like KAWE (Kenya Association for the Welfare of People with Epilepsy) offer affordable clinics on specific days.
• Anti-epileptic drugs (AEDs), the most common treatment.
• Surgery, only on a neurologist's advice.
• A small electrical device implanted to help reduce seizures, again only on specialist advice.
• A special ketogenic diet, which can help control seizures for some people.