Jamal Musiala's Epilepsy Diagnosis: Understanding Absence Epilepsy

When Jamal Musiala suddenly crumpled to the turf in a friendly against RB Leipzig on Saturday, the football world held its breath. The images flashed around the globe within minutes. For one neurologist watching from Munich, the pattern was instantly familiar.

“Because it happened so suddenly and he then obviously recovered quickly, as a neurologist I immediately thought of an epileptic seizure,” said Dr Regina Becker, who previously worked at the neurology clinic at the University Hospital of Munich’s Ludwig Maximilian University and now runs the Munich Schwabing Neuro Centre.

Four days later, Musiala went down again, this time against 1. FC Heidenheim. The Bayern star later spoke publicly of “temporary brief absences caused by a neurological dysfunction”. The suspicion had been confirmed.

What is happening in Musiala’s brain?

Dr Becker explains that Musiala is dealing with absence epilepsy – a specific form of epilepsy that affects consciousness.

“Absence epilepsy originates in the so-called thalamus, the diencephalon, which controls consciousness,” she said. “Anyone who has a dysfunction there can suddenly become unresponsive. The brain enters an exceptional state, the neurons start firing uncontrollably, and communication between the thalamus and the so-called cerebral cortex, where we consciously perceive things, is interrupted.”

The result is dramatic to those watching, but often a blank space to the person affected.

“The patient no longer takes in their surroundings, stares into space or, as in Musiala’s case, even falls over. To outsiders, the patient often appears frozen.”

Most sufferers, she adds, don’t feel it coming.

“Most patients have no warning beforehand. It suddenly comes over them and they have no chance to react. Sometimes they do not even notice the seizure itself. Afterwards, they simply carry on as if nothing had happened.”

That unpredictability raises a chilling scenario for any elite footballer: could it strike at the decisive moment?

Could Musiala, for example, step up to take a penalty and collapse mid-run-up?

“Yes, that is conceivable,” Becker said bluntly.

Why he must come off – even if he feels fine

In both recent incidents, Musiala was substituted immediately. From the outside, some might wonder whether that is strictly necessary if he appears to recover within seconds.

From a medical and professional standpoint, there is no debate.

“In itself, the patient has no problem with the cardiovascular system, the organs function normally,” Becker explained. “Even so, in professional sport, carrying on is not possible for reasons of liability and duty of care.”

High-intensity elite football is a perfect storm of triggers.

“Factors such as heat and hyperventilation in particular could trigger further seizures, even if he himself is quickly fit again after a seizure.”

Why now – and why at 23?

Musiala is 23. Until now, there had been no public indication of such issues. That age alone makes the diagnosis unusual.

“Normally, this form of epilepsy occurs between the ages of four and 10,” Becker said. “However, there are also forms such as juvenile absence epilepsy, where the illness only appears later. In any case, 23 is late for a diagnosis.”

There is, though, an important caveat.

“We do not know whether this had also happened to him earlier and has now simply become more frequent and happened in public for the first time.”

So what might cause a sudden spike in episodes?

“Provided there is a genetic predisposition, environmental factors such as high temperatures, dehydration or stress can contribute to the frequency of seizures increasing, or even to the first seizure occurring at all.”

One thing Becker rules out completely is any link to Musiala’s serious leg injury.

About a year ago, the Bayern attacker suffered a broken fibula. Could trauma to a completely different part of the body have played a role?

“No, that has nothing to do with it,” she said.

“Very promising medications” – and how treatment works

In his statement, Musiala described his condition as “treatable”. Becker has no doubt he is right.

“Yes, there are very promising medications for absence epilepsy. Most patients become completely seizure-free as a result.”

Treatment relies on so-called seizure-suppressing medication.

“Patients are given what are known as seizure-suppressing medications, which prevent the uncontrolled firing of neurons and are intended to suppress epileptic seizures,” Becker explained. “They take the medication daily as a preventive measure, and it builds up the necessary level in the blood within two to three weeks.”

During that period, doctors monitor the process closely.

“Doctors carry out regular checks to see how the level is developing and whether the dose needs to be adjusted. Once that level has been reached, there is normally sufficient protection against further seizures.”

The key drug for this form of epilepsy is clear.

“The treatment of choice is ethosuximide,” Becker said. “In principle, it is a very well-tolerated medication, but it can lead to headaches and tiredness.”

Another option is valproic acid.

“Valproic acid, which is also very effective, can have stronger side effects such as weight gain, hair loss or drowsiness. It has to be tried individually to see which medication is the best fit. Most patients tolerate both medications well.”

How long Musiala will need therapy is harder to predict.

“Even if the medications make someone seizure-free after a short time, they are taken for several months or years,” Becker said. “In children who suffer from this form of epilepsy, there is a chance they will also become seizure-free in adulthood without medication. If the illness occurs later, lifelong therapy may be necessary. So the question cannot be answered in general terms, it varies from person to person.”

Can he keep playing at the top?

For Bayern and Germany, one question towers above all others: does this diagnosis threaten Musiala’s career?

Becker’s answer is reassuring.

“With this form of epilepsy I have no concerns about his future career,” she said. “In the adjustment phase of the medication, which is now presumably beginning, he will have to ease off a little so that the body has a chance to adapt.”

That period of adaptation will demand patience from club, country and player. But if the medication settles as expected and the seizures are brought under control, the prognosis is clear: Jamal Musiala can continue at the highest level.

The next test will not be a defender or a knockout tie. It will be how his body responds in the coming weeks as science and sport work side by side to keep one of football’s brightest talents on the pitch.