Jamal Musiala's Absence Epilepsy: Understanding His Condition
Jamal Musiala had barely hit the turf before the replays started circling the globe. No crunching tackle, no clash of heads, no obvious trigger. Just a sudden collapse, then a quick recovery. For most viewers, it was a shock. For neurologist Dr Regina Becker, it was something else: a familiar pattern.
“Because it happened so suddenly and he then obviously recovered quickly, as a neurologist I immediately thought of an epileptic seizure,” says 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”.
The first incident came in a friendly against RB Leipzig on Saturday. The second, more alarming because it confirmed a trend, followed on Tuesday against 1. FC Heidenheim. After that game, Musiala himself went public, speaking of “temporary brief absences caused by a neurological dysfunction”. The phrase is clinical. The reality is not.
What is happening in Musiala’s brain?
Becker calls it what it is: absence epilepsy.
It starts deep in the brain, in the thalamus – the part of the diencephalon that helps control consciousness. When it misfires, everything can change in an instant.
“Absence epilepsy originates in the so-called thalamus, the diencephalon, which controls consciousness,” Becker explains. “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 outside world keeps moving. The patient doesn’t.
“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.”
That frozen moment, those few seconds when a player simply “switches off” mid-movement, are what the football world saw twice in four days.
How does the player experience it?
The unnerving part: most patients never see it coming.
“Most patients have no warning beforehand,” Becker says. “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.”
So could this really strike at any moment? Even in a high‑pressure situation like a penalty?
Yes.
“If it comes on so suddenly, could it be that Musiala goes to take a penalty and simply keels over during the run-up?” Becker is asked.
Her answer is blunt: “Yes, that is conceivable.”
Why he must come off – even if he feels fine
Both times Musiala collapsed, he was substituted immediately. On TV, he looked relatively stable again shortly afterwards. From a purely physical standpoint, Becker says, his organs and cardiovascular system are not the problem.
“In itself, the patient has no problem with the cardiovascular system, the organs function normally,” she explains. “Even so, in professional sport, carrying on is not possible for reasons of liability and duty of care.”
The risk lies in what might come next. Heat, intense exertion, hyperventilation – all standard elements of elite football – can act as triggers.
“Factors such as heat and hyperventilation in particular could trigger further seizures, even if he himself is quickly fit again after a seizure.”
So the substitution is not about what Musiala feels in that moment. It is about what could happen in the next.
Why now – and why at 23?
Absence epilepsy is usually associated with children. It typically appears between the ages of four and ten. Musiala is 23.
“Normally, this form of epilepsy occurs between the ages of four and 10,” Becker says. “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.”
That does not mean the condition suddenly arrived this summer.
“But of course 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 have pushed it into the open now? Provided there is a genetic predisposition, the environment can start to matter.
“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,” Becker explains.
One thing she rules out immediately: the serious broken fibula Musiala suffered about a year ago.
“No, that has nothing to do with it.”
The good news: “very promising medications”
Musiala’s own statement used a word that offered hope: “treatable”. Becker backs that up without hesitation.
“Yes, there are very promising medications for absence epilepsy. Most patients become completely seizure-free as a result.”
The principle is clear. Doctors use so‑called seizure‑suppressing medications to calm the uncontrolled firing of neurons and prevent the brain from slipping into that exceptional state.
“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 says. “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 closely.
“During this time, 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.”
Ethosuximide, valproic acid – and side effects
Becker is clear about the standard approach.
“The treatment of choice is ethosuximide,” she says. “In principle, it is a very well-tolerated medication, but it can lead to headaches and tiredness.”
There is another powerful option: valproic acid. It is effective, but the trade‑off can be harsher.
“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 would a player like Musiala have to stay on such treatment? There is no one‑size‑fits‑all answer.
“Even if the medications make someone seizure-free after a short time, they are taken for several months or years,” Becker says. In children, there is a chance the epilepsy fades and they can eventually stop. “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?
This is the question hanging over every discussion: does this diagnosis threaten Musiala’s career?
Becker does not hesitate.
“With this form of epilepsy I have no concerns about his future career,” she says.
There is a caveat. The next weeks will be an adjustment phase, as the medication is introduced and fine‑tuned. That period demands patience.
“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.”
Elite footballers push their bodies to extremes. For once, Musiala will need to resist that instinct and let the medicine do its work.
The spotlight will stay on him, of course. Every stumble, every pause, every substitution will be scrutinised. But if the treatment works as Becker and many specialists expect, the story may soon shift from fear to something else entirely: how one of Europe’s brightest talents plays on, and thrives, with a condition that once left him staring into space in the middle of a match.
