Jamal Musiala’s Absence Epilepsy: Impact on His Career

Jamal Musiala’s sudden collapses have shaken German football. For a few stark seconds in two separate friendlies, one of Europe’s most gifted playmakers lay on the turf, motionless, as teammates and opponents froze.

For Dr Regina Becker, those images told a clear story.

“When it happens so suddenly and he then obviously recovers 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.

Musiala has since confirmed that suspicion himself. After his second collapse, against 1. FC Heidenheim on Tuesday, the 23-year-old explained in a public statement that he is suffering from “temporary brief absences caused by a neurological dysfunction”.

When the brain suddenly “switches off”

Becker describes absence epilepsy as a disturbance rooted in the thalamus – the part of the diencephalon that helps control consciousness.

“Absence epilepsy originates in the so-called thalamus, the diencephalon, which controls consciousness,” she 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 result on the outside is dramatic, even if it lasts only seconds.

“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.”

Inside, it can feel like nothing at all.

“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.”

That is what makes the condition so treacherous in elite sport. There is no build-up, no obvious sign for a player to slow down or step away.

Could it really happen in the middle of the biggest moment of all – a run-up to a penalty?

“Yes, that is conceivable,” Becker admits.

Why Musiala must be taken off immediately

In both friendlies, Musiala was substituted straight after his collapse. From a purely physical standpoint, Becker says, his body is not failing in the way people might fear.

“In itself, the patient has no problem with the cardiovascular system, the organs function normally,” she notes.

But that does not mean he can simply carry on.

“In professional sport, carrying on is not possible for reasons of liability and duty of care,” Becker stresses. Heat, hyperventilation, the intensity of competition – all of that can act as a trigger for further seizures, even if the player feels fine again within minutes.

The decision to remove him is not about weakness. It is about responsibility.

A late diagnosis – and why it may have surfaced now

Musiala is 23. Absence epilepsy is usually associated with children.

“Normally, this form of epilepsy occurs between the ages of four and 10,” Becker explains. “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 necessarily mean the condition is brand new.

“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,” she says.

What might cause such an increase?

“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.”

High summer friendlies, heavy training loads, the mental weight of a career at the top – the environment is not exactly gentle.

One thing Becker rules out is any link to Musiala’s serious leg injury from about a year ago.

“No, that has nothing to do with it,” she says of his broken fibula.

“Very promising” treatment – and real hope

Musiala called his condition “treatable” in his statement. Becker backs that up without hesitation.

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

Treatment revolves around daily, preventive medication that calms the electrical storm in the brain.

“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 explains. “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 those first weeks, doctors monitor the blood levels closely and adjust the dose if needed. Once the right level is reached, Becker says, “there is normally sufficient protection against further seizures.”

The key drug in absence epilepsy is well established.

“The treatment of choice is ethosuximide,” Becker says. “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 will this last – and what does it mean for his career?

There is no simple, one-size-fits-all timetable.

“Even if the medications make someone seizure-free after a short time, they are taken for several months or years,” Becker explains. “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.”

The crucial issue for fans and clubs is obvious: can Jamal Musiala continue at the highest level?

Becker is clear.

“With this form of epilepsy I have no concerns about his future career,” she says. The caveat lies in the coming weeks. “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 short period of recalibration could shape how quickly he returns to his usual, elusive brilliance.

Musiala has spoken in the past about his enthusiasm for neuro-athletics training, praising its benefits publicly. Whether that work was connected to any early awareness of his condition remains unanswered. What is clear now is that his future will be managed not just with tactics and training plans, but with finely tuned neurological care.

The next time he glides past defenders, the question will linger in the background: not whether he is still good enough, but how a generational talent adapts to a diagnosis that, with the right treatment, should not stop him at all.