Jamal Musiala's Collapses: Understanding Absence Epilepsy in Football

Jamal Musiala’s sudden collapses have shaken German football. For a few seconds in two different friendlies, one of Europe’s brightest attacking talents simply disappeared from the game – not with a tackle, not with an injury, but as if someone had briefly pulled the plug.

A leading Munich neurologist says there is a clear explanation.

“I immediately thought of an epileptic seizure”

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”, watched the footage of Musiala’s first collapse in the friendly against RB Leipzig on Saturday.

“Because it happened so suddenly and he then obviously recovered quickly, as a neurologist I immediately thought of an epileptic seizure,” she explains.

When Musiala went down again on Tuesday against 1. FC Heidenheim, the suspicion hardened. In his public statement, the 23-year-old spoke of “temporary brief absences caused by a neurological dysfunction”. For Becker, that description fits a very specific diagnosis: absence epilepsy.

What actually happens in Musiala’s brain?

Absence epilepsy, Becker says, starts deep in the brain.

It originates in the thalamus – part of the diencephalon – which plays a central role in controlling consciousness. When there is a dysfunction there, consciousness can suddenly switch off.

“The brain enters an exceptional state,” Becker explains. Neurons fire uncontrollably, and the communication between the thalamus and the cerebral cortex – the area where we consciously perceive the world – is interrupted.

The result: the person suddenly stops taking in their surroundings. They stare blankly, freeze, or, as in Musiala’s case, even collapse. To those watching, it can look like the player has just been switched off mid-movement.

Many patients don’t feel anything 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.”

That raises a brutal scenario for any elite footballer: could Musiala be about to take a penalty and just go down mid-run-up?

“Yes, that is conceivable,” Becker admits.

Why he must come off – even if he feels fine

Both times Musiala collapsed, he was substituted immediately. From the outside, that looked like the only logical decision. From a medical and legal standpoint, Becker says, there is no alternative in professional sport.

“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.”

Heat, stress, hyperventilation – all of them are part of a high-intensity match. All of them can act as triggers and increase the risk of another seizure, even if the player feels fully recovered within minutes.

Why now – and why at 23?

Absence epilepsy is usually associated with children.

“Normally, this form of epilepsy occurs between the ages of four and 10,” Becker says. There are variants, though, such as juvenile absence epilepsy, that appear later. Even then, Musiala’s age is unusual.

“In any case, 23 is late for a diagnosis,” she concedes. But that does not mean the condition has only just appeared.

“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 can cause a sudden increase in seizures?

If there is a genetic predisposition, environmental factors can tip the balance. High temperatures, dehydration, stress – all everyday companions in a top player’s life – can boost the frequency of seizures or trigger a first one.

What it is not, Becker stresses, is a consequence of his broken fibula a year ago. The serious leg injury is “nothing to do with it”.

“Treatable” – and with good prospects

In his statement, Musiala called his condition “treatable”. Becker backs that up clearly.

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

The principle is straightforward, the process less so.

Patients receive seizure-suppressing medications designed to stop the uncontrolled firing of neurons and prevent epileptic episodes. The drugs are taken daily as a preventive measure, building up to an effective level in the blood over two to three weeks. During that phase, doctors closely monitor the levels and adjust the dose if needed.

Once the right level is reached, Becker says, “there is normally sufficient protection against further seizures.”

But how long does a player like Musiala have to stay on the medication? There is no one-size-fits-all answer.

Even if the seizures stop quickly, the treatment usually continues for months or years. In children, there is a chance the epilepsy will disappear in adulthood and the medication can be discontinued. If the illness only appears later, lifelong therapy may be necessary. Each case is different.

Ethosuximide, valproic acid – and side effects

Becker names ethosuximide as the “treatment of choice” for absence epilepsy. It is generally well tolerated, but it can cause headaches and tiredness – hardly ideal side effects for a player whose game is built on sharpness, agility, and constant movement.

Valproic acid is another highly effective option, but it carries heavier baggage: possible weight gain, hair loss, drowsiness. For a professional athlete, that cocktail sounds even more problematic.

“It has to be tried individually to see which medication is the best fit,” Becker says. Most patients, she adds, tolerate both well. The fine-tuning now will be crucial: finding a dose that controls the seizures without dulling one of the most electric attacking players in Europe.

Can Musiala keep playing at the top?

This is the question that matters most to his club, his national team, and to Musiala himself.

Becker’s answer is clear.

“With this form of epilepsy I have no concerns about his future career,” she says.

There is a caveat. In the adjustment phase of the medication – the phase Musiala is presumably entering now – he will have to ease off. The body needs time to adapt to the new substances, to the new balance in the brain. Training loads, match minutes, travel, heat: all of it will be managed more cautiously.

The long-term outlook, though, is optimistic. With the right treatment, absence epilepsy can be controlled. The seizures can stop. The risk can be reduced to a level that allows a full professional career.

The image of Musiala suddenly crumpling to the turf twice in a few days has rattled fans and teammates. The science behind it is complex. The message from one of Munich’s leading neurologists is not.

If the therapy works as expected, Jamal Musiala’s biggest opponents in the coming years should still be defenders, not neurons.