Seizures can be detrimental to an athlete's career. It can limit how much one can do. Fortunately, seizures can be treated and controlled. German footballer, Jamal Musiala, is the latest to be diagnosed with being susceptible to them.
Bayern Munich midfielder Jamal Musiala said he is dealing with a neurological issue but is doing well; despite collapsing during a pre-season game at Heidenheim, three days after a similar incident against Leipzig.
The 23-year-old German international went down shortly after entering Tuesday’s friendly as a substitute in the second half. Players from both teams made a circle around Musiala as he received medical treatment. He was then helped as he walked off the pitch.
Musiala had collapsed on Saturday during a friendly against Leipzig. German news agency DPA reported he had left the field on his own but still appeared dazed.
After Tuesday’s game, Musiala posted a message on his Instagram account, explaining that he had been diagnosed with temporary "but easily treatable absence seizures" caused by a neurological problem.
"These can lead to the moments that happened recently, such as against Leipzig or even now in Heidenheim," Musiala wrote.
Bayern, in its report on Tuesday’s game, only said of the incident: "There was a setback when Jamal Musiala had to be subbed off with a knock minutes after coming on." Musiala said he’s "very optimistic" and is receiving excellent medical treatment. "The important thing is that there is no additional health risk," he wrote.
"In close coordination and regular communication with experts, it has been my personal wish to face the challenge and, with the endorsement of the neurological specialists, to devote myself to what helps me most in recovery: to simply live my everyday life and keep up with my passion of playing football," Musiala added.
Bayern have confirmed there were signs of Musiala's condition before the World Cup but they had yet to affect him playing football.
Speaking to Sky Sports, honourary president, Uli Hoeness, said: "We have been aware of the problems for some time. But last weekend against Leipzig was the first time it happened on the pitch and was visible to everyone."
"We thought that if it didn't happen again so quickly, the medication he is taking would help. But when it happened again four days later, in the same way, I was stunned."
Many supporters questioned the decision to play Musiala so soon after he fainted on Saturday. Bayern officials have moved quickly to assure supporters the German international had been cleared to play on Tuesday by medical experts .
"We've already taken precautions," added Hoeness. "The doctors treating him, the neurologists and specialists, have provided us with written confirmation - because this was absolutely essential for us - that, in their view, there are no concerns regarding Jamal taking part in high-performance sport."
"Without that, we would have been acting negligently. Since we've had this written confirmation, we've been sleeping a little more soundly. But I must say, I'm rarely at a loss for words or without a clear solution. We'll have to feel our way through this new situation first."
Bayern Munich striker, Harry Kane, said the players will rally around Musiala to give him all the support he needs. "He is a great player, extremely talented," he added. "He is a big part of our team. We feel really sorry for him and frustrated for him when things happen like they do in the last couple of games."
"He has the full support from everyone here at Bayern and his friends and family, and we will be there to help him deal with it. He came off the back of a tough injury last season, I know how much he works behind the scenes and on the training pitch. From our point of view it is just to be there to support him and not just from my point of view, but the whole team as well."
Absence seizures are a type of generalised seizure that commonly affect children and young adults.
There are two types of absence seizures: typical and atypical.
Dr. Meneka Sidhu, a consultant neurologist at the National Hospital for Neurology and Neurosurgery in London, said typical absence seizures usually last seconds and the person affected may appear to be daydreaming or looking blank.
In an absence seizure, a person has varying degrees of loss of awareness and can result in the person affected losing balance and being unresponsive during the seizure itself.
"It can be very short-lasting, and the person can continue like nothing happened," she said. "With atypical absences that last longer, people may have automatic movements like fidgeting with their hands, eyelid fluttering and lip smacking. Some people may fall."
Repeated episodes of an absence seizure over more than 24 hours can be an indication of epilepsy; although the seizures can be treated with medication.
"For anybody affected by epilepsy, it is important to try to identify triggers," added Dr. Sidhu. "For people who play sport, triggers may include hyperventilation and dehydration."
"When effectively treated, there is no reason absence seizures should stop anyone playing sport."
Musiala's condition is one that has been managed by other elite athletes. Rugby player Tommy Freeman started having absence seizures as a 14-year-old and, after later being diagnosed with epilepsy, he now manages the condition by taking tablets alongside playing for Northampton and England.
German press agency DPA subsequently verified the situation with Bayern sources, who emphasised that there is no indication Musiala's career is at risk. Club insiders added that his involvement in the last two fixtures was "completely unproblematic" and extensively discussed with medical specialists, though no official prognosis has been given on his immediate return timeline.
Physical exercise and sports in healthy people are very important factors for physical and mental health; however, in patients with epilepsy (PWE), there are still questions for the beginning or continuity of their practice, becoming restricted in most cases (Carranza-Alva, Guzman-Sanchez, Alderete-Berzabá, Shkurovich-Bialik, 2025).
Therefore, it is necessary to have more information about the type of seizures, treatment, control and evolution of each patient; as well as the physical exercise and sports options that they can practice. The implementation of recommendations for the different cases of seizures/epilepsy and their association with physical exercise/sports is of great importance for the permissions or restrictions depend on each patient (Carranza-Alva, Guzman-Sanchez, Alderete-Berzabá, Shkurovich-Bialik, 2025).
The positions toward the participation of PWE in contact sports have changed over time. It has been thought that injuries from contact or sports collisions resulting in mild head injuries may worsen epilepsy; however, most of these risks are theoretical and very few case reports support this position (Carranza-Alva, Guzman-Sanchez, Alderete-Berzabá, Shkurovich-Bialik, 2025).
A more appropriate approach is to individualise the decision for each sport and patient based on a risk-benefit analysis; leading to few restrictions overall. Although it is possible that the presence of a seizure during certain athletic events could cause a substantial increase in risk to the patient; this is more related to sports such as gymnastics or horseback riding and contact sports such as football, hockey and soccer induce seizures (Carranza-Alva, Guzman-Sanchez, Alderete-Berzabá, Shkurovich-Bialik, 2025).
In the case of boxing, studies in amateur boxers showed that concussions were mild and did not result in clinical or neurophysiological signs of epilepsy (Carranza-Alva, Guzman-Sanchez, Alderete-Berzabá, Shkurovich-Bialik, 2025).
One of the arguments for not allowing participation in contact or collision sports is that the multiple mild head trauma associated with such participation could exacerbate seizures; however, there is little evidence for this and for most PWE not there is evidence that contact sports are harmful (Carranza-Alva, Guzman-Sanchez, Alderete-Berzabá, Shkurovich-Bialik, 2025).
Although there is evidence that head trauma can cause epileptic seizures, this association is only valid for severe trauma. There are no consistent reports of an increased risk of epilepsy following mild head injury in the general population; typical sports-related injuries are so mild that they are highly unlikely to be associated with epilepsy (Carranza-Alva, Guzman-Sanchez, Alderete-Berzabá, Shkurovich-Bialik, 2025).
Based on prospective and retrospective studies, PWE and epileptic seizures have a higher risk of injury. The most common are: mild head injuries; submersion injuries; burns and fractures (Carranza-Alva, Guzman-Sanchez, Alderete-Berzabá, Shkurovich-Bialik, 2025).
The risk of seizures and the association of injuries is higher in uncontrolled epilepsy, high seizure frequency and with primarily or secondarily generalised seizures. In these cases, there is a greater risk of presenting seizures during activities of daily living or exercise and the conclusion of multiple studies is that the most common injuries related to seizures are soft tissue injuries; therefore, it is important to know the type of crisis when exercise is recommended and the associated risks (Carranza-Alva, Guzman-Sanchez, Alderete-Berzabá, Shkurovich-Bialik, 2025).
For high-risk sports, some authors prohibit their practice in the PWE; however, if patients decide to continue practicing them, the cases must be individualised based on the risk-benefit of each patient. For example, to perform diving in a review; it was concluded that although the risk of death is high, if there is freedom from seizures for at least 4 years, the risk of having a seizure during is minimal, due to the sedative effect of some ASDs, it is recommended not to dive as it increases the risk of nitrogenous narcosis (Carranza-Alva, Guzman-Sanchez, Alderete-Berzabá, Shkurovich-Bialik, 2025).
The UK Sports Committee recommends diving in patients with epilepsy with 5 years of seizure freedom and no treatment, in the event that seizures are exclusively nocturnal, this can be considered individually with the committee through the appeals process (Carranza-Alva, Guzman-Sanchez, Alderete-Berzabá, Shkurovich-Bialik, 2025).
In basic research, positive results have been obtained about physical exercise, it has been found that it can help reduce cell loss or neuronal damage secondary to brain lesions in animal studies (Carranza-Alva, Guzman-Sanchez, Alderete-Berzabá, Shkurovich-Bialik, 2025).
In animals with epilepsy induced with pilocarpine, penicillin, pentylenetetrazole and kainic acid have had the same positive results in terms of the presence of a lower frequency of spontaneous seizures by carrying out a physical training program, as well as a low probability of seizures induced by exercise, without the presence of sudden death during exercise. Even intense training improved seizure frequency (Carranza-Alva, Guzman-Sanchez, Alderete-Berzabá, Shkurovich-Bialik, 2025).
Several studies report a decrease in the frequency of seizures when performing aerobic exercise or the absence of exercise as a seizure inducer. PWE who regularly exercise tend to report fewer seizures than sedentary patients, indicating that exercise may be a complementary therapy for patients with epilepsy (Carranza-Alva, Guzman-Sanchez, Alderete-Berzabá, Shkurovich-Bialik, 2025).
Another of the benefits of exercise is that it helps prevent or treat comorbidities such as obesity by reducing the percentage of body fat, as well as cardiovascular and metabolic risk in patients with epilepsy (Carranza-Alva, Guzman-Sanchez, Alderete-Berzabá, Shkurovich-Bialik, 2025).
The therapeutic effect of exercise on depression in patients with epilepsy has been studied with good results. Some explanations for this consist in the increase and regulation of neurotransmitter systems involved in the pathophysiology and improvement of other comorbidities that may influence depression. Patients with epilepsy who exercise present lower levels of depression regardless of other factors such as age, gender, seizure frequency, or stress (Carranza-Alva, Guzman-Sanchez, Alderete-Berzabá, Shkurovich-Bialik, 2025).
This topic hits close to home for me. This is because I suffer from epilepsy. Thankfully, mine is controllable so I haven't had a seizure in years. I'm glad that Musiala is fine.
I hope this incident creates more awareness for the disorder. Epilepsy can never be taken lightly or as a joke.
Reference List
Alderete-Berzabá, J., Carranza-Alva, C.A.., Guzman-Sanchez, K.E. & Shkurovich-Bialik, P. 2025. Exercise and sports in patients with seizures and epilepsy. Literature review. MedXplora, 70(3): 244-250. Available at: DOI: 10.24875/AMH.24000018.