Jamal Musiala's Absence Epilepsy: Impact on Career

Jamal Musiala’s sudden collapses have shaken German football. Twice in four days the Bayern and Germany playmaker simply went down on the pitch – first in a friendly against RB Leipzig, then against 1. FC Heidenheim. No crunching tackle. No clash of heads. Just a 23-year-old elite athlete crumpling to the turf.

For a neurologist watching from afar, the pattern was instantly familiar.

“As a neurologist I immediately thought of an epileptic seizure,” says 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.

Musiala later confirmed that suspicion in a public statement, speaking of “temporary brief absences caused by a neurological dysfunction”. The phrase sounds clinical. What it describes is anything but.

What is happening in Musiala’s brain?

Dr Becker explains that this is a classic picture of absence epilepsy – a disturbance that originates deep inside the brain.

“Absence epilepsy originates in the thalamus, the diencephalon, which controls consciousness,” she says. “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 cerebral cortex, where we consciously perceive things, is interrupted.”

The result is brutal in its simplicity. The player no longer takes in his surroundings. He stares into space or, as in Musiala’s case, simply falls over. To those nearby, the patient often looks frozen.

On the inside, it can feel like nothing at all.

“Most patients have no warning beforehand,” Dr Becker stresses. “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 the chilling part for any professional footballer. There is no build-up, no dizziness, no signal to sit down. One second you are running up to strike the ball, the next your brain cuts the lights.

Could that really happen in a decisive moment – for instance, during the run-up to a penalty?

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

Why he had to come off – every time

Both against RB Leipzig and Heidenheim, Musiala was substituted immediately after collapsing. To the layman, that might look cautious, especially when he appeared to recover quickly.

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

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

The match environment itself becomes a risk factor. Heat, physical strain, hyperventilation – all can trigger further seizures, even if the player feels fine minutes later. The body looks ready. The brain is not to be trusted without protection.

Why now – and why at 23?

The timing of Musiala’s diagnosis is unusual. Absence epilepsy is typically something seen in childhood.

“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 problem suddenly appeared this summer.

“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 adds.

So what might have pushed it to the surface now? Provided there is a genetic predisposition, the modern demands on a top player can act as a catalyst.

“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 says.

One thing she rules out straight away is any link to Musiala’s previous serious injury.

About a year ago, the attacking midfielder suffered a broken fibula. Could that trauma have played a role?

“No, that has nothing to do with it,” comes the clear answer.

Treatment, medication – and side effects

Musiala described his condition as “treatable”. That is not a hopeful gloss. It is accurate.

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

The therapy is preventative rather than reactive. You do not wait for the next collapse.

“Patients are given seizure-suppressing medications, which prevent the uncontrolled firing of neurons and are intended to suppress epileptic seizures,” she 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 that period, doctors monitor the blood levels closely and adjust the dose if needed. Once the right level is reached, the protection is usually strong enough to block further seizures.

The standard first-choice drug in this form of epilepsy is ethosuximide.

“In principle, it is a very well-tolerated medication, but it can lead to headaches and tiredness,” Becker notes.

Another powerful option is valproic acid. It works, but the price can be higher.

“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.”

This is not a quick, two-week course. Even if the seizures stop, the tablets keep coming.

“Even if the medications make someone seizure-free after a short time, they are taken for several months or years,” says Becker. In children, there is a realistic chance that the epilepsy will burn out and they can later live without medication. If the condition appears later in life, lifelong therapy may be necessary.

“There is no general answer, it varies from person to person,” she says.

Can Musiala keep playing at the top?

This is the question that hangs over every medical bulletin and every club statement. For Becker, the outlook is reassuring.

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

There is a caveat. The coming weeks matter.

“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 means patience – from the player, the club, and a national team that has come to rely on his creativity. The temptation will be to rush back as soon as he feels normal. The smarter play is to let the medicine settle, the levels stabilise, the brain find its new equilibrium.

Musiala has spoken in recent years about his neuro-athletics training and praised its impact. That work, though, is not a sign that he secretly knew about epilepsy and tried to train it away. The condition he is dealing with sits deeper, in the wiring of consciousness itself.

For now, the picture is clear: a late diagnosis, a well-understood illness, strong medication, and a player whose career does not need to be defined by the word “epilepsy”.

The next time Jamal Musiala glides past defenders, the biggest question will not be whether he is at risk – but how quickly he can get back to being one of the most fearless dribblers in the game.