Jamal Musiala’s Epileptic Seizures: Impact on His Football Career

Jamal Musiala’s sudden collapses have rattled German football. For a moment, the sport’s usual language of tactics and transfers gave way to something far more human: fear.

Twice in four days, the Bayern and Germany star went down off the ball – first in a friendly against RB Leipzig on Saturday, then again on Tuesday against 1. FC Heidenheim. Each time he was substituted immediately. Each time, the images spread within minutes.

For Dr Regina Becker, a neurologist who previously worked at the University Hospital of Munich’s Ludwig Maximilian University and now runs the “Munich Schwabing Neuro Centre”, the first incident already rang loud alarm bells.

“When it happens so suddenly and he then obviously recovers quickly, as a neurologist I immediately thought of an epileptic seizure,” she says.

Musiala’s own statement after the second collapse confirmed that suspicion. He spoke of “temporary brief absences caused by a neurological dysfunction”. Behind that clinical phrase lies a very specific diagnosis: absence epilepsy.

What is happening in Musiala’s brain?

Absence epilepsy, Dr Becker explains, starts deep in the brain.

“It originates in the so-called thalamus, the diencephalon, which controls consciousness,” she says. “Anyone who has a dysfunction there can suddenly become unresponsive.”

In those moments, the brain flips into an exceptional state. Neurons fire uncontrollably. The normal communication between the thalamus and the cerebral cortex – the area where conscious perception takes place – breaks down.

The result is dramatic, but often silent.

“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.”

For the person affected, it can be even stranger.

“Most patients have no warning beforehand. It suddenly comes over them and they have no chance to react,” Dr Becker says. Sometimes they do not even notice the seizure itself. “Afterwards, they simply carry on as if nothing had happened.”

That unpredictability is the frightening part. Could it happen in the middle of a decisive moment – a sprint, a challenge, a penalty run-up?

“Yes, that is conceivable,” she admits.

Why he must come off – even if he feels fine

In both matches, Musiala left the pitch immediately after the incidents. From a purely physical standpoint, that is not because his heart or other organs are failing.

“In itself, the patient has no problem with the cardiovascular system, the organs function normally,” Dr Becker says.

The issue lies elsewhere: responsibility.

“In professional sport, carrying on is not possible for reasons of liability and duty of care,” she stresses. Conditions on the pitch 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.”

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

Why now – and why at 23?

Musiala is 23. Until now, there had been no public indication of such problems. That timing is unusual.

“Normally, this form of epilepsy occurs between the ages of four and 10,” Dr Becker explains. There are, however, variants such as juvenile absence epilepsy, which appear later.

“In any case, 23 is late for a diagnosis,” she says. “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 caused a sudden 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.”

One thing, though, can be ruled out. About a year ago, Musiala suffered a broken fibula. Does that serious injury have anything to do with his current condition?

“No, that has nothing to do with it,” Dr Becker says bluntly.

Treatment, medication – and the road back

Musiala called his illness “treatable” in his statement. Dr Becker backs that up.

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

The therapy is clear and structured. Patients receive seizure-suppressing drugs designed to stop the uncontrolled firing of neurons and prevent further attacks. They are taken daily as a preventive measure.

The medication needs time to settle.

“It builds up the necessary level in the blood within two to three weeks,” Dr Becker explains. During that phase, doctors monitor the levels closely and adjust the dose if needed. “Once that level has been reached, there is normally sufficient protection against further seizures.”

The standard first choice, she says, is ethosuximide. “In principle, it is a very well-tolerated medication, but it can lead to headaches and tiredness.”

Another option is valproic acid. It is also very effective but can come with more noticeable side effects: weight gain, hair loss, drowsiness. “It has to be tried individually to see which medication is the best fit. Most patients tolerate both medications well.”

How long will he have to take them? There is no single answer.

“Even if the medications make someone seizure-free after a short time, they are taken for several months or years,” Dr Becker says. Children with absence epilepsy sometimes grow out of it and become seizure-free in adulthood without medication. If the illness appears 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 that hangs over everything: does this diagnosis threaten his career?

Dr Becker’s assessment is clear.

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

There is, however, a transitional phase to manage.

“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.”

The fine-tuning of dosage, the monitoring, the way his body responds – all of that will dictate how quickly he can return to full intensity. But the outlook, medically, is positive.

In recent years, Musiala has spoken openly and enthusiastically about his neuro-athletics training, a programme designed to sharpen the connection between brain and body. That work now sits in a new light, framed by a diagnosis he and the public only fully understand today.

The next time he steps onto a pitch, every eye will search for signs of vulnerability. The medicine, and his own resilience, must now answer a different kind of pressure than any defender ever could.