Introduction <p>The correlation between seizure activity and brain damage represents one of the critical issue in epilepsy. In spite of the extensive literature on the topic, very few studies addressed the causal relation between brain tissue worsening and seizure recurrence. We specifically address this issue in the present manuscript. We define potential scenarios and review evidence of causality between seizures recurrence and brain injury in focal structural epilepsies, such as temporal lobe epilepsy and focal cortical dysplasia and extend the analysis to the pathophysiology of the aging brain.</p> Results <p>Experimental findings based on temporal lobe epilepsy models suggest that only conditions characterized by convulsive status epilepticus can induce secondary epileptogenesis that add injury to the brain tissue. When addressing late-onset epilepsies in elderly, it is still not clear whether seizures exacerbate the progression of the underlying pathological brain condition.</p> Conclusion <p>At the light of these results, we cannot conclude that seizures as such are responsible for a direct alteration of the brain tissue, whereas experimental evidence suggests that severe convulsive seizures may worsen an ongoing pathological process.</p>