Epilepsy

Epilepsy is a brain condition where a person has repeated unprovoked seizures. About 1% of Indians have epilepsy — around 12 million people — making it one of the most common neurological conditions. With modern treatment, up to 70% of people with epilepsy have their seizures fully controlled and lead normal lives.

Causes

• Genetic predisposition.
• Previous brain injury (birth injury, head trauma, stroke).
• Brain infection — neurocysticercosis (NCC) is a leading cause of adult-onset epilepsy in India (from pork tapeworm larvae).
• Tuberculomas, brain abscesses (TB still relevant).
• Brain tumours.
• Post-stroke.
• Developmental disorders.
• Many have no identifiable cause.

Evaluation

• Detailed history from patient + witness.
• EEG.
• MRI brain (preferred over CT) — looks for NCC cysts, TB, tumours, scars.
• Blood tests.
• Always treat reversible causes (NCC, low sugar, low sodium) alongside anti-seizure medicine.

Treatment

• Anti-seizure medicines (ASMs) — many options; dose adjusted to control seizures with fewest side-effects; affordable generics available in India.
• Don't stop medicines on your own — abrupt stopping triggers seizures; changes made under neurology guidance.
• Lifestyle — regular sleep, avoid alcohol excess, recognise triggers (flashing lights for some).
• Record seizure diary — helps tune treatment.
• Surgery — for selected drug-resistant epilepsy; excellent outcomes at experienced Indian epilepsy centres.
• Vagus nerve stimulation, responsive neurostimulation, dietary therapy (ketogenic) — specialised options.
• Neurocysticercosis treatment — anti-parasitic + steroid + anti-seizure medicines; often clears cysts and cures epilepsy in suitable cases.

Living with epilepsy — Indian realities

• Education, employment, marriage, driving — the law and evidence both support inclusion. Many people work and live full lives.
• Driving — most countries (including India) require seizure-freedom for a defined period. Follow your state's rules.
• Pregnancy — plan ahead with a neurologist; most women with epilepsy have healthy babies; specific medicines may need switching.
• Stigma still hurts — particularly in small towns and villages. Epilepsy is not a curse, madness, or contagious. Support groups (Indian Epilepsy Association, state chapters) help.
• Safety precautions during seizures — don't lock bathroom doors; use shower (not bath tub); don't work at heights unsupervised.
• Ayushman Bharat PM-JAY covers epilepsy medicines and some surgery for eligible patients at empanelled centres.