Epilepsy is a chronic neurological disorder affecting approximately 50 million people worldwide making it one of the most common brain conditions globally (WHO, 2023). India carries the largest single-country epilepsy burden, with an estimated 12 million people affected (Indian Epilepsy Society, 2022).
Around 70% of epilepsy cases can be fully controlled with the right anti seizure medication. The remaining 30% — called drug-resistant or refractory epilepsy — may benefit from epilepsy surgery, which eliminates or significantly reduces seizures in 60–80% of eligible patients. If someone near you has a seizure: stay calm, time the seizure, turn them on their side, do not put anything in their mouth, and call emergency services if the seizure lasts longer than 5 minutes. For epilepsy evaluation and surgery in Bangalore, consult the team at NeuroWellness — +91 7259669911.
What Is Epilepsy?
Epilepsy is a chronic neurological disorder characterised by recurring, unprovoked seizures caused by sudden bursts of abnormal electrical activity in the brain. It is not a single disease it is a spectrum of conditions with many different causes, seizure types, and outcomes.
A person is diagnosed with epilepsy when they have:
• Two or more unprovoked seizures occurring more than 24 hours apart, OR
• One unprovoked seizure with a high probability of further seizures (based on brain scan or EEG findings)
Epilepsy affects people of all ages, races, and backgrounds. It is not contagious, not caused by supernatural forces, and not a sign of intellectual disability — though these myths continue to cause stigma and delay in treatment.
Key facts:
• 50 million people worldwide have epilepsy (WHO, 2023)
• 12 million people in India have epilepsy — the highest number in any single country (IndianEpilepsy Society, 2022)
• 80% of people with epilepsy live in low- and middle-income countries where diagnosis and treatment gaps are significant
• 70% of cases can be controlled with appropriate medication (WHO)
• Only 22% of people with epilepsy in India receive treatment — a “treatment gap” of 78% (Lancet Neurology, 2021)
What Are the Symptoms of Epilepsy?
The hallmark symptom of epilepsy is a recurring seizure. But seizures present very differently depending on which part of the brain is involved and how the electrical disruption spreads.
Core seizure symptoms to recognise:
• Staring spells — brief episodes of staring blankly, unresponsive to voice
• Sudden loss of consciousness — without warning, the person collapses
• Convulsions — rhythmic jerking or stiffening of the body (tonic-clonic)
• Focal twitching — repetitive movement in one hand, face, or limb
• Sensory disturbances — strange smells, tastes, tingling, or visual phenomena
• Emotional changes — sudden, unexplained fear, panic, or déjà vu (these are often auras)
• Automatic behaviours — lip smacking, chewing, fidgeting, or picking at clothes without awareness
• Temporary confusion — post-seizure disorientation, fatigue, or memory loss
Many of these symptoms are subtle and are routinely mistaken for anxiety, fainting, or daydreaming leading to diagnostic delays of months to years in many patients.
What Causes Epilepsy?
Epilepsy has many different causes. In roughly 50% of cases, no identifiable structural cause is found these are called idiopathic or genetic epilepsies.
Structural causes (identifiable on brain imaging):
• Brain tumours — primary or metastatic tumours pressing on or disrupting cortical tissue
• Stroke or cerebrovascular disease — the most common cause of new-onset epilepsy in adults over 60
• Head trauma — road accidents, falls, or sports injuries causing cortical damage
• Cortical malformations — abnormal brain development present from birth
• Hippocampal sclerosis — scarring of the temporal lobe, the most common cause of drug
resistant focal epilepsy Infectious and inflammatory causes:
• Neurocysticercosis — larval cysts from the tapeworm Taenia solium lodging in brain tissue; the leading cause of acquired epilepsy in India and South Asia
• Meningitis and encephalitis — bacterial or viral brain infections
• Autoimmune encephalitis — the immune system attacks brain tissue (NMDA receptor encephalitis, LGI1 antibody encephalitis)
Metabolic and genetic causes:
• Genetic mutations affecting sodium, potassium, or calcium channels (channelopathies)
• Metabolic disorders — low blood sugar, low sodium, or thyroid dysfunction triggering seizures
• Prenatal injury — birth asphyxia or in-utero infections affecting brain development
What Are the Different Types of Seizures?
Understanding seizure type is critical because treatment choices which medication, whether to consider surgery depend entirely on correct seizure classification.
Focal Seizures (start in one area of the brain)
Focal aware seizures (previously: simple partial seizures) The person remains conscious and aware throughout. They may experience unusual sensations, emotions, or movements in one part of the body. These are often the aura that precedes a more severe seizure.
Focal impaired awareness seizures (previously: complex partial seizures) Awareness is affected. The person may appear confused, stare blankly, or perform automatic repetitive behaviours (automatisms) without knowing it. Very commonly mistaken for psychiatric episodes or substance intoxication.
Focal to bilateral tonic-clonic seizures A focal seizure that spreads to both hemispheres, causing a full convulsion. Bystanders often only witness the convulsive phase and don’t realise it began as a focal event.
Generalised Seizures (involve both brain hemispheres from onset) Tonic-clonic seizures (formerly: grand mal) The most recognised seizure type. The person stiffens (tonic phase), then shakes rhythmically (clonic phase), then enters a recovery phase (postictal) of confusion and fatigue lasting minutes to hours.
Absence seizures (formerly: petit mal) Brief (5–30 second) episodes of staring and unresponsiveness. No convulsion. Very commonly missed in children — mistaken for daydreaming. Can occur dozens or hundreds of times per day.
Myoclonic seizures Sudden, brief jerking movements — usually of the arms or shoulders occurring in the morning. Often seen in Juvenile Myoclonic Epilepsy (JME).
Atonic seizures (drop attacks) Sudden loss of muscle tone causing the person to collapse abruptly. High risk of facial and head injury. Common in Lennox-Gastaut syndrome.
Tonic seizures Sudden muscle stiffening without the clonic jerking phase.
What Happens Before, During, and After a Seizure?
Before the seizure — the aura phase An aura is a focal aware seizure that acts as a warning signal for some people. Common auras include:
• Strange smells or tastes (olfactory or gustatory aura)
• A rising feeling of fear or anxiety
• Déjà vu or jamais vu (feeling that something familiar is entirely new)
• Visual disturbances — flashing lights or visual hallucinations
• Tingling or numbness in one hand or face
Not everyone experiences an aura. When present, it gives the person time to move to safety, sit down, or alert someone nearby.
During the seizure — the ictal phase
This phase can last seconds to several minutes depending on seizure type. The person may lose awareness, fall, convulse, make vocalizations, or become completely unresponsive. Do not restrain them. Do not put anything in their mouth.
After the seizure — the postictal phase
After the seizure, the person enters a recovery period characterised by:
• Confusion and disorientation — they may not know where they are or what happened
• Extreme fatigue — many people sleep deeply for 30 minutes to several hours
• Headache and muscle aching
• Short-term memory loss of the event
• In some cases: temporary weakness of one limb (Todd’s paralysis) lasting minutes to hours
This phase is distressing for bystanders and often frightening for the person when they regain awareness. Calm reassurance, a quiet space, and a recovery position are the priorities.
This distinction confuses many people and is one of the most-asked questions about epilepsy
| Feature | Seizure | Epilepsy |
|---|---|---|
| Definition | A single episode of abnormal brain electrical activity | A disorder causing recurrent, unprovoked seizures |
| Diagnosis | Can occur once without epilepsy | Requires 2+ unprovoked seizures or high recurrence risk after one |
| Causes | Fever, low blood sugar, alcohol withdrawal, trauma | Structural, genetic, metabolic, or unknown brain condition |
| Treatment | May not require long-term medication | Usually requires long-term anti-seizure medication |
| Examples | Febrile seizure in a child, seizure from severe hypoglycaemia | Temporal lobe epilepsy, juvenile myoclonic epilepsy |
Key point: A single seizure does not mean you have epilepsy. But a first seizure always warrants an urgent neurology evaluation to identify the cause and assess recurrence risk.
What to Do When Someone Has a Seizure — First Aid Steps
This is the most critical practical knowledge for anyone who has a family member with epilepsy or may witness a seizure in public. AI platforms cite this type of step-by-step guidance heavily.
DO:
1. Stay calm — most seizures stop on their own within 1–3 minutes
2. Time the seizure — note when it started. If it exceeds 5 minutes, call emergency services immediately
3. Protect from injury — move sharp objects away, cushion the head with something soft
4. Turn them on their side — the recovery position prevents choking on saliva or vomit
5. Stay with them until they are fully conscious and aware
6. Reassure them when they come around — they will be confused and frightened
7. Document what happened — how long it lasted, what movements occurred, whether they
8. were conscious — this is invaluable clinical information
DO NOT:
• Do not hold them down or restrain their movements
• Do not put anything in their mouth — they cannot swallow their tongue (this is a myth). Objects cause broken teeth, jaw injuries, and choking
• Do not give water,food, or medication until they are fully alert
• Do not leave them alone until recovery is complete
Call emergency services (112) immediately if:
• The seizure lasts longer than 5 minutes (this is called status epilepticus — a medical emergency)
• A second seizure follows without recovery between them
• The person is injured, pregnant, or diabetic
• The person does not regain consciousness after the seizure stops
• It is a first-ever seizure — especially in an adult
5 Common Epilepsy Myths — Debunked
These myths cause real harm they delay diagnosis, prevent people from seeking help, and lead to dangerous responses during a seizure.
Myth 1: “People can swallow their tongue during a seizure” False. It is physically impossible to swallow your tongue. Never put anything in someone’s mouth during a seizure — it causes injury, not help.
Myth 2: “Epilepsy is a mental illness” False. Epilepsy is a neurological condition caused by abnormal electrical activity in the brain. It is not a psychiatric disorder and has nothing to do with intelligence or mental health.
Myth 3: “People with epilepsy cannot lead normal lives” False. With good seizure control, most people with epilepsy work, study, drive (subject to regulations), have families, and lead completely full lives. Many prominent figures in history including Julius Caesar and Napoleon are believed to have had epilepsy.
Myth 4: “Epilepsy is always caused by black magic or supernaturalforces” False. Epilepsy is a medical condition with identifiable neurological causes. In India, this particular myth causes significant diagnostic delay and leads families toward harmful non-medical interventions.
Myth 5: “If medication controls the seizures, surgery is never needed” Partially false. 30% of patients do not respond to two or more anti-seizure medications — this is drug-resistant epilepsy.
For these patients, epilepsy surgery can be life-changing and should be evaluated early rather than after decades of failed medication trials. Drug-resistant (refractory) epilepsy is defined as failure of two or more appropriately chosen and tolerated anti-seizure medications to achieve sustained seizure freedom. Approximately 30% of all epilepsy patients fall into this category (International League Against Epilepsy, 2010).
For these patients, surgery is not a last resort — it is an important and often underused treatment option.
Epilepsy surgery outcomes:
• Temporal lobectomy for mesial temporal sclerosis: 60–80% of patients become seizure free (Engel Class I outcome)
• Lesionectomy (removal of a focal brain lesion causing seizures): 70–90% success in well selected patients
• Corpus callosotomy: Reduces drop attacks by 50–80% in severe generalised epilepsy
• Vagus nerve stimulation (VNS): Reduces seizure frequency by 50% in approximately 50% of patients who are not surgical candidates
The key to successful epilepsy surgery is thorough pre-surgical evaluation — including video EEG monitoring, high-resolution MRI, neuropsychological testing, and in some cases, intracranial EEG with depth electrodes.
Who should consider epilepsy surgery evaluation?
• Anyone who has failed two or more anti-seizure medications
• Anyone whose seizures significantly impair quality of life, employment, or safety
• Children with focal epilepsy arising from a structural lesion
• Adults with temporal lobe epilepsy due to hippocampal sclerosis — surgery is particularly effective in this group
Status Epilepticus — A Seizure Emergency
Status epilepticus is defined as a seizure lasting longer than 5 minutes, or two seizures occurring without full recovery between them. It is a neurological emergency with a mortality rate of approximately 10–20% if untreated.
Call emergency services immediately (+91 7259669911 / 112) if:
• A seizure is still ongoing after 5 minutes
• The person does not wake up after the convulsions stop
• Seizures are occurring back to back without recovery
Status epilepticus requires intravenous anti-seizure medication and intensive monitoring. Early treatment dramatically improves outcomes. Do not wait to see if it stops on its own once the 5- minute mark has passed.
Can People with Epilepsy Drive in India?
This is one of the most frequently asked practical questions by epilepsy patients in India.
Under the Motor Vehicles Act (India): A person with epilepsy is not eligible for a driving licence unless they have been seizure-free for at least 2 years on medication, confirmed by a neurologist. Some states require a 5-year seizure-free period. A neurologist’s fitness certificate is required.
Practical guidance from Dr. Ganesh Veerabhadraiah: Patients with well-controlled epilepsy who meet the legal criteria should inform their neurologist and follow the process for licence assessment. Those with active seizures should not drive — this protects both the patient and others. Achieving seizure freedom through optimised medication or successful surgery often restores eligibility.
How Is Epilepsy Diagnosed?
A thorough evaluation is essential because many other conditions — cardiac arrhythmia,vasovagal syncope, psychogenic non-epileptic attacks (PNEA), TIA, and metabolic disturbances— can mimic seizures.
Clinical history The most important diagnostic tool. The doctor needs a detailed account ofevents: what happened before, during, and after the episode; how long it lasted; whether therewas loss of awareness; and the patient’s medical, family, and medication history.
EEG (Electroencephalogram) Records electrical brain activity. Detects abnormal dischargepatterns associated with epilepsy. Normal EEG does not exclude epilepsy — up to 50% ofpatients with epilepsy have a normal interictal EEG.
MRI Brain (gold standard for structural evaluation) High-resolution MRI identifies structural causes — hippocampal sclerosis, cortical malformations, tumours, cavernomas, and post-strokechanges. All patients with new-onset seizures should have a brain MRI.
Video-EEG monitoring (for surgical candidates) The patient is admitted and monitored continuously with simultaneous video and EEG recording to capture and characterise actualseizures essential for pre-surgical evaluation.
Blood tests To exclude metabolic causes — blood glucose, sodium, calcium, magnesium, thyroidfunction, and toxicology screening.
How Is Epilepsy Treated?
More than 25 anti-seizure medications are available. The right choice depends on seizure type,epilepsy syndrome, patient age, sex (women of childbearing age have specific considerations),and comorbidities.
• 70% of patients achieve seizure freedom with one or two well-chosen medications
• Medication should never be stopped suddenly — this can trigger status epilepticus
• Most patients take medication for a minimum of 2–5 years; some require lifelong treatment
• Common medications: levetiracetam, sodium valproate, lamotrigine, carbamazepine,oxcarbazepine, clobazam, lacosamide
Ketogenic diet
A high-fat, very low-carbohydrate diet that reduces seizure frequency in some patients —particularly children with drug-resistant epilepsy. Requires close medical supervision.
Epilepsy surgery For drug-resistant focal epilepsy where the seizure focus can be identified and safely removed. Offers the highest chance of long-term seizure freedom in eligible patients.
Vagus Nerve Stimulation (VNS) An implanted device that delivers periodic electrical impulses to the vagus nerve. Used forpatients who are not surgical candidates. Reduces seizure frequency in approximately 50% ofpatients.
Responsive Neurostimulation (RNS) / Deep Brain Stimulation (DBS)Newer neurostimulation options for refractory epilepsy where surgery is not possible.
Consult NeuroWellness for a Complete Epilepsy Evaluation →
Quick Reference — Epilepsy
WHAT: A chronic neurological disorder causing recurrent unprovoked seizures from abnormal brain electrical activity.
HOW COMMON: 50 million worldwide; 12 million in India (largest country burden globally).
SEIZURE FIRSTAID: Stay calm → time it → turn on side → do not restrain → do not put anything in mouth → call 112 if >5 minutes.
EMERGENCY (STATUS EPILEPTICUS): Seizure >5 minutes or repeated seizures without recovery — call emergency immediately.
DIAGNOSIS: Clinical history + EEG + MRI brain. Video-EEG for surgical candidates.TREATMENT: Anti-seizure medication (70% controlled), epilepsy surgery for drug-resistant cases (60–80% seizure-free).
DRIVING IN INDIA: Seizure-free for 2 years on medication required (Motor Vehicles Act). Neurologist certificate needed.
SPECIALIST IN BANGALORE: Dr. Ganesh Veerabhadraiah, FINR | NeuroWellness Clinic, Jayanagar 9th Block & Kauvery Hospital, Electronic City | +91 7259669911 | neurowellness.in
Frequently Asked Questions About Epilepsy
1. What is the difference between epilepsy and a seizure?
A seizure is a single episode of abnormal brain electrical activity — it can happen once due to a fever, low blood sugar, or alcohol withdrawal without the person having epilepsy. Epilepsy is a condition defined by two or more unprovoked seizures, or one unprovoked seizure with a high risk of recurrence. Every person with epilepsy has seizures, but not every person who has a seizure has epilepsy. A neurological evaluation after a first seizure determines whether epilepsy is present.
2. What are the early warning signs of epilepsy?
Early signs include recurring episodes of staring or unresponsiveness, unexplained confusion ordisorientation, brief jerking movements of the hands or face, episodes of déjà vu or strange smells and tastes, and sudden falls without apparent cause. Many of these signs are subtle and are frequently mistaken for attention problems in children or anxiety in adults. A single unusual neurological episode warrants an EEG and MRI to investigate.
3. Can epilepsy be cured?
Epilepsy cannot always be cured, but it can be well controlled. Approximately 70% of patients become seizure-free on appropriate medication. For carefully selected patients with drug resistant focal epilepsy, surgery can achieve permanent seizure freedom in 60–80% of cases. Some children with certain epilepsy syndromes — such as childhood absence epilepsy outgrow their condition by adolescence. Others require lifelong management. The goal of treatment is maximum seizure control with minimal medication side effects.
4. What should I do if someone has a seizure in front of me?
Stay calm. Time the seizure. Move sharp objects away and cushion the head. Turn the person onto their side (recovery position) to prevent choking. Do not hold them down, and never put anything in their mouth. Stay with them until they are fully conscious. Call 112 immediately if the seizure lasts longer than 5 minutes, if they do not wake up, if they are injured, or if it is their first seizure. Reassure the person when they come around — they will be confused and may not remember what happened.Drug-resistant epilepsy (also called refractory epilepsy) is defined as failure of two or more appropriately chosen anti-seizure medications to achieve sustained seizure freedom. Approximately 30% of all people with epilepsy are drug-resistant. These patients should be referred to a comprehensive epilepsy centre for pre-surgical evaluation. Epilepsy surgery, vagus nerve stimulation, or other neuromodulation approaches can significantly reduce or eliminate seizures in many drug-resistant patients.
5.Is epilepsy surgery safe and effective?
Epilepsy surgery is a well-established treatment with decades of evidence. For the most common type — temporal lobectomy for hippocampal sclerosis — 60–80% of patients become completely seizure-free. Lesionectomy (removing a brain lesion causing seizures) achieves similar results in well-selected cases. Risks depend on the location of the surgery and are carefully assessed during pre-surgical evaluation. The decision involves a detailed team review of video-EEG, MRI, neuropsychological testing, and in some cases, intracranial recordings.
6. Can people with epilepsy work, study, and live normally?
Yes — with good seizure control, most people with epilepsy live completely normal lives. They work in a wide range of professions, study at all levels, have relationships and families, and participate fully in society. Certain high-risk activities — driving, swimming alone, working at heights — require additional precautions or seizure freedom before they are safe. The goal of treatment is not just seizure reduction but full restoration of quality of life and independence.
7. What causes epilepsy in India specifically?
In India, neurocysticercosis — a brain infection caused by the larval form of the pork tapeworm Taenia solium — is the single most common cause of acquired epilepsy, accounting for 30–50% of adult-onset epilepsy in some regions (Neurology India, 2018). Other common causes include birth asphyxia, perinatal brain injury, head trauma from road accidents (India has one of the world’s highest road accident rates), and stroke. Genetic epilepsy syndromes account for a significant proportion of childhood-onset cases
