Dr explains: What is epilepsy and why millions in India still go untreated

Epilepsy remains one of the most misunderstood neurological disorders in India, even as around 15 million people live with the condition and fewer than half receive adequate treatment, according to experts.  

Globally, more than 50 million people have epilepsy, most of them in low- and middle-income countries, yet in many regions, up to 90 per cent of those affected lack access to treatment. 

The World Health Organisation estimates that about 70 per cent of people with epilepsy could become seizure-free with proper diagnosis and care. But in India, a severe treatment gap persists, driven by stigma, poor infrastructure, and lack of awareness.  

Firstpost talked to Dr Anurag Lamba, Director of Neurology at Paras Health (Panchkula) to demystify epilepsy — what causes it, how to recognise it and why many people never get the help they need.

What is epilepsy and how can one distinguish between a single seizure and chronic epilepsy?

Dr Lamba: Epilepsy is a chronic neurological condition where the brain’s electrical activity becomes suddenly disorganized, leading to recurrent seizures. A single seizure doesn’t automatically mean a person has epilepsy. Sometimes, a high fever, a head injury, or even a sudden dip in blood sugar can trigger a one-off episode.

Epilepsy is diagnosed only when a person experiences two or more unprovoked seizures separated by at least 24 hours, or if brain scans and EEGs show changes that make further seizures likely. Recognising this difference is crucial, because while a one-time seizure may not need long-term treatment, epilepsy requires regular medication and follow-up care.

What triggers epileptic seizures and how can patients manage them?

Dr Lamba: Seizure triggers vary from person to person, but some patterns are common like missing medicines, poor sleep, high stress, dehydration, fever, or exposure to flickering lights. For many people, identifying triggers is half the battle. Keeping a simple “seizure diary” helps note what you were doing, eating, or feeling before an episode. Over time, these notes reveal clear patterns. Once triggers are known, they can be managed by getting enough rest, eating regularly, staying hydrated, avoiding skipped doses, and maintaining a routine. Consistency often makes the biggest difference in controlling seizures.

How can caregivers spot early seizure signs and what should they do?

Dr Lamba: Some people experience subtle warning signs called auras before a seizure, these can include confusion, fear, nausea, or strange smells and sounds. Recognising these cues allows caregivers or teachers to guide the person to a safe place. During a seizure, it’s important to stay calm and act quickly. Do not put anything in the person’s mouth or try to hold them down. Instead, gently turn them on their side, cushion their head, and clear the area around them. Most seizures pass within a few minutes. If one lasts more than five minutes or repeats without recovery, it becomes a medical emergency and immediate help is needed.

What impact do sleep, stress, alcohol, diet and exercise have on epilepsy management?

Dr Lamba: Sleep and stress directly affect brain activity, which is why they’re two of the biggest seizure triggers. Alcohol and certain drugs can interfere with anti-seizure medications or make the brain more prone to abnormal electrical activity. On the other hand, a regular sleep routine, balanced diet, and moderate exercise can help stabilise brain function. Some people benefit from specific diets like the ketogenic diet, but such changes should always be done under a neurologist’s guidance. The idea is to build a lifestyle that supports brain health and medication effectiveness.

Can excessive screen time trigger seizures in people with epilepsy?

Dr Lamba: Screens don’t cause epilepsy, but in a small number of people, especially those with photosensitive epilepsy, rapidly flashing or flickering lights can trigger seizures. This sensitivity can show up during gaming, scrolling, or watching videos with bright, strobing effects. For those who are prone, reducing screen brightness, taking regular breaks and using blue-light filters can help. It’s also wise for everyone, not just those with epilepsy to practise healthy screen habits since prolonged use affects focus, sleep, and mental well-being.

In India, how do stigma and misconceptions hinder timely epilepsy care?

Dr Lamba: Epilepsy continues to be clouded by stigma and misinformation, especially in smaller towns and rural areas. Many still mistake seizures for signs of possession or bad luck, leading families to seek religious or traditional remedies before medical help. This delay can make the condition harder to control. Awareness that epilepsy is a treatable neurological disorder, not a mental illness or a curse is vital. With correct medication and timely care, nearly 70–80% of people with epilepsy can live completely seizure-free lives, go to school, work, and participate fully in society. Normalising conversations about epilepsy is the first step to ending the stigma.

How does epilepsy affect women during pregnancy and reproductive years?

Dr Lamba: For women, epilepsy can become more complex due to hormonal changes, menstruation, birth control, and pregnancy. Some anti-seizure medicines can interfere with fertility or cause complications during pregnancy, which makes medical supervision essential. Preconception counselling helps doctors adjust medication doses or switch to safer alternatives. The goal is to control seizures while keeping both the mother and baby safe. With careful planning and regular monitoring, most women with epilepsy can have healthy pregnancies and deliveries.

What can India do to bridge its epilepsy treatment gap?

Dr Lamba: Bridging India’s epilepsy treatment gap requires strong coordination between healthcare providers, policymakers, and communities.

*Early detection at the primary care level is crucial, many patients first present to general practitioners who must be trained to identify seizures early.

*Improving access to neurologists, affordable medicines, and EEG/MRI facilities can prevent years of untreated illness.

*Public awareness campaigns must challenge myths and misinformation, showing epilepsy as a manageable condition.

*Schools and workplaces should be sensitised to handle seizures calmly and inclusively.

*Patient counselling and follow-ups can improve medication adherence, which is key to long-term control.

*When awareness, empathy and access come together, epilepsy can be managed like any other chronic health condition and no one needs to suffer in silence.