Epilepsy & Seizures

Stay calm. Do: protect the person from injury — move hard or sharp objects away, cushion their head with something soft. Time the seizure from onset. Turn them onto their side (recovery position) to prevent choking if they vomit. Stay with them until they are fully conscious and oriented. Don't: put anything in their mouth — the old advice about biting tongues is a myth and fingers have been badly injured this way. Don't restrain them. Don't give water or medication during the seizure. Call an ambulance if: the seizure lasts more than 5 minutes, a second seizure follows immediately, the person doesn't regain consciousness within 5-10 minutes, or this is their first known seizure. Most seizures stop within 2-3 minutes on their own.

Not necessarily. A single seizure can be provoked by a reversible cause — fever (especially in young children), very low blood sugar, electrolyte imbalance, sleep deprivation, alcohol withdrawal, or a medication side effect. These provoked seizures don't constitute epilepsy and the underlying cause is treated. Epilepsy is diagnosed after two or more unprovoked seizures (seizures without an identifiable trigger), or after one unprovoked seizure with a high risk of recurrence (based on EEG or MRI findings). After a single unprovoked seizure, recurrence risk over the next 2 years is about 40% — a neurologist assesses whether immediate treatment is warranted based on the seizure type, EEG results, and imaging.

Most antiepileptic medications (AEDs) are safe when monitored appropriately, and the risk of uncontrolled seizures is far greater than the side effects of medication for most patients. Common side effects: sedation, dizziness, and weight changes — often manageable with dose adjustment. Sodium valproate is highly effective but causes birth defects and should not be used in women of childbearing age without specialist guidance and a strict pregnancy prevention programme. Phenobarbitone, still widely used in India because of cost, causes cognitive effects at higher doses. Newer medications (levetiracetam, lamotrigine, lacosamide) generally have better tolerability profiles. Blood levels and liver function monitoring are recommended for some AEDs. Stopping medication abruptly can trigger dangerous seizures — never stop without a neurologist's guidance.

Driving: most Indian states prohibit driving until seizure-free for 12 months. This rule exists to prevent accidents — disclose your condition honestly to licensing authorities. Work: most jobs are compatible with well-controlled epilepsy. Avoidance of heights, open water, and operating heavy unguarded machinery without safety protocols is advised. Children: women with epilepsy can have healthy pregnancies — but pregnancy planning with a neurologist is essential. Valproate must be avoided; safer alternatives (lamotrigine, levetiracetam) are used. Folic acid supplementation (5mg daily) is started before conception. Most antiepileptic drug levels change during pregnancy and require close monitoring. The key message: epilepsy is manageable and compatible with a full life when treated effectively and consistently.

After two appropriate AEDs fail to control seizures, the condition is classified as drug-resistant epilepsy — affecting about 30% of people. This deserves referral to a specialised epilepsy centre for re-evaluation: confirming the epilepsy diagnosis (some 'refractory' epilepsy turns out to be non-epileptic events), identifying the seizure type precisely, and exploring advanced options. Epilepsy surgery — removing the seizure focus — is curative in 60-70% of carefully selected patients and is available at NIMHANS, AIIMS, and major centres. Other options: vagus nerve stimulation (a device implanted under the collarbone), corpus callosotomy for drop attacks, and the ketogenic diet (a high-fat, very low-carbohydrate diet with proven efficacy in drug-resistant epilepsy, especially in children). Don't accept inadequate seizure control without seeking specialist review.