Living Seizure-Free is Possible

Understanding Epilepsy in the Indian Context

Epilepsy—recurrent unprovoked seizures—affects 10 million Indians, yet 70% have no access to treatment. At Ajuda Hospitals, we bridge this gap with video EEG monitoring, evidence-based medications, and comprehensive lifestyle counseling for seizure freedom and safety.

Seizures result from abnormal brain electrical activity. Causes range from genetic (channelopathies) to structural (brain injury, stroke, tumors) to unknown. Early diagnosis and optimal medication achieve 70% seizure control, enabling patients to work, drive, and live independently.

Stigma and misinformation keep many from care. We provide patient education in Telugu, Hindi, and Urdu, emphasizing that epilepsy is a treatable medical condition—not a curse or mental illness.

When to Consult Our Epilepsy Specialists

Schedule a consultation if seizures are increasing, medication causes side effects (dizziness, rash, cognitive slowing), or you're planning pregnancy (medication safety review essential).

Our Diagnostic Approach

Seizure Classification

Detailed history from patient and witness: description of event, triggers, aura, post-ictal confusion. Classify per ILAE 2017—focal (localized origin) vs generalized (whole brain). Video review from family if available.

Video EEG Monitoring (VEEG)

Gold standard for diagnosis. Patient admitted for 24-48 hours; continuous EEG with synchronized video captures seizures. Differentiates epileptic from psychogenic non-epileptic seizures (PNES), syncope, or movement disorders. Maps seizure focus for surgery planning.

MRI Brain (Epilepsy Protocol)

Thin-cut temporal lobe sequences, FLAIR, contrast; identify mesial temporal sclerosis, cortical dysplasia, tumors, vascular malformations. Standard MRI often misses these—dedicated epilepsy imaging is critical.

Metabolic & Genetic Workup

Blood glucose (hypoglycemia mimics seizures), electrolytes (low sodium, calcium), renal/liver function (affects drug clearance). Genetic panel if early-onset, family history, or developmental delay.

Treatment Pathways

First-Line Anti-Seizure Medications (ASM)

Focal Seizures: Levetiracetam, carbamazepine, oxcarbazepine, lamotrigine Generalized Seizures: Valproate (avoid in women of childbearing age), levetiracetam, lamotrigine

Titration Protocol: Start low, increase every 1-2 weeks to therapeutic dose. Monitor levels (valproate, carbamazepine) and side effects (rash with lamotrigine, mood changes with levetiracetam).

Outcome: 60% seizure-free with first medication.

Combination Therapy

If first ASM fails at max tolerated dose, add second agent. Rational combinations: avoid inducer + inhibitor (carbamazepine lowers levels of lamotrigine). Consider mechanism—combine sodium channel blocker with SV2A modulator.

Outcome: Additional 15-20% seizure control.

Drug-Resistant Epilepsy (DRE)

Failure of 2-3 appropriate ASMs. Options:

• Epilepsy Surgery: Temporal lobectomy for mesial temporal sclerosis (70% seizure-free).
• Vagus Nerve Stimulation (VNS): Implantable device; 50% seizure reduction.
• Dietary Therapy: Ketogenic diet for pediatric refractory epilepsy (40% seizure-free).

Our neurosurgery team evaluates surgical candidacy via VEEG, PET, WADA test.

Status Epilepticus Emergency

Protocol:

1. IV lorazepam 0.1mg/kg (repeat once if needed).
2. Phenytoin or levetiracetam loading dose.
3. ICU with continuous EEG if seizures persist.
4. Refractory status: general anesthesia (propofol, midazolam).

Outcome: Seizure termination in 80% within 30 minutes.

Women's Epilepsy Clinic

Pre-conception:

• Switch from valproate (teratogenic) to lamotrigine or levetiracetam.
• Folic acid 5mg daily (prevents neural tube defects).

Pregnancy:

• Monthly ASM level checks (pregnancy lowers levels; adjust dose).
• Fetal anatomy scan at 20 weeks.
• Seizure-free status maintained in 90% with dose optimization.

Postpartum:

• Resume pre-pregnancy dose; breastfeeding safe with most ASMs.

Lifestyle & Safety Counseling

• Sleep: 7-8 hours; avoid shift work or irregular schedules.
• Alcohol: Complete avoidance (lowers seizure threshold).
• Driving: 1-year seizure-free rule; certificate provided when eligible.
• Job Safety: Avoid heights, heavy machinery, swimming alone.
• Seizure First-Aid: Family training; medical alert bracelet.

What to Expect: Your Care Journey

First Visit (60 min)

History, neurological exam, review of prior EEGs/MRIs. Discuss seizure triggers, medication history, side effects. Plan VEEG if diagnosis unclear.

Video EEG Admission (24-48 hrs)

Comfortable room with camera and EEG leads; family stays with patient. Reduce ASM dose or sleep-deprive to provoke seizures if none occur naturally. Report within 48 hours.

Follow-Up (2-4 weeks)

Review VEEG and MRI results; confirm diagnosis; initiate or adjust ASM. Provide seizure diary and safety checklist. Schedule next visit for 3 months.

Month Reviews

Assess seizure frequency, side effects, drug levels. Titrate dose or add second ASM if needed. Reinforce adherence and lifestyle modifications.

Annual Check-Up

EEG, liver/renal function tests. If seizure-free 2-5 years, discuss medication taper. Driving eligibility certificate if applicable.

Technology & Innovation

Video EEG Telemetry

Synchronized video-EEG captures ictal (during seizure) and interictal (between seizures) patterns. Cloud storage allows remote specialist review. AI algorithms detect spike-wave patterns, reducing analysis time.

Telemedicine Epilepsy Clinic

For patients in Warangal, Karimnagar, Nalgonda:

• Virtual consults for dose adjustment, side effect management.
• Seizure diary shared via app; alerts if frequency increases.
• Annual in-person visit for EEG and labs.

Outcome: 85% adherence vs 50% with standard care.

Preventing Complications

Sudden Unexpected Death in Epilepsy (SUDEP):

• Risk 1 in 1,000 annually; higher in uncontrolled epilepsy.
• Prevention: Achieve seizure control; avoid sleeping prone; nocturnal supervision if frequent seizures.

Injuries:

• Head trauma, burns, drowning during seizures.
• Mitigation: Helmet if frequent falls; shower instead of bath; supervise swimming.

Cognitive Side Effects:

• Topiramate, phenytoin cause memory/concentration issues.
• Switch to levetiracetam or lamotrigine if impairing work/study.

Osteoporosis:

• Enzyme-inducing ASMs (carbamazepine, phenytoin) lower vitamin D.
• Supplement calcium + vitamin D; DEXA scan if long-term use.

Why Ajuda for Epilepsy Care?

Take the First Step

If first seizure: Call 9010550550 for urgent evaluation. Early diagnosis and treatment prevent recurrence.

If uncontrolled epilepsy: Request VEEG and surgical evaluation. Drug-resistant epilepsy has solutions—surgery, VNS, dietary therapy.

If planning pregnancy: Schedule pre-conception consult. Medication adjustments take 3-6 months—plan ahead for safe pregnancy.

Ajuda Hospitals: Where epilepsy meets expertise, and seizure freedom becomes reality.