Causes of Epilepsy: How Is It Diagnosed and Treated? 

Epilepsy is a chronic neurological disorder defined by recurrent, unprovoked seizures from sudden bursts of abnormal electrical activity in the brain. The triggers vary from one patient to the next, genetic mutations, head injury, stroke, brain tumours, or central nervous system infections like meningitis and neurocysticercosis. In nearly half of all diagnosed cases, no clear cause shows up at all. Diagnosis follows a stepwise workup, clinical history first, then a neurological exam, EEG to capture abnormal electrical discharge, and MRI to look for structural lesions or hippocampal sclerosis. Treatment runs through a clear hierarchy, antiepileptic drugs as first-line therapy controlling seizures in around 70% of patients, ketogenic diet in select paediatric cases, and surgical options including resection, vagus nerve stimulation, responsive neurostimulation, and LITT for the drug-resistant 30%.

According to Dr. Gurneet Singh Sawhney, a senior neurosurgeon in Mumbai, Epilepsy is not one disease, it is a spectrum of seizure disorders. Until the exact seizure focus is pinned down through video-EEG and advanced imaging, long-term control is largely guesswork. In carefully selected drug-resistant cases, surgery renders close to 7 out of 10 patients seizure-free.

Most cases trace back to gene mutations, head trauma, stroke, brain tumours, or infections of the central nervous system. Sometimes nothing shows up. Nearly half the time, in fact.

• Genes: Inherited mutations bring down the seizure threshold.
• Head injury: Brain tissue scars after trauma. Focal seizures often follow.
• Brain lesions: Tumours, stroke, vascular malformations. All can disrupt signals.
• CNS infections: Meningitis, encephalitis, neurocysticercosis. Pretty common in India.
• Perinatal injury: Birth asphyxia or trauma. Hits developing neural tissue.

For surgical routes, see our piece on epilepsy surgery in Mumbai.

Seizure type depends on the starting point and how far the misfiring spreads. This part matters more than most patients realise. It decides drug choice. Sometimes it decides whether surgery is even an option.

Diagnosis is a stepwise thing. History first, then neurological exam. EEG and MRI come next. Trickier cases? Video-EEG monitoring, or PET, to pin down where seizures begin.

• EEG: Picks up abnormal electrical bursts in the brain.
• MRI brain: Finds lesions, hippocampal sclerosis, or cortical issues.
• CT scan: Used in emergencies. Rules out bleed or sudden lesions.
• Video-EEG: Records seizures live. Needed before surgery.
• PET, SPECT: Helpful when MRI looks clean but seizures continue.

For early warning signs, read warning signs of a seizure in adults.

Drugs first. That is the standard. If drugs fail, the rest of the toolbox opens up. Surgery, nerve stimulation, diet, all depend on the case.

• Antiepileptic drugs: Control seizures in around 70% of patients.
• Resective surgery: Removes the seizure-generating brain area. Used in drug-resistant cases.
• Vagus nerve stimulation: Programmed pulses. Cuts seizure frequency.
• Responsive neurostimulation: A device that catches seizures early and shuts them down.

Ketogenic diet: High fat, low carb. Mostly for kids who do not respond to drugs.

Dr. Gurneet Singh Sawhney practises at Fortis Hospital Mulund. Over 16 years in functional neurosurgery, including epilepsy surgery, DBS, and complex resections. He treats both children and adults. His approach is straightforward, video-EEG mapping before surgery, neuro-monitoring during, structured care after. The target is seizure freedom, not just symptom patching. 

Reference:

1. World Health Organization — Epilepsy Fact Sheet
2. National Institute of Neurological Disorders and Stroke — Epilepsy Information Page

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