How is epilepsy diagnosed and treated in adults?
Epilepsy in adults is diagnosed through a combination of clinical history, neurological examination, and tests such as EEG and MRI. Treatment typically begins with anti-seizure medications, which control seizures in the majority of patients. For those who do not respond to medication, surgical and other advanced options are available.
Deccan Hardikar Hospital in Pune offers comprehensive neurology and neuro science services for adults living with epilepsy and other seizure disorders, combining accurate diagnosis with personalised treatment plans.
Note: Epilepsy is defined as having two or more unprovoked seizures occurring more than 24 hours apart, or one unprovoked seizure with a high risk of recurrence.
What causes epilepsy in adults?
Epilepsy in adults can arise from a range of structural, metabolic, genetic, and unknown causes. Identifying the underlying cause guides treatment decisions and helps assess long-term prognosis.
- Structural causes: Stroke, traumatic brain injury, brain tumours, or cortical malformations
- Infectious causes: Meningitis, encephalitis, or neurocysticercosis (particularly relevant in India)
- Metabolic causes: Electrolyte imbalances, liver or kidney disease, or low blood glucose
- Genetic factors: Certain inherited conditions affecting brain excitability
- Autoimmune causes: Autoimmune encephalitis where the immune system attacks brain tissue
- Unknown (idiopathic): In many adults, no specific cause is identified despite thorough investigation
In older adults, stroke is among the most common identifiable causes of new-onset epilepsy.
What are the first signs of epilepsy in adults?
Seizure presentations vary widely depending on which part of the brain is affected. Recognising early signs helps adults seek timely neurological evaluation.
- Sudden, unexplained episodes of confusion or blank staring
- Uncontrolled jerking movements of the arms or legs
- Temporary loss of awareness or consciousness
- Stiffening of the body
- Unusual sensations — tingling, visual disturbances, or a rising feeling in the stomach
- Psychic symptoms such as déjà vu or sudden fear without cause
- Brief episodes of repetitive, purposeless movements (automatisms) such as lip-smacking or hand-wringing
Warning: A seizure lasting more than five minutes, or two seizures without regaining consciousness between them, is a medical emergency. Seek immediate care.
How is epilepsy diagnosed at Deccan Hardikar Hospital in Pune?
Accurate diagnosis requires ruling out other conditions that mimic seizures — such as fainting, transient ischaemic attacks, or psychogenic episodes. The diagnostic process at Deccan Hardikar Hospital in Pune follows a structured, evidence-based pathway.
| Diagnostic Step | Purpose |
|---|---|
| Clinical history & witness account | Characterise seizure type, frequency, and triggers |
| Neurological examination | Assess baseline brain and nerve function |
| Electroencephalogram (EEG) | Detect abnormal electrical activity in the brain |
| MRI brain | Identify structural abnormalities, lesions, or tumours |
| Blood investigations | Rule out metabolic and infectious causes |
| Video-EEG monitoring (if indicated) | Correlate clinical events with brain activity for complex cases |
The number of seizures required before a formal epilepsy diagnosis depends on clinical context. Two unprovoked seizures are the standard threshold, but a single seizure with high recurrence risk may also meet diagnostic criteria.
How is epilepsy treated in adults — medication, surgery, and beyond?
Treatment is tailored to seizure type, epilepsy syndrome, underlying cause, and the individual's overall health. The goal is complete seizure freedom with minimal side effects.
Anti-seizure medications (ASMs) are the first line of treatment. Most adults achieve good seizure control with one or two medications. Common ASMs used in India include sodium valproate, levetiracetam, carbamazepine, lamotrigine, and clobazam, among others — the choice depends on seizure type and patient profile.
For adults whose seizures are not controlled by two or more appropriately chosen medications (drug-resistant epilepsy), further options include:
- Epilepsy surgery: Resection of the seizure focus in carefully selected candidates — advanced neuro care at Deccan Hardikar Hospital supports pre-surgical evaluation
- Vagus nerve stimulation (VNS): A device implanted to reduce seizure frequency
- Ketogenic diet: A high-fat, low-carbohydrate diet with evidence of benefit in selected patients
- Responsive neurostimulation (RNS): Detects and responds to abnormal brain activity in real time
Note: Never stop or adjust anti-seizure medication without consulting your neurologist. Abrupt withdrawal can trigger prolonged seizures.
How can adults with epilepsy live well and manage daily life?
With appropriate treatment and lifestyle adjustments, many adults with epilepsy lead full, active lives. Practical self-management reduces seizure risk and improves quality of life.
- Take medication consistently — at the same time each day, without skipping doses
- Prioritise sleep — sleep deprivation is a well-established seizure trigger
- Limit alcohol — alcohol lowers the seizure threshold and interacts with many ASMs
- Manage stress — stress and anxiety can precipitate seizures in susceptible individuals
- Inform close contacts — ensure family members or colleagues know basic seizure first aid
- Driving and safety — follow the applicable regulations; discuss driving fitness with your neurologist
- Keep a seizure diary — record date, duration, possible triggers, and recovery time to assist your doctor
Adults with well-controlled epilepsy can typically work, exercise, and maintain social relationships. Those with focal epilepsy can also live normal lives when seizures are adequately managed.
When should an adult with seizures see a neurologist?
Prompt neurological evaluation is important. Consult a neurologist if any of the following apply:
- You have experienced a first-ever unprovoked seizure
- Seizures are occurring more than once despite being on medication
- A seizure lasts longer than five minutes
- You experience a change in seizure pattern, frequency, or severity
- Side effects from anti-seizure medication are affecting daily function
- You are planning a pregnancy — medication review is essential before conception
- You have not had a seizure review in more than 12 months
Deccan Hardikar Hospital in Pune, a NABH Pre-Accredited facility, provides neurology consultations for adults with new or established epilepsy. Use the booking form on this page to schedule an appointment with our neurology team.
Book a Neurology Consultation at Deccan Hardikar Hospital
Located at 1160/61, University Rd, Shivajinagar, Pune 411005. Use the booking form on this page to reach our neurology team.