In 2025, understanding of Epilepsy continues to evolve - from classification and diagnostics to emerging therapies and patient-care models. We cover what epilepsy is, how it presents, what’s new in 2025, how it’s managed in India and globally, and what to ask your neurologist.

What is Epilepsy?

Epilepsy is a chronic neurological condition in which groups of nerve cells (neurons) in the brain sometimes send abnormal, excessive or synchronous electrical impulses, leading to seizures.

A seizure is a transient occurrence of signs and/or symptoms due to this abnormal electrical activity.

Having one seizure doesn’t always mean you have epilepsy; typically the diagnosis is considered when a person has two or more unprovoked seizures or one seizure plus high risk of more, depending on the circumstances.

According to the World Health Organization (WHO) global fact sheet, around 50 million people worldwide have epilepsy, making it one of the most common neurological disorders.

In low- and middle-income countries, up to 80 % of people with epilepsy may not receive adequate treatment.

Why This Matters in 2025

A) Updated Classification

In 2025 the International League Against Epilepsy (ILAE) published a revised classification of epileptic seizures. Key changes include:

• Keeping four main seizure-classes (Focal, Generalised, Unknown, Unclassified) but reducing the number of named seizure types from 63 to 21.
• Shifting language: e.g., removing “onset” in class names, replacing “awareness” with “consciousness”, and replacing motor/non-motor dichotomy with observable vs non-observable manifestations.

These refinements help clinicians make more meaningful diagnostic distinctions and align classification with treatment decisions.

B) Emerging Research & Technologies

While many seizures are well-controlled by current therapies, around 30 % of patients continue to have uncontrolled (drug-resistant) epilepsy. Recent studies in 2025 highlight:

• New molecular mechanisms underlying seizures (for example, the discovery of a process called “paroxysmal depolarisation shifts” in hippocampal neurons) which may pave the way for causal therapies rather than just symptom control.
• Advancements in gene- and cell-therapy approaches. For example, adeno-associated virus (AAV) mediated delivery of genes encoding neuromodulatory peptides or potassium channels is under investigation in animal models.
• AI and deep-learning techniques being used to predict seizure freedom outcomes and identify subtle brain lesions.

C) Global and Indian Context

In India, the burden of epilepsy remains significant (with issues of access, stigma, delayed diagnosis). According to WHO, many patients in low- or middle-income countries don’t receive adequate care.

Thus, 2025 is a pivotal year for translation of research into practice, better access to diagnostics, and expanded public awareness.

Causes of Epilepsy

Epilepsy is a heterogeneous condition: many different causes and risk-factors may lead to it. In many cases, no clear cause is found.

Major categories of causes include:

• Genetic factors: many forms of epilepsy have a hereditary component or are due to gene-mutations affecting ion-channels, synaptic signalling etc.
• Structural brain lesions: brain injury (trauma), stroke, brain infections (meningitis, encephalitis), brain tumours, malformations.
• Metabolic or biochemical causes: e.g., severe electrolyte imbalance, hypoglycaemia, uremia.
• Developmental causes: especially in children, abnormal brain development may play a role.
• Unknown (“idiopathic”): In many adults, no specific cause may be identified, yet epilepsy still occurs.

Symptoms & Seizure Types

Symptoms

Symptoms depend on where in the brain the abnormal electrical activity arises, and how far it spreads.

Some common manifestations:

• Brief confusion, staring spells (especially in absence seizures)
• Jerking of arms or legs (myoclonic movements), stiffening of body (tonic), convulsions (tonic-clonic)
• Loss of consciousness or awareness, unusual behaviour, sudden fear, déjà vu, odd smell or taste (aura)
• Post-ictal (after a seizure) confusion, drowsiness, headache.

Types of Seizures (in brief)

According to the new classification (2025):

• Focal seizures: begin in one hemisphere or region of the brain.
• Generalised seizures: involve both hemispheres from the start.
• Unknown onset seizures: when the onset cannot be clearly determined.
• Unclassified: when the seizure doesn’t fit the other categories.

The ILAE’s refined system helps clinicians better tailor diagnosis and treatment.

Diagnosis: What to Expect

When someone is suspected of epilepsy, the diagnostic work-up may include:

• 1. Clinical history - detailed description of the events, any triggers or preceding aura, frequency, duration, recovery.
• 2. Witness account or video - in many cases, the person having the seizure may not remember, so eye-witness or recorded video (by family) is helpful.
• 3. Electroencephalography (EEG) - to look for abnormal electrical brain activity.
• 4. Neuroimaging (MRI/CT) - to identify structural lesions, malformations, tumours etc.
• 5. Additional tests - labs (metabolic causes), possibly genetics (especially in children), neuropsychology.

Early & accurate diagnosis is crucial because timely treatment improves outcomes.

Management & Treatment in 2025

A) Medications (Anti-Seizure Drugs)

Most patients will be offered anti-seizure (antiepileptic) medications tailored to their seizure type, age, comorbidities and underlying cause.

With optimal treatment, up to ~70 % of people with epilepsy may be able to achieve seizure control.

Factors influencing choice of drug: side-effect profile, drug-interactions, fertility/pregnancy issues (very relevant for female patients of child-bearing age in India/Delhi).

B) Non-Medication Approaches

• Surgery: For selected focal epilepsies (especially drug-resistant cases), surgical removal of the seizure-focus may be an option. Recent imaging advances improve lesion detection.
• Neuromodulation: Devices such as vagus nerve stimulation (VNS), deep-brain stimulation or responsive neurostimulation may be considered in certain cases.
• Dietary therapy: In children especially, ketogenic diet or modified diets may help in drug-resistant epilepsy.
• Lifestyle & trigger-management: Sleep hygiene, avoidance of known triggers (e.g., alcohol, flashing lights for some patients), stress-management.
• Emerging therapies: As noted earlier, gene/cell therapies are under research; the promise of causal treatments is becoming more tangible in 2025.

C) Special Considerations in India

• Given limited access in some areas, early referral to a neurologist and timely imaging/EEG are key.
• Addressing stigma and educating patients/families about adherence to medication are important.
• Pregnancy, women’s health, comorbidities (e.g., diabetes, hypertension) need tailored care in metropolitan settings.
• At Neotia Getwel Multispecialty Hospital, specialists in neurology, neuroimaging, and epilepsy units can provide comprehensive care.

Living with Epilepsy: Practical Guidance

• Seizure diary: Record seizure frequency, duration, triggers, post-ictal symptoms.
• Medication adherence: Skipping doses is a major cause of breakthrough seizures.
• Safety planning: For example, avoid unsupervised swimming, use caution with heights or driving (depending on local regulations).
• Psychosocial support: People with epilepsy may face anxiety, depression, stigma or work/school challenges. Open communication and support groups help.
• Pregnancy & family planning: Women with epilepsy should consult neurologist and obstetrician simultaneously; some medications may affect foetus or maternal health.
• Emergency plan: Know what to do if a seizure lasts more than 5 minutes, or has repeated convulsions (status epilepticus).

When to Seek Urgent Help

You should seek urgent medical attention if:

• It’s your first seizure (especially with no known cause)
• A seizure lasts more than 5 minutes (risk of status epilepticus)
• Two seizures occur back-to-back without recovery in between
• There is injury, breathing trouble, prolonged confusion, or fevers/infection involved
• A person with epilepsy has a sudden change in seizure pattern, increased frequency, or new type of seizure

Conclusion

Epilepsy in 2025 is a field in transition - while many patients already benefit from effective treatments, new horizons in imaging, genetics, neuromodulation, AI and personalised medicine are rapidly reshaping what is possible. For patients and families, the key remains early diagnosis, adherence to treatment, lifestyle management and working closely with the care-team.

At Neotia Getwel Multispecialty Hospital (NGMH), our goal is to partner with you - focusing on the person behind the diagnosis, rather than simply the seizure label. With the advances of today and a clear pathway forward, many people with epilepsy can look forward to better outcomes, improved quality of life and hope for the future.

Disclaimer

This blog post is intended for general informational purposes only and does not replace professional medical advice. It should not be used for diagnosing or treating epilepsy or any other medical condition. Always consult a qualified healthcare professional for diagnosis and personalised treatment. The content herein does not constitute a guarantee of outcomes or specific results.