Epilepsy in Nepal: Diagnosis, Treatment and Living with Seizures
Epilepsy affects roughly 50 million people worldwide. In Nepal, the prevalence is estimated at 7–10 per 1,000 population — meaningfully higher than the global average of approximately 6 per 1,000. This elevated rate is driven in part by specific local causes, including a parasitic brain infection tied to common dietary practices. Understanding epilepsy accurately — not through cultural myth — is the first step toward appropriate care.
What Is Epilepsy and How Is It Different From a Single Seizure?
Epilepsy is defined as a tendency to have recurrent unprovoked seizures. A single seizure does not constitute epilepsy. The current clinical definition requires either two unprovoked seizures occurring more than 24 hours apart, or one unprovoked seizure with a brain abnormality or EEG pattern that indicates a high risk (greater than 60%) of recurrence.
A seizure is a sudden, abnormal electrical discharge in the brain that disrupts normal function. It may or may not involve convulsions. Provoked seizures — occurring during fever, severe infection, very low blood sugar, or drug withdrawal — carry a lower risk of recurrence than unprovoked seizures and do not automatically lead to an epilepsy diagnosis.
This distinction matters because antiepileptic medication is not started after every single seizure. The decision to begin long-term treatment involves weighing the risk of recurrence against medication side effects and the patient’s specific circumstances.
What Are the Main Types of Seizures Seen in Nepal?
Seizures are classified as focal (starting in one part of the brain) or generalised (involving both hemispheres simultaneously from onset). The older terms “grand mal” and “absence” remain in common use and refer to specific seizure types.
A generalised tonic-clonic seizure — formerly called grand mal — is what most people picture: the patient loses consciousness, falls, the body stiffens (tonic phase), then shakes rhythmically (clonic phase), followed by a period of confusion and deep sleep. This is the type most likely to bring a patient to medical attention.
Absence seizures are brief — typically 5 to 30 seconds — episodes of staring and unresponsiveness, often mistaken for daydreaming. They are most common in children and adolescents. The child may be unaware the episode occurred. Teachers are often the first to notice a pattern.
Focal seizures originate in one brain region and may remain focal or evolve into a bilateral tonic-clonic seizure. Focal aware seizures preserve consciousness; focal impaired awareness seizures cause altered consciousness. In Nepal, focal seizures are commonly caused by structural brain lesions, including neurocysticercosis.
What Causes Epilepsy in the Nepal Context?
Neurocysticercosis (NCC) is one of the most important and preventable causes of epilepsy in Nepal. It results from ingestion of the eggs of the pork tapeworm Taenia solium — typically through contaminated food or water, or via contact with an infected pig handler. The larvae travel to the brain, forming cysts that can remain dormant for years before causing seizures. NCC is identified on brain CT or MRI and is treatable with specific antiparasitic drugs (albendazole or praziquantel) alongside anti-inflammatory medication.
Head injury is the second major preventable cause. Road traffic accidents, falls from height during agricultural work, and occupational injuries all contribute. Post-traumatic epilepsy can develop months to years after the original injury.
Birth hypoxia — oxygen deprivation at birth — remains more common in Nepal than in countries with universal skilled birth attendance. This is a significant cause of epilepsy beginning in childhood.
Idiopathic epilepsy, including genetic generalised epilepsies, occurs without an identifiable structural or metabolic cause and represents a substantial proportion of cases in younger patients.
Other causes include stroke, brain tumours, meningitis/encephalitis (bacterial, tuberculous, or viral), and metabolic conditions.
How Is Epilepsy Diagnosed at A&B International Hospital?
Diagnosis begins with a detailed clinical history — the type and duration of episodes, what the patient experiences before, during, and after, and any triggers. Witness accounts from family members are invaluable, because the patient is often unaware of what happened during a seizure.
EEG (electroencephalography) records electrical activity in the brain. It can identify abnormal patterns that support an epilepsy diagnosis, classify the seizure type, and guide medication choice. A normal EEG does not exclude epilepsy; conversely, some EEG abnormalities occur in people who never have seizures. EEG findings are interpreted alongside the clinical picture.
MRI of the brain is the preferred structural imaging test and can identify NCC, mesial temporal sclerosis, tumours, cortical dysplasia, and other lesions. CT scan is used when MRI is unavailable or as a first-line investigation in resource-limited settings.
Blood investigations check for metabolic causes: blood glucose, electrolytes, calcium, renal and liver function, and in appropriate cases, NCC serology.
What Antiepileptic Drugs Are Used and How Are They Selected?
Drug selection depends on seizure type, the underlying cause, the patient’s age and sex, other medications, and comorbidities. Sodium valproate has broad efficacy across multiple seizure types but is teratogenic and should not be used in women of childbearing age unless alternatives have been exhausted. Levetiracetam is increasingly used as a first-line agent due to its efficacy, minimal drug interactions, and availability in IV form for acute seizure management. Carbamazepine remains a standard treatment for focal epilepsy. Phenobarbitone, though older, remains in use due to cost and availability.
Most patients with epilepsy achieve seizure freedom on a single drug. Those who fail two adequate drug trials are classified as drug-resistant and require specialist review.
What Is the Correct First Aid for Someone Having a Seizure?
Do not restrain the person. Do not put anything in their mouth. Clear the area of hard or sharp objects. Place something soft under the head. Time the seizure. Turn the person onto their side (recovery position) as the convulsive phase ends, to protect the airway.
Call for emergency help if the seizure lasts longer than five minutes, if a second seizure begins without the person regaining consciousness, if the person is injured or pregnant, or if this is a first seizure.
After the seizure, the person will be confused and may be distressed. Stay with them, speak calmly, and do not offer food or drink until they are fully alert.
What Social and Practical Issues Do People With Epilepsy Face in Nepal?
Stigma around epilepsy is substantial in Nepal. It affects marriage prospects, employment, and social participation. Traditional beliefs attributing seizures to spirit possession or divine punishment still circulate in some communities and can delay medical help-seeking by months or years.
Driving is prohibited in most countries for people with uncontrolled epilepsy, and Nepal is no exception. Swimming alone and working at heights or near heavy machinery are also restricted until seizure freedom is established.
Pregnancy in a woman with epilepsy requires careful planning. Some antiepileptic drugs are teratogenic. Folate supplementation before conception and during the first trimester is essential. Uncontrolled seizures during pregnancy carry their own risks. Specialist neurological and obstetric co-management is important.
Children with epilepsy should attend school. Teachers should be trained in seizure recognition and first aid. Restrictions on school activities should be proportionate and evidence-based, not based on fear.
A&B International Hospital
Pokhara-02, Bindhyaabasini Way to Sarangkot
Phone: +977 061-412512
Website: abinthospital.com
If you or a family member has had a seizure, or has a confirmed epilepsy diagnosis requiring review, book a consultation with A&B’s neurology team. EEG and MRI are available on-site. ECHS polycards accepted for eligible ex-servicemen and their families.
