- Early seizure recognition protects young brains from damage
- Ketogenic diet, laser surgery, genetic testing offer new hope
- Timely EEG, MRI, specialist care key to preventing brain damage
Epilepsy in children is a chronic neurological condition characterised by two or more unprovoked, recurring seizures resulting from sudden, abnormal electrical activity in the brain, affecting approximately 50 million people globally and making it one of the most common neurological diseases worldwide, with the burden in India remaining high due to infections, birth-related complications, delayed diagnosis, and limited neurological services.
In an interview with Rising Kashmir’s Senior Reporter and Health Correspondent Mansoor Peer, Dr Suhail Naik, Senior Consultant and Assistant Professor in the Department of Paediatrics at GMC Srinagar, who has 50 research publications in paediatric neurology, discussed the situation and how early diagnosis changes lives.
RK: How significant is paediatric epilepsy globally and in India?
Dr Suhail: Paediatric epilepsy is one of the most common neurological disorders affecting children worldwide. Millions of children suffer from epilepsy, and in India, the burden remains particularly high because of infections, birth-related complications, delayed diagnosis, and limited neurological services in many areas.
People must understand that epilepsy is not a single disease. It is a spectrum of disorders with different causes, severity, and outcomes. Many children with epilepsy can live completely normal lives if diagnosed early and treated properly. Unfortunately, stigma, fear, and misinformation still delay treatment in many families.
RK: Is epilepsy only about violent convulsions?
Dr Suhail: The violent convulsions that most people recognise, where a child suddenly loses consciousness, becomes stiff, turns blue, and develops jerking movements, are called generalised tonic-clonic seizures. These are widely recognised in both urban and rural areas of Kashmir.
However, epilepsy can present in many other forms and patterns. This is known as seizure semiology. Some children may suddenly stop speaking and stare blankly for a few seconds. Parents often do not realise these are seizures. These episodes repeatedly disconnect the child from the surroundings and can gradually affect academic performance. Such seizures are called absence seizures and may occur even hundreds of times a day. Other children may have repeated blinking, lip smacking, sudden falls, abnormal jerks during sleep, or brief episodes of loss of awareness. Some seizures may present with purposeless laughing, crying, running, or spinning movements.
RK: Can seizures occur from birth?
Dr Suhail: Seizures can occur even before birth. There is a rare epilepsy known as pyridoxine-responsive epilepsy, which may begin while the baby is still in the mother’s womb.
In newborns, seizures are often very subtle. They may appear as abnormal eye movements, cycling movements of limbs, breathing pauses, stiffness, or unusual repetitive behaviours. These neonatal seizures usually occur as symptoms of underlying disorders such as birth asphyxia, low blood sugar, low calcium, brain infections, brain malformations, rarely genetic disorders, or metabolic diseases. Such seizures are called acute symptomatic seizures because they reflect an underlying medical problem. Recognising them early is extremely important because repeated uncontrolled seizures can affect the developing brain permanently.
RK: What are febrile convulsions? Should parents worry?
Dr Suhail: Febrile seizures are seizures associated with fever and usually occur in children between six months and six years of age. They are extremely common, affecting nearly five per cent of children, and most have an excellent outcome. The majority of children with simple febrile seizures never develop epilepsy later in life.
However, prolonged seizures, repeated episodes within a short period, or seizures affecting only one side of the body require careful medical evaluation because they may occasionally indicate an underlying neurological predisposition.
RK: What are developmental and epileptic encephalopathies?
Dr Suhail: Developmental and epileptic encephalopathies are among the most serious forms of paediatric epilepsy. Sometimes, a developmental delay caused by birth-related brain injury itself leads to severe seizures, and repeated frequent epileptic episodes can further worsen brain development. Such seizures contribute directly to developmental slowing, speech delay, behavioural problems, and cognitive impairment. Early diagnosis and aggressive treatment are extremely important because delayed intervention can permanently affect neurodevelopment and quality of life.
RK: How important is EEG in diagnosing epilepsy?
Dr Suhail: The single most important step in diagnosing epilepsy is obtaining a proper history from the person who witnessed the seizure episode.
Electroencephalography, or EEG, is one of the most important tools in epilepsy diagnosis. It records the electrical activity of the brain and helps identify abnormal epileptic discharges. However, people should understand that an EEG may be normal in more than half of children with true epilepsy. A normal EEG does not mean the child does not have epilepsy.
RK: Parents often compare EEG to ECG. What do you tell them?
Dr Suhail: A normal EEG never completely excludes epilepsy. More than 50 per cent of children with genuine epilepsy may have a completely normal EEG between seizure episodes. Clinical history, therefore, remains extremely important.
RK: What is the role of MRI in paediatric epilepsy?
Dr Suhail: A seizure may result from something as microscopic as an abnormal sodium channel in a brain neuron, or it may be the first sign of a brain tumour or another major structural abnormality. Therefore, MRI is important in children, particularly those with focal seizures, developmental delay, abnormal neurological findings, drug-resistant epilepsy, or abnormal eye and ear examination findings. MRI helps identify structural causes of epilepsy and plays a major role in deciding long-term treatment plans.
RK: What are modern advancements in paediatric epilepsy treatment?
Dr Suhail: Paediatric epilepsy care has advanced enormously in recent years. Children with difficult or refractory epilepsy are now treated using therapies such as the ketogenic diet, laser ablation techniques, immunotherapy for autoimmune epilepsies, vagus nerve stimulation, and advanced epilepsy surgery.
Modern genetic testing and gene sequencing can now identify epilepsy-related mutations. This allows doctors to choose more targeted and personalised anti-epileptic medications based on the specific genetic abnormality detected.
RK: Can you explain stereotactic minimally invasive epilepsy surgery?
Dr Suhail: Modern epilepsy surgery is no longer limited to large open brain operations. Today, stereotactic techniques allow doctors to precisely target seizure-generating areas of the brain with exceptional accuracy using advanced neuro-navigation systems. Procedures such as laser interstitial thermal therapy and minimally invasive ablative surgeries treat epileptic foci while minimising injury to surrounding healthy brain tissue. These advances have significantly improved safety and outcomes.
RK: What is your message to the public?
Dr Suhail: Epilepsy is treatable. Children with epilepsy deserve education, dignity, opportunity, emotional support, and inclusion—not discrimination or stigma.
Early diagnosis changes lives. Timely EEG, MRI, specialist evaluation, and modern therapies can dramatically improve outcomes. Families should never ignore recurrent unusual movements, staring spells, developmental regression, or prolonged febrile seizures.
The future of paediatric epilepsy care is extremely promising. With advances in neuroscience, genetics, neuroimaging, and minimally invasive surgery, we are entering an era where many children can achieve seizure freedom and live healthy, productive lives.