Dr Gurneet Singh Sawhney, Director – Stereotactic and Functional
Neurosciences & Senior Consultant  Dept. of NeuroSpine Surgery, Fortis Hospital, Mulund

For many years, epilepsy management primarily focused on controlling seizures through
medication. While this approach remains a cornerstone of treatment, advances in
neurological care have transformed our understanding of epilepsy and the importance of
identifying its underlying cause. Today, the goal is not merely to reduce symptoms but to
improve long-term quality of life through accurate diagnosis and targeted treatment.

This shift is particularly relevant because not all seizures are caused by generalized
neurological disorders. In some patients, seizures may be a symptom of an underlying
structural abnormality within the brain, such as a tumour, vascular malformation,
developmental anomaly, or scar tissue. Identifying these causes early can significantly alter
treatment outcomes.

I recently treated a 39-year-old woman who had been experiencing recurrent seizures since
the age of 19. At the time of her initial diagnosis two decades ago, MRI imaging was not
routinely recommended for every patient presenting with seizures. As a result, her treatment
focused primarily on controlling episodes through anti seizure medications.

Although medication helped manage her condition to some extent, the seizures never
completely disappeared. Over the years, she learned to live with the uncertainty that
accompanies epilepsy. Like many individuals with long-standing seizure disorders, she
adapted her personal and professional life around the condition while continuing treatment.

It was only when a detailed neurological evaluation and advanced imaging were eventually
performed that the underlying cause became apparent. An MRI scan revealed a small
tumour measuring approximately two centimetres located in the outer layer of her brain.

Despite its relatively small size, the lesion was positioned in a region capable of triggering
abnormal electrical activity, making it the likely source of her seizures.

The finding highlighted an important reality in neurological care. The size of a brain tumour
does not necessarily determine its impact. Even small lesions can cause significant
symptoms when located near critical functional areas of the brain. In many cases, seizures
may be the first and sometimes the only warning sign.

The case also reflects how dramatically epilepsy management has evolved over the past two
decades. Today, neuroimaging plays a central role in evaluating patients with recurrent or
unexplained seizures. MRI technology has become more accessible, more precise, and
more capable of identifying subtle abnormalities that may have previously gone undetected.

Had the lesion been identified earlier, it is possible that the patient could have avoided years
of recurring seizures and the associated physical, emotional, and social challenges. Living
with epilepsy often extends far beyond the seizures themselves. Patients frequently
experience anxiety, restrictions on driving and travel, limitations in career choices, concerns
regarding relationships, and reduced confidence in daily activities.

For women, the implications can be even more complex. Epilepsy requires careful
management during pregnancy, as both seizures and certain medications can influence

maternal and fetal health. This patient successfully navigated major life milestones, including
marriage and childbirth, despite her underlying condition. However, her experience
underscores the importance of understanding the root cause of seizures, particularly during
critical stages of life when treatment decisions can have broader implications.

The encouraging aspect of modern neurological care is that many patients with structurally
caused epilepsy now have access to treatment options beyond medication. Depending on
the nature and location of the abnormality, surgery can sometimes eliminate or significantly
reduce seizure activity while addressing the underlying cause. Advances in neuroimaging,
surgical navigation systems, intraoperative monitoring, and minimally invasive techniques
have improved both safety and outcomes.

The broader message is clear: seizures should never be viewed as a condition to simply
endure or suppress indefinitely without understanding why they are occurring. Persistent or
recurrent seizures warrant comprehensive evaluation, including appropriate imaging studies,
to identify potentially treatable causes.

As medicine continues to advance, early diagnosis is becoming just as important as effective
treatment. For many patients, timely investigation can mean the difference between decades
of symptom management and a pathway toward lasting seizure control and a better quality
of life.