Epilepsy
Also called: seizure disorder, fits, convulsions, mirgi (Urdu)
Epilepsy is a long-term brain condition that causes repeated seizures (fits). It is common, is not contagious and is not caused by spirits. Most people can become free of seizures with the right daily medicine, taken regularly.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Epilepsy is a condition of the brain in which a person has seizures again and again. A seizure happens when brain cells suddenly send out a burst of abnormal electrical signals. Depending on the part of the brain involved, a seizure can cause a short blank stare, odd feelings or movements, or loss of consciousness with stiffening and shaking of the whole body. One single seizure that never comes back is not epilepsy.
About 50 million people in the world have epilepsy, and nearly 8 in 10 of them live in low- and middle-income countries such as Pakistan. It can start at any age, but it is most common in young children and in people over 65. In about half of people no cause is found. In others it follows a brain injury, a stroke, a brain infection, a problem around birth, or it runs in the family. Epilepsy is not contagious and is not caused by evil spirits, jinn or bad behaviour.
The good news is that up to 7 in 10 people with epilepsy could live without seizures if they get proper treatment. Treatment is mainly daily anti-seizure medicine chosen by a doctor for the type of seizure, age and sex of the person. Taking it regularly, avoiding triggers and knowing seizure first aid make life much safer.
In Pakistan
A population-based study in Pakistan found active epilepsy in about 1 in 100 people, and in the 1980s almost all rural patients were untreated; treatment is paid out of pocket and beliefs about evil spirits and jinn have been a major barrier to care. In a Peshawar hospital study most patients came from poor families and about 4 in 10 from cousin marriages.
Symptoms
- Tonic-clonic seizure (the classic 'fit'): the person loses consciousness, may fall, the body goes stiff and then jerks or shakes
- Absence seizure: a brief loss of awareness of what is going on around them, often seen as a blank stare
- Focal seizure: strange feelings such as a smell that is not there, tingling or numbness, changes in vision, or sudden fear; the person may fidget or walk about without being aware of it
- Myoclonic seizure: sudden, brief jerks of the muscles
- Tonic seizure: the muscles suddenly go stiff and the person may fall, then recovers quickly
- Atonic seizure (drop attack): the muscles suddenly go floppy and the person may fall, then recovers quickly
- A warning feeling (aura) at the start, such as tingling, a strange smell or a change in mood
- After a big seizure the person may be slow to wake up, and injuries such as a bitten tongue or bumps from falling can happen
Causes and risk factors
Causes
- Unknown in about half of people; the brain is simply more easily triggered into abnormal electrical activity
- Brain damage from problems before, during or soon after birth, or brain defects present from birth
- Severe head injury
- Stroke, brain tumours, abnormal blood vessels in the brain, and dementia in older people
- Brain infections such as meningitis, encephalitis or neurocysticercosis (tapeworm cysts in the brain)
- Genetic (inherited) epilepsy syndromes and some rare metabolic conditions present from birth
What makes it more likely
- A family history of seizures or epilepsy
- Young childhood and older age (over 65)
- A past serious head injury, stroke or brain infection
- Complications at birth
- In someone who already has epilepsy, seizures are more likely with missed doses of medicine, lack of sleep, tiredness and stress
- Drinking alcohol or using recreational drugs
- Illness, especially infections, and in some people flashing or flickering lights, periods or pregnancy
Complications
Seizures can cause injuries from falls and bites, and accidents while driving, using machines or in water. Food or saliva can go into the lungs during a seizure and cause a chest infection (aspiration pneumonia). A seizure that lasts too long, or seizures that follow one another without recovery (status epilepticus), are a medical emergency and can cause lasting brain damage. People with epilepsy have more anxiety and depression, and some have learning difficulties. The risk of early death is up to three times higher than in other people; one rare cause is sudden unexpected death in epilepsy (SUDEP), and treatment lowers this risk. Some medicines cause side effects, and some can harm an unborn baby. Stigma can limit schooling, jobs and driving licences.
When to see a doctor
- A seizure lasting more than 5 minutes, or longer than the person's usual seizures: call an ambulance at once
- Another seizure soon after the first, or 3 or more seizures in 24 hours, or the person does not recover between seizures: call an ambulance
- Trouble breathing or not waking up normally after the seizure: call an ambulance
- A first-ever seizure, even if the person seems to recover
- The person is injured, the seizure happened in water, the person is pregnant, or has diabetes and has lost consciousness
- A seizure after a long seizure-free period: see a doctor urgently
- A new rash, strong drowsiness, confusion, shaking or unsteadiness after starting an epilepsy medicine: contact your doctor
Diagnosis
Anyone who may have had a first seizure should be seen quickly by a doctor experienced in epilepsy (a neurologist, or a paediatrician for children). Diagnosis depends mostly on a careful story of what happened, so an eyewitness account or a mobile phone video of the event is very useful. The doctor also examines the nerves and does an ECG (heart tracing) because some heart problems cause blackouts that look like seizures.
An EEG (a painless recording of brain waves from the scalp) helps show the type of epilepsy, but a normal EEG does not rule epilepsy out; sometimes a sleep-deprived or longer recording is needed. An MRI brain scan is usually done to look for a cause such as a scar, tumour or old stroke; CT is used if MRI is not possible. Blood tests check sugar, salts, kidney and liver function and infection, and a lumbar puncture (spinal tap) may be done if a brain infection is suspected.
Treatment
- Learn seizure first aid (see the questions below) and agree a written care plan that says when to call an ambulance and whether rescue medicine should be given.
- Once epilepsy is confirmed, the specialist usually starts one anti-seizure medicine (monotherapy), chosen for the seizure type, age, sex and other health issues. Your doctor decides the dose.
- Take the medicine every day, exactly as advised. Never stop it suddenly or change the dose yourself, because this can bring on severe seizures.
- If seizures continue or side effects are a problem, the doctor may switch to a different medicine or add a second one. Blood levels are sometimes checked.
- Girls and women who could become pregnant should discuss medicine choice, contraception and folic acid with their specialist before pregnancy; valproate and topiramate carry serious risks for an unborn baby.
- If two or more medicines have not controlled seizures, ask for referral to a specialist epilepsy centre, where surgery, vagus nerve stimulation (a small device under the skin of the chest) or a special ketogenic diet may be considered.
- After about 2 years without seizures, the specialist may discuss slowly stopping medicine. Doses are reduced gradually over months, never all at once.
Medicines in Pakistan
Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Newer anti-seizure medicines | first choice for focal seizures, and for generalised tonic-clonic seizures in girls and women who may become pregnant; levetiracetam is also a first choice for myoclonic seizures in this group, and both are later options for absence seizures | Lamotrigine = (89 brands), Levetiracetam (426 brands) |
| Valproate medicines | first choice for generalised tonic-clonic and myoclonic seizures, and also used for absence seizures, in boys, men and women who cannot have children; must not be used in girls and women who could become pregnant unless other medicines have failed and a pregnancy prevention plan is in place; men taking it are advised to use effective contraception | Sodium valproate (42 brands), Valproic acid (28 brands), Divalproex sodium (66 brands) |
| Older anti-seizure medicines | carbamazepine is a second-line choice for focal seizures; it can make absence seizures worse, can weaken hormonal contraception, and carries a higher risk of serious skin reactions in people of some ethnic backgrounds | Carbamazepine (66 brands) |
Also used (not yet in our price list): ethosuximide (first choice for absence seizures), oxcarbazepine and zonisamide (second-line choices for focal seizures), lacosamide (third-line choice for focal seizures), phenytoin and phenobarbital (older medicines that can make absence seizures worse; phenytoin can also weaken hormonal contraception), topiramate (should not be used in pregnancy unless there is no other suitable option), emergency rescue medicine for long seizures, given by a trained family member or carer as set out in the care plan, folic acid for women with epilepsy who are planning a pregnancy, vitamin D and calcium, which may be considered with long-term use of some anti-seizure medicines
Self-care and prevention
Self-care
- Take your medicine every day as prescribed; set a reminder so you do not miss doses
- Keep a seizure diary of dates, what happened and possible triggers such as tiredness, stress, periods, flashing lights or certain foods and drinks
- Avoid lack of sleep, and avoid alcohol and recreational drugs
- Make your home safer: use a shower rather than a bath where you can, use covers on heaters, and consider an alarm to call for help
- Do not swim alone, and take care with cooking, climbing, tools and machinery
- Do not drive while seizures are not controlled; follow your doctor's advice and the law
- Wear a medical alert bracelet or carry a card, and teach family, teachers and co-workers seizure first aid
- Tell your doctor about low mood or anxiety, which are common with epilepsy
Prevention
- Good care in pregnancy and around birth lowers the risk of brain injury in newborns
- Prevent head injuries, for example from road accidents and falls
- Reduce stroke risk factors such as high blood pressure
- Control infections that can damage the brain, such as neurocysticercosis
- Control fever in young children
- For people who already have epilepsy, regular medicine and avoiding personal triggers prevent most seizures
Common questions
What should I do if someone is having a seizure?
Stay calm and ease them to the ground. Clear the space around them, put something soft under the head, remove glasses and loosen anything tight around the neck. Turn them gently onto one side so the airway stays clear, and time the seizure. Do not hold them down, do not put anything in their mouth, and do not give water or food until they are fully awake.
When is a seizure an emergency?
Call an ambulance if a seizure lasts more than 5 minutes or longer than usual, if another seizure follows soon after, or if the person has trouble breathing or does not wake up properly. Also call for help if it is a first seizure, the person is hurt, the seizure happened in water, or the person is pregnant or has diabetes.
Is epilepsy caused by jinn or black magic?
No. Epilepsy is a medical condition caused by abnormal electrical activity in the brain. It is not contagious and is not caused by spirits, witchcraft or bad behaviour. Delaying proper medical treatment puts the person at risk of injury and harm.
Can women with epilepsy have children?
Yes. A healthy pregnancy is possible, although seizures may become more frequent and some medicines can harm the baby, so plan ahead with the specialist. Keep taking your medicine and contact your specialist straight away if you plan a pregnancy or become pregnant. Breastfeeding is generally safe with most anti-seizure medicines.
Will I need medicine for life?
Not always. Some childhood epilepsies improve or go away by the late teens or twenties. After 2 years without seizures, your specialist may discuss slowly stopping medicine, but for many people epilepsy is lifelong and medicine keeps them seizure-free.
Sources
- NICE. Epilepsies in children, young people and adults (NICE guideline NG217) (2022).
- WHO. Epilepsy (2024).
- CDC. First Aid for Seizures | Epilepsy | CDC (2024).
- MedlinePlus. Epilepsy: MedlinePlus Medical Encyclopedia (2025).
- NHS. Epilepsy - NHS (Symptoms) (2025).
- Frontiers in Neurology. The Epidemiological Characteristics of Epilepsy in the Province of Khyber Pakhtunkhwa, Pakistan (Ullah S et al. Front Neurol 2018;9:845) (2018).
- NHS. Epilepsy - NHS (Living with) (2025).
- Epilepsy & Behavior (via ILAE). Epilepsy treatment gap and stigma reduction in Pakistan: A tested public awareness model (Mogal Z, Aziz H. Epilepsy & Behavior 2020;102:106637) (2020).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.