What Is Epilepsy?

Epilepsy, a predisposition to unprovoked seizures, is not a single condition but is a symptom of underlying neurological or somatic ailments, which may result in seizures. The guidelines for diagnosis, apart from the need to confirm the unprovoked nature of the seizure, emphasise frequency, recurrence risk, and the presence of specific syndromes. Globally affecting over 70 million people, predominantly in low and middle-income countries, epilepsy imposes a significant burden, including comorbidities, highlighting the need for comprehensive care beyond seizure control. Diagnosis relies on history, recurrence risk assessment, and syndrome identification, with ‘resolved epilepsy’ recognised after prolonged seizure freedom off-medication. Diverse presentations reflect varied underlying causes, highlighting epilepsy as a symptom of broader issues. Accurate diagnosis is crucial, as several paroxysmal disorders, including syncope, cardiac arrhythmias, migraine, sleep disorders, and functional seizures, can mimic epilepsy. Distinguishing these and also provoked or acute symptomatic seizures necessitates thorough clinical evaluation and investigations to ensure appropriate management.