Epilepsy is a chronic neurological disorder characterized by a persistent predisposition to generate epileptic seizures, resulting from abnormal, excessive, or synchronous neuronal activity in the brain. It is defined clinically by the occurrence of two or more unprovoked seizures or one unprovoked seizure with a high risk of recurrence. Epilepsy affects individuals of all ages and represents a significant neurological condition requiring long-term specialist care.

The clinical spectrum of epilepsy is broad and depends on the type of seizures, underlying etiology, and brain regions involved. Seizures may be focal, originating from a specific cortical area, or generalized, involving both cerebral hemispheres from onset. Clinical manifestations range from brief lapses in awareness or focal motor activity to generalized tonic–clonic seizures with loss of consciousness. The heterogeneity of seizure types necessitates precise neurological classification to guide treatment.

Accurate diagnosis of epilepsy is primarily clinical and relies on detailed history, witness accounts, and seizure semiology. Electroencephalography plays a crucial role in identifying epileptiform activity and supporting seizure classification, while neuroimaging is essential to detect structural, vascular, infectious, or neoplastic causes. In many patients, epilepsy is idiopathic, whereas in others it is secondary to brain injury, stroke, infection, developmental abnormalities, or genetic disorders.

Medical management is the cornerstone of epilepsy treatment. Antiepileptic medications aim to suppress seizure activity by modulating neuronal excitability. Drug selection is individualized based on seizure type, patient age, comorbidities, and potential adverse effects. Achieving seizure freedom with minimal side effects is the primary therapeutic goal. Long-term adherence and regular neurological follow-up are essential to optimize outcomes.

A subset of patients develops drug-resistant epilepsy, defined by failure of adequate trials of appropriate antiepileptic medications. These patients require advanced neurological evaluation and may benefit from specialized investigations, medication optimization, or referral for further interventions. Continuous reassessment is critical, as seizure patterns and treatment response may evolve over time.

Epilepsy has significant psychosocial implications, including restrictions on driving, employment challenges, stigma, and mental health comorbidities. Neurologists play an important role in patient education, counseling, and coordination of multidisciplinary support to improve quality of life.