Inside One Of The World’s Busiest Epilepsy Clinics - Delivering Care At Scale - Prof. Mamta Singh, All India Institute of Medical Sciences (AIIMS), New Delhi
Dr. Mamta Singh shares what high-volume epilepsy care really looks like in New Delhi - from specialist epilepsy clinics to outreach services across rural regions. We discuss why seizure freedom doesn't automatically equate to good quality of life, how experienced clinicians detect mental health and functional symptoms through observation and communication, cultural aspects, and why listening carefully to patients can sometimes be just as important as EEGs, MRIs, and other investigations.
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Episode Highlights
What epilepsy care looks like in clinics seeing 60 people
Why seizure freedom doesn’t automatically equate to good quality of life
How clinicians detect mental health and functional symptoms through observation
The realities of access to EEGs, MRIs, and surgery across urban and rural India
About Mamta
Prof. Mamta Bhushan Singh is an epileptologist based at AIIMS New Delhi, with extensive experience delivering high-volume epilepsy care across both specialist urban services and outreach clinics in rural India. Her work focuses on epilepsy diagnosis, quality of life, mental health, and improving access to epilepsy care across diverse populations.
Full profile: Mamta-Singh
Topics mentioned
epilepsy care
seizure freedom
quality of life
mental health
functional seizures
eeg
mri
epilepsy surgery
culture
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Could you use the text highlighted in blue for the trailer, please? It starts in the 07:54 paragraph. Thanks!
Trailer
00:00 Mamta Bhushan Singh
So if a patient, for example, is actually describing their seizures; the look on their face, the emotion in their voice, will tell… not just me, I think most doctors who are dealing with epilepsy, “Is this a genuine epileptic seizure or is it likely to be a functional dissociative seizure?”. So, I would, I think, credit observation, and kind of wanting to know everything about the patient, you know? And in some way, I feel patients also reciprocate this sense if a doctor really wants to know about them. If they get that vibe, they pour their heart out to you.
Torie Robinson
Yeah, I agree.
Mamta Bhushan Singh
It’s very often a resident comes to me with a patient and they tell me something and I feel something’s amiss, and the moment I ask the patient the patient will immediately spill the beans and the missing pieces there. And that’s not because a resident wasn’t trying to get a history but probably they were getting it a little mechanically and just checking boxes.
Intro
00:59 Torie Robinson
Welcome to Epilepsy Sparks Insights! I’m your host, Torie Robinson, and today I’m joined by Prof. Mamta Singh who is going to be sharing with us what high-volume epilepsy care really looks like in India (which has a population of almost 1.5 billion people!). From seeing dozens of patients in a single day, to the importance of communication, observation, and making people with an epilepsy feel genuinely heard.
We also talk about access to EEGs, MRIs, surgery pathways, and outreach epilepsy services across rural regions of India, alongside why listening carefully to people can sometimes be just as important as investigations themselves.
If you’re new here, please subscribe so you don’t miss future conversations - and let’s get into today’s episode!
Seizures, non-seizure outcomes, and quality of life
01:42 Torie Robinson
So Mumta, tell us about what it's like in Delhi, in India; because you have high volume epilepsy services. You've told me about this. Now, often clinicians often worry that scale comes at the cost of quality. And from your experience and drawing on data from your own work (‘cause I know you have like so many publications), what does excellent epilepsy care actually look like at scale?
02:08 Mamta Bhushan Singh
You know, the numbers in clinics, not just mine, but probably all my colleagues in India, we have very large volume clinics. And while we know that in epilepsy, the main thing that one gets focused, remains focused at is the seizure outcomes. All of us who work in epilepsy and who also have, you know, have been researching epilepsy, we know that it's the non-seizure outcomes which actually contribute to the quality of life. So, a patient can be seizure free and yet all may not be well with them. So, if it's a busy clinic, you do worry if you have missed things in a patient. And also, I think in India, lot of patients are relatively reticent - especially about their mental health issues. They may not very openly complain that they were feeling anxious or have a low mood, so those are specific things that one has to look out for. In a busy clinic you may not have the time to use a screening tool but I think with experience, you do just from the way the patient is carrying themselves and the way they're talking to you, you do get a sense of if things may not be all right. And then you can enquire and ascertain if, you know, there may be something which the patient is harbouring in addition to epilepsy. That's one thing. And then, you know, you have these of late, you have these checklists which are very handy tools for busy clinics. And we've kind of devised something for our own clinic; I have a student who’s currently working on that to validate that checklist. So we do not want to miss, for example, drug-related side effects, sleep issues, sexual health. Sexual health is again something that Indian patients may not be very open about. Especially as a woman I know that my male patients may not really walk up to me and talk about something which may be really bothering them but because of the reluctance to speak to a woman about their sexual health. So, I think just being a little more… looking out for stuff, using a checklist, these may definitely improve quality in the care that we are providing and hopefully, in spite of the volumes being quite large, we do hopefully manage to give our patients good care, which would be acceptable probably anywhere in the world.
60 patients a day
05:16 Torie Robinson
Numbers wise, how many people may you see a day on average?
05:19 Mamta Bhushan Singh
At the teaching hospital clinic that I work in New Delhi, I would see close to 12 to 15 new patients and there would be about 40 to 50 or about 55-60 follow-up patients.
05:41 Torie Robinson
Wow.
05:41 Mamta Bhushan Singh
So… but then I do have a resident, you know, neurology resident who are trainees who are learning neurology; one of them would be with me and I generally have the resident go through the follow-up patients and I look at the new patients myself because I want to get a sense of the new patients upfront before we make any mistakes, establish if they do have epilepsy and what kind of epilepsy and what… plan some kind of a treatment management plan for them upfront. So I do the new patients entirely myself but in the follow-up because the resident is sitting just close by in the same room so I do have one year over there trying to listen and pick up anything which requires my attention and I can just hop in, but between us we might take… we start clinics at around eight the morning and generally try and finish by four to five sometimes it gets a bit later so it's a long clinic and we're very used to doing that but so we get it done.
06:54 Torie Robinson
That is full on. It's really good to get that insight that I think most people in high income countries have… or in the West, have no idea of this. For me personally, that's rather motivating.
Importance of documentation
07:06 Mamta Bhushan Singh
Maybe, you know, a lot of time has to be spent in the documentation. So, we do maintain patient files in our clinic because especially for chronic conditions, you know, the records are so important, so, the next time the patient comes, one needs to know what whatever was discussed in the previous visit, what were the issues with needed attention and which we have flagged for further, you know, for any further action. So, but I think our record keeping still is not so obsessive. It's very much kind of need-based. So, I mean…
07:42 Torie Robinson
Right.
07:42 Mamta Bhushan Singh
…I might note that this patient, for example, is putting on weight - so that I remember to see, you know, and I might help them make a plan as to how, you know, what they can do going forward. And I need to remember that because the next time when the patient comes, you can imagine, you know, with so many patients, it's very easy to forget what was the issue for this particular patient. Or if somebody, for example is planning a pregnancy and, you know, there's a…So the important things are going to be noted in the file so that… and even if I don't happen to be there in a particular clinic for some reason, if those issues are flagged. So the documentation and the case notes, I think that's very important for busy clinics.
Intuition and non-verbal communication
08:25 Torie Robinson
Clinician intuition. You have this in spades, but I think some people would be like “What does that even mean? That sounds quite vague.”, but I imagine it's kind of crucial given the number of people you see. But what is “clinician intuition” and how can you pick up on things not just like seizures, but as you've mentioned, people's mental health, if they want to have children, their weight, their physical health as a whole; how does your intuition work with that? And how does it work when you've got so little time?
08:52 Mamta Bhushan Singh
Of course, one can't entirely rely only on intuition, but there's a lot of non-verbal communication. So, you know, the way people walk into your clinic, looking confident or looking anxious, looking sad, for example. So, it's not I wouldn't entirely label it as “intuition”, but I would label it as good or keen observation, you know? If a child, for example, or a young person is being brought in or is accompanied by a parent, you can, in a moment, sense if there's any tension between the two when the child/the younger patient is trying to tell you something that the parent is trying to, you know, that it not be spoken about so things like that. If a woman for example is accompanied by her husband or a mother-in-law or a father-in-law, and, you know, you can make out if there are issues that she is trying to resolve or at least inform you [of], but whether she's finding the freedom in this person… So some of it is intuition, but I think a lot of it is observation, and the way people talk to you, the way people describe what’s happening to them. So if a patient, for example, is actually describing their seizure; the look on their face, the emotion in their voice, will tell… not just me, I think most doctors who are dealing with epilepsy “Is this a genuine epileptic seizure or is it likely to be a functional dissociative seizure?”. So, I would, I think, credit observation, and kind of wanting to know everything about the patient, you know? And in some way, I feel patients also reciprocate this sense if a doctor really wants to know about them. If they get that vibe, they pour their heart out to you.
10:58 Torie Robinson
Yeah, I agree.
10:59 Mamta Bhushan Singh
It’s very often a resident comes to me with a patient and they tell me something and I feel something’s amiss, and the moment I ask the patient, the patient will immediately spill the beans and the missing pieces there. And that’s not because a resident wasn’t trying to get a history but probably they were getting it a little mechanically and just checking boxes, rather than really… you know so the patients are also very intuitive in that way and they know and they kind of feel that “Well this person wants to help me” and I need to tell them all the time
Access to EEGs, MRIs, and CT scans
11:59 Torie Robinson
Tell us about the access to EEGs and MRIs, and basically, data that is going to help you make these decisions. What is your access to stuff like that like?
11:41 Mamta Bhushan Singh
At AIIMS in New Delhi, where I am working, I have excellent access. I can ask for a CT scan sitting in my clinic and maybe in a couple of hours I'll have it, you know. And if an EEG is urgent, I can get it done in over the next hour and I can just go walk down to the lab and have a look at the EEG. So, I have no complaints about not having access to any kind of investigations here in New Delhi. But it's very different when I go for my outreach clinics. So, there it's almost like a dream for a patient to get any kind of a CT scan or an MRI or an EEG. It's not easy. It would entail travelling a long distance, spending money that they might not have. So, they're very different scenarios if you ask me. Because, I work in Delhi most of the time, but I also travel and work in these outreach clinics very often and I've been doing that for long enough. So, I somehow, I'm very comfortable, you know, at either place. I sometimes in outreach clinics, I do, you know, in an occasional patient who's just had one seizure, maybe the first time in their lives, three days back, and I do want to look at the scan because I am worried “What could it be, what could it be caused by?”, but that's not a very frequent occurrence. In outreach clinics, most patients generally have had epilepsy for long enough for you to know that, well, it's not a glioma or it's not, you know, something that sinister. But just because it's been there for 20 years, no glioma would be sitting there for 20 years.
13:24 Torie Robinson
Right.
13:24 Mamta Bhushan Singh
So you don't really, I don't really kind of feel shorthanded that I don't have an investigation at my beck and call all the time when I'm doing my outreach clinics. Very comfortable with managing most patients even with clinical information that I can get from the history. So that's how it is.
Complex/rare epilepsies and multidisciplinary teams
13:44 Torie Robinson
And what about people who have, for instance, a rare epilepsy? Or people who are having multiple seizures a day or have, you know, other sort of symptoms of, say, a genetic abnormality? How do you help people in those cases?
13:57 Mamta Bhushan Singh
So those are not patients that one can manage in outreach clinics. Those patients require a multidisciplinary approach, they require extensive tests, including genetics. They require very refined, tailored images sometimes, they require video-EEG records, extended video-EEG studies, where we want to record seizures to see what exactly the seizures look like. Sometimes these are surgical candidates, and all kinds of other investigations are required. So, you know, in my hospital over here, it's all available and it can be managed. But if I see a patient of this kind in a village somewhere, then I have to try and ensure that they are able to make it to New Delhi to my hospital so that they are able to get the care. Because that's… not possible to really manage these patients in outreach clinics in the community, where, you know, with very limited resources that are available over there.
Funding for those in rural areas
15:01 Torie Robinson
And how is that funded? Because the people have to come into your clinic, right? It's not a, well, I suppose they do have the choice, but as far as quality of life and potentially just life itself, they have to come in.
15:13 Mamta Bhushan Singh
So, most of the time, the least that the patient has to do or is expected to do is make the journey. So, unless, you know, sometimes when I'm working with local government health machineries; sometimes they've found assistance - at least they provide travel assistance - to these patients and once they reach our hospital in New Delhi it's almost, you know, no-cost kind of care that is available. We have a kind of government provided insurance for people of a certain economic status and if they have that, well, then just everything is free for them, even admissions, surgeries, all investigations, whatever. So, a lot of patients from outreach clinics, over the years, have managed to come to New Delhi and even get surgery and get complicated, difficult treatments, investigations, everything. Travel by train isn't that exorbitant. A lot of people can even afford it. If they find assistance for it, of course it's great. Sometimes I have funding and I'm also able to help them with travel as in when I have funding for such patients. So, all in all, it does work out for most people who need to come.
Recommendation: sit down and listen to patients
16:42 Torie Robinson
So if you have one or even two recommendations for people who are in countries such as yourself, but also those in higher income countries, say those in Europe or, you know, North America or Australasia, what would your tips be?
16:59 Mamta Bhushan Singh
Even if doctors who manage epilepsy, even if they do have a very easy access to investigations, even then, I feel epilepsy patients are going to be served far more if we can sit with them patiently and listen to them. I think you cannot overvalue the time and attention that you can give to your patient. No MRI, no PET scan, no EEG can really replace that. So, it doesn't matter where in the world you are, I think a patient would be far more grateful to you, you know, if you have had the time and the inclination to sit while you're not distracted on your mobile phone, while you're not staring at a screen, but you're looking at the patient, listening to them and letting them speak. That's what I think, strongly believe in.
18:03 Torie Robinson
I agree - as somebody who's experienced both A great clinician and what I would consider “not so great”. Listening and understanding enables you to be a better clinician when it comes to helping that person, doesn't it?
18:14 Mamta Bhushan Singh
Absolutely. So, most of the time you do have the patient tell you their diagnosis, you know; if you're willing to listen. And then of course later on the patient is thanking you but you know that the patient has told you what they had because you could not have known what you know simply because the patient has told you so. And it doesn't matter what kind of a patient it was; whether they were literate or not, whether they were rich or poor, or where they were coming from. Sometimes I may not even understand the language that they are speaking, but you know, yet, I feel that communication, and that trying to understand, and just wanting to know what exactly is happening to you; I think it is the most invaluable thing that a clinician has and I think everybody should use that as much as they can.
Closing thoughts & thanks
19:10 Torie Robinson
Massive thanks to Mamta for joining us and sharing such valuable insights into epilepsy care in India. Out chat highlighted something that can easily be overlooked in modern medicine - that even in very busy clinics, careful listening, observation, and communication remain some of the most important tools a clinician has.
It was also fascinating to hear more about the scale of epilepsy services available across India, including access to EEGs, MRIs, surgery pathways, and specialist multidisciplinary care for many people who may otherwise be assumed to have little or no access to treatment.
If you enjoyed our conversation, please share it with a friend or colleague, and hit follow or subscribe so you do not miss future episodes - and see you next time!