Eating Epilepsy: Clinico-Electro-Imaging Profiles and Treatment Outcomes in Patients from Northeast India

Abstract Eating epilepsy (EE) is a rare type of reflex epilepsy that predominantly affects South Asian populations. Its pathophysiology involves activation of the insular-opercular and perisylvian networks during eating, although the clinical spectrum and treatment outcomes remain underrecognized in certain regions. This study aimed to describe the clinico-electro-imaging profile and treatment outcomes of patients with EE at a tertiary care hospital in Assam, Northeast India. This retrospective case series identified consecutive patients with EE between 2018 and 2025. Demographic and clinical information was collected from medical records and summarized. A total of 26 patients with EE, mainly young adults (mean age, 23.9 ± 6.1 years), experienced seizure onset during adolescence, and 65.4% were male. Rice-related triggers were identified in 30.8% of patients. Interictal electroencephalogram abnormalities were identified in 88.5% of cases, whereas magnetic resonance imaging abnormalities were observed in 23.1%. All patients presented with focal epilepsy, predominantly originating from the parieto-occipital and frontotemporal regions. At follow-up, 92.3% achieved seizure freedom while receiving appropriate antiseizure medications. These findings underscore the importance of region-specific, culturally aware assessment in the management of EE.