Ambulatory EEG Monitoring in India: A Narrative Review and Roadmap for Integration into Epilepsy Care

Abstract Epilepsy is a major public health challenge in India, where nearly 10 million people are affected and access to specialized care remains limited. Routine electroencephalography (EEG), although widely available, often fails to capture infrequent or transient seizures, resulting in missed diagnoses. Ambulatory EEG (AEEG) enables prolonged recording in the patient's natural environment and can increase the likelihood of detecting epileptiform activity, particularly when hospital-based video-EEG monitoring in epilepsy monitoring units (EMUs) is not feasible. This narrative review synthesizes existing literature and expert commentary to assess the current status, challenges, and opportunities for AEEG in India. AEEG occupies a diagnostic niche between routine EEG and EMU-based video-EEG, offering portability, lower cost, and improved convenience, but with limitations including susceptibility to artifacts, reliance on patient diaries, and lack of synchronous video in many systems. In India, widespread use is constrained by shortages of neurologists and trained EEG technologists, absence of standardized certification pathways, limited infrastructure, and low patient awareness. A phased roadmap is proposed: first, strengthening foundational epilepsy care through physician training, reliable drug supply, and public awareness; second, targeted integration of AEEG via hub-and-spoke tele-EEG models supported by tertiary centers; and third, leveraging innovations such as artificial intelligence-assisted review and cloud-based storage to extend reach. While AEEG is not a standalone solution to the treatment gap, it can function as a complementary technology within a tiered, evidence-based care model, expanding diagnostic capacity and promoting more equitable epilepsy services in India.