A new study published in Neurology, the medical journal of the American Academy of Neurology, has found a potential link between the use of GLP-1 receptor agonist drugs and a lower risk of developing epilepsy among people with type 2 diabetes.
The findings suggest that people using these glucose-lowering medications, including semaglutide, which is sold under the brand names Ozempic, Wegovy, etc., may have a modestly reduced likelihood of developing epilepsy compared with those taking other diabetes drugs.
What is Ozempic?
Ozempic is the brand name for semaglutide, a once-weekly injectable medication for adults with uncontrolled type 2 diabetes, alongside diet and exercise.
Semaglutide belongs to a class of drugs known as glucagon-like peptide-1 (GLP-1) receptor agonists, which mimic the action of the GLP-1 hormone that helps regulate blood sugar levels, appetite and digestion. In recent years, GLP-1 drugs have also gained global attention for their role in weight loss.
Considering that around 5 crore people worldwide live with epilepsy, making it one of the most common neurological disorders globally, and that up to 70 per cent of people with epilepsy could live seizure-free if properly diagnosed and treated, the findings are particularly significant. However, this study is observational and retrospective in nature.
The study also comes at a time when Ozempic has officially entered the Indian market, raising questions about whether such medications could have broader public health implications in a country that bears a significant share of both the global diabetes and epilepsy burden.
Findings of the study
The preliminary study examined whether the use of GLP-1 receptor agonists was associated with a reduced risk of developing epilepsy in people with type 2 diabetes. The findings were released on December 10, 2025, in Neurology.
Researchers analysed data from a large US health database that included adults diagnosed with type 2 diabetes. The study compared individuals who had started treatment with GLP-1 drugs with those who were prescribed a different class of glucose-lowering medications known as dipeptidyl peptidase-4 inhibitors, or DPP-4 inhibitors, also referred to as gliptins. Importantly, none of the participants had a prior diagnosis of epilepsy or seizure disorders at the start of the study.
The GLP-1 medications included in the analysis were dulaglutide, liraglutide and semaglutide. Over 4.52 lakh people were followed, with an average age of 61 years. Half of the participants were prescribed GLP-1 drugs, while the other half received DPP-4 inhibitors. Each individual was monitored for at least five years.
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Over the follow-up period, 1,670 people using GLP-1 medications developed epilepsy, which amounted to 2.35 per cent of the group. In comparison, 1,886 people taking DPP-4 inhibitors developed epilepsy, representing 2.41 per cent of that group. While the absolute difference between the two groups was small, adjusted analyses revealed a modest but statistically significant reduction in epilepsy risk among GLP-1 drug users.
After accounting for other health conditions that could influence epilepsy risk, such as age, high blood pressure and cardiovascular disease, the researchers found that people taking GLP-1 drugs were 16 per cent less likely to develop epilepsy than those using DPP-4 inhibitors.
When individual GLP-1 medications were analysed separately, semaglutide showed the strongest association with a reduced risk of epilepsy.
Commenting on the findings, study author Edy Kornelius, MD, PhD, of Chung Shan Medical University in Taichung, Taiwan, said, “Additional randomised, controlled trials that follow people over time are needed to confirm these findings, but these results are promising, since people with diabetes are at increased risk for developing epilepsy later in life.”
He added, “Epilepsy can have many physical, psychological and social consequences, and many people do not respond to the current medications, so finding ways to reduce this risk is critical.”
The researchers emphasised that the study does not prove that GLP-1 drugs prevent epilepsy, but rather highlights a potential association that merits further investigation.
“More research is needed, but these findings support the theory that GLP-1 drugs may have neurological benefits beyond controlling blood sugar. It should be noted that these findings do not imply that DPP-4 inhibitors are harmful in any way or that GLP-1 drugs are definitely beneficial for brain health,” Kornelius added.
Limitations of the study
The authors acknowledged several important limitations that should be considered when interpreting the findings. First, the study was retrospective and observational in nature, meaning it analysed existing health records rather than following participants in a controlled experimental setting. As a result, it cannot establish a causal relationship between GLP-1 drug use and reduced epilepsy risk.
Kornelius also noted that tirzepatide - a newer medication that acts as a dual GLP-1 and GIP (glucose-dependent insulinotropic polypeptide) receptor agonist, was not included in the analysis. This was because tirzepatide became available after the study period had already begun. Therefore, the findings may not apply to this newer class of drugs.
In addition, the researchers lacked data on several factors that could influence epilepsy risk, including family history of epilepsy, genetic susceptibility and alcohol consumption. These unmeasured variables may have affected the results.
Prescription patterns may also have introduced bias. Factors such as medication cost, insurance coverage, physician preference or the severity of a person’s diabetes could have influenced whether a patient was prescribed a GLP-1 drug or a DPP-4 inhibitor. Such differences between the two groups may not have been fully captured in the analysis.
Why the findings matter for India
In India, around 7.7 crore adults are living with type 2 diabetes, while nearly 2.5 crore more are prediabetic, placing them at high risk of developing the disease in the coming years. What makes the situation more concerning is that over half of those affected are unaware of their diabetic status, delaying diagnosis and increasing the risk of long-term complications.
People with diabetes are known to have a higher risk of developing neurological conditions, including epilepsy, due to factors such as vascular damage, metabolic changes and inflammation.
It is estimated that around 5 crore people worldwide live with epilepsy, making it one of the most common neurological disorders. Nearly one-sixth of this global population resides in India, translating to approximately 1 to 1.2 crore people living with epilepsy in the country.
Despite the availability of effective treatments, a significant proportion of people with epilepsy remain untreated or inadequately treated, particularly in low- and middle-income countries. Social stigma, lack of access to healthcare and delayed diagnosis continue to contribute to poor outcomes.
What experts say
Dr Rajiv Kovil, Head of Diabetology and Weight Loss Expert at Zandra Healthcare, said the findings should be interpreted with caution, as the research is retrospective and observational in nature, not proof of cause and effect. “The study analysed retrospective data and followed patients for nearly five years. Observational studies like this can provide a proof of concept, but they do not establish direct causality,” he explained.
Dr Kovil noted that while the gut–brain connection is well recognised, epilepsy has multiple contributing factors, including genetics, alcohol use and family history. “It is not correct to say that taking Ozempic will directly reduce epilepsy risk. Epilepsy has many causes,” he said.
However, he added that the biological mechanisms of GLP-1 receptor agonists could help explain the observed association. “Ozempic and semaglutide do not typically cause hypoglycaemia. Low blood sugar lowers the seizure threshold, particularly in elderly patients. By reducing glucose variability and avoiding sudden sugar drops, these drugs may indirectly lower seizure risk,” he said.
The study database included nearly 4.5 lakh patients, and according to Dr Kovil, stable blood sugar control itself may play a role in reducing seizure risk by minimising hypoglycaemic episodes.
Beyond glucose control, Dr Kovil pointed to the anti-inflammatory effects of GLP-1 drugs. “Semaglutide has shown a 57 per cent reduction in high-sensitivity CRP, a key inflammatory marker. Many benefits seen in heart, kidney and liver disease appear even before significant weight loss occurs, suggesting an anti-inflammatory effect,” he explained.
He also highlighted indirect benefits that may influence neurological health. “Weight loss can improve sleep apnea, insulin resistance and sleep quality. Sleep disruption is a known trigger for seizures, so improved sleep may further reduce seizure risk.”
Dr Kovil added that emerging evidence suggests GLP-1 drugs may have broader neurological implications. “Observational studies and randomised trials such as EVOKE and EVOKE+ have examined semaglutide in cognitive decline and Alzheimer’s disease. While primary endpoints were not statistically significant, several biomarkers linked to neurodegeneration and inflammation improved,” he said.
However, he stressed that patients should not seek off-label use based on this study alone. “We must stick to approved indications. Ozempic is approved for diabetes control and cardiovascular risk reduction in people with diabetes, and in some regions, for kidney disease and weight management,” he cautioned.
With Ozempic now officially launched in India at a more accessible price, Dr Kovil said its use could expand within approved indications. “Nearly 50 to 70 per cent of patients visiting a diabetes clinic may already qualify for GLP-1 therapy due to obesity, fatty liver disease, kidney disease or cardiovascular risk. Even if we strictly follow the labelled indications, a large number of patients stand to benefit, especially now that cost is becoming less of a barrier,” he added.
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS.
