Epilepsy is a chronic (long-term) disease, also known as epilepsy. In epilepsy, sudden and uncontrolled discharges occur in neurons in the brain. As a result, involuntary contractions, sensory changes and changes in consciousness occur in the patient. Epilepsy is a disease that occurs in seizures. Between seizures, the patient is healthy. A patient who has had only one seizure in his life is not considered to have epilepsy.
What is an epileptic seizure?
Seizures, which may be accompanied by symptoms such as aggressive tremor, loss of consciousness and control, which occur as a result of changes in the electrical activities of the brain, is an important health problem in one of the earliest times of civilization.
A seizure occurs as a result of synchronous excitation in a group of nerve cells in the nervous system over a period of time. In some epileptic seizures, muscle contractions may accompany the seizure.
Although epilepsy and seizure are terms used interchangeably, they do not actually mean the same thing. The difference between an epileptic seizure and a seizure is that epilepsy is a disease that progresses with recurrent and spontaneous seizures. A single seizure history does not indicate that the person has epilepsy.
What are the causes of epilepsy?
Many different mechanisms may play a role in the development of epileptic seizures. The imbalance between resting and arousal states of nerves may be the underlying neurobiological basis of epileptic seizures.
In all cases of epilepsy, the underlying cause cannot be determined exactly. Birth traumas, head traumas due to previous accidents, difficult birth history, vascular abnormalities seen in brain vessels at advanced ages, high fever diseases, excessive decrease in blood sugar, alcohol withdrawal, intracranial tumors and brain inflammations are some of the causes associated with predisposition to seizures. Epilepsy can occur in any period from infancy to advanced age.
There are many conditions that can increase a person's susceptibility to developing epileptic seizures:
- Age
Epilepsy disease can be seen in any age group, but the most frequently diagnosed age groups of this disease are individuals in early childhood and after 55 years of age.
- Brain Infections
There is an increased risk of developing epilepsy in diseases with inflammation such as meningitis (inflammation of the meninges) and encephalitis (inflammation of the brain tissue).
- Childhood Seizures
Seizures not associated with epilepsy may occur in some young children. Seizures, which occur especially in diseases with high fever, usually disappear with the growth of the child. In some children, these seizures may end with the development of epilepsy.
- Dementia
There may be a predisposition to the development of epilepsy in diseases such as Alzheimer's disease, which is characterized by loss of cognitive functions.
- Family Story
People who have a close relative with epilepsy are considered to have an increased risk of developing the disease. There is a 5% predisposition to this disease in children whose parents have epilepsy.
- Head Traumas
Epilepsy may occur in people after head trauma such as falls and bumps. It is important to protect the head and body with the right equipment during activities such as cycling, skiing and motorcycle riding.
- Vascular Disorders
Strokes, which occur as a result of conditions such as blockage or bleeding in the blood vessels responsible for the oxygen and nutritional support of the brain, can cause brain damage. Damaged tissue in the brain may trigger seizures locally, causing the development of epilepsy in people.
What are the symptoms of epilepsy?
Some types of epilepsy can occur simultaneously or sequentially, causing many signs and symptoms to occur in people. The duration of symptoms can vary from a few seconds to 15 minutes.
Some symptoms are important because they occur before the epileptic seizure:
- Sudden intense fear and anxiety
- Nausea
- Dizziness
- Changes in vision
- Partial lack of control in the movements of the feet and hands
- feeling like you're out of the body
- Headache
Various symptoms that occur following these situations may indicate that a person has developed a seizure:
- Confusion following loss of consciousness
- uncontrolled muscle contractions
- foamy mouth
- Fall
- Occurrence of a strange taste in the mouth
- clenching of teeth
- biting the tongue
- Sudden onset of rapid eye movements
- Making strange and meaningless sounds
- Loss of control over the bowel and bladder
- sudden mood changes
What are the types of seizures?
There are many types of seizures that can be defined as an epileptic crisis. Short eye drops are called absence seizures. If a seizure occurs in only one part of the body, it is called a focal seizure. If contractions occur in the whole body while having a seizure, if the patient is leaking urine and foaming at the mouth, this is called a generalized (common) seizure.
While there is neuronal discharge in most of the brain in diffuse seizures, only one region of the brain (focal) is involved in regional seizures. In focal seizures, consciousness may be on or off. A focal seizure may become common. Focal seizures are examined in two main groups. Simple focal seizures and complex (complex) seizures make up these 2 subtypes of focal seizure.
It is important to maintain consciousness in simple focal seizures and these patients can answer questions and commands during the seizure. At the same time, people after a simple focal seizure may remember the seizure process. In complex focal seizures, there is a change in consciousness or loss of consciousness, so these individuals cannot respond appropriately to questions and commands at the time of the seizure.
Distinguishing these two focal seizures is important because people with complex focal seizures should not engage in activities such as driving or operating machinery.
A number of signs and symptoms may occur in epilepsy patients with simple focal seizures:
- Twitching or twitching of body parts such as arms and legs
- Sudden mood changes that occur for no apparent reason
- Problems with speaking and understanding spoken words
- A feeling of déjà vu or a feeling of reliving an experience over and over
- Unsettling sensations such as rising in the stomach (epigastric), rapid heartbeat
- Sensory hallucinations, flashes of light, or intense tingling sensations that occur without any stimulus to sensations such as smell, taste, or hearing
In complex focal seizures, a person's level of awareness changes and these changes in consciousness can be accompanied by many different symptoms:
- Various sensations (aura) that indicate the development of a seizure
- Blank gaze towards a fixed point
- Meaningless, purposeless and repetitive movements (automatism)
- Word repetitions, screaming, laughing and crying
- unresponsiveness
In generalized seizures, many parts of the brain are involved in the development of seizures. There are 6 different types of generalized seizures in total:
- In the tonic seizure type, there is a continuous, strong and severe contraction of the affected part of the body. Changes in muscle tone can result in stiffness of these muscles. Arm, leg and back muscles are the most frequently affected muscle groups in tonic seizure type. Consciousness changes are not seen in this seizure type.
Tonic seizures usually occur during sleep and their duration varies between 5 and 20 seconds.
- In the clonic seizure type, repetitive rhythmic contractions and relaxations may occur in the affected muscles. Neck, face and arm muscles are the most frequently affected muscle groups in this seizure type. Movements that occur during the seizure cannot be stopped voluntarily.
- Tonic-clonic seizures are also called grand mal seizures, which means major illness in French. This type of seizure tends to last 1-3 minutes, and lasting longer than 5 minutes is a medical emergency that requires intervention. Convulsions in the body, tremors, loss of control over the bowel and bladder, biting the tongue and loss of consciousness are among the symptoms that may occur during the course of this seizure type.
People who have had a tonic-clonic seizure experience an intense feeling of fatigue after the seizure and do not have any memory of the event.
- In atonic seizure, another type of generalized seizure, people experience loss of consciousness for a short time. The word atony refers to the loss of muscle tone, resulting in muscle weakness. When people start to have this type of seizure, they can suddenly fall to the ground if they are standing. The duration of these seizures is usually less than 15 seconds.
- Myoclonic seizures are a type of generalized seizure characterized by rapid and spontaneous twitching of the leg and arm muscles. This type of seizure usually tends to affect muscle groups on both sides of the body at the same time.
- In absence seizures, the person becomes unresponsive, their gaze is constantly stuck on one point, and there is a short-term loss of consciousness. It is very common especially in children aged 4-14 years and is also called petit mal seizures. Symptoms such as lip smacking, chewing, sucking, constant wiggling or washing of the hands, and subtle tremors in the eyes may occur during absence seizures, which usually tend to improve before the age of 18.
Continuation of the child's current activity as if nothing had happened after this short-term seizure has diagnostic importance for absence seizures.
There is also a form of somatosensory seizure in the form of numbness or tingling of a part of the body. In psychic seizures, a sudden feeling of fear, anger or joy can be felt. It may be accompanied by visual or auditory hallucinations.
How is epilepsy diagnosed?
In order to diagnose epilepsy, the seizure type must be well described. For this reason, people who see the seizure are needed. The disease is followed by pediatric or adult neurologists. Examinations such as EEG, MRI, computed tomography and PET may be requested to diagnose the patient. Laboratory tests, including blood analysis, may be helpful if the symptoms of epilepsy are thought to be caused by an infection.
Electroencephalography (EEG) is a very important test for the diagnosis of epilepsy. During this test, electrical activities in the brain can be recorded by means of various electrodes placed on the skull. These electrical activities are interpreted by the physician. Detection of unusual activities that are different from normal may indicate the presence of epilepsy in these individuals.
Computed tomography (CT) is a radiological examination that provides cross-sectional imaging and examination of the skull. Thanks to CT, physicians examine the brain cross-sectionally and detect cysts, tumors or bleeding areas that may cause seizures.
Magnetic resonance imaging (MRI) is another important radiological examination that provides detailed examination of the brain tissue and is useful in the diagnosis of epilepsy. With MRT, abnormalities can be detected in various parts of the brain that may lead to the development of epilepsy.
In the positron emission tomography (PET) examination, the electrical activity of the brain is examined by using a low dose of radioactive material. Following the administration of this substance through the vein, the substance is expected to pass into the brain and images are taken with the help of a device.
How is epilepsy treated?
Epilepsy is treated with drugs. Epileptic seizures can be prevented to a large extent with medication. It is very important to use epilepsy drugs regularly throughout the treatment. While there are patients who do not respond to drug treatment, there are also types of epilepsy that can pass with age, such as childhood epilepsy. There are also lifelong forms of epilepsy. Surgical treatment can be applied in patients who do not respond to drug therapy.
There are many narrow-spectrum antiepileptic drugs that prevent seizure development:
- Antiepileptic drugs with carbamazepine active ingredient may be beneficial in epileptic seizures originating from the brain region (temporal lobe) located under the temple bones. Since drugs with these active ingredients interact with many other drugs, it is important to inform physicians about the drugs used for other health conditions.
- In absence and focal seizures, drugs with the active ingredient clobazam, which is a benzodiazepine derivative, can be used. It is among the important features that these drugs, which have calming, sleep-enhancing and anxiety-relieving effects, can also be used in young children. Care should be taken as serious allergic skin reactions may occur, albeit rare, after the use of drugs with these active ingredients.
- Divalproex is a drug that acts on a neurotransmitter called gamma-aminobutyric acid (GABA) and can be used in the treatment of absence, focal, complex focal or multiple seizures. Since GABA is an inhibitory substance in the brain, these drugs may be beneficial in controlling epileptic seizures.
- Ethosuximide-based drugs can be used for the control of all absence seizures.
- Another type of drug used for the treatment of focal seizures is drugs with the active ingredient gabapentin. Care should be taken as more side effects may occur after the use of gabapentin-containing drugs compared to other antiepileptic drugs.
- Drugs containing phenobarbital, one of the oldest drugs used for the control of epileptic seizures, may be beneficial in generalized, focal and tonic-clonic seizures. Apart from its anticonvulsant (anti-seizure) effects, extreme drowsiness may develop after the use of drugs containing phenobarbital, as they also have long-term sedative effects.
- Phenytoin-based drugs are another type of drug that stabilizes the membranes of nerve cells and has been used in antiepileptic therapy for many years.
In addition to these drugs, broad-spectrum antiepileptic drugs can be used in patients who have different types of seizures together and who develop seizures as a result of excessive activation in different parts of the brain:
- Clonazepam is a long-acting benzodiazepine derivative antiepileptic drug that can be prescribed for the prevention of myoclonic and absence seizures.
- Drugs containing lamotrigine are among broad-spectrum antiepileptic drugs that can be beneficial in many types of epileptic seizures. Care should be taken as a rare but fatal skin condition called Stevens-Johnson Syndrome may occur after the use of these drugs.
- Seizures that last longer than 5 minutes or occur consecutively with little time in between are defined as status epilepticus. Drugs containing lorazepam, another benzodiazepine derivative, may be beneficial in controlling these types of seizures.
- Levetiracetam-containing drugs constitute the group of drugs used in the first-line treatment in focal, generalized, absence or many other types of seizures. Another important feature of these drugs, which can be used in all age groups, is that they cause less side effects than other drugs used for the treatment of epilepsy.
- Apart from these drugs, drugs containing valproic acid acting on GABA are also included in broad-spectrum antiepileptic drugs.
How can a person suffering from an epileptic seizure be helped?
If someone has a seizure near you, you should:
- First of all, stay calm, put the patient in a position that will not harm himself. It would be good to turn it sideways.
- Do not try to forcibly stop movements and open his jaw, stick out his tongue.
- Loosen the patient's belongings such as belts, ties, and headscarves.
- Do not try to drink water, it may suffocate.
- There is no need to resuscitate a person who has an epileptic seizure.
Epilepsy patients should pay attention to:
- Take your medicines on time.
- Keep a card on you that you have epilepsy.
- Avoid activities such as climbing trees, hanging from balconies and terraces.
- Do not swim alone.
- Do not lock the bathroom door.
- Do not stay for a long time in front of a constantly flashing light, such as a television.
- You can exercise, but be careful not to become dehydrated.
- Avoid excessive fatigue and insomnia.
- Be careful not to get a head injury.
What occupations can epilepsy patients not do?
Epilepsy patients cannot do professions such as piloting, diving, surgeon, professions that work with cutting and drilling machines, professions that require working at height, mountaineering, vehicle driving, firefighting, and police and military service that require the use of weapons. In addition, epilepsy patients should notify their workplace about their disease.