Epilepsy is a chronic (long-term) disease known as epilepsy among people. In epilepsy, sudden and uncontrolled discharges occur in the neurons in the brain. As a result, involuntary contractions, sensory changes, and changes in consciousness occur in the patient. Epilepsy is a seizure disorder. Between the seizures, the patient is healthy. A patient who has only one seizure in his life is not considered an epilepsy patient.
There are approximately 65 million epilepsy patients in the world. Although a drug that can provide the definitive treatment of epilepsy is currently not available, it is a disease that can be controlled with strategies and drugs to prevent seizures.
What is an epileptic seizure?
Seizures, which may be accompanied by symptoms such as aggressive tremors, loss of consciousness, and control that occur due to changes in the brain’s electrical activities, are an important health problem that existed in the first times of civilization.
A seizure occurs when a group of nerve cells in the nervous system are stimulated synchronously 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 epileptic seizures and seizures is that epilepsy is a disease with recurrent and spontaneous seizures. A single history of seizures 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.
The underlying cause cannot be determined in all epilepsy cases. Birth traumas, head trauma due to previous accidents, difficult birth history, vascular abnormalities seen in the brain vessels in advanced ages, high fever diseases, excessive blood sugar, alcohol withdrawal, intracranial tumors, and brain inflammations are some of the reasons determined about the susceptibility to seizures. Epilepsy can occur in any period from infancy to older ages.
Many conditions can increase a person’s susceptibility to developing epileptic seizures:
Epilepsy disease can be seen in any age group, but the most common age groups diagnosed with 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 that 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.
There may be a predisposition to the development of epilepsy in diseases such as Alzheimer’s disease, which is accompanied by loss of cognitive functions.
- Family Story
People with epilepsy in close relatives are considered to have an increased risk of developing this disease. There is an approximately 5% susceptibility to this disease in children whose mother or father has epilepsy.
- Head Injuries
Epilepsy may occur in people after head injuries 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 Conditions
Strokes, which occur as a result of obstruction or bleeding in the blood vessels responsible for oxygen and nutrient supply in the brain, can cause brain damage. Damaged tissue in the brain may locally trigger seizures and cause the development of epilepsy in individuals.
What are the symptoms of epilepsy?
Some types of epilepsy can occur simultaneously or sequentially, causing many symptoms and signs to appear in individuals. The duration of symptoms can range from a few seconds to 15 minutes.
Some symptoms are important because they occur before the epileptic seizure:
- Sudden intense fear and anxiety
- Vision changes
- Partial loss of control in the movements of the feet and hands
- Feeling like it is outside of the body
Various symptoms that occur following these situations may indicate that the person is developing a seizure:
- Confusion following the loss of consciousness
- Uncontrolled muscle contractions
- Foam from the mouth
- A strange taste in the mouth
- Tooth clenching
- Biting of the tongue
- Sudden onset 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?
Many types of seizures can be defined as epilepsy crises. Short eye dips are called absence seizures. If only one part of the body has a seizure, it is called a focal seizure. If there are contractions in the whole body while having a seizure, if the patient is urinating and his mouth is foaming, this is called a generalized seizure.
While there is neuron discharge in most of the brain in a widespread seizure, only one part of the brain (focal) participates in regional seizures. In focal seizures, consciousness may be open or closed. A focal seizure may become common. Focal seizures are examined in 2 main groups. Simple focal seizures and complex (complex) seizures constitute these 2 subtypes of focal seizures.
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 can remember the seizure process. In complex focal seizures, there is a variability of consciousness or loss of consciousness, so these people cannot respond appropriately to the questions and commands at the time of the seizure.
The distinction between these two focal seizures is important as people with complex focal seizures should not take actions such as driving and operating machinery.
Some signs and symptoms may occur in epilepsy patients with simple focal seizures:
- Stiffness or twitching in parts of the body such as arms and legs
- Sudden mood swings that occur for no apparent reason
- Problems with speaking and understanding spoken
- A feeling of déjà vu, or a feeling of having an experience over and over
- Uncomfortable sensations such as an epigastric rise in the stomach, a rapid heartbeat
- Sensory hallucinations, light flashes, or intense tingling sensations that occur without any stimulus to feelings such as smell, taste, or hearing
In complex focal seizures, a person’s awareness level changes, and these changes in consciousness may be accompanied by many different symptoms:
- Various sensations that indicate seizure development (aura)
- Blank stare towards a fixed point
- Frivolous, purposeless, and repetitive movements (automatism)
- Repetitions of words, screaming, laughter, and crying
In generalized seizures, many parts of the brain play a role in the development of seizures. There are a total of 6 different types of generalized seizures:
- There is a constant, strong, and severe contraction in the affected part of the body in the tonic seizure type. Changes in muscle tone can result in the stiffness of these muscles. Arm, leg, and back muscles are the most frequently affected muscle groups in tonic seizure types. Changes in consciousness are not seen in this type of seizure.
Tonic seizures usually occur during sleep and their duration varies between 5 and 20 seconds.
- In clonic seizure type, repetitive rhythmical contractions and relaxations may occur in the affected muscles. Neck, face, and arm muscles constitute the most frequently affected muscle groups in this seizure type. The 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 lasts longer than 5 minutes is one of the medical emergencies that require intervention. During the course of this type of seizure, symptoms that may occur include contractions in the body, tremors, loss of control over the bowel and bladder, biting of the tongue, and loss of consciousness.
People who have tonic-clonic seizures experience an intense feeling of fatigue after the seizure and they do not have any memory of the moment the event happened.
- 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 may fall to the ground suddenly if they are standing. The duration of these seizures is usually less than 15 seconds.
- Myoclonic seizures are generalized seizures with rapid and spontaneous twitches in the leg and arm muscles. This type of seizure generally tends to affect muscle groups on both sides of the body at the same time.
- In the absence of seizures, the person becomes unresponsive and his gaze is constantly stuck at one point, and there is a short-term loss of consciousness. It is very common especially in children aged 4-14 and is also called petit mal seizures. Symptoms such as lip-smacking, chewing, sucking, constantly wiggling or washing the hands, and subtle tremors in the eyes may occur during absence seizures, which generally tend to improve before the age of 18.
The child’s continuation of his current activity as if nothing had happened after this short-term seizure is of 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?
To diagnose epilepsy, the seizure type should be well defined. For this reason, people who see the seizure are needed. The disease is followed by a child or adult neurologist. Tests such as EEG, MRI, computed tomography, and PET may be requested to diagnose the patient. Laboratory tests, including blood analysis, may be helpful if 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, the electrical activities that occur in the brain can be recorded thanks to the various electrodes placed in 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. With 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 enables detailed examination of brain tissue and is useful in the diagnosis of epilepsy. With MRI, abnormalities that can cause the development of epilepsy can be detected in various parts of the brain.
In the positron emission tomography (PET) examination, the brain’s electrical activity is examined using a low dose of radioactive material. Following the administration of this substance through vascular access, the substance is expected to pass into the brain, and images are taken with the help of a device.
How is epilepsy treated?
Epilepsy treatment is done with drugs. Epileptic seizures can be prevented to a great extent with drug therapy. Regular use of epilepsy drugs is of great importance throughout the treatment. Some patients do not respond to drug treatment and types of epilepsy that can pass with age, such as childhood epilepsies. There are also lifelong types of epilepsy. Surgical treatment can be applied in patients who do not respond to drug therapy.
Many narrow-spectrum antiepileptic drugs prevent the development of seizures:
- Antiepileptic drugs with carbamazepine active ingredients may be useful in epileptic seizures originating from the brain region (temporal lobe) located under the temporal bones. Since these active ingredient drugs interact with many other drugs, it is important to inform physicians about the drugs used for other health conditions.
- In the absence and focal seizures, drugs containing clobazam, a benzodiazepine derivative, can be used. It is one of the important features of 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 rarely, 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 a substance that acts as an inhibitor (inactivating, slowing down) in the brain, these drugs may be useful in the control of epileptic seizures.
- Drugs containing Ethosuximide active ingredients can be used for the control of all absence seizures.
- Another type of drug used for the treatment of focal seizures is drugs with active ingredients gabapentin. Care should be taken, since more side effects may occur after the use of drugs containing gabapentin 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. Due to the long-term sedative effects besides its anticonvulsant (anti-seizure) effects, excessive dizziness may develop after the use of drugs containing phenobarbital.
- Phenytoin active ingredient drugs are another type of drug that stabilizes the membranes of nerve cells and has been used in antiepileptic therapy for many years.
Apart from these drugs, a broader spectrum of antiepileptic drugs can be used in patients who have different types of seizures and who develop seizures as a result of overactivation in different parts of the brain:
- Clonazepam is a long-acting benzodiazepine-derived antiepileptic drug that can be prescribed to prevent myoclonic and absence seizures.
- Lamotrigine active ingredient drugs are among the broad spectrum antiepileptic drugs that can be useful 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 more than 5 minutes or occur sequentially with little time between them are defined as status epilepticus. Drugs containing lorazepam, another benzodiazepine derivative, can be useful in the control of such seizures.
- Levetiracetam-containing drugs constitute the drug group used in the first-line treatment of 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 fewer side effects than other drugs used for epilepsy treatment.
- Apart from these drugs, drugs containing valproic acid effective on GABA are also among broad-spectrum antiepileptic drugs.
How can we help the person having epileptic seizures?
If a person has a seizure next to you, you should:
- First of all, be calm, put the patient in a position that will not harm himself. You’d better turn it sideways.
- Do not try to stop forced 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 could suffocate.
- There is no need to resuscitate a person who has an epileptic seizure.
Epilepsy patients should pay attention to:
- Take your medication on the clock.
- Carry a card stating that you have epilepsy.
- Avoid activities such as climbing a tree, hanging from a balcony or terrace.
- Do not swim alone.
- Do not lock the bathroom door.
- Do not stay for a long time in front of a constantly shining light, such as a television.
- You can exercise, but be careful not to get dehydrated.
- Avoid extreme fatigue and insomnia.
- Be careful not to get ahead hit.
What professions cannot epilepsy patients do?
Epilepsy patients cannot perform professions such as piloting, scuba diving, surgeon, professions working with cutting and piercing machines, professions that require working at height, mountaineering, driving a car, firefighter and police and military service that require using weapons. In addition, epilepsy patients should report their condition to their workplace.
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