WHAT IS EPILEPSY?
Epileptic seizure is a condition that occurs due to uncontrollable, sudden, excessive and abnormal discharges of cells in the brain. Epilepsy is popularly known as “Sara’s disease”.
In its simplified form, an epileptic seizure is due to short-term brain dysfunction. The brain is like the main command center of the human body. The harmonious work between brain cells is provided by electrical signals. The cause of the seizure can be thought of as a kind of unexpected electrical stimulus. Briefly; Epileptic seizure is a short-term and temporary condition that occurs as a result of strong and sudden electrical discharge of the brain.
Epilepsy is a disease that can be seen in every region of the world, in men and women, in all races, and in about one in 100 people. The annual rate of patients with epilepsy in the community is around 45/100000. In addition, about one in 20 people may experience a seizure once in their lifetime, and the seizure may not recur in these individuals.
In about half of the patients, no specific cause can be found. In a certain group of patients; Brain development problems during pregnancy, causes at birth, meningitis, brain infection, brain tumors, poisoning or serious head injuries can cause epileptic seizures.
Unless the cause of the seizure is a tumor or another disease, there is no progression of epilepsy, and sometimes the frequency of seizures may decrease with age.
Although epileptic seizures often seem to last for a very long time, the contractions stop within 1-3 minutes and the patients regain their normal activities before the seizure after a certain period of time.
Epilepsy is not a contagious disease. There is no reason why the person with epilepsy should not be known by others. Your close friends, relatives and neighbors, your teacher should know about your illness. When the seizures are well controlled, the epileptic person can live well, have fun, work and be an active member of the society.
A person with epilepsy can marry and have children. Planned pregnancy is recommended for women with epilepsy, so they should definitely talk to their doctor before getting pregnant. Due to the different effects of the drugs used in the treatment on the child; The appropriate drug and dose should be arranged by the doctor, based on the type and condition of seizures before pregnancy.
TYPES OF SEIZURE
Epileptic seizures can be of different types. seizures; It may occur as large (generalized, generalized tonic-clonic, Grand mal, only facial, arm or leg contractions (simple partial) or characterized by meaningless speech and behavior (complex partial)) seizures.
Complex partial seizures The difference between simple partial seizures and simple partial seizures is that the consciousness is fully open in simple partial seizures. Common symptoms; sudden fear, feeling as if something has not happened before or as if something has not happened (deja-vu, jamais-vu), feeling as if you have known someone you do not know before, unpleasant smells and tastes, recipe rising from the stomach There may be power, an unpleasant feeling (aura), turning the head, raising the arm up, bouncing, spasmodic movements in the arms and legs.
In addition, short-term (5-20 seconds), staring, unresponsive at this moment, with seizures without contraction (absence); There may also be myoclonic seizures, which occur especially in the mornings after waking up, and in the form of jumps and beats in the arms.
HOW IS EPILEPSY DIAGNOSED?
The most important point in the diagnosis of epilepsy; information about seizures. In particular, the person who sees the seizure should be listened to by the doctor. Therefore, when someone has a seizure, it is very helpful to take notes about the seizure and even take a video. The first laboratory examination tool to be applied after the general physical and neurological examination is; electroencephalography (EEG). This examination is a method in which brain waves are recorded by attaching electrodes to the scalp.
Normal EEG does not indicate absence of epilepsy, and abnormal EEG does not always mean epilepsy. Since the EEG examination is a short-term and dynamic examination, no abnormality may occur during the recording. Because; Repeated or insomnia/sleep EEG recordings can be made to aid the diagnosis. EEG is the most important test in diagnosing epilepsy. Computed tomography of the brain (CT) and magnetic resonance imaging (MRI) may be helpful in revealing events that cause epileptic seizures.
TREATMENT OF EPILEPSY
Epilepsy is a disease that can be treated with medication or surgery, and seizures can be controlled with a single drug in most patients (70-75%). The patient with epilepsy can lead an active life by using the drug. Drugs used in the treatment of epilepsy; It should be given by a specialist doctor according to the patient’s age, physical condition and seizure type. The drug, which will be used unconsciously, does not prevent seizures and may cause unwanted side effects.
If seizures do not occur consecutively for several years (2-4 years depending on the patient’s condition) with treatment, a doctor’s control may try to reduce and discontinue the drugs. However, it should be known that there is a risk of recurrence of seizures in one quarter of the patients, although it varies according to the seizure type after drug withdrawal. If the seizures do not recur, the treatment is terminated, and if they do, the treatment is started again. Discontinuation of the drug is an important issue that must be decided by the doctor monitoring the patient.
SURGICAL TREATMENT IN EPILEPSY
Epilepsy surgery is a treatment method that can be applied to patients whose seizures (fainting) cannot be controlled with drugs. The application of this treatment method dates back to a century ago, but the use of epilepsy surgery as a current treatment method has increased after the 1980s and 90s.
In some of this patient group resistant to drug therapy, surgical treatment can be applied. Epilepsy surgery can be applied to 50% of patients who are generally drug-resistant. With surgical treatment, the seizures either completely disappear or the frequency and severity of the seizures are significantly reduced. Patients who will be treated surgically are patients with “low quality of life” due to their ongoing seizures and unacceptable side effects of the high-dose drugs they use. Patients in these situations can be given the chance for surgical treatment and taken to pre-surgical examinations.
Patients who refer or are referred to a neurologist for surgical treatment do not necessarily mean that they will have surgery. Patients should first undergo a series of weeks-long pre-surgical examinations and discuss the surgical method to be applied. After that, it can be decided whether the patient is a good candidate and whether other treatment plans are made.
Before deciding on surgical treatment, the patient’s seizures should be shown to be resistant to medical treatment. For this reason, it should be ensured that at least 2-3 appropriate antiepileptic drugs are used individually and together in sufficient doses and for a period of time. These drugs need to be gradually increased until seizures are controlled or until unacceptable dose-related side effects develop. Surgical treatment can be decided earlier in patients whose seizures are due to a structural disorder such as a tumor or vascular abnormality in the brain.
There are three main types of epilepsy surgery methods. The first and preferred is the removal of the epileptic focus itself. The other is the surgical method that aims to reduce the spread, frequency and severity of seizures by cutting the ways of seizure spread. The third method is vagal nerve stimulation.
Resective surgical methods for the complete elimination of seizures are applied to patients who have partial onset seizures, that is, their seizures start from a specific focus. If the epileptic focus is on one side of the brain and in a relatively harmless place, that is, if important cognitive functions such as mobility, memory, speech and vision will not be impaired after the operation, the surgical method should be determined without delay. This decision can only be made after pre-surgical examinations. Before the surgery, it is decided whether the patient is suitable for this type of surgery as a result of the tests performed by a team of neurologist, neurosurgeon, radiology and neuropsychology, and psychiatry specialists. Epilepsy surgery should be performed in centers with this team and technical equipment.
In the majority of patients who are scheduled for surgery, surgery can be decided after the noninvasive Stage 1 examinations. These examinations constitute the patient’s seizure history, physical and neurological examinations, radiological imaging examinations, neuropsychological tests, psychiatric examination and long-term video/EEG monitoring. Monitoring is continued uninterrupted until at least 3 or more of the typical seizures are observed while the patient is lying down. The patient’s image and simultaneous EEG are recorded before and during the seizure. The patient’s medications are often reduced or completely discontinued if necessary in order to see his seizures. During sleep and wakefulness, the pre-seizure and seizure EEG changes are examined repeatedly, and the seizure onset focus or area is investigated. If all the tests are compatible with each other as a result of the stage 1 examinations and if it is taken in a single part of the brain as the seizure focus and if it does not cause a significant loss of cognitive function in the patient after the surgery, surgery is decided.
In a small group of patients, Stage 1 examinations may not be sufficient to detect the seizure focus, or if it is necessary to determine the relationship of the seizure focus with important functional areas of the brain such as language, motor and sense, further examinations called “invasive investigations” are started. Further investigations are performed only in patients whose seizures are still thought to originate from a single focus as a result of Stage 1 examinations.
The success of resective surgery depends on patient selection, epilepsy type, location of epilepsy focus, and research before surgery. The patient takes medication for 1-2 years after the operation. If seizures no longer occur, drugs are gradually reduced and discontinued.
Developed in recent years and popularly known as “battery” therapy, “vagal nerve stimulation” is also a surgical method. It is a method of stimulating a nerve called vagus on the left side of the neck continuously or when necessary. In a small operation, two cables and a stimulating device are placed on the neck nerve in the upper part of the left chest. When the patient feels that there will be a seizure, he starts the stimulation by bringing a special magnet to the stimulating device and can prevent the seizure. It is an easy but expensive method to implement. Vegal nerve stimulation is used to reduce the frequency and severity of seizures.
ISSUES TO KNOW/ATTENTION ABOUT EPILEPSY
1. Epilepsy is a disease originating from the brain that recurs in the form of short-term seizures. Seizures can be stopped with medication.
2. There is no need to care for an epileptic patient excessively, to exclude them from social life, to follow them and to show more attention than necessary.
3. The person with epilepsy should not be excessively sleepy, he should sleep at least 7-8 hours a day.
4. Drinks such as tea, coffee and cola should be consumed in moderation.
5. You should not watch television for a long time and closely (at least 3 meters) and computer should not be used too much. During these periods, the room light should be on.
6.Epileptic patients should not exert excessive effort and sports activities that require this should be avoided.
7. Alcoholic beverages should never be used as they may cause seizures and change the effects of epilepsy drugs.
8. Do not starve.
9. It should not be on the edge of high places (balcony, roof, etc.).
10. Motor vehicles should not be used until seizures are brought under control.
11. The patient with epilepsy should not be upset as much as he can, and should not worry about things that happen as soon as he can.
12. A person with epilepsy can marry and have children. If an epileptic person is going to marry, his spouse should know about his illness. Women should talk to their doctor before getting pregnant
13. It should be known that the drugs taken may not completely cure the disease. But drugs will prevent seizures or reduce their number.
14. Medicines should be used regularly and as recommended.
15. The number of seizures and the days and hours should be recorded.
16. A doctor’s control should be done at regular intervals.
17. Patients can swim in the sea, provided that they are accompanied by someone who can swim well, but they should not stay in the sea for a long time, under the sun, and should not be overly tired.
18. Epilepsy can partially affect your life, but it does not prevent you from living a normal, active life. There is nothing you can’t do, except in some professions.
19. Parents should not allow their child to see himself as sick or to use epilepsy as an excuse.
20. Epilepsy is not a disease that will prevent you from working and being successful at work. Do not forget that; Many famous and successful people in the world also have epilepsy.
WHAT TO DO AND NOT TO DO WITH A PATIENT WITH AN EPILEPTIC SEIZURE?
THINGS TO DO
Keep calm, turn the patient’s head and body to the side.
Prevent injury during the seizure (Prevent his head from hitting the ground, falling off the bed. Remove sharp and injuring objects around him).
Loosen collar and any tight clothing.
If he is acting unconsciously, prevent it with non-violent movements.
Observe what he is doing during the seizure and tell your doctor about them.
Wait for the seizure to end and stay with the patient until he or she regains consciousness.
Inform doctor if possible.
DON’Ts
Don’t panic.
Do not alarm the patient.
Ignore biting the tongue.
Do not prevent by using force, be in soothing behavior.
Do not administer artificial respiration and CPR.
Don’t try to open your mouth, don’t try to give medicine during a seizure, don’t do anything for the seizure to pass by yourself! Onion, garlic, cologne etc. Don’t smell things!
Do not do movements such as pouring cold water, slapping, giving pain, which are thought to be stimulating.
