What is Epilepsy? What are the symptoms of epilepsy?

Epilepsy is a chronic (long-term) disease, also known as epilepsy. 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 disease that causes seizures. The patient is healthy between seizures. A patient who has only one seizure in his life is not considered to have epilepsy.

There are approximately 65 million epilepsy patients in the world. Although there is currently no medication that can provide a definitive treatment for epilepsy, it is a disorder that can be kept under control with seizure-preventing strategies and medications.

What is an Epilepsy Seizure?

Seizures, which occur as a result of changes in the electrical activities of the brain and may be accompanied by symptoms such as aggressive tremors and loss of consciousness and control, are an important health problem that existed in the early days of civilization.

A seizure occurs as a result of synchronized stimulation of 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 seizures are terms used interchangeably, they do not actually mean the same thing. The difference between epileptic seizure and seizure is that epilepsy is a disease characterized by recurrent and spontaneous seizures. A single seizure history does not indicate that a 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 the resting and excitation states of the nerves may constitute the neurobiological basis underlying epileptic seizures.

The underlying cause cannot be fully determined in all cases of epilepsy. Birth traumas, head traumas due to previous accidents, a history of difficult birth, vascular abnormalities in the brain vessels in older ages, diseases with high fever, excessive low blood sugar, alcohol withdrawal, intracranial tumors and brain inflammations are some of the causes identified as being related to the tendency to have seizures. Epilepsy can occur at any time from infancy to older ages.

There are many conditions that may increase a persons susceptibility to developing epileptic seizures:

• Age

Epilepsy can be seen in any age group, but the age groups in which this disease is most commonly diagnosed are individuals in early childhood and after the age of 55.

• Brain Infections

There is an increase in the risk of developing epilepsy in diseases that progress with inflammation, such as meningitis (inflammation of the brain membranes) 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 accompanied by high fever, usually disappear as the child grows. 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 Alzheimers disease, which progresses with loss of cognitive functions.

• Family History

People who have close relatives with epilepsy are considered to have an increased risk of developing this disease. There is an approximately 5% predisposition to this disease in children whose mother or father has epilepsy.

• Head Traumas

Epilepsy may occur in people after head trauma such as falls and impacts. 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 oxygen and nutritional support of the brain, can cause brain damage. Damaged tissue in the brain can trigger seizures locally, causing people to develop epilepsy.

What are the symptoms of epilepsy?

Some types of epilepsy can occur simultaneously or sequentially, causing many signs and symptoms to appear in people. The duration of symptoms may vary from a few seconds to 15 minutes.

Some symptoms are important because they occur before an epileptic seizure:

• A sudden state of intense fear and anxiety
• Nausea
• Dizziness
• Vision-related changes
• Partial lack of control in the movements of the feet and hands
• Feeling like youre walking out of your body
• Headache

Various symptoms that occur following these situations may indicate that the person has developed a seizure:

• Confusion following loss of consciousness
• Uncontrolled muscle contractions
• Foam coming from the mouth
• Fall
• A strange taste in the mouth
• Tooth clenching
• Biting the tongue
• Sudden onset rapid eye movements
• Making strange and meaningless sounds
• Loss of control over bowel and bladder
• Sudden mood changes

What are the Types of Seizures?

There are many types of seizures that can be defined as epileptic seizures. Brief eye movements are called absence seizures. If a seizure occurs in only one part of the body, it is called a focal seizure. If contractions occur throughout the body during a seizure, the patient loses urine and foams at the mouth, this is called a generalized seizure.

In generalized seizures, there is neuronal discharge in most of the brain, whereas in regional seizures, only one region of the brain (focal) is involved in the event. In focal seizures, consciousness may be on or off. Seizures that begin focally may become widespread. Focal seizures are examined in two main groups. Simple focal seizures and complex (complex) seizures constitute these 2 subtypes of focal seizure.

It is important to maintain consciousness in simple focal seizures and these patients can respond to 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 change in consciousness or loss of consciousness, so these people cannot respond appropriately to questions and commands during the seizure.

Differentiating these two focal seizures is important because people with complex focal seizures should not engage in activities such as driving or operating heavy machinery.

Some signs and symptoms may occur in epilepsy patients experiencing simple focal seizures:

• Twitching or twitching in body parts such as arms and legs
• Sudden mood changes that occur without any reason
• Problems in speaking and understanding what is spoken
• A feeling of deja vu, or the feeling of reliving an experience over and over again
• Uneasy feelings such as rising in the stomach (epigastric) and rapid heartbeat
• Sensory hallucinations, flashes of light, or intense tingling sensations that occur without any stimulus in sensations such as smell, taste, or hearing

In complex focal seizures, a change occurs in the persons level of awareness, and these changes in consciousness may 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, laughter and crying
• Unresponsiveness

In generalized seizures, many parts of the brain play a role in seizure development. There are a total of 6 different types of generalized seizures:

• In the tonic type of seizure, there is continuous, strong and severe contraction in the affected part of the body. Changes in muscle tone can result in stiffness of these muscles. Arm, leg and back muscles are the muscle groups most commonly affected in tonic seizure type. Changes in consciousness are not observed in this type of seizure.

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 type of seizure. Movements that occur during a 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 between 1-3 minutes, and if it lasts longer than 5 minutes, it is one of the medical emergencies that require intervention. Body spasms, tremors, loss of control over the bowels and bladder, tongue biting and loss of consciousness are among the symptoms that may occur during the course of this type of seizure.

People who have tonic-clonic seizures feel intense fatigue after the seizure and do not have any memory of the moment the event occurred.

• In atonic seizure, which is 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 having this type of seizure, they may 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 in the leg and arm muscles. This type of seizure usually tends to affect muscle groups on both sides of the body simultaneously.

• In absence seizures, the person becomes unresponsive and their gaze is constantly fixed on one point, and a short-term loss of consciousness occurs. It is especially common in children between the ages of 4-14 and is also called petit mal seizures. During absence seizures, which generally tend to improve before the age of 18, symptoms such as lip smacking, chewing, sucking, constantly moving or washing hands, and subtle tremors in the eyes may occur.

The fact that the child continues his/her 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 which there is numbness or tingling of a part of the body. In psychic seizures, sudden feelings of fear, anger or joy may be felt. It may be accompanied by visual or auditory hallucinations.

How to Diagnose Epilepsy?

To diagnose epilepsy, the seizure pattern must be well described. Therefore, 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 tests, may be helpful if epilepsy symptoms are thought to be caused by an infection.

Electroencephalography (EEG) is a very important examination for the diagnosis of epilepsy. During this test, electrical activities occurring in the brain can be recorded thanks to various electrodes placed on the skull. These electrical activities are interpreted by the physician. Detection of unusual activities that differ from normal may indicate the presence of epilepsy in these people.

Computerized tomography (CT) is a radiological examination that allows 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 allows detailed examination of brain tissue and is useful in the diagnosis of epilepsy. With MRI, abnormalities that may cause the development of epilepsy can be detected in various parts of the brain.

In positron emission tomography (PET) examination, the electrical activity of the brain is examined using low doses of radioactive material. Following the administration of this substance through the vein, the substance is waited for its passage to the brain and images are taken with the help of a device.

How to Treat Epilepsy?

Epilepsy treatment is done with medications. Epilepsy seizures can be largely prevented with drug treatment. It is of great importance to use epilepsy medications regularly throughout the treatment. While there are patients who do not respond to drug treatment, there are also types of epilepsy that can resolve with age, such as childhood epilepsies. There are also life-long types of epilepsy. Surgical treatment can be applied to patients who do not respond to drug treatment.

There are many narrow-spectrum antiepileptic drugs that have the ability to prevent seizures:

• Antiepileptic drugs containing the active ingredient carbamazepine may be beneficial in epileptic seizures originating from the brain region located under the temporal bones (temporal lobe). Since drugs containing this active ingredient interact with many other drugs, it is important to inform physicians about the drugs used for other health conditions.

• Medicines containing the active ingredient clobazam, a benzodiazepine derivative, can be used for absence and focal seizures. One of the important features of these drugs, which have sedative, sleep-enhancing and anti-anxiety effects, is that they can also be used in young children. Care should be taken as serious allergic skin reactions, although rare, may occur after the use of drugs containing these active ingredients.

• Divalproex is a drug that acts on a neurotransmitter called gamma-aminobutyric acid (GABA) and can be used to treat absence, focal, complex focal or multiple seizures. Since GABA is a substance that has an inhibitory effect on the brain, these drugs may be beneficial in controlling epileptic seizures.

• Medicines containing the active ingredient ethosuximide can be used to control all absence seizures.

• Another type of medication used for the treatment of focal seizures is medication containing the active ingredient gabapentin. Caution should be exercised as more side effects may occur after the use of drugs containing gabapentin than other antiepileptic drugs.

• Medicines containing phenobarbital, one of the oldest drugs used to control epileptic seizures, can be beneficial in generalized, focal and tonic-clonic seizures. Extreme dizziness may occur after the use of medications containing phenobarbital, as it has long-term sedative effects in addition to its anticonvulsant (seizure-preventing) effects.

• Drugs containing the active ingredient phenytoin are another type of drug that stabilizes the membranes of nerve cells and has been used in antiepileptic treatment for many years.

Apart from these drugs, broader spectrum antiepileptic drugs can be used in patients who experience different types of seizures together and who develop seizures as a result of excessive activation in different parts of the brain:

• Clonazepam is a bezodiazepine derivative antiepileptic drug that acts for a long time and can be prescribed to prevent myoclonic and absence seizures.
• Medicines containing the active ingredient Lamotrigine are among the broad-spectrum antiepileptic drugs that can be beneficial in many types of epileptic seizures. Caution should be exercised as a rare but fatal skin condition called Stevens-Johnson Syndrome may occur after the use of these drugs.

• Seizures that last for more than 5 minutes or occur consecutively without much time in between are defined as status epilepticus. Medicines containing lorazepam, another active ingredient derived from benzodiazepines, may be beneficial in controlling this type of seizures.

• Medicines containing levetiracetam 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 the treatment of epilepsy.

• Apart from these drugs, drugs containing valproic acid, which acts on GABA, are also among the broad spectrum antiepileptic drugs.

How Can a Person Having an Epilepsy Seizure Be Helped?

If someone has a seizure near you, you should:

• First, stay calm and place the patient in a position that will not harm himself. It would be better to turn it sideways.
• Do not try to forcefully stop the movements and open his jaw or stick out his tongue.
• Loosen the patients belongings such as belts, ties and headscarves.
• Do not try to make him drink water, he may drown.
• There is no need to resuscitate a person having an epileptic seizure.

Things epilepsy patients should pay attention to:

• Take your medications on time.
• Keep a card stating that you have epilepsy.
• Avoid activities such as climbing trees or hanging from balconies and terraces.
• Dont swim alone.
• Do not lock the bathroom door.
• Do not stay in front of a constantly flashing light, such as a television, for a long time.
• You can exercise, but be careful not to become dehydrated.
• Avoid excessive fatigue and insomnia.
• Be careful not to get a head blow.

What Professions Cant Epilepsy Patients Do?

Epilepsy patients cannot work in professions such as piloting, diving, surgery, working with cutting and drilling machines, professions that require working at heights, mountaineering, vehicle driving, firefighting, and police and military service that require the use of weapons. In addition, epilepsy patients must inform their workplaces about their disease-related condition.