Epilepsy

Our brain can be compared to a computer that is built on the infinite possibility of interconnections of a large number of nerve cells, with a processing capacity of millions of bits per second. In the system where there is such an intense connection and flow of information, small flaws that occur every day are eliminated by our brain without us noticing. However, if the malfunction exceeds a certain threshold value from time to time, an unusual electrical activity occurs in the relevant region of the brain. The abnormal function (contraction, licking-swallowing movement) or the inability to perform the existing function (halting speech) in the body part represented by this region is known as an epileptic seizure in medicine and a falling sickness among the public.

Having a single seizure does not mean that a person has epilepsy, but an examination for epilepsy and a follow-up by a neurologist is essential. Conditions such as fever, metabolic disorders (low or high blood sugar, changes in blood salts), thyroid diseases, some medications, long-term sleeplessness, excessive alcohol use, or after cessation may cause seizures.

Epilepsy is a disease that affects approximately 1% of the world’s population . Epileptic seizures can occur at any age but often affect the young and old. Although genetic predisposition is known in some types of epilepsy, it is not a disease that is inherited directly from parent to child. Epilepsy is not a contagious disease.

An epileptic seizure may not only be in the form of a contraction attack. There may be different symptoms depending on the affected area of the brain. If there is a loss of consciousness, usually the seizure has spread to the whole brain. An epileptic seizure can start directly from the whole brain, or sometimes it can start and spread from a part of the brain. In this case, the symptoms at the beginning of the seizure are guiding for the determination of the seizure onset zone.  For this reason, those who witness a person having a seizure should pay attention to whether the patient has contractions in the arms or legs or repetitive movements called automatic movements before the seizure, whether the patient loses consciousness, the condition of the eyes, whether there is a forced rotation in the head, which parts of the body are contracted and in what order, and whether the person has urinary incontinence. When this information is passed to the doctor, diagnosis and treatment will be faster and more accurate.

The causes of epilepsy are very diverse. The most common causes are:

• Trauma
• Developmental disorders of brain tissue
• Genetic diseases
• Hippocampal sclerosis
• Brain tumors
• Hypoxic-ischemic brain injuries (e.g., cerebral palsy)
• Central nervous system infections (meningitis, encephalitis)
• Immune-mediated inflammations
• Stroke (after cerebral vascular occlusion or cerebral hemorrhage)

When doctors encounter a patient presenting with a seizure, they first listen to those who witnessed the seizure and the family. Recording the seizure with smartphones that have been around everyone lately helps the doctor to understand the seizure. Then the patient is examined. To understand whether there is an evident cause of the seizure, analyzes are performed, brain MRI and EEG (electroencephalography) are taken, and other tests may be requested in special cases.  As a result, the patient is informed about the cause, type, and treatment of the seizure. Started treatments often need to be used for a long time, many drugs require special follow-up. Therefore, patients should be in constant communication with their doctors. Some epileptic seizures may not be controlled by medication. In such cases, vagus nerve stimulation, ketogenic diet, or epilepsy surgery may be considered, depending on the patient.

The epileptic seizure usually ends within 1-2 minutes, but it may take up to 30 minutes for the patient to fully recover. An epileptic seizure lasting longer than 5 minutes or a succession of seizures before the patient regains consciousness is defined as Status Epilepticus. It requires urgent intervention. Patients whose seizures cannot be stopped despite the intervention are followed up in intensive care units.

If you encounter someone who is having an epileptic attack;

• First, make sure the patient is in a safe place
• Lay the patient on their side in a suitable place
• Call 112 emergency services immediately
• If there is a contraction in the jaw, a soft towel-like cloth can be squeezed between the teeth so that the patient does not bite his or her tongue
• Do not crowd around the patient so that he or she can breathe easily, remove any items such as ties and scarves from the throat
• Watch carefully what happens during the seizure so that you can inform the incoming team
• After the seizure has passed, keep the patient in the same position for a while so that he or she can recover.

What is Epilepsy?

Epilepsy is a chronic disease characterized by recurrent, unprovoked seizures. A person is diagnosed with epilepsy if they have two unprovoked seizures that were not caused by a known and reversible medical condition like alcohol withdrawal or extremely low blood sugar, or one unprovoked seizure with the likelihood of more.

The seizures in epilepsy may be related to brain damage or a family tendency, but often the cause is completely unknown. The word epilepsy indicates nothing about the cause or severity of the person’s seizures.

Many people with epilepsy have more than one type of seizure and may have other symptoms of neurological problems as well. Sometimes the findings of the EEG (electroencephalogram) test, clinical history, family history, and outlook are similar among a group of people with epilepsy. In these cases, their condition may be described as a specific epilepsy syndrome.

Although the symptoms of a seizure can affect any part of the body, the electrical events that produce the symptoms occur in the brain. The location of that event, how it spreads, how much the brain is affected, and how long it lasts have profound effects. These factors determine the character of a seizure and its effect on the individual. Having seizures and epilepsy can affect one’s safety, relationships, work, driving, and so much more. Public misperception and mistreatment of people with epilepsy are often bigger problems than actual seizures.

What Are the Symptoms of Epilepsy?

Although a variety of behaviors occur in different types of seizures, not all behavioral changes are seizures. Some symptoms may be caused by other medical problems or even by the side effects of medication.

• You cannot predict when and where the seizure may occur
• Seizures can be brief and go away
• It usually takes only a few seconds to a few minutes.
• Symptoms are similar when they appear.
• Now consider the different emotions and behaviors that may occur at the beginning, middle, or end of a seizure.
• Sometimes these symptoms can be considered a warning for a seizure or be part of the seizure itself.
• If any of these symptoms are present, start keeping track of what happens and share it with your doctor.

Some warning signs of possible seizures may include:

• Odd feelings, often indescribable
• Unusual smells, tastes, or feelings
• Unusual experiences- “out of body” sensations
• Feeling detached; body looks or feels different
• Situations or people may look unexpectedly familiar or strange
• Feeling blurred or confused
• Periods of forgetfulness or memory lapses Daytime vision problems
• Jerking movements of an arm, leg, or body Falling Tingling
• Numbness, or feeling of electricity in a part of the body
• Headaches Unexplained  confusion
• Sleepiness
• Weakness
• Losing control of urine or stool unexpectedly

Changes in Your Thoughts and Emotions:

• Fear or panic
• Negative or frightening feelings
• Pleasant feelings
• Déjàvu (feeling you’ve had that moment before)
• Jamais vu (feeling that something familiar is foreign)
• Thinking that your body feels or looks different
• Out of body sensations

Changes in Your Body:

• Feeling hot, cold, or sweaty
• Pale or flushed appearance
• Heart racing
• Dizziness or feeling lightheaded
• Nausea (feeling like you might vomit)
• Other stomach feelings (such as a rising feeling from your stomach to your throat)
• Changes in Your Senses:
• Headache or pain in the body
• Numbness, tingling, or feeling like an electric shock in a part of your body
• Unusual smells, sounds, or tastes
• Vision loss, blurred vision
• Seeing flashing lights or things that aren’t really there
• Hearing loss (inability to hear)
• Hearing different or strange sounds
• Unusual tastes or smells

What is Epilepsy Treatment?

Doctors generally begin by treating epilepsy with medication. If medications do not treat the condition, doctors may propose surgery or another type of treatment. Most people with epilepsy can become seizure-free by taking an anti-seizure medication, which is also called an anti-epileptic medication.

Others may be able to decrease the frequency and intensity of their seizures by taking a combination of medications. Many children with epilepsy who do not experience epilepsy symptoms are eventually able to stop their medication and live a seizure-free life. Many adults can stop using medications after two or more years without seizures.

Your doctor will advise you about the appropriate time to stop taking medications. Finding the right medication and dosage can be complicated. Your doctor will review any other medications you may be taking to ensure the anti-epileptic medications will not interact with them. Your doctor likely will first prescribe a single medication at a relatively low dosage and may increase the dosage gradually until your seizures are well-controlled. Anti-seizure medications may have some side effects.

Mild side effects include:

• Fatigue
• Dizziness
• Weight gain
• Loss of bone density
• Skin rashes
• Loss of coordination
• Speech problems Memory and thinking problems

More-severe but rare side effects include:

• Depression
• Suicidal thoughts and behaviors
• Severe rash
• Inflammation of certain organs, such as the liver

Inform your doctor immediately if you notice new or increased feelings of depression, suicidal thoughts, or unusual changes in your mood or behaviors. Tell your doctor if you have migraines. Doctors may prescribe one of the anti-epileptic medications that can prevent your migraines and treat epilepsy. At least half the people newly diagnosed with epilepsy will become seizure-free with their first medication.