What Is Epilepsy?

The brain functions by transferring information between neurons and recipient or other effector cells through electrochemical vibrations. This transfer is made through chemical loadings and electrical vibrations. In other words, our brain is an electrochemical organ and there is an electrical activity in every individual’s brain. This electrical activity is more active in people with epilepsy. This can be pictured as an electrical bombardment. There are numerous indentations and protrusions on the upmost layer of our brain and all of those have different functions. Multiple seizures occur due to the region with excessive electrical activity and the processes for which that region is responsible and those seizures have different courses.

What Are Types of Epilepsy?

Epilepsy is roughly divided into two groups: Generalized epilepsies and focal epilepsies.

Generalized epilepsies are seizures that affect all brain regions. The most common subtype is absence epilepsies. Being frequently seen in childhood period, absence epilepsies may manifest themselves with loss of awareness for a few seconds, glassy gaze or twitches in eyelids or facial muscles. In atonic seizures, which represent another subtype, all muscles loosen suddenly and patient falls just like an empty sack. In tonic seizures –another subgroup of generalized epilepsies-, unlike the atonic seizures, all muscles contract and patient suddenly falls like toppling of a tree. Atonic and tonic epilepsies do not show any prior symptoms and the patient does not know when or how he/she will fall.

Focal epilepsies are the seizures that affect a part of the brain and they manifest some signs. The signs include an usual sense that advances upwards from stomach, feeling like experiencing a past memory again or a reasonless fear. Thanks to these signs, the patient can move to a safe place before the seizure.

Both epilepsy groups can be associated with crisis that cause contractions, which are known as generalized seizures. Sometimes, focal seizures may also turn into generalized seizures.

What Is Absence Epilepsy?

This condition is characterized with short term loss of consciousness that manifests itself with freezing and staring blankly mostly for 4 to 20 seconds. Absence epilepsy is mostly seen in childhood period while it may also develop at advanced ages. These episodes of loss of conscious manifest themselves with almost 100 or more seizures in a day in childhood absence epilepsies. Unless it is managed with medical treatment, absence epilepsy has a significant negative effect in child’s success at school. Quite successful outcomes can be achieved with treatment in this group.

What are symptoms of epilepsy?

There are many recesses and protuberances in our brain. Each one of them has a unique function. Signs and symptoms of the seizure are dictated by unique functions of the epileptic focus. For example, if the epileptic seizure is triggered by the area that controls movements of arms and legs, minor jerks are observed in the hand along with twitches in the arms. If the speech center is affected by the epilepsy, the patient cannot speak or the speech is suddenly stopped. If the epileptic seizure involves the area of brain that controls eyesight, the patient may see a light or become totally blind or reversibly blind.

Is there any treatment of epilepsy? How is epilepsy treated?

We have numerous methods for treatment of epilepsy; success rate of these treatment methods gradually increase every other year. Medication treatment starts with a single agent at low dose. If this approach stops seizures, the treatment is maintained. Success rate of monotherapy (use of only one medication) is 70 to 100 percent. It may, sometimes, be necessary to increase the dose or add another medication to the treatment. Two-agent therapy adds 10 to 15 points to the success rate relative to monotherapy. Therefore, it is possible to speculate that medication treatment is effective in 85% of patients. On the other hand, medication is not the only treatment modality for epilepsy; other options include surgical treatment and a stimulator, which is inserted into the neck and colloquially called Vagus Battery, and other stimulators inserted into brain – although they are not used in Turkey. Moreover, ketogenic diet, a dietary therapy, may also offer success.

How about stages of antiepileptic treatment?

Treatment of epilepsy starts with medications. If no seizure is observed in children for 2-3 years in response to medication treatment, dose of the medication is very slowly reduced and the treatment is gradually stopped. Treatment can be stopped in adults following three to four seizure-free years.

How Is Surgery Performed for Treatment of Epilepsy?

Surgical treatment is another method that can be considered for patients with no response to medication treatment. It is necessary to emphasize that surgical procedures are an option only for patients with focal epilepsy.

Surgical treatment is employed, if epileptic seizures cannot be eliminated, although minimum two or three medications are used as monotherapy or multi-agent therapy at sufficient dose and time.

When surgical treatment is considered, it necessary to review thin-slice MR images (Epilepsy Protocol), neuropsychological tests and Video EEG monitoring, which records at least three seizures. Based on such review, specialists decide whether the patient is a good candidate for surgical treatment or not. These tests are mostly sufficient for surgical treatment of patients.

However, if MRI points to no lesion or multiple lesions, various functional imaging technologies are used to determine which one of these lesions is epileptic. Among the most common ones are PET, ictal SPECT and interictal PET.

In the light of data derived from such technologies, electrodes are attached to scalp of the patient and a hypothesis is developed about the location of the epileptic focus. Here, the aim is to ensure that patients without any preoperative problem in speaking and movements of arms and legs do not face any problem in such activities after the surgery.

Therefore, electrode tests also evaluate speech area and movements of arms and legs. Surgery can be easily performed, if the epileptic focus is distant to such centers. However, a part of the epileptic focus is located close to the speech center in some cases, while the other part is located outside the speech center. In such cases, only the epileptic focus that is located outside the speech center is removed, while the speech center is left untouched. Thus, speech function of the patient is not damaged.

In such cases, seizures can be substantially suppressed, although they cannot be completely eliminated. The patient cannot be operated on, if the epileptic focus is located over the speech center or the motor center that controls movements of arms and legs.

How about postoperative monitoring and follow-up?

If no seizure occurs for at least 2 years after the surgery, dose of medication treatment is very carefully reduced and it is gradually stopped. Undoubtedly, it is observed that patients become more social and more active and their self confidence boosts after the surgery. Seizures may persist after the surgery in a group of patients. In such cases, dose of the medication is slightly reduced, but no significant change can be made. Other medications can be tried to inhibit seizures.

Is Herbal Treatment Possible in Epilepsy?

There is no herbal treatment for epilepsy. Although no scientific study is conducted, use of methods, which are claimed to treat epilepsy, may lead to significant hazards for the patient. On the other hand, herbal products or teas may increase severity of seizures. Therefore, it is very important for our patients to avoid alternative therapies and to seek scientific treatments.

Here, it is necessary to re-emphasize that ketogenic diet has a role in treatment of epilepsy. Effect of ketogenic diet is proven by scientific studies, which show promising results in treatment of epilepsy.

What Should We Do When We See a Person Suffering From an Epileptic Seizure?

Sometimes, preliminary signs can be observed in epileptic seizures. A patient with preliminary sign will already get a safe place and move away from dangerous areas. However, when a person suffers from a seizure without any preliminary sign, senseless activities may cause self-harm. For example, a seizure may occur while the patient is ascending/descending stairs or nearby the window or any place close to a fire. In this case, we should try to the patient move away from the area without using too much force. If the seizure is characterized with major contractions, we should carry the patient to a safer area, such as carpet and arm chair, in order to prevent falls. Thus, we may prevent a potential head trauma. After such a danger is eliminated, we may placed a soft material into any corner of the mouth, if patient’s mouth is open during the seizure. Head of the patient can be turned to right or left side and a blanket or a piece of cloth can be placed near the corner of the mouth in order to prevent tongue bite. Never use your hands to open the mouth; the patient may unconsciously bite your fingers. Do not forcefully control movements of arms and legs during a seizure. Such interventions may lead to dislocations and fractures in arms and legs. Anybody who witnesses the seizure should also measure how long it lasted. Transfer of the patient to the hospital may not be required, if the patient does not hit the head, the seizure lasts shorter than 5 minutes and it is similar to previous seizures. However, it is necessary to visit a specialist, if the seizure lasts longer than 5 minutes, the patient hit the head or fell down.  

What Should We Not Do When We See a Person Suffering From an Epileptic Seizure?

A person in an epileptic seizure is mostly made smell onion by others in order to help the person. However, this approach is useless.

If the mouth is clenched during the seizure, efforts to open the mouth may break patient’s teeth. Although this act aims to help patient not bite his/her tongue, it may convert into an activity that is harmful for the patient. Bleeding will stop after a while even if the patient bites and bleeds the tongue. In such cases, the best intervention is to turn the head to right or left if the patient has not closed the mouth and to place a soft material, such as side of a blanket or a part of trousers, into upper part of the mouth cavity.

Making efforts to prevent movements of the patient is hazardous, as it may lead to fracture(s) in legs and/or arms.

Finally, it is dangerous to make the patient eat or drink during the seizure.

Which medications should not be used by patients with epilepsy?

A patient with epilepsy should necessarily consult a patient, if any medication other than antiepileptic agents will be used. They should also notify the fact that they have epilepsy when they visit other doctors for other ailments in order to ensure that an appropriate drug is prescribed. Patients mostly use medications that prevent runny nose for very common diseases, such as flu and common cold. However, many drugs that prevent runny nose increase number of epileptic seizures. Therefore, it is necessary to avoid this group of medications. Moreover, grapefruit may trigger seizures by interacting with antiepileptic agents. Therefore, patients are recommended not to eat grapefruit.