What is Epilepsy?

What is Epilepsy?

An epileptic seizure is a clinical condition in which the normal activity of the brain is temporarily impaired as a result of abnormal electrical activity in nerve cells. Epilepsy, also known as "Falling Sickness" among people, manifests itself with epileptic seizures. When an epileptic seizure occurs, the patient experiences a temporary loss of consciousness or symptoms of different characteristics. Just because a person has one seizure does not mean they have epilepsy.

Epilepsy is a fairly common disease. The incidence of non-occurrence in society is between 0.5% and 1%, as in Türkiye and the world. There was no difference in the incidence of epilepsy disease between genders.

Epilepsy can occur at any age and at any time, not in a specific age group; however, its incidence increases up to the first 16 years of age and after 65 years of age. The most common neurological disease in children up to the age of 16 is epilepsy.

Observations of parents play an important role in diagnosis in childhood when the disease is common. Occasionally, the child may slurp their mouth, have sudden jumps and startles in their arms and legs, have a bad smell in their nose that no one can hear (for example, the smell of a burnt tire), or occasionally dive into the child's eye, or stare blankly at a place for a few seconds. Some of these behaviors are not normal and it is beneficial to consult a neurologist if they are suspected.

What are the Causes of Epilepsy?

The causes of epilepsy are very diverse and vary. Overall, the following factors are among the causes of epilepsy:

• Hippocampal sclerosis
• Brain tumors
• Hypoxic-ischemic brain injuries
• Central nervous system infections
• Immune-mediated inflammation
• Developmental disorders of brain tissue,
• Developmental disorders of brain vessels
• Hereditary diseases and genetic causes.

However, despite all the developments in the diagnosis methods of epilepsy, there are also a group of patients who do not know what the cause of the disease is, apart from the reasons mentioned above.

What is the Importance of Genetic Factors for Epilepsy Patients?

In epilepsy, there is a group that plays an important role in genetic predisposition; however, the same does not apply to every patient. Although there are a few diseases that we know which gene and which pathway it passes through today, we do not know about many of them due to complex genetic transmission.

How is Epilepsy Diagnosed?

It is very valuable to observe the seizure for the diagnosis of the disease and to transfer these observations to the physician, EEG (Electroencephalography), brain imaging (magnetic resonance MRI), and blood analyses that the neurology physician will consider necessary should be performed.

It is very important that the patient or the person witnessing an attack can accurately communicate their observations to the neurologist to determine whether an attack has epilepsy. If the attack is an epileptic seizure, the physician needs the above-mentioned examinations in order to determine the type of epilepsy and to decide which medication will be more effective. Use the applications developed by Yeditepe University Hospital on smartphones in order to help patients and their relatives to observe and transfer different types of seizures in epilepsy patients to your physician:

• Capture and record the video of the person as soon as they have a seizure
• Lose the person's seizures to the calendar in the app 
• Record information about the number, day, time, duration, and type of seizures
• Record a person in the emergency call section to call in case of an emergency

In addition, with the smartphone applications working synchronously with the epilepsy diary at "yeditepeepipelsisiz.com", the person can access their data from anywhere and share this information with their physician and benefit from it for accurate diagnosis and treatment.

Yeditepe University Hospital is one of the best centers in Türkiye for the diagnosis and treatment of epilepsy as a neurological science center.  Service is provided to patients with the most advanced diagnostic facilities for the diagnosis of epilepsy.

Epilepsy Treatment

Epilepsy is a treatable disease but may require long-term treatment and follow-up. Among people with epilepsy, there is a group of patients who are one hundred percent treatable.  However, since the causes of epilepsy are very different, it is not appropriate to give a general rate for the fully treatable patient group. The cause of epilepsy is the most important factor determining the success of treatment. There is also a group of patients with a poor course and very low treatment success due to the nature of the disease, which constitutes a group of roughly 25-30%.

Recent advances in treatment for epilepsy disease can be summarized: new drugs, new surgical methods, new devices in brain cells, and new imaging methods.

Drug Treatment

Treatment planning for epilepsy patients is primarily done with drugs; however, drugs do not cure the disease, as in diabetics or blood pressure patients, but have a suppressive effect on their symptoms. In approximately 45% to 65% of patients receiving medication, seizures can be fully controlled with a single type of medication.    

Epilepsy Surgery

People who are eligible for epilepsy surgery can be successfully treated with this method.

Pacemaker Application

Another method applied in the treatment of epilepsy is pacemaker applications to the brain. After the selection of patients suitable for pacemaker application in the Center for Neurological Sciences, pacemaker placement is performed by the Department of Neurosurgery with the appropriate operation.

What Should Epilepsy Patients Consider?

There is no obstacle for a patient whose seizures are under control to continue their normal life.  However, there is still a great prejudice against this disease in society. People with epilepsy have great difficulty in finding a job, getting married, having children, and choosing their hobbies due to this prejudice in society. These basic problems stem from the ignorance of individuals and society about epilepsy.

It is inappropriate for people with epilepsy to do certain occupations even when their seizures are under control. These professions can be summarized: pilot, surgeon, and driving on public transport. In addition, it will not be appropriate for the person to do work such as roof work, or diving where there is a risk of falling and injury. It is inappropriate to work the night shift as insomnia may trigger seizures for epileptics other than such occupations. There is no harm in doing any work other than these.

Suggestions for Patients

Recommendations for epilepsy patients can be listed as follows:

• Hunger and insomnia can be triggers for epileptic seizures,
• Febrile diseases should be treated by a specialist physician appropriately
• They should avoid the use of some drugs, the use of drugs should be limited for any reason without asking the physician.
• Anxiety and depression can be triggers for epilepsy,
• Factors such as alcohol, flickering and bright lights, and drug use negatively affect the disease by lowering the threshold of the person in epilepsy patients.

In addition, there is no specific dietary recommendation for the patients or a specific sports recommendation for them to do.

History of Epilepsy

The prevalence of epilepsy among people has caused it to be mentioned in many sources throughout history. Epilepsy was mentioned in some of the "Sakikku clay" tablets, which were composed of about forty tablets and meant "all diseases" in ancient Mesopotamia. These documents are tablet inscriptions written in New Assyrian writing in Sultantepe near Urfa in Türkiye (718-612 BC).

The other tablet is in the Babylonian collection in the British Museum1000 BC). Babylonian physicians thought that the cause of epilepsy was related to demons and ghosts. Despite this, they have worked to identify the types of seizures and have also taken the right approach to the triggering of epilepsy due to reasons such as lack of sleep and emotional problems.

Hippocrates, on the other hand, wrote his first book on epilepsy in 400 BC with the title "On the Sacred Disease". In the ancient Sumerian language, epilepsy in the sense of "falling disease" was mentioned in tablets.

During the Byzantine period, Oribasius of Pergamum (4th century AD) mentioned epilepsy in his medical texts and explained what should be done during seizures.

Two famous physicians during the Islamic period were Ibn Sina (980-1037) and Muhammad Ibn Zakariya al-Razi (865-925).  Ibn Sina approached epilepsy treatment more scientifically and in the 12th century, his book was translated into Latin and considered a masterpiece in Europe and the Middle East.