Epileptic seizure is a clinical condition resulting from the temporary abnormal electrical extension in brain cells .Disorders related to functions of consciousness, behavior, emotions, motions or perception are seen clinically limited to a period of time. Every person suffering a seizure does not mean that he/she has epilepsy. Epilepsy is diagnosed if the attacks recur over time with certain characteristics for every patient, sometimes spontaneously and sometimes on the basis of triggering factors.
Epilepsy is the most common neurological disorder of childhood and adolescence and the second disorder in adulthood after stroke. The incidence in developed countries is 20-50/100.000. This disease is seen with equal frequency in men and women in all age groups, but it is mostly seen in the youngest and oldest groups.
Requiring a long-term treatment and monitoring , this disease affects the quality of life significantly. Seizures are controlled with accurate treatment in the majority of patients and patients continue their normal life. Thus it is very important to control the seizures. However seizures cannot be controlled in 25% of the patient despite appropriate use of drugs. The patients who are resistant to drug therapy or who can’t tolerate the treatment due to side effects of the antiepileptic drug therapy , are candidates for epilepsy surgery.
How is epilepsy diagnosed?
Epilepsy is a disease which is clinically diagnosed. Determining whether a seizure is epilepsy or not, if it is epilepsy, observation of the patient and/or patient’s relative and its accurate presentation to the physician in order to detect its type are very important. After diagnosing epilepsy, determining the type of epilepsy will be helpful about which epileptic medication would be more effective.
The tests for the diagnosis of epilepsy
Electroencephalography: EEG constitutes the main pillar of Epilepsy science. EEG is based on the principle of recording the fluctuation in the electrical activity of a wide nerve cell group. Recording is done by pasting the electrodes to the scalp. This examination is not painful or harmful to health. There is no contact with electricity. In addition to the conventional EEG devices increasingly developed with the support of technology, telemetric examinations and video-EEG monitoring examinations also helpful for better evaluation of epilepsy patients. Since EEG examination is a short-term evaluation, the disorder may not be detected for the first evaluation. EEG examination more than once or even long and short term sleeping monitoring by keeping the patient awake may be required in clinically suspected or recurrent cases
Magnetic resonance imaging (MRI): giving the best information about the structure of the brain, MRI is performed in supine position inside a large circular magnet. Though not required for every patient, perfoming MRI is very important in order to reveal the underlying cause especially in patients who are considered to have with focal epilepsy.
Computed tomography (CT): Although it is not as sensitive as MRI, CT is an analysis method used for imaging the structural lesions that operates by using X-rays . It may be preferred in the absence of MRI.
Blood tests: It may be required to evaluate the general health condition of the patient with variety of blood examinations and examine the reasons which may be responsible from epilepsy.
Treatment of epilepsy disease:
Epilepsy is a disease that can be treated. The first step in the treatment of epilepsy is accurate diagnosis and to determine whether medical treatment is required or not. Approximately one person in 20 people may have seizure once a lifetime and a seizure may not recur after a single seizure . Thus, starting medication after the first seizure is mostly not preferred.
After making the accurate diagnosis and determining that a treatment is required, then decision about which drug therapy to be initiated is made. Generally, a single medication with a low dose is initiated and then the dose is increased gradually. In the meanwhile, follow up by the physician continues and medication blood levels that can be measured by obtaining blood sample when necessary are evaluated. Cooperation of the patient is very important in terms of adapting to the regular treatment which continues for years.
Beside the benefits of each drug, side effects will also be present. Some side effects decrease and disappear as the body gets accustomed to the drug. The most common side effects are drowsiness, dizziness and imbalance. In case this type of side effects expected to be lost within the first few weeks continue, while sometimes dose reduction is sufficient, other drug options may be tried in some conditions, too.
While epileptic seizures in four of five patients can be controlled with appropriate medication use, seizures may continue in one patient. This condition is called drug resistant epilepsy. Initially, the drug which was firstly started is replaced or a second drug is added. Epilepsy surgery may be performed for some selected patients having resistant epilepsy. Evaluating such patients by physicians specialized in epilepsy at epilepsy centers would be appropriate.
Approximately 10 to 15% of individuals with epilepsy require epilepsy center. The patient should be evaluated by a multidisciplinary team if epileptic seizure cannot be controlled within 1-2 years after starting medication, usage of combined drugs fails, unacceptable side effects of antiepileptic medications occur, MRI lesion is present, the type of the seizure or epilepsy syndrome is uncertain, and accompanying psychological and / or psychiatric disease is present.
In our center constituted within Istanbul Florence Nightingale Hospital Neurology Unit, research and treatments requiring medical and surgical treatment can be applied with a multidisciplinary approach for the epilepsy patients. At our center, multidisciplinary experts such as neurologists, neurosurgery and neuroradiology specialists, psychiatrists, neuropsychologists, physical therapists who have specialized in epilepsy work together.
1. Epilepsy clinic:
Today's advanced diagnostic and treatment programs are applied to patients who are referred to this clinic from emergency or general neurology clinic due to preliminary diagnosis or diagnosis of epilepsy. Among this group, patients with resistant epilepsy who are considered to be candidate for epilepsy surgery are directed to epilepsy surgery clinic and followed up according to the preoperative preparation of epilepsy surgery. Also counseling are scheduled within this clinic for the patients and their relatives about the social issues that the epilepsy patients have difficulty such as marriage and having children, military and education ; patients are evaluated with psychiatric clinic when necessary.
2. Epilepsy Surgery Clinic:
Preoperative and postoperative follow-up of patients who are candidate for epilepsy surgery or who underwent epilepsy surgery are scheduled in these clinics. Patients are hospitalized and observed for 1 to 7 days particularly in order to perform the examinations quickly and completely during preoperative preparation period.
3. Routine EEG laboratory:
Including 2 32 channels of EEG device , our laboratory has one fixed and one portable units and in service for 24 hours / 7 day. Currently, short term sleeping, night-long sleeping and video EEG examinations are performed with our fixed device. Bedside EEG is performed with our portable EEG device that are not able to come to the laboratory.
4. Video EEG monitoring laboratory:
Preoperative non-invasive monitorings of the patients who are initially candidate for epilepsy surgery are performed with our 128 channel EEG device. at least 5 times of clinic and electrophysiological recording of the seizures are required to be performed to make a healthy decision. 1 to 5 days of monitoring is planned for this reason. Reducing the medication or even discontinuing the treatment when necessary is a method practiced at our center same as all over the world . In addition, video monitoring unit is the only diagnostic method for the separation of the actual seizure from pseudo-seizures. For this purpose, services are also provided for the patients being referred from cardiology clinic for the differential diagnosis of particularly psychiatry and syncope.