Epilepsy is a chronic neurological disease known among the public as sara hastalığı, which occurs as a result of abnormal and excessive electrical activities of nerve cells in the brain. This condition is characterized by recurrent seizures, and during seizures, loss of consciousness, involuntary contractions, staring spells, or brief behavioral changes may occur. Epilepsy seizures do not manifest in the same way in every individual; the type, duration, and severity of seizures can vary from person to person.
Epilepsy is not a disease diagnosed by having a single seizure. Diagnosis generally requires the presence of intermittently recurring seizures and the evaluation of underlying neurological causes. Brain traumas, congenital brain injuries, genetic factors, infections, tumors, or conditions whose exact cause cannot be determined can lead to epilepsy. Therefore, epilepsy is a disease that can be seen in all age groups, from childhood to advanced ages.
Epilepsy can affect not only the moments of a seizure but also an individual's daily life, social relationships, and educational and professional life. However, with accurate diagnosis and appropriate treatment, seizures can be brought under control in a large proportion of epilepsy patients, allowing them to lead a normal life. Today, alongside pharmacological treatments in epilepsy therapy, surgical interventions and special treatment approaches can also be applied in certain patients.
Epilepsy is a disease that requires accurate information and regular medical follow-up. Early diagnosis, appropriate treatment planning, and regular check-ups performed by a neurology specialist play an important role in reducing the frequency and severity of seizures. Therefore, it is of great importance for individuals experiencing epilepsy symptoms to consult a healthcare institution without wasting time.
What Are the Types of Epilepsy?
Epilepsy types are classified according to the region of the brain where the seizures begin, their pattern of spread, and their clinical symptoms. This classification is of great importance for making an accurate diagnosis and establishing the most appropriate treatment plan. In current medical approaches, epilepsy is primarily addressed as focal (partial), generalized, and unknown onset epilepsies. Each type of epilepsy may exhibit different symptoms and course characteristics.
1. Focal (Partial) Epilepsy
Focal epilepsy occurs when seizures begin in a specific region of the brain. In this type of epilepsy, symptoms vary depending on the brain area where the seizure originates. Focal epilepsy is divided into two main groups:
a) Focal Seizures with Preserved Awareness
In these seizures, the person does not lose consciousness. Contractions in the hand, arm, or a part of the face, numbness, a tingling sensation, sudden fear, and sensory changes such as smelling or tasting things can occur. The person is aware of what is happening and can remember the event after the seizure.
b) Focal Seizures with Impaired Awareness
In these seizures, consciousness is partially or completely affected. The person may become dazed, their communication with the environment decreases, and they may exhibit repetitive movements (such as lip-smacking or hand-rubbing). He may have difficulty remembering what happened after the seizure.
Focal seizures can in some cases spread to the entire brain and evolve into a secondary generalized seizure.
2. Generalized Epilepsy
In generalized epilepsy, seizures affect both hemispheres of the brain simultaneously. These types of epilepsy usually begin in childhood and adolescence, but can be seen at any age. The types of generalized epilepsy are:
a) Tonic-Clonic Seizures (Grand Mal)
This is the best-known type of epileptic seizure. Along with loss of consciousness, body stiffening (tonic phase) followed by rhythmic muscle jerks (clonic phase) are observed. After the seizure, the person often feels tired, confused, and may have a headache.
b) Absence Seizures (Petit Mal)
These are seen mostly in children. The person disconnects from the environment for a few seconds, stares blankly, and then returns to normal. Because these seizures are brief, they may go unnoticed, but they can repeat frequently throughout the day.
c) Myoclonic Seizures
They are characterized by sudden, brief muscle jerks. They usually occur in the morning hours, and the arms, shoulders, or the entire body can be affected.
d) Atonic Seizures
With the sudden loss of muscle tone, the person may fall to the ground. Therefore, the risk of injury due to falls is high.
e) Tonic Seizures
They occur with sudden and continuous contraction of the muscles. They are usually seen during sleep and take the form of sudden stiffening.
3. Unknown Onset Epilepsy
In some epilepsy cases, the region of the brain where the seizure begins cannot be clearly determined. In such cases, the epilepsy is classified as unknown onset epilepsy. As the diagnostic process progresses, the seizure type can be defined more clearly as a result of detailed evaluations.
4. Epileptic Syndromes
Some types of epilepsy are evaluated as epileptic syndromes that are seen in specific age groups and have unique symptoms. These syndromes are defined by seizure types, EEG findings, age, and course characteristics. Identifying epileptic syndromes is important in terms of treatment selection and predicting the course of the disease.
5. Types of Epilepsy by Cause
Epilepsy can also be classified according to its underlying cause:
Genetic epilepsy: Conditions where hereditary predisposition is prominent
Structural epilepsy: Due to causes such as brain damage, tumors, and vascular diseases
Metabolic epilepsy: Epilepsies developing due to metabolic disorders
Epilepsy of unknown cause: Situations where the cause cannot be identified despite examinations performed
Epilepsy is not a single-type disease; it can manifest with different seizure types and clinical pictures. Therefore, accurately determining the type of epilepsy forms the basis for establishing an effective treatment plan. It is of great importance for individuals with seizure complaints to consult a neurology specialist for a detailed evaluation and appropriate treatment.
What Are the Symptoms of Epilepsy?
Epilepsy symptoms may vary depending on the type of seizure, the affected region in the brain, and the person's age. Therefore, epilepsy is not a disease that manifests with uniform symptoms. While some symptoms are quite distinct and easy to notice, some seizures may be overlooked by the person and their surroundings because they are brief or mild. Certain types of epilepsy seen particularly in children and elderly individuals can be confused with behavioral changes or lack of attention. Epilepsy symptoms generally appear as recurrent seizures, and the person can lead a completely normal life between seizures.
Epilepsy symptoms are generally addressed in two main groups: symptoms seen during the seizure and conditions that emerge after the seizure. While the symptoms appearing during the seizure manifest with different clinical pictures depending on the type of epilepsy, the symptoms experienced after the seizure reflect the person's recovery process. This distinction serves as an important guide both in the diagnostic process and in planning epilepsy treatment.
Symptoms Seen During an Epileptic Seizure
The symptoms that appear during an epileptic seizure vary depending on the type of seizure and the affected region in the brain. Seizures can last for a few seconds or continue for a few minutes, and in some cases, the person may not remember what happened. The most common symptoms during an epileptic seizure are:
- Loss of consciousness or clouding of consciousness,
- Sudden muscle contractions or rhythmic muscle twitching in the body,
- Blank staring, dazedness, or brief disconnection from the environment,
- Involuntary movements in the hand, arm, face, or leg,
- Repetitive behaviors such as lip-smacking, chewing, or hand-rubbing,
- Sudden fear, restlessness, or a feeling of unexplained anxiety,
- Changes in the perception of smell, taste, sound, or vision,
- Difficulty speaking or making meaningless sounds,
- Incontinence,
- Sudden falling and collapsing to the ground.
These symptoms may not manifest in the same way in every epilepsy patient. While only brief changes in consciousness are experienced by some individuals, some seizures progress with more pronounced contractions and loss of consciousness. Therefore, in the presence of different and recurring symptoms, it is of great importance for an evaluation to be made by a neurology specialist.
What Causes Epilepsy?
Epilepsy is not a disease that arises due to a single cause; it generally develops as a result of various biological, structural, and genetic factors that disrupt normal electrical transmission in the brain. Abnormal and uncontrolled electrical activity between brain cells (neurons) forms the basis of epileptic seizures. While this condition is linked to a specific cause in some individuals, a clear cause cannot be identified in some cases despite all examinations performed.
The causes of epilepsy can vary depending on the person's age, medical history, and the type of seizure. Therefore, epilepsy is a neurological disease that can appear in any period from childhood to advanced age.
Structural Causes Related to the Brain: Structural disorders occurring in the brain are among the most frequent causes of epilepsy. Brain damages, traumas, or certain diseases occurring during or after birth can lay the groundwork for epilepsy. These causes may include:
- Brain traumas (damages occurring after an accident, fall, or blow)
- Congenital brain damages
- Brain tumors
- Cerebrovascular diseases and stroke
- Brain hemorrhages
Such structural problems can lead to abnormal electrical activity in certain regions of the brain, causing epileptic seizures to occur.
Genetic Factors: Genetic predisposition plays an important role in certain types of epilepsy. The risk of developing the disease may be higher in individuals with a family history of epilepsy. Genetic epilepsies usually appear in childhood or adolescence and often develop without significant structural brain damage.
Causes Arising Before and During Birth: Certain problems experienced during pregnancy and the birth process may increase the risk of developing epilepsy in later years:
- Infections contracted in the womb
- Lack of oxygen during birth (hypoxia)
- Premature birth
- Low birth weight
- Infections
Certain infectious diseases affecting the brain can lead to epilepsy. Infections involving the central nervous system are particularly important in this regard:
- Meningitis
- Encephalitis
- Brain abscesses
Epilepsy developing after such infections may be permanent in some individuals.
Metabolic and Systemic Causes
- Certain metabolic disorders in the body can also cause epileptic seizures:
- Low or high blood sugar
- Electrolyte imbalances
- Kidney or liver failure
- Certain medications or substance use
In such situations, when the underlying problem is corrected, seizures can also be brought under control.
Epilepsy of Unknown Cause (Idiopathic Epilepsy)
In some epilepsy cases, a clear cause cannot be identified despite all tests performed. This condition is called unknown cause or idiopathic epilepsy. However, this does not mean that the disease cannot be treated; seizures can be brought under control with appropriate treatment.
Epilepsy is a complex neurological disease that can develop due to numerous different causes. Identifying the underlying cause is of great importance in terms of determining the type of epilepsy and selecting the most appropriate treatment method. It is recommended that individuals experiencing epilepsy symptoms consult a neurology specialist for detailed evaluation and accurate diagnosis.
How is Epilepsy Diagnosed?
Epilepsy diagnosis is not a simple diagnosis made with a single test; it requires the detailed clinical evaluation, patient history, and various diagnostic methods to be handled together. The primary goal of the diagnostic process is to determine whether the experienced seizures are of epileptic origin and to correctly classify the seizure type. Accurate diagnosis is the most important step of effective epilepsy treatment.
1. Detailed Patient History (Anamnesis)
The most important step in diagnosing epilepsy is the seizure history recounted by the patient and witnesses, if any. The neurology specialist obtains detailed information regarding the following subjects:
How the seizure began,
What was experienced during the seizure,
Whether there was a loss of consciousness,
How long the seizure lasted,
Whether weakness, confusion, or forgetfulness was experienced after the seizure,
The frequency of seizures and whether they are recurrent,
Since the patient may not remember what happened during certain epileptic seizures, the accounts of people who witnessed the seizure are of great importance for diagnosis.
2. Neurological Examination
The neurological examination performed by a neurology specialist aims to evaluate the general functions of the brain and nervous system. This examination can help detect findings pointing to an underlying structural or neurological problem. However, a normal examination result does not mean that epilepsy is not present.
3. EEG (Electroencephalography)
EEG is one of the most frequently used and important tests in diagnosing epilepsy. The electrical activity of the brain is recorded with an EEG. In epilepsy patients, abnormal waves suggesting epileptic activity can be seen on the EEG.
- EEG is not always performed during a seizure.
- Findings specific to epilepsy can also be detected during the interictal period (between seizures).
- A normal EEG result does not completely rule out epilepsy.
- In some cases, a sleep EEG or long-term video EEG examination may be required.
4. Brain Imaging Methods
Brain imaging methods are utilized to detect structural problems that may cause epilepsy:
Magnetic Resonance Imaging (MRI): This is the method most frequently preferred in diagnosing epilepsy. Brain tumors, congenital anomalies, vascular diseases, and past damage can be evaluated with MRI.
Computed Tomography (CT): It can be used in emergency situations or certain special cases.
These examinations play an important role in determining the underlying cause of epilepsy.
5. Blood Tests and Other Tests
In some cases, blood tests can be performed to differentiate conditions resembling epileptic seizures. Metabolic disorders, electrolyte imbalances, or infections are evaluated through this method. These tests help determine factors accompanying epilepsy or triggering the seizure.
6. Differential Diagnosis Process
In diagnosing epilepsy, it is necessary to differentiate conditions that resemble seizures but are due to non-epileptic causes. Fainting (syncope), panic attacks, psychogenic seizures, and certain
sleep disorders can be confused with epilepsy. Therefore, the diagnostic process requires a careful and comprehensive evaluation.
Epilepsy diagnosis is made by evaluating the patient history, neurological examination, EEG, and brain imaging methods together. A single test is not sufficient to make a diagnosis. Accurate and early diagnosis is of great importance for bringing epileptic seizures under control and establishing an appropriate treatment plan. It is recommended that individuals with suspected epilepsy consult a neurology specialist without wasting time. How is Epilepsy Treated? (H2)
Epilepsy treatment is a long-term and personalized process aiming to bring seizures under control, preserve the individual's daily quality of life, and prevent potential complications. The treatment plan is determined according to the type of epilepsy, the frequency and severity of seizures, the patient's age, general health status, and the underlying cause. With appropriate treatment initiated after an accurate diagnosis, seizures can be successfully controlled in a large proportion of epilepsy patients.
1. Pharmacological Treatment (Antiepileptic Drugs)
The first and most frequently applied method in epilepsy treatment is antiepileptic drug therapy. These drugs aim to prevent seizures from occurring by suppressing abnormal electrical activity in the brain.
- Treatment is usually initiated with a single drug.
- The dosage is adjusted gradually according to the patient's response.
- Regular use of the drugs in accordance with the physician's recommendation is extremely important.
- Abruptly stopping the medication may increase the risk of seizures.
- With the appropriate drug and dosage, seizures can be completely stopped or significantly reduced in a significant portion of patients.
2. Treatment of Drug-Resistant Epilepsy
In some patients, seizures cannot be brought under control despite appropriate drug therapy. This condition is called drug-resistant epilepsy. In such cases, different treatment options are evaluated:
The combined use of multiple antiepileptic drugs,
Advanced evaluation with long-term video EEG,
Investigation of suitability for epilepsy surgery,
3. Epilepsy Surgery
Epilepsy surgery can be applied in cases where seizures originate from a specific focus in the brain and this region can be safely removed. Surgical treatment can be an effective option especially in drug-resistant epilepsy patients.
Detailed examinations are performed before surgery:
- Video EEG
- Brain MRI
- Neuropsychological evaluations
Not every epilepsy patient is suitable for surgery; the decision is made by a multidisciplinary team.
4. Other Treatment Methods
Alternative or supportive treatment methods can also be applied in some patients:
Vagus nerve stimulation (VNS): It provides electrical stimulation via the nerves leading to the brain.
Ketogenic diet: It can be effective particularly in certain types of epilepsy in childhood.
Deep brain stimulation (DBS): This is an advanced method that can be applied in selected cases. These methods aim to increase seizure control in addition to drug therapy.
5. Lifestyle Modifications
Not only medical interventions but also lifestyle modifications are important in epilepsy treatment:
- Regular sleep,
- Avoiding alcohol and stimulant substances,
- Stress management,
- Regular use of medications.
These factors can directly affect the frequency and severity of seizures.
Epilepsy treatment is a process requiring patience and regular follow-up. With appropriate treatment, a large majority of epilepsy patients can lead a seizure-free life. The success of treatment is closely related to early diagnosis, accurate treatment selection, and patient-physician cooperation. It is of great importance for individuals diagnosed with epilepsy to regularly continue their treatment process accompanied by a neurology specialist. How to Approach Someone Having an Epileptic Seizure? (H2)
Approaching a person having an epileptic seizure correctly is of great importance in terms of ensuring the person's safety and preventing potential injuries. Seizures are mostly brief and terminate on their own; therefore, it is necessary to remain calm and apply the correct first aid steps. Incorrect interventions, even if done with good intentions, can harm the person.
What to Do During an Epileptic Seizure
- If a person is having an epileptic seizure, the following steps should be followed:
- Stay calm and do not panic.
- Lay the person down on the floor and prevent him from falling.
- Protect his head; if possible, place a soft object (such as a jacket or bag) under his head.
- Move hard and dangerous objects away from him.
- Turn the person to his side (recovery position). This prevents saliva or vomit from escaping into the airways.
- Keep time. Knowing how long the seizure lasted is important for medical teams.
- Wait for the seizure to pass on its own. Most epileptic seizures end within 1–2 minutes.
What NOT to Do During an Epileptic Seizure
- Common misconceptions should be specifically avoided:
- Do not try to open his mouth.
- Do not put water, medication, or any object into his mouth.
- Do not try to stop his contractions by holding him.
- Do not engage in behaviors such as slapping, shaking, or shouting.
- Do not try to make the person stand up during the seizure.
- These interventions can lead to injuries and respiratory problems.
How to Behave After the Seizure?
After the seizure ends, the person enters a recovery process called the postictal period. During this period:
- The person may be dazed, tired, or confused.
- Be calm and supportive, do not force him to talk if he has difficulty.
- Allow him to rest.
- Stay by his side until he understands what happened.
- Inform his relatives if necessary.
Once the person recovers, it may generally not be necessary to go to the hospital; this situation depends on whether the person has been previously diagnosed with epilepsy.
When Should Emergency Help Be Called?
- Emergency 112 should be called in the following situations:
- If the seizure lasts longer than 5 minutes,
- If seizures occur back-to-back and the person does not regain consciousness in between,
- If the person is having a seizure for the first time,
- If a serious injury has occurred during the seizure,
- If consciousness does not return for a long time after the seizure,
- If the person is pregnant, is a child, or has additional diseases such as diabetes.
The correct approach to a person having an epileptic seizure mostly consists of simple but vital steps. The most important points are staying calm, protecting the person, and avoiding incorrect interventions. Proper first aid knowledge increases the safety of epilepsy patients and prevents unnecessary complications. Epilepsy in Infants and Children (H2)
Epilepsy in infants and children is a neurological disease that emerges as a result of abnormal electrical activities in the brain and progresses with recurrent seizures. Although epilepsy can be seen at any age, childhood epilepsies can manifest with different symptoms and
causes compared to adults. Seizures seen particularly in infancy may not always be in the form of pronounced contractions; this situation can lead to a delay in diagnosis.
Epilepsy in children is a disease that can be brought under control to a large extent with early diagnosis and accurate treatment. Therefore, it is extremely important for parents to recognize the symptoms and consult a specialist without wasting time in suspicious situations.
Symptoms of Epilepsy in Infants
Symptoms of epilepsy in infants can differ from classical seizures seen in adults and can manifest themselves with behaviors that are often difficult to notice. The symptoms of epilepsy that can be seen in infants are:
- Sudden startles or jerks,
- Staring fixedly at a single point,
- Repetitive movements resembling lip-sucking or chewing,
- Rhythmic contractions in the arms or legs,
- Sudden relaxation and dropping of the head,
- Cyanosis, breath-holding-like conditions,
- Pauses and dazedness during feeding,
These symptoms can be brief and repeat frequently during the day. Since they can negatively affect infant development in some cases, early evaluation is of great importance.
Symptoms of Epilepsy in Children
Symptoms of epilepsy in children can be more pronounced, but they can still be confused with other diseases. The most common symptoms are:
- Loss of consciousness or staring spells,
- Sudden falls,
- Contractions in the hands, arms, or legs,
- Automatic movements such as lip-smacking or hand-rubbing,
- Frequent staring off into space during lessons,
- Weakness and confusion after a seizure,
- Unfounded feeling of fear or restlessness,
Particularly absence (staring) seizures may go unnoticed by teachers and families because they can be confused with attention deficit.
Causes of Epilepsy in Infants and Children
The causes of epilepsy in infants and children can differ from adults. The most common causes are:
- Lack of oxygen during birth,
- Congenital brain development disorders,
- Genetic predisposition,
- Epilepsy developing after febrile seizures,
- Brain infections (meningitis, encephalitis),
- Head traumas,
- Metabolic diseases,
In some children, however, a clear cause cannot be found despite all examinations performed.
Diagnosis of Epilepsy in Infants and Children
Parental observations are extremely important during the diagnostic process. The neurology specialist obtains detailed information regarding the form, duration, and frequency of seizures. For diagnosis, frequently:
- EEG (electroencephalography)
- Brain MRI imaging
- Blood tests are used when necessary.
- The diagnostic process is conducted more carefully and comprehensively in infants.
Treatment of Epilepsy in Infants and Children
In childhood epilepsy, treatment is planned according to the seizure type and epilepsy type. The most frequently applied treatment method is antiepileptic medications. Seizures can be completely brought under control with appropriate drug therapy in a significant portion of children.
In some children, epilepsy may continue up to a certain age and completely resolve over time. In drug-resistant cases, advanced treatment options are evaluated.
What Should Families Pay Attention To?
Families must exhibit a conscious and careful approach during the treatment and follow-up process of infants and children diagnosed with epilepsy. Using medications regularly at the doses and times recommended by the physician is of great importance in terms of seizure control. Ensuring the child's sleep routine and protecting him from excessive fatigue and stress help reduce factors that could trigger seizures. Keeping a seizure log where the time, duration, and form of seizures are recorded can be guiding in physician evaluations. Additionally, informing the school and teachers supports the child in continuing his social and academic life safely. Knowing what to do and what not to do during a seizure by family members and not neglecting regular doctor check-ups are fundamental elements in terms of the child's healthy development and quality of life.
- Medications must be used regularly and at the recommended dose.
- Keeping a seizure log is beneficial in diagnosis and follow-up.
- Sleeplessness and excessive stress must be prevented.
- The school and teachers must be informed.
- What to do and what not to do during a seizure must be learned.
Epilepsy in infants and children is a disease that can be brought under control to a large extent with early diagnosis and accurate treatment. Being conscious, recognizing symptoms early, and regular physician follow-up are critically important for the child's healthy development. Consulting a pediatric neurology or neurology specialist in suspicious situations is recommended.