What Is Epilepsy, Its Causes and Symptoms? How Is It Treated?

Epilepsy is a neurological disorder that affects the brain and causes recurrent seizures. During seizures in particular, people may experience loss of consciousness, staring blankly in one direction for a period of time, and repetitive trembling movements in the hands and arms.

Epilepsy is diagnosed by a specialist physician using various screening methods and tests. Treatment is planned according to the type and severity of epilepsy and the individual's medical history. Throughout treatment, a neurologist, a specialist dietitian, a psychologist and the healthcare team work together. The main goal of treatment is to reduce the frequency of seizures or to eliminate seizures completely.

What Is Epilepsy?

It is a neurological disorder that affects the brain and sometimes causes recurrent seizures, such as loss of consciousness. Epileptic seizures occur as a result of an uncontrolled burst of electrical activity produced by damaged neurons (nerve cells) in the brain. During seizures, increased electrical activity in neurons causes involuntary actions, emotions and behaviors.

Types of Epilepsy

Types of epilepsy are classified according to their symptoms and the region of the brain where they originate. The types of epilepsy are:

Absence epilepsy: It usually occurs due to genetic factors. It is characterized by recurrent epileptic episodes that cause sudden loss of consciousness. After the episodes, the person may be able to resume their life where they left off; however, this becomes difficult because seizures occur very frequently in epilepsy.

Frontal lobe epilepsy: It is a type of epilepsy originating from the frontal lobe (the front part of the brain), which controls movement ability. For this reason, it causes unusual movements such as muscle weakness, shaking of the arms and legs, grimacing, and the eyes turning to one side.

Temporal lobe epilepsy (TLE): Epileptic seizures originate from the temporal lobe, which controls abilities such as speech, memory and hearing. They are usually seizures associated with fear, nausea, and unusual taste and smell.

Neocortical epilepsy: It is a type of epilepsy originating from the neocortex (the outer layer of the brain).

What Are the Early (Initial) Signs of Epilepsy?

Epilepsy causes recurrent seizures in people. Usually, no symptoms are observed before they occur. However, in some people, early signs are observed before seizures appear. Especially in adults with neurological diseases such as dementia, individuals with head trauma, stroke and brain tumors, and children with growth and developmental delay, early signs may appear. In adults, early signs include neurological disorders such as coordination problems, weakness and memory disturbances. In children, initial signs of epilepsy include symptoms such as difficulty learning, delayed walking, vision problems and attention deficit. Babies who have epilepsy from birth may experience problems with muscle control and sleep patterns.

What Causes Epilepsy?

Epilepsy may develop due to brain trauma, a medical condition affecting the brain, or idiopathically (unknown cause). The most common factors causing epilepsy are:

Stroke

Genetics

Family history of hereditary epilepsy

Brain tumor

Abnormal blood vessels in the brain

Neurological diseases such as Alzheimer's disease

Traumatic brain injury

Infections such as HIV, AIDS and brain abscess

Brain damage occurring during and after birth

Congenital brain anomalies

Inherited metabolic disorders such as phenylketonuria

Is Epilepsy Genetic?

Epilepsy occurs as a result of having multiple genes that increase the likelihood of seizures and the interaction of these genes with environmental factors. Genetic and environmental interactions play an important role in approximately 70% of epilepsy patients. To date, approximately 265 genes contributing to the development of epilepsy have been identified.

What Are the Symptoms of Epilepsy?

Symptoms occurring in epilepsy may vary from person to person depending on how widespread the damage in the brain is and in which region it occurs. The most important symptom of epilepsy is seizure. The severity of the seizure varies from person to person depending on the type of epilepsy. Some people experience muscle contractions and loss of consciousness, while others experience behavioral changes such as stopping what they are doing or briefly zoning out. Symptoms that occur due to epileptic seizures are:

Anxiety

Fear

Worry

Depression

Loss of consciousness

Muscle stiffness

Uncontrollable trembling movements in the arms and legs

Types of Seizures in Epilepsy

In epilepsy, seizures are divided into two groups: focal seizures, which arise from a specific region of the brain, and generalized seizures, which result from neuronal activity in both lobes of the brain.

Focal seizures: These are seizure types that originate from a single part of the brain. They occur especially in the frontal and temporal regions of the brain.

Generalized seizures: They occur as a result of abnormal electrical activity in every region of the brain. These seizure types are:

Sudden loss of consciousness: Slight twitching of the muscles and the person staring into space.

Tonic seizures: Seizures that cause the body's muscles to stiffen.

Atonic seizures: Seizures that cause loss of normal muscle tone, leading to involuntary falls.

Clonic seizures: A type of seizure causing jerking movements in the arm and leg muscles of the body.

Myoclonic seizures: A type of seizure causing sudden muscle jerks in the upper body, arms and legs.

Tonic-clonic seizures: A type of seizure causing the body to stiffen and repetitive movements in the arms and legs.

Secondary generalized seizures: A seizure that begins as a focal seizure and then spreads to the entire brain.

How Is Epilepsy Diagnosed?

If a specialist physician is consulted, epilepsy is diagnosed with the help of a detailed medical evaluation and diagnostic tests. During the physical examination, the doctor gathers information about seizure frequency and family history of epilepsy. Usually, epilepsy is diagnosed after the person has had one or more uncontrolled seizures at least 24 hours apart. In addition to this diagnostic method, the doctor may use various tests and screening methods to make a diagnosis. The tests and imaging methods used by the doctor are:

Blood tests: Metabolic and genetic problems that may cause seizures are detected.

Magnetic resonance imaging (MRI) and computed tomography (CT) scans: MRI and CT scans allow detection of tumors or tissue anomalies in the brain that may cause seizures.

Electroencephalography (EEG): It allows measurement of the effectiveness of drug treatment.

Stereo electroencephalography (SEEG): It allows identification of the region of the brain from which seizures originate.

Positron emission tomography (PET): It allows detection of brain regions with abnormal and normal chemical activity by taking a picture of the brain.

How Is Epilepsy Treated?

Treatment should begin shortly after epilepsy is diagnosed. The neurologist aims to reduce the frequency of seizures or, if possible, eliminate seizures. Epilepsy treatment includes drug therapy, surgery, ketogenic diet and nerve stimulation.

Medications

Antiepileptic drugs prevent seizures by altering the way brain cells function. The type and dose of medication recommended by the doctor vary according to the type of epilepsy the individual has, seizure frequency, age, sex and other medical conditions. The effectiveness of the medication recommended by the doctor is monitored in the initial stages. If the doctor thinks the drug is insufficient, or if the person complains about side effects of the drug, the doctor tries different medications. When an antiepileptic drug suitable for the person and responding well to treatment is identified, regular use is ensured.

Surgery

Some epilepsy patients have difficulty controlling seizures despite many medication trials. Also, epileptic seizures may originate from abnormal brain tissue. Therefore, if the doctor determines through the screening methods and tests performed that the tissue is in a removable location, the doctor resorts to surgical intervention. Before deciding on surgery, the doctor uses the tests performed to determine that the epileptic seizures originate from the same region of the brain. In addition, the doctor determines the effect of the brain tissue to be removed on vital functions such as speech and movement ability. The doctor evaluates these conditions and decides on surgery.

Ketogenic Diet

In the ketogenic diet, fats are used instead of carbohydrates as the body's energy source. Ketones are formed as a result of the body breaking down fats. The accumulation of ketones in the body is called ketosis. Ketosis causes chemical changes in the body that help control seizures. The ketogenic diet is applied as a joint decision of the neurologist, dietitian and family, because it is a very difficult and strict diet to implement. The diet usually begins under the supervision of a dietitian in the hospital. The doctor monitors the individual's ketone levels and possible side effects of the diet through blood tests performed during the diet process. The ketogenic diet generally reduces seizure frequency. Because the ketogenic diet is a strict diet, in recent years the modified Atkins diet, which is more tolerable and tasty, and low glycemic index diets have also been applied. These diets are also successful in reducing seizure frequency.

Vagus Nerve Stimulation

In cases where medications are insufficient to control seizures and surgical intervention is not possible, the doctor applies vagus nerve stimulation in epilepsy treatment. The vagus nerve helps establish a connection between the brain and the heart, and is also connected to many tissues in the body. In vagus nerve stimulation, a stimulator placed in the upper part of the chest sends regular electrical signals to the vagus nerve and the brain. With the help of these regular signals, it reduces the frequency and severity of seizures.

What Is the Process After Epilepsy Treatment?

After treatment, the neurologist informs the individual and their relatives about epileptic seizures. Epilepsy should have a minimal impact on the person. The person should be helped to think positively about their condition. Therefore, in the post-treatment phase, it is important to cooperate with the specialist physician and to take the prescribed medications. Follow-up after treatment is necessary so that the person can maintain a healthy and balanced life. Especially at this stage, to prevent recurrence of seizures, triggering factors should be avoided. Factors that may trigger epileptic attacks after treatment may include:

Lack of sleep

Not adhering to drug therapy

Alcohol

Drugs

Stress

Frequently Asked Questions About Epilepsy

In addition to physical injuries related to seizures, people may experience complaints such as anxiety, depression and fatigue. As a result, a decline in the person's performance and communication problems with their social environment may occur. Epileptic seizures can trigger psychological disorders such as anxiety and depression in people. Symptoms occurring in babies vary according to the type of seizure. Symptoms caused by seizures are mild and not immediately noticeable. They usually resemble a normal baby's movements. These symptoms are:

Random eye movements

Tongue protruding

Smacking chewing movements

Repetitive facial movements

Prolonged pauses in breathing

Epilepsy treatment includes drug therapy, surgical intervention, ketogenic diet and vagus nerve stimulation therapy. The doctor decides which treatment is appropriate based on the screening methods and blood tests applied. Dietary models applied in epilepsy treatment are the ketogenic diet, modified Atkins diet, low glycemic index diet and gluten-free diet. The common feature of these three diets is that they are low in carbohydrates and rich in fat. Uncontrolled epileptic seizures can cause serious, life-threatening injuries. Furthermore, anti-seizure drugs, which are also used in the treatment of mania and bipolar disorder arising from prolonged epileptic attacks, may increase suicidal thoughts and actions in the person. In epilepsy, loss of reflexes varies according to the region of the brain involved. If it occurs in the frontal lobe, loss of reflexes in movements is experienced, while if it occurs in the temporal lobe, loss of reflexes related to abnormal taste, smell and hearing is experienced. One should cooperate with the doctor and healthcare team and adhere to the treatment plan. Negative emotions and thoughts should be avoided during and after treatment. Thus, seizures can largely be prevented. Prolongation of seizures, or failure of the person's consciousness to fully return between repeated seizures, may occur. However, more seriously, when epileptic seizures affect the heart and respiratory tract, unexplained sudden death in epilepsy may occur. In epilepsy, the most important sign that is life-threatening and negatively affects quality of life is seizure. Epilepsy most often occurs in people who have experienced brain damage, brain infection and brain anomalies. In addition, the most important cause of epilepsy is genetic predisposition. Epilepsy may also develop later due to trauma or disease affecting the brain. During epileptic seizures, a person may faint, tremble and lose consciousness. In this case, attempts should not be made to stop the person's movements. Nothing should be put in their mouth, as this may damage the jaw and teeth. Artificial respiration should not be given to the person. Furthermore, no food or drink should be given to the person until the seizure has completely ended. The first aid that can be given to a person having an epileptic seizure includes:

If possible, the person should be laid on the ground. They are gently turned to one side. This makes it easier for them to breathe.

All hard and sharp objects around the person are cleared away. If the person is wearing glasses, they are removed.

Something soft and flat, such as a jacket or pillow, must be placed under their head.

If clothing is tight around the person's neck area, it should be loosened.

If the seizure lasts longer than 5 minutes, call 112.