النزيف

Epilepsy is a tendency to have repeated, unprovoked seizures, which are bursts of abnormal electrical activity in the brain. A single seizure is not epilepsy; about 1 person in 10 has one at some point, while around 1 in 100 has epilepsy.

Seizures are focal, starting in one area, or generalised, involving both sides from the outset. About two thirds of people become seizure-free on medication. For those who do not, surgery, neurostimulation or dietary therapy may help, and these should be considered early, not after decades.

Symptoms

• Convulsive (tonic-clonic) seizures: stiffening, rhythmic jerking, loss of consciousness, a bitten tongue, then confusion and sleepiness
• Absence seizures: brief blank stares lasting seconds, many times a day, mainly in children
• Focal aware seizures: a rising feeling in the stomach, deja vu, a strange smell or taste, tingling or jerking of one limb
• Focal impaired awareness seizures: staring, lip smacking, fumbling, not responding for 1 to 2 minutes
• Myoclonic jerks, typically shortly after waking
• Sudden falls from loss or stiffening of muscle tone
• Waking with a bitten tongue, sore muscles or a wet bed after a seizure in sleep

Causes and risk factors

In about half of people no structural cause is found, and many of these epilepsies are genetic in origin. Identifiable causes include scarring of the hippocampus, malformations of cortical development, stroke (the leading cause starting in later life), head injury, brain tumours, infections such as meningitis, encephalitis and neurocysticercosis, birth injury, autoimmune encephalitis and dementia. Triggers that lower the threshold in someone with epilepsy include missed medication, sleep deprivation, alcohol, illness, stress and, in about 3 percent, flashing lights.

How it is diagnosed

• Eyewitness account and video: The most useful diagnostic information. A phone recording of an event is often decisive.
• EEG: Records brain activity. A normal routine EEG does not exclude epilepsy; sleep-deprived or prolonged recordings raise the yield.
• MRI with an epilepsy protocol: High resolution imaging looking for hippocampal sclerosis, cortical dysplasia, tumours and scars.
• Video-EEG telemetry: Several days of inpatient monitoring to capture seizures, confirm the diagnosis and localise the onset before surgery.
• ECG and cardiac assessment: To exclude fainting and heart rhythm disorders, the commonest mimics.
• Blood tests, genetic panels and antibody tests: Particularly in childhood-onset, drug-resistant or rapidly evolving epilepsy.
• PET, SPECT, neuropsychology and invasive EEG: Part of surgical evaluation when MRI and scalp EEG do not agree.

Treatment options

• Anti-seizure medication: Chosen by seizure type, age, sex and other conditions. Lamotrigine and levetiracetam are common first choices; valproate is highly effective for generalised epilepsy but avoided in women who could become pregnant.
• Second drug or combination: If the first medicine fails at an adequate dose. After two appropriate medicines have failed, the epilepsy is termed drug-resistant and referral to a specialist centre is advised.
• Epilepsy surgery: Removal or disconnection of the seizure focus. For well-selected temporal lobe epilepsy, around 60 to 70 percent become free of disabling seizures. Laser ablation is a less invasive option at some centres.
• Vagus nerve stimulation: An implanted device that reduces seizure frequency over time in people who are not candidates for resective surgery. Seizure freedom is uncommon.
• Deep brain and responsive neurostimulation: Further options for drug-resistant focal epilepsy.
• Ketogenic dietary therapy: Medically supervised; used chiefly in children and in certain metabolic conditions.
• Rescue medication and safety planning: Buccal midazolam for prolonged seizures, advice on bathing, heights, swimming and driving, and an honest discussion of SUDEP risk.
• Pre-pregnancy planning: Medicine review and high dose folic acid before conception.

When it is urgent

Call an ambulance locally for a convulsive seizure lasting more than 5 minutes, repeated seizures without recovery in between, a first ever seizure, a seizure in water, in pregnancy or in someone with diabetes, a serious injury, or breathing difficulty afterwards. Never stop anti-seizure medicine abruptly.

Travelling to Türkiye for treatment

Routine epilepsy care means dose adjustments over months and a neurologist who can be reached when things change, so it should be local. Where a visit adds real value is drug-resistant epilepsy: a pre-surgical evaluation with video-EEG telemetry, epilepsy-protocol MRI, PET and neuropsychology takes about 1 to 2 weeks, and surgery or stimulator implantation can follow on the same or a later trip. Carry medicines in hand luggage, keep dose times steady across time zones, protect your sleep, and bring seizure videos and all previous scans.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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