What is epilepsy?
Epilepsy, also known as 'Sara' among the people, is a disease that dates back to ancient times. In ancient times, epilepsy patients were treated as gods who had been punished by the gods or bad spirits. The examination and treatment of epilepsy has continued to develop since the 1850s. Appropriate antiepileptic selection and use, as well as good monitoring of patients with epilepsy can completely recover or reduce seizures 3/4 rate can be achieved. On the other hand, reasons such as failure to select or apply appropriate treatment and investigation of non-scientific treatment methods cause this disease to be under control. Therefore, informing the patient and his / her family about epilepsy has priority as the starting point of treatment.
Epilepsy is, in short, paroxysmal (recurrent), reversible (transient), electrical discharges of neurons of the central nervous system. According to the location of discharges, seizures with different clinical features are observed. These seizures can develop without loss of consciousness as well as loss of consciousness. It was named and classified according to these characteristics. In 1981, the International Classification of the Epilepsy International was adopted and changes and arrangements are made periodically.
What are the types of epilepsy?
Partial (Local, Focal) Seizures: Seizures originating from any part of the cerebral cortex (gray matter containing nerve cells on the outside of the brain). The discharge can only remain where it originates, or it can spread to other areas through the connecting fibers in the brain. At that time, the findings of the place where the discharge began and spread. If discharges become widespread, grand mal seizures, which we call big seizures, develop with contraction and tremor, accompanied by loss of consciousness.
These seizures are sensory, motor or speech related and are called simple seizures if there is no loss of consciousness and complex seizures if there is loss of consciousness. a) Absence Seizures:
Complex Partial Seizures: They are seizures with various clinical features and complete loss of consciousness. Creates clinical findings according to the region of origin. Running aimlessly, smacking, playing with his head, making aimless movements, lying, swallowing, etc. clinical features. The relationship with the environment is broken. The patient does not fall, does not contract. The other person doesn't know he's having a seizure. Automatism (automatic movements) needs to be well evaluated because it can be mistaken for many other diseases.
a) Absence Seizures:They are seizures that are short-term and go on in seconds, with loss of consciousness, which are also known as diving seizures, which start in childhood and may also be genetic. The patient abruptly stops what he is doing, looks around, and resumes his work after the seizure.
b) Myoclonic Seizures: These are seizures that originate from the deep midline structures of the brain and spread to all parts of the brain at the same time.
c) Tonic Seizures: These are seizures caused by the contraction of the body.
d) Clonic Seizures: It is a type of seizure in the form of tremor in one half of the body.
e) Atonic - Akinetic Seizures: Suddenly and very loose fall attacks are manifested.
f) Tonic Clonic Seizures: These are the typical big seizures called sar'a among the people called as Grand mal. Such partial seizures develop when partial seizures become more severe and spread to other parts of the brain.
What is Status Epilepticus?
Epilepsy is a clinical condition characterized by prolonged seizures or recurrent recurrence. In order to use the term status, seizures must be repeated continuously for at least 30 to 60 minutes, or the consciousness should not be opened at all between seizures. Status is a term used when various types of epilepsy are prolonged or continuous. It is a life-threatening clinical development. As soon as this condition develops, the patient should be admitted to the hospital immediately and the necessary treatment should be started. There is a 40% risk of death, especially if the status is of the grand mal type and is not treated at home.
How is it treated?
A tendency to start an antiepileptic drug immediately is a common condition. This may lead to incorrect or incomplete treatment. It is necessary to make a good decision whether the patient's complaints are epileptic seizures, the type of seizures and the etiologic cause.
Drug therapy involves a long period of time that requires the patient and the doctor to be patient. Therefore, the doctor and the patient should establish a good relationship.
The treatment should be started with the most effective drug on seizures, with the least side effects, easy to use and supply, and the most suitable drug for the economic situation of the patient. Seizures should be controlled with a single drug. In cases where seizures cannot be controlled, the drug dose should be increased to the maximum tolerable level. If there is no response despite the highest dose, it may be possible to revise the situation or switch to another drug or add a second drug to the treatment. In case of a drug change, the first drug should be discontinued slowly and the second drug should be taken slowly.
Each drug requires a certain amount of time to reach an effective and regular plasma level. Therefore, it is not right to change the doses of drugs frequently. Sudden cessation of drugs is the most effective cause of status. Therefore, it is a wrong attitude for patients to stop taking their medications suddenly.
On the one hand, the physical and mental side effects of the drugs used for a long time, on the other hand, after discontinuation of the drugs, because of the possibility of recurrence of seizures, the decision to discontinue anti-epileptic treatment or to continue for life should be taken carefully.
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Hisar Intercontinental Hospital