Epilepsy is the name given to abnormal electrical propagation after a disturbance in the transmission between nerve cells in the brain. Epilepsy is very common in both children and adults. While epileptic seizures can be very mild, they sometimes have severe seizures and apply to the emergency services of hospitals. Relatives of the patients, on the other hand, are looking for medical intervention in the emergency services, being very worried. In the diagnosis of epilepsy, diseases that mimic epilepsy are very important in the differential diagnosis. There are many different types of epilepsy. It is very important to define which epilepsy is in the diagnosis of epilepsy. Epilepsy should be evaluated separately in children and adults.
The incidence of epilepsy;
100 000/ 135-155 for under 1 year olds
100 000/ 47 for those over the age of 18,
It is seen with a frequency of 100 000/63-68 in those over the age of 60.
As can be seen, the incidence of epilepsy is quite high.
While approximately 75-80% of all epilepsies are treated with anti-epileptic drugs at a high rate, 20-25% of the remaining epilepsies cannot be prevented despite the drugs. In this article, information will be shared mostly on drug-refractory epilepsies and/or operative epilepsies.
The definition of drug-resistant epilepsy is the patients who do not prevent epileptic seizures despite the use of one or more anti-seizure drugs in sufficient dose and duration. Resistant epilepsies have led doctors who have been dealing with epilepsy for many years to do many researches and studies. Thus, after research, alternative treatment options (epilepsy surgery) have been a glimmer of hope for epilepsy patients in this difficult and complicated condition. Successful results have been started to be obtained with brain surgeries for patients with epilepsy, whether they are children or adults. Although it has been an area of interest in the history of epilepsy surgery since 1886, after the first world war, it was possible to prevent epileptic seizures by surgically removing the scar tissue in the brain due to brain injuries. The results of these pioneering brain surgeries have been a glimmer of hope for other resistant epileptic seizures. In the scientific studies conducted in the 1930s, the determination of the location of electrical impulses in the brain is among the very important discoveries. Especially in the 1980s, brain Magnetic Resonance (MR) technique, which is one of the new discoveries in diagnostic methods, is a gold standard development for epilepsy surgery. Thus, surgeries have started to be performed increasingly for resistant epilepsy patients in the world. In the same years, very few centers in our country started to perform brain surgeries on resistant epilepsy patients. First of all, teams consisting of experienced epilepsy and surgery teams (Neurolok, Neurosurgeon, Neuropsycholoc) for resistant epilepsy patients were established. After these teams worked together, they determined which type of epilepsy would be treated with medication or which type of epilepsy would be operated on.
After the work of experienced epilepsy medicine teams, epileptic seizures do not respond to medication
Appropriate screening tests (routine EEG, sleep EEG, continuous recorded EEG, Brain MRI, Brain Pet-CT, invasive electrode recorded EEG, and neuropsychological tests) are performed respectively. After these medical tests and clinical examinations together, it is concluded that brain surgical epilepsies are evaluated. In addition, in epilepsy surgery, diseases that mimic epilepsy (psychogenicity, vitamin deficiencies, muscle diseases, etc.) should be distinguished very well in the preoperative period. If it is eliminated, seizures can be successfully prevented in 70-80% of patients with epilepsy. If no epileptic seizures are observed in the one-year follow-up after brain surgery and brain EEG activities improve from the tests, the doses and number of anti-seizure drugs used for years before surgery can be reduced.
As a result
Very successful results can be obtained after brain microsurgery operations performed by experienced physicians, especially physicians with epilepsy experience, especially in advanced hospitals with advanced technology. As the number of epilepsy surgeries increases in the world and in our country, it provides very important positive contributions to the budgets of both countries and patients’ relatives. Epilepsy surgery is an alternative treatment option to reduce both the drama of the patient and the urgent sad events experienced by his relatives. Epilepsy surgery is a multidisciplinary team effort.
After the joint decision of these experienced epileptic medicine teams, successful brain microsurgery surgery performed in medical centers with advanced and cutting-edge technologies, such as in our hospital, gives excellent results, and most importantly, I believe that this difficult and complicated disease can be treated.