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Created at22 October 2021
Update20 March 2023

Sultan Tarlaci, MD, Professor of Neurology at NPISTANBUL Brain Hospital, which is affiliated with Üsküdar University shared his medical opinion on epilepsy its symptoms, diagnostics and treatment facilities ibn NPISTANBUL Brain Hospital.


“It is estimated that around 70% epilepsy cases can be controlled through first-line therapy, it means that correct treatment results in significant decrease in epilepsy seizures. However, there is so-called “drug-resistant epilepsy”, when seizures are nearly impossible to be controlled over a one year period”, said the doctor, “If not diagnosed and treated at the early stage, epilepsy can cause brain cells damage in the future.”

Epilepsy is a neurological (central nervous system) disorder, when brain activity becomes abnormal, resulting in seizures or loss of consciousness, etc. The doctor notes that there are several obvious implications that can cause epilepsy, they are divided into the following categories: genetic, structural, infectious, metabolic, and immune. A healthy human brain functions perfectly and systematically. When electrical signals in the brain become scrambled, sudden bursts of electrical activity occur, as a result, they cause seizures and other epileptic symptoms.

Epilepsy manifestations can vary widely from one person to another and usually depend on where in the brain the disturbances starts, whether it spreads or not. “For instance”, continues the neurologist, “Some people with epilepsy can blankly stare for a minute, while others lose their consciousness or experience seizures, loss of bowel and bladder control”.  

Sometimes those clusters of brain cells may send abnormal electrical signals to all brain causing major seizures, muscle stiffness, inability to swallow, tongue biting, hoarse breathing, loss of consciousness, loss of bowel and bladder control as well as hoarse breathing.

Rare symptoms

Epileptic seizures include several phases. A seizure is not necessary starts from loss of consciousness. At the beginning, a patient can experience temporary confusion, blanking out or staring into space for a few seconds. Though rarely, people with epilepsy even are not aware of this disorder, because their symptoms are limited to memory loss and visual disconnections.

Drug-resistant epilepsy

A single seizure does not signify epilepsy. A person is diagnosed with epilepsy if two or more unprovoked seizures take place. Though epilepsy is a lifelong condition, but most people with it are able to have normal lives if their seizures are well controlled. Anti-epileptic drugs (AEDs) are the commonly used and first-line treatment of epilepsy. However, if regardless of medicine intake seizures keep occurring, it can be anti-epileptic drug resistant epilepsy. Epilepsy is usually well-controlled with the help of AEDs, around 70% of all cases. Drug-resistant epilepsy is usually observed in patients, who have abnormal electrical bursts in the temporal lobe of the brain.

Medical history   

One of the serious and severe epilepsy types is one that involves the temporal lobe functions’ abnormality. “For such a severe case, the second-line therapy will be applied, the one of a surgical type, i.e. brain implants”, said the doctor. It should be noted that before the implantation, there are certain procedures should be performed as EEG, a sleep EEG, SPECT (CT and radioactive tracer). Nevertheless, to confirm the diagnosis doctors need also to gather a detailed medical history of their patients. EEG is non-invasive diagnostic test, which is applied onto the skin of the patient’s head, therefore, there is no 100% guarantee that the location of electric impulses will be detected precisely.

Aim of treatment

The doctor would like to highlight that surgical implant treatment is not an alternative to AEDs. Brain implants are only applied for those who have a strong confirmed drug-resistant epilepsy, and who have certain indications for this procedure. Therefore, the first-line therapy for patients with epilepsy is anti-epileptic drugs. AEDs in many cases are able to take under control seizures and other epileptic symptoms. You also might need some time to try several AEDs to find the one that works for you. AEDs are prescribed in accordance with a patient’s age, whether or not the patient plans to give birth.  

Brain tissue damage

As it was mentioned above, those sudden bursts of electrical activity can occasionally cause brain tissue damage. Thus, Professor Tarlaci highlights once again importance of early diagnostics and required treatment. People with epilepsy might be targets of prejudice, and sometimes they are more difficult to overcome than seizures themselves. It is obvious that the impact of epilepsy varies significantly depending on the duration and severity of the condition, response to treatment and the healthcare system of a particular region. However, there is still effective treatment opportunities. It means that people with epilepsy are able to have normal lives if their seizures and other symptoms are controlled.