A neurological evaluation process in which the cause of recurrent seizures is investigated and antiepileptic drug (AED) therapy is planned according to the focal or generalized seizure type.
Indication
- History of two or more unprovoked seizures
- High recurrence risk after a single seizure (abnormal EEG, brain lesion)
- Episodes of loss of consciousness, convulsions, or staring spells
- Suspicion of focal-onset (starting in one area) seizures
- Generalized absence, myoclonic, or tonic-clonic seizures
- Evaluation of treatment-resistant (refractory) epilepsy
- Adjustment of medication dose and monitoring of treatment response
Preparation
- Keeping a seizure diary (frequency, triggers, duration)
- Sleep deprivation may be requested before EEG (sleep-deprivation EEG)
- Bringing a current list of all medications
- Bringing previous MRI and EEG reports
How it's performed
- Detailed neurological examination and information from seizure witnesses
- EEG to record the brain's electrical activity
- Brain MRI imaging to look for structural lesions
- Classification as focal or generalized based on seizure type
- Treatment usually begins with a single drug (monotherapy); combination therapy if response is inadequate
- Regular monitoring of blood drug levels and liver function
Post-procedure
- Frequent visits in the first 3-6 months; then every 6-12 months
- Review of seizure frequency and medication side effects
- Assessment of driving and occupational restrictions
- Referral for epilepsy surgery or VNS in resistant cases
- Reassessment for medication tapering after two seizure-free years
Risks
- Side effects of antiepileptic drugs (drowsiness, rash, liver effects)
- Drug-drug interactions
- Refractory epilepsy in which seizures cannot be controlled (about 30%)
- Emergencies such as status epilepticus (prolonged seizure)
- Teratogenic effects of some AEDs during pregnancy
FAQ
Does epilepsy treatment last a lifetime?
In a significant portion of patients, medication can be tapered under physician supervision after 2-5 seizure-free years; however, some patients require long-term treatment.
Can I drive a car?
According to Turkish regulations, a defined seizure-free period and a physician's report are required. Discuss your individual situation with your doctor.
What should be done during a seizure?
Lay the person on their side, place something soft under the head, and do not put anything in the mouth. If the seizure lasts longer than 5 minutes, seek emergency care.
What if a single drug does not control seizures?
A second antiepileptic is added or substituted; in resistant cases, surgical options can be evaluated at advanced centers.
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