Neurology

The diagnosis and treatment of adult and pediatric brain-nerve muscle diseases are performed using clinical experience and technological developments at Yeditepe University Hospital, Department of Neurology.

• General Neurology
• Epilepsy
• Stroke Center
• Neuropsychology
• Headache
• Neuro-oncology
• Alzheimer
• Sleep disorders
• Dizziness and balance disorders
• Multiple Sclerosis
• Parkinson’s and movement disorders
• Neuromuscular Diseases

• When cerebrovascular diseases (stroke-stroke) can be treated especially within minutes and hours when they first occur, permanent damage can be prevented. In addition, diagnosis and treatment follow-up for secondary prevention is also performed after stroke.The diagnosis and treatment of epilepsy is evaluated by preoperative evaluation, long-term video-EEG examination, neuropsychological evaluation, MR, PET-CT and SPECT tests.

• Neuropsychology Laboratory: EEG, EMG, Transcranial Magnetic Stimulation
• Balance Laboratory: Posturography
• Neurocongnitive Laboratory
• Sleep Disorders Laboratory

Intraoperative imaging methods, methods of monitoring and prevention of possible diseases are also used.

In Turkey and all over the world, every year thousands of people are diagnosed with epilepsy. Every year, 26th of March is accepted as “Purple Day”, that is “Epilepsy Awareness Day” in the world. The idea for Purple Day originated in 2008 in Canada, led by Cassidy Megan, a 10-year-old girl with epilepsy. The main purpose of Cassidy in launching the Purple Day event was to make sure that epilepsy patients know that they are no different from other people and that epilepsy patients are not alone. Purple color preferred it in some cultures because it signifies loneliness. This corresponded to the sense of social isolation that many people with epilepsy felt. The “Purple Day” event, which was initiated with the aim of understanding epilepsy by people and raising awareness on this issue, continues to be echoed all over the world. Thanks to the Purple Day event, every year on March 26th, people support patients with epilepsy by dressing in purple. As Yeditepe University Hospital, we stand by patients and their relatives to raise awareness of the society about epilepsy.

An epileptic seizure (or crisis) is a clinical condition that occurs when the normal activity of the brain is disrupted by the temporary abnormal electrical activity in nerve cells. Epilepsy, also known as “Sara’s Disease” among the people, manifests itself with epileptic seizures. When an epileptic seizure occurs, the patient may experience temporary loss of consciousness or symptoms of different characteristics. Having a single seizure does not mean that a person has epilepsy.
Epilepsy is a very common disease. The incidence in the society is between 0.5% and 1% as in our country and in the world. There is no difference in the incidence of epilepsy between genders.
Epilepsy can occur at any age and time, not in a particular age group; However, its incidence increases until the age of 16 and after 65 years of age. Epilepsy is the most common neurological disease in children up to the age of 16.
Observations of the mother and father play an important role in the diagnosis in childhood when the disease is common. Occasionally following situations may be observed; the child smacks his mouth, sudden jumps-jerking on his arms and legs, a bad smell in his/her nose that no one can hear (for example, the smell of burnt rubber) or the child stares into space, and stays blank for a few seconds. Some of these behaviors are not normal and it is useful to consult a neurologist if they are suspected.

The causes of epilepsy are very diverse and varied. To summarize in general, the following factors are among the causes of epilepsy:

• Hippocampal sclerosis
• Brain tumors
• Hypoxic-ischemic brain injuries
• Central nervous system infections
• Immune-mediated inflammations
• Developmental disorders of brain tissue,
• Developmental disorders in brain vessels
• Hereditary diseases and genetic causes.

However, despite all the improvements in the diagnostic methods of epilepsy, there is a group of patients who do not know what the cause of the disease is, apart from the reasons mentioned above.

There is a group in epilepsy disease where genetic predisposition plays an important role; However, it is not the same for every patient. Today, although there are several diseases that we know which gene and by which way it is transmitted, we do not know about many of them due to complex genetic transmission.

For the diagnosis of the disease, observing the seizure and transferring these observations to the doctor is very valuable. EEG (Electroencephalography), brain imaging (magnetic resonance-MRI) and blood analyzes that the neurology physician deems necessary should be done.

In order to decide whether a previous attack is epilepsy or not, it is very important for the patient or the person who witnessed that attack to be able to accurately convey their observations to the neurologist. If the attack of the patient is an epileptic seizure, the doctor needs the above-mentioned examinations in order to determine what type of epilepsy it is and to decide which drug will be more effective. Using the applications developed by Yeditepe University Hospital on smart phones to help patients and their relatives to observe different types of seizures in epilepsy patients and transfer them to your doctor:

• Capture and record video of the person when he / she has a seizure.
• Record the person’s seizures in the calendar in the application
• Can note information about the number, day, time, duration, type of seizures
• You can save a person to the emergency call section to call in case of emergency.

In addition, with smart phone applications that work in sync with the epilepsy diary at “yeditepeepilepsisiz.com”, they can access personal data from anywhere and share this information with their physician for accurate diagnosis and treatment.

Yeditepe University Hospital in epilepsy diagnosis and treatment of the neurological sciences center is one of the best centers in Turkey. Patients are served with the most advanced diagnostic possibilities for the diagnosis of epilepsy.

An epileptic seizure occurs as a result of abnormal electrical discharge in a certain area of the brain. Depending on the type of epilepsy, the abnormal electrical discharge of the brain may be limited to one area or spread to more distant areas. These abnormal electrical discharges are restricted to the area or cause many different types of symptoms depending on the rate of diffuseness and the regions where they spread. Today, more than 25 different types of seizures and over 100 different epilepsy syndromes have been identified.

The disease is generally known as seizures that occur only in the form of loss of consciousness, spasm, and foaming of the mouth. However, it can occur with many different symptoms; Attacks characterized by sudden freezing, blank stare, unresponsiveness, sometimes licking in the mouth, swallowing and chewing movements, abnormal movements of the arms and legs that start suddenly and end abruptly, easily noticeable behavioral abnormalities such as making strange sounds, or the state of hearing sounds or smells that the people around do not hear, sensations such as nausea, the feeling of dreaming with the eyes ope or can occur in the form of sensations that the patient feels only.

Epilepsy Seizures are generally divided into two main groups as partial (focal) and generalized according to the way the abnormal electrical activity spreads. Clinical symptoms vary according to the rate and localization of this activity.

In partial seizures, abnormal electrical activity starts in a limited area of the brain, it can stay in that area or spread to neighboring areas or more distant areas depending on the strength and propagation speed of the electrical discharge. In such seizures, the entire brain is not simultaneously affected.

In Generalized Seizures, electrical activity either affects all brain regions simultaneously from the beginning or, like in partial seizures, it starts from a limited area and becomes generalized by spreading to all other areas of the brain (which are called secondary generalized seizures).

Attacks can occur for no reason at all, as well as hunger, febrile illnesses, other medications used together, or sleep deprivation in some patients (both sleep itself and insomnia can trigger attacks).

As long as the patient has an epileptic seizure, the patient should not be intervened in any way. Trying to insert a finger, spoon between the teeth to open the patient’s mouth, or press down to prevent contractions may harm the patient.

Under normal conditions, the attack spontaneously ends within a maximum of 1-2 minutes. If the epileptic attack does not end in this period, the patient should definitely be taken to the hospital. While the patient is having an epileptic seizure, it may be necessary to take precautions only to prevent environmental factors from harming him.

• If there is a sharp object or a hard object that may harm the patient in cases such as falling and contraction during the patient’s seizure, the patient should be removed from that danger.
• In case of an attack, tightly tied neckties and scarves that tighten the patient’s throat should be loosened so that the patient can breathe comfortably.
• Making the patient sniff onion, cologne, etc. has no curative meaning in epileptic seizures.
• Holding the arms and legs of a patient with a seizure by relatives or people around him, trying to take control by pressure may cause orthopedic problems such as shoulder dislocation.
• Trying to open the mouth while the patient is contracting; Jaw dislocation can cause many problems such as breaking their teeth, biting the fingers of the person trying to open them by the patient, causing bleeding.
• The person may feel exhausted after recovering, temporarily loss of consciousness and dizziness may occur. This is why the patient should rest for a while.

An epileptic seizure occurs as a result of abnormal electrical discharge in a certain area of the brain. Depending on the type of epilepsy, the abnormal electrical discharge of the brain may be limited to one area or spread to more distant areas. These abnormal electrical discharges are restricted to the area or cause many different types of symptoms depending on the rate of diffuseness and the regions where they spread. Today, more than 25 different types of seizures and over 100 different epilepsy syndromes have been identified.

Epilepsy is a treatable disease; however, it may require long-term treatment and follow-up. Among people with epilepsy, there is a group of patients who can be treated 100 percent. However, since the causes of epilepsy are very different, it is not correct to give a general rate for the patient group that can be treated completely. The cause of epilepsy is the most important factor that determines treatment success. Due to the nature of the disease, there is a group of patients with a poor prognosis and very low treatment success, which roughly constitutes a group of 25-30%.

Recent developments in the treatment of epilepsy disease: new drugs, new surgical methods, new devices in brain batteries and new imaging methods.

Treatment planning for epilepsy patients is primarily done with drugs; However, just like diabetics or blood pressure patients, drugs do not cure the disease but suppress the symptoms. In the group of approximately 45% to 65% of patients receiving medication, seizures can be fully controlled with a single type of medication.

People who are found suitable for epilepsy surgery can be successfully treated with this method.

There is no obstacle for a patient whose seizures are under control to maintain a normal life. However, there is still a huge prejudice against this disease in the society. Due to this prejudice in society; People with epilepsy have great difficulty in finding a job, getting married, having children, choosing their hobbies. These basic problems arise from the ignorance of individuals and society’s perception of epilepsy.

It is not appropriate for people with epilepsy to do some professions even if their seizures are under control. These professions are: pilot, surgeon, and being a driver in public transport. In addition, it will not be appropriate for the person to do work such as roof work and diving where there is a risk of falling and injury. Apart from such professions, it is not suitable for epilepsy patients to work in night shifts, as it may trigger insomnia attacks. Apart from these, there is no harm in working in any job.

Recommendations for epilepsy patients can be listed as follows:

• Hunger and insomnia can be triggers for epilepsy attacks,
• Fever diseases should be properly treated by a specialist.
• They should stay away from the use of some medicines, and their use of medication should be restricted for any reason without consulting the doctor.
• Anxiety and depression can be triggers for epilepsy,
• Factors such as alcohol, flickering and bright lights, and drug abuse affect the illness negatively by lowering the threshold of patients with epilepsy.

In addition, there is no special diet recommendation for the patients or a special exercise recommendation for them to do.

EPILEPSY CAN BE TREATED WITH BOTH MEDICATION AND SURGERY. EPILEPSY DISEASE, WHICH CAN OCCUR DUE TO CONSANGUINEOUS MARRIAGE AND GENE DISORDERS, CAN BE TREATED WITH SURGICAL AND NERVE STIMULATION METHODS, ESPECIALLY MEDICATION. IN THIS WAY, BOTH THE HEALTH AND QUALITY OF LIFE OF THE PERSON CAN BE TAKEN UNDER CONTROL.

Epilepsy is as old as human history! So much so that even Hammurabi Laws mention this. It is known that many people, from the Roman Emperor Julius Caesar to Alexander the Great, from Dostoyevsky to Vincent van Gogh, had epilepsy. This disease, which is seen with certain seizure attacks as a result of impaired electrical activity in the brain, affects 50 out of 100 thousand people a year. This rate can go up to 80-100 in underdeveloped countries due to difficulties during delivery or delays in diseases that need to be treated. Professor Canan Aykut Bingöl, the Rector of Yeditepe University and Neurology Specialist of Yeditepe University Hospitals, stated that epilepsy can be seen at any age, and it is more common in the first five years of age. “While the disease is observed at a certain rate until the age of 10, it is less common between the ages of 10-40. After the age of 40s, the incidence of epilepsy increases in parallel with the prevalence of vascular and brain diseases ”.

Consanguineous marriage is an important risk factor for epilepsy. Stating that the risk of the disease increased 40 times for this reason, Prof. Dr. Canan Aykut Bingöl gives the following information about a research they conducted: “There may be a genetic predisposition in epilepsy. However, as of today, there are very few epilepsy diseases that have been identified and genetically diagnosed. We know that especially consanguineous marriages increase the incidence of the disease. In a study we did in Turkey in the past year, we have examined seven families with consanguineous marriage group of about 2000 people. As a result of the research; It was found that epilepsy was 40 times more common in consanguineous marriages than those who did not. The disease may not occur in people with a genetic predisposition, but epilepsy can be encountered in couples who have consanguineous marriages when genes come together. On the other hand, due to the decrease in consanguineous marriages in our country in recent years, there may be a decrease in the rate of the disease that has occurred. ”

Symptoms of the disease can vary depending on the age at which it occurs. It is also known that there are some environmental factors that trigger the seizures. For example; like drug use, excessive insomnia, stress, alcohol consumption and some medications … Many factors that may have a chemical effect on the body can also trigger seizures. On the other hand, children with learning difficulties should be evaluated in terms of epilepsy. Canan Aykut Bingöl underlined that epilepsy seizures that are not noticed can cause learning difficulties and memory problems, “In this case; the school success of the child falls, it is difficult for the child to establish a relationship. It is important for children with learning difficulties to be evaluated together by a psychologist and a neurologist to distinguish between epilepsy. When these children are treated, both their school success and their relationships with their friends improve; “they come to the same point as their peers.” SURGICAL TREATMENT IS APPLIED TO 15 PERCENT OF THE PATIENTS. 70 percent of epilepsy patients can be treated with medication. In the 15 percent group, seizures can be controlled by surgical or nerve stimulation methods. Canan Aykut Bingöl stated that patients who underwent surgery were a little more fortunate as the risk of seizure later decreased, she adds; “Surgical treatment is used in 15 percent of patients who do not respond to medication. The sooner the treatment is evaluated after the seizures begin and the surgery is directed when necessary, the higher the probability of success after the seizures, namely the recurrence of the seizures. Therefore, it is very important to evaluate patients well and direct them to the right centers.”

The history of modern epilepsy surgery dates back to the 1950s. After it was determined that the disease was caused by the temporal brain, Dr. Wilder Penfield began to treat adult patients by removing the entire temporal brain. Emphasizing that this treatment is still the most widely used method, Yeditepe University Faculty of Medicine Head of Department of Neurosurgery, Specialist Uğur Türe says that in some cases it is sufficient to remove only the damaged hippocampus area in the brain: “However, removing that area required a difficult process. The inadequacy of imaging methods and surgical techniques of that period was also important in this. In the 1970s, Prof. Gazi Yaşargil removed only the damaged area of the hippocampus with the microsurgery method he developed. This treatment by Yaşargil was acknowledged as a revolution in epilepsy surgery. “

Conventional temple neurosurgery is performed on the front of the head. However, the procedure involves the risk of having difficulty reaching the back of the brain and damaging the brain. Stating that they plan to perform the surgery from the nape area for such reasons, Prof Türe said, “We brought this method, which we developed over time, to the world as a new surgical development. When approaching from the front of the head to remove the posterior part of the hippocampus, the procedure may become impossible. However, with our method, the hippocampus can be removed without coming into contact any healthy and normally functioning tissue of the brain” he says. This type of surgery developed by Prof. Uğur Türe and his team was published in the Journal of Neurosurgery, a world-renowned scientific publication, in April 2012 and shared with scientific community. Saying that many surgeons around the world learn this method in training courses, Professor Doctor Türe adds that neurosurgery is a team work. “