Epilepsy (also called lobe epilepsy by doctors) is a neurological brain disease characterized by repeated attacks of very varied. We distinguish two types according to their visible progress (signs), but also their electrical sequence described by the electroencephalogram (EEG) with generalized epilepsy total unconsciousness and partial epilepsy (or focal) where consciousness is only altered, suspended.
A first seizure may mean an entry of epilepsy (repeated attacks), or otherwise never be followed by no other. A crisis that remains isolated (50% of cases) is not epilepsy.
Epilepsy affects all ages, its genetic share is estimated at 40%. Half of the cases begins in childhood. It is not always definitive: an epileptic child often more crisis after adolescence, when the brain completes its maturation.
A seizure lasts a few minutes. The longer it takes the more it is serious. Beyond 30 minutes, we speak of a "status epilepticus". This is a medical emergency.
Risks and origins of epilepsy
In 2010, various forms of epilepsy is the most common neurological disability in Europe, affecting 6 million patients of all ages and all conditions. With a total cost estimated at 0.2% of GDP in industrialized countries.
Second neurological disease after migraine: it affects about 1% of the population is 500,000 to 600,000 people, half under 20 years. ; at an estimated annual cost of 3.5 billion euros. Better management of epilepsy represents a major economic issue. A 10% misdiagnosis would allow savings of around 15 million euros per year (National Committee report for Epilepsy, March 2011).
This health problem is even heavier than epilepsy is still considered a shameful disease by the general public and patients themselves. The refusal of the disease leads to poor adherence to long-term treatment, which limits its effectiveness.
Any seizure exposed to fatal accidents since the unconscious person loses all protective reflex drowning, road accidents, fractures ...
Epilepsy also exposed to a high risk of sudden death during attacks by neurons disturbances to control heart rhythm (autonomic nervous system). Genes and environment (neuronal growth) are very involved in this entanglement epilepsy / sudden death.
The repetition of seizures decreased brain performance. For each crisis frees aggressive substances for neurons, which cause their "suicide" (apoptosis). Which in turn results in a greater tendency to crisis by aberrant reorganization of neuronal connections. Hence the aphorism doctors "that crisis crisera" ... unless effective treatment.
The deterioration in intellectual performance promotes socio-professional failure patients who already suffer discrimination for safety reasons: temporary license and under conditions prohibiting workstations requiring sustained attention.
Causes and mechanisms of seizure
It is a disorder of brain function that promotes the unexpected appearance of electrochemical discharges of neurons, intense and synchronous discharges. These bursts can travel throughout the brain or remained localized. They stop themselves through brain brakes (inhibitor system), except during a status epilepticus.
Brain activity is regulated in particular by gamma-aminobutyric acid (GABA), the major inhibitory neurotransmitter in the central nervous system. In patients with epilepsy, the inhibitory action of GABA is reduced. In addition, the control of neuronal receptors to GABA is deficient in patients with epilepsy.
In one third of cases, cerebral scar serves as a trigger, we speak of epileptic focus. It is frequently due to a head injury, brain damage at birth, meningitis, cerebral vascular accident (stroke), a brain tumor, a fever ... Two-thirds of epilepsies have no identifiable initial focus in imaging.
A large Danish study (Christensen et al. Lancet Neurology, March 28, 2009) showed that the risk of epilepsy in a child or young adult is doubled after moderate head injury, and increased more than 7 when the brain injury is severe. This risk persists after 10 years and is even higher than the young is older (over 15 years) at the time of trauma and it belongs to a family of epilepsy.
An epileptic focus can trigger a crisis if the state allows neurons: high level of excitability, inefficient stabilizer systems. It is the seizure threshold which, if exceeded, enables the deployment of the crisis. It varies from one individual to another and for the same individual, depending on the genes, the circumstances of his traumatic story ... Some situations lower the seizure threshold. They expose anyone to a crisis, even non-epilepsy fatigue, lack of sleep, overwork, alcohol, repetitive visual stimulation (tree-lined road, video screen), consumption of stimulants, drugs and toxic.
Symptoms of an epileptic seizure
The symptoms depend on the brain area concerned: generalized or partial seizure. The epileptic focus (area where born the anarchic activation of neurons) is also used to describe them.
They can be dramatic or very discreet, ranging from a simple muscle twitching cheek, from the corner of the mouth, and the rhythm generalized spasm of four members.
The widespread crisis ("grand mal") is the most spectacular manifestation but not the most common. Unconsciousness is complete and is accompanied by a fall, sometimes a tongue biting and loss of urine. A temporary amnesia is still present even at least: amnesia of the crisis, the current date, events before the crisis.
In children, the generalized crisis occurs most often as an absence ("petit mal") that is to say, a break contact of a few seconds, with a stare, automatic gestures and mouthing. It is very often overlooked. And frequent.
Will it possible prevention of epilepsy?
Avoid or aggressively treat any infringement or acquired brain injury: environmental toxins, alcohol, drugs, infectious meningitis and encephalitis ...
Every human being has an epileptic personal threshold. If it's low (by genetic constitution, disease, brain trauma), it is necessary to avoid anything which further lowers and enables the emergence of a crisis. First, the lack of sleep. Then stimulants (tea, coffee), drugs, alcohol, overwork and repetitive visual stimulation (video screens, TV, etc.).
When to see the doctor?
Once a person has a loss of consciousness accompanied by contractions or spasms, even discrete, members or face. Especially if there is amnesia of the episode and loss of urine. Sphincter relaxation is an evocative sign of seizure.
How to prepare for the consultation?
Keep a calendar of bizarre events, crises and circumstances in which they appear: current medications taken of toxic, lack of sleep, pee in bed suddenly ...
Maintain his medical book containing all treatment history and personal and family medical history.
What does the doctor?
The doctor examines and questions the patient and then prescribe an electroencephalogram (EEG - recording brain electrical activity), and a CT scan or MRI to take stock of a possible outbreak brain behind the crisis.
It sends the patient to a neurologist epileptologist to confirm the diagnosis, initiation of treatment and follow-up are specialist.
Support 100% is under Affection Long Term (ALD) 9 for severe epilepsy.
A long-term treatment is not systematic in a single isolated attack. But when it is required, it is introduced for several years.
In case of inefficiency (persistence of crises under treatment) or intolerance, we can change and / or combine several different drugs.
Taken properly, effective treatment can lead a normal life during drug-sensitive epilepsy (two-thirds of cases).
When the disease is resistant to treatment (drug-resistant epilepsy, 30% of cases), surgery is possible if there is an epileptogenic focus that can be removed without too much damage to brain function. The total cure is possible in about 70% of cases (National Committee report for Epilepsy, March 2011).