Epilepsy or comitialite, sometimes called high-evil, evil or fell ill sacred, is a neurological condition which is a symptom of hyperactivity paroxysmal brain can be manifested by convulsions or loss of consciousness, even by complex hallucinations inaugural ( visual and / or hearing and / or somesthésiques), with or without convulsions, but this is not a mental illness, contrary to the image that may be sick.
The image of mental illness which is often associated is because, during crises, some patients may have behavioural disorders, but epilepsy does not alter the intellectual capacities. Once out of two, it starts from childhood.
The causes are multiple and still poorly understood. We know that fatigue, stress and physical or mental, exciting (alcohol, tobacco, coffee, tea), some permanent or abnormal noises, strobe lighting or fasting can promote the emergence of a crisis.
According to Professor René Soulayrol: "Violations of the body, shame falls, the confiscation of time limitation pleasures, the veil on intelligence, barriers to freedom, the rejection of others, problems at school, penalty of parents involved in the suffering of epilepsy. ".
There is no one but epilepsy. The diversity of causes-the origins of disorders suffered by each individual, instead of the brain occur where the electrical malfunctions, their greater or lesser resistance to treatment, the diversity of crises induced, their pace, generated handicaps, their consequences social, mean that each lives epileptic seizures but is not sick with epilepsy. The plural is necessary in the social or public mention of these neurological disorders disabling their victims.
History of epilepsy
In Greek, the word epilêpsis or epilêpsia means "to take action, put his hand on something, attack, interception, stopping suddenly." It has its origin in ancient Greek: "επιλαμβανειν (epilambanein), which means" criser or attack. "
Contrary to its etymological origin, the first concepts concerning epilepsy appeared to be not in ancient Greek, but in ancient Indian medicine "Ayurvedique" and would be refined and developed during the Vedic period between 4500 and 1500 BC. There are J.-C. including epilepsy in the Charaka Samhita (about 400 BC. AD), the oldest text describing this ancient system of medicine, under the name "apasmara" which means "loss conscience. " The Charaka Samhita référençait already different aspects of epilepsy at symptomatologique, etiology, diagnosis and therapy. (WHO, Satyavati., 2003)
The so-called "epilepsy" was known to the Babylonians in the Code of Hammurabi under the name "benu", and among Egyptians on papyrus Ebers under the name "nsjt."
The first true medical Treaty on epilepsy is attributed to Hippocrates (De Disease sacred); after him, have written about epilepsy several Greek authors whose Galien Aretaeus of Cappadocia and Cappadocia, followed by Latin which Celsus and Caelius Aurelianus.
And it was not until the sixteenth century literature that will offer new - written in latin - treaties complete with epilepsy Cardan, and especially Gabuccini.
The first publication in French, and that is not a translation of classical authors, is that of Jean Taxil in 1602 (Traicte of epilepsy, disease vulgarly called the country of Provence, gouttete small enfans). Others will follow, without bringing anything new well, both mainly religious superstitions have prevented any significant progress in scientific understanding of diseases in general, and neuro-psychiatric in particular.
Thus, it was not until the late nineteenth century with John Hughlings Jackson will advance knowledge about the disease epilepsy, giving a first classification anatomical-clinical phenomena epilepsy. Then, through the EEG, the authors of the next century will further advance the classification of different forms and different types of epilepsy (Lennox Gastaut, Gibbs, etc.).
Epidemiology of epilepsy
* Prevalence: Epilepsy is a neurological disorder most prevalent (0.5% to 0.7%) after migraine and concern in France about 1% of the population. Epilepsy in its various forms, affects nearly 50 million people around the world, infants, children, adolescents and adults alike.
* Impact: 53 cases per 100 000 inhabitants per year (30 000 new cases in France every year).
* The average duration of the disease is 6 to 10 years.
* 30% of epilepsy cases are genetic in origin;
* 70% of cases of epilepsy are acquired, half of whom have a cause determined (a brain injury due to the aftermath of suffering during pregnancy and childbirth, a head injury during infancy, or a vascular problem…), for others, the causes remain unclear.
The lengthening of life expectancy increases the risk of occurrence among the elderly, seizures linked to stroke or degenerative diseases.
Epilepsy is a neurological symptom caused by a malfunctioning passenger brain, some say that "bypasses". During an epileptic seizure, neurons (brain nerve cells) suddenly produce an abnormal electrical discharge in certain brain areas.
Normally, epilepsy does not have the intellectual capacity. However, if crises occur in young children, so on a young brain not mature and therefore more sensitive crises can eventually generate a mild brain dysfunction. Studies have shown that 20% of children with epilepsy showed a slight delay in various learning, including reading.
Anyone can be affected by a first seizure, but in half the cases there will never be others. They did not speak until then epilepsy that if the crises répètaient, but since 2006 doctors agree to say one is enough to be epileptic.
In children, epilepsy disappears during adolescence, in 6 out of 10 cases, when the neural circuits have finished their development. In two other cases out of 10 drugs can be removed after several years of treatment without crisis. There is a 2008 no treatment to treat epileptic seizures.
The various partial seizures
The symptomatology is extremely polymorphic (there may be many symptoms): the epileptic focus is restricted to a limited area of the brain and results in clinical signs correlated to the affected area. The signs may be one of the following items:
* Sensory hallucinations (visual, auditory, taste, vertiginous)
* Abnormal movements (crisis tonic-clonic focal) or paralysis of the muscles of a member, head, voice…
* Disorders of the sensitivity (numbness, paresthesias)
* Appearance psychiatric disorders such as a
o dysphasia (disruption of expression or understanding of language)
o dysmnesie (his life paraded in front of his eyes) (note: "to have his life that scrolls under his eyes" is approaching rather a symptom known as ecmnesie)
o psychotic hallucinations
o metamorphopsia (feeling distortion of objects)
o anxieties phobiques
* Nervous system disorders vegetative:
o tachycardia, hypotension, vomiting, diarrhea, dyspepsia (indigestion), hypersalivation, gastralgies, gastroesophageal reflux disease.
The simple partial seizures are not accompanied by disturbances of consciousness, unlike the complex partial seizures.
In some cases, partial seizures may become widespread (tonicocloniques) in a second time by extension the entire brain of the seizure.
A number of epileptic syndromes have been individualized, characterized by the clinical symptoms epilepsy, and the results of electro-encephalogramme.
* Syndrome West: Affection seriously affecting the infant before 1 year. Characterized by spasms, psychomotor with bad intellectual development, and an electroencephalogram showing a typical hypsarrhythmia. The child will keep severe neurological sequelae, with a low percentage of emergency.
* Syndrome Lennox-Gastaut: serious illness affecting young children from 2 to 6 years. There are generalized seizures tonic or absences pluriquotidiennes, intellectual. The electroencephalogram between two crises is also typical. The child usually keep neurological more or less severe. However, rare cases can evolve without sequelae.
* Epilepsy absence of the child.
* Epilepsy juvenile myoclonic: Sickness appearing in adolescence from myoclonic seizures, with an abnormal electroencephalogram. Evolution favorable.
* Autosomal dominant nocturnal frontal lobe epilepsy
* Febrile Convulsions of the Child: These are generalized convulsions (tonic-clonic) and appear in children between 6 months and 5 years, during hyperthermia, whatever its origin - except for meningitis, which is the direct cause seizures. These children have a higher sensitivity to other children to convulsions in a febrile (at a fever). This condition disappears with age. Electro-encéphalogramme is quasi-normal between crises.
Etiologies of epilepsy
There is an international classification of epilepsies. The causes of epilepsy are very numerous, everyone perhaps concerned by the appearance of an epileptic seizure without being epileptic. A number of conditions diminish the resistance to fight against the spread of electrical discharge in the brain. It is said that there is a decrease in the threshold epileptogenic responsible for the seizure.
* Occasional Crises: crises occurring in special conditions
o Convulsions febrile
o Troubles ionic, hypocalcemia, hyponatremia
o Alcoholism by drunkenness or especially acute withdrawal.
o Drug Overdose (theophylline) or weaning to antiepileptic medication (benzodiazepines)
* Epilepsy symptomatic
o brain tumor
o Head Injury ...
* Epilepsy cryptogénique (epileptic syndromes see above) which it is assumed that organic cause exists, but we can not yet identify.
* Epilepsy idiopathic (no cause detected or suspected).
It is important to understand that a seizure in an individual can occur for many reasons, and that all seizures are not due to illness but the epileptic crossing this threshold epileptogenic. The disease was epileptic disorders that have accompanied the decline of this threshold to an abnormally low level and therefore easily be crossed when small provocations encountered in everyday life (fasting, alcohol, fatigue…).
They are the first information gathered when a patient comes forward to a diagnosis of his epilepsy. They include the results of a series of tests and questions to quickly give tracks on the type of epilepsy or at least focus on certain lines of research into the causes of the disease. One can distinguish 4 categories:
* The history of the disease patient: The neurologist tries, interviewing the patient and his family, to determine the possible origins of the disease (age of onset, falls, head trauma, family history, etc.). ,
* The symptoms of a crisis type: The patient and his entourage are trying to describe the unfolding crisis (spasms, absences, falls, stiffness, convulsions…). This semiology will perhaps clarify at a hospital with EEG-video (coupled EEG recordings and video). How do crises can in many cases to specify the location of epileptogenic home,
* The neurological examination: It is a battery of tests used to determine possible deficits in the neurological function of the patient. The functions are tested mainly motor and sensory functions,
* The neuropsychological examination: Complementary of the neurological examination, it consists of a review of the functions above using standardized tests selected according to their relevance (language, visual and spatial abilities, and executive functions mainly memory). Deficits in one or more of these functions can make an assumption about the hemispheric lateralization of the epileptogenic zone.
Data anatomical and functional
The anatomical data make clear whether brain damaged structures and thus knowing the home injury likely to generate seizures. These data are saved through several brain imaging modalities such as x-ray images, scanners or the Magnetic Resonance Imaging (MRI). Moreover, thanks to progress made in the field of brain imaging in recent years, it is now possible to record areas of operation of certain parts of the brain using fMRI.
Tomodensimetrie or brain scanner
The tomography (CT) is based on the principle of incremental acquisition: several successive cuts are obtained in different anatomical levels. Before each cut, the examination table is moved to a predetermined increments. The distance between two cups is therefore correct for anatomical structures but is still very affected by movements of the patient.
The indications of a scanner epileptologie have significantly decreased since the improvement and dissemination devices Magnetic Resonance Imaging (MRI). Indeed, its sensitivity to detect lesions associated with epilepsy is quite low (15 to 35%) and is strongly linked to type of epilepsy encountered at the age of onset of the disease and neurological signs associated.
There is, however, circumstances in which CT is still useful. First in newly diagnosed epilepsy, it may be the first consideration because delays in obtaining are usually very short. It is particularly interesting to prescribe when the first crisis associated with focal neurological signs, because it helps eliminate a diagnosis of brain damage expansive and brain damage congenital or acquired. CT is also the only consideration imaging anatomical available when the patient presents an against-indication to MRI.
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