Epilepsy

The epilepsy or comitiality , sometimes named high evil , badly null and void or badly crowned , is a neurological affection which is the Symptôme of a cerebral hyperactivity paroxystic which can appear by Convulsion S or a loss of conscience, even by inaugural Hallucination S complexes (visual and/or auditive and/or somesthesic), with or without convulsions, but it is not a Mental disease, contrary to the image which one can have of the patients.

The image of mental disease which is often associated for him is due to the fact that, during the crises, certain sick can present behavioral problem , but the epilepsy does not deteriorate of anything the intellectual abilities. Once on two, it begins as of childhood.
Les causes multiple and is still badly included/understood of it. It is known that tiredness, the stress physical and/or psychic, exciting them (alcohol, tobacco, coffee, the), certain permanent or abnormal noises, stroboscopic lighting or the fast can support the appearance of a crisis.

According to the professor Rene Souleyrol: " the attacks of the body, the shame of the falls, the confiscation of time, the limitation of the pleasures, the veil on the intelligence, the obstacles with freedom, the rejection of the others, the school difficulties, the sorrow of the parents take part in the suffering of the epileptics. ".

There does not exist a but epilepsies . The diversity of the cause-origins of the disorders undergone by each individual, of the place of the brain where appear the electric dysfunctions, their more or less great resistance to the treatments, the diversity of the induced crises, their rate/rhythm, of the generated handicaps, their social consequences, make that each epileptic saw an epilepsy but is not sick epilepsy . Plural is essential in the social or public evocation of these central nervous system disorders handicapping their victims.

History of the epilepsy

In Greek, the word epilêpsis or epilêpsia means: action to seize, to put the hand on something, attacks, interception, sudden stop . It draws its origin from the old Greek: “επιλαμβανειν” (epilambanein) which means “to grate or attack”.

Contrary to its etymological origin, the first concepts concerning the epilepsy would have appeared, not in Greek Antiquity, but in Indian ancient medicine “Ayurvedique” and would have specified themselves and developed for the vedic period between 4500 and 1500 av J-C. One finds in particular the epilepsy in Charaka Samhita (approximately 400 av J-C), the oldest text describing this ancient system of medicine, under the denomination of: “will apasmara” which means “loss of conscience”. Charaka Samhita referred already the various aspects of the epilepsy at the level symptomatologic, etiologic, diagnostic and therapeutic. (WHO, Satyavati., 2003)

What is called " épilepsie" was known Babylonians in the Code of Hammourabi under the denomination of benu , and among Egyptians in the Papyrus Ebers under the denomination of nsjt .

The first true medical treaty on the epilepsy is allotted to Hippocrates ( Of the crowned Disease ); after him, on the epilepsy several Greek authors wrote of which Galien and Arétée de Cappadoce, then Latin of which Celse and Caelius Aurelianus.

And it is only at the 16th century that the literature will again offer - Latin writings - complete treaties on the epilepsy with Cardan, and especially Gabuccini.

The first publication in French language, and which is not a translation of the classic authors, is that of Jean Taxil in 1602 ( Traicté of the Epilepsy, Maladie vulgarly called with the country of Provence, the gouttete with small the enfans ). Others will follow, without bringing anything new good, so much the religious superstitions mainly prevented any significant progression in the scientific comprehension of the diseases in general, and neuro-psychiatric in particular.

Thus, it will be necessary to await the end of the 19th century with John Hughlings Jackson which will advance knowledge on the disease epileptic, by giving the first classification anatomo-private clinic of the phenomena epileptics. Then, thanks to EEG, the authors of the next century will still make progress the classification of the various forms and the various types of epilepsy (Lennox, Gastaut, Gibbs,…).

Epidemiology of the epilepsy

  • Prevalence: The epilepsy is the neurological affection most frequent (0,5  % with 0,7  %) after the Migraine and concerns, in France nearly 1% of the population. The epilepsy in its various forms touches nearly 50 million de people in the world, infants, children, teenagers and adults confused.
  • Incidence: 53 cases for 100  000 inhabitants and per annum (30  000 new cases in France every year).
  • the calculated intermediate duration of the disease is from 6 to 10 years.
  • 30  % of the cases of epilepsy are of origin genetic;
  • 70  % of the cases of epilepsy would be acquired, of which the half have a given cause (a cerebral Lésion due to the after-effects of a suffering at the time of the Grossesse and the Accouchement, of a cranial Traumatism at the time of early childhood, or of a vascular problem…); for the others, the causes remain not elucidated.

The lengthening of the life expectancy increases the risk of appearance, in the elderly, of epileptic fits related to accidents cérébrovasculaires or degenerative diseases.

Private clinic

The epileptic fit

The epilepsy is a neurological disease caused by a momentary dysfunction of the brain; some say that it “shorts-circuit”. At the time of an epileptic fit, the Neuron S (cerebral nervous cells) suddenly produce an abnormal electric shock in certain cerebral zones.

Normally, the epilepsy does not deteriorate the intellectual abilities. However, if the crises occur on infants, therefore on a young nonmature and thus more sensitive brain, the crises can end up generating a light cerebral dysfunction. Studies showed that 20  % of the children epileptics presented a light delay in various trainings, in particular the reading.

Everyone can be concerned by a first epileptic fit, but in half of the cases there will be never again of others. One spoke until there about epilepsy only if the crises were repeated, but since 2006 the doctors agree to say that only one is enough to be epileptic.

In the children, the epilepsy disappears with the Adolescence, in 6 cases out of 10, when the neuronal circuits finished their development. In two other cases out of 10, the Médicament S can be removed after several years of treatment without crisis. For the moment (2007), the epileptic fits are not looked after. They do not have treatment.

Various generalized epileptic fits

Tonico-clonic epilepsy, or “Great evil”

It represents the most spectacular form of epilepsy. The patient brutally loses knowledge and his organization present of the demonstrations evolving/moving in three phases:

  • tonic phase : stiffening, contraction of the whole of the muscles of the members, the trunk and the face of which the muscles oculomoteurs and masticateurs;
  • clonic phase : convulsions, disordered contractions of the same muscles;
  • recovery : phase of unconsciousness (Coma during a few minutes at a few hours), characterized by a noisy breathing due to the bronchial obstruction. This phase is an intense phase of relieving during which one notes a loss of the Urine S…
The return to the conscience is progressive, there exists often a post-critical confusion and the absence of remembering the crisis.

Absence, or “Small evil”

The absences represent a frequent form of epilepsy and concern the children almost exclusively (until the Puberté). They appear by an abrupt loss of the contact with vitreous glance, areactivity with the stimuli, of the tonic phenomena (stiffening of the trunk), clonic (blinking of the Paupière S, spasms of the face, chewings), or vegetative (loss of urines, hypersalivation). In the typical absences, the loss of conscience and the return to the conscience are brutal, the absence during a few seconds. The falls on the ground are rare. The absences can repeat 10 to 100 times per day in the absence of treatment.

This section is the subject of an article with whole share on wikipédia in and

Myoclonie S
They appear by jolts muscular brutal, rythmées, intense, bilateral and synchronous, concerning the arm or the Jambe S, without loss of the conscience.

Various partial epileptic fits

Symptomatology is extremely polymorphic (there can be many symptoms): the hearth epileptic is circumscribed at a limited zone of the brain, and involves clinical signs correlated in the affected area. The signs can be one of the items according to:

  • of the sensory Hallucination S (visual, auditive, gustatory, vertiginous)

  • of the abnormal movements (focal tonico-clonic crisis) or a paralysis of the muscles of a member, head, voice…
  • of the disorders of the sensitivity (numbness, Paraesthesia S)
  • of the disorders of psychiatric appearance a such
    • Dysphasie (disorder of the expression or comprehension of the language)
    • Dysmnésie (its life ravels under its eyes) (note: " to have its life which ravels under its yeux" approaches rather a symptom known under the name of ecmnesia)
    • hallucinations psychotics
    • metamorphopsy (feeling of distortion of the objects)
    • phobic anguishes
  • of the disorders of the vegetative Nervous system :

The partial crises simple are not accompanied by disorders of the conscience, unlike the partial crises complex .

In certain cases, the partial crises can spread (tonicoclonic) in the second time by extension to all the Encéphale of the crisis epileptic.

Syndromes epileptics

A certain number of syndromes epileptics were individualized, characterized by the clinical context, the symptoms epileptics, and the results of the electroencephalogram.

  • Syndrome of West: Affection engraves concerning the Nourrisson before 1 year. Characterized by psychomotor spasms , disorders with bad intellectual development, and an electroencephalogram showing a typical Hypsarythmie. The child will keep severe Séquelle S neurological, with a low percentage of exception.

  • Syndrome of Lennox-Gastaut: Affection engraves concerning the young children from 2 to 6 years. One finds tonic crises generalized or absences pluriquotidiennes, intellectual disorders. The electroencephalogram between two crises is also typical. The child will keep usually more or less severe neurological after-effects. However rare cases can evolve/move without after-effects.

  • Epilepsy-absence of the child.

  • youthful myoclonic Epilepsy: Disease appearing with the made adolescence of myoclonic crises, with an abnormal electroencephalogram. Favorable evolution.

  • feverish Convulsions of the child: These convulsions are generalized (tonico-clonic) and appear in the child, between 6 months and 5 years, at the time of a Hyperthermie, whatever is the origin - except for the Méningite which is the direct cause of the convulsives crises. These children have a sensitivity higher than the other children to make convulsions in a feverish context (at the time of a fever). This affection disappears with the age. The electroencephalogram is quasi-normal between the crises.

Etiologies of the epilepsy

There exists an international classification of the epilepsies. The causes of the epilepsy very many, everyone are perhaps concerned with the appearance of a crisis of epilepsy without to be epileptic . A certain number of affections decrease resistance to fight against the propagation of the electric shock in the brain. It is said that there is a fall of the threshold epileptogene responsible for the epileptic fit.

  • cryptogenic Épilepsie (see the syndromes epileptics above) which one supposes that an organic cause exists, but that one cannot still highlight.

  • idiopathic Epilepsy (no detected cause nor suspectée).

It should well be understood that a convulsive crisis at an individual can occur for multiple reasons, and that all the convulsions are not due to a disease epileptic but to the crossing of this threshold epileptogene. The diseases epileptics not being that affections having for corollary the fall of this threshold on an abnormally low and thus easily passable level at the time of small provocations met in the life of the every day (Fast, alcohol, tiredness…).

Diagnosis

Clinical data

They are the first information collected when a patient presents himself for a diagnosis of his epilepsy. They gather the results of a whole of tests and questions making it possible quickly to give tracks on the type of epilepsy or at least to privilege certain research orientations of the causes of the disease. One can distinguish 4 categories:

  • the history of the disease of the patient: The Neurologue tests, by questioning the patient and his family, to determine the possible origins of the disease (age of appearance of the primary symptoms, falls, cranial traumatisms, family antecedents, etc),

  • the semiology of a standard crisis: The patient and his entourage try to describe the course of the crises (spasms, absences, falls, stiffness, convulsions…). This semiology will be perhaps to specify at the time of a hospitalization with EEG-video (coupled recordings EEG and video). The way in which the crises proceed makes it possible in many cases to specify localization of the hearth epileptogene,
  • the neurological examination: It consists of a battery of test which is used to determine the possible deficits in the neurological functions of the patient. The functions tested are mainly the driving and sensory functions,
  • the neuropsychological examination: Complementary to the neurological examination, it is composed of an examination of the higher functions using standardized tests selected according to their relevance (language, visual and space capacities, executive functions and mainly memory). Deficits in one or several of these functions make it possible to put forth an assumption as for the hemispherical lateralization of the zone epileptogene.

Anatomical and functional data

The anatomical data make it possible to highlight the existence or not of damaged cerebral structures and thus to know the organic hearth likely to generate the epileptic fits. These data are recorded thanks to several methods of cerebral imagery such as the radiological images, the scanner S or the Imagery by Magnetic resonance (IRM). Moreover thanks to the progress made in the field of the encephalic imagery these last years, it is today possible to record the zones of operation of certain parts of the brain thanks to the IRMf.

Tomodensimetry or cerebral scanner

The Tomodensitométrie (TDM) is based on the principle of incremental acquisition: several successive cuts are obtained on different anatomical levels. Before each cut, the table of examination is moved of a preset increment. The distance separating two cuts is thus exact for the motionless anatomical structures but is very affected by the movements of patient.

The indications of the scanner in epileptology thus clearly decreased since the improvement and the diffusion of the apparatuses of Imagery by Magnetic resonance (IRM). Indeed, its sensitivity to detect lesions associated with the epilepsy is rather low (15 to 35%) and is strongly related to the type of epilepsy met, at the age of beginning of the disease and the associated neurological signs.

There are nevertheless circumstances for which the TDM is still useful. First of all in the lately diagnosed epilepsies, it can constitute the examination of first intention because the production times are in general very short. It is particularly interesting to prescribe it in the event of first crisis associated with focal neurological signs, because it makes it possible to eliminate a diagnosis from expansive as well as congenital cerebral lesions or acquired cerebral lesion. The TDM is also the only examination of anatomical imagery available when the patient presents a counter-indication to IRM.

IRM

Within the framework of the anatomical study of the brain, IRM gives images more precise than the scanner, one sees the various cerebral structures well there, one distinguishes the gray substance there and the white substance, one can see the vessels precisely also there. In epileptology, IRM became the examination of choice to seek a cerebral lesion old or recent at the origin of the epilepsy because its sensitivity (for the detection of an anomaly in epilepsy it can reach the 90%) and its space resolution are larger than those of a scanner. One can also follow the evolution of a lesion by remaking IRM regularly at a few months or years of interval. Another advantage of this method is that the generation of the images is based on a completely inoffensive principle for the organization contrary to the scanner which use x-rays.

There are however formal counter-indications with this type of examination. Indeed, it should never be practiced on a patient having a cardiac pacemaker, having a prosthesis in the middle ear or the least ferromagnetic foreign body inside cranium. IRM can require the use of a product of contrast (gadolinium salt) injected into blood, it is also necessary to take special precautions in the event of allergic ground.

The only difficulty of IRM is its interpretation because there does not exist really normal IRM because it is always decorated more or less many artefacts. Those all must thus be perfectly known of the doctor who analyzes the image and can cause mistake in interpretation.

Functional imagery

The techniques of functional imagery make it possible to study the operation of the brain. They are different and to some extent complementary to the IRM which it studies its morphology. Today, there exist mainly two types of techniques of functional imagery, those with injection of an isotope, practiced in services of nuclear medicine, and the functional IRM which is practiced in the services of radiology. However, these examinations are not yet used in a current way and remain still the object of many research. They are generally prescribed in the case of partial and refractory epilepsies with the medicamentous treatments in order to pose a possible surgical indication.

The isotopic techniques consist in injecting a radioactive tracer which one will then be able to follow through a succession of images taken at various moments. They are the TEMP (Tomography by MonoPhotonique emission) and the Mtoe (Tomography by emission of positons). By measuring either the cerebral blood flow, or the metabolism of glucose in the brain, these methods of imagery make it possible to locate the hearths of the partial epilepsy. These examinations can be realized apart from the crisis periods (examination interictal) and in this case, the hearth is identifiable thanks to the reduction in the blood flow or the metabolism. In crisis period (TEMP ictal), the hearth will be in hyperdébit or hypermetabolism.

Functional IRM has a different objective which is to locate the cerebral areas implied in precise functions, like the movement, the language or the memory, in order to respect these areas at the time of the surgery. It is an examination which does not require injection of product of contrast and which is based on the detection of variation of the oxygen concentration in the areas activated during the examination.

Electrophysiological data

The recording of the electroencephalographic data is the single means directly of highlighting the epileptic activity. Indeed, the electroencephalography (EEG) makes it possible to record in a direct way the electric activity produced at the most elementary level by the neurons. Contrary to the other techniques of recording, the EEG provides information in real-time and with an excellent temporal resolution about the millisecond (see figure). This examination is impossible to circumvent for the diagnosis and the classification of the epilepsies.

The first experiments made at the man go back to 1924 and the first publications are appeared in 1929 although they began definitely earlier in the animal (as of 1875 by the English physiologist Caton). Since, a number increasingly larger of research were dedicated to him in order to know some always more about associated physiopathology, the nature of the rates/rhythms observed, the clinical utility and this in multiple fields (problem of the sleep, epilepsy, insanities, potentials evoked,…). The epilepsy represents one of the largest topics associated with EEG.

Seek on the epilepsy

Several work is undertaken in Neurosciences in connection with the epilepsy. It is a question of including/understanding the biological corrélats what is observed in private clinic, to describe the neuronal activity during a crisis epileptic, and to include/understand the mechanisms of initiation of a crisis and its physiological consequences with more or less long run.

Animal models of the epilepsy

Since the epilepsy seems to be more one group of symptoms that a single disease, several models are used to study the biological mechanisms of the epilepsy.

  • the convulsive crisis is caused in young rats (10 to 11 days after the birth) by a hyperthermia during 30 minutes.
  • Of the longer crises épileptiformes can be caused at the same age by the application of Kaïnate.
  • a statute epileptic ( status epilepticus ) can be caused by the injection of a strong amount of Pilocarpine, a agonist of the receivers muscarinic. After such a treatment, the animal develops a profile EEG comparable with a statute epileptic.

Corrélats biological of the epilepsy

During a crisis epileptic, a great number of neurons discharges from the potential from action in a synchronized way. The synchronization of the Neuron S is an intrinsic property of the neural networks. The observation of EEG of healthy subjects reveals the existence of various Eigen frequencies to the cerebral activity which correspond to synchronizations of groups of neurons. It would seem that in the case of the epilepsy, this synchronization would pack. More exactly, a dysfunction occurs in the synaptic transmission. During this transmission, neuro-transmitters do not leave the presynaptic termination to the post-synaptic target termination but some are attached to other synapses. This phenomenon is about 5% with the normal, but in the generalized epilepsies, it is of 25%.

Several causes can explain this " emballement" :

  • a surexcitability of the neurons
  • a reduction in the level of inhibition of the neural network.

A crisis epileptic causes on each neuron concerned a series of changes which can explain why an epilepsy becomes chronic. These changes are comparable to the neuronal Plasticité, which explains also the processes of memorizing and training.

Neuronal inhibition seems controlled by an enzyme of the energy metabolism. In the epileptics, this control could be defective, thus supporting the release of the crises.

Implication of the genetics

It is probable that a multitude of genes - of which much is still to identify - interact in a very complex way. In certain family genetic forms - concerning hardly 1% of the cases - Australian researchers of Epilepsy Research Center of Melbourne (Australia) succeeded in identifying ten genes. Genetic research, which is at the borders of research and the private clinic, is only with their stammerings, but should be able to help in the future in the diagnosis and the choice of certain strategies of treatments. For example, in the case of certain types of epilepsy, likely to become complicated of a Encephalopathy in very young children, the epileptologists hope to be able to much earlier diagnose them, as of the first months of life, thanks to the molecular genetics. This, in order to be able to propose a treatment able to reduce the gravity of these encélopathies, to even prevent some occurred.

In France, a molecular center of genetics especially dedicated to these rare pathologies was set up at Pity-Salpêtrière.

Complications

Complications of the epileptic fit

The repetition of the epileptic fits can involve the appearance of cerebral lesions. These lesions prevail in the cerebral areas at the origin of the crises but also in a particular area, the inner face of the temporal Lobe. They are likely to be thereafter at the origin of new crises - it is said that the disease car-worsens.

The convulsives crises of the epilepsy are great muscular jolts at an unconscious subject. There exists a risk of wound (falls, luxation of the shoulder, traumatisms various) and of bite of the language. The patient never swallows his language, therefore one should not try to introduce its fingers into the mouth of a patient in full convulsion.

The state of evil epileptic

The state of evil epileptic : it is the medical complication most dreaded of the epilepsy, it engages the vital prognosis and functional (risk of final neurological after-effects). It is defined by a crisis epileptic of abnormally long duration (more than 30 minutes), or by which has occurred of crises if brought closer that the patient does not have the time of retrouvrer his spirits between two crises. The state of evil epileptic must make seek a starting cause: stop of the treatment, catch of poisons (ic intoxication alcohol in particular), taken Drug S contra-indicated, Infection, etc

In the case of a state of evil by tonicoclonic convulsives crises, the duration of the crisis makes fear:

  • respiratory Insufficiency by bronchial obstruction and Bradypnée (respiratory deceleration)
  • Circulatory trouble
  • neurological and intellectual After-effects final
  • Turbid hydro-electrolytic (dehydration, Lactic acidosis)
  • cerebral Edema

The state of evil can also occur within the framework of the small evil: one then finds a prolonged confusional state, associated with clonic demonstrations of the face very evocative. In the event of state of evil by partial epilepsy, the diagnosis can be difficult because of the resemblance of the Symptôme S to those of an cerebral vascular accident. The electroencephalogram makes it possible to make the difference.

In the extreme cases, the crisis can lead to the Mort of the patient, by cerebral Anoxie.

Medical treatment and assumption of responsibility

Action to be taken vis-a-vis an epileptic fit

Foreword

It should well be understood that the epilepsy is a medical diagnosis. All the crises epileptics are not accompanied by convulsives crises, and all the convulsives crises are not epileptics. One can easily confuse a convulsive crisis with a crisis of Tétanie, and a convulsive crisis can be due to a neurological traumatism (cranial Traumatism or rachidian) or to a Hyperthermie - it is in particular the case of the convulsives crises due to the fever in the infant.

The crises can really be impressive , with movement convulsifs and loss of consciousness, in 3 cases out of 10. But generally, the crisis touches only one cerebral zone and the symptoms show through only on part of the body or a function: muscular jolts, sensitive disorders…

In the child, the epileptic fit can appear by absences, short ruptures of contact with fixity of the glance, sometimes of the blinkings of eyelids. The child is known as “in the moon”.

First emergency measures

If one is in the presence of a crisis of convulsion, it should be made sure that the person cannot be wounded by her movements (one it protects): one draws aside the objects around it, and one can pose a folded linen or a cushion under his head.

Once the crisis passed (it lasts seldom more few tens of seconds, even if this time appears longer), one approaches the victim for him to put questions. If she does not answer or does not react, one controls his breathing and one acts consequently: put in side Position of safety and alarm at the helps if it breathes (in the majority of the cases), or cardiopulmonary alarm then Réanimation if it does not breathe any more.

In general, the person will take again conscience after the convulsive crisis, the action to be taken vis-a-vis a Malayan is to put the person at rest, to question him on the circumstances of her faintness, in particular if it is the first time, if she is under medical care and if she had an accident recently. One will ask for a medical opinion near a doctor, for example by calling the services of emergency medical assistance by specifying all the noted elements.

Especially not to make:

  • phase 1: fall stiff muscles: nothing to put in the mouth the victim

  • phase 2: convulsion: not to intervene or try to stop the movements
  • phase 3: loss of conscience: when the person takes again conscience only not to leave it

Medical care of a crisis

The transfer as soon as possible in medical reanimation is an urgency as of the diagnosis posed. A EEG in urgency as well as a medical check-up will have to be carried out, without delaying the implementation of the methods of reanimation and the treatment medicamentous:

  • Maintenance of a good respiratory function: installation of a Nozzle of Guedel, ventilation with the mask, aspiration of bronchial secretions, intubation and mechanical Ventilation to the maximum.
  • cardiovascular Monitoring: scopage cardio-tensionnel with monitoring of the cardiac rhythm, the blood pressure, blood oxygen saturation.
  • Installation of a venous way for hydro-electrolytic balancing and perfusion of the anti-convulsivants drugs.

The anticonvulsivant treatment rests in first intention on a Benzodiazépine injected by intravenous way slowly over 2 minutes. In the event of failure at 10 minutes, a second injection is carried out. In all case, at the conclusion of two injections (and even if the crisis yielded), one associates a second antiepileptic IV (type Valproate).

Medical care of the epilepsy

When the crisis bursts, there is seldom average to stop it, it is thus necessary to act as prevention. In the Années 1980 there existed only 4 drugs; today, a score of molecules Antiépileptique S are at disposal of the doctors, all more effective and with less side effects on vigilance and the memory of the patients.

Today, 7 patients out of 10 are followed only with one drug, and can carry out a normal life without crises, realizing some precautions however.

Independent groups of antiepileptic

The independent groups of Antiépileptique S (or anticonvulsivants) are:

Surgical treatment

Certain patients see their crises controlled in monothérapie or after various therapeutic adjustments associating several drugs anti-epileptics. However, one observes sometimes a resistance relative or absolute with the treatment: one speaks about pharmacorésistance. The severe forecast of these epilepsies pharmacorésistantes can be improved by the recourse to the surgery. For certain forms of primarily partial epilepsies pharmacorésistantes, it is thus possible to consider an surgical operation with aiming curatrice (cortectomies or disconnections).

To pose the indication of such an intervention requires standardized diagnostic procedures extremely fine. It is initially a question of delimiting in a very precise way the starting point of the crises and to determine which are the cortical territories concerned. The epilepsies multifocales will be challenged most of the time with the profit of the partial epilepsies, of better forecast.

The patients candidates with the surgery are thus subjected to a complete pre-surgical assessment carried out by a multi-field team. It is composed of at the same time neurological, electroclinic and neuropsychological investigations. Crucial data are also collected in electrophysiology (recording EEG, SEEG) and during examinations of cerebral imagery (morphological and functional IRM, study of the metabolism…). It is a question of assessing the benefit ratio/risk of the possible surgical treatment.

All in all, they are 70 to 80% of the selected patients reached of epilepsies (primarily temporal but also frontal, parietal or occipital) which see their crises disappearing or decreasing significantly into post-operative. The result of the surgery depends mainly on a rigorous selection of the patients.

In France, each year, only 200 to 300 people are concerned with this operation, and according to a neuropédiatre of the Robert-Debré hospital of Paris: “ It is too little, and in addition the withdrawal periods between the assessment and the intervention are too much long, with the risk of an additional cognitive deterioration ”, and according to French association for the epilepsy: “ It is not the panacea and she does not address herself to all the patients (...) One should not give false hopes to people, the majority of the patients are not operable . ”

Treatment by stimulation

For the others, the crises involve a psychological distress generated by the fear which a crisis occurs any time and anywhere. For a few years, in the case of persistent forms of the disease it has been possible to consider the installation of stimulative under clavicle, connected to the vagus, whose function will be to send stimulations to the brain. Treatment by stimulation with the advantage of being a good alternative if surgical operation is not possible. In spite of the little of retreat, this technique has encouraging results for the future of these people. Certain side effects can be made feel, in particular a contraction of the throat for the periods of stimulation, sometimes involving a light modification of the voice, and breathlessness for the periods of effort (in particular in altitude).

Treatment by the modification of the food

In certain cases, especially in the children, the ketogenetic Diète can be tested. The ketogenetic diet is a rigid therapeutic mode and strictly calculated, prescribed by a neurologist to treat the refractory epilepsy in the children. The diet is rich in lipids and very low in proteins and glucids.

Precautions of life for the people epileptics and their family

All should in a general way be avoided that can support the disorders:

  • situations of tiredness, lack of sleep
  • the alcohol consumption
  • physical, and/or psychic stress
  • permanent or abnormal noises
  • the light intermittent, particularly that of the Stroboscope S
  • the fast

The Tobacco, the Coffee, the The can, indirectly, increase the frequency of the crises, by a negative effect on quality of the Sommeil.

Particular cases

The video games, the Data-processing video and it in general, can start crises among patients having a photosensitive epilepsy “”, i.e. sensitive to the light. It is necessary to use screens or Télévision S with a Fréquence at least equal to 100 Hz, or screens with liquid crystals.

The sport

The physical-activity and sporting is strongly recommended for its virtues of integration and self-confidence (sports of team in particular).

However, certain sports are to be practiced with a particular vigilance or specific equipment, because their practice could put the patient in critical situation and risky in the event of which has occurred of a crisis. For example:

The driving license automobile

In France, it is usually interdict with the epileptics to pass the driving license, but since the improvement of the medical assumption of responsibility of the disease a medical opinion can grant a temporary authorization to driving of a car. On the other hand the epileptics do not have access to the professions of the road (Transporteur, Autobus…)

Prohibited professions

  • heavy plant drivers, bus and heavy truck.

  • Plunger rescuer, swimming teacher.
  • Flight crew air.
  • Surgery Police N
  • and fireman

Others

Insurance

It always should be checked that different the Assurance S personal subscribed does not exclude disease (contracts of assistance, insurances cars, etc)

Loans

The people epileptics can have difficulties in negociate loans of long life; often, an additional insurance their is imposed, or the insurance suggested excludes the cover from the risks related to the epilepsy. New legal tendencies however oblige the French banks with an special attention and loans can however from now on be granted to expensive conditions, more expensive than with the other citizens, but still reasonable. One should not in any case not stop with the reflex of safety of the banker, and in the event of failure, ask Banque de France an arbitration.

Herb trade

In Herb trade, the GUI was prescribed against the epilepsy.

Famous characters which one claims that they suffered from epilepsy

Works treating of the epilepsy

  • the Rise of the High Evil of David B. (1996 - 2003).
  • the epileptics do not hide any more to cure by the professor Rene Souleyrol, a work impresses humanism on lived of the patients.
  • epilepsy, a disease refuge of Dr. Gilbert Diebold, Calman-Levy editions; one of the only works which approaches the psychic aspects of this disease. Dr. Diebold exerts at the same time in neurology and psychoanalysis.
  • " Epilepsy of Sujet" of Andre Polard ED. Harmattan the 2004 author proposes in particular a " dispositif" of reception of the first crise/L' author is psychoanalyst and devoted a thesis of doctorate to the epilepsy.

Congress

The 26e international congress on the epilepsy was held with Paris at the end of August 2005 and has joins together more than five thousand specialists come from the whole world. At the time of this congress the problems involved in the life of the people were particularly tackled -- schooling of the young epileptics, depression and anxiety related to the disease, the desire of child and the follow-up of the pregnancy of the women epileptics -- but also with the genetics and the therapeutic prospects for the surgery.

External bonds and references

Random links:Slade | The Master and Marguerite | Valley of Giffre | Marfa Boretskaya | Jan Metzelaar