Epilepsy is a neurological condition which is the symptom of paroxysmal cerebral hyperactivity may manifest as seizures or unconsciousness, or even by complex hallucinations (visual and / or hearing and / or somatosensory), with or without convulsions, but this is not a mental illness!
Fortunately, many children have little crises today, if they respond well to antiepileptic drugs. By taking regular medication, it is possible that a child has never or very rarely attack.
It is a common misconception that epilepsy is a mental illness during crisis because some patients may exhibit behavioral disorders, but epilepsy does not affect intellectual ability.
The causes are multiple and still poorly understood. We know that fatigue, stress and physical or mental, stimulants, some noises or permanent abnormal strobe lighting or fasting may promote the emergence of a crisis.
There are several types of epilepsy. The differences relate not only to the causes or origins of the disorder or malfunction of electrical cerebral localization, but also on more or less resistance to treatment, the diversity of crises induced, their rhythm, the problems generated, their social consequences, their evolution and their management.
Epilepsy is a neurological symptom caused by abnormal brain activity, some say that "bypasses". During an epileptic seizure, neurons (brain nerve cells) produce a sudden abnormal electrical discharge in certain brain areas.
Normally, epilepsy does not affect mental capacity. However, if attacks occur on young children, so on a young brain is not mature and therefore more sensitive attacks can eventually generate a slight brain dysfunction. Studies have shown that 20% of epileptic children showed a slight delay in various learning, particularly reading.
In children, epilepsy disappears during adolescence, in 6 cases out of 10, when neural circuits have finished their development. In two other cases over 10, drugs can be removed after several years of treatment without a crisis.
Different generalized seizures
tonic-clonic or grand mal
It represents the most dramatic seizure. The patient abruptly loses his knowledge and organization has clearly evolved in three phases: Phase
tonic stiffening, contraction of all muscles of the limbs, trunk and face with the extraocular muscles and mastication;
phase clonic convulsions , disordered contraction of the same muscles
Recovery: Phase of unconsciousness (coma for a few minutes to several hours), characterized by wheezing due to bronchial congestion. This phase is a phase of deep relaxation during which it is possible but not systematic leak urine ...
The return to consciousness is gradual, there is often a postictal confusion and lack of memory of the crisis.
Absence, or petit mal
absences are a common form of epilepsy and relate almost exclusively to children (up to puberty). They manifest themselves sudden loss of contact with eyes glassy aréactivité to stimuli, phenomena clonic (blink eyelid, spasms of the face, chewing), sometimes tonic (stiffening of the trunk) or vegetative (loss of urine, salivation). In typical absence seizures, loss of consciousness and return to consciousness are brutal, the absence for a few seconds. Falls on the ground are rare. In some cases, the absence is not preceded by warning symptoms, or followed a particular feeling. Also, without external evidence, the person with epilepsy sometimes has no way of knowing it was a crisis.
Absences can be repeated 10 to 100 times per day in the absence of treatment.
myoclonus
Myoclonus manifested by sudden twitching, rhythmic, intense, bilateral or unilateral and synchronous on the arms or legs, without loss of consciousness but causing falls to the ground.
Different partial seizures
There may be many symptoms, the epileptic focus is confined to a limited area of the brain and causes clinical signs correlated to the affected area. Signs can be one of the following items:
Sensory hallucinations (visual, auditory, gustatory, vertiginous)
abnormal movements (tonic-clonic seizure focus) or paralysis of the muscles of a limb, head, voice ...
of sensory disturbances ( numbness, paresthesia)
appearance psychiatric disorders such as:
dysphasia (impairment of speech or language comprehension)
dysmnésie (his life flashes before his eyes) (Note: "to have his life which runs under his eyes "is closer to a symptom known to ecmnésie)
psychotic hallucinations
metamorphopsia (distortion of sense objects)
phobic anxiety disorders
autonomic nervous system:
tachycardia, hypotension, vomiting, diarrhea, dyspepsia (indigestion), salivation, gastric pain, gastroesophageal reflux disease.
Simple partial seizures are not accompanied by disturbances of consciousness, unlike complex partial seizures.
In some cases, partial seizures can become generalized (tonic-clonic) in a second time by extension the entire brain of the seizure.
epileptic syndromes
A number of epileptic syndromes have been recognized:
West syndrome: A serious condition affecting infants under one year. Characterized by spasms, psychomotor problems with poor intellectual development, and an EEG showed typical hypsarrhythmia. The child will keep severe neurological sequelae, with a low percentage of emergency.
Lennox-Gastaut syndrome: A serious condition affecting young children two to six years. Found generalized tonic seizures or multiple daily absences, intellectual disabilities. The electroencephalogram between two seizures is also typical. The child usually keep neurological sequelae of varying severity. However, rare cases can progress without sequelae.
Dravet Syndrome, long known as severe myoclonic epilepsy in infancy 'or SMEI has seizures susceptible to foot that can be generalized or partial. It often begins between 4 and 8 months in an infant with no history or delay pre-existing but little trip later and accuse delayed until sometime in the second year. Epilepsy begins with seizures, generalized or unilateral, spontaneous or caused by fever or by a vaccine's development is different depending on the case but often characterized by an unstable behavior, motor skills and language delay. (Source epilepsy France)
Epilepsy absence of the child.
juvenile myoclonic epilepsy: A disease occurring in adolescence made of myoclonic seizures with abnormal electroencephalogram. Favorable.
Epilepsy nocturnal frontal seizures
Febrile convulsions in children: These are generalized seizures (tonic-clonic) and appear in children, between six months and five years on the occasion of hyperthermia, whatever its origin - except for meningitis, which is the direct cause of seizures. These children are more sensitive than other children to have convulsions in a fever (at a fever). This condition disappears with age. The EEG is nearly normal between attacks.
occasional crises: crises in special conditions:
febrile convulsions
Hypoglycemia
ionic disorders, hypocalcemia, hyponatremia
Alcohol intoxication by especially acute withdrawal.
Overdose of drugs (theophylline) or withdrawal of antiepileptic drugs (benzodiazepines)
symptomatic epilepsy: Brain Tumor
Stroke
Encephalitis
head injury: cerebral contusion (loss of consciousness after trauma, without brain damage demonstrated) doubles the risk of developing epilepsy. This risk is increased more than 10 years after the initial accident [3].
Alzheimer's Disease: There is a complication often too little known, but both unsystematic and at an advanced stage of the disease.
cryptogenic epilepsy (epileptic syndromes see above) which it is assumed that organic cause exists, but we can not yet identify.
Epilepsy idiopathic (no cause found or suspected).
There are familial forms of epilepsy, to suspect a genetic cause.
Complications of seizures ¸
Repeated seizures can cause brain lesions. These lesions predominate in brain regions at the root of crises but also in a particular region, the inner surface of the temporal lobe. They may eventually be the source of new crises - they say that the disease is self-aggravating.
The seizures of epilepsy are major twitching in a subject unconscious. There is a risk of injury (fall, dislocated shoulder, various injuries) and tongue biting. The patient never swallow his tongue, so do not try to insert his fingers into the mouth of a patient in full seizure.
status epilepticus
status epilepticus Epilepsy is the most feared medical complication of epilepsy. it is life threatening and functional (risk of permanent neurological damage). It is defined by seizures of unusually long duration (over 30 minutes) or by the occurrence of crises so close that the patient did not have time to recover his wits between two crises. Status epilepticus should call for a precipitating cause.
In the case of status epilepticus with tonic-clonic seizures, the duration of the crisis is feared
respiratory insufficiency and bronchial congestion bradypnea (slowed breathing)
circulatory disorders and neurological sequelae
definitive intellectual
Fluid and electrolyte disturbances (dehydration, acidosis)
cerebral edema
status epilepticus may also occur as part of petit mal: here we find a confused state prolonged, associated with clonic facial expressions very evocative. In case of status epilepticus in partial epilepsy, the diagnosis can be difficult because of the similarity of symptoms with those of a stroke. The EEG can make a difference.
Medical Treatment of Epilepsy
When the crisis broke, there is rarely stopping it, we must act preventively. In the 1980s there were only 4 drugs, now about twenty antiepileptic drugs are available to doctors, each more effective with fewer side effects on alertness and memory in patients.
Today, 7 out of 10 patients are followed with a single drug, and can lead a normal life without seizures, providing that certain precautions.
Surgical
Some patients have their seizures controlled monotherapy or combination therapy after various adjustments several antiepileptic drugs. However, there may be relative or absolute resistance to treatment: one speaks of drug resistance. The poor prognosis of these drug-resistant epilepsy can be improved by surgery. For some forms of drug-resistant epilepsy mostly partial, it is possible to consider a curative surgery (cortectomy or disconnections).
Ask an indication of such an intervention requires highly standardized diagnostic procedures fine. This is a first step to define very precisely the point of crisis and identify the cortical areas concerned. Multifocal epilepsy are mostly rebutted advantage of partial seizures, a better prognosis.
Overall, 70 to 80% of selected patients with epilepsy (mainly temporal but also frontal, parietal or occipital) who see their seizures disappear or decrease significantly postoperatively. The result of the surgery depends largely on careful selection of patients.
Treatment by stimulation
For others, the seizures cause psychological distress generated by the fear that a crisis may happen anytime and anywhere. In recent years, in the case of persistent forms of the disease it is possible to consider the installation of a pacemaker under clavicle connected to the vagus nerve, whose function is to send stimulation to the brain. The stimulation therapy has the advantage of being a good alternative in cases where surgery is not feasible. Despite the step back, this technique results encouraging for the future of these people. Some side effects can be felt, including a contraction of the throat during periods of stimulation, sometimes resulting in a slight change of voice and breathlessness during times of stress (particularly at altitude).
Treatment with dietary modification
In some cases, especially among children, the ketogenic diet may be tried. The ketogenic diet is a regimen calculated rigid and strictly prescribed by a neurologist to treat refractory epilepsy in children. The diet is rich in fat and very low in protein and carbohydrates.
Precautions of life for people with epilepsy and their families
should generally avoid anything that may promote disorders in children:
situations of fatigue, sleep deprivation, physical stress
and / or psychological
permanent or abnormal noises
light intermittently, especially the strobes
fasting
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