February 14, 2022 is International Epilepsy Day, a chronic disease that affects more than 650,000 people in France. The manifestations of this disease are very varied. Definition, causes of a seizure, treatments, figures in France… Update on epilepsy with Dr. Alexandre Morin, neurologist.
[Mise à jour le 14 février 2022 à 09h50] Epilepsy is a neurological disease unknown chronicle which concerns 50 million people in the world according to the WHO, including more than 650,000 in France. February 14, 2022 is the International Epilepsy Day. This Day was launched in 2015 at the initiative of the International Bureau for Epilepsy (IBE) and the International League Against Epilepsy (ILAE). It is relayed by the association Epilepsy France. In everyday life, the people with epilepsy are often stigmatized : child whose “absences” mistakenly lead to think that he is constantly in the moon, or that he is not making an effort, or labeled as having learning difficulties without further investigation to understand the reasons, adult whose colleagues say he/she is slow and not very concentrated in his/her work…
L’epilepsy correspond to a neurological disease which can take many forms and comes in seizures. Epilepsy is caused by sudden activation of a large number of neurons. “It can be like an electric shock that short-circuits a brain region and can spread to the whole brain“, explains Dr. Alexandre Morin, neurologist at Pitié-Salpêtrière (Paris).
- Epilepsy is the second most common chronic neurological disease after migraine.
- About 50 million people worldwide are affected by epilepsy (WHO).
- In France, 650,000 people suffer from epilepsy, i.e. 1% of the population and 50% of them are under 20 (Inserm)
- In more than 50% of cases, epilepsy begins in childhood, before the age of 10: access to education may be compromised.
- the mortality rate is 2 to 3 times higher than that of the general population, and 5 times higher for drug-resistant patients.
- The drug-resistant epileptic population has a suicide rate 10 times higher to that of the general population.
- The risk of premature death in people with epilepsy is almost 3 times higher than in the general population.
Every year, 1 in 1000 people with epilepsy die suddenly.
- Every year, 1 in 1000 people with epilepsy die suddenly and for no apparent reason.
About 50 distinct forms of epilepsy are listed, in their symptomatology and in their evolution. Epileptic seizures manifest themselves in the form of the symptoms mentioned: tremors, muscle contractions, absences, loss of consciousness…
Temporal epilepsy
L’temporal epilepsy corresponds to the most frequent form of epilepsy since it represents about 25 to 30% of cases of epilepsy. This neurological pathology affects the hippocampus located in the temporal lobe of the brain. Neuronal damage leads to a progressive loss of contact with reality and repeated attacks can alter the subject’s memory. The psychic manifestations can be frequent deja vu illusions or, conversely, never seen (a known place or object is not identified as such).
Partial frontal epilepsy
When epilepsy remains localized in the frontal region (cerebral area located in the frontal lobe and involved in language, motor skills, behaviors), the symptoms are as follows:
- tremors,
- contractions,
- muscle spasms…
That’s what we call partial frontal epilepsy.
Due to the great diversity of the areas of the brain affected and the types of abnormalities encountered, the clinical manifestations vary. “Absences”, abrupt and fleeting suspension of consciousness, can occur, “but rather in children. They usually last a minute.“, specifies the neurologist. In its generalized forms, epilepsy can cause more spectacular symptoms:
- body convulsions,
- rolling eyes,
- loss of saliva,
- more or less prolonged loss of consciousness which can in rare cases lead to coma.
Symptomatic epilepsy
L’symptomatic epilepsy is due to brain damage. “Any lesion to the brain can generate epilepsy; epilepsy is then secondary to this lesion“, adds the specialist. When epilepsy is not linked to brain damage, we speak of idiopathic (or cryptogenetic) epilepsy.”This is rather observed in children or young adults, particularly those suffering from a genetic disease. In adults, the disease is most often secondary to a lesion. he continues.
nocturnal epilepsy
L’nocturnal epilepsy occurs during sleep. “In epilepsy, the short-circuit intervenes according to the rhythms of the brain; gold, during sleep, neurons synchronize in very different ways. It can lead to a crisis“, explains the neurologist.
The diagnosis is based on questioning (with a witness, if possible) and clinical examinations. One electroencephalogram (EEG) makes it possible to measure the electrical activity of the brain and to visualize and locate electrical discharges. A brain MRI and a blood test may be prescribed to find the cause of epilepsy: brain tumors or metabolic abnormalities may be the cause of the disease.
The occurrence of a convulsion or muscle stiffening does not necessarily indicate epilepsy. To make the diagnosis of epilepsy with certainty, it is necessary:
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Epileptic seizures manifest themselves in the form of the symptoms mentioned: tremors, muscle contractions, absences, loss of consciousness…”The patient can do nothing to fight, he is not aware of the situation. This is why he must avoid being in dangerous situations (swimming pool, car, etc.)“, explains Dr. Morin. It is necessary to consult a doctor at the first crisis. “The problem is that you need a witness because the patient doesn’t remember. Before consulting a neurologist, you can talk to your general practitioner about it: sometimes it’s just simple vagal discomfort“, wishes to reassure the neurologist. 110 people a day in France have their first epileptic seizure. In the event of a crisis, the entourage must not try to prevent the person from convulsing, let alone place an object in her mouth to prevent her from swallowing her tongue. “This is inefficient and very risky. The strength of a person in a state of epileptic seizure is increased tenfold; you can lose your fingers by putting them in your mouth”. On the other hand, you can try to place the person away and secure the environment by placing dangerous objects out of reach (sharp objects, for example). “It you have to call the Samu and wait“, adds Dr. Morin.
110 people a day in France have their first epileptic seizure.
In the vast majority of cases (60 to 70%) thanks to drug treatments, epilepsy can be controlled (absence of seizures) (Inserm) and patients can lead an almost normal life: go to school, work, drive . Nevertheless, a third of epilepsies do not respond to drug treatments, and are said to be drug-resistant.
Medications
There are many antiepileptic drugs which aim to space out crises, or even eliminate them altogether. It is estimated that antiepileptic drugs control seizures in 70% of patients. The doctor constantly assesses the molecule and the dosage adapted to each patient, depending on the nature of the epileptic syndrome and its intensity. Monotherapy (taking a single drug) is generally recommended. For the most complex cases, the combination of two drugs can offer better therapeutic efficacy.
Operation
Surgical intervention may be offered. “If a tumor is causing epilepsy, it is removed. We can also remove the part of the brain that produces these discharges. These interventions take place on forms resistant to other treatments“, recommends the expert.
Treatment by electrical stimulation of the vagus nerve
Electrical stimulation treatment is part of the therapeutic arsenal. This treatment consists of electrically stimulating the vagus nerve along its path. Also called vagus nerve, this cranial nerve regulates vegetative functions (digestion, heart rate). In practice, it involves implanting an electrical stimulator under the left clavicle, and connected to electrodes attached to the nerve. This procedure is performed under general anesthesia by a neurosurgeon, and reserved for patients whose drug treatment offers insufficient results.
In order to avoid epileptic seizures in an epileptic patient, the treatment must be taken correctly, fatigue must be avoided, as well as alcohol and toxic substances. Certain trades or activities are not indicated for patients with epilepsy, and driving may be suspended.
Epilepsy-France is a national association of patients whose objective is to improve the quality of life of people with epilepsy (care, social integration, schooling, professional life). Local branches are spread throughout France.
Thanks to Dr Alexandre Morin, neurologist at Pitié-Salpêtrière (Paris).