Comitial crisis: what is it, causes, what to do?

Definition: what is a crisis?

A crisis is a epileptic crisisthe definition of comitial being: “relating to epilepsy“. The epileptic seizure is characterized by transient physical manifestations that result from sudden and excessive electrical discharges of nerve impulses in the brain, veritable ‘lightning’ across many neurons. These discharges appear in the peripheral part of the brain (or cortex) notes the Ameli.fr site. “A seizure can be generalized – it then affects the entire brain -, or focal (previously called partial) – it then affects only one area of ​​the brain.“, specifies Dr. Norbert Khayat, epileptologist. In the majority of cases, focal epilepsy remains confined to the area usually affected by seizures. “Small flat however, by dint of making crises always on the same zone, the electric storm may end up spreading to a nearby area, which is called a mirror focus“, notes the doctor.

Is it the same as an epileptic seizure?

Seizure or epileptic seizure, it’s the same thing. “This term ‘comitiale’ is actually very little used in our profession. In medicine, it is epileptic seizure that we use“, notes Norbert Khayat.

What are the signs of a crisis?

In generalized epileptic seizure, we can describe:

► The jerky movements of the four limbs : “this is the most classic sign“
► The contact breaking episodes : “the patient is absent, staring into space, without associated movement. This is called absence epilepsy.

When a crisis is localized to an area of ​​the brain, it manifests itself differently depending on the area concerned. “If the electrical storm in the brain affects only the area of ​​the brain controlling the right arm, then the patient will only move the right arm. If it only affects the area of ​​vision, then only the sense of sight is affected“, illustrates the doctor. He adds: “more rarely, it happens that the electrical storm that affects one area generalizes to the whole brain. Some patients, who suffer from focal epilepsy, see their epilepsy evolve into secondary generalized epilepsy”.

What are the causes of a crisis?

Epilepsy can be idiopathic – with no known cause – or related to various factors:

• The genetic cause would be present in two thirds of epilepsies. “Apart from certain family forms due to an anomaly of a single gene, epilepsy is most often linked to anomalies concerning several genes.s”, specifies Ameli.fr
• Brain damage : brain tumours, during or after a stroke, in the presence of a vascular malformation, after a head trauma
• An infectious disease of the nervous system such as encephalitis and meningitis
• A brain malformation
• A systemic disease

“Note also that taking alcohol, certain drugs, lack of sleep, the onset of menstruation will favor the onset of an epileptic seizure in an epileptic person“, says Dr. Khayat.

How long does a seizure last?

A seizure usually lasts no longer than two to three minutes. It ends when the movements stop.

Who to consult in the event of a crisis?

First we consult his attending physician who will refer the patient to a neurologist, more particularly an epileptologist. “Obviously, if it is a first crisis, it is necessarily necessary to consult. But if the patient or his parents are used to it and the crisis is short – less than 5 minutes – then it is necessary to practice first aid actions but not to consult., summarizes Dr. Khayat. It is also necessary to consult if a patient has a seizure when his epilepsy has been balanced for a while. “He may then have an associated neurological disorder.

80% of epileptic patients have balanced epilepsy

The diagnosis is based on the clinical examination, the signs described by the patient or his entourage during crises and analysis of an electroencephalogram which records the electrical activity of the brain. “The fact that the patient always has the same type of seizures is also an argument to guide the diagnosis.“, notes the epileptologist. “However, absence epilepsy in young children can progress, as they grow, to generalized epilepsy of all four limbs.further specifies the specialist.

Treatment: what to do in the event of a crisis?

Thanks to the treatments, we know that 80% of epileptic patients have balanced epilepsy. “The treatment is drug. It’s about antiepileptics such as Depakine, Tegretol, Lamictal… These drugs act on the electrical activity of the brain to make it more stable“, says the doctor. In very rare cases, the treatment can be surgical. “In case of focal epilepsy due to a lesion in the brain and if drug treatments are ineffective, this lesion is removed if possible“, he continues. Finally, the vagus nerve stimulator (VNS) is a medical device that sends weak electrical impulses to the left vagus nerve. It is a remedy when the drugs are not effective.

In a crisis, you don’t swallow your tongue, it’s a false belief

Sometimes the patient feels the crisis coming. In that casehe must take shelter: sit down or get into bed especially to avoid injury. “But the majority of patients do not feel the crisis coming. In this case it is important to carefully note the time of the crisis, to protect the person. Once the movements stop, the patient is placed in the lateral safety position and reassuredAbove all, we do not try to take the patient’s tongue out of the mouth. “He won’t swallow his tongue, that’s a false belief. On the other hand, you can make the situation worse by putting your fingers in his mouth.“, warns Norbert Khayat. If a seizure lasts more than 5 minutes, without taking a treatment to stop the seizures, it can then last at least 30 minutes, which is then called convulsive status epilepticus (EMEC ), accompanied by loss of consciousness, and there is a risk of brain damage and death.

“A certain type of epilepsy only manifests itself at night, this is often the case for frontal epilepsy. The right gestures are the same as during a crisis during the day, but the crisis is less dangerous since the patient is already safe in his bed“, specifies Norbert Khayat.

Thanks to Dr. Norbert Khayat, epileptologist and vice-president of the Epilepsie-France association, for his expertise.