Monday, February 13, 2023 is International Epilepsy Day. This chronic neurological disease is manifested by “crises” responsible for tremors, muscle contractions, absences… The essential thing to know.
[Mise à jour le 10 février 2023 à 11h00] Epilepsy is a neurological disease chronic which affects 50 million people in the world according to the WHO, including more than 650,000 in France. It can take many forms and comes in seizures. These crises manifest themselves in the form of the symptoms mentioned: tremors, muscle twitches, absences, fainting… In the vast majority of cases (60 to 70%) thanks to drug treatments, epilepsy can be controlled and patients can lead an almost normal life. There International Epilepsy Day is celebrated on February 13, 2023. 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 Epilepsie France.
Definition: what is epilepsy?
I’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 in numbers
- Epilepsy is the second most common chronic neurological disease after migraine.
- Approximately 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.
Symptoms
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, etc.
Temporal epilepsy
I’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
I’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
I’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.
Diagnosis: blood test, MRI or EEG?
The diagnosis is based on questioning (with a witness, if possible) and clinical examinations. A 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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What to do in case of an epileptic seizure?
“The patient can do nothing to fight, he is unaware 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, we can try to place the person aside and securing the environment by placing dangerous objects out of reach (eg sharp objects). “You have to call the Samu and wait“, adds Dr. Morin.
What are the treatments for epilepsy?
“Epilepsy does not systematically justify the prescription of a disease-modifying treatment” recalled the High Authority of Health in 2020. It recommends in children and adults that a treatment is offered “after the second epileptic attack, if the symptoms are disabling and present a risk for the patient and/or his entourage”. The treatment can be prescribed after a first crisis under conditions. In the vast majority of cases (60 to 70%) thanks to drug treatments, epilepsy can be controlled (absence of seizures) and patients can lead an almost normal life: go to school, work, drive. Nevertheless, a third of epilepsies do not respond to drug treatment, and are said to be drug-resistant. Surgical intervention may be proposed: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.
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 (dual therapy) can offer better therapeutic efficacy. In June 2022, the ANSM reported new data concerning the topiramate, pregabalin, and valproate medicationsall three used in the treatment of epilepsy.
► Topiramate : A study published in JAMA Neurol. highlighted a increase with the use of topiramate risk of developing autism spectrum disorders multiplied by 2.77 and intellectual disability multiplied by 3.47 compared to a pregnancy of an epileptic mother without exposure to antiepileptics. In pregnant women, as well as in women of childbearing age and not using an effective method of contraception, in particular because of the high risk of malformations, topiramate:
- should not be used in epilepsy unless absolutely necessary
- should not be used in migraine
- should not be used in any other situation outside of marketing authorization
► Pregabalin : Data from an observational study have confirmed the risk of malformation linked to exposure to pregabalin during pregnancy: this risk is multiplied by nearly 1.5 compared to the population not exposed to this drug. Pregabalin should not be used during pregnancy unless clearly necessary.
► Valproate : valproate and its derivatives are formally contraindicated during pregnancy. In question, risks of eye defects and a risk of malformation estimated at 11% for children exposed to valproate and its derivatives during pregnancy. It is also specified that, in the treatment of epilepsy, taking several drugs including valproate exposes the unborn child to a higher risk of major congenital malformations compared to taking several drugs without valproate.
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.
prevent epilepsy
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.
Association
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).
Sources:
Epilepsies: Management of children and adults. HAS. October 8, 2020
Valproate and derivatives: updated risk information. ANSM. July 8, 2022