It is the second neurological disease after migraine: 600,000 individuals suffered from epilepsy in France in 2018, according to Inserm. In the collective imagination, an individual having an epilepsy crisis refers to the vision of an unconscious person, paralyzed and agitated by convulsions.
This crisis exists: it is called generalized tonic. However, this is just one of the many that can occur when you have epilepsy. We thus speak of “epilepsies” in the plural, because the disease manifests itself in very different crises depending on the part of the brain affected: a distinction is made between generalized crises and so-called focal or partial crises.
A single mechanism is responsible for epileptic seizures: hyperactivity of neurons which creates too much electrical intensity in the brain. When they are generalized, they are caused by the excitation of a diffuse network of neurons in the two hemispheres of the brain. When the crises are focal, the electric discharge only affects one region of the latter.
The “tonicoclonic” or “convulsive” crisis is the most typical manifestation of a generalized crisis. During one to three minutes, the patient falls, utters a possible cry and paralyzes. Then, it is agitated by large shakes, sometimes loses its urine and secretes saliva in greater quantity.
A generalized crisis can also be revealed by what are called “absences”, which are frequent in children. The patient suddenly loses consciousness, his gaze becomes fixed, and this for about ten seconds.
Regarding partial seizures, which affect more than two thirds of patients, the symptoms differ according to the location of the brain concerned and are manifested for example by stiffening, uncontrolled movements, tingling or even auditory and visual hallucinations .
Stiffness, tingling and hallucinations
Additional complexity, the causes of epilepsy vary widely. “Each age group will have its own causes,” explains Sophie Dupont, neurologist at the AP-HP at La Pitié-Salpêtrière. In childhood, they tend to be genetic or metabolic, but can also result from birth accidents.
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Growing up, these are problems of cortical or vascular malformations that can lead to epilepsy. As we get older, it can be brain tumors, sequelae of strokes, or Alzheimer’s disease.
Thanks to many antiepileptic drugs, almost 70% of patients are stabilized, that is to say that they will not have an attack, if the treatment is followed scrupulously and they maintain an adequate lifestyle.
For patients with treatment-resistant partial epilepsy, suppression of the epileptic focus in the brain may be considered during epilepsy surgery. A practice which only concerns a few hundred cases a year, and which Bertrand Devaux, neurosurgeon at the Sainte-Anne hospital in Paris, seeks to democratize. “The means exist, it is simply necessary that a certain number of taboos be broken and that we understand that surgery is an effective treatment. The benefits are generally far greater than the risks involved, ”he says.
For children suffering from absence of epilepsy, there is a high dropout rate. “As contact is broken for a few seconds at a frequency of several times a day, with normal intelligence, their understanding is impaired”, develops Sophie Dupont. Similarly, certain professions are prohibited for epilepsy, such as civil aviation and the national police. Access to the steering wheel is also limited, which has a strong impact on daily life.
If you are near someone who is having a seizure, certain reflexes can protect them.
First, put aside potential objects that could hurt him and protect his head. If she has any, take her glasses off. It is not recommended to put anything in her mouth, as she could bite very hard and break a tooth. Finally, put it in the lateral safety position to allow it to breathe better.
The important thing is not to leave the person alone, and to call for help if the convulsions do not stop or if the recovery takes too long.
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