In France, about 500,000 persons - more than half of whom are children - have epilepsy.
The diagnosis is made on the basis of a precise and detailed description of the epileptic seizure: convulsions, loss of consciousness, falls, absences, loss of sphincter control, automatisms, … The diagnosis is confirmed by an electroencephalogram (EEG).
Several methods, including magnetic resonance imagery (RMI), are used to find the cause of the epilepsy. 40% of epilepsies are associated with a brain lesion (congenital malformation, encephalitis, sequels of a brain trauma at birth or following an accident, a brain haemorrhage or infarct, or a tumour. The percentage of tumours that have genetic causes varies between 10 and 25%. The causes of epilepsy are not psychological but organic. However, a seizure can be facilitated by emotions (joy, fear, conflict, …). The consequences of the seizures for the psychological state of patients are distressing. Even benign seizures are difficult to tolerate, and some patients need temporary psychological support. Severe epilepsies can be associated with cognitive deficits, or changes in behaviour, character or personality. These problems need specific attention, especially in children.
There are two major types of seizures:
Generalized seizures, also called tonico-clonic, and partial, or focal, seizures. The tonico-clonic seizures are the best known and most striking, but not the most frequent. Patients lose consciousness, fall, have convulsions, bite their tongue, …
Absences are a brief loss of contact (a few seconds), recognized by a fixed gaze, fluttering of the eyelids, chewing, or inappropriate involuntary movements called automatisms. Absences occur repeatedly during the day.
Partial or focal seizures affect only part of the body. They can affect motor or sensory functions, memory or consciousness. Partial seizure sometimes evolve into generalized tonic-clonic seizures.
Epilepsy is mostly treated by drugs, but they must be taken regularly every day to be efficacious.
Three types of effects are observed:
- the seizures disappear rapidly after the start of the treatment, which should never be interrupted without consulting the doctor;
- the seizures disappear, but the risk of a relapse remains high if treatment is interrupted;
- the seizures persist. This is termed pharmacoresistant epilepsy. It can be treated by surgery to eliminate the brain region responsible for the electric discharge, but only in certain neurosurgery departments specialized in epilepsy. If the treatment is appropriate, most epileptic children do not have seizures. They may, however, have problems in school because of cognitive disorders. A neuropsychological examination is useful to understand these problems that can be handled with appropriate methods of rehabilitation.
