Epilepsy can start at any age in life. The intermittent and unpredictable nature of crises is a sword of Damocles, which has a major impact on patients' quality of life.
Treatments for epilepsy
Therapeutic management of epilepsy depends on its origin (focal or generalized) and its cause (lesion, genetic, etc.).
This care must be comprehensive, aimed on the one hand at making crises disappear, or at least alleviating them, on the other hand at eliminating or correcting their causes, but also at identifying and treating the consequences of the disease on the patient’s life, such as learning disabilities or depression.
Anti-epileptic therapies
Anti-epileptic drugs work through a variety of mechanisms to try to prevent recurrence of seizures:
- by stabilizing the membrane of neurons by regulating the opening and closing of ion channels, particularly those permeable to sodium, thus preventing the excessive propagation of neuronal discharges.
- blocking excessive stimulation of receptors, which excite neurons (such as glutamate receptors)
- activating receptors, which inhibit neurons (such as GABA receptors)
- by modulating the release of synaptic vesicles.
These treatments are chosen by the neurologist according to the type of seizure (indeed, some drugs may be ineffective in absences, myoclonus), and above all according to the patient’s terrain (there are side effects specific to each treatment, so the choice will depend on the patient’s age, his sex, and the associated diseases).
In 30% of patients, anti-epileptic drugs are ineffective. It is therefore necessary to continue to identify new anti-crisis mechanisms, and therefore to develop new medicines. The epilepsy team at the Salpêtrière hospital, in coordination with the Centre d’investigation Clinique, at Paris Brain Institute, led by Dr Céline Louapre and Professor Jean-Christophe Corvol, enables the early evaluation of new anti-epileptic drugs in therapeutic trials. This allows some patients to benefit from new drugs before they are marketed.
Epilepsy surgery
In the case of “drug-resistant” focal epilepsy, removal of the area of the brain that caused the seizures may be considered.
In order to target the brain area responsible for seizures, the epileptogenic focus, the clinicians and researchers of the Brain Institute use different technologies, within the framework of a unique technical plateau in Ile-de-France. Pre-surgical assessment requires:
- Surface and sometimes intracerebral electroencephalography (EEG). These continuous recordings are made 24 hours a day, 7 days a week, for 2 to 3 weeks, in the Epilepsy Unit to collect several seizures.
- Positron emission tomography (PET), carried out in the Nuclear Medicine department, makes it possible to identify brain areas that do not take up glucose well, and therefore are involved in the epileptogenic focus.
- SPECT during a seizure is an examination that visualizes the region of the brain activated by a seizure: this examination identifies the increase in local cerebral blood flow, linked to the increased energy needs of neurons recruited by the seizure.
- Functional Magnetic Resonance Imaging (fMRI), carried out in the Neuroradiology department, makes it possible to assess whether the brain area identified as the cause of seizures can be operated on. If this area is still functional, i.e. activates during certain exercises, then the surgical operation can be recused.
When the brain region responsible for epilepsy is very finely determined at the end of this complex assessment, a neurosurgical intervention is proposed: resection of the epileptogenic focus, in the Neurosurgery Department, by Dr. Bertrand Mathon, allows the complete recovery of 50 to 80% of patients.
Other neurosurgical approaches such as vagus nerve stimulation may be proposed. Their principle is to perform a chronic neuro-modulation of the brain to decrease the frequency and severity of seizures.
New techniques are being evaluated, including laser treatment of the epileptogenic region, when it is inaccessible to a conventional surgical procedure.
