Epileptic Persons Research Articles

Wearable Epileptic Seizure Prediction System Based on Machine Learning Techniques Using ECG, PPG and EEG Signals

Epileptic seizures have a great impact on the quality of life of people who suffer from them and further limit their independence. For this reason, a device that would be able to monitor patients' health status and warn them for a possible epileptic seizure would improve their quality of life. With this aim, this article proposes the first seizure predictive model based on Ear EEG, ECG and PPG signals obtained by means of a device that can be used in a static and outpatient setting. This device has been tested with epileptic people in a clinical environment. By processing these data and using supervised machine learning techniques, different predictive models capable of classifying the state of the epileptic person into normal, pre-seizure and seizure have been developed. Subsequently, a reduced model based on Boosted Trees has been validated, obtaining a prediction accuracy of 91.5% and a sensitivity of 85.4%. Thus, based on the accuracy of the predictive model obtained, it can potentially serve as a support tool to determine the status epilepticus and prevent a seizure, thereby improving the quality of life of these people.

Violence and epilepsy: Descriptive study of 33 cases

Questions are often raised about the relationship between recurrent seizures and the behaviour of the epileptic person. However, some people who have seizures have behavioural problems and are responsible for medico-legal procedures despite the progress of anticomitial chemotherapy. The objective of this work is to develop the sociodemographic and clinical profile found in epileptic patients who committed violent acts.

IMPROVED ARTIFICIAL NEURAL NETWORK FOR EPILEPTIC SEIZURES DETECTION

Electroencephalogram (EEG) is a fundamental and unique tool for exploring human brain activity in general and epileptic mechanism in particular. It offers significant information about epileptic seizures source known as epileptogenic area. However, it is often complicated to detect critical changes in EEG signals by visual examination, since this signal aspect of epileptic persons seems to be normal out of the seizure. Thus, the challenge is to design such a robust and automatic system to detect these unseen changes and use them for diagnosis. In this research, we apply the Artificial Metaplasticity Multi-Layer Perceptron (AMMLP) together with discrete wavelet transform (DWT) to Bonn EEG signals for seizure detection goal. Significant features were then extracted from the well-known EEG brainwaves. Aiming to decrease the computational time and improve classification accuracy, we performed a features ranking and selection employing the Relief algorithm. The obtained AMMLP classification accuracy of 98.97% proved the effctiveness of the applied approach. Our results were compared to recent researches results on the same database, proving to be superior or at least an interesting alternative for seizures detection within EEG signals.

ADASYN and ABC-optimized RBF convergence network for classification of electroencephalograph signal

Electroencephalograph (EEG) is supposed to be a major challenge in the area of biomedical signal processing. Being one of the widely used invasive techniques, it is capable to find many cases of brain disorder problems like epileptic seizures and sleep disorder. This work follows the procedure of convergence computing where there are different computing techniques have been combined together to achieve our final goal with much perfection. radial basis function (RBF) being one of the simplest forms of neural network (NN) can be used for the purpose of EEG signal classification, where the network uses the radial basis function as an activation function. In this study, artificial bee colony (ABC) technique was applied for optimizing the parameters that were required in the RBF network for the EEG signal classification. Adaptive synthetic oversampling (ADASYN) process was considered for improving the learning method of managing the class imbalance problem in the EEG dataset. An EEG dataset for normal and epileptic person is typically seen and is processed where five datasets are combined together in three different ways. The new datasets were grouped and were created as set 1 (A+D & E), set 2 (B+D & E), and set 3 (C+D & E). The ABC optimized RBF classifier is applied along with ADASYN method where the resolution for the above stated datasets states that the classification accuracy for set 1 and set 3 were increasing significantly as compared to the standard RBF classifier network.

Knowledge, Attitudes, and Practices with Respect to Epilepsy among Nurses in the City of Niamey, Niger.

Objective The aim of this study is to evaluate knowledge, attitudes, and practices about epilepsy among nurses in the city of Niamey, Niger, to identify existing gaps in their knowledge concerning epilepsy to formulate recommendations to improve the quality of care for people with epilepsy. Materials and Methods We conducted a descriptive cross-sectional survey on epilepsy knowledge among nurses in the city of Niamey, using a self-administered questionnaire including questions related to knowledge about epilepsy. Results A total of 98 nurses (29 men and 69 women) were included in the survey. The mean age of the participants was of 32.88 ± 10.87 years (range: 17–58 years). The sample consisted of 10.2% of student nurses, 64.3% of college patent, and 25.5% of bachelor nurses. Only 22.4% of participants reported having heard about epilepsy during their training programs. Among the respondents, 43.9% of them had already attended at least one epileptic seizure. Epilepsy is considered as a psychiatric illness and contagious disease by 11.2 and 19.4% of respondents, respectively. The main transmission routes reported were physical contact with an epileptic person (14.3%) and contact with saliva (4.1%). Epilepsy was considered as an incurable disease by 5.1% of respondents. When someone has an epileptic seizure, 10.2% of respondents think that physical contact with this person should be avoided to prevent from contamination. Only 6.1% of respondents had appropriate attitudes when someone has an epileptic seizure such as lying the patient on his side, clearing the airway if necessary, and diazepam injection. Conclusion Considering that people with epilepsy are largely cared out by nurses in Niger, the results of the study justify the need to train nurses with respect to epilepsy to improve their knowledge about epilepsy and the care of people with epilepsy.

Knowledge, attitudes, and practices with respect to epilepsy among primary and secondary school teachers in the city of Niamey, Niger.

ObjectiveWe aimed firstly to evaluate knowledge, attitudes, and practices about epilepsy among primary and secondary school teachers in the city of Niamey and secondly to formulate targeted sensitization messages for these teachers.Materials and methodsA descriptive cross‐sectional survey was carried out among primary and secondary school teachers in the city of Niamey, capital of Niger, using a self‐administered questionnaire including questions related to knowledge, attitudes, and practices about epilepsy.ResultsOne hundred and forty‐five (145) teachers aged 27–69 (mean age: 39.57 ± 8.304 years) had answered the questionnaire (52 men and 93 women). In 62.1% of cases, respondents had a bachelor degree in education signifying a high level of education. Sixty‐one respondents (42.1%) considered epilepsy as a brain disease, whereas it was considered as a psychiatric illness by 15.9% of respondents and as an impurity by 38.9%. Sixteen respondents (11%) considered it as a hereditary disease. Epilepsy was considered as a contagious disease by 46.2% of teachers, and the main transmission routes reported were contact with places of crisis (26.2%), physical contact with an epileptic person (16.6%), and contact with saliva (6.9%). It was considered as an incurable disease by 6.9% of teachers. Of the 115 respondents (79.3%) who considered epilepsy as a treatable condition, 46 of them believe that epilepsy is treated by traditional medicine. When someone has an epileptic seizure, 28.3% of respondents think that physical contact with him should be avoided and that the places of the crisis should be avoided.ConclusionConsidering that epilepsy is common in school‐age, the study results suggest the need to train teachers with respect to epilepsy to change misconceptions about epilepsy and to promote positive attitudes toward epileptic people to avoid the rejection of these people by the society responsible for problems of social integration.

Knowledge, perceptions, and attitudes of students of health-related science colleges towards epilepsy in Taif, Saudi Arabia

Background:Epilepsy is one of the most common disorders that may be associated with negative attitudes among general populations. This may be due to poor public awareness and knowledge toward epilepsy.Aim:To assess knowledge, perceptions and attitudes of students of health-related science colleges toward epilepsy in Taif.Methods:This study was conducted in three health-related science colleges in Taif University. A questionnaire was distributed to students of these colleges.Results:More than 80% of the participants have heard or read about epilepsy. About half of them had witnessed a seizure attack. More than three quarters of the participants thought that epilepsy is a neurological disease. In total 97% of the participants stated that convulsions are the main manifestations of epilepsy. In total 77.7% of the participants selected the medical treatment and follow-up as the most effective treatment of epilepsy. More than three quarters of the participants agreed with that epileptic woman can get married and have children. About 90% agreed to work with epileptic persons and become a close friend of them. About half of the participants believed that the equal job opportunity for epileptic and normal persons should be practiced.Conclusion:The knowledge, perceptions, and attitudes of students of health-related science colleges toward epilepsy in Taif were acceptable regarding to this study. However, the negative attitudes and misconceptions still exist. Further studies are needed to determine methods of overcoming these negative attitudes and misconceptions.

Experiences of epileptic adults with searching for and maintaining a job in the Czech republic: qualitative study


 Epilepsy is the most frequent seizure disorder affecting both social and occupational life of the patients. On the open labour market, these individuals might encounter a number of obstacles, lack of understanding, and limitations. Although epileptic employees do not currently require any adjustments to their working environment in order to improve or perform their jobs, they are often confronted with prejudices, misguided attitudes, stigmatization, and lack of awareness on the part of the employees but also the patients themselves. The presence of epilepsy has multiple implications for occupational life in terms of limited job opportunities on the labour market and decreased chances of getting/maintaining a job.
 The objective of the present qualitative study was to identify, analyse and describe the experiences and needs of epileptic persons concerning their employment. The study was of an exploratory-descriptive nature and involved 25 epileptic adults (17 women and 8 men) with a minimum of 6 months of occupational experience in their current job. The data were obtained by means of the unfinished sentences method (total of 16 sentences) and were analysed using an interpretative content analysis. The content of the unfinished sentences reflected the following timeline: (1) Link to the disease (4 sentences) – (2) Experiences of epileptic persons with searching for a job (5 sentences) – (3) Experiences with performance of the job (7 sentences).
 The participants perceive epilepsy as a barrier to their occupational self-actualization, some of the participants consider themselves as persons with health disability. The social dimension included the participants’ experience with meeting people and their desire for a job, which is often inaccessible due to their disease. The participants consider the process of searching for a job a journey full of hardship and hard-earned experience. The factors that affect getting a job are as follows: stage of disease, employer’s requirements, but also personal efforts and luck. An important aspect is the very first personal presentation during a job interview. A decisive aspect is disclosing the diagnosis during a job interview, or concealing the health status in order to get the job. The participants appreciate when the employer allows adjustment to the working hours or home office, or accepts the participants’ health status. The participants agree that an important aspect is positive assessment by their colleagues; they appreciate their helpfulness, fair approach, support and motivation. They appreciate if their colleagues do not show sympathy. One of the problematic aspects related to employment includes fear of seizures, seizures at work, their frequency and intensity. These and other manifestations of the disease (for example unrest, inattention, fatigue and lack of concentration) raise uncertainty and fear of losing the job. According to the participants, a significant barrier is a low level of awareness and the resulting impoliteness of other people.
 Despite the fact that some of the participants report unpleasant feelings when talking about their disease and consider the disclosure of this information an unpleasant necessity due to possible help required later, being employed is an opportunity for them to work fully and independently, achieve success, become self-reliant, self-confident, responsible and important. These are all qualities that are associated with being employed.

Public knowledge awareness and attitudes toward epilepsy in Al-Kharj Governorate Saudi Arabia.

Introduction:Epilepsy is one of the most stigmatizing disorders. Stigmas and negative attitudes associating epilepsy are due to poor public awareness and knowledge. This study evaluated Saudi public Knowledge, awareness, and attitude towards epilepsy.Materials and Methods:A cross-sectional study conducted during the period from September 16, 2014 to January 1st 2015. A 20-item questionnaire adapted from the literature was validated and distributed to 422 adults living in Al-Kharj governorate, and 22 participants were excluded as they have never heard or read about epilepsy.Results:About 94.79% of participants have heard or read about epilepsy, 63% of them knew someone with epilepsy, and 49.75% have witnessed a seizure attack. Seventy per cent of subjects thought that epilepsy is a neurological disease and 59% believed it is a brain disease. Almost 46.5% selected possession by demons or evil spirits and 51.25% cited envy or evil eye. More than half of subjects selected the medical treatment and follow-up as the most effective treatment of epilepsy. Rather, 41% believed in the faith healing. Most of respondents (81.5%) believed that epileptic children could be successful in normal classes. The vast majority agreed with that epileptic woman can get married and have children. Moreover, 65.25% would allow their offspring to play with epileptic persons and surprisingly, 59% would let their offspring marrying a person with epilepsy. As much as 82.75% agreed to work with epileptic persons and 85.5% would easily become a close friend of them. The equal job opportunity for epileptic and normal persons should be practiced to about 53.75% of subjects. The predictors of good knowledge, limited misconception, and positive attitudes were female gender, being a relative of an epileptic person, and having high educational level.Conclusion:The public knowledge, awareness of and attitudes toward epilepsy were acceptable with regard to this study. However, the negative attitudes and misconceptions still exist.

'Epileptic', 'epileptic person' or 'person with epilepsy'? Bringing quantitative and qualitative evidence on the views of UK patients and carers to the terminology debate.

How to refer to someone with epilepsy is a divisive topic. Arguments for and against different approaches, including traditional adjective labels, disability-first labels, and person-first terms have been presented. The preferences of those with epilepsy and their family and friends have, though, never been determined. This study provides this information for the first time. Via epilepsy interest groups and organizations in the UK and Republic of Ireland, 638 patients and 333 significant others completed an online survey. Three distinct phrases were presented: "They're epileptic" (traditional label), "They're an epileptic person" (disability-first) and "That person has epilepsy" (person-first). Participants identified which they preferred and explained their choices. Patients' median age was 39, with 69% having experienced seizures in the prior 12months. Significant others were typically parents. Most (86.7%) patients and significant others (93.4%) favored the person-first term. Traditional and disability-first terms were "Disliked"/"Strongly disliked". Regression found it was not possible to reliably distinguish between participants favoring the different terms on the basis of demographics. Qualitative analysis of answers to open-ended questions, however, revealed most favored person-first terminology as by not including the word 'epileptic' and by affirming personhood before disability, it was felt to less likely restrict a listener's expectations or evoke the condition's negative association. It was also considered to suggest the person being referred to might have some mastery over their condition. The findings indicate consensus amongst these key stakeholders others for the use of person-first terminology in English. A truly informed debate on the topic can now begin.

Public attitudes and knowledge toward epilepsy in ismailia governorate

Objective This study was conducted to find out knowledge and attitudes toward epilepsy among a sample of people living in Ismailia governorate in Egypt. Patients and methods A cross-sectional survey was conducted by using a face-to-face interview; 840 respondents were included, among whom 420 were from an urban area − Sheikh Zayed district − and 420 were from a rural area − Abu-Sultan village. The survey instrument was a 26-item questionnaire in Arabic form that was designed to evaluate knowledge and attitudes with respect to epilepsy. Results Of the 840 respondents, 91.2% had heard of or read about epilepsy, 24.8% knew someone with epilepsy, and 30.7% had witnessed a seizure. According to the respondents, the main cause of epilepsy was psychological disease (63.7%), followed by evil spirits (Jinn) (49.5%) and a form of insanity (47.4%). Approximately 70% of the respondents (70.7%) agreed that the intelligence of an epileptic patient is below average. About three-quarters of the respondents (74.6%) believed that epilepsy cannot be cured. More than 50% of the respondents believed that an epileptic patient could not get married (57.5%), nor have a child (58.7%). About 80% of the respondents refused to marry an epileptic patient (77.7%) or to marry their child to an epileptic patient (83.0%). Fifty-nine percent of the respondents would not offer a job to a person with epilepsy, and 41.1% refused working with an epileptic patients. The negative attitudes toward an epileptic person were more common among rural, female, less-educated, and elderly respondents. Conclusion Public perception of epilepsy is lacked and needs attention. The study revealed that practices and knowledge toward epilepsy were limited, especially with respect to epilepsy’s cause, manifestation, and management. Continuing effective educational interventions would be needed to improve the appropriate understanding of epilepsy, and to ameliorate the social discrimination and misconceptions against epilepsy.

Seroprevalence and risk factors of human cysticercosis and taeniasis prevalence in a highly endemic area of epilepsy in Bangoua, west Cameroon

Cysticercosis caused by the larvae of Taenia solium is a serious and emerging threat to public health in the endemic areas as well as in the non-endemic areas. Neurocysticercosis, an affection of the central nervous system is a leading cause of epilepsy in endemic areas. This study was carried out to investigate human cysticercosis, taeniasis and risk factors, and also their association with epilepsy in Bangoua, west Cameroon where epilepsy is highly prevalent. Out of 384 people investigated, 12 (3.1%) exhibited antibody response against low molecular weight antigens of T. solium by ELISA. Immunoblot revealed that six persons (1.6%) were seropositive with the same antigens. Among 61 epileptic patients, only one was seropositive by immunoblot and the study did not find any statistically significant difference (P>0.05) in seropositivity to T. solium between epileptic persons (1/61, 1.6%) and non-epileptic group (5/323, 1.5%). In addition, cysticercosis was associated with households eating pork meat from pigs slaughtered at home, but not with other factors. The risk factors including pig farming, the consumption of pork meat, vegetables, and non-drinkable water were attenuated by the relatively good hygiene and pig husbandry practices of the population. No egg of Taenia was found in stool by microscopic examination. All data obtained in this study suggested that cysticercosis might not be the principal causative agent of epilepsy in this area.

TIME-FREQUENCY PROCESSING METHOD OF EPILEPTIC EEG SIGNALS

Wavelet transform decomposition of electroencephalogram (EEG) signals has been widely used for the analysis and detection of epileptic seizure of patients. However, the classification of EEG signals is still challenging because of high nonstationarity and high dimensionality. The aim of this work is an automatic classification of the EEG recordings by using statistical features extraction and support vector machine. From a real database, two sets of EEG signals are used: EEG recorded from a healthy person and from an epileptic person during epileptic seizures. Three important statistical features are computed at different sub-bands discrete wavelet and wavelet packet decomposition of EEG recordings. In this study, to select the best wavelet for our application, five wavelet basis functions are considered for processing EEG signals. After reducing the dimension of the obtained data by linear discriminant analysis and principal component analysis (PCA), feature vectors are used to model and to train the efficient support vector machine classifier. In order to show the efficiency of this approach, the statistical classification performances are evaluated, and a rate of 100% for the best classification accuracy is obtained and is compared with those obtained in other studies for the same dataset. However, this method is not meant to replace the clinician but can assist him for his diagnosis and reinforce his decision.

Knowledge and attitudes towards epilepsy among inhabitants of Silesia. A questionnaire study

Background and purposeEpilepsy is one of the most frequent neurological diseases. Social acceptance is very important for people with epilepsy and their relatives. The aim of the study was to assess public knowledge and attitudes towards epilepsy in Silesia. Material and methodsWe examined 419 people, inhabitants of Silesia, at the mean age of 34 ± 15 years. The study was performed using a questionnaire containing 15 questions evaluating knowledge about epilepsy and attitudes towards people with epilepsy. Results43.2% of the respondents knew an epileptic person themselves. 44.7% had witnessed an epileptic seizure; 68.8% would help a person during an epileptic seizure, but most of them (73.4%) would do it incorrectly (by putting an object into the mouth to prevent biting the tongue). 94.5% of respondents had nothing against friendship with an epileptic person, but 12.1% suggested that children with epilepsy should attend special schools. 85.9% of all those examined said that people with epilepsy should inform others about their disease, 81.9% would mention the existence of an epileptic person in their family. 40.5% of respondents believe that people with epilepsy can do the same jobs as healthy people, 75.3% would employ an epileptic person themselves. ConclusionsThe knowledge about epilepsy and first aid during epileptic seizure is still insufficient among inhabitants of Silesia. Most of the responders, especially better educated ones, declare acceptance and tolerance of people with epilepsy. More effort should be made to improve public knowledge of epilepsy by preparing wide-spread educational programmes.

P02-113 - Mental health and coping strategies in families caring for patient with epilepsy in Iran

IntroductionA research base should be of mental health and coping strategies in families of having patient with epilepsy, in Iran.Objective and aimThese families are at increased risk of stress and weakened family relationship, and to identify the variables that have a negative impact on a families and possible moderating influences on them.MethodThis research was a descriptive study on 150 families of epileptics referring to the Iranian Association of Epilepsy Selected Using a Systematic sampling. All subjects were living with the epileptic person, were at least 16, all Iranian and it was at least six month after the beginning of the family’ epileptic members’ illness. For obtaining further information, a questionnaire consisting of three parts was used. The first part indicated the demographic specifications of the patient's family, the second part showed the General Health Questionnaires (GHQ), and the third part indicated stress coping strategies carversheier- weinrub questionnaires.ResultsAccording to the acquired screen in the total mental health score, the majority of the epileptic patients’ family (56/7%) were not in an appropriate mental health condition. In this report contains depression (56/7%), social functional disorder (52%) somatic signs (61/3%) and anxiety and sleep disorder (6/7%). The majority of under research units based on acquired scores of general stress coping strategies, used this strategies in a medium level.ConclusionThe result is that if there is more mental health in the family of the epileptic patient, they will use stress coping strategies in more suitable level.

Knowledge, Attitude And Perception Of Epilepsy Among Traditional Healers In Uyo, Nigeria

The poor knowledge of epilepsy among traditional healers is due to cultural prejudices and environment. The resultant deep-rooted misconceptions and myths negatively affect the attitudes and encourage traditional care with high morbidity and mortality. The objectives of the study were to assess knowledge of epilepsy among traditional healers and to determine the modalities used in the care. One hundred and seventy three traditional healers from villages/communities in Uyo were assessed for knowledge; attitude and perception of epilepsy, using an interviewer assisted Attitude Questionnaire. Data from 166 (95.9%) healers, consisting of 123 (71.1%) males and 43 (24.8%) females were analyzed. Many of the healers, 139 (83.7%) had little or no formal education. Knowledge about causes, diagnosis and treatment of epilepsy was poor; 74 (44.6%) attributed the cause of epilepsy to witchcraft, 53 (31.9%) to spiritual attacks, 23 (13.9%) punishment for sins. A total of 121 (72%) of them diagnosed epilepsy through oracles/gods. Majority, 161 (97.0%) of the healers preferred native treatment; 54 (32.5%) appeased gods/ancestors, 47 (28.3%) used herbs, roots/animal residues as cure, 10 (6.0%) preferred spiritual/prayers; while 48 (28.9%) used a combination of the rituals. There were prevalent negative attitudes and perception about epilepsy among the healers, as 146 (88.0%) of them viewed it as contagious; 149 (89.8%) would decline either marrying or eating with epileptic persons. Although traditional healers are frequently involved in the care of epilepsy in our environment, they have little or no scientific knowledge about the condition. Adequate knowledge about epilepsy is essential for diagnosis and treatment. Therefore, there is need to improve the knowledge about epilepsy in order to encourage positive attitudes and care. KEY WORDS: Knowledge; Attitude; Perception; Epilepsy; Traditional healer.

The effect of L-Carnitine on Sodium Valproate-Induced Physiological Disturbances in Rats

Background: Chronic treatment with sodium valproate (VPA) can lead to elevation of specific oxidative metabolites that associated with the drug’s toxicity. Results: Valproate exposure leads to an increase in reactive oxygen species (ROS). The levels of lipid peroxidation (malondialdehyde), and lipid profile variables (cholesterol, phospholipids, triglycerides and free fatty acids) were significantly increased (p<0.001) in orally administrated rats with sodium valproate at 400 mg/kg body weight/day. Also the deflection in the activities of catalase (CAT), lactate dehydrogenase (LDH) and Na,K-ATPase was registered where CAT, LDH and Na-K, ATPase activities were decreased (p<0.001) in rats under VPA treatment compared to the controls. These changes were more pronounced in valproate 60 days treated group than in valproate 30 days treated group. Oral administration of l-carnitine (L-CAR) at 300 mg/kg b. w. /day showed alleviation in all metabolic and physiologic changes in rats treated with sodium valproate. L-CAR supplementation might be recommended for human especially for epileptic persons subjected for long term to sodium valproate treatment.

The effect of L-Carnitine on Sodium Valproate-Induced Physiological Disturbances in Rats

Background: Chronic treatment with sodium valproate (VPA) can lead to elevation of specific oxidative metabolites that associated with the drug’s toxicity. Results: Valproate exposure leads to an increase in reactive oxygen species (ROS). The levels of lipid peroxidation (malondialdehyde), and lipid profile variables (cholesterol, phospholipids, triglycerides and free fatty acids) were significantly increased (p<0.001) in orally administrated rats with sodium valproate at 400 mg/kg body weight/day. Also the deflection in the activities of catalase (CAT), lactate dehydrogenase (LDH) and Na,K-ATPase was registered where CAT, LDH and Na-K, ATPase activities were decreased (p<0.001) in rats under VPA treatment compared to the controls. These changes were more pronounced in valproate 60 days treated group than in valproate 30 days treated group. Oral administration of l-carnitine (L-CAR) at 300 mg/kg b. w. /day showed alleviation in all metabolic and physiologic changes in rats treated with sodium valproate. L-CAR supplementation might be recommended for human especially for epileptic persons subjected for long term to sodium valproate treatment.

Altered expression of connexin subtypes in mesial temporal lobe epilepsy in humans

The causes of epileptic events remain unclear. Much in vitro and in vivo experimental evidence suggests that gap junctions formed by connexins (Cxs) between neurons and/or astrocytes contribute to the generation and maintenance of seizures; however, few experiments have been conducted in humans, and those completed have shown controversial data. The authors designed a study to compare the level of expression of Cxs in hippocampi from epileptic and nonepileptic patients to assess whether an alteration of gap junction expression in epileptic tissue plays a role in seizure origin and propagation. The expression of Cxs32, -36, and -43 was studied in 47 consecutive samples of hippocampi obtained from epileptic patients who had undergone an amygdalohippocampectomy for the treatment of intractable seizure. These expression levels were compared with those in hippocampi obtained in nonepileptic patients during postmortem dissection. Immunostaining was performed to create one slide for each of the three Cxs. Each slide demonstrated multiple cells from each of six regions (CA1, CA2, CA3, CA4, dentate gyrus, and subiculum). Two independent reviewers rated each Cx-region combination according to an immunoreactive score. Across all three measures-that is, staining intensity, percentage of positively stained cells, and immunoreactive score-Cx32 appeared to be expressed at a significantly lower level in the epileptic patients compared with controls (p < 0.001 for each measure), whereas Cx43 appeared to be expressed more among the epileptic patients (p < 0.001 for each measure). There was no evidence of any differential expression of Cx36. There was, however, regional variation within each Cx subtype. For Cx36, the staining intensity was higher in the CA2 region in the epilepsy group. The increase in Cx43, decrease in Cx32, and preservation of Cx36 expression in hippocampi from epileptic persons could play a role in the development of seizures in patients with temporal sclerosis. Additional studies must be completed to understand this mechanism better.

Prise en charge médico-sociale spécifique des épilepsies partielles pharmaco-résistantes

L’emploi figure parmi les premières préoccupations des personnes épileptiques ; or, celles-ci se heurtent à un taux de chômage particulièrement élevé en cas de pharmaco-résistance. Toutefois, la persistance des crises ne résume pas à elle seule les obstacles à l’insertion socio-professionnelle, qui peuvent aussi comprendre des perturbations des fonctions cognitives, des difficultés psycho-comportementales, ou encore un déficit des acquisitions scolaires et de qualification professionnelle lorsque l’épilepsie pharmaco-résistante a débuté dès l’enfance. La chirurgie de l’épilepsie, dont la mission est de faire disparaître les crises, peut ne pas contribuer de façon déterminante, tout du moins à court ou moyen terme, à l’insertion socio-professionnelle qui reste dépendante de la conjugaison de l’ensemble de ces facteurs. La prise en charge médico-sociale se doit de prendre en compte ces éléments propres au patient, mais aussi des éléments extérieurs : famille, neurologue et/ou médecin traitant, milieu scolaire, employeur, médecin du travail. Les principales mesures et procédures d’accompagnement médico-scolaire et médico-social sont évoquées. Notre expérience de travail coopératif « de terrain », dans la durée, entre neurologue, médecin du travail, et structures d’insertion, illustre l’utilité d’un accompagnement personnalisé de la personne épileptique depuis son élaboration d’un projet jusqu’à son insertion. While employment appears to be among major concerns for epileptic patients, these are confronted with a very high rate of unemployment, especially when epilepsy is pharmacoresistant. However, the persistence of seizures is not the only factor bearing on vocational training or employment; other factors may intervene as well: cognitive dysfunctions, psychological/behavioral disturbances, impact of AEDs, education, vocational training, family members and relatives’ attitude, school teams’ attitude, employers’ attitude, occupational physicians’ attitude. Educational level is lower when epilepsy started at school-age; persisting seizures together with other problems may lead the epileptic child or teenager to attend specialized schools. In France, there are few institutions dedicated to children or teenagers with severe epilepsy, and these are very unevenly distributed over the French territory. The main social measures regarding children with epilepsy in France are mentioned. Besides being seizure-free and able to drive, work is one major expectation of patients from epilepsy surgery. The results of epilepsy surgery regarding employment are somewhat controversial; in some studies, temporal lobe surgery may not raise the employment rate; other studies point out that operated-on patients need a long time (up to 6 years) to find a job after surgery. The vocational level or the previous work experiences appear to be as important factors for further employment as being seizure-free, a condition which may not be met in all favourable work outcomes. The medico-social support to patients with pharmacoresistant partial epilepsies has to deal with all the factors mentioned previously; the opportunity for epilepsy surgery may have to be considered early in order to try and prevent the detrimental impact of pharmacoresistant epilepsy on school achievement and vocational training; adult patients with pharmacoresistant epilepsy often cumulate a low qualification level, an absence of a solid work experience, a lack of motivation and a social deprivation… Neurologists may have an insufficient knowledge of social and work regulations: in this paper we describe the main possibilities for epileptic patients to obtain social supports in France. Likewise, occupational physicians seldom know much about epilepsies… We have a positive experience of a multidisciplinary approach combining neurologists, occupational physicians and insertion teams. We are convinced that a personalized follow-up of the epileptic person is useful and often.