Le diagnostic de l'épilepsie fait appel à l'électroencéphalographie. Le scanner cérébral et l'imagerie par résonance magnétique (I.R.M.) permettent parfois d'en trouver la cause.
TRAITEMENT
Le traitement d'une crise de grand mal consiste d'abord en mesures de protection (allongement en position latérale de sécurité, pose d'une canule) et si besoin en une injection intramusculaire de benzodiazépine. Le traitement de fond repose sur la prise de médicaments antiépileptiques pour éviter les récidives des crises. Les épilepsies secondaires ne disparaissent pas toujours avec le traitement de leur cause.
PRONOSTIC
Il est difficile d'établir un pronostic général pour l'épilepsie, celui-ci dépendant de l'existence ou non d'une cause (en particulier, tumeur cérébrale chez l'adulte), de la fréquence des crises et de leur type. Néanmoins, la plupart des épileptiques ont une maladie bien contrôlée par les antiépileptiques et peuvent mener une vie pratiquement normale. Cette qualité de vie est obtenue au prix d'une observation régulière du traitement, qui doit parfois être poursuivi à vie. L'espérance de vie n'est aucunement diminuée dans cette maladie.
L'épilepsie a cependant un retentissement sur la vie privée et professionnelle des patients. Ils doivent en effet respecter une certaine hygiène de vie : heures de sommeil suffisantes et régulières, pas de consommation régulière de boissons alcoolisées. Seuls les patients ayant une épilepsie photosensible (survenant lors d'une stimulation lumineuse intermittente) doivent prendre des précautions lorsqu'ils regardent la télévision, travaillent sur ordinateur ou s'adonnent aux jeux vidéo : pièce suffisamment éclairée, respect d'une distance suffisante entre l'écran et le patient. Dans tous les cas doivent être exclues les activités sportives où une crise peut mettre en jeu la vie du sujet : plongée sous-marine, alpinisme, sports aériens, etc. La baignade en eau peu profonde peut être autorisée si les crises sont bien contrôlées, à condition que le patient soit accompagné. De même, certaines professions sont déconseillées ou proscrites : chauffeur de poids lourd ou de véhicules de transport en commun, personnel navigant des compagnies aériennes, professions où le travail en hauteur est fréquent, etc. Enfin, chez l'enfant épileptique, il existe souvent des difficultés scolaires, dont les causes sont multiples : troubles de l'attention liés au traitement, absentéisme dû aux crises, troubles du caractère.
Voir : antiépileptique.
épiphénomène
Symptôme accessoire qui peut accompagner les autres symptômes d'une maladie, mais qui ne modifie pas le cours de celle-ci et ne nécessite généralement pas de traitement spécifique.
épiphora
Larmoiement anormal consistant en un écoulement des larmes sur les joues.
Un épiphora résulte d'une obstruction du canal lacrymonasal ou d'un ectropion de la paupière inférieure. Les larmes ne sont alors pas évacuées normalement par les voies lacrymales vers les fosses nasales et débordent sur les joues. L'épiphora disparaît avec le traitement de sa cause.
épiphyse
Chacune des deux extrémités d'un os long, souvent renflée et porteuse d'une surface articulaire.
L'épiphyse est constituée d'os spongieux. Elle dépend, pour sa formation, d'un noyau d'ossification spécifique, différent de celui de la diaphyse (corps de l'os long), dont elle est séparée par une zone de cartilage de croissance.
Déplacement de l'épiphyse supérieure du fémur, ou tête du fémur, dû à une anomalie de croissance du cartilage de conjugaison.
Synonyme : coxa vara de l'adolescent.
Tant que dure la croissance du fémur, son épiphyse est séparée de la partie médiane de l'os par une zone cartilagineuse particulièrement fragile, si bien qu'un trouble perturbant la croissance de cette région peut entraîner un déplacement de la tête du fémur hors de son logement. L'épiphysiolyse est une maladie rare qui apparaît chez l'enfant entre 11 et 14 ans.
Ses causes sont mal connues. Le malade boite et peut parfois ressentir des douleurs aiguës à l'aine. La radiographie montre nettement le glissement de la tête par rapport au col du fémur. Le traitement de l'épiphysiolyse est le plus souvent chirurgical : il consiste à fixer la tête fémorale au col, en général par vissage. Il doit être effectué le plus rapidement possible, car les complications de la maladie peuvent être graves : nécrose du cartilage avec contractures musculaires douloureuses, arthrose précoce de la hanche, etc.
épiphysite
Maladie des extrémités des os, touchant l'enfant et l'adolescent, localisée sur le noyau de l'épiphyse de certains os.
Le surmenage des zones articulaires pendant la croissance, dû notamment à la pratique intensive d'un sport, est une cause importante d'épiphysite.
La maladie se manifeste par des douleurs persistantes. Elle aboutit à la nécrose du noyau osseux atteint, entraînant des séquelles parfois importantes et des déformations de la région articulaire lésée.
Différentes localisations ont été distinguées. L'épiphysite peut atteindre le col du fémur ; appelée dans ce cas maladie de Leggs-Perthes-Calvé, elle provoque des déformations, sources d'arthrose très précoce de la hanche, se déclenchant avant 40 ans. Lorsqu'elle est localisée aux vertèbres, l'épiphysite, appelée maladie de Scheuermann, provoque une incurvation excessive de la colonne vertébrale (cyphose), au niveau du thorax. Enfin, elle peut atteindre les os du pied (épiphysite métatarsienne de Köhler) ou du tibia (épiphysite tibiale supérieure déformante, plus connue sous le nom de maladie de Blount, ou épiphysite tibiale antérieure, également appelée maladie d'Osgood-Schlatter).
TRAITEMENT
Il demande souvent une immobilisation dans une attelle ou un plâtre pour réduire le risque de déformation ; une intervention orthopédique peut également se révéler nécessaire.
épiploïte
Inflammation aiguë ou chronique du grand épiploon.
Isolée, l'épiploïte est exceptionnelle. Dans la pratique, elle est presque toujours associée à une inflammation d'un organe abdominal (lors d'une appendicite, par exemple). Son traitement consiste en l'ablation du segment d'épiploon atteint par l'inflammation.
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