, Concernant le type de crises d'épilepsie des SME, 53% présentaient des crises d'épilepsie à départ généralisé, contre 47% à départ focal (figure 25A)

, Une bilatéralisation des crises pouvait survenir chez 11 patients (soit 52%). Dix sujets (48%) pouvaient présenter une aura (sensitive, visuelle, gustative, olfactive, céphalée, trouble végétatif, vol.17

, Au sein des 24 patients présentant des crises à début généralisé, toutes étaient des crises motrices et 9 sujets (37,5%)

, Concernant l'étiologie de l'épilepsie des SME, l'origine structurelle et l'origine génétique dominaient (18 et 17 sujets respectivement), alors que 22% étaient d'origine inconnue (épilepsie focale sans lésion retrouvée ou 1 ère crise généralisée sans anomalie du bilan complémentaire), (figure 25B)

, Certaines pathologies sous-jacentes étaient responsables de migraine et d'épilepsie à la fois, telles que des cavernomes (4 sujets), une MAV, une maladie de Sturge Weber

, La plupart des épilepsies étaient équilibrées avec 34% des sujets ayant moins d'une crise d'épilepsie par an, et 31% moins d'une crise par mois

, Chez les SME, la sévérité de la maladie migraineuse (> 8 migraines par mois chez 12 patients), ne semblait pas corrélée à la fréquence des crises d'épilepsie (16,7% > 1 crise par semaine

, 7% > 1 crise par mois, vol.16

, 33% > 1 crise par an ; et 33% < 1 crise par an), ni avec la pharmacorésistance de l'épilepsie (estimée à 41,7% au sein de cette sous-population

, Les facteurs déclenchant de crises d'épilepsie et ceux de la migraine se recoupaient, avec en tête, la fatigue et le stress

, Nous avons pu montrer que le risque que la fatigue déclenche une crise d'épilepsie était, vol.7, p.25

, fois plus élevé chez les sujets pour lesquels la fatigue déclenche une migraine, p.3

, De même le stress a une tendance, non significative, à favoriser la survenue d'une crise d'épilepsie chez les sujets pour lesquels le stress favorise une migraine (p=0, vol.27

, Les migraines sont jugées comme le 3 ème élément pouvant déclencher une crise d'épilepsie. 5. Comorbidités et altération de la qualité de vie de l'épilepsie

S. Chez-les, échelle visuelle évaluant le retentissement sur la vie quotidienne de 0 à 4, la moyenne était de 2,49 pour la migraine contre 2,44 pour l'épilepsie. de CNEP notifiées dans les dossiers médicaux était de 11, p.9

, Les migraines per-ictales, plus rare, sont considérées par certains auteurs comme des symptômes dysautonomiques d'une crise d'épilepsie à part entière, et pour lesquelles les anomalies EEG ne seraient pas enregistrées efficacement en raison de leur caractère profond

, Dans plusieurs études, les migraines péri-ictales et notamment post-ictales ont été fréquemment observées chez les patients ayant une épilepsie occipitale, ce qui conforte les hypothèses physiopathologiques d'une origine partagée puisqu'il s'agit de la zone où se développe la DCE (63,119). Cependant, aucun sujet dans notre étude ne présentait ce type d'épilepsie. b) Caractéristiques de l'épilepsie

, ? Des crises d'épilepsie généralisées signature d'une origine génétique ? Nous avons retrouvé une proportion de crises d'épilepsie à début généralisé plus élevée (53%)

, De façon contradictoire, les études de Leniger et al, et de Gameleira et al (59) ne retrouvaient pas de différence en terme de type de crises d, qu'en population épileptique générale (environ 30%)

L. , épilepsie était fréquente au sein de notre population, ce qui est cohérent avec une base génétique commune entre migraine et épilepsie, probablement médiée par des dysfonctions de canaux ioniques à l'origine de l'hyperexcitabilité corticale (5)

, Une maladie épileptique possiblement plus sévère

É. Dans-notre, 1/3 des patients épileptiques avaient une épilepsie totalement équilibrée

, Une polythérapie était utilisée dans 42,2% des cas, une monothérapie dans 53,3% des cas, alors que 4,4% ne recevaient aucun traitement médicamenteux. Ces résultats se superposent à ceux de Mainieri et al qui retrouvaient globalement les mêmes proportions

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