By Jacques Emmery, General Practitioner, “Order of Tarn’s doctors”’ vice-president
Next the chronic phase occurs Epileptic seizures are less violent and less frequent. The child wakes up slowly but seizures are still resistant to treatments (they are called “drug-resistant”). It is at this time that an evaluation of the after effects can be carried out. Unfortunately after effects will often be severe particularly on a cognitive level, that is to say waking and connecting with the environment. There can also be a major deficiency of episodic memory, significant language troubles both with understanding and expression as well as behaviour troubles with a “frontal syndrome”.
Indeed, the brain’s frontal lobes are the seats of the psyche and their damage provokes a “frontal syndrome” which is manifested in deterioration, sometimes really significant, of mood and character. These cognitive and behavioural troubles can be matched with the seizures, the patients make good progress during calm periods but regress when the seizures become more frequent.
At this stage, MRI scans show brain damages is usually non-existent at the first examination. The hippocampus is atrophied, explaining the loss of episodic memory. The cerebral cortex (which can be compared to the brain’s envelope where the most important psychomotor activity takes place) is damaged mostly in temporal, parietal (brain’s sides) and frontal areas. A more sophisticated examination, the Positron Emission Tomography (PET), allows doctors to understand the deterioration level of the brain’s activity (hypometabolism), sometimes more clearly than MRI imaging shows.