L'EEG per la diagnosi di epilessia
L'EEG per la diagnosi di epilessia

Cos’è l’epilessia? Perché viene chiamata il “Grande Male” o il “Piccolo Male”? Cosa avviene esattamente nel cervello? Esiste una cura? Si può condurre una vita normale con questa patologia? Scopriamolo attraverso questo viaggio nei secoli.

Le epilessie sono sindromi caratterizzate dalla comparsa di manifestazioni critiche a carattere convulsivo oppure altre manifestazioni a carattere motorio, sensitivo, psichico o neurovegetativo. Alla base della crisi epilettica c’è un’evidenza di un’ipersincronia parossistica delle onde cerebrali, ciò significa che al momento della crisi si verifica un’ipereccitabilità patologica di alcuni gruppi di neuroni (tutto documentabile all’EEG). Esistono due forme di epilessia: il cosiddetto “grande male” ed il cosiddetto “piccolo male”, analizziamoli uno alla volta.

Il Grande Male è caratterizzato da crisi che iniziano con perdita di coscienza accompagnata dalla caduta a terra del soggetto con un ipertonia muscolare generalizzata, questa è la fase tonica, che dura circa una ventina di secondi. A questa fase segue quella delle contrazioni tonico-cloniche di arti e testa (quelle che comunemente vengono dette convulsioni) per circa un minuto per poi esaurirsi spontaneamente. Durante la crisi può essere che il soggetto si morda la lingua, che perda il controllo degli sfinteri e il riflesso pupillare. Al risveglio il soggetto non conserverà alcun ricordo della crisi, dovuta in questo particolare caso a scariche centroencefalica con frequenza molto variabile.

Il Piccolo Male, invece, consiste in un breve periodo di perdita di coscienza (dai 5 ai 20 secondi) che si ripete frequentemente nel corso della giornata. Si manifesta con le cosiddette “assenze”, il soggetto durante la crisi interromperà qualsiasi attività rimanendo fermo e con lo sguardo fisso nel vuoto per poi riprendere l’attività che stava svolgendo senza conservare alcun ricordo della crisi.

Ancora esiste l’epilessia focale o parziale caratterizzata da crisi dovute a foci epilettogeni a sede corticale le cui manifestazioni dipendono dalle funzioni della corteccia in cui hanno sede i neuroni responsabili.

Ad oggi esistono molti farmaci i cui principi attivi riescono a controllare i sintomi dell’epilessia. Qualora i farmaci non risultassero del tutto benefici per la salute del paziente, lo specialista potrebbe proporre un trattamento chirurgico o altre cure alternative. Il problema più complesso sembra essere la scelta del farmaco più adatto per il paziente, sia in termini di tipologia, che di dosaggio; I principali farmaci utilizzati sono: Fenitoina, Sodio Valproato, Topiramato, Clobazam, Clonazepam, Lacosamide ed altri. Ciononostante il 25-30% dei pazienti risulta resistente al trattamento farmacologico, questo impone un’alternativa, cioè il trattamento chirurgico della malattia. Esistono la chirurgia restrittiva e la chirurgia palliativa: la prima è rivolta ai pazienti che soffrono di epilessia focale e consiste nell’asportazione della parte del cervello che genera le crisi epilettiche, e pertanto la sua asportazione porta al controllo delle crisi. Tale area, per poter essere asportata deve essere unica e la sua asportazione non deve portare a nessun deficit neurologico post-operatorio. La chirurgia palliativa invece si rivolge ai pazienti che non possono essere candidati all’intervento resettivo, ed ha lo scopo di ridurre la frequenza e la gravità delle crisi. Esistono varie tecniche, la più utilizzata è la stimolazione del nervo vago.

Ed ora veniamo alla storia, chi ne ha sofferto? Esistono documenti che provano la malattia di:

  • Giulio Cesare: Negli scritti di Svetonio e Plutarco si parla del generale in preda a malori durante i comizi, sembra trattarsi di un’epilessia acquisita in tarda età. Ma come mai avava cominciato a soffrirne? Tra le ipotesi più accreditate nel passato ci sono state quelle di infezioni croniche come la neurosifilide, data l’elevata promiscuità sessuale del generale romano, la tubercolosi cerebrale, il tifo, la malaria, dal momento che il generale era un frequente viaggiatore in zone geografiche ad alto rischio. Ma c’è chi ha ipotizzato, data l’età di insorgenza, anche un tumore benigno come un meningioma o un glioma. Comunque sia, le manifestazioni epilettiche non si accompagnavano ad un deterioramento delle funzioni cognitive del Generale che ha potuto svolgere adeguatamente le sue funzioni di senatore fino al momento dell’assassinio nel 44 a.C.
  • Fëdor Dostoevskij: Nei suoi scritti si legge “Voi non potete capire la gioia che prova un epilettico un secondo prima di una crisi”. Definiva gli attacchi “il tocco di Dio”, il punto più alto della sua ispirazione artistica. Leggiamo nei suoi libri che moltissimi dei suoi personaggi soffrono di sintomi simil-epilettici, ma qual è stato il decorso di questa sua malattia? La prima ipotesi è che Dostoevskij ebbe il primo attacco di convulsioni intorno ai diciott’anni, appena saputo della morte del padre, in seguito alle prime nozze con Marija Dimitrevna, Dostoevskij venne colpito da un fortissimo attacco che lo lasciò immobilizzato a letto per qualche giorno. Non si tentò mai alcuna cura e questo non era insolito per un’epoca che ancora tendeva a marchiare l’epilessia come un male dell’anima. Resta la tragica morte del figlio Aleksej di tre anni, avvenuta quando Dostoevskij ne aveva cinquantasei, dovuta a un attacco epilettico forse sintomatico di qualche infezione cerebrale. Gli ultimi studi, tendono a diagnosticare un’epilessia del lobo temporale mediale sinistro, probabilmente esordita intorno al 1846.
  • Vincent Van Gogh: Dai documenti si evince che la malattia di Van Gogh si slatentizzò lentamente nel corso della sua vita. Si pensa che un giorno, dopo una crisi di furore in cui aveva gettato un bicchiere di assenzio verso la testa di Gauguin, accaddero una serie di strani eventi. Van Gogh si avvicinò a Gauguin con un rasoio, fu respinto da lui, si allontanò e si mozzò un pezzo dell’orecchio sinistro del quale fece un regalo alla sua prostituta preferita. Lo trovarono incosciente in casa e lo ricoverarono in ospedale. In ospedale scivolò in un acuto stato psicotico di agitazione, delirio e allucinazioni per cui dovette essere isolato per tre giorni. Non conservò alcun ricordo della sua aggressione a Gauguin, né della sua automutilazione nè dei primi giorni di ricovero in ospedale. Félix Rey, il giovane medico curante di van Gogh, diagnosticò una epilessia e gli somministrò del bromuro di potassio. Van Gogh recuperò in qualche giorno. Il suo male fu accompagnato tutta la vita da sintomi psicotici e depressivi che lo portarono alla fine al suicidio.

Ed ancora tanti altri come Alessandro Magno, Aristotele, Charles Dickens, Ludwig van Beethoven, Isaac Newton, Pietro Il Grande, e si potrebbe continuare con una lunga lista.

Ora nel XXI secolo non corriamo più il rischio di cadere nelle credenze di un tempo e considerare l’epilessia come un intervento del diavolo, la manifestazione di un’anima perduta, la mente oscurata dal male. I nomi di queste persone fanno luce su un cammino ben definito, quello di una vita normale, se non addirittura sopra le righe, condotta in concomitanza con una patologia simile.

Fonte | Immagine in evidenza: abcsalute.it

Vicepresidente | Nata a Napoli il 25 Giugno 1992. Ho frequentato l'università degli studi della Campania "Luigi Vanvitelli" laureandomi in Medicina e Chirurgia nel 2017. Attualmente sono una specializzanda in Ostetricia e Ginecologia presso l'Università degli studi di Torino. Mi occupo di coordinare la Redazione de "La Medicina In Uno Scatto", di cui sono anche Vicepresidente.

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