La Revue du praticien最新文献

EFFECTS OF AIR POLLUTION ON EYE HEALTH. In addition to its well-known effects on cardio-respiratory health, air pollution could also have an impact on eye health. Indeed, certain air pollutants, especially fine particles and nitrogen dioxide, can enter the bloodstream, triggering oxidative and inflammatory mechanisms involved in the development of the major eye diseases (glaucoma, age-related macular degeneration [AMD], cataracts). Over the past 5 years, some 15 epidemiological studies carried out in Asia, Europe and Canada have consistently shown an increased risk of these diseases in individuals most exposed to air pollution at long term, particularly to fine particles. These results support the lowering of air pollution thresholds recommended by the World Health Organization (WHO) in 2021, which nevertheless continue to be exceeded in most European cities.

EFFECTS OF YOGA ON MENTAL HEALTH. The literature is piling up on the effects of yoga on health in the three most studied areas: on the brain, stress and anxio-depressive symptoms. Following the "evidence-based practice" approach, studies highlight the positive effects of yoga practice at these different levels in a variety of adult populations. It also involves identifying the modalities of yoga practice (type, duration and frequency of session, etc.) commonly used in these studies, and ultimately benefiting from scientific evidence of their effect on health that can be used for interventions in the f ield.

EPILEPSY DEFINITIONS, CLASSIFICATIONS AND EPIDEMIOLOGY. Epilepsy is the most common neurological disease in the world and the second most common in France. It is defined by the occurrence of 2 unprovoked (or reflex) epileptic seizures more than 24 hours apart, or by the occurrence of an unprovoked (or reflex) epileptic seizure with a recurrence probability of at least 60%. Anti-epileptic treatment can now be started immediately after a first unprovoked epileptic seizure, if risk factors for recurrence are identified, principally the presence of epileptic abnormalities on the electroencephalogram or abnormalities on brain imaging. Epileptic syndromes can either have a characteristic age of onset (newborn, infant, child) or, in the case of other syndromes, a variable age of onset. We are currently witnessing the emergence of epileptic syndromes specific to a given etiology, often genetic.

MANAGING AND PLANNING PREGNANCY IN PATIENTS WITH EPILEPSY. Managing the pregnancy of a patient with epilepsy involves multidisciplinary management and pregnancy planning. Thanks to pregnancy registries, the impact of certain antiepileptic drugs in terms of teratogenicity and neurodevelopment is better known. Two anti-epileptic drugs are particularly deleterious in this respect: sodium valproate and topiramate. Data are awaited on the most recent molecules. The postpartum period should also be closely monitored: management of breastfeeding, screening for postpartum depression, rebalancing of antiepileptic drug dosages.

EPILEPSY AND PSYCHIATRIC DISORDERS (EPI-PSY). Epilepsy is not only a brain pathology characterized by a lasting predisposition to generate seizures, it is also associated with cognitive, behavioral, psychological, and social disorders. The interaction between psychiatric pathologies and epilepsy is bidirectional and complex. This association is summarized in the neologism Epi-Psy. Psychiatric pathologies affect at least one third of epileptic patients and up to 80% in cases of drug-resistant epilepsy. The diagnostic approach should distinguish between peri-ictal disorders (chronologically linked to the seizure: pre-ictal, ictal, or post-ictal) and inter-ictal disorders (not chronologically linked to the seizures: iatrogenic, specific to epilepsy or non-specific). The main psychiatric disorders related to epilepsy are psychosis, depression, anxiety and substance use. The impact on quality of life is significant. The therapeutic strategy is both pharmacological and psychotherapeutic. The prescription of selective serotonin reuptake inhibitors (SSRIs) is possible and desirable for anxiety or depressive disorders, with no contraindication for epilepsy. Collaboration between general practitioners, epileptologists, and psychiatrists is valuable in the field of Epi-Psy.