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L'pilepsie dsigne les symptmes lis un fonctionnement hypersynchrone de populations de neurones, crises et ou dtrioration motrice, sensorielle ou cognitive. Chez l'enfant, comme chez l'adulte, elle peut rsulter d'une prdisposition gntique ou d'une lsion crbrale, celle-ci pouvant tre prnatale. Elle peut en outre tre la consquence de crises longues ayant produit une lsion crbrale, hippocampique, voire hmisphrique. La frquence trs leve de l'pilepsie dans les premires annes de vie traduit en outre l'implication possible de facteurs maturatifs. Cette frquence leve trouve son explication dans la prsence d'un excs de synapses excitatrices au cours du dveloppement, un phnomne transitoire ncessaire l'tablissement des rseaux fonctionnels du cerveau adulte. L'pilepsie partielle paroxysmes centrotemporaux EPCT ; est l'essence mme de l'implication de ce facteur propre l'enfant. Il est classique de dire chez l'adulte que l'pilepsie rsulte d'un dsquilibre entre excitation et inhibition. Chez l'enfant, il y a physiologiquement une hyper-inhibition, qui s'accentue encore comme consquence de l'hyper-excitation. Cette combinaison ralise les encphalopathies pileptiques dans lesquelles la dtrioration des fonctions crbrales rsulte de l'pilepsie elle-mme. Le type mme en est le syndrome des pointes-ondes continues du sommeil, forme extrme de l'EPCT. L'activit pileptique un ge donn prdomine dans les parties du cerveau qui connaissent l'excs d'excitation le plus marqu cet ge. Chez le nourrisson, il s'agit des rgions postrieures : une lsion de cette partie du cerveau peut produire une pilepsie focale prcoce. Lorsque le nourrisson dpasse 3-4 mois d'ge, il apparat des anomalies paroxystiques diffuses associ une modification du type de crises. Les anomalies intercritiques sont asynchrones en raison de l'absence de myline qui permettrait une conduction rapide des activits paroxystiques. Les nouvelles crises sont des spasmes gnrs par des structures sous-corticales en consquence de leur dsinhibition lie au dysfonctionnement diffus du cortex. Cette combinaison constitue le syndrome de West. Un traitement assez prcoce a non seulement un effet antipileptique mais galement antipileptogne, prvenant la constitution d'une pilepsie chronique. Le contrle des pointes et ondes lentes continues rvle des anomalies focales, montrant qu'ici l'pilepsie rsulte de la combinaison de facteurs lsionnel et dveloppemental. Chez l'enfant plus g, une association semblable prend le nom de syndrome de Lennox-Gastaut, qui associe crises toniques et pointes-ondes lentes tandis que l'association prdisposition gntique et facteurs maturatifs donne une pilepsie myoclonique, le syndrome de Doose. Le lobe temporal est le sige de plusieurs types d'pilepsies. Une gliose temporale msiale aprs tat de mal fbrile chez le nourrisson donne une pilepsie l'adolescence, le temps que maturent les voies msionocorticales. Une dysplasie temporale nocorticale donne au contraire une pilepsie prcoce. Des pointesondes continues du sommeil produisent une perte du langage, p arfois sans crises. Ce syndrome de LandauKleffner est rversible s'il est identifi tt. Un tat de mal temporal et temporo-frontal bilatral dclench par la fivre peut entraner une perte des fonctions frontales, d'autant plus svres qu'il persiste une pilepsie rebelle. Certains enfants peuvent avoir successivement plusieurs types d'pilepsie temporale. Le retentissement cognitif de l'pilepsie est d'autant plus marqu que celle-ci a dbut prcocement et que la lsion causale a t constitue tt. Au cours de la maturation normale, les synapses qui reoivent une activit asynchrone de leurs affrences sont prfrentiellement limines. L'activit synchrone due l'pilepsie prvient, au contraire, cette limination et induit la persistance de rseaux pileptognes qui auraient normalement du tre limins au cours de la plasticit physiologique. Mais il persiste une possibilit de rcupration, par les mmes rgions aprs disparition de l'pilepsie ou par les rgions homologues controlatrales en p articulier dans le cas du langage ; tant que la priode critique de maturation n'est pas termine. Pour le langage, une rcupration vritablement fonctionnelle par les aires contro-latrales n'est cependant possible que s'il y a eu destruction pralable de la rgion implique dans l'pilepsie. En somme, la maturation est un facteur tiologique majeur de l'pilepsie pdiatrique, elle en accentue le retentissement sur les fonctions crbrales et la pharmacorsistance, mais elle offre aussi des possibilits uniques de rcupration.
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Community Health Workers La Clinica de la Raza and Asian Health Services 30 Alameda County, California In response to community input relayed by their Community Health Workers CHWs ; , Asian Health Service and La Clnica de la Raza have moved from outstationing CHWs in the community to having them work in their clinics. In doing so, they are able to better integrate CHWs with other clinic staff, identify community members eligible for health care coverage, and link enrollment for health insurance with receipt of services. This placement also reflects the reality that foreign-born individuals are often accustomed to different mechanisms of health service delivery and payment for services. The CHWs' "front line" expertise often informs practice and policy efforts undertaken by their affiliated clinics, as reflected in strides towards cultural competency, e.g., the development and implementation of linguistic adequacy standards and the financing of translation services, and integration of complementary and alternative medicine with Western-based medicine. Asian Health Services and La Clnica de la Raza are two community health centers that provide services for immigrant communities in Alameda County, California. As part of Community Voices-Oakland, these community health centers offer services in various languages, translation services and culturally-appropriate materials including educational fliers and enrollment forms to uninsured residents and immigrants in Alameda County. As part of its "Social Health Model of Care" and "No Wrong Door" policies for enrollment and access, Community Voices-Oakland employs teams of multi-lingual CHWs through Asian Health Services and La Clnica de la Raza to: Assist Asian, Pacific Islander, and Latino immigrants to enroll in either existing public coverage programs Medi-Cal and Healthy Families ; or their program Alliance Family Care ; Provide community members with health and health care-related information Gather data and testimonials to provide feedback for policy efforts 31 The Asian and Latino communities served by these two community health centers are largely comprised of families with limited or no English proficiency. These community members were born in numerous different countries and speak many different languages and dialects. Their Latino clientele are primarily of Mexican and Central American descent; their Asian clientele are primarily of Chinese, Vietnamese, and Korean descent, with smaller percentages of clientele of Cambodian, Laotian, and Mien descent. Accordingly, the CHWs at Asian Health Services and La Clnica de la Raza reflect the variety of ethnicities present in the Oakland Bay Area and can therefore serve those communities individually and as a diverse team that can share cross-cultural perspectives, practices and values as a part of the work and decisionmaking process. 37.

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