Spasmophilie: qu’est-ce que c’est?

Lu par 6735 Boytown

Le terme « spasmophilie » est généralement utilisé en France pour désigner des manifestations d’origine psychologique caractérisées par des crises de tétanie musculaire qui s’accompagnent d’une difficulté à respirer (sentiment d’oppression, d’étouffement, hyperventilation, etc). En fait, ce terme est très controversé car il ne s’agit pas d’une maladie reconnue dans les classifications médicales, ni en France ni internationalement. Les symptômes de la spasmophilie, de la tétanie ou encore de l’hyperventilation psychogène s’apparentent à ceux présents lors d’attaques de panique. On rapproche la spasmophilie de l’attaque de panique car la spasmophilie « serait une manifestation (parmi d’autres) de l’attaque de panique ». Le concept de spasmophilie est encore assez flou de nos jours, il existe peu de documentation scientifique s’y rapportant1.

Pourtant, pour les personnes qui souffrent de ce type de trouble, les symptômes sont bien réels. En fait, ils correspondent, dans la plupart des cas, à des manifestations d’origine psychologique, en lien avec un stress ou une anxiété, qui déclenchent une hyperventilation (accélération du rythme respiratoire). C’est probablement cette hyperventilation qui, à son tour, entraîne une sensation de paralysie ou tétanie musculaire.

La spasmophilie n’est pas un concept médical. C’est un terme largement employé par le grand public, relayé par les médias, utilisé pour décrire des crises d’angoisse alliant difficultés respiratoires et tétanie musculaire. Derrière le concept de spasmophilie perdure la croyance d’une maladie autonome dont la cause proviendrait d’un désordre biologique (carences en magnésium ou en vitamines D). Le médecin parlera de crise d’angoisse aiguë (attaque de panique) pour qualifier le syndrome que le patient apparentera à de la spasmophilie ou de la tétanie. Les anglo-saxons utilisent également le terme de « syndrome d’hyperventilation » pour désigner les troubles respiratoires qui surviennent pendant la crise d’angoisse.

Remarque :

Il serait faux de dire que les difficultés respiratoires ou les problèmes de tétanie sont toujours synonymes de crise d’angoisse. De nombreuses maladies peuvent causer ce type de symptômes (l’asthme, par exemple), et il est important de consulter son médecin dans tous les cas pour obtenir le bon diagnostic.

Qui est touché ?

Les crises d’angoisse surviennent le plus souvent chez des personnes jeunes (entre 15 et 45 ans) et elles sont plus fréquentes chez les femmes que chez les hommes.

Causes de la maladie

Les mécanismes de la crise d’angoisse ne sont pas très bien connus, mais ils font interagir de nombreux facteurs d’ordre biologique, psychologique, génétique, et cardio-respiratoire.

Selon certaines théories, il s’agirait d’une réaction inappropriée ou excessive au stress.

Ainsi, différentes situations de peur et d’angoisse (dont celle de ne plus pouvoir respirer) peuvent déclencher l’hyperventilation, qui peut elle-même engendrer certains symptômes, en particulier les vertiges, l’engourdissement des membres, les tremblements et les palpitations2.

À leur tour, ces symptômes aggravent la peur et l’anxiété. Il s’agit donc d’un cercle vicieux qui s’auto-entretient.

Évolution et complications possibles

L’anxiété et les attaques de panique ne sont pas graves en tant que telles, mais elles peuvent être impressionnantes, voire traumatisantes, pour la personne atteinte et son entourage. Elles sont souvent associées à une baisse importante de la qualité de vie, et peuvent entraîner des troubles psychiatriques très handicapants comme la peur de sortir, d’être en présence d’inconnus ou de participer à des activités sociales ou professionnelles diverses (agoraphobie secondaire). Chez certaines personnes, la fréquence des crises est très élevée (plusieurs par jour), on parle alors de trouble panique. Le risque de dépression, de pensées suicidaires, de passage à l’acte suicidaire, d’abus de drogues ou d’alcool est accru en cas d’attaques de panique fréquentes3.

Cependant, avec une prise en charge adéquate, il est possible de maîtriser cette angoisse et de réduire la fréquence des crises.

Symptômes

Les principaux symptômes de la spasmophilie, tels qu’ils sont traditionnellement décrits, sont :
■ une accélération du rythme respiratoire associée à une sensation d’étouffement, d’oppression, de difficulté à trouver l’air
■ un sentiment de tétanie musculaire, principalement dans les membres supérieurs (incapacité à bouger, fourmillements, picotements)

En fait, les manifestations des attaques de panique peuvent être multiples et variées. Généralement, la crise débute brutalement, de façon imprévisible, et dure 10 à 60 minutes. Elle s’accompagne de nombreux symptômes1, qui peuvent s’ajouter à ceux classiquement associés à la spasmophilie.

On peut retrouver des manifestations psychiques, somatiques, psychosensorielles et comportementales associées de façon variable.

Des troubles somatiques

Ces troubles varient d’une personne à l’autre et d’une crise à l’autre. Ils sont parfois spectaculaires pour la personne qui en souffre et pour les personnes témoins de la crise. Il est important de distinguer ces troubles d’une affection somatique (asthme, troubles cardiaques, etc). Ces troubles peuvent être cardiovasculaires, musculaires, sensoriels, urinaires et respiratoires.
■ des palpitations cardiaques
■ une augmentation du rythme cardiaque (tachycardie)
■ des douleurs dans la poitrine
■ des tremblements ou secousses musculaires
■ des malaises, étourdissements, vertiges
■ des démangeaisons
■ une vision floue
■ des sifflements ou bourdonnements dans les oreilles (acouphènes)
■ des douleurs dans le bas ventre
■ des nausées
■ des sueurs, des frissons
■ un besoin fréquent d’uriner

Des troubles du psychisme
■ une impression de danger imminent accompagnée de pensées angoissantes (peur de s’évanouir, d’étouffer, de faire un malaise cardiaque)
■ une peur irraisonnée de perdre le contrôle, de devenir fou

Des troubles psychosensoriels

Lorsque l’angoisse est très intense, il est fréquent d’observer :
■ un sentiment de dépersonnalisation au cours duquel la personne peut avoir des difficultés à ressentir ses limites corporelles ou avoir une sensation de dédoublement corporel.
■ un sentiment de déréalisation. La personne a une vision de la réalité qui devient floue.

Des troubles comportementaux

Plus rares lors d’une attaque de panique, les symptômes comportementaux peuvent revêtir les formes suivantes :
■ une inhibition ou au contraire une grande agitation comportementale. La personne peut vouloir fuir vers un lieu sécurisant ou au contraire se recroqueviller sur elle-même et devenir mutique.
■ de l’agressivité qui peut être dirigée vers les autres ou vers la personne elle-même pouvant aller jusqu’à un passage à l’acte suicidaire

Dans certains cas, les symptômes suivants surviennent en même temps :
■ des diarrhées
■ des maux de tête intenses

Les symptômes s’estompent ensuite progressivement, laissant place à de la fatigue.

Le début de la crise est souvent précédé d’une période où le degré d’anxiété augmente progressivement. La fréquence des attaques de panique varie de une ou deux seulement dans toute la vie à plusieurs par jour.

Personnes à risque

Les personnes les plus touchées sont :
■ les femmes (elles sont 1,5 à 2 fois plus touchées que les hommes)4
■ les jeunes (entre 15 et 20 ans)
■ les personnes ayant des antécédents familiaux de troubles paniques
■ les personnes ayant des antécédents d’abus sexuels ou de maltraitance

Facteurs de risque

Plusieurs facteurs peuvent déclencher les crises de panique ou de spasmophilie. Ceux-ci varient énormément d’une personne à l’autre, et dans de nombreux cas il n’y a pas de facteur déclenchant clairement identifié même si plusieurs études ont montré l’influence d’événements traumatisants vécus durant l’enfance, notamment en lien avec l’angoisse de séparation (peur de se séparer de ses parents)5.

Parmi les facteurs fréquemment retrouvés :
■ un contexte de difficultés relationnelles (divorce, conflit, maltraitance…)
■ un deuil ou une maladie
■ la consommation d’alcool, de cannabis ou de drogue

Certaines situations anxiogènes, comme les transports en commun, l’avion, la foule…

La prise ou l’arrêt brutal de certains médicaments, en particulier certains antidépresseurs.

Peut-on prévenir?

Il n’y a pas de méthode vraiment efficace pour prévenir les crises d’angoisse, d’autant qu’elles surviennent généralement de façon imprévisible.

Cependant, une prise en charge appropriée, tant pharmacologique que non pharmacologique, peut permettre d’apprendre à gérer son stress et d’éviter que les crises ne deviennent trop fréquentes ou trop invalidantes. Il est donc important de consulter un médecin rapidement pour enrayer le cercle vicieux le plus tôt possible.

Mesures préventives de base

Pour réduire le risque de faire des crises d’angoisse, les mesures suivantes, qui relèvent surtout du bons sens, sont très utiles :

– Bien suivre son traitement, et ne pas interrompre les médicaments sans avis médical

– Éviter de consommer des substances excitantes, de l’alcool ou de la drogue, qui peuvent déclencher les crises

– Apprendre à gérer son stress pour limiter les facteurs déclenchants ou interrompre la crise lorsqu’elle débute (relaxation, yoga, sports, techniques de méditation…)

– Adopter une saine hygiène de vie : bonne alimentation, activité physique régulière, sommeil réparateur…

– Trouver du soutien auprès de thérapeutes (psychiatre, psychologue), et d’associations de personnes souffrant des mêmes troubles anxieux, pour se sentir moins seul(e) et bénéficier de conseils pertinents.

Traitements médicaux

Il peut être difficile de venir à bout des crises d’angoisse, mais il existe des traitements et des thérapies efficaces. Il faut parfois en essayer plusieurs ou les combiner, mais la grande majorité des personnes réussissent à réduire voire éliminer leurs crises en quelques semaines ou quelques mois grâce à ces mesures.

Thérapies

L’efficacité de la psychothérapie pour traiter les troubles anxieux est bien établie. C’est même le traitement à privilégier dans de nombreux cas, avant de devoir recourir aux médicaments.

Pour traiter les crises d’angoisse, la thérapie de choix est la thérapie cognitive et comportementale, ou TCC6. En pratique, les TCC se déroulent généralement sur 10 à 25 séances espacées d’une semaine, en individuel ou en groupe.

Les séances de thérapie ont pour but d’informer sur l’état de panique et de modifier petit à petit les « fausses croyances », les erreurs d’interprétation et les comportements négatifs qui y sont associés, afin de les remplacer par des connaissances plus rationnelles et réalistes.

Plusieurs techniques permettent d’apprendre à enrayer les crises, et à se calmer lorsqu’on sent l’anxiété monter. Des exercices simples doivent être effectués d’une semaine à l’autre pour pouvoir progresser. Précisons que les TCC sont utiles pour réduire les symptômes mais leur objectif n’est pas de définir l’origine, la cause de l’émergence de ces crises de panique. Il peut être intéressant d’y associer un autre type de prises en charge psychothérapeutique (thérapie analytique, systémique, etc) afin d’éviter que les symptômes ne se déplacent pour réapparaître sous d’autres formes.

Médicaments

Parmi les traitements pharmacologiques, plusieurs classes de médicaments ont fait leur preuve pour réduire la fréquence des crises d’angoisse aiguës.

Les antidépresseurs sont les traitements de premier choix, suivis des benzodiazépines (Xanax®) qui présentent toutefois plus de risque de dépendance et d’effets secondaires. Ces dernières sont donc réservées au traitement de la crise, quand elle se prolonge et qu’un traitement est nécessaire.

En France, les deux types d’antidépresseurs recommandés7 pour traiter les troubles paniques sur le long terme sont :
■ les inhibiteurs sélectifs de la recapture de la sérotonine (ISRS) dont le principe est d’augmenter la quantité de sérotonine dans les synapses (jonction entre deux neurones) en empêchant la recapture de cette dernière. On recommande en particulier la paroxétine (Deroxat® / Paxil®), l’escitalopram (Seroplex® / Lexapro®) et le citalopram (Seropram® / Celexa®)
■ les antidépresseurs tricycliques comme la clomipramine (Anafranil®).

Dans certains cas, la venlafaxine (Effexor®) peut aussi être prescrite.

Le traitement antidépresseur est d’abord prescrit pour 12 semaines, puis une évaluation est faite pour décider de la poursuite du traitement ou de sa modification.

L’opinion du médecin

« Souffrir de crises d’angoisse peut devenir un véritable handicap pour les personnes qui en sont atteintes. Gouvernées par la peur qu’une autre crise survienne, elles peuvent petit à petit s’isoler et se replier sur elle-même. Afin d’éviter la mise en place du cercle vicieux de la peur d’avoir peur de faire une crise, j’invite ces personnes à consulter un médecin qui les adressera à un spécialiste. Une crise apparaissant de façon isolée n’est pas alarmante. Toutefois, il vaut toujours mieux en parler avec votre généraliste qui sera le plus à même de savoir s’il s’agit bien d’une attaque de panique ou d’une autre pathologie. Avoir des crises d’angoisse a un moment donné dans sa vie ne signifie pas que toute la vie sera ponctuée par ces mauvaises expériences. Les thérapies, notamment les TCC, sont très efficaces contre ces troubles. Vous travaillerez avec votre thérapeute à identifier les pensées et les situations qui sont à l’origine de ces crises. Petit à petit, le thérapeute vous confrontera à ces peurs et vous réussirez à les affronter sans faire de nouvelles crises. La relaxation et les médicaments sont des béquilles importantes, nécessaires pendant la période de la thérapie. »

Approches complémentaires

La thérapie cognitivo-comportementale est sans aucun doute la meilleure approche non médicamenteuse pour traiter l’anxiété et prévenir les crises de panique. Les méthodes de relaxation ont aussi fait leurs preuves.

Lu par 6735 Boytown

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