Epilepsies: don't face your seizures alone!

Brussels, 13/02/2023 – Too many patients suffering from epilepsy are still lacking  the right treatment, stress expert teams of neurologists, neuropaediatricians and epileptologists at the Brussels University Hospital, a grouping of the HUDERF (Queen Fabiola Children's University Hospital), the Erasmus Hospital and the Jules Bordet Institute. A precise diagnosis of the type of epilepsy a child or adult may be suffering from is essential in choosing the right treatment and providing an accurate prognosis. Today, a range of solutions makes it possible to have a positive impact on the quality of life of epilepsy patients or even to cure the epilepsy completely.  In the case of children and adolescents acting early to overcome learning, cognitive and behavioural difficulties caused by epileptic activity is essential to their development and autonomy. This aspect of multidisciplinary care for epilepsy is also essential for adults in facilitating their well-being and social integration.   

Epilepsy is the most common chronic neurological disease after migraine.  It affects almost 1% of the population and 4 in every 1,000 children.  Epilepsies, in the plural as the term in fact covers several diseases, give rise to seizures whose frequency and nature can vary greatly.   They affect patients of all ages and can appear spontaneously or be the result of illness or accident.  Thanks to their complementary approach within the H.U.B., specialised epilepsy teams from the Erasmus Hospital and the HUDERF propose the very latest treatment for epilepsies in children and adults.  Epileptic seizures result from the abnormal and excessive activity of a group of neurones that can disrupt certain brain functions such as memory, speech, motor functions, sight and/or consciousness.  A large percentage of epilepsies in children disappear naturally as the brain matures and often require no treatment. For the rest, there are drugs that can effectively treat the majority of cases of epilepsy.  However, in approximately 35% of patients, both adults and children, treatment does not make it possible to eliminate seizures totally, however strictly it is adhered to. In such cases we speak of refractory epilepsy. However, teams in the field have noted that many patients affected by these drug-resistant epilepsies are too late in receiving the necessary in-depth care and consequently continue to have seizures that affect their everyday life and to suffer intellectual, motor and behavioural disabilities that are vectors for stigmatisation.     

In the case of a refractory epilepsy, precisely identifying the type of seizure and location can make it possible to determine the most appropriate treatment to stop these seizures permanently or to act on their frequency, intensity or impact on the rest of the body. Always with the aim of having a positive impact on the quality of life of patients.  A full range of treatment, from the latest drugs and the ketogenic diet to surgery (brain surgery, Gamma Knife, vagus nerve stimulation, deep brain stimulation), can be envisaged depending on the individual patient.  In the case of surgery, the precise identification of the zone to be removed requires a number of high-tech tools (electroencephalography (EEG), magnetoencephalography (MEG), structural and functional neuroimaging, intracranial EEG).  This care adapted to the needs and particularities of each patient requires multidisciplinary teams of doctors, nurses, neuropsychologists, speech therapists, physicists and highly specialised engineers  

Even children with benign epilepsies encounter learning difficulties more frequently than the general population and there can be major consequences for autonomy in adulthood. To minimise these consequences in the long term, the HUDERF teams have developed a unique screening and treatment programme for these associated difficulties, known as comorbidities.   Dyslexia, dyspraxia, dysphasia, attention or behavioural problems are encountered more frequently in epileptic patients. Thanks to a team of highly specialised neuropsychologists, speech therapists, physiotherapists and ergotherapists, the hospital is able to offer a treatment plan adapted to each situation. This global, multidisciplinary care of the patient, whether a child or adult, is of major significance in acting on factors that will favour social integration.    

A lot of progress is to be expected from scientific research seeking to better characterise the cognitive and behavioural difficulties of patients and their treatment; also to adapt the surgical approaches or to explore the genetic cause.  The excellent treatment proposed by the H.U.B. draws on a number of research projects developed in cooperation with the Neuropsychology and Functional Neuroimaging Research Unit    (UR2NF) and the Laboratory of Translational Neuroatonomy and Neuroimaging of the ULB.  Recent years have seen increased cooperation between these  centres of expertise, both within the H.U.B. with the teams from the Erasmus Hospital and the HUDERF as well as with other national and international centres within the French-speaking BRACE   (Brussels Rare and Complex Epilepsies) consortium, itself recognised as a full member of ERN   EpiCARE (European Reference Network for Rare and Complex Epilepsies). This has permitted an enriching and sharing of practices in terms of research, treatment and patient services.