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When suffering a stroke or when a loved one suffers one, the initial urgency is survival, recovery and rehabilitation. But several weeks or months later some patients face an unexpected phenomenon:  epileptic seizures. Read more Interview with Professor Nicolas Gaspard, Head of the Department of Neurology at the H.U.BWhen suffering a stroke or when a loved one suffers one, the initial urgency is survival, recovery and rehabilitation. But several weeks or months later some patients face an unexpected phenomenon:  epileptic seizures when they have never had one previously. This can be surprising, worrying and sometimes misinterpreted. This article is to help you understand  what is happening without over-dramatising it.  1. Why can an epileptic seizure occur after a stroke?A stroke leaves a small scar in the brain. In approximately 1 in 10 patients this scar becomes the point of departure for epileptic seizures. This has nothing to do with any seizures experienced on the day of the stroke as the latter are caused by the acute event whereas epilepsy is a disease that develops over time. “This phenomenon is not rare, especially when the stroke has been severe or in the case of a haemorrhagic stroke,” explains Professor Gaspard.2. And if the person was already epileptic?“This is a much less common situation. A stroke does not usually change the nature of a pre-existing epilepsy. But in persons aged over 65, an epilepsy of vascular origin (related to the blood vessels) is very common,”    explains Professor Gaspard.In other words: when an elderly person starts having epileptic seizures it could be a sign that they are at risk of a stroke. In these cases the doctors put into place a policy of strict prevention, as if it were a first stroke. 3. What are the warning signs after a stroke?  Epileptic seizures can take many different forms. They do not always resemble “conventional” convulsions. The following should cause you to see a doctor quickly:  Loss of consciousness, even briefly;Involuntary shaking;Sudden speech difficulty;These can resemble a further stroke, which means there is even more reason for concern. If in doubt  call 112 or the Stroke Unit at the H.U.B.4. How is a diagnosis made?In most cases it is the account given by the patient or those close to them that is most helpful.  A recording of the brain activity (electroencephalogram - EEG) can show any anomalies but not always.  “Whatever the result, doctors make their diagnosis above all on the basis of what you describe to them,”  stresses Professor Gaspard.5. Effective treatmentThe good news is that stroke-related epilepsies respond very well to treatment: The vast majority of patients experience no further seizure  if they take the right medication. In deciding the treatment, doctors take into account:  Age;Memory and concentration (some medication can affect them);  Other treatment already followed.6. How to reduce the risk of further seizures?A few simple practices can make a real difference:Adhere strictly to the treatment, every day;Use a dosette box, alarms, or ask a close friend or relative for help in the event of any difficulties;Be sure to get regular sleep of good quality;Limit alcohol consumption;Tell the doctor about any  new medicine  as some may make seizures more likely.In shortPost-stroke epilepsy is not rare and nor is it inevitable. The treatment is effective and provided you are vigilant there is no reason why you cannot resume a normal life with peace of mind.  If there are any doubts  – an abnormal movement, disorientation  or brief lapses of consciousness, speech problem – it is important to seek medical advice. The H.U.B Stroke Unit is your privileged point of contact.Do you want to make an appointment with one of our specialists for yourself or a loved one? Then contact us by telephone on   +32 (0)2 555 33 52 or by email at cons [dot] neuro [dot] erasme [at] hubruxelles [dot] be (cons[dot]neuro[dot]erasme[at]hubruxelles[dot]be) Image

Different forms of asthma Asthma affects all age groups. It is important to consider the age at which it begins: before or after 30 years. Early-onset asthma is often allergic, more common in boys, and usually (but not always) less severe. It may disappear in adulthood. Asthma that develops after 30 is usually non-allergic (though it can be), more common in women, and often more unpredictable. Contrary to common belief, asthma can also develop at an advanced age.The severity of asthma requires several months of observation to be defined and may change over time. Allergic asthma is often associated with allergic rhinitis, which should be properly treated to improve asthma control. The connection between lower airways (asthma) and upper airways (rhinitis, sinusitis, nasal polyps) is so important that joint consultations are offered every two weeks.From a pathophysiological perspective, the airways of asthma patients are affected by inflammation and bronchospasm, varying in intensity over time and usually reversible with treatment or sometimes spontaneously.Airway obstruction and inflammation cause asthma symptoms, which are non-specific and include shortness of breath, cough, sputum production, wheezing, and chest pain. These symptoms occur more often at night and may appear as attacks or become chronic. Asthma management Management begins with a detailed history to identify triggering circumstances, especially possible allergic causes (dust, animals, seasonal factors such as pollen), and to assess lifestyle factors (smoking, sports, occupation).In addition to clinical examination, tests are performed to confirm the diagnosis, assess inflammation and allergic status, and characterize the asthma type. The main test is a pulmonary function test to demonstrate airway obstruction and its reversibility with bronchodilators. Outside of attacks, results may be normal, requiring a bronchial provocation test.Because asthma is also an inflammatory disease, airway inflammation is assessed by measuring nitric oxide (NO) in exhaled air. This is a simple and harmless test. Inflammation can also be evaluated through blood tests or, less commonly, induced sputum analysis.The allergic nature of asthma is confirmed through specific tests. Skin prick testing is the preferred method: allergen extracts are introduced into the skin, and results are read after 20 minutes. A positive reaction causes redness, slight swelling, and itching. This method is quick, painless, and suitable even for young children. Blood tests can also provide this information.Highly effective inhaled treatments have been available for about twenty years. These combine an anti-inflammatory drug (inhaled corticosteroid) and a bronchodilator. Proper inhaler use is essential and must be taught by qualified staff. The clinic provides an “Asthma School” for this purpose.When allergic rhinitis is present, antihistamines or nasal corticosteroids improve symptoms and asthma control. Allergen immunotherapy (desensitization) may be proposed, involving gradually increasing doses of the allergen to build tolerance.Significant progress has been made in treating severe asthma over the past 15 years. Biological therapies (injections) target specific mechanisms and are tailored to different asthma types. They are costly and subject to strict reimbursement criteria.The clinic also manages other allergies, including food, drug, and insect venom allergies. About one in two people will experience an allergic reaction during their lifetime. Diagnosis may involve skin tests, blood tests, and oral provocation tests under medical supervision, as well as controlled desensitization procedures in hospital settings.