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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.

13/03/2023 On the occasion of International Women's Rights Day on 8 March, the Brussels University Hospital (H.U.B.) - which brings together the Erasmus Hospital, the Children's Hospital and the Jules Bordet Institute -  is highlighting, as a space dedicated to life and care excellence, the gynaecological and obstetrical violence suffered by women. Violence that is a reality. Violence that exists, which happens, whether voluntarily or otherwise. It is time to speak of the damage done and to achieve medical progress thanks to the experience of patients.  Anne Delbaere, Clotilde Lamy, Isaline Gonze, Anne Holoye, Maxime Fastrez & Philippe Simon   The medicalization of childbirth, together with all the advances in terms of medical care and treatment, represents major progress that has made it possible to considerably reduce maternal and infant mortality as well as the various complications associated with childbirth.  This is accompanied, however, by new medical procedures, actions and techniques (episiotomy, caesarean section, etc.) that can be violent for the patient and generate a negative perception of childbirth.  These practices can be carried out too quickly and in cases that sometimes could have been avoided. The WHO has warned of an excessive use of these practices and advocates a "positive experience of childbirth". Members of the medical profession and medical structures and institutions are an inherent part of this experience.     Gynaecological and obstetrical practices evolve over time. On one hand, among members of the medical profession, the practices of a few decades ago are no longer those of today. With developments in scientific knowledge, gynaecological and obstetrical medicine is becoming increasingly precise and personalised. On the other hand, among patients tongues have loosened and women are daring to say what they feel. Based on the experience of care staff and patients, acts of the past, such as systematic vaginal examinations, are no longer practised today. Nothing is set in stone, medicine will continue to evolve and continued dialogue between women, or between women and care staff, will lead to a better understanding of what each patient feels.    Dialogue, mutual respect and trust between the carer and the woman constitute the foundation for a care that respects the woman's needs. Within our institutions our patients are active partners in their own care, whether in terms of a parental project, childbirth or the choice between the treatment options available for different gynaecological pathologies. This dialogue enables our patients to assume an increasingly important role in choosing the treatment they receive. The different clinics and the functional unity of the service are rooted in an approach that integrates the human aspect and respect for patients. Dialogue is primordial and results from the desire of both parties to progress together in these life projects   True to the humanist values of our institutions, we are committed to training the gynaecologists and obstetricians, midwives, and nurses of the future to pay particular attention to the relationship between care staff and patient, to communication, to the notion of informed consent and to promoting a human approach to medical care.  As the training of care staff extends beyond the hospital itself, we also support professional associations that participate in the profession's general development by sharing their expertise.  We encourage patients to give thought to their birth plan. On a day-to-day basis we discuss cases as a team to analyse delicate situations, in particular in the event of emergency interventions, difficult consultations or during technical procedures. For us, patient consent is of the utmost importance. It is important to discuss what the patient has experienced and feels and, as far as possible, to anticipate together any situations that may arise   – even the most serious ones – and how to react in such cases. We approach these discussions in a spirit of total transparency and goodwill. We encourage every doctor and every nurse to take the time to listen to each and every patient.    Women are entitled to gynaecological and obstetrical care that respects their wishes and right to be heard. While women themselves have the right to take care of themselves in the best way possible, to monitor their own gynaecological health and to make the choices that they feel are right for them, in terms of motherhood, the refusal of motherhood or contraception, for example. The dialogue must be two-way and it is by bringing together the experiences of the care staff and the patient that in partnership one can arrive at the very best possible care that respects the decision-making autonomy of the patient.