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  The optimal care of a patient with cancer is based on a combination of medical and technological expertise, together with a human and personalised approach to the patient and their family. At Erasme Hospital, an academic general hospital, this approach is coordinated and integrated within the Multidisciplinary Oncology Care Programme (PSOM). Through this programme, all the specialties and experts involved in the care of patients with cancer interact and work together in a coordinated manner for the benefit of the patient, who receives both a comprehensive and an “individualised” approach from the various services involved. From the time of diagnosis, the patient follows a specific care pathway within the hospital, where they are guided, accompanied and supported by oncology care nurse coordinators (ICSO) throughout the various stages of their treatment. Care for patients and their families As soon as the diagnosis is announced, a range of professionals are involved in order to provide the patient and their family with all the information relating to the selected treatment and its initiation, whether it is medication-based (chemotherapy, targeted therapies), surgical or radiotherapy-based. Practical and logistical aspects are taken into account, as is the patient’s environment, both socially and within the family. As part of the comprehensive approach, the patient also receives psychological, dietary and social assessment and support, as well as specific care for symptoms such as pain and for aspects related to their well-being. The patient’s family and children also receive appropriate support where necessary. Brochures covering these aspects and practical advice are available to patients.

Vascular pathology is the specialty concerned with diseases of the blood vessels (arteries, veins and lymphatic vessels) and performs vascular surgery. The department consists of a medical and surgical team dedicated to caring for patients with vascular conditions. Pathology Department The medical and surgical team in the Vascular Pathology Department includes vascular surgeons, internists and physiotherapists. There is also close collaboration with interventional radiologists, anaesthetists and other specialties such as Dermatology, allowing for a multidisciplinary approach to patient care. The department provides vascular surgery and treats a wide range of conditions, including: Peripheral arterial disease of the lower limbs. Lesions of the supra-aortic vessels (carotid arteries, thoracic outlet syndrome). Venous insufficiency of the lower limbs and varicose veins. Aortic aneurysms (open and endovascular surgery). Venous thromboembolic disease. Raynaud’s phenomenon and other acrosyndromes. Creation of arteriovenous fistulas. Surgical management of diabetic foot. Lymphoedema.

The Trauma Centre provides care for severely injured patients and mobilises an expert, trained multidisciplinary medical and paramedical team every day (24 hours a day, 7 days a week) to ensure comprehensive and optimal care, from the call to 112 through to patient stabilisation (the chain of survival) and then rehabilitation. Severe trauma affects a large number of people every year, whether they are involved in road traffic, occupational or domestic accidents, or are victims of assault, and has become a major public health issue. Indeed, severe trauma is recognised as the leading cause of death among people under 40 and, if the patient survives, as a cause of severe morbidity and disability. The care of severely injured patients cannot be improvised. It requires expertise, equipment, protocols and a specific care pathway in order to optimise patient survival rates. Erasme Hospital has the infrastructure, equipment and medical resources required to offer a comprehensive care pathway for severely injured patients. This structured chain of care involves an expert, trained multidisciplinary medical and paramedical team to ensure comprehensive and optimal care, from the call to 112 through to patient stabilisation (the chain of survival) and then rehabilitation. “Trauma Centre” certification Since September 2022, Erasme Hospital has been accredited to provide level 1 care for severely injured patients.  

Gamma Knife is a radiosurgery technique used to treat deep-seated areas of the brain with gamma rays. This technique is used to treat certain intracranial vascular abnormalities, certain functional neurological disorders, and certain benign or malignant brain tumours.The challenge facing present-day and future neurosurgery is to treat brain diseases by acting in areas of the brain that are difficult to access, while avoiding damage along the route of the procedure. A technique combining performance, precision and effectiveness, while allowing patients to return home the following day and to work in the days thereafter, was therefore needed to meet this challenge.The successful operation of Gamma Knife is the result of a fruitful collaboration established from the outset between the Neurosurgery Department of Erasme Hospital and the Radiotherapy Department of the Jules Bordet Institute.Approximately 300 patients from all over Belgium are treated each year, as well as many patients from countries without a Gamma Knife centre, such as Bulgaria and Algeria. Gamma Knife treatments are provided for certain intracranial vascular abnormalities, certain functional neurological disorders, and certain benign or malignant brain tumours.Alongside its clinical activities, the Gamma Knife Centre also contributes to the development of knowledge in the field of radiosurgery through significant scientific and research output.The Gamma Knife Centre was incorporated into the New Erasme project in two phases. As the Gamma Knife building is located on the site of the future New Erasme construction project, it will first have to be relocated within the hospital. At the end of the works, the centre will then move into the new New Erasme hospital, in new premises that will house medical imaging.Visit the Gamma Knife websiteGamma Knife philosophy“The sterile conflict between conventional microneurosurgery and Gamma Knife radiosurgery is behind us. Today, it is clear that these two treatment modalities are complementary. When there is a choice between these two therapies, the better one should be offered to the patient, taking into consideration the results and risks of each treatment, with the ultimate goal of preserving the best possible quality of life” (Professor Jacques Brotchi, founder of the ULB Gamma Knife Centre).Cost of Gamma Knife treatmentThe cost of Gamma Knife treatment depends on the patient’s administrative status:Belgian patient with valid health insurancePatient from a European Union country in possession of an E112 formPatient from a European Union country without an E112 formPatient from a country outside the European UnionMaking an appointmentTel.: 02 555 3357Fax: 02 555 3158Email: Patients [dot] GammaKnife [dot] erasme [at] hubruxelles [dot] be (Patients[dot]GammaKnife[dot]erasme[at]hubruxelles[dot]be)SecretariatTel.: 02 555 3060Fax: 02 555 3176

The nutrition group brings together people working in the field of nutrition across various hospital departments. The nutrition team’s main areas of interest are oral nutritional supplements, enteral tube feeding and parenteral nutrition. TeamCoordinatorProf. Jean-Charles PreiserMembersProf. Marianna ArvanitakisDr Sandra De BreuckerDr Johanne GarbusinskiDr Nicolas RoperMs Myriam AutphenneMs Asuncion BallarinMr Daniele ColluraMr Mathieu De RyckereMs Sylvie FarineMs Nathalie GuerryMs Viviane LievinMs Justine ThomasMaking an appointmentTeamEmail: Nutrition [dot] erasme [at] hubruxelles [dot] be (Nutrition[dot]erasme[at]hubruxelles[dot]be)Home SupportEmail: Support-Domicile [dot] Nutrition [dot] erasme [at] hubruxelles [dot] be (Support-Domicile[dot]Nutrition[dot]erasme[at]hubruxelles[dot]be)This multidisciplinary service comprises physicians from various departments of Erasme Hospital, pharmacists, dietitians and nurses working in different care units. Nutrition nurse coordinatorBallarin AsuncionTel.: 02 555 5578Email: asuncion [dot] ballarin [at] hubruxelles [dot] be (asuncion[dot]ballarin[at]hubruxelles[dot]be)Enteral nutrition (tube feeding)Tel.: 02 555 3908Parenteral nutrition (infusion)Tel.: 02 555 4481

What is Parkinson’s disease? Parkinson’s disease is a chronic, progressive and degenerative neurological disease. It primarily affects movement control, which may cause tremors, slowness of movement, muscle rigidity, and balance and postural disorders. Over time, the disease may also affect other functions, such as sleep, mood, attention, memory, or certain automatic functions of the body (for example, digestion or blood pressure). The disease is linked to the progressive destruction of neurons located in an area of the brain called the substantia nigra. These neurons produce dopamine, a chemical messenger essential for coordinating and controlling voluntary movements. The decrease in dopamine disrupts communication between the different areas of the brain involved in movement, which explains the onset of symptoms. Symptoms Motor symptomsThe best-known signs are:Tremors at rest,Slowness of movement (bradykinesia),Muscle rigidity,Balance and gait disturbances. Non-motor symptomsThe disease is also often accompanied by less visible symptoms:sleep disturbances,loss of smell,constipation,mood disorders (anxiety, depression),fatigue, pain, cognitive impairment.  Causes and risk factors The exact causes are not yet fully known, but several factors are involved:Genetic factors: certain rare genetic variations increase the risk.Environmental factors: exposure to certain chemicals (pesticides, heavy metals), certain solvents or head injuries could increase the risk.Advanced age: the disease is more common in older people, although cases in younger people also occur (before the age of 40).  Prevalence in Belgium The number of people living with Parkinson’s disease in Belgium is estimated at between 30,000 and 50,000, with approximately 2,000 to 3,000 new diagnoses each year. It is the second most common neurodegenerative disease in the country after Alzheimer’s disease. Medical care Screening and diagnosisThe diagnosis is clinical and is based on a careful neurological examination of the patient. There is no single blood test that confirms the disease, but certain tests (MRI, dopaminergic scintigraphy) can help to rule out other causes. The general practitioner often refers the patient to a specialised neurologist, who establishes the diagnosis and proposes an appropriate treatment plan.Symptomatic treatmentsAt present, there is no curative treatment, but several options can help manage the symptoms effectively:Dopaminergic medications, such as levodopa, which replace the dopamine lacking in the brain.Dopamine agonists and other classes of medication, used according to the symptoms and their progression.Medications that modulate the action or metabolism of dopamine:MAO inhibitors (MAOIs) and COMT inhibitors (COMTIs), which allow dopamine or levodopa to act for longer in the brain;Amantadine, which can improve certain motor symptoms and help reduce involuntary movements associated with treatment.Rehabilitation therapies (physiotherapy, occupational therapy, speech therapy) to maintain mobility, balance, speech and quality of life.Deep brain stimulation (DBS), offered to some people when medication no longer controls the symptoms sufficiently, by implanting electrodes in the brain. Your specialists at H.U.B. Brussels University Hospital has a clinic specialising in the diagnosis and management of movement disorders, including those caused by Parkinson’s disease (the Parkinson’s disease and Abnormal Movements Clinic). We offer personalised care focused on quality of life and the patient’s goals, including through a multidisciplinary approach that addresses both motor and non-motor aspects (cognition, sleep, pain, mood, independence, etc.). When necessary, we refer patients to advanced therapies and specialised care pathways. The H.U.B. Abnormal Movements Clinic team includes specialist physicians and multidisciplinary healthcare staff, including neurologists specialising in movement disorders, a physiotherapist, a speech therapist, neuropsychologists and a psychologist. Discover the Abnormal Movements Clinic Dr Frédéric Supiot, Director of the Abnormal Movements Clinic Position: Neurologist, Specialist in Abnormal Movements.Consultations for Parkinson’s disease, tremors, dystonias and other movement disorders.Principal investigator in clinical research (Enroll-HD Programme for Huntington’s disease)Administration of botulinum toxin injections for certain movement disorders, such as dystonias and hemispasm.Expertise in the implantation and programming of DBS (deep brain stimulation).Expertise in initiating, adjusting and monitoring patients receiving treatment with a Duodopa pump. Dr Virginie Destrebecq Role: Neurologist, Specialist in Abnormal Movements.Consultations for Parkinson’s disease, tremors, dystonias and other movement disorders, as well as degenerative disorders of the cerebellum (ataxia) and functional neurological disorders.Reference specialist for rare ataxias within the European Reference Network (ERN-RND)Principal investigator in clinical and translational research (on essential tremor).  Dr Vincent Leclercq Position: Neurologist, Specialist in abnormal movements.Provides consultations for Parkinson’s disease, tremors, dystonia and other movement disorders.Pays particular attention to non-motor symptoms (behavioural disorders, mood disorders, sexual dysfunction, urinary and digestive disorders, pain, …).Promotes a comprehensive approach, with referrals to neurological rehabilitation where necessary (physiotherapy, occupational therapy, speech therapy, neuropsychology, …).Performs DBS (deep brain stimulation) programming and botulinum toxin injections. Dr Alexandra Boogers Position: Neurologist, Specialist in Abnormal Movements.Consults patients with Parkinson’s disease, tremors, dystonia and other movement disorders.Expertise in the implantation and programming of DBS (deep brain stimulation).

Interventional radiology uses imaging to perform diagnostic or therapeutic procedures with extreme precision by accessing the organ through a simple puncture or a very small incision (a few millimetres). The unit is equipped with state-of-the-art technology: Doppler ultrasound, an angiography table with a latest-generation “Cone Beam CT” system, and an interventional CT scanner. Our patients’ cases are most often discussed at multidisciplinary meetings. Our team consists of experienced operators specialising in interventional radiology, treating a range of conditions. These patients mainly present with haemorrhage or require drainage, most often because of a severe infection.Conditions treatedInterventional radiology for vascular diseasesAngiography and arterial angioplasty (dilatation or stent placement to treat stenoses (narrowings) or occlusions)Venous angiography and angioplasty (stenosis, thrombotic or tumour-related thrombosis), placement of a vena cava filterEmbolisation of aneurysms or arteriovenous malformations.Osteoarticular interventional radiologyBone biopsyInjectionsCementoplastyThermal ablation of malignant and benign bone tumoursWith or without percutaneous osteosynthesis, in collaboration with orthopaedic surgery.Urological and gynaecological interventional radiologyUterine fibroid embolisationProstatic artery embolisation for prostatic enlargementNephrostomy – placement of a double-J ureteral stentEmbolisation of varicoceles and pelvic varices (pelvic congestion syndrome)Interventional oncologyTumour destruction by thermal ablation: radiofrequency and microwave ablation (liver, kidney, lung and bone), cryoablation and electroporationTransarterial chemoembolisation (TACE) and portal vein embolisationHepatic radioembolisationPlacement of an implantable port and PICC line (venous access)Pain control: injections, neurolysis by alcoholisation or radiofrequency.Haemostatic embolisationUpper or lower gastrointestinal haemorrhagePostpartum haemorrhageHaemoptysisRectal bleeding caused by haemorrhoidsVarious biopsies and drainagesUnder ultrasound, radiological or computed tomography (CT) guidance

Mental illness can take different forms. It may involve a psychotic disorder with delusions and/or hallucinations, or a mood disorder with agitation, insomnia, sadness or suicidal thoughts. The patient may be admitted voluntarily or involuntarily. In all cases, multidisciplinary care is provided with a view to rehabilitation. Involuntary admission takes place under specific conditions governed by the Observation Act (Act of 26 June 1990). Its purpose is to keep the patient safe during periods of crisis and to provide treatment when they are no longer able to ask for help. The Observation Act provides for compulsory hospitalisation for a limited period when there is no other solution. The aim is to enable the patient to regain their independence and a good quality of life. Hospitalisation involves multidisciplinary care. In addition to psychiatric follow-up and support from the nursing team, this means that the patient takes part in therapeutic activities, either individually or in groups. The occupational therapist and physiotherapist offer various activities focused on the body and creativity. In general, outpatient follow-up at the Psychiatry Clinic at Erasme Hospital or at another centre (according to your preferences) will be arranged. The patient may also be referred to a day centre.

A multidisciplinary specialist team for Multiple Sclerosis that places the patient at the centre of care to ensure a good quality of life Multiple sclerosis (MS) is a chronic neurological disease that mainly affects young adults. Being informed of the diagnosis profoundly disrupts the patient’s life, exposing them to sometimes disproportionate fears and many unanswered questions. However, nowadays, with prompt and effective care, the prognosis of this disease has improved significantly. The Clinical Neuroimmunology and Multiple Sclerosis Unit at Erasme Hospital works along several lines: Medical expertise The medical team ensures care based on the latest recommendations and closely follows scientific publications on inflammatory diseases of the central nervous system. Patients undergo physical and cognitive assessments using validated and reproducible tests. Patients have easy and rapid access to consultations, without delay, and the necessary additional examinations are organised at Erasme Hospital by the MS team. Treatment is chosen together with the patient after analysing the individual benefit–risk ratio. Communication Patients receive ongoing explanations about their disease and treatment. Dialogue is open and dynamic. Patients and their relatives receive support from a specialised nurse and learn to live with the diagnosis without restrictions. Personalised meetings and group meetings with other patients are offered. Physiotherapy Multidisciplinary care is available at the Centre for Outpatient Neurological Functional Rehabilitation. Annual assessments are carried out and regular follow-up is arranged to preserve patients’ abilities. The team also includes psychotherapists and occupational therapists. Psychological support The Centre for Outpatient Neurological Functional Rehabilitation also has a team of psychotherapists who are familiar with the challenges of multiple sclerosis and can provide occasional support. Patients can also take part in a monthly support group, where they can support one another and approach the disease differently. Administration Patients receive administrative support for every request submitted to their health insurance fund, employer, etc. Research The Neuroimmunology Unit participates in numerous clinical studies and contributes to fundamental research, with the aim of gaining a better understanding of the pathophysiological mechanisms of multiple sclerosis and other inflammatory diseases, making diagnosis more precise and faster, and providing effective, well-tolerated treatments.

Sadness, loss of pleasure, anxiety, low energy, lack of self-confidence, thoughts of dying, irritability, weight loss/gain, ... If certain negative thoughts become obsessive and prevent you from living normally, hospitalisation may be indicated. The North Unit of the Department of Psychiatry specialises in the diagnostic assessment and therapeutic management of people suffering from depression, manic depression (bipolar disorder), anxiety (generalised or specific, such as phobias, obsessive-compulsive disorder or post-traumatic stress disorder). People with a “fragile” personality, that is, those at risk of developing a psychiatric illness, also receive in-depth care. Diagnostic assessments are based in particular on structured interviews and the use of specific questionnaires. The therapeutic approach is primarily based on the combined use of psychotherapeutic and pharmacological treatments. The care provided to each patient is based on a multidisciplinary approach involving the psychiatrist, the nurse co-therapist, the psychologist, the social worker, the psychocorporal physiotherapist and the occupational therapist. What happens during hospitalisation? Hospitalisation generally takes place at the request of a psychiatrist whom you have seen in consultation. Its duration will depend on the objectives of the therapeutic plan discussed with you. The multidisciplinary approach means that, in addition to pharmacological treatment, you will take part in therapeutic activities. Occupational therapy and physiotherapy organise various activities relating to mental health (relaxation, workshops, sophrology, hypnosis, mental health education, fitness, board game sessions and walks, gentle exercise). These activities are an integral part of the care programme and are adapted to your personal circumstances and the progression of your illness. Hospital stays in the North Unit rarely last more than a few weeks and lead to different types of follow-up, discussed by the team. If a return home is envisaged, the team will probably offer you outpatient follow-up (consultation). If your health does not allow this, admission to a specialised psychiatric centre may be proposed.

Neurocognitive and behavioural disorders can cause anxiety, stress, depression, distress, disability and difficulties in everyday life. It is therefore important to provide help and support to patients suffering from such disorders and to those close to them. To assist these individuals, the Memory Unit at Erasme Hospital works along several lines: medical expertise, the quality of explanations provided, a range of services — neuropsychology, psychology, occupational therapy and speech therapy — and administrative support. Cognitive and behavioural disorders can cause anxiety, stress, depression, distress, disability and difficulties that may lead to a loss of independence, resulting in greater or lesser needs for help and support. Investigating these disorders requires active listening and an informed assessment of all remaining abilities and disabilities. In addition to the scientific rigour essential to all medical care, each approach is individualised and human-centred, enabling a systematic response to each person’s specific needs. Meeting the medical and paramedical teams, learning about the examinations required to establish a diagnosis, receiving the diagnosis and discussing therapeutic options are all stressful moments that can be difficult to manage and require dedicated time adapted to each individual. Thanks to our teamwork and close collaboration with the Geriatrics Department, such personalised and specific care pathways are possible. Our areas of work The Memory Unit at Erasme Hospital works along several lines: 1) Medical expertise: As part of the diagnosis and support of dementia syndromes, psychoeducation is offered to patients’ relatives when useful (ASAPP Project). The department, its doctors and its teams provide individually tailored medical care based on systematically updated scientific data. Patients are assessed in all areas — physical, cognitive, behavioural and social — using modern and reliable tests; Treatment is chosen together with the patient after analysing the individual benefits and risks; A care plan is also systematically proposed, with the possibility of rapid consultations after the diagnosis has been disclosed, if necessary; Patients have access to modern communication tools (telephone, email, fax, etc.), enabling them to communicate easily and without delay with their medical team; Psychoeducation is offered to patients’ relatives when useful; This psychoeducation programme, unique in Belgium, is supported by specific funding under Protocol 3 (INAMI), enabling art therapy sessions to be added for patients, as well as a home-support plan provided by a specialised nurse; Clinical study protocols involving both new therapeutic approaches and more fundamental research approaches are regularly offered to patients and their relatives if they wish to participate. Patients and their relatives always remain entirely free to decline participation. 2) Explanations: In addition to dynamic listening during each consultation, our teams formally meet twice a week to discuss each patient in greater detail; Consultations after the diagnosis has been disclosed are organised within the Geriatric Day Hospital, with which we work in very close collaboration; Psychoeducation and art therapy sessions are organised at the residential care home “Les Jardins de la Mémoire”, adjacent to the institution (792, route de Lennik). (ASAPP Project) 3) Neuropsychology, psychology, occupational therapy and speech therapy: Patients and those around them are accompanied and supported throughout their difficulties. Individualised meetings, as well as joint meetings with other patients, are also offered. 4) Administration: Patients receive administrative support for each request submitted to their health insurance fund, for their activities, etc. Download the leaflet for the ASAPP Project (Assistance and Support for Informal Carers and People with Alzheimer’s disease or a related condition) File depliant_asapp.pdf Training With the aim of promoting communication across the care network and continuity of care from the hospital to the home (including residential and nursing care homes), we offer an adapted psychoeducation training programme for professionals working with people affected by dementia syndromes (we also travel to residential and nursing care homes, in particular). In addition to providing explanations about dementia syndromes and their main symptoms, the overall objective is to encourage reflection on the best ways to care for and interact with people experiencing a loss of physical and psychological autonomy. This is therefore a theoretical but also interactive training programme: each participant is encouraged to bring the difficulties, questions and problems they encounter, so that we can reflect together on the best ways to respond to them (through discussions, exercises, role plays, etc.). The content of the training can be adapted, within certain limits, to meet participants’ needs.

How is hyper-eosinophilia treated when its cause has been identified? How is eosinophilia treated when its cause has been identified? If a classical cause of eosinophilia is found, it must be treated. For example, a parasitic infection will be treated with antiparasitic medication (often a very simple, well-tolerated, short course taken by mouth), a drug allergy will be treated by stopping the medication, and lung cancer will be treated with surgery, chemotherapy and/or radiotherapy. If the treatment is effective, the eosinophilia will disappear. A short course of cortisone may sometimes be added to lower the eosinophil count more rapidly, if the doctor considers that the eosinophils are causing concerning tissue damage. Treatment of rarer chronic inflammatory diseases is often based on cortisone and/or other immunosuppressive medicines (which reduce the immune response). Chronic eosinophilic leukaemia responds poorly to cortisone. However, in almost all cases, it responds extremely well to low doses of imatinib mesylate (Glivec). This is a highly specific treatment that directly targets the cellular defect responsible for the proliferation of eosinophils. This low-dose treatment is taken by mouth, is effective within a few days and is very well tolerated. Treatment of the other haematological diseases differs for each one and is beyond the scope of this summary. How is idiopathic hypereosinophilic syndrome treated? When hypereosinophilia remains unexplained despite an extensive work-up, it must nevertheless be treated to limit and prevent the damage it causes and, where possible, reverse it. The blood eosinophil count and clinical manifestations are used to determine whether the patient is responding to treatment. At the start of treatment, and for as long as the situation is not under control, medical check-ups are frequent in order to monitor several elements: the response to treatment, any treatment-related toxicity, and the progression of complications or the emergence of new complications of hypereosinophilia that may require additional symptomatic treatment (for example, heart failure requires medicines specifically intended to support cardiac function, in addition to treatment aimed at reducing the eosinophil count). Once the situation is under control, visits can gradually be scheduled less frequently. Treatment is started with corticosteroids (Medrol, or prednisolone capsules prepared by the pharmacist), which are effective in the majority of cases and act rapidly, within a few hours or days. Corticosteroids have numerous mechanisms of action; in particular, they accelerate eosinophil death and reduce the production of growth factors, including interleukin-5, by T lymphocytes. The side effects of corticosteroids are numerous and often well known to the general public: facial swelling, reduced muscle mass, the appearance of stretch marks and thinning of the skin, high blood pressure, diabetes, cataracts, glaucoma, gastric ulcer, bone demineralisation (osteoporosis), and increased susceptibility to certain infections, to mention the most common ones. 1. In the event of a response to corticosteroids If there is a good response to corticosteroids, the dose will be gradually reduced to the lowest dose that ensures disease control. This so-called “maintenance” dose will then be continued for at least several months. If corticosteroids are effective but the maintenance dose is high and/or causes significant side effects, second-line treatments will be used (known as “corticosteroid-sparing treatments”, as they make it possible to reduce the dose of corticosteroids needed to control the disease). The most commonly used agent is hydroxyurea (Hydrea), as it is easy to take (tablets taken by mouth) and prescribe (available on prescription from all pharmacies), and is free of charge in Belgium. This medicine, used to treat haematological diseases such as chronic myeloid leukaemia or essential thrombocythaemia (an abnormally high platelet count), works by reducing the production of blood cells in the bone marrow, including eosinophils. The main side effects are haematological toxicity, with an excessive decrease in white blood cells, red blood cells and/or platelets. Patients may also experience digestive intolerance, with abdominal discomfort, loss of appetite, nausea, diarrhoea and/or mouth ulcers. Interferon-alpha is also used to treat idiopathic hypereosinophilic syndrome. This treatment acts on eosinophils and T lymphocytes by “modulating” their functions. For example, it reduces the production of interleukin-5 by T lymphocytes without reducing immune defences. It belongs to a family of molecules that we naturally produce to fight certain viral infections, such as influenza. This agent is rarely prescribed in Belgium to treat hypereosinophilic syndrome because it is not reimbursed for this indication and costs several hundred euros per month. In addition, it is administered by subcutaneous injection several times a week, and the side effects are often poorly tolerated. Among these, a flu-like syndrome (with fever, chills, muscle pain and headaches) is the one most likely to lead to discontinuation of treatment. Some immunosuppressive medicines are sometimes tried to reduce the corticosteroid dose, but they are rarely effective and have numerous side effects: ciclosporin (Neoral), azathioprine (Imuran), cyclophosphamide (Endoxan). Mepolizumab (Nucala) is an agent that specifically targets interleukin-5 (it binds to this growth factor and neutralises its effects). It has recently been approved as a treatment for severe eosinophilic asthma that is not controlled by standard treatments. It proved to be an effective corticosteroid-sparing treatment for hypereosinophilic syndrome when administered intravenously once a month as part of a clinical study. However, it is not yet available to treat this disease because it has not been approved for this indication by the regulatory agencies (in particular, the Food and Drug Administration, or FDA, in North America; and the European Medicines Agency, or EMA, in Europe). It is currently available to treat hypereosinophilic syndrome only במסגרת a compassionate-use programme based on an individual case assessment, for patients with disease considered very severe (potentially life-threatening), for whom the conventional treatments mentioned above are ineffective and/or poorly tolerated. A new clinical study assessing the efficacy of subcutaneous mepolizumab administration in patients with hypereosinophilic syndrome is currently being prepared. 2. In the absence of a response to corticosteroids If the eosinophil count and symptoms do not respond, or respond only very partially, to corticosteroids, selecting an effective treatment may require several trials and changes of medicines over a period of several months, during which eosinophils may continue to cause damage. Close medical follow-up is essential during this period. The corticosteroid-sparing agents mentioned in the previous section may sometimes be effective, possibly in combination (for example, hydroxyurea and interferon-alpha). Rarely, some of these patients have an acquired genetic mutation that remains undetected (it is invisible using the techniques currently available to us) and that justifies a short trial (one month) of imatinib mesylate (Glivec). The recommended dose is higher than that used for chronic eosinophilic leukaemia and is therefore more often associated with side effects, including swelling of the legs and eyelids, fatigue, and bone marrow toxicity. Mepolizumab has never been tested in corticosteroid-resistant patients as part of a clinical study. However, it is available במסגרת the compassionate-use programme mentioned above, with patient eligibility determined individually after assessment of the medical file. Very rarely, a patient may not respond to any of the treatments mentioned above, while persistent hypereosinophilia continues to cause significant damage (to the heart, brain or blood vessels, for example) that threatens survival. The possibility of a stem cell transplant (formerly called a bone marrow transplant) from a healthy donor (either a close family member, where possible, or an unrelated donor) must then be discussed. This procedure consists of administering high-dose chemotherapy in the hope of killing all the abnormal cells in the bone marrow that are responsible for the hypereosinophilia. One consequence (unintended but unavoidable) of this treatment is that the other bone marrow cells needed to produce red blood cells, healthy white blood cells required to protect us against infections, and platelets will also be destroyed. It is then necessary to provide the patient with healthy cells (collected from a healthy donor), which will repopulate the bone marrow and enable it to produce new red blood cells, white blood cells and platelets. This procedure exposes the patient to the risk of numerous serious complications during the period before the donor cells have colonised the bone marrow, and will therefore be reserved for the most severe cases.