Recherche

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.

What is sickle cell disease? Sickle Cell Disease is a genetic disorder of haemoglobin, the main component of red blood cells, which transports oxygen throughout the body. In sickle cell disease, the haemoglobin is abnormal and is called haemoglobin S (normal haemoglobin is called haemoglobin A). This abnormal haemoglobin causes the red blood cells to become crescent-shaped (known as sickle-shaped red blood cells). This abnormal haemoglobin causes the red blood cells to become crescent-shaped (known as sickle-shaped red blood cells). These abnormal red blood cells have two main consequences:Abnormal rigidity, which causes obstruction of the blood vessels and prevents blood—and therefore oxygen—from reaching the tissues and organsSignificant fragility, which causes their accelerated destruction and leads to anaemia (red blood cell and haemoglobin levels that are too low)These mechanisms lead to acute and chronic complications affecting all of the patient’s organs, requiring specialised multidisciplinary follow-up. Watch our films on Sickle Cell Disease Sickle Cell Disease, those who are looking They know about Sickle Cell Disease—do you? Causes and risk factors  Sickle cell disease is an inherited genetic disorder, meaning that abnormal haemoglobin (haemoglobin S) is transmitted by the parents to their children and is present from birth. We all carry two copies of each gene: one copy is inherited from the mother and one copy is inherited from the father. To have sickle cell disease, a person must have two abnormal genes and therefore have received one copy of an abnormal gene from each parent. People carrying only one abnormal gene are referred to as “healthy carriers” and show no signs of sickle cell disease. Care: diagnosis and treatment Diagnosis involves a blood test to detect the presence of abnormal haemoglobin (not to be confused with the A, B and O blood groups, which are unrelated to sickle cell disease). This test is sometimes supplemented by genetic analysis to clarify the diagnosis. Our laboratory is recognised as a Belgian and European reference laboratory for the biological and genetic diagnosis of red blood cell diseases.The only current curative treatment is a bone marrow transplant (or haematopoietic stem cell transplant), mainly performed in paediatric care. At present, management is based on screening for and treating complications, as well as treatments capable of alleviating red blood cell abnormalities and their consequences (for example, hydroxyurea or Hydrea®). Thanks to our expertise, our centre also has several clinical study protocols enabling patients to benefit from therapeutic innovations in this field. Clinical studies enable patients to participate in research and help advance care for people with sickle cell disease, while offering them the possibility of benefiting from new treatments or approaches for this condition. Red blood cell transfusion also plays an important role in the therapeutic arsenal. Its use in patients with sickle cell disease is complex and requires close collaboration between clinicians, the laboratory and technical platforms (such as dialysis for carrying out exchange transfusions). Orphanet Search In addition to research into new treatments, our team coordinates several studies aimed at improving our understanding of the disease and its clinical consequences, as well as improving patient care (what is known as clinical research).Furthermore, our team collaborates with various research laboratories in Belgium and abroad to advance our understanding of the mechanisms underlying sickle cell disease and other red blood cell disorders. This research helps link cellular mechanisms to clinical manifestations and paves the way for new treatments (what is known as translational research). Discover our video on Sickle Cell Disease research at H.U.B. Team and multidisciplinary care Patient care is provided by a multidisciplinary team comprising physicians specialising in sickle cell disease, as well as coordinating and specialist nurses. When hospitalisation is required, patients are admitted to a dedicated inpatient unit providing care specific to this condition. Follow-up also relies on a network of referring physicians specialising in the various affected organs, with particular expertise in aspects related to sickle cell disease (Neurology, Ophthalmology, ENT, Stomatology, Cardiology, Pneumology, Gastroenterology, Nephrology, Urology, Digestive surgery, Orthopaedic surgery, etc.). The department works closely with the hospital’s Erythrocyte Chemistry, Genetics and Immunohaematology/Transfusion laboratories.Our physicians are also members of the red blood cell subgroup of the Belgian Society of Haematology and maintain close collaboration with the team of Professor P. Bartolucci at the reference centre for rare red blood cell diseases, CHU Mondor in Créteil, Paris, France.Our department is recognised as a national and European reference centre for rare red blood cell diseases (ERN) and by the French healthcare network for rare constitutional diseases of red blood cells and erythropoiesis (MCGRE). Expertise and multidisciplinary discussions Complex cases are discussed monthly during a multidisciplinary meeting attended by experts in the relevant areas. These meetings are also open to other hospitals within the network, enabling collaboration and the sharing of expertise for the benefit of patients. To register a patient for this multidisciplinary consultation meeting, please complete the information form and send it to secretariat [dot] hematologie [at] hubruxelles [dot] be (secretariat[dot]hematologie[at]hubruxelles[dot]be). A service recognised as a centre of expertise Brussels University Hospital – Erasme Hospital is recognised as a European reference centre for the management of red blood cell disorders, including Sickle Cell Disease. ERN EuroBloodNet Orphanet Associated services Our specialist doctors in Sickle Cell Disease Prof. Martin ColardProfessor of Haematology, H.U.B. – Erasme; national adult sickle cell disease expert, coordinator of the sickle cell disease inpatient unit Dr Aude Theunissen Clinical haematologist, Adult Sickle Cell Disease Reference Centre, Red Blood Cell Disorders Unit, Brussels University Hospital – Erasme Send a message Image Cross-functional collaboration: Queen Fabiola Children’s University Hospital At H.U.B, care for Sickle Cell Disease is also provided at the Children’s Hospital (HUDERF). For more information, click on the link below. Sickle Cell Disease Children’s Hospital

The term “systemic and autoimmune inflammatory diseases” encompasses a range of different conditions that share an abnormal and persistent activation of the immune system, leading to impaired function of several organs, tissues and/or systems. These include, in particular: Autoimmune diseases, such as systemic lupus erythematosus, Sjögren’s disease, scleroderma (or systemic sclerosis), and polymyositis Vasculitis, such as granulomatosis with polyangiitis (formerly Wegener’s disease), eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome), giant-cell arteritis (also known as Horton’s disease), and Behçet’s disease Non-infectious granulomatous diseases, such as sarcoidosis Autoinflammatory diseases, such as familial Mediterranean fever and TRAPS And various other conditions, including IgG4-related disease and relapsing polychondritis. Since 2011, several departments at Erasme Hospital have pooled their clinical immunology expertise to create a transdisciplinary care platform for these conditions, known as the MISIM platform (for “Systemic and Immuno-Mediated Inflammatory Diseases”). Numerous medical specialists are involved in this unique platform. Transdisciplinary care is essential for identifying, monitoring and treating, in the most appropriate way, complications directly related to diseases that may affect different organs and tissues, as well as complications resulting from prolonged treatments. The departments actively involved in this platform include: Internal medicine Rheumatology Nephrology Pneumology Gastroenterology Neurology Dermatology Ophthalmology Cardiology The optimal management of chronic inflammatory diseases also often relies on specific blood tests, the interpretation of which can be challenging and may require discussion between laboratory specialists and clinicians. This is why an immunology laboratory specialist is also involved in the platform. The creation of a single platform for such diverse diseases is justified by a number of reasons related to the diseases themselves (the way they manifest and their complications) and to their management. Indeed, although each of these diseases has its own specific features, they share many common characteristics: In terms of manifestations and complications, there is considerable overlap between these diseases. For example, the lung inflammation that may occur in scleroderma or Sjögren’s disease is the same; it requires the same diagnostic tests and the same treatments. In terms of medical management, the approach is similar, particularly with regard to the investigations leading to the diagnosis, the types of medication prescribed, the prevention of treatment-related complications, and follow-up.

Presentation HIV infection is the most common cause of acquired immunodeficiency. Without treatment, this infection leads to AIDS, a fatal disease that can now be readily prevented through treatment supervised by a specialised team in this field. The AIDS Reference Centre and the Immunodeficiency Treatment Unit provide preventive and therapeutic care for patients suffering from different forms of immunodeficiency.   HIV seropositivity and AIDS HIV (human immunodeficiency virus) infection is the most common cause of acquired immunodeficiency. Without treatment, this infection leads to AIDS, a fatal disease that can now be easily prevented through treatment supervised by a specialised team. The Erasme Hospital reference centre provides: regular medical follow-up by specialist physicians in collaboration with your general practitioner free multidisciplinary care under an agreement with INAMI (nurses, sexologists, psychologists, dietitians, social workers, etc.) close collaboration with other medical disciplines (hepatology, dermatology, gynaecology, medically assisted reproduction, proctology, etc.) collaboration with various organisations active in the field of HIV (Plateforme prévention SIDA, Ex-Aequo, Aide Info SIDA, SIDA SOS, SIDA Sol, SIDAIDS Migrant, Sensoa, etc.) The reference centre also participates in numerous clinical studies. Screening and treatments Do you think you may have been exposed to HIV or other STIs? It is now possible to receive emergency preventive treatment that can significantly reduce the risk of contracting HIV. It is called Post-Exposure Prophylaxis (PEP), and you can access it 24/7. This treatment must be taken within 72 hours of a high-risk exposure. It is available during the day by appointment (02 555 7484) and at the Emergency Department at night and on weekends. Would you like to be screened for sexually transmitted infections? We offer immediate comprehensive screening for the most common STIs (chlamydia, gonorrhoea, hepatitis, syphilis and HIV). This screening is partially reimbursed by INAMI. Would you like to take PrEP? Pre-exposure prophylaxis has been shown to be effective in reducing the risk of acquiring HIV in specific situations. If you are already taking PrEP or would like follow-up in connection with future PrEP use, we offer specialised follow-up. More information: www.myprep.be.

Presentation The National Reference Centre for Congenital Infections is part of the network of National Reference Centres coordinated by Sciensano. Our specialties The NRL performs serological (confirmatory) and microbiological (PCR) analyses for the following conditions: cytomegalovirus (CMV), Toxoplasma gondii, rubella and parvovirus B19. It is accredited in accordance with the EN ISO 15189 standard. The NRL provides its expertise by advising clinicians and biologists on the diagnosis and prognosis of congenital infections. Contact National Reference Centre for Congenital InfectionsDr Marie-Luce DelforgeBrussels University Hospital: Erasme Hospital - ULBRoute de Lennik 808, 1070 BrusselsTel.: 02 555 66 81Email: marie-luce [dot] delforge [at] erasme [dot] ulb [dot] ac [dot] be (marie-luce[dot]delforge[at]hubruxelles[dot]be) Useful links Sciensano – National Reference Centre for Congenital Infections Compendium

The departments we collaborate with The Clinical Neurophysiology Laboratory places its expertise at your service by working in close collaboration with:Our Neuromuscular Disease Reference Centre (CRMN), to enable the diagnosis and monitoring of rare diseases such as:Neuropathies of immune origin (Guillain–Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP))AmyloidosisMotor neuron diseases such as Charcot disease, also known as amyotrophic lateral sclerosisNeuromuscular junction disorders such as myasthenia gravis or Lambert–Eaton syndromePeriodic paralyses and other muscle diseases (myopathies such as myositis, dermatomyositis, myotomies, …), Various departments, such as neurosurgery, the endocrinology department, internal medicine, oncology, rheumatology, orthopaedics, and gastroenterology, for common conditions regularly requiring examinations in our laboratory:Polyneuropathies, polyneuritis or neuropathies related to diabetes, vitamin deficiencies, chemotherapy toxicity, …Sciatica, radiculopathies and plexopathiesCarpal tunnel syndrome or other nerve compressions.We also provide our expertise for monitoring these conditions, in close cooperation with all these departments whenever necessary. The tests performed by the H.U.B Neurophysiology Laboratory We also perform evoked potential tests, which assess the function of the neural structures associated with our senses (somatosensory, visual and auditory) or with motor pathways. We use these tests to investigate conditions with a complex diagnosis, such as:        Multiple sclerosisCervical myelopathy,Myelitis,Syringomyelia,Amyotrophic lateral sclerosis… The tests most frequently performed in this department are as follows:Nerve conduction velocity testingDiseases affecting the peripheral nerves may cause a slowing of the conduction velocity of nerve impulses, as well as a reduction in the amplitude of responses in the muscles activated by these nerves, or a reduction in the amplitude of the electrical response of the nerves that carry sensory information. To record these responses, the doctor will place adhesive electrodes either on a muscle activated by the nerves being studied or along the path of a sensory nerve. The nerves being studied are most often activated using a stimulator that delivers an electrical current whose intensity is gradually increased to obtain the largest possible response. To ensure that this test is performed properly, please keep your hands and/or feet as warm as possible (for example, by wearing boots or gloves in winter and closed shoes during the other seasons, etc.). Also avoid using oily or moisturising ointments, as these interfere with contact between the electrodes and your skin.Electromyography (EMG) This test involves inserting a fine needle into the muscle being examined. The needle records the electrical activity produced by the muscle fibres when the muscles are activated or when they are at rest and fully relaxed. This analysis can detect abnormalities related to impaired nerve function (neurogenic involvement) or muscle function (myopathic involvement). Please remember to tell us if you are taking anticoagulant medication, as this test involves a needle puncture.Repetitive stimulationWhen a motor nerve is activated, the electrical impulse travels through the nerve ending that is in contact with the muscle. This specialised structure is called the neuromuscular junction. A neurotransmitter (acetylcholine) is released, enabling the muscle to be activated. Certain conditions, such as myasthenia gravis and Lambert-Eaton syndrome, cause dysfunction of this neuromuscular junction, preventing normal activation and resulting in abnormal muscle fatigue.Evoked potentialsThese techniques involve stimulating the sensory organs to assess the function of the specialised neural structures responsible for transmitting information related to touch, hearing and vision, using electrical shocks, headphones or a screen, respectively. These stimuli activate different structures of the nervous system. Electrodes placed at specific points on the scalp, neck and limbs record electrical activity, making it possible to analyse the time required for nerve impulses to travel through the activated structures. Somatosensory evoked potentials assess sensitivity using stimulation—most commonly an electrical shock—of the sensory nerves in the upper or lower limbs. Auditory evoked potentials are recorded using headphones that produce sounds which activate the inner ear and generate electrical currents in the auditory pathways. Visual evoked potentials are recorded while a screen displays checkerboard patterns alternating between white and black squares. This visual stimulation activates the retinal cells, optic nerve and specialised brain structures involved in processing visual information, ultimately activating neurons in the occipital cortex. Motor evoked potentialsThis test assesses the motor pathways by stimulating the motor neurons in the cerebral cortex using a magnetic field produced by a current delivered to an electrical coil placed on the head. This technique produces painless stimulation through the skull or at the cervical or lumbar region. The resulting response is recorded by electrodes placed on the muscles of the hands or legs. Please remember to tell us if you have epilepsy or if you have any implanted metal devices in your body (pacemaker, cochlear implant, etc.) or retained metal fragments (bullets, etc.).   Professor Nicolas MAVROUDAKIS Director of the H.U.B Neurophysiology Laboratory

Neuromuscular diseases account for a significant proportion of acquired or genetic neurological disorders. They encompass all diseases affecting the peripheral nervous system.From an anatomical perspective, they include diseases of the peripheral nerves in the broadest sense (motor neurons, spinal ganglia, myelin sheath, small peripheral nerve fibres, sensory or motor nerve fibres, the autonomic nervous system, etc.), diseases of the neuromuscular junction (myasthenia gravis, Lambert–Eaton syndrome) and diseases of the muscle (myopathies). Most of these diseases are rare and are generally characterised by a chronic course. Professional and psychosocial impactIn most patients, neuromuscular diseases regularly result in the development of a disability that may have a significant professional and psychosocial impact. They may be associated with an acute, subacute or progressive risk to life, primarily affecting the respiratory and cardiac systems. They regularly require end-of-life care, with all the ethical issues that arise during these difficult times. Their management requires specific expertise at every stage of the disease, including the diagnostic phase. The need to centralise the care of patients with neuromuscular diseases is well established. This approach is implemented in many European countries. To this end, Neuromuscular Reference Centres (CRNMs) have been developed. Extended multidisciplinary careThe Neuromuscular Reference Centre (CRNM) brings together a team of medical and paramedical experts in the field of neuromuscular diseases. It is intended to organise multidisciplinary consultations in coordination with the treating doctors and paramedical professionals. For many chronic diseases, centralising care in a specialised centre improves outcomes in terms of morbidity and mortality. Some of the objectives are to preserve autonomy and prevent complications. These two factors have an impact on the direct and indirect costs of the disease. Bringing together within a single entity all the expertise required for the diagnostic and therapeutic management of patients with rare, chronic and progressive diseases is therefore a rational approach. Patients are monitored by a specialised team dedicated to their condition. At the heart of treatment is an extended multidisciplinary approach bringing together adult and paediatric, medical and paramedical expertise in a wide range of fields, such as neurology, genetics, functional rehabilitation, anatomical pathology, cardiology, pulmonology, physiotherapy, occupational therapy, treatment of neuropathic pain, treatment of autoimmune diseases through immunomodulation, surgical treatments such as thymectomy in certain cases of myasthenia gravis, and scoliosis correction procedures for myopathies.At Erasme Hospital, Dr Gauthier Remiche is the medical director of the Neuromuscular Reference Centre (CRNM).

Primary immunodeficiencies unrelated to HIV, most of which are hereditary, are rarer and require a multidisciplinary approach provided by the various members of the team. These include, among others: common variable immunodeficiencies antipolysaccharide antibody deficiencies chronic granulomatous diseases predispositions to fungal, viral and mycobacterial infections The unit provides daily consultations to ensure prompt care and works closely with the infectious diseases clinic. Our centre is one of the few authorised reference centres (www.bpidg.be) eligible for reimbursement of antibody replacement therapies in this context.

Epilepsy—or rather epilepsies, since the term actually encompasses several diseases—is the most common chronic neurological disease after migraine. It affects just under 1% of the population. Epilepsy and its treatments Epilepsy manifests itself through seizures, whose frequency and nature can vary considerably. It affects patients of all ages and may occur spontaneously or result from an illness or an accident. Effective medicines are available to treat epilepsy, but in a significant minority of patients—approximately 35%—these treatments, even when taken as prescribed, do not completely eliminate the seizures. This is referred to as refractory epilepsy. Epilepsy care at Erasme Hospital The Neurology Department provides comprehensive care for epilepsy.