Refractory Epilepsy
Epilepsy is, unfortunately, one of the most common neurological diseases, affecting approximately 70,000 people in Belgium, equivalent to one person per Belgian street. Among chronic neurological diseases, it is the most stigmatized. It is characterized by unusual neuronal excitation leading to disabling seizures. These seizures can manifest through various clinical signs such as convulsions, absences, significant anxiety, hallucinations, or vomiting, depending on the seizure's origin.
Epilepsy can occur at any age, affecting adults and children alike. The causes of epilepsy are varied and may include stroke, tumor, cortical malformation, or genetic factors. However, the cause sometimes remains undetermined. In children, the brain is particularly vulnerable to infections or trauma, making the condition relatively common among them. Quick and critical management is essential, as epilepsy can directly influence cognitive development, potentially leading to intellectual disability with a prevalence up to eight times higher than in the general population.
In both adults and children with epilepsy, seizures can sometimes resist medication considered adequate. This condition is known as refractory epilepsy, affecting about one in three patients. Without additional treatment, these patients face not only a significant social and professional handicap but also a high risk of premature sudden death related to unstable seizures (Sudden Unexpected Death in Epilepsy, or SUDEP). These sudden deaths are unfortunately more frequent in younger patients, underscoring the critical need for appropriate management to ensure their future.
For patients with refractory epilepsy, additional treatments such as brain surgery are offered. However, identifying the brain areas responsible for epileptic activity (epileptogenic zone) is not always straightforward, making some patients ineligible for surgery. In such cases, neurostimulation treatments like VNS can be proposed. Although effective in about one-third of refractory epilepsy patients, the mechanisms of VNS therapy are still under investigation. A better understanding of these mechanisms could improve patient care by maximizing the therapy's antiepileptic effects and predicting treatment response to avoid ineffective implantations.