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Vagal Nerve Stimulation (VNS) has been approved since 1994 in Europe and since 1997 in USA. The first implantation of electrodes for vagal nerve stimulation into humans was performed i n 1988. Despite the availability of multiple antiepileptic medication s and surgical procedures with which to resect seizure foci, there is a subset of epilepsy patients for whom little can be done. VNS is an alternative treatment for drug resistant epilepsy for patients with recurrent seizures after resective surgery or who are not candidates for curative surgery.Purpose : the objective of our study is to identify the main factors influencing the response to vagal nerve stimulation for drug resistant patients implanted between 2001 and 2012 in the Cliniques Universitaires Saint-Luc.Method : our study is based on a retrospective analysis of the medical files of 132 patients. The collected data were encoded i n a structured database. The levels of response to VNS were determined on the basis of case by base analysis of the follow-up profiles corresponding to a period of 6 months. These levels have been categorized.The influence of the variables on the level of response has been studied using the Chi Square statistical method (X2). This method allowed us to identify the most discriminating variables. The impact (positive or negative) and the magnitude of the influence of these variables have been determined from the detailed analysis of the distribution of the responses of ail patients.Results : We have demonstrated that patients having received surgical treatment for epilepsy are Jess responding to VNS compared to those who have been directly implanted . We have also shown that the delay between the diagnostic and the implantation of the electrode is a important variable. It appears that the level of response to VNS is inversely proportional to this delay. It is then key to consider the placement of vagal nerve stimulator as soon as possible. In our study, the threshold is 15 years. However, this threshold allows comfortable latitude to set a thorough examination ail the more since, according to our results, the use of invasive surgery techniques such as EEG investigation did not influence the response to VNS.It appears that the patients who don’t have tonico-clonic seizures show higher probability to positively respond to VNS. However, we observed mainly slight improvements with seizures frequency reduction level below 50%. Consequently, on a therapeutic point of view this variable could not be considered as significant. We have emphasized that overweight is also a key variable having a negative impact on the VNS efficiency. This result is, according to our knowledge, the first reported impact of overweight and is most probably a consequence of the secondary pathologies caused by overweight.Finally, we have highlighted that genetic epilepsies have a lower probability to positively respond to VNS.Conclusion : knowing the influence of the discriminating variables, the results of our study pave the way to a better understanding of the probability of success of VNS for future patients who will be treated at the Cliniques Universitaires Saint-Luc. If it is difficult to consider the development of a robust predictive model at this stage, we recommend to put in place, at the patient intake, a description sheet allowing to record the discriminating variables as well as, to a lesser extent, the variable characterized by a probability level of 75%. The objective is to estimate a priori the expected level of response of the patient. La stimulation du nerf vague (VNS) a été validée en Europe dès 1994 et en 1997 aux USA. La première implantation d'électrodes chez l'homme remonte à 1988. Malgré l'avènement de nouveaux antiépileptiques et les progrès concernant la chirurgie curative, il reste un certain nombre de patient pour lesquels le contrôle des crises reste difficile. La VNS est un traitement alternatif pour l'épilepsie médicalement réfractaire non seulement pour des patients présentant des crises récurrentes malgré une intervention mais également chez les patients qui ne sont pas candidats à la chirurgie curative.Objectif : L'objectif de ce mémoire est de mettre en évidence les facteurs qui influencent l’efficacité du traitement par stimulation du nerf vague chez les patients épileptiques pharmaco-résistants implantés aux cliniques universitaires Saint-Luc entre 2001 et fin 2012.Méthode : Notre étude se base sur l’analyse rétrospective des dossiers de 132 patients. Les données collectées ont été reportées dans une base de données structurée. Les niveaux de réponse à la VNS ont été déterminés sur base de l'analyse au cas par cas des profils de suivi des patients sur une période de 6 mois. Ceux ont été répartis en classes de réponse.L'influence des variables sur la réponse a été étudiée en utilisant la méthode du Chi Carré (X2). Cette technique nous a permis d'identifier les variables les plus discriminantes. Le sens et l'ampleur de l’influence de ces variables ont ensuite fait l 'objet d'une analyse approfondie de la répartition des profils de réponse de tous les patients.Résultats : Nous avons démontré que les patients ayant bénéficié d'une chirurgie de l'épilepsie à visée thérapeutique répondaient moins bien à la VNS que ceux qui se dirigent d'emblée vers la stimulation du nerf vague. Nous avons également mis en évidence que le temps écoulé entre le diagnostic et la mise en œuvre du traitement est une variable importante. Il apparaît en effet que le taux de succès de la VNS est inversement proportionnel à la durée de l’épilepsie. Il est donc important de considérer l'implantation du stimulateur du nerf vague rapidement. Dans notre étude, le seuil critique se situe à 15 ans. Ce seuil laisse cependant une latitude confortable pour la mise en œuvre d'une investigation approfondie qui se justifie d'autant plus que, selon nos résultats, l'utilisation de techniques de chirurgie d'investigation comme l'EEG invasif n'influence pas la réponse à la VNS.Il apparaît en outre que les patients ne présentant pas de crises de type Tonico-clonique ont des chances de mieux répondre à la VNS. Cette amélioration est cependant d'ampleur limitée avec un taux de diminution attendue des crises <50%. Par conséquent, nous pouvons considérer que du point de vue thérapeutique, cette variable n 'influence pas la réponse à la VNS.Nous avons observé que la présence de surpoids était également un paramètre ayant un impact négatif sur l'efficacitéde la VNS. Ce résultat, qui n'a à notre connaissance pas encore été décrit dans la littérature, est probablement associé aux pathologies secondaires causée par ce surpoids.Enfin, notre étude démontre que les épilepsies d'origine génétique ont moins de chance de répondre positivement à la VNS que les épilepsies symptomatiques ou probablement symptomatiques.Conclusion : Grâce à la connaissance de l’influence des variables discriminantes, les résultats de notre étude devraient permettre de mieux appréhender la probabilité de succès de la VNS chez les patients se présentant aux cliniques Universitaires Saint-Luc. S'il est difficilement envisageable de pouvoir établir un modèle mathématique robuste à ce stade, il est tout à fait possible de mettre en place, au niveau de l'accueil du patient, une fiche signalétique permettant de relever spécifiquement les variables que nous avons identifiées comme discriminantes ainsi que dans une moindre mesure celles présentant un niveau de probabilité supérieur à 75%. L'objectif final est de déterminer a priori les chances de succès de la VNS.

Epilepsy --- Vagus Nerve Stimulation

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The stimulation of the vagus nerve allows a decrease in the frequency of seizures in epileptic people. The neurostimulators currently on the market are not compatible with MRIs, yet monitoring these patients by medical imaging would be very interesting. Therefore, Synergia decided to create a glass implant and reinforce it with resin. This combination causes many breakage problems, which is what my work will focus on. A first goal is to understand why some resins cause the glass encapsulation to break and others do not. A second goal is to be able to propose more advantageous resins than those currently used.

Epilepsy, vagus nerve stimulation, implantable pulse generator, brittle encapsulation, glass, reinforcement, resin, fracture, thermal tests, mechanical tests --- Ingénierie, informatique & technologie > Ingénierie mécanique --- Ingénierie, informatique & technologie > Multidisciplinaire, généralités & autres

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This e-book summarises the latest advances in the rheumatic diseases with a focus on the recent efforts of vascular and pulmonary manifestations and anticipate the new and future directions of these research topic. Rheumatic diseases represent a heterogeneous group of severe autoimmune disorders. The present Special Issue aims to provide an overview of the complexity of vascular and pulmonary manifestations of rheumatologic diseases and helps in knowledge to manage them. The eleven published articles here collected underline the complexity of rheumatic diseases and the difficult to treated them. The manuscripts provide an overview of the pathophysiology and current treatment regimes of these disorders, highlighting tools which assist with diagnosis, risk stratification and therapy. Finally, we underline the importance of a multidisciplinary team working using the skills of clinicians, radiologists, and pathologists.

Medicine --- Pharmacology --- systemic sclerosis --- scleroderma --- interstitial lung disease --- pulmonary function tests --- high-resolution computed tomography --- rheumatic --- pulmonary arterial hypertension --- targeted therapy --- systemic lupus erythematosus --- airway disease --- shrinking lung syndrome --- diffuse alveolar hemorrhage --- pleurisy --- infection --- cardiopulmonary exercise testing --- osteopontin --- connective tissue diseases --- pulmonary involvement --- microvascular involvement --- nailfold capillaroscopy --- rheumatoid arthritis --- interstitial lung diseases --- CX3CL1/fractalkine --- CX3CR1 --- M1 macrophage --- M2 macrophage --- SKG mice --- heart failure --- 3D-echocardiography --- ventricular function --- outcome --- ventricular-arterial coupling --- antifibrotic agents --- COVID-19 --- IPF --- progressive fibrosing ILD --- UIP --- pharmacological interactions --- fibromyalgia --- gastrointestinal symptoms --- probiotic --- VSL#3® --- efficacy --- tolerability --- polymyalgia rheumatica --- vagus nerve stimulation --- inflammatory response --- PMR --- t-vns

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This e-book summarises the latest advances in the rheumatic diseases with a focus on the recent efforts of vascular and pulmonary manifestations and anticipate the new and future directions of these research topic. Rheumatic diseases represent a heterogeneous group of severe autoimmune disorders. The present Special Issue aims to provide an overview of the complexity of vascular and pulmonary manifestations of rheumatologic diseases and helps in knowledge to manage them. The eleven published articles here collected underline the complexity of rheumatic diseases and the difficult to treated them. The manuscripts provide an overview of the pathophysiology and current treatment regimes of these disorders, highlighting tools which assist with diagnosis, risk stratification and therapy. Finally, we underline the importance of a multidisciplinary team working using the skills of clinicians, radiologists, and pathologists.

Medicine --- Pharmacology --- systemic sclerosis --- scleroderma --- interstitial lung disease --- pulmonary function tests --- high-resolution computed tomography --- rheumatic --- pulmonary arterial hypertension --- targeted therapy --- systemic lupus erythematosus --- airway disease --- shrinking lung syndrome --- diffuse alveolar hemorrhage --- pleurisy --- infection --- cardiopulmonary exercise testing --- osteopontin --- connective tissue diseases --- pulmonary involvement --- microvascular involvement --- nailfold capillaroscopy --- rheumatoid arthritis --- interstitial lung diseases --- CX3CL1/fractalkine --- CX3CR1 --- M1 macrophage --- M2 macrophage --- SKG mice --- heart failure --- 3D-echocardiography --- ventricular function --- outcome --- ventricular-arterial coupling --- antifibrotic agents --- COVID-19 --- IPF --- progressive fibrosing ILD --- UIP --- pharmacological interactions --- fibromyalgia --- gastrointestinal symptoms --- probiotic --- VSL#3® --- efficacy --- tolerability --- polymyalgia rheumatica --- vagus nerve stimulation --- inflammatory response --- PMR --- t-vns --- systemic sclerosis --- scleroderma --- interstitial lung disease --- pulmonary function tests --- high-resolution computed tomography --- rheumatic --- pulmonary arterial hypertension --- targeted therapy --- systemic lupus erythematosus --- airway disease --- shrinking lung syndrome --- diffuse alveolar hemorrhage --- pleurisy --- infection --- cardiopulmonary exercise testing --- osteopontin --- connective tissue diseases --- pulmonary involvement --- microvascular involvement --- nailfold capillaroscopy --- rheumatoid arthritis --- interstitial lung diseases --- CX3CL1/fractalkine --- CX3CR1 --- M1 macrophage --- M2 macrophage --- SKG mice --- heart failure --- 3D-echocardiography --- ventricular function --- outcome --- ventricular-arterial coupling --- antifibrotic agents --- COVID-19 --- IPF --- progressive fibrosing ILD --- UIP --- pharmacological interactions --- fibromyalgia --- gastrointestinal symptoms --- probiotic --- VSL#3® --- efficacy --- tolerability --- polymyalgia rheumatica --- vagus nerve stimulation --- inflammatory response --- PMR --- t-vns