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Interview with Kees Braun and Maeike Zijlmans

Getting closer to the epileptic action

"Building expertise in rare and complex forms of epilepsy."

Around 120,000 people in the Netherlands live with epilepsy, over 20.000 of them are children. A small group benefits from surgery. Around 80 patients per year –25 adults and 55 children– are surgically treated in the UMC Utrecht, which has been endorsed by the Netherlands Federation of University Medical Centres (NFU) and by Orphanet as a center of expertise for rare epilepsy in children: the Center for Refractory Pediatric Epilepsy.  

To become a reliable expert, one has to single out one’s strengths. This epilepsy group’s main strength is refractory epilepsy, particularly in children. Looking at hard to treat types of epilepsy from all angles boils down to three research topics:

  • How did epilepsy come to exist, what are its genetic origins, and what characterizes the process of epileptogenesis? Can the understanding of genetic causes of epilepsy lead to the development of novel therapeutic options?
  • How can focal epilepsy damage the integrity of the entire brain and compromise the child’s cognitive development?
  • How can we better help our patients by delineating the epileptogenic focus and neighbouring brain functions, in order to improve the selection of candidates for epilepsy surgery?

Epilepsy is one of the research themes of Brain Center Rudolf Magnus. This has encouraged the development of a large epilepsy research group. “Our aim is to create an epilepsy platform, in which we’ll establish both research and patient care projects that go hand in hand and will truly make a difference,” says Kees Braun, head of the department of Child Neurology and coordinator of the epilepsy group. “Five different research groups, that have been involved in different aspects of epilepsy for many years, now come together. Our aim is that in five years’ time our group will be one of the leading centers in Europe, hopefully even worldwide.” 

HFO detection

Neurologist Maeike Zijlmans works on the third topic. She’s been exploring how to pinpoint the exact source of epilepsy in the brain. Localizing the tissue a neurosurgeon needs to remove is a difficult job, because distinguishing affected from normal brain tissue is hard. Zijlmans looked into a potentially precise way of presurgical localization; by measuring high frequency oscillations (HFOs) of over 80 Hz, you can see where the epileptic action is. She wants to reach further: “My aim is to develop a device that helps surgeons find the pathological brain tissue directly. Bringing together the right people for this is my main challenge at the moment." 

Zijlmans dissertation earned five prizes, primarily due to the direct value it offers to patient care: “I like the challenge of presenting my research and ideas in a clear and simple way. I’d like to make a documentary about neurology one day, explaining the vastness of research, and showing what I like about it: the puzzle-solving, the closeness of abnormality next to normality in our brain, the exploration of all these little fields that have so many implications for a patient’s life.” A multidisciplinary research group, where the technically and clinically talented share in each other’s knowledge, that’s Zijlmans’ goal. Kees Braun can relate to that: “I’m a child neurologist, but I keep learning from my colleague clinicians and researchers: neurosurgeons, engineers, radiologists, geneticists and basic neuroscientists. Working together, that’s how we can improve the field.”

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