A clinician, researcher and teacher, Philippe Evrard (1) is one of
Europe\\\'s pioneer paediatric neurologists. For the past three decades he
has been investigating the structure of the brain, the factors which
could distort its development in the womb, the neurological handicaps
which affect very premature babies and possible forms of preventive or
curative treatment.
THERE was a group of us who used to skip as many
lectures as we could so that we could spend all our time in the
laboratory, where we also spent a large part of our weekends and
holidays. I was lucky in that in my second year at university I was
granted the status of student-researcher, which existed in Belgium at
the time.\\\' Philippe Evrard got off to an early start, and under
favourable auspices. After coming to the attention of Pierre Baudhuin
and Christian de Duve, the future Nobel prizewinner, he worked for
several years in their cellular biology unit while pursuing his medical
studies at the University of Louvain. He then went on to set up his own
clinic in paediatric neurology. That was in 1969, at the age of just
27...
 Migrating neurons
Philippe was and remains fascinated by the human brain: \\\'I first wanted
to be a generalist but when someone I knew spent three months in a
coma, I was desperate to understand why.\\\' He can speak at length and
with an undiminished sense of wonder of the hundred billion neurons
which, between the third and sixth months of pregnancy, migrate from
the centre to the periphery of this mysterious organ, to form the
successive layers of the cortex. \\\'It is a very long way - equivalent to
us travelling 10 kilometres.\\\' Each neuron - and they can be produced at
the rate of 5 000 a second - must reach precisely its allotted place.
\\\'Special cells, called radial glial fibres, nourish the young neurons
and help them find their way. They are like cables, extending from the
deep matricial bulb to the surface of the developing brain.\\\'
But accidents occur along the way. Neuronal migration can, for example,
be thrown off course by \\\'foetal alcoholism\\\' or the consumption of
cocaine. Since 1974 Philippe Evrard and his research team have been
working on Zellweger\\\'s syndrome and other neuronal migration disorders.
Some of these are the result of a peroxisome deficiency which upsets
the flow of calcium through the neuronal membrane which controls the
migration. \\\'When we increase or decrease the trans-membrane calcium
flow on animal models, we halt the migration and cause brain
abnormalities like those found in the brains of some epileptics. This
research has allowed us to understand many errors which can arise in
the construction of the foetus\\\' brain, as well as the frequent cerebral
lesions which appear in very premature babies. This fundamental
research has allowed us to propose new tools for neuroprotection at
this stage of life.\\\'
Science or religion?
From his window in central Paris , Philippe Evrard looks out on a red,
white and blue statue by Jean Dubuffet on one of the terraces. The
Hôpital Robert Debré is built in a series of wide tiers laid out in a
gentle arc, at the centre of which stands a rather surprising yet
evocative feature: a church. \\\'This sparked a lot of debate. Should the
church be demolished to make room for the hospital? Finally, Pierre
Riboulet - a great architect - came up with this very successful
planning solution.\\\' Devoted to birth and children, this hospital is a
place of joy and gaiety with its children\\\'s library where the sections
are marked with large coloured spots, a corridor with a glass roof
opening out on to trees (\\\'we are just a stone\\\'s throw from the Butte du
Château Rouge, where Jaurès gave his famous antimilitarist speech in
1913\\\') and a painting by Ben, with just two words, in the distinctive
rounded letters: Je vis (\\\'I am alive\\\').
Life, that is what it is all about. \\\'In the most developed countries,
about 3% of children are born with serious and permanent abnormalities
of the nervous system. Many of these malformations originate at the
foetal stage.\\\' Care for premature and disabled babies has nevertheless
saved many children who would otherwise have died. This is why the
prevalence of neurological handicap of prenatal origin is currently
close to the level in the 1960s, after having previously fallen
sharply. But who can deny the right to life?\\\'
\\\'There is something above the law, above morals even, and that is the
obvious,\\\' (Charles de Gaulle). Philippe Evrard likes quotations: \\\'I use
a lot of them. Perhaps it is because I do not feel able to say things
as succinctly, and then there are other phrases, that I must have read
25 years ago and absorbed to such an extent that I feel they have
become my own.\\\' To his mind (and no quotation this time), \\\'Morals are
explained by history. Every European country is a kind of laboratory
and I do not believe you should have too many common regulations. Any
scientific question which raises ethical issues must be the subject of
public debate and legal regulation. But one must also remember that
these rules are always very provisional and that it must be possible to
change them.\\\'
Small patients, small budgets
But Europe could play a major role in resolving an issue which offends
paediatricians. \\\'At present there is an odious discrimination against
the child and the pregnant woman. The pharmaceutical industry is simply
not interested in the medicines which could be developed for them. If
you discover a molecule in paediatrics, you will be asked if it could
be used to treat Alzheimer\\\'s, because drugs are developed for the
largest group - and that means an ageing population of consumers.\\\'
The solution? The European marketing authorisations, which for many
medicines are enough in themselves to lead to national authorisation.
\\\'Our proposal is that when an application is submitted for an adult
product, it should be accompanied by an application for a similar
children\\\'s product. If the pharmaceutical industry believes this is
impossible from an economic or practical point of view, or simply that
it is not necessary, it should be required to present a well-argued
case establishing the fact.\\\' Philippe Evrard sees this research
obligation on the part of the private sector as a just return for the
public aid which supports the majority of fundamental research projects
which precede the development of new drugs.
Philippe Evrard also believes that Europe can play a role in the
developing public debate between science and society. \\\'This debate is
essential, but it is of poor quality, quite simply because the public
is insufficiently educated and informed.\\\' Who is to blame for this? The
researchers who are ineffective communicators? Journalists who fail to
do credit to their profession? \\\'There are good journalists, but in the
mass media they are given neither the time nor the space to express
themselves.\\\' He suggests that a public body (the European Union?)
should in some way \\\'sponsor\\\' quality information pages in the
non-specialist media.
In the context of his own clinical practice, Philippe Evrard would like
to see the Hôpital Robert Debré devote a page of its website to
providing information to patients. \\\'Very often those who come in for a
consultation have sought information on the internet and found some
very simplistic sites. When we refer them to other more interesting
sites, they come back and tell us, "We don\\\'t understand anything now,
it\\\'s all much more complicated than we thought." But from that point we
can start to discuss the matter on another basis.
Published in RDT-info in 2001
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