Seizures and Epilepsies (2023)

Published 2023-08-24

This video is intended to serve as an overview of seizures and epilepsies for medical students. Students will learn the differential diagnosis of transient neurological dysfunction, how to identify and classify a seizure, how to localize seizure focus based on presenting signs/symptoms (for focal seizures), how to estimate risk of seizure recurrence and the requirements to diagnose epilepsy. The video will then proceed to review antiseizure drug treatments and the treatments of status epilepticus, as well as risks/benefits of epilepsy surgery.

00:00 - Intro
00:49 - OBJECTIVES
03:01 - CASE
05:32 - DEFINING A SEIZURE
07:50 - Anatomy of a seizure
10:28 - SEIZURE CLASSIFICATION
16:21 - LOCALIZATION of seizure focus
23:21 - DIAGNOSTIC TESTING
25:39 - Brain imaging
30:05 - EEG
33:28 - Sensitivity, specificity of EEG
35:12 - EPILEPSY
38:19 - Epilepsy syndromes
43:46 - PHARMACOLOGICAL TREATMENTS for epilepsy
47:28 - Antiseizure medication side-effects
53:06 - Antiseizure drug table
56:25 - Choice of antiseizure drugs: Practice
01:06:37 - Management of CONVULSIVE STATUS EPILEPTICUS
01:08:27 - Pharmacological treatment of status
01:13:44 - Causes of status epilepticus
01:16:19 - SURGICAL TREATMENTS for epilepsy
01:18:05 - Benefits of epilepsy surgery
01:20:08 - Ideal candidate for epilepsy surgery
01:21:03 - Neuromodulation
01:22:55 - SUMMARY and the approach

Created, produced and narrated by:
Helen Han MD
Assistant Professor
Division of Epilepsy

Igor Rybinnik MD
Associate Professor
Neurology Clerkship Director
Division of Stroke and Critical Care

Content experts:
Bradley Kamitaki MD, Shelly Rishty MD, Ram Mani MD
Division of Epilepsy
Department of Neurology
Rutgers Robert Wood Johnson Medical School

Images, videos adapted from:
- Tinea soleum - Teresa Zgoda, Rochester Institute of Technology
- Astrocytoma - Gaillard F, rID 49912
- Cavernoma - Haouimi A, rID 72043
- Focal Cortical Dysplasia - Alkenawy M, rID 77002
- Chowdhury FA, et al. Pract Neurol 2021;21:481–491
- Kandel ER, et al. Principles of Neural Science 5th Edition. McGraw Hill, 2012.
- Bradshaw MJ, et al. Neurol Neuroimmunol Neuroinflamm 2021;8:e1084
- Neonatal Hypoxic Ischemic Encephalopathy - Mahmoud Yacout Alabd, rID: 41406
- Schmidt D, Schachter SC. BMJ 2014;348:g2546
- Absence Seizure courtesy of Epilepsy Action (epilepsy.org.uk)
- Absence seizure courtesy of I.M.S.
- Infantile Spasms Awareness - Epilepsy Foundation of Metropolitan New York
- MR-Guided Stereotactic Laser Amygdalohippocampotomy - Willie JT, et al. Neurosurgery
. 2014 Jun;74(6):569-84
- Myoclonic Seizure courtesy of Nancy Davie
- Understanding Infantile Spasms by Dr John Bodensteiner (Child Neurology Society)
- NeuroPace RNS System Patient Manual. 2021 NeuroPace, Inc
- Deep Brain Stimulation illustration adapted from Okun MS. NEJM 2012:367;16
- Schenck C, Mahowald M. REM Sleep Behavior Disorder (RBD). University of Minnesota, 1986.

References:
- Fisher RS, et al. Epilepsia, 2014;55(4):475-482
- Fisher RS, et al. Epilepsia 2017;58(4):522-30
- Scheffer RS, et al. Epilepsia 2017;58(4):512-21
- Chowdhury FA, et al. Pract Neurol 2021;21:481–491
- Neligan A, et al. Cochrane Database of Systematic Reviews 2023;1:CD013847.
- Brigo F, Marson A. Continuum 2022;28(2):483–499.
- Kwan P, Brodie MJ. Epilepsia 2001;42(10):1255-60
- Chen Z, Brodie MJ, Liew D, Kwan P. JAMA Neurol 2018;75(3):279-286
- Brophy GM, et al. Neurocrit Care 2012;17(1):3-23.
- Trinka E, et al. Epilepsia 2015;56(10):1515.
- Brigo F, et al. Epilepsy Behav 2015;49:325-336
- Kapur J, et al. NEJM 2019;381:2103-2113
- Engel J, et al. JAMA 2012;307(9):922-30
- Wiebe S, et al. N Engl J Med 2001;345(5):311-18
- Dwivedi R, et al. N Engl J Med 2017;377:1639-47

Music, Sounds:
- Waititi, Taika. 2022. "Thor Love and Thunder" [Film] - Screaming Goats sound
- HondEpic, "Goodbye" from "Arcane" (Epic Instrumental Cover)
- Peter Hollens, "This is Me" from "The Greatest Showman" (Cover)
- The Tower of Light - Beginnings (Intro). Auto-generated by YouTube.

DISCLAIMER: Please note that this material was simplified for educational purposes. For patient management, please review your clinical society's guidelines and engage expert consultation where appropriate. Also, the opinions of the presenters do not necessarily reflect those of Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, RWJBarnabus Health, or Rutgers University as a whole.

@antonribkin5319 8 months ago

It’s very inspiring to see that you always can improve, even if you’re already very good. Because these lectures are getting better and better. I’m so happy I found this channel 🎉

@lyubomirgeorgiev1465 8 months ago

One of the best lectures, if not the best one on that topic! Amazing work! Thank you

@santanawilian 6 months ago

I'm a 6th-year medical student from Brazil and am currently doing a 2-month observership at the Neurocritical Care Department at the University of Florida Shands Hospital. I am grateful to have found this channel a few years ago because your lectures have been invaluable during my observership. Thank you for this incredible resource!