Seizures and Epilepsies (2023)

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 KZbin.
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]

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 🎉

[@theneurophile]

Absolutely! I’m learning new things daily.

[@user-op5cw6hg1l]

Ohhhh....Amazing... Thanks a million dear Doctor

[@ShonMardani]

Both EEg and MRI are fake, please have some respect for your education. The reason you have many reasons/causes for the same symptoms, it means that none are valid.@@theneurophile

[@mohamudege3664]

An eye opening lecture. Thanks very much.

[@santanawilian]

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!

[@theneurophile]

I'm glad you found it useful. Best of luck to you.

[@hldmyhndPX]

Aí chefe, me passa as dicas pra conseguir um clerkship no exterior, massa dms

[@musamula3709]

Que beleza

[@lyubomirgeorgiev1465]

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

[@theneurophile]

Wow, thank you! I’m glad it is helpful.

[@swaathivenkatesan191]

Did not expect that tapeworm jumpscare lol

[@dos7.11]

This videos are gold. Thank you for sharing this incredible review for free for us to learn!

[@user-ml2pg6xq2t]

I'm not a native english speaker but this class is made in an universal language, thank you

[@aconcretemoth9382]

nurse who is going to start in an EMU. very helpful background. not much of this is covered even in a high-quality nursing school.

[@OksanaD-lj6ph]

Amazing work! Thank you so much for this lecture.

[@caiyu538]

Great lecture

[@kal8621]

I love these video series so much. As an aspiring medical student interested in neurology, your videos are so good.

[@bogerej.b6414]

nice presentation and well presented. thank you. keep up the good work. God bless you.

[@ely762]

Many thanks for this fabulous presentation, so educational and enriching !

[@jjaboube]

Thank you for your high quality work!

[@asaul6718]

Absolutely incredible lecture

[@meuthiafaralita6812]

Always love your videos. Couldn't be any more grateful that I found this channel.

[@HenIchaer]

These videos are 🔥 Thanks so much for making them!

[@martinkirov2585]

a mini holiday every time you guys post

[@theneurophile]

Awesome!

[@PhuongHna0902]

amzing

[@bilgetonyukuk248]

this is a beautiful presentation. Thanks.

[@matt234111]

Amazing talk. Really appreciate it!

[@kartikgarg441]

Great video doc!

[@user-wc9te9fx4y]

best lectures ever!

[@mayfouad2954]

Perfekt as usual 😊... Thanks alot

[@iCanonKiD]

Wow! I love this channel so much!

[@drbalachandran8720]

This year,we eagerly waitfor more topics

[@AisaWilliam]

Thank you so much for these videos! Could you do one about approach to localization please?

[@theneurophile]

Yep. I'm working on a 3-hour series on clinical neuroanatomy, localization, and neurological examination.

[@AisaWilliam]

@@theneurophile yay!! I’m so excited for that!

[@MardinUzeri]

Thank you for the great content

[@georgebashour4333]

Thanks for the amazing explanation and videos

[@dilaozut]

love you incredible effort and work appreciated every time that i watch the lectures

[@theneurophile]

Glad you like them!

[@ryuzakigarcia4972]

I LOVE YOU, THANK YOU FOR UR FANTASTIC WORK

[@user-xy5wh7bm7t]

great, very useful video for all doctors. I wish you all goods, may Allah save you.

[@prabhudevmhiremath1490]

Hello, Dr. Rybinnik. I am a great admirer of your work and conveyed the same through Dr. Priyank Khandelwal. Hope you have received it. From India. Keep it coming please.

[@theneurophile]

Thank you for your kind words!

[@vxp999]

Hello, Is there is a link where we can dowload these slides for studying Purposes? Much Thanks for all the work your doing! Nuerology looks much easier after watching your videos!

[@henk-3098]

Thanks for the video! I'm a student nurse so I really don't have to know all these details but it's just so fascinating. Maybe I've chosen the wrong side of health care...

[@theneurophile]

Come join us in med school or NP school. You will love it.

[@rodrigosanjinez]

Thanks for making such good content!

[@hussinmunzer4303]

Thanks very much

[@TimZomb]

Gosh... that screamer at 28:28 :D

[@theneurophile]

That was meant to keep you awake.

[@potatonail7463]

Wow, love you man.

[@fahadalrayes9930]

Love it , keep going

[@FlyingVolvo]

Excellent video! I'm surprised these continue to raise the ceiling with every video put out! I'd just like to make a minor addition, in the 'Neuromodulation' section you mentioned the patient had failed multiple medications. Patients don't fail medications, medications fail patients. It might seem pedantic but I think it's important how language is used to describe others since it might unconsciously effect how they're perceived.

[@theneurophile]

I think you are absolutely correct! Thank you for that comment.

[@FlyingVolvo]

@@theneurophile I'm glad! I totally get why the slide was written as it is since I believe the wording is extremely common in medicine. My comment was just meant as some food for thought!

[@simple25124]

Thank you for the great lectures. You have a lot of publicity in germany and switzerland :)

[@theneurophile]

Glad you like them!

[@Mateo_237]

Love your videos! Hopefully becoming a neurologist one day

[@theneurophile]

Best of luck. It's an awesome specialty.

[@muhammedwahab5804]

That was amaziiiiiing ❤

[@torrag]

love it

[@juangabrielsalguerozambran3672]

please a video of electroencephalogram

[@M.elhassanAhmed-hv2bi]

Great

[@user-ox6jx9ck7z]

Wonderful video, thank you for making. Would it be possible to post the slides you used to study from?

[@theneurophile]

Will do, when I have a moment.

[@arcdexie913]

you are the GOAT🥰

[@theneurophile]

Thank you!

[@camerony6930]

Great video! I'm new to learning about seizures and wanted to ask why the localization of the seizure of the pt @18:33 most likely started from the frontal lobe, rather than the temporal lobe. If he started with behavioral arrest, wouldn't the seizure have come from the temporal lobe? Is there something I'm missing? Thanks!

[@theneurophile]

Behavioral arrest is possible with both temporal and frontal seizures. In this case, the turning of the gaze and the head and fencer posturing that occurred right after behavioral arrest points to the frontal lobe. Temporal lobe patients typically have an aura of funny smells/deja vu, then automatisms, then behavioral arrest and motor phenomena.

[@michaelquentin3782]

Within the first 3 min..as soon as you said burning rubber. I knew. It is a scary ass disease. That’s temporal lobe epilepsy.

[@gunduzosmanli1685]

Thank you. A note: Lacosamide is not a broad-spectrum agent and is not a first line treatment for generalized epilepsy:/

[@theneurophile]

Thank you for your comment. Point well taken. Actually based on Vossler DG, et al. J Neurol Neurosurg Psychiatry 2020;0:1-9 our Epileptologists are starting to use it more and more as first line for gen epilepsy, especially considering favorable side effect profile. Also, while Lacosamide is a sodium channel blocker, it does act differently than other narrow-spectrum sodium channel blockers (that is less well understood).

[@LEARNING-MEDICAL-EDUCATION]

plz upload one video on nerve conduction study for beginner level.

[@kiraowens9107]

Now what I don't understand is why i began having repeated seizures. Mine started when i was age 23 going 24, first it was aura weird smells then full blackout clonic tonic, screaming, tongue n cheek bites plus the left side of body was limp and numb...did a mri but they didn't tell me anything was wrong, also blood test fine. Wasnt taking medication nor real physical injuries before seizure .. (Now i dropped head first on concrete floor falling out chair. Durning blackout seizure, Massive concussion) ...took 4 weeks to fully regain control of both sides of body....then the real fun began, i still kept having seizures while on medication, though i never got another clonic tonic sezuire again. Though i did noticed the ones i have happened when i listened to certain music. On my computer too long or apon waking up. ...And these seizures came with auras, head turning, smacking and eye flutters, and impaired movement. Felt like i was trapped in a statue sometimes...or really hard to speak but now the vision in my left eye was altered, (and still kinda is) i would go "blind" i mean the objects are still seen but my eye couldn't tell the difference between a human and a broom stick, it is like the two are the same thing and i just knew not to bump into them. Cant tell facial expression can truly "hear" the person or really differentiate color... just a object. Also time or objects began to slow down. The eeg i did showed nothing ..(but the test was done 4 days after first seizure) and my seizures continued a week later Note the massive concussion was on my LEFT side but last i checked the right side controls the left and most of my seizures feel like they come from the right half, there is sometimes a tension headache on the RIGHT half before a seizure comes...not always but once one happens the right side headache becomes intense... But Before my first clonic tonic i did have staring spells, stopped in place while doing task and a few urine incontinence one month Pryor but NO HEAD INJURIES. Theres more to it but the only good side is the seizures are "weaker" but STILL HAPPEN even when taking meds... i just dont get WHY it happened now, im 26 and only one person in my family developed epilepsy from car accident 😕 mine started after a car accident but I didn't get truly injured it just kick started afterwards, i only bring it up cause my doctor and hospital has no real answers for me 😔

[@theneurophile]

I’m very sorry to hear that you are having difficulties. Sometimes it is very difficult to answer the question why seizures start at a particular point in a person’s life. Please keep communicating with your doctor and hopefully you will find an appropriate treatment plan.

[@shaunakayhibbert1942]

I am in Jamaica

[@aldospolaore]

I lobe you too.

[@theneurophile]

Haha. Awesome attention to detail.

[@profaakashassad]

great, but no more scenes from movies, why

[@theneurophile]

I guess they were a bit distracting. I’ll consider adding them in future videos

[@profaakashassad]

for me they made it more interesting, maybe it takes a lot of effort for you@@theneurophile

[@Dalal9797]

Is there such thing as aware focal seizures ?

[@theneurophile]

Yes, certainly. Focal motor, visual and sensory seizures do not have to affect awareness.

[@tracyhernandez4312]

Would ECT sessions qualify as a traumatic brain injury?

[@theneurophile]

By ECT, do you mean electroconvulsive therapy? If so, ECT should not damage the brain.

[@tracyhernandez4312]

Yes, two neurologists have told us ECT is a life saving measure for major depressive episodes with suicidal ideations which don’t respond to meds but that it is a trauma to the brain and are suggesting it is why my husbands cognitive condition is so impaired, that his brain will take time to heal. We suspect possible temporal lobe epileptic seizures - it runs in his family and he has these episodes that sound like what others report. They’re gonna do a EEG test to try and diagnose this. It’s so frustrating

[@gentleman7951]

Creating you dr rybbnik Thank you very much But I am wondering who add this terrifying theme about the sclolex of cystecercosis that suddenly appeared 😂🤔 we could have heart attack 😂😂

[@gentleman7951]

* greating

[@theneurophile]

The scolex was just to keep you awake and attentive throughout the video.

[@gentleman7951]

The mission completed 😂 You are the best 🙏🌺🍀

[@shaunakayhibbert1942]

I was born with it

[@shaunakayhibbert1942]

If I have seizure can I drink trumpet leaf for it

[@theneurophile]

I am sorry that you are suffering with seizures. I highly recommend that you follow the advice of your seizure doctor on how to properly treat your seizures. I am not aware of any studies that used trumpet leaf as treatment.

[@ekupu6501]

how to cure completely epilepsy without operation

[@theneurophile]

There is no one cure or one treatment for epilepsy. Each treatment depends on each individual case. Please have a discussion with your doctor about the appropriate treatment for you.

[@rayhasasyan]

This is simply brilliant, I’m in awe 🤩 best lecture I stumbled upon so far, glad I found your channel! Thank you so much for your work and dedication! 🤍🤍🤍

[@theneurophile]

Thank you so much!