Epilepsy & seizures

Released 25 Sep 2025

Seizure definition & classification

This video explores the ways in which seizures can be pathophysiologically, clinically and electrographically defined, and considers the various possible clinical manifestations of seizures, before scrutinising the current 2025 International League Against Epilepsy (ILAE) classification of seizures, encompassing focal, generalised and unknown-onset seizures, followed by a comparison of this current schema with their previous iterations. The video then takes a deep dive into the distinction between unprovoked seizures vs. provoked/acute symptomatic seizures vs. reflex seizures, and by extension the distinction between precipitating, provoking and triggering factors for a seizure. The video then concludes with a detailed discussion of the clinical definitions of convulsive (generalised and focal) and non-convulsive status epilepticus (NCSE).

https://open.spotify.com/episode/4AiGwpFh3gzvaPUEhEq1hQ?si=3joSrINGSMq73c1JFjih1Q

Released 26 Sep 2025

Epilepsy definition & classification

This video first explores the clinical definition of epilepsy, why diagnosing epilepsy is important, and the fundamental steps required to make an accurate diagnosis. It then discusses the relationship between seizure classifications and epilepsy classifications, and the core clinical and electrographic components that constitute an epilepsy syndrome. It then provides a detailed overview of the specific epilepsy syndromes as defined by the International League Against Epilepsy (ILAE), divided into age of onset (neonates/infants, children, and juveniles/adults/variable age of onset), including a closer look at Lennox-Gastaut Syndrome (LGS) in particular. It then addresses the relationship between the Genetic Generalised Epilepsies (GGEs), Idiopathic Generalised Epilepsies (IGEs) and Developmental and/or Epileptic Encephalopathies (DEEs), before concluding with a discussion regarding how making a specific epilepsy syndromic and/or aetiological diagnosis can positively influence management including treatment choices, along with a cautionary discussion regarding the use of sodium channel blocker antiseizure medications (ASMs) in the context of myoclonic epilepsies.

Corrections (in video): 31:50 Apologies, West syndrome is actually encompassed by EISS, not by EIDEE as was written; 1:04:55 Apologies, West syndrome is actually encompassed by EISS, not by EIDEE as was written.

https://open.spotify.com/episode/580hQq1eJdlZLzz1eC3Dr5?si=RIH1RcSDSoi1TEAes1W0jQ

Released 28 Sep 2025

Is it a seizure? Distinguishing seizures, convulsive syncopes & psychogenic non-epileptiform spells (PNESs)

This episode discusses how to distinguish a bilateral tonic-clonic seizure (of generalised, focal or unknown onset) from a convulsive syncope and from a psychogenic non-epileptiform spell/seizure (PNES, as part of functional neurological disorder, FND). To do so, we focus on key aspects of the semiology of the episode in addition to other relevant historical factors in the systems review, past medical history, epilepsy risk factors, family history and psychosocial history, along with important discriminatory examination and investigation findings. The episode then discusses how to weigh all of this information together in order to formulate a provisional diagnosis, and then concludes by discussing cases of co-diagnosis of epilepsy and syncope, and co-diagnosis of epilepsy and FND.

https://open.spotify.com/episode/78vz39ozLqdK61XSVtGQgd?si=cOmAG_wNSqun5UQz0gYR0Q

Released 30 Sep 2025

Nocturnal hypermotor (hyperkinetic) seizures vs. physiological arousals & parasomnias

This episode discusses how to semiologically distinguish nocturnal hypermotor (hyperkinetic) seizures typical of sleep-related hypermotor epilepsy (SHE, formerly nocturnal frontal lobe epilepsy, NFLE) from the two main differential diagnoses for paroxysmal sleep behaviours, namely exaggerated/confusional physiological arousals and various parasomnias (in both NREM and REM sleep, especially night terrors and REM sleep behaviour disorder). The semiological features that we focus on are the frequency, timing and duration of the events, whether the events are triggered and whether they have a discrete offset and result in complete arousal from sleep, whether there is subsequent coherent recall, whether the motor features are stereotyped, and a number of other helpful discriminating phenomenological observable motor characteristics. The episode concludes with a discussion on the benefits and challenges regarding inpatient electroencephalography (EEG) monitoring to further assist in diagnosing difficult cases.

https://open.spotify.com/episode/0r9YM0NoYaxj3kxmugGNJp?si=Zr61silKSLeKoIYFTYsoMw