WEBVTT - Ep 112 Epilepsy: It’s always the phlegm

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<v Speaker 1>My name is Louise.

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<v Speaker 2>I live in Johannesburg, South Africa, originally from Kapta. In

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<v Speaker 2>roughly early two thousand and four, I started having what

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<v Speaker 2>seemed like I would blank out, basically, so I could.

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<v Speaker 1>Be doing anything.

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<v Speaker 2>I might be in the middle of a sentence and

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<v Speaker 2>I would just kind of stop, so it would seem

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<v Speaker 2>like I was conscious. My eyes would be open, but

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<v Speaker 2>I would essentially be unconscious. I did not know what

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<v Speaker 2>this was At first, I didn't particularly seem to bother me,

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<v Speaker 2>but it started happening more and more. Sometimes it was

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<v Speaker 2>accompanied by what I would now describe as an aura,

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<v Speaker 2>so sort of a strange sensation almost physically inside my brain.

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<v Speaker 2>It felt like having an electric shock inside my brain.

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<v Speaker 2>For a while, we didn't do much about this. I

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<v Speaker 2>was about sixteen at the time, and my mother was

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<v Speaker 2>of the opinion that this was happening because I was

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<v Speaker 2>not managing my stress levels sufficiently. I am not entirely

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<v Speaker 2>sure what that was supposed to mean, and she was

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<v Speaker 2>not entirely wrong. Stress was a factor, but this was

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<v Speaker 2>not actually me not managing it properly. So at the

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<v Speaker 2>end of that year she took me to a psychiatrist

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<v Speaker 2>to try and see what we could do about this,

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<v Speaker 2>because you know, she said to me, if this carried

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<v Speaker 2>on happening, I would not be allowed to get a

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<v Speaker 2>learner's license.

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<v Speaker 1>So anyway, my mother takes.

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<v Speaker 2>Me to a psychiatrist and I have a session and he.

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<v Speaker 3>Says to her, take a terenurologist. She has epilepsy.

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<v Speaker 2>I get sent for an EEG. Afterwards, we go back

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<v Speaker 2>into the doctor's rooms. He has a look at the

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<v Speaker 2>and he says, oh, yes, this is textbook epilepsy. You

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<v Speaker 2>had an eight second seizure while you were during the EG.

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<v Speaker 2>I have to say, my poor mother, that was the

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<v Speaker 2>first time I've ever.

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<v Speaker 1>Seen anyone's jaw literally drop.

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<v Speaker 3>She was so shocked.

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<v Speaker 2>I was just really relieved to know that the plot

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<v Speaker 2>in fact my fault. So what the doctor explained to

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<v Speaker 2>me was that I had ABSMS.

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<v Speaker 3>Epilepsy what used to be called pitimol.

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<v Speaker 2>I did not know that there was any kind of

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<v Speaker 2>epilepsy other than the kind where you fell on the

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<v Speaker 2>floor and shake, and that was what was epilepsy in

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<v Speaker 2>my mind. So I was surprised to discover there was

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<v Speaker 2>something else. So I was put on medication. The brand

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<v Speaker 2>name here is epilem or epilsine.

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<v Speaker 3>Is the generic. It's sodium valpert.

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<v Speaker 2>The doctor told me I should be careful because this

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<v Speaker 2>can increase my appetite and caused me to gain weight.

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<v Speaker 2>Now I'm a sixteen, almost seventeen year old girls, so

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<v Speaker 2>this caused me a great deal of anxiety, and I

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<v Speaker 2>remember telling my mother, Okay, well, you know, help me

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<v Speaker 2>look out for you know, am I eating more? Another

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<v Speaker 2>side effect is developing acne. Now I have been quite

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<v Speaker 2>a lucky teenager.

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<v Speaker 1>I never had serious breakouts.

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<v Speaker 2>I had the occasional pimple, and suddenly I was developing

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<v Speaker 2>pretty serious acne. And again I'm seventeen, SUNNYA, I have acne,

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<v Speaker 2>I'm gaining weight. It really did a number on my confidence.

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<v Speaker 2>In my early twenties. My seizures had been completely controlled

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<v Speaker 2>for ye since I had initially started on a medication.

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<v Speaker 3>So twenty ten.

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<v Speaker 2>I was twenty two, and my doctor agreed with me

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<v Speaker 2>that we could try and low the dose and if

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<v Speaker 2>that goes well, we can stop the medication and see

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<v Speaker 2>what happens. So I started having brains at again occasionally,

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<v Speaker 2>and I kind of ignored them because I thought, nope, nope,

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<v Speaker 2>I'm fine.

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<v Speaker 1>I don't want to rely on the medication.

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<v Speaker 2>And then one day, it was after class in the afternoon,

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<v Speaker 2>I was sitting in the computer lab where some of

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<v Speaker 2>my classmates we were busy working on assignments. And the

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<v Speaker 2>next thing I know, I opened my eyes and I

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<v Speaker 2>am flat on my back on the floor, and there

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<v Speaker 2>are several very concerned faces sort of crowding above me.

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<v Speaker 1>So what had happened.

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<v Speaker 2>Was that I had been in front of my computer

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<v Speaker 2>and I had all of a sudden had a Grandma seizure.

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<v Speaker 2>What used to be called grandma these days are called

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<v Speaker 2>tonic clonic seizures, and this is the classic one where

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<v Speaker 2>you fall on the floor and your body stiffens and

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<v Speaker 2>then you shake.

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<v Speaker 3>I later asked.

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<v Speaker 2>Some of my classmates sort of what did it look like,

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<v Speaker 2>and apparently I had been for me at the mouth,

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<v Speaker 2>because I bet in my tongue there was blood in

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<v Speaker 2>the saliv which cannot have been easy for them to see.

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<v Speaker 2>I think I am very lucky that I did not

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<v Speaker 2>lose blood or bowel control, because that is something that

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<v Speaker 2>can happen during a tony clinic seizure. And obviously, you

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<v Speaker 2>know it's not something that you can help. It's just

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<v Speaker 2>a medical thing, but I would have been just so embarrassed.

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<v Speaker 2>I was incredibly confused after the seizure. I was also

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<v Speaker 2>completely fatigued. I could barely move my body.

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<v Speaker 3>I couldn't walk, so I go back to my.

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<v Speaker 2>Previous dose of medication. The year after that, twenty eleven,

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<v Speaker 2>is when I moved to Joburg. Things seem to be

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<v Speaker 2>going fine. I of course had to switch to a

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<v Speaker 2>different doctor. This is also the first time that I

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<v Speaker 2>find out that you're not supposed to get pregnant while

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<v Speaker 2>you are on Valbert because it has a potential to

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<v Speaker 2>be teratogenic, which you know. None of my previous doctors

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<v Speaker 2>had told me this. I am a young woman of

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<v Speaker 2>reproductive age, I'm someone who can get pregnant, and no

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<v Speaker 2>one bothered to tell me this, so I was quite upset.

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<v Speaker 2>Fast forward to twenty sixteen November. I am freelancing at

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<v Speaker 2>an ad agency. I'm doing prove fruiting for them. I'm

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<v Speaker 2>sitting in front of the computer and suddenly I opened

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<v Speaker 2>my eyes and I'm lying flat on my back on

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<v Speaker 2>the floor, and there are several really anxious faces crowded

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<v Speaker 2>over me. And I've just had another Grandma's seizure.

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<v Speaker 3>Again.

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<v Speaker 2>I'm very confused. I can barely move my limbs. These

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<v Speaker 2>are people I don't know. I've only been there for

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<v Speaker 2>a week, and on my first day, I accidentally.

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<v Speaker 3>Got locked in the toilets, so I'm.

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<v Speaker 1>Already known for that. But no, I'm no.

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<v Speaker 3>Longer the girl got stuck in the toilets on the

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<v Speaker 3>girl had seizure on the office, so that's fine.

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<v Speaker 2>So not long after that, I go and see my neurologist.

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<v Speaker 2>This is the first time in several months that he's

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<v Speaker 2>had a good look at me, and he says, Okay,

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<v Speaker 2>you have lost a very large amount of weight. Your

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<v Speaker 2>body is metabolizing your medication too quickly. That is why

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<v Speaker 2>you had a seizure on top of all the stress

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<v Speaker 2>and so on. So we increase I think actually we

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<v Speaker 2>doubled my medication. Things have gone medicines.

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<v Speaker 3>Then that was the last seizure of.

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<v Speaker 1>Any kind that I've had.

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<v Speaker 2>My stress levels improved, macne improved, so things are generally

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<v Speaker 2>better now. I have pressed pause on any kind of

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<v Speaker 2>reproductive decisions for now.

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<v Speaker 1>I'm turning thirty five now.

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<v Speaker 3>So I still have a little.

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<v Speaker 1>Bit of time if I want to think about it.

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<v Speaker 2>The epilepsy has been under control for several years now,

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<v Speaker 2>so for the most part, it's not giving me grief.

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<v Speaker 2>But that was quite an unpleasant experience, that realization about

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<v Speaker 2>just things that I hadn't been told. Maybe it's because

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<v Speaker 2>I was a teenage goal and my doctor didn't think

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<v Speaker 2>that it was particularly necessary to tell me about certain

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<v Speaker 2>side effects apart from getting weight, because obviously that's the

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<v Speaker 2>only thing that could worry me. For me, my epilepsy

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<v Speaker 2>experience has been quite a mixed bag. I am technically

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<v Speaker 2>quite lucky that mine is easy controlled with medication, I

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<v Speaker 2>can lead a normal life, but it's also been a

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<v Speaker 2>giant Panama ass and I would prefer not to have it.

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<v Speaker 2>I don't have any sort of feelings about, oh, it's

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<v Speaker 2>made me a stronger person or anything like that, and

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<v Speaker 2>it has also given me some insight into aspects of

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<v Speaker 2>the medical profession that are disappointing. That's where things stand

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<v Speaker 2>at this moment. I am hoping for maybe a magical miracle,

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<v Speaker 2>gene therapy or something that will remove us, but we

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<v Speaker 2>will see where things go.

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<v Speaker 4>Thank you so much, Louise for sharing your story with us.

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<v Speaker 5>Yes, thank you so so much for sharing that Hi

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<v Speaker 5>I'm Aaron Welsh and I'm Erin almon Updyke and this

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<v Speaker 5>is this podcast will Kill You, And today it's a

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<v Speaker 5>very big topic. We're talking about epilepsy.

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<v Speaker 4>It's the biggest topic that we've covered in a very

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<v Speaker 4>long time.

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<v Speaker 5>Do we say that every single episode?

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<v Speaker 4>Yes? Is it true this time? Yes, it is absolutely true. Yeah.

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<v Speaker 4>This is going to be a long but chock full

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<v Speaker 4>of information and questions episode. I can already tell and

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<v Speaker 4>Erin you and I talked about this. It was an

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<v Speaker 4>interesting and difficult balance to strike between too much detail

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<v Speaker 4>and not enough detail.

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<v Speaker 5>Yeah, it was. It was a difficult episode to kind

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<v Speaker 5>of piece together for me, and I know you said

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<v Speaker 5>the same. So we'll just see how we did. Yeah,

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<v Speaker 5>but first we all know what time it is.

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<v Speaker 4>Is it quarantine?

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<v Speaker 5>It's quarantiny time. What are we drinking this week? We're

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<v Speaker 5>drinking the Clonic Tonic.

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<v Speaker 4>We are This is one of my favorite names, and

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<v Speaker 4>we were inspired by a listener who sent in a

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<v Speaker 4>very similar suggestion, so thank you, Robin. And the Clonic

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<v Speaker 4>Tonic is a very simple drink. It is simply campari

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<v Speaker 4>and tonic water and a slice of orange. And I

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<v Speaker 4>love this because I think it's actually surprisingly adaptable to

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<v Speaker 4>a non alcoholic cocktail because there are bitter non alcoholic

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<v Speaker 4>liqueurs or whatever for lack of a better word, that

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<v Speaker 4>seemed to really take the place of campari, and one

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<v Speaker 4>of them that I've tried that's delicious is Gia. But anyway,

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<v Speaker 4>there are options out there, so it's a simple recipe.

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<v Speaker 4>But we will post it for both the Quarantini as

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<v Speaker 4>well as the Place Barta on our website. This podcast

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<v Speaker 4>will as well as on all of our social media channels.

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<v Speaker 5>On our website. Since we're still at the beginning of

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<v Speaker 5>the season, let us tell you about what you can

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<v Speaker 5>find there. It's fantastic. It's this podcast will kill You

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<v Speaker 5>dot com. We've got sources from every one of our episodes.

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<v Speaker 5>We've got transcripts of those episodes as well. We've got

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<v Speaker 5>links to our merch which is fantastic. We've got a

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<v Speaker 5>good Reads list, We've got a link to our bookshop

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<v Speaker 5>dot org affiliate account. We've got Bloodmobile, our music, We've

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<v Speaker 5>got there's probably more. Our Patreon it's there, check it out.

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<v Speaker 4>It's all there. I'm wearing one of the very cool

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<v Speaker 4>new crew neck sweatshirts that you can find on our

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<v Speaker 4>merch page and it's the best. You should get one

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<v Speaker 4>for yourself everyone. I was actually.

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<v Speaker 5>Wearing one of our new sweatshirts recently when I went

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<v Speaker 5>out to get a milkshake and somebody was like, I

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<v Speaker 5>love your sweatshirt. I love that podcast, and I got

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<v Speaker 5>so embarrassed that I just was like, thanks, cool, And

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<v Speaker 5>then I started talking to my dog again.

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<v Speaker 4>That's amazing. Oh my gosh, Hello, it's a great sweatshirt.

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<v Speaker 5>All right, Well, shall we get into the actual topic

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<v Speaker 5>of this episode?

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<v Speaker 4>I think we should right after this break.

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<v Speaker 5>We said it at the top, and I do feel

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<v Speaker 5>like we say almost every episode these days, what a

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<v Speaker 5>huge topic we're dealing with, And it's usually true, although

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<v Speaker 5>we probably also usually exaggerate for sure, But when it

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<v Speaker 5>comes to the topic of epilepsy, this really is something

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<v Speaker 5>that could probably be split into, quite honestly, a whole

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<v Speaker 5>season of episodes, depending on how deep you wanted to

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<v Speaker 5>get in all of the various types of seizures and

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<v Speaker 5>types of epilepsy and the specific path of physiology, not

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<v Speaker 5>to mention history and epidemiology and so on and so forth.

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<v Speaker 5>It really is an absurdly large topic to try and

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<v Speaker 5>cover in under two.

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<v Speaker 4>Hours, hopefully overly ambitious.

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<v Speaker 5>So we are not going to cover every detail today,

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<v Speaker 5>which means that we might not cover any one particular

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<v Speaker 5>form of epilepsy or type of seizure that some listeners

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<v Speaker 5>might be hoping for in the amount of detail that

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<v Speaker 5>you might want. But the good news is we'll have

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<v Speaker 5>plenty of resources for you who want to dive deeper.

0:14:51.800 --> 0:14:53.560
<v Speaker 5>And what I'm hoping that we can all get out

0:14:53.600 --> 0:14:56.960
<v Speaker 5>of this biology section at least is an appreciation of,

0:14:57.320 --> 0:15:01.880
<v Speaker 5>first of all, what the heck is a seizure anyway? Yeah,

0:15:02.440 --> 0:15:06.080
<v Speaker 5>what are some of the various types of seizures, because spoilers,

0:15:06.120 --> 0:15:09.680
<v Speaker 5>it's not just what you've seen on TV. How do

0:15:09.760 --> 0:15:12.640
<v Speaker 5>these seizures differ, and what's going on in our brains

0:15:12.800 --> 0:15:17.120
<v Speaker 5>during this process? And then what is epilepsy in the

0:15:17.160 --> 0:15:21.520
<v Speaker 5>context of seizures? Yeah, So that's where we're going to try.

0:15:21.320 --> 0:15:23.920
<v Speaker 4>To get to. I want to know the answers to

0:15:24.160 --> 0:15:25.840
<v Speaker 4>all of those questions.

0:15:26.000 --> 0:15:29.440
<v Speaker 5>I'll do my best. So I'll start out with just

0:15:29.480 --> 0:15:34.120
<v Speaker 5>some definitions, and for these I will quote, because love

0:15:34.160 --> 0:15:39.520
<v Speaker 5>to have a quote definition epilepsy. The definition from the

0:15:39.800 --> 0:15:46.080
<v Speaker 5>International League Against Epilepsy is defined as quote a chronic

0:15:46.200 --> 0:15:52.560
<v Speaker 5>disease of the brain characterized by an enduring predisposition to

0:15:52.720 --> 0:15:59.960
<v Speaker 5>generate seizures unprovoked by any immediate central nervous system insult

0:16:00.200 --> 0:16:03.680
<v Speaker 5>risk Aaron's words. That part's really important, and we'll get

0:16:03.680 --> 0:16:11.320
<v Speaker 5>into it. Back to the quote, and by the neurobiological, cognitive, psychological,

0:16:11.440 --> 0:16:17.680
<v Speaker 5>and social consequences of seizure recurrence. So let's kind of

0:16:18.000 --> 0:16:23.479
<v Speaker 5>just reiterate in maybe more easy language, epilepsy is recurrent

0:16:24.040 --> 0:16:29.440
<v Speaker 5>seizures that happen chronically without a clear provoking cause, at

0:16:29.520 --> 0:16:35.000
<v Speaker 5>least not acutely, like not a single identifiable cause of seizures,

0:16:35.680 --> 0:16:38.960
<v Speaker 5>and all of the consequences that result from those recurrence

0:16:39.000 --> 0:16:44.840
<v Speaker 5>of seizures. So clearly, to understand what the heck that means,

0:16:44.880 --> 0:16:47.160
<v Speaker 5>like what the heck epilepsy is in that context, we

0:16:47.240 --> 0:16:52.040
<v Speaker 5>have to first understand seizures and realize that not all

0:16:52.120 --> 0:16:56.240
<v Speaker 5>seizures are indicative of or lead to the disease known

0:16:56.280 --> 0:17:00.800
<v Speaker 5>as epilepsy. So while all people living with epilepsy experienced

0:17:00.840 --> 0:17:04.280
<v Speaker 5>seizures in one form or another, not all people with

0:17:04.440 --> 0:17:09.160
<v Speaker 5>seizures or who have had seizures have epilepsy by definition, right,

0:17:10.040 --> 0:17:14.800
<v Speaker 5>So what is a seizure. Then and again, the International

0:17:14.880 --> 0:17:18.280
<v Speaker 5>League Against Epilepsy has a definition for us, and I

0:17:18.359 --> 0:17:23.400
<v Speaker 5>quote a seizure is a transient occurrence of signs and

0:17:23.560 --> 0:17:29.480
<v Speaker 5>or symptoms due to abnormal, excessive, or synchronous neuuronal activity

0:17:29.680 --> 0:17:33.320
<v Speaker 5>in the brain. Episode over that was so clear.

0:17:33.119 --> 0:17:36.000
<v Speaker 1>Right, A.

0:17:37.840 --> 0:17:39.400
<v Speaker 4>I have so many questions already.

0:17:39.560 --> 0:17:45.040
<v Speaker 5>I do too, Aarin, And while that definition might have

0:17:45.080 --> 0:17:48.080
<v Speaker 5>been helpful for some people, I actually really struggle with

0:17:48.119 --> 0:17:50.359
<v Speaker 5>that definition. So I'm going to try and really break

0:17:50.400 --> 0:17:53.680
<v Speaker 5>this down in the way that my brain makes sense

0:17:53.680 --> 0:17:57.439
<v Speaker 5>of it, which is on a very basic level we

0:17:57.520 --> 0:18:00.159
<v Speaker 5>all know and I've talked about on this podcast before

0:18:00.200 --> 0:18:03.640
<v Speaker 5>in other episodes where we've dealt with things like meningitis

0:18:03.840 --> 0:18:08.600
<v Speaker 5>or other kind of brain related injuries that our brain

0:18:08.640 --> 0:18:13.959
<v Speaker 5>communicates via both electrical and chemical signals. So in general,

0:18:14.000 --> 0:18:16.880
<v Speaker 5>what happens in our brain is that chemical signals are

0:18:16.960 --> 0:18:21.800
<v Speaker 5>converted into actual electrical impulses, and that is what is

0:18:21.840 --> 0:18:27.240
<v Speaker 5>transmitting information to allow us to do literally everything like blink, breathe,

0:18:27.280 --> 0:18:32.280
<v Speaker 5>talk wave type, et cetera. And these electrical signals and

0:18:32.520 --> 0:18:36.080
<v Speaker 5>the chemical signals as well have to be very tightly

0:18:36.119 --> 0:18:39.400
<v Speaker 5>regulated both in their circuits of where they go, and

0:18:39.440 --> 0:18:41.840
<v Speaker 5>how they go, and the timing for us to be

0:18:41.880 --> 0:18:46.320
<v Speaker 5>able to do all of the things. So what happens

0:18:46.359 --> 0:18:49.520
<v Speaker 5>in a seizure is that we see a burst of

0:18:49.560 --> 0:18:57.040
<v Speaker 5>these electrical impulses, an abnormal amount and or abnormal networks

0:18:57.119 --> 0:19:00.879
<v Speaker 5>or pathways of activity. That is what we are seeing

0:19:00.920 --> 0:19:03.320
<v Speaker 5>in a seizure, and that is what is picked up

0:19:03.440 --> 0:19:07.080
<v Speaker 5>on an EEG. When they're hooking up all those electrodes

0:19:07.119 --> 0:19:09.280
<v Speaker 5>to look at the electrical activity in your brain and

0:19:09.320 --> 0:19:15.000
<v Speaker 5>they say, this looks like a seizure. And this abnormal activity,

0:19:15.440 --> 0:19:17.639
<v Speaker 5>it can start from just one part of the brain,

0:19:18.040 --> 0:19:21.560
<v Speaker 5>which results in what we call a focal seizure or

0:19:21.560 --> 0:19:25.760
<v Speaker 5>what used to be called partial seizures, or sometimes we

0:19:25.840 --> 0:19:29.200
<v Speaker 5>can see this burst of electrical impulses from both sides,

0:19:29.280 --> 0:19:32.720
<v Speaker 5>both hemispheres of our brain at the same time, and

0:19:32.800 --> 0:19:36.639
<v Speaker 5>that results in what we call a generalized seizure. And

0:19:36.720 --> 0:19:40.480
<v Speaker 5>because our brain is suffice it to say, very complicated,

0:19:41.720 --> 0:19:44.160
<v Speaker 5>it's a complex structure with a lot of different layers

0:19:44.920 --> 0:19:50.280
<v Speaker 5>between which these electrical impulses have to travel. So these

0:19:50.440 --> 0:19:54.480
<v Speaker 5>abnormal bursts of activity can happen in any given part

0:19:54.520 --> 0:19:58.439
<v Speaker 5>of our brain, which means that those signs or symptoms

0:19:58.480 --> 0:20:01.040
<v Speaker 5>that we might see or a sonociate with the seizure

0:20:01.560 --> 0:20:06.560
<v Speaker 5>can actually very incredibly widely depending on where in the

0:20:06.600 --> 0:20:07.760
<v Speaker 5>brain they're occurring.

0:20:08.760 --> 0:20:13.480
<v Speaker 4>I have a question about the word abnormal. Ooh, yeah,

0:20:14.040 --> 0:20:17.680
<v Speaker 4>what is normal? And then how far outside of normal

0:20:17.920 --> 0:20:22.040
<v Speaker 4>is abnormal? What does the range look like? You know

0:20:22.080 --> 0:20:22.600
<v Speaker 4>what I mean?

0:20:22.880 --> 0:20:27.600
<v Speaker 5>Yeah, that is a really really good question, and I'm

0:20:27.600 --> 0:20:29.320
<v Speaker 5>going to just say I don't have an answer for

0:20:29.440 --> 0:20:33.600
<v Speaker 5>it because I don't know enough about EEG readings, and

0:20:33.640 --> 0:20:37.040
<v Speaker 5>I know that there are sometimes things that can be

0:20:37.160 --> 0:20:40.160
<v Speaker 5>called by some people this looks like what we would

0:20:40.160 --> 0:20:44.280
<v Speaker 5>call an epileptiform or a seizure like change in an

0:20:44.280 --> 0:20:48.160
<v Speaker 5>EEG that maybe by other people would be interpreted as

0:20:48.240 --> 0:20:51.199
<v Speaker 5>not quite that. So it's a really good question, and

0:20:51.240 --> 0:20:53.760
<v Speaker 5>I don't think that there in some cases is a

0:20:53.800 --> 0:20:57.560
<v Speaker 5>cut and dry answer. But what we see on these

0:20:57.680 --> 0:21:05.359
<v Speaker 5>electrical readings is basically just impulses that often associate with

0:21:05.520 --> 0:21:09.080
<v Speaker 5>specific seizure like activity that we'll talk about in a minute,

0:21:09.960 --> 0:21:13.320
<v Speaker 5>that also correlate with what we're seeing on an EEG

0:21:14.400 --> 0:21:18.440
<v Speaker 5>that is different than a person's baseline brain activity.

0:21:18.840 --> 0:21:23.479
<v Speaker 4>Okay, two questions. One, when you're comparing to baseline is

0:21:23.480 --> 0:21:28.280
<v Speaker 4>that that person's baseline or like population baseline. And then

0:21:28.560 --> 0:21:33.240
<v Speaker 4>number two is who is doing the reading. Is it

0:21:33.320 --> 0:21:36.720
<v Speaker 4>a person or is it a computer or is it both?

0:21:36.920 --> 0:21:41.280
<v Speaker 4>Like how who determines what is an epileptiform pattern?

0:21:41.560 --> 0:21:44.600
<v Speaker 5>Excellent questions. For the first one, I don't fully know.

0:21:44.920 --> 0:21:48.600
<v Speaker 5>There are I think enough egs done in the world

0:21:48.680 --> 0:21:51.040
<v Speaker 5>and being studied for many decades that we have a

0:21:51.080 --> 0:21:55.919
<v Speaker 5>sense of what typical brain patterns look like across various people.

0:21:56.520 --> 0:22:00.960
<v Speaker 5>You would still also compare one person's e E at

0:22:01.040 --> 0:22:04.560
<v Speaker 5>their baseline when they're not having seizures versus when they

0:22:04.600 --> 0:22:06.479
<v Speaker 5>are having seizures. So I think it's a little bit

0:22:06.480 --> 0:22:09.879
<v Speaker 5>of both, okay, and it is not me. It's a

0:22:09.960 --> 0:22:13.760
<v Speaker 5>neurologist who is reading the EEG's okay, but it is

0:22:13.800 --> 0:22:14.200
<v Speaker 5>a human.

0:22:14.359 --> 0:22:14.879
<v Speaker 4>It's a human.

0:22:14.920 --> 0:22:16.840
<v Speaker 5>A lot of times there's you know, just like with

0:22:16.880 --> 0:22:19.040
<v Speaker 5>an EKG when we're looking at your heart, there's usually

0:22:19.080 --> 0:22:22.520
<v Speaker 5>a computer readout component, but then an actual human is

0:22:22.560 --> 0:22:24.280
<v Speaker 5>always going to be the one looking at it and

0:22:24.400 --> 0:22:31.000
<v Speaker 5>determining a human with a lot of training, a lot okay, fascinating, cool,

0:22:31.560 --> 0:22:33.360
<v Speaker 5>But it is also true that because of that there

0:22:33.400 --> 0:22:37.600
<v Speaker 5>is a certain amount of subjectivity, right right right, Okay,

0:22:37.640 --> 0:22:40.680
<v Speaker 5>so what then might some of these different types of

0:22:40.720 --> 0:22:46.000
<v Speaker 5>seizures look like. I think most people listening likely associate

0:22:46.040 --> 0:22:49.879
<v Speaker 5>seizures with one very specific type of seizure, and that

0:22:50.000 --> 0:22:54.480
<v Speaker 5>seizure type is called a generalized tonic clonic seizure. These

0:22:54.560 --> 0:22:57.879
<v Speaker 5>used to be called Grand Mall seizures, so that terminology

0:22:57.920 --> 0:23:00.880
<v Speaker 5>might be familiar to some people. These are the kind

0:23:00.920 --> 0:23:05.199
<v Speaker 5>that you see on TV where somebody might collapse and

0:23:05.400 --> 0:23:09.800
<v Speaker 5>is unconscious and then they have a rhythmic jerking of

0:23:10.080 --> 0:23:13.400
<v Speaker 5>especially the large muscles of their body. They'll be kind

0:23:13.400 --> 0:23:18.440
<v Speaker 5>of rigid and then have muscle convulsions. They might bite

0:23:18.480 --> 0:23:22.000
<v Speaker 5>their tongue during this process, they might have loss of

0:23:22.040 --> 0:23:26.280
<v Speaker 5>bladder or bowel function because of autonomic nervous system involvement.

0:23:27.160 --> 0:23:29.679
<v Speaker 5>And then usually when they wake up, they have a

0:23:29.720 --> 0:23:33.520
<v Speaker 5>period of confusion where they're not quite sure what's going on,

0:23:33.760 --> 0:23:37.359
<v Speaker 5>and this might take some time to resolve. That is

0:23:37.440 --> 0:23:41.560
<v Speaker 5>one type of seizure, but it is just one, and

0:23:41.640 --> 0:23:45.960
<v Speaker 5>there are so many more than that. And that makes

0:23:46.000 --> 0:23:48.359
<v Speaker 5>sense since now we know that any part of the

0:23:48.359 --> 0:23:51.960
<v Speaker 5>brain can be affected. So let's get into how we

0:23:52.040 --> 0:23:57.520
<v Speaker 5>can classify seizures. We define seizures first from their point

0:23:57.560 --> 0:24:01.640
<v Speaker 5>of origin. So, like I said four, seizures can be focal,

0:24:01.800 --> 0:24:05.600
<v Speaker 5>which means they start from one part one hemisphere, and

0:24:05.680 --> 0:24:09.160
<v Speaker 5>one little part of the brain. Don't ask me how

0:24:09.160 --> 0:24:12.360
<v Speaker 5>little aaron, just like one area of the brain, okay.

0:24:13.359 --> 0:24:16.680
<v Speaker 5>Or they can be generalized, meaning that they're starting at

0:24:16.760 --> 0:24:20.760
<v Speaker 5>onset from both hemispheres of the brain, and a lot

0:24:20.760 --> 0:24:23.720
<v Speaker 5>of times we actually don't know we don't know necessarily

0:24:23.760 --> 0:24:26.679
<v Speaker 5>what that pinpoint origin is. And so then these seizures

0:24:26.720 --> 0:24:30.119
<v Speaker 5>are classified as unknown origin, and then we can further

0:24:30.160 --> 0:24:32.960
<v Speaker 5>classify them by what signs and symptoms we see after that.

0:24:33.800 --> 0:24:38.080
<v Speaker 5>Then to further break this down, there are also motor

0:24:38.560 --> 0:24:44.600
<v Speaker 5>and non motor seizures. So motor seizures have like physical

0:24:45.040 --> 0:24:51.199
<v Speaker 5>skeletal muscle involvement, so moving of usually the extremities or

0:24:51.240 --> 0:24:56.119
<v Speaker 5>something in some way. This can look like spasms. It

0:24:56.160 --> 0:25:00.679
<v Speaker 5>can be like a hyperkinetic or a myoclonic like and

0:25:00.760 --> 0:25:07.080
<v Speaker 5>tightening of muscles. It could be a tightening and relaxing

0:25:07.480 --> 0:25:12.240
<v Speaker 5>very rapidly, which is what results in that tonic clonic description.

0:25:12.359 --> 0:25:16.159
<v Speaker 5>That's what tonic clonic means. It's alternating between tensing and

0:25:16.240 --> 0:25:19.760
<v Speaker 5>relaxing of muscles. With this like jerking motion. It could

0:25:19.800 --> 0:25:23.080
<v Speaker 5>also be much smaller twitches of muscles, just say of

0:25:23.119 --> 0:25:26.560
<v Speaker 5>the hand or the face. Or it could also be

0:25:26.680 --> 0:25:30.720
<v Speaker 5>a sudden weakness, so rather than a tension of muscles,

0:25:31.000 --> 0:25:35.160
<v Speaker 5>it could be a sudden flacidity of muscles. And that's

0:25:35.160 --> 0:25:39.720
<v Speaker 5>all just within motor seizures. It could also have none

0:25:39.720 --> 0:25:43.119
<v Speaker 5>of that and be a non motor seizure, which could

0:25:43.200 --> 0:25:47.320
<v Speaker 5>have a huge variety of symptoms. It could have cognitive

0:25:47.359 --> 0:25:51.840
<v Speaker 5>symptoms like just a blank stare where people just suddenly

0:25:52.280 --> 0:25:54.840
<v Speaker 5>like have no emotion on their face. It is a

0:25:54.840 --> 0:26:00.000
<v Speaker 5>blank stare and is unresponsive. It could be sensory symptoms

0:26:00.200 --> 0:26:03.240
<v Speaker 5>that might even be something that people are feeling or

0:26:03.320 --> 0:26:08.200
<v Speaker 5>are aware of sudden sensory changes. Or it could be

0:26:08.720 --> 0:26:13.080
<v Speaker 5>a complete loss of activity all of a sudden, which

0:26:13.080 --> 0:26:17.280
<v Speaker 5>is called behavioral arrest, where someone just suddenly stops exactly

0:26:17.359 --> 0:26:20.000
<v Speaker 5>what they're doing, and a whole bunch of other things

0:26:20.080 --> 0:26:26.040
<v Speaker 5>even within that, and when we especially talk about focal seizures,

0:26:26.320 --> 0:26:29.199
<v Speaker 5>this is not true for generalized seizures. But then the

0:26:29.240 --> 0:26:31.359
<v Speaker 5>third step that we have to look at is whether

0:26:31.520 --> 0:26:37.160
<v Speaker 5>awareness is intact or impaired. So because a focal seizure

0:26:37.240 --> 0:26:40.120
<v Speaker 5>happens in only one part of the brain. Someone may

0:26:40.280 --> 0:26:43.359
<v Speaker 5>or may not know and be aware that they're having

0:26:43.440 --> 0:26:47.399
<v Speaker 5>a seizure at the time that they're having it, and

0:26:47.440 --> 0:26:50.840
<v Speaker 5>so we say that their awareness is either impaired or intact.

0:26:51.280 --> 0:26:56.160
<v Speaker 5>With generalized seizures, awareness is not intact because it's happening

0:26:56.160 --> 0:26:58.320
<v Speaker 5>in both hemispheres of your brain at the same time.

0:26:59.000 --> 0:27:02.439
<v Speaker 5>But of times people do have like prodromes or what

0:27:02.480 --> 0:27:05.840
<v Speaker 5>we call auras prior to a seizure, so they might

0:27:05.920 --> 0:27:09.000
<v Speaker 5>know that one is coming and before you ask, because

0:27:09.040 --> 0:27:11.280
<v Speaker 5>I know you're going to have a million questions.

0:27:11.600 --> 0:27:13.560
<v Speaker 4>I do you can already see one on my face?

0:27:13.840 --> 0:27:18.040
<v Speaker 5>Yep, I can. All of these different seizure types are

0:27:18.080 --> 0:27:23.760
<v Speaker 5>not mutually exclusive. Different types of epilepsy or even a

0:27:23.800 --> 0:27:28.840
<v Speaker 5>single seizure episode can have multiple of these forms within them.

0:27:29.200 --> 0:27:32.640
<v Speaker 5>So for example, something could start as a focal seizure,

0:27:33.080 --> 0:27:37.960
<v Speaker 5>but could then generalize and become bilateral and then end

0:27:38.160 --> 0:27:41.760
<v Speaker 5>with something that looks like a generalized tonic chlonic seizure,

0:27:42.760 --> 0:27:47.680
<v Speaker 5>Or people could have different fauxci of seizures throughout their

0:27:47.720 --> 0:27:51.840
<v Speaker 5>brain that result in throughout their lifetime having seizures of

0:27:51.920 --> 0:27:55.840
<v Speaker 5>multiple types or multiple forms and my last important note

0:27:55.880 --> 0:27:57.840
<v Speaker 5>before I let you ask questions that I hope I

0:27:57.840 --> 0:28:01.440
<v Speaker 5>can answer, is that one of the things that's very

0:28:01.480 --> 0:28:06.200
<v Speaker 5>important to know about seizures is that these are brief episodes.

0:28:06.280 --> 0:28:11.399
<v Speaker 5>These are brief episodes of this intense neuuronal activity. And

0:28:11.480 --> 0:28:13.639
<v Speaker 5>when I say brief, I mean on the order of

0:28:13.760 --> 0:28:18.800
<v Speaker 5>seconds to one to two minutes, because any seizure lasting

0:28:18.880 --> 0:28:23.040
<v Speaker 5>more than five minutes, or if you have multiple seizures

0:28:23.160 --> 0:28:26.879
<v Speaker 5>happening within a short time frame where someone does not

0:28:27.119 --> 0:28:31.240
<v Speaker 5>return to full consciousness in between, that results in something

0:28:31.280 --> 0:28:35.520
<v Speaker 5>known as status epilepticus and is a major medical emergency.

0:28:36.440 --> 0:28:38.920
<v Speaker 5>We thought, I think for a long time in the

0:28:39.000 --> 0:28:44.080
<v Speaker 5>kind of history of epilepsy, that it was twenty or

0:28:44.120 --> 0:28:47.000
<v Speaker 5>thirty minutes before this became an emergency.

0:28:47.240 --> 0:28:47.760
<v Speaker 4>But it's not.

0:28:48.400 --> 0:28:53.080
<v Speaker 5>If seizures are happening for five minutes straight, that's a

0:28:53.120 --> 0:28:56.000
<v Speaker 5>medical emergency because there's so much brain activity that can

0:28:56.160 --> 0:29:02.280
<v Speaker 5>result in long lasting damage. This is rare. Status epilepticus

0:29:02.360 --> 0:29:06.920
<v Speaker 5>is rare. It most often happens with generalized tonic clonic seizures,

0:29:07.640 --> 0:29:10.440
<v Speaker 5>so that seizure that's happening on both sides resulting in

0:29:10.440 --> 0:29:14.040
<v Speaker 5>that convulsive whole body seizure. But it's also possible to

0:29:14.080 --> 0:29:17.400
<v Speaker 5>have non convulsive status epilepticus, and that's I think really

0:29:17.480 --> 0:29:22.560
<v Speaker 5>important where EEGs can be so integral in like figuring

0:29:22.560 --> 0:29:25.120
<v Speaker 5>out what's going on, because you might be having more

0:29:25.160 --> 0:29:28.160
<v Speaker 5>seizures than you even have very obvious signs.

0:29:27.880 --> 0:29:30.200
<v Speaker 4>Or symptoms of Right, that makes sense.

0:29:31.440 --> 0:29:33.200
<v Speaker 5>Okay, I know you have a million questions.

0:29:33.400 --> 0:29:38.240
<v Speaker 4>Yeah, okay, I want to start pretty general. Okay, we

0:29:38.360 --> 0:29:41.800
<v Speaker 4>have all of these different seizure classification types. There can

0:29:41.840 --> 0:29:44.920
<v Speaker 4>be overlap, there can be multiple descriptors for a certain

0:29:44.920 --> 0:29:49.480
<v Speaker 4>type of seizure. That is important information. What does that

0:29:49.680 --> 0:29:54.040
<v Speaker 4>information help you decide to do? Does it have an

0:29:54.040 --> 0:29:57.600
<v Speaker 4>impact on treatment, on prognosis, on Yeah, like what what

0:29:57.640 --> 0:30:00.239
<v Speaker 4>sort of information do you get from that? Beyond just

0:30:00.240 --> 0:30:01.120
<v Speaker 4>what type of seizure?

0:30:01.480 --> 0:30:06.160
<v Speaker 5>It is excellent question. It has implications for kind of

0:30:06.840 --> 0:30:11.200
<v Speaker 5>so many different things. So, for example, especially when it

0:30:11.240 --> 0:30:14.880
<v Speaker 5>comes to focal seizures, if we can identify that a

0:30:14.920 --> 0:30:19.720
<v Speaker 5>seizure is coming from one specific focus, then there are

0:30:19.720 --> 0:30:23.280
<v Speaker 5>potentially treatment options that might be very targeted. Let's say

0:30:23.400 --> 0:30:27.160
<v Speaker 5>that a seizure is emanating from a particular area of

0:30:27.200 --> 0:30:30.960
<v Speaker 5>the brain where there is a tumor that's something that

0:30:31.000 --> 0:30:33.960
<v Speaker 5>we're going to be more easily able potentially to target

0:30:34.040 --> 0:30:39.040
<v Speaker 5>and to treat directly. It also does affect what medications

0:30:39.120 --> 0:30:40.880
<v Speaker 5>might be used, and I don't have a lot of

0:30:40.920 --> 0:30:43.719
<v Speaker 5>details on that because there are so many different anti

0:30:43.840 --> 0:30:48.959
<v Speaker 5>epileptic medications and anti seizure medications, but there are different

0:30:49.000 --> 0:30:51.760
<v Speaker 5>ones that have maybe been shown to be more beneficial

0:30:51.800 --> 0:30:54.280
<v Speaker 5>in certain types of seizures than other types of seizures.

0:30:55.120 --> 0:30:57.400
<v Speaker 5>So it's important to note and be able to kind

0:30:57.440 --> 0:30:59.480
<v Speaker 5>of identify what type of seizure to be able to

0:30:59.560 --> 0:31:04.640
<v Speaker 5>pick the best medication. And then when you have, say,

0:31:04.720 --> 0:31:08.880
<v Speaker 5>focal seizures, whether there's an impairment of awareness or not,

0:31:09.880 --> 0:31:12.280
<v Speaker 5>that also is going to be important for not only

0:31:12.440 --> 0:31:15.840
<v Speaker 5>just a person's general life, but also determining if it's

0:31:15.880 --> 0:31:19.600
<v Speaker 5>safe for them to be doing activities like driving, etc.

0:31:20.400 --> 0:31:22.240
<v Speaker 4>Okay, Okay, that makes sense.

0:31:22.320 --> 0:31:24.320
<v Speaker 5>Yeah, So there's kind of a lot of layers of

0:31:24.360 --> 0:31:28.720
<v Speaker 5>why it's important not just medications, but also additional treatments

0:31:28.720 --> 0:31:32.240
<v Speaker 5>that might be available and just kind of determining what

0:31:32.520 --> 0:31:35.200
<v Speaker 5>somebody's prognosis might be and things like that as well.

0:31:35.560 --> 0:31:39.680
<v Speaker 4>Okay, my other question is about something that you mentioned,

0:31:39.840 --> 0:31:45.120
<v Speaker 4>and that is the damage that can result from status epilepticus,

0:31:45.600 --> 0:31:47.520
<v Speaker 4>But I also wanted to know, first of all, how

0:31:47.520 --> 0:31:50.479
<v Speaker 4>does that damage occur and does that damage happen in

0:31:50.600 --> 0:31:55.200
<v Speaker 4>people who, for instance, have epilepsy, not status epilepticus, but

0:31:55.280 --> 0:31:57.200
<v Speaker 4>repeated seizures throughout their life.

0:31:57.400 --> 0:32:03.280
<v Speaker 5>Yeah, absolutely excellent question. So the short answer is, yes,

0:32:03.600 --> 0:32:05.840
<v Speaker 5>there are changes in the brain that are going to

0:32:05.960 --> 0:32:11.800
<v Speaker 5>happen with epilepsy and with recurren seizures. And one of

0:32:11.880 --> 0:32:14.160
<v Speaker 5>the things that I always try and touch on it

0:32:14.240 --> 0:32:18.400
<v Speaker 5>in all of our episodes is the pathophysiology of whatever recovering,

0:32:18.440 --> 0:32:20.600
<v Speaker 5>and so that usually means trying to get into some

0:32:20.760 --> 0:32:24.200
<v Speaker 5>of that nitty gritty detail, like what is happening in

0:32:24.240 --> 0:32:28.920
<v Speaker 5>our brain during this process. When it comes to epilepsy,

0:32:29.040 --> 0:32:33.600
<v Speaker 5>it's really difficult to get super into the nitty gritty details,

0:32:34.120 --> 0:32:37.840
<v Speaker 5>not just because I'm not a neurologist, but also because

0:32:38.800 --> 0:32:44.400
<v Speaker 5>the underlying brain changes that can lead to epilepsy to

0:32:44.480 --> 0:32:48.880
<v Speaker 5>these recurrents of seizures are manyfold. There's a lot of

0:32:48.880 --> 0:32:52.400
<v Speaker 5>different potential changes in the brain that can result in epilepsy.

0:32:53.280 --> 0:32:57.080
<v Speaker 5>So then it makes the specific details of what's causing

0:32:57.200 --> 0:33:01.320
<v Speaker 5>seizures also really varied, and so it's hard to kind

0:33:01.360 --> 0:33:06.720
<v Speaker 5>of generalize it, but I'm going to try. So the

0:33:06.800 --> 0:33:10.000
<v Speaker 5>leading hypothesis is that when it comes to epilepsy, when

0:33:10.040 --> 0:33:15.040
<v Speaker 5>it comes to recurrent, unprovoked seizures, what happens is that

0:33:15.120 --> 0:33:20.440
<v Speaker 5>you end up with an imbalance of excitatory and inhibitory

0:33:20.800 --> 0:33:24.840
<v Speaker 5>currents at its most basic form. And we've talked on

0:33:24.840 --> 0:33:28.200
<v Speaker 5>this podcast before about how in our brain we have

0:33:28.480 --> 0:33:33.320
<v Speaker 5>neurotransmitters and electrical signals that are promoting action like bend

0:33:33.360 --> 0:33:35.960
<v Speaker 5>your arm, and we have pathways in our brain that

0:33:36.000 --> 0:33:40.320
<v Speaker 5>are inhibiting action like unbend your arm right or stop bending.

0:33:41.520 --> 0:33:45.320
<v Speaker 5>And there's a lot of different neurotransmitters and ions and

0:33:45.360 --> 0:33:48.320
<v Speaker 5>receptors that are involved in all of this complex signaling

0:33:48.680 --> 0:33:55.880
<v Speaker 5>and converting these excitatory and inhibitory signals into that electricity. Right, So,

0:33:56.000 --> 0:34:00.320
<v Speaker 5>epilepsy arises when those signals are malfunctioning. But that can

0:34:00.400 --> 0:34:05.160
<v Speaker 5>happen through any of those particular pathways, through changes in

0:34:05.200 --> 0:34:10.359
<v Speaker 5>ion channels, through changes in the concentration of neurotransmitters, from

0:34:10.520 --> 0:34:16.160
<v Speaker 5>changes in receptors in our brain. And there's some hypothesis

0:34:16.320 --> 0:34:21.279
<v Speaker 5>that part of the recurrence of seizures in epilepsy is

0:34:21.360 --> 0:34:26.480
<v Speaker 5>due to inflammation that happens during this seizure process. And

0:34:26.520 --> 0:34:29.120
<v Speaker 5>it might be that inflammation as well plays a really

0:34:29.120 --> 0:34:33.840
<v Speaker 5>big role in the kind of perpetuation of epilepsy and seizures.

0:34:35.280 --> 0:34:40.440
<v Speaker 5>I don't know if that fully answers your question, but

0:34:41.440 --> 0:34:46.919
<v Speaker 5>the truth is that it's because seizures can occur from

0:34:47.000 --> 0:34:52.640
<v Speaker 5>so many different possible sources. It can also result in

0:34:52.719 --> 0:34:56.960
<v Speaker 5>so many different changes in the brain, both changes in

0:34:57.320 --> 0:35:00.799
<v Speaker 5>things like our ion channels or the concentration of their transmitters.

0:35:01.120 --> 0:35:04.560
<v Speaker 5>It can result in changes of the structural cells, the

0:35:04.600 --> 0:35:08.719
<v Speaker 5>glial cells within our brain. It can also result in

0:35:08.800 --> 0:35:13.200
<v Speaker 5>changes in the actual connectivity of our neural networks themselves

0:35:13.480 --> 0:35:16.000
<v Speaker 5>when you have seizures and when you have recurrent seizures,

0:35:16.840 --> 0:35:19.120
<v Speaker 5>so any and all of the above are possible.

0:35:20.120 --> 0:35:23.719
<v Speaker 4>Does having one seizure make you more likely to have

0:35:23.760 --> 0:35:24.600
<v Speaker 4>a second seizure?

0:35:24.920 --> 0:35:29.080
<v Speaker 5>That's a good question. I don't think that we can

0:35:29.120 --> 0:35:32.879
<v Speaker 5>one hundred percent say yes or one hundred percent say no.

0:35:33.840 --> 0:35:35.279
<v Speaker 5>There are a lot of ways that you can have

0:35:35.320 --> 0:35:39.720
<v Speaker 5>a seizure that you may never have a seizure again.

0:35:40.880 --> 0:35:47.040
<v Speaker 5>For example, febrow seizures, which happen in kids, usually young kids.

0:35:47.200 --> 0:35:50.240
<v Speaker 5>Most commonly like twelve to eighteen months, but usually anywhere

0:35:50.280 --> 0:35:54.000
<v Speaker 5>from six months to five years can have a seizure

0:35:54.080 --> 0:35:56.719
<v Speaker 5>in the context of an acute illness where they have

0:35:56.760 --> 0:36:01.080
<v Speaker 5>a fever that's not from es central nervous infection, because

0:36:01.080 --> 0:36:06.000
<v Speaker 5>that would be something else entirely, and these most often

0:36:06.080 --> 0:36:11.760
<v Speaker 5>resolve spontaneously. We don't usually see any permanent or residual damage.

0:36:12.719 --> 0:36:17.600
<v Speaker 5>And while there may be some association between kids who

0:36:17.680 --> 0:36:22.040
<v Speaker 5>have febrowse seizures and who later do get diagnosed with epilepsy,

0:36:22.120 --> 0:36:25.560
<v Speaker 5>that doesn't mean that most kids who have feebrow seizures

0:36:25.560 --> 0:36:30.120
<v Speaker 5>are going to develop epilepsy by any means. Okay, same thing.

0:36:30.640 --> 0:36:33.600
<v Speaker 5>If you think of someone who's a child or an

0:36:33.640 --> 0:36:36.719
<v Speaker 5>adult who ends up having a seizure because of metabolic

0:36:36.800 --> 0:36:42.040
<v Speaker 5>derangements like severe hypoglycemia in the context of something like diabetes,

0:36:42.520 --> 0:36:45.160
<v Speaker 5>oh okay, that can result in seizures, but this would

0:36:45.200 --> 0:36:48.040
<v Speaker 5>be a reflex or a provoked seizure due to that

0:36:48.200 --> 0:36:53.839
<v Speaker 5>clear factor hypoglycemia causing that seizure, And no matter how

0:36:53.880 --> 0:36:57.560
<v Speaker 5>many times you might have a hypoglycemic seizure, that doesn't

0:36:57.560 --> 0:36:59.680
<v Speaker 5>necessarily mean that you have epilepsy.

0:37:00.440 --> 0:37:03.759
<v Speaker 4>That was my other question which was unprovoked. What is

0:37:03.920 --> 0:37:06.760
<v Speaker 4>a provoked versus unprovoked? Okay, exactly.

0:37:06.960 --> 0:37:07.120
<v Speaker 1>Yeah.

0:37:07.200 --> 0:37:09.560
<v Speaker 5>The same is true for something like alcohol withdrawal, which

0:37:09.640 --> 0:37:12.920
<v Speaker 5>is a very common cause of seizures. So if your

0:37:12.960 --> 0:37:16.840
<v Speaker 5>seizures are only and exclusively in the context of alcohol withdrawal,

0:37:16.840 --> 0:37:19.719
<v Speaker 5>that doesn't necessarily mean you have epilepsy.

0:37:20.000 --> 0:37:23.239
<v Speaker 4>Right, And so when you're talking about unprovoked, you're not

0:37:23.280 --> 0:37:29.759
<v Speaker 4>talking about triggers for epilepsy seizures like flashing lights or

0:37:29.800 --> 0:37:33.319
<v Speaker 4>which I know is correct not very yeah, okay.

0:37:33.080 --> 0:37:36.640
<v Speaker 5>Yeah, Actually that's a really good important point. Yes, I'm

0:37:36.680 --> 0:37:40.520
<v Speaker 5>not talking about that which can trigger someone who has epilepsy.

0:37:41.160 --> 0:37:44.080
<v Speaker 5>And one thing I think is really important that I

0:37:44.120 --> 0:37:46.360
<v Speaker 5>saw in a paper that I never thought of that

0:37:46.440 --> 0:37:50.879
<v Speaker 5>way is that epileptic seizure. So people who have epilepsy,

0:37:51.840 --> 0:37:57.520
<v Speaker 5>their seizures are not random, Like seizures are not entirely random.

0:37:57.719 --> 0:38:01.480
<v Speaker 5>We might not know by any means what any provoking

0:38:01.560 --> 0:38:05.760
<v Speaker 5>factor is for any given particular seizure that someone has.

0:38:06.239 --> 0:38:09.440
<v Speaker 5>But something is going on in a person's brain that

0:38:09.560 --> 0:38:12.279
<v Speaker 5>ends up leading to a seizure in a person who

0:38:12.360 --> 0:38:19.040
<v Speaker 5>has epilepsy. Okay, so they're not entirely random, gotcha? Yeah,

0:38:19.160 --> 0:38:22.080
<v Speaker 5>that's honestly most of what I have for the kind

0:38:22.120 --> 0:38:25.400
<v Speaker 5>of biology of seizures and of epilepsy.

0:38:26.440 --> 0:38:28.399
<v Speaker 4>Okay, so then I do have more questions, Race.

0:38:29.560 --> 0:38:31.640
<v Speaker 5>I was going to talk about treatment, but I want

0:38:31.680 --> 0:38:33.759
<v Speaker 5>to know if you have any more questions first.

0:38:34.520 --> 0:38:37.800
<v Speaker 4>So you went through a bunch of different types of seizures.

0:38:38.680 --> 0:38:42.920
<v Speaker 4>Epilepsy also comes in many different forms. What are some

0:38:43.000 --> 0:38:44.120
<v Speaker 4>of those forms?

0:38:44.320 --> 0:38:48.880
<v Speaker 5>Yeah, so, and I will say that the terminology surrounding epilepsy,

0:38:49.040 --> 0:38:52.680
<v Speaker 5>much like the terminology surrounding seizures themselves, has changed a

0:38:52.719 --> 0:38:56.080
<v Speaker 5>lot in recent years. I'm going to talk about the

0:38:56.080 --> 0:39:00.680
<v Speaker 5>most current terminology that we have. So in general, today

0:39:01.200 --> 0:39:06.799
<v Speaker 5>epilepsy is classified as either genetic, meaning predominantly arising from

0:39:07.000 --> 0:39:12.960
<v Speaker 5>an identifiable genetic cause, be that a single mutation or multiples,

0:39:13.600 --> 0:39:17.840
<v Speaker 5>or structural or metabolic, which means it's caused initially at

0:39:17.960 --> 0:39:22.520
<v Speaker 5>least by something like say a stroke, or a trauma

0:39:22.600 --> 0:39:27.759
<v Speaker 5>like a traumatic brain injury or a tumor in the

0:39:27.800 --> 0:39:31.240
<v Speaker 5>case of structural, or even a malformation of the brain

0:39:31.360 --> 0:39:37.759
<v Speaker 5>itself which might be congenital, or various metabolic syndromes that

0:39:37.880 --> 0:39:41.719
<v Speaker 5>might lead to seizures, which can also be genetics. So

0:39:41.760 --> 0:39:46.040
<v Speaker 5>it gets a little confusing or instigated by something like

0:39:46.080 --> 0:39:50.840
<v Speaker 5>a meningitis or an encephalitis that later leads to recurrent seizures,

0:39:52.520 --> 0:39:55.040
<v Speaker 5>and then if we can't pinpoint any of those, then

0:39:55.040 --> 0:39:58.920
<v Speaker 5>an epilepsy would be classified as unknown and a really

0:39:59.000 --> 0:40:02.840
<v Speaker 5>big proportion of epilepsy and I don't have an exact

0:40:02.920 --> 0:40:07.120
<v Speaker 5>number on this is actually unknown origin, so we don't

0:40:07.200 --> 0:40:11.720
<v Speaker 5>always know what the instigating factor was, Okay.

0:40:12.440 --> 0:40:17.720
<v Speaker 4>And then what about different types of epilepsy?

0:40:17.840 --> 0:40:21.920
<v Speaker 5>Yeah, I know, I mean this one is hard, I

0:40:21.920 --> 0:40:25.600
<v Speaker 5>think because I think it was more common in the

0:40:25.640 --> 0:40:33.600
<v Speaker 5>past to separate out very specific forms of epilepsy, and

0:40:33.680 --> 0:40:37.359
<v Speaker 5>now I think we have started lumping a lot more

0:40:37.440 --> 0:40:41.960
<v Speaker 5>of them together based on those classifications that I mentioned,

0:40:42.160 --> 0:40:45.600
<v Speaker 5>like what type of seizures do you have with your epilepsy?

0:40:46.239 --> 0:40:46.600
<v Speaker 4>Okay?

0:40:46.880 --> 0:40:49.000
<v Speaker 5>So I know when I was in med school, I

0:40:49.040 --> 0:40:52.040
<v Speaker 5>had to memorize a whole bunch of different seizure types

0:40:52.080 --> 0:40:56.480
<v Speaker 5>and a whole bunch of different types of epilepsy. And

0:40:56.560 --> 0:40:59.600
<v Speaker 5>it seems like the trend now is more to focus

0:40:59.640 --> 0:41:03.400
<v Speaker 5>on what seizure types does a person with epilepsy experience

0:41:03.800 --> 0:41:07.000
<v Speaker 5>and classify it based on that. So, as an example

0:41:07.040 --> 0:41:09.719
<v Speaker 5>of that, a lot of people might have heard of

0:41:10.120 --> 0:41:15.440
<v Speaker 5>temporal lobe epilepsy. Temporal lobe epilepsy means seizures that are

0:41:15.520 --> 0:41:18.440
<v Speaker 5>arising from the temporal lobe, which is one lobe of

0:41:18.480 --> 0:41:20.880
<v Speaker 5>our brain. We have one temporal lobe on each side.

0:41:21.480 --> 0:41:24.319
<v Speaker 5>So now it would be more common to classify that

0:41:25.040 --> 0:41:29.480
<v Speaker 5>as a person who has epilepsy whose seizure type is

0:41:29.640 --> 0:41:34.800
<v Speaker 5>a focal onset impaired awareness seizure originating from the temporal

0:41:34.840 --> 0:41:38.640
<v Speaker 5>lobe with motor symptoms of various forms.

0:41:39.000 --> 0:41:40.479
<v Speaker 4>Okay, does that make sense?

0:41:40.680 --> 0:41:44.719
<v Speaker 5>So it's like more cumbersome, but a lot more specific.

0:41:44.600 --> 0:41:47.000
<v Speaker 4>Right, I mean, and it makes sense in terms of

0:41:47.719 --> 0:41:51.240
<v Speaker 4>treatment issue, I would imagine.

0:41:50.800 --> 0:41:54.239
<v Speaker 5>And then within that you'll still be able to classify

0:41:54.280 --> 0:41:57.000
<v Speaker 5>the type of epilepsy based on whether it's genetic or

0:41:57.040 --> 0:42:03.080
<v Speaker 5>whether it was from a structural change or a metabolic disorder, etc. Right.

0:42:03.600 --> 0:42:07.279
<v Speaker 4>Important also that genetic does not mean hereditary necessarily.

0:42:07.600 --> 0:42:08.520
<v Speaker 5>Yes, absolutely.

0:42:09.520 --> 0:42:13.759
<v Speaker 4>Speaking of treatment, Yeah, what treatments are there? How do

0:42:13.840 --> 0:42:14.280
<v Speaker 4>they work?

0:42:14.840 --> 0:42:15.600
<v Speaker 3>Great question?

0:42:16.680 --> 0:42:20.680
<v Speaker 5>There are a whole host of anti epileptic or anti

0:42:20.719 --> 0:42:25.440
<v Speaker 5>seizure medications. And the good news that I have is

0:42:25.480 --> 0:42:28.040
<v Speaker 5>that most data that I saw suggests that up to

0:42:28.200 --> 0:42:32.840
<v Speaker 5>seventy or some places say eighty percent of people living

0:42:32.840 --> 0:42:37.719
<v Speaker 5>with epilepsy will achieve remission, and often this happens with

0:42:37.760 --> 0:42:41.440
<v Speaker 5>the first drug tried, the first anti seizure medication that

0:42:41.480 --> 0:42:45.560
<v Speaker 5>somebody tries, regardless of what one they end up trying.

0:42:47.040 --> 0:42:51.759
<v Speaker 5>There are too many different anti seizure medications for me

0:42:51.800 --> 0:42:55.920
<v Speaker 5>to list. Some of them act, for example, on sodium

0:42:56.000 --> 0:42:59.320
<v Speaker 5>channels and so they're modulating some of those chemical signals.

0:43:00.040 --> 0:43:03.759
<v Speaker 5>Some of them might act on certain neuro receptors or

0:43:03.800 --> 0:43:07.600
<v Speaker 5>other neurotransmitters like gabba or glutamate. So I'm not going

0:43:07.640 --> 0:43:09.400
<v Speaker 5>to get into the nitty gritty of how each of

0:43:09.440 --> 0:43:12.879
<v Speaker 5>these different medications work. But you can imagine that if

0:43:12.880 --> 0:43:16.239
<v Speaker 5>we can pinpoint any specifics about a seizure, we might

0:43:16.280 --> 0:43:19.240
<v Speaker 5>be able to pick one anti seizure medication over another.

0:43:19.719 --> 0:43:26.040
<v Speaker 5>Right and seventy percent remission sounds pretty good, but it

0:43:26.080 --> 0:43:29.000
<v Speaker 5>also means that right now, thirty percent of people do

0:43:29.080 --> 0:43:31.560
<v Speaker 5>not or will not necessarily achieve remission.

0:43:32.280 --> 0:43:36.680
<v Speaker 4>What proportion of that is lack of access versus not

0:43:36.760 --> 0:43:37.880
<v Speaker 4>finding the right drug.

0:43:37.719 --> 0:43:40.360
<v Speaker 5>That's a good question. That's not counting lack of access,

0:43:40.400 --> 0:43:44.080
<v Speaker 5>that's people who are tried on anti seizure medication, yeah,

0:43:44.120 --> 0:43:46.120
<v Speaker 5>which is really important because we'll get into lack of

0:43:46.120 --> 0:43:49.960
<v Speaker 5>access later. This is where it becomes really important to

0:43:49.960 --> 0:43:52.040
<v Speaker 5>be able to identify as much as we can about

0:43:52.080 --> 0:43:55.680
<v Speaker 5>seizures because for some people who can't achieve remission with

0:43:55.840 --> 0:44:00.120
<v Speaker 5>medication so far, there may be surgical options depending on

0:44:00.160 --> 0:44:04.759
<v Speaker 5>the focality of their epilepsy. So surgery might mean resection

0:44:05.160 --> 0:44:09.759
<v Speaker 5>or destruction of an area of epileptic focus, or it

0:44:09.880 --> 0:44:15.680
<v Speaker 5>might be nerve stimulation, usually peripheral nerve stimulation rather than

0:44:15.719 --> 0:44:21.000
<v Speaker 5>deep brain stimulation. Various forms of this have been shown

0:44:21.040 --> 0:44:23.920
<v Speaker 5>in some cases to lead to a reduction in seizure burden,

0:44:24.440 --> 0:44:28.560
<v Speaker 5>maybe not complete remission. Another treatment that a lot of

0:44:28.600 --> 0:44:31.680
<v Speaker 5>people have probably heard of because it's all over everything

0:44:32.360 --> 0:44:37.360
<v Speaker 5>is a dietary control known as the ketogenic diet. The

0:44:37.440 --> 0:44:40.160
<v Speaker 5>ketogenic diet is very interesting and probably could be its

0:44:40.200 --> 0:44:45.040
<v Speaker 5>whole own episode. In general, the quality of evidence that

0:44:45.080 --> 0:44:47.680
<v Speaker 5>we have is not all that great, but likely because

0:44:47.719 --> 0:44:51.360
<v Speaker 5>of small sample sizes, but it has been shown for

0:44:51.480 --> 0:44:56.960
<v Speaker 5>treatment resistant childhood epilepsy to improve the chances of seizure

0:44:57.000 --> 0:45:02.880
<v Speaker 5>reduction or remission. There's a lot less evidence for less

0:45:02.880 --> 0:45:06.400
<v Speaker 5>restrictive diets like there's a modified at Kins, there's a

0:45:06.400 --> 0:45:12.320
<v Speaker 5>low glycemic index version. But for someone who is living

0:45:12.360 --> 0:45:16.280
<v Speaker 5>with very frequent seizures, even a small reduction in caizure

0:45:16.280 --> 0:45:19.120
<v Speaker 5>burden might be a pretty big deal in pretty life changing.

0:45:19.800 --> 0:45:21.799
<v Speaker 5>But the data that we have is just not all

0:45:21.840 --> 0:45:26.480
<v Speaker 5>that strong, and a true ketogenic diet like is used

0:45:26.680 --> 0:45:30.400
<v Speaker 5>in these studies to look at epilepsy is incredibly difficult

0:45:30.480 --> 0:45:34.440
<v Speaker 5>to achieve. It is very very restrictive. So it's not

0:45:34.840 --> 0:45:38.600
<v Speaker 5>the ketodiet that's on the news throwing that out there.

0:45:39.360 --> 0:45:41.920
<v Speaker 5>I also am really I just am personally very interested

0:45:41.920 --> 0:45:45.200
<v Speaker 5>in the potential mechanisms of the ketogenic diet. So I

0:45:45.280 --> 0:45:47.319
<v Speaker 5>do have a couple papers if people want to read

0:45:47.320 --> 0:45:51.680
<v Speaker 5>more about it. Spoilers, We don't know, but there's a

0:45:51.760 --> 0:45:55.960
<v Speaker 5>lot of different hypotheses with various levels of potential, theoretical

0:45:56.040 --> 0:46:01.600
<v Speaker 5>and actual support on how this change in forcing our

0:46:01.640 --> 0:46:06.640
<v Speaker 5>brain to use keytnes rather than glucose might shift basically

0:46:06.680 --> 0:46:10.200
<v Speaker 5>metabolism or mitochondrial function to then change the way that

0:46:10.239 --> 0:46:14.520
<v Speaker 5>electrical impulses are generated. It's pretty cool, but it's all

0:46:14.840 --> 0:46:16.520
<v Speaker 5>kind of theoretical at this point, so.

0:46:16.800 --> 0:46:19.799
<v Speaker 4>Yeah, yeah, okay, interesting.

0:46:19.520 --> 0:46:21.440
<v Speaker 5>It's interesting, and there's more if you want to read

0:46:21.440 --> 0:46:27.920
<v Speaker 5>about it. But that essentially is what I have at

0:46:28.000 --> 0:46:31.360
<v Speaker 5>least about epilepsy and seizures.

0:46:32.320 --> 0:46:36.399
<v Speaker 4>I have two questions. Okay, My first question is how

0:46:36.440 --> 0:46:41.120
<v Speaker 4>many recurrent seizures does it take to be diagnosed as epilepsy?

0:46:41.239 --> 0:46:41.520
<v Speaker 6>Oh?

0:46:41.680 --> 0:46:42.320
<v Speaker 5>Great, question?

0:46:42.640 --> 0:46:42.920
<v Speaker 1>Two?

0:46:43.760 --> 0:46:44.280
<v Speaker 4>Oh really?

0:46:44.360 --> 0:46:46.680
<v Speaker 5>Two or more? I can give you, like a full

0:46:46.800 --> 0:46:53.240
<v Speaker 5>even more formal definitions, two or more unprovoked seizures greater

0:46:53.360 --> 0:46:57.160
<v Speaker 5>than twenty four hours apart, so not within the same

0:46:57.239 --> 0:47:01.719
<v Speaker 5>day or And this part's very interesting and has really

0:47:01.840 --> 0:47:06.520
<v Speaker 5>huge implications for the treatment of people with epilepsy going forward.

0:47:07.160 --> 0:47:12.239
<v Speaker 5>It can also be a single unprovoked seizure in a

0:47:12.320 --> 0:47:16.560
<v Speaker 5>person who has a greater than sixty percent risk of

0:47:16.600 --> 0:47:19.799
<v Speaker 5>having another seizure over the next ten years. And the

0:47:19.840 --> 0:47:22.799
<v Speaker 5>way that they determine that is by looking at an

0:47:22.840 --> 0:47:27.000
<v Speaker 5>EEG to see if the findings on there look like

0:47:27.560 --> 0:47:29.960
<v Speaker 5>there are changes in the brain already that have the

0:47:30.000 --> 0:47:36.960
<v Speaker 5>potential to result in seizures or any epileptiform activity that

0:47:37.000 --> 0:47:39.319
<v Speaker 5>you can see on an EEG, even if you're not

0:47:39.440 --> 0:47:42.640
<v Speaker 5>having seizures at the time. And so those two things

0:47:43.080 --> 0:47:46.600
<v Speaker 5>with a sixty percent probability would then even with a

0:47:46.640 --> 0:47:50.920
<v Speaker 5>single seizure mean that you have epilepsy. Okay, and then

0:47:50.960 --> 0:47:52.600
<v Speaker 5>the third thing would be also if you have an

0:47:52.600 --> 0:47:55.560
<v Speaker 5>epilepsy syndrome, so like a genetic or other disorder that

0:47:55.680 --> 0:47:57.880
<v Speaker 5>is known to be associated with epilepsy.

0:47:58.160 --> 0:48:03.400
<v Speaker 4>Gotcha. Yeah, question is you know you talked about how

0:48:04.040 --> 0:48:06.879
<v Speaker 4>epilepsy A lot of the time we don't know what

0:48:07.000 --> 0:48:11.640
<v Speaker 4>causes someone's epilepsy. Yeah, a lot of the time. Also,

0:48:11.760 --> 0:48:20.360
<v Speaker 4>epilepsy can just stop. Yeah, why, how when does that happen?

0:48:20.719 --> 0:48:24.240
<v Speaker 4>Under what circumstances? How often? Yeah?

0:48:24.360 --> 0:48:31.280
<v Speaker 5>If I had those answers erin it is more common.

0:48:32.600 --> 0:48:39.239
<v Speaker 5>I believe with childhood epilepsies that they may resolve over time. Why,

0:48:39.480 --> 0:48:43.879
<v Speaker 5>I don't know. And beyond that, it's just a really

0:48:43.920 --> 0:48:47.160
<v Speaker 5>good and interesting question some people. And maybe it could

0:48:47.200 --> 0:48:50.680
<v Speaker 5>also be related to if there is an instigating factor,

0:48:51.000 --> 0:48:57.400
<v Speaker 5>Let's say a meningdroitis infection or a traumatic brain injury,

0:48:57.960 --> 0:49:01.080
<v Speaker 5>something that changes the brain enough that you have this

0:49:01.320 --> 0:49:05.720
<v Speaker 5>chance of recurrent seizures, or you've had two seizures greater

0:49:05.800 --> 0:49:08.600
<v Speaker 5>than twenty four hours apart, so you meet this definition

0:49:08.680 --> 0:49:12.520
<v Speaker 5>for epilepsy. But over time, maybe your brain remodels itself

0:49:12.640 --> 0:49:17.480
<v Speaker 5>enough to then no longer have this epileptiform activity. Huh,

0:49:17.520 --> 0:49:19.960
<v Speaker 5>then you can, yes, resolve your epilepsy.

0:49:20.600 --> 0:49:21.560
<v Speaker 4>I'm fascinating.

0:49:21.719 --> 0:49:23.640
<v Speaker 5>Yeah, And that's also part of the change in the

0:49:23.640 --> 0:49:27.560
<v Speaker 5>definition of epilepsy that happened relatively recently, is that it

0:49:27.960 --> 0:49:30.320
<v Speaker 5>can be a disease that is also resolved.

0:49:30.320 --> 0:49:32.840
<v Speaker 4>Okay, also a temporary chronic disease.

0:49:33.200 --> 0:49:37.919
<v Speaker 5>Yeah. Yeah, well, and also something that is classified as

0:49:38.000 --> 0:49:41.200
<v Speaker 5>a disease and not a disorder. And that was a

0:49:41.320 --> 0:49:45.799
<v Speaker 5>very intentional change when they kind of updated these definitions,

0:49:45.800 --> 0:49:50.160
<v Speaker 5>which I think is very interesting. So, Aaron, that was

0:49:50.200 --> 0:49:53.800
<v Speaker 5>a lot, it was, and also probably not enough.

0:49:54.120 --> 0:49:54.440
<v Speaker 4>Yep.

0:49:55.600 --> 0:49:58.840
<v Speaker 5>So tell me where did all of this come from?

0:50:00.239 --> 0:50:01.160
<v Speaker 4>How did we get here?

0:50:01.680 --> 0:50:03.279
<v Speaker 5>Have we always had epilepsy?

0:50:04.280 --> 0:50:04.520
<v Speaker 1>What?

0:50:07.920 --> 0:50:11.600
<v Speaker 4>I will start the deep deep dive into the history

0:50:11.640 --> 0:50:53.200
<v Speaker 4>section right after this break quote. A history of epilepsy

0:50:53.360 --> 0:50:57.680
<v Speaker 4>seems a premature, perhaps even a doubtful enterprise. There is

0:50:57.719 --> 0:51:01.279
<v Speaker 4>no unanimity about the range of the concept of epilepsy,

0:51:01.719 --> 0:51:04.920
<v Speaker 4>and the nature of the disease is as yet obscure.

0:51:05.680 --> 0:51:06.240
<v Speaker 4>End quote.

0:51:06.960 --> 0:51:08.400
<v Speaker 5>Wow, so the end?

0:51:08.520 --> 0:51:14.400
<v Speaker 4>Huh? The end? I borrowed this quote from a book

0:51:14.440 --> 0:51:18.279
<v Speaker 4>called The Falling Sickness by Aosey Tempkin, considered to be

0:51:18.440 --> 0:51:21.960
<v Speaker 4>the authority on the history of epilepsy in the Western world.

0:51:22.719 --> 0:51:26.040
<v Speaker 4>These words mark the very beginning of the first edition

0:51:26.120 --> 0:51:29.640
<v Speaker 4>of this book, published back in nineteen forty five, and

0:51:29.880 --> 0:51:33.440
<v Speaker 4>when twenty six years later the author revised and published

0:51:33.440 --> 0:51:36.640
<v Speaker 4>a second edition, there they stayed right at the beginning,

0:51:36.719 --> 0:51:39.600
<v Speaker 4>and I think they were even in the fourth edition

0:51:39.680 --> 0:51:41.280
<v Speaker 4>published in the mid nineties.

0:51:41.400 --> 0:51:46.680
<v Speaker 6>Oh no, yeah, because when that fourth edition came out

0:51:46.760 --> 0:51:52.080
<v Speaker 6>in nineteen ninety four, they remained just as true as they.

0:51:51.920 --> 0:51:53.319
<v Speaker 4>Were in nineteen forty five.

0:51:53.680 --> 0:51:53.919
<v Speaker 1>Wow.

0:51:54.480 --> 0:51:58.439
<v Speaker 4>And now in twenty twenty three, I feel like there's

0:51:58.520 --> 0:52:02.520
<v Speaker 4>still an accurate descript of the mystery that surrounds epilepsy.

0:52:03.360 --> 0:52:05.680
<v Speaker 4>So that's why I thought it was the perfect way

0:52:05.760 --> 0:52:11.080
<v Speaker 4>to start the history section. Great, even though we've come

0:52:11.200 --> 0:52:14.719
<v Speaker 4>a tremendously long way in our understanding and treatment of

0:52:14.760 --> 0:52:19.319
<v Speaker 4>epilepsy since those words were first written, as the biology

0:52:19.360 --> 0:52:23.920
<v Speaker 4>section just demonstrated, there are still so very many unanswered questions.

0:52:24.840 --> 0:52:29.839
<v Speaker 4>But having unanswered questions isn't a bad thing. Necessarily look

0:52:29.880 --> 0:52:33.480
<v Speaker 4>at the nature of those questions and how specific they are.

0:52:34.080 --> 0:52:37.880
<v Speaker 4>That alone, I think shows incredible progress in our knowledge

0:52:37.920 --> 0:52:42.680
<v Speaker 4>of epilepsy, and that progress, along with the historical social

0:52:42.719 --> 0:52:46.280
<v Speaker 4>perceptions of epilepsy is what I want to talk about today,

0:52:46.560 --> 0:52:49.680
<v Speaker 4>particularly in the Western world, since that's where most of

0:52:49.680 --> 0:52:54.280
<v Speaker 4>the sources that I found concentrated on. When did humans

0:52:54.320 --> 0:52:58.480
<v Speaker 4>first recognize epilepsy, How did the meaning of this condition

0:52:58.680 --> 0:53:02.920
<v Speaker 4>shift over time? What did people think caused epilepsy, and

0:53:03.000 --> 0:53:07.560
<v Speaker 4>how did they treat it? This is a massive topic,

0:53:07.719 --> 0:53:11.600
<v Speaker 4>like we keep saying, and I'm going to try my best,

0:53:11.680 --> 0:53:14.319
<v Speaker 4>but there are parts that I simply won't get to

0:53:14.680 --> 0:53:18.319
<v Speaker 4>or won't go into in great depth. And like we

0:53:18.440 --> 0:53:20.920
<v Speaker 4>keep saying, the good news is that we will give

0:53:20.960 --> 0:53:25.239
<v Speaker 4>you plenty of material to read on if you are

0:53:25.360 --> 0:53:31.040
<v Speaker 4>still curious. Always always the other challenge, or maybe not

0:53:31.120 --> 0:53:34.279
<v Speaker 4>necessarily challenge. But something that I want to note is

0:53:34.280 --> 0:53:38.960
<v Speaker 4>that the definition of epilepsy has changed substantially throughout history,

0:53:39.600 --> 0:53:42.400
<v Speaker 4>and even at any one given point in time, you

0:53:42.400 --> 0:53:45.080
<v Speaker 4>would probably get a dozen different answers if you ask

0:53:45.200 --> 0:53:49.800
<v Speaker 4>a dozen different people what epilepsy was. In ancient times

0:53:49.840 --> 0:53:55.680
<v Speaker 4>and into the Middle Ages and the Renaissance, epilepsy, seizure, attack, convulsion,

0:53:56.440 --> 0:54:00.880
<v Speaker 4>Many different words or terms were all used, interchangeable. So

0:54:00.960 --> 0:54:04.080
<v Speaker 4>while today we think of epilepsy as a chronic condition

0:54:04.800 --> 0:54:07.440
<v Speaker 4>in the past. It could have meant that, or it

0:54:07.480 --> 0:54:10.760
<v Speaker 4>could have meant an isolated seizure, so keep that in mind.

0:54:12.719 --> 0:54:16.680
<v Speaker 4>I usually try in these history sections to talk a

0:54:16.719 --> 0:54:20.600
<v Speaker 4>bit about the evolutionary origins of whatever topic we're covering,

0:54:21.760 --> 0:54:25.440
<v Speaker 4>but I decided not to attempt that for epilepsy for

0:54:25.520 --> 0:54:30.800
<v Speaker 4>several reasons. There is still so much unknown about its pathophysiology.

0:54:31.239 --> 0:54:34.719
<v Speaker 4>You can't even really say it's pathophysiology, since there are

0:54:34.760 --> 0:54:39.319
<v Speaker 4>so many different types of seizures, each with different histories

0:54:39.360 --> 0:54:42.040
<v Speaker 4>and causes and triggers, and so I felt that a

0:54:42.120 --> 0:54:46.120
<v Speaker 4>discussion of each of those evolutionary histories would probably have

0:54:46.200 --> 0:54:50.520
<v Speaker 4>been more confusing than enlightening. I will go so far

0:54:50.560 --> 0:54:53.320
<v Speaker 4>as to say that it's likely that humans have experienced

0:54:53.320 --> 0:54:57.840
<v Speaker 4>epilepsy for as long as we've been human, and probably

0:54:57.880 --> 0:55:01.200
<v Speaker 4>long before that, and instead I'll start with the very

0:55:01.360 --> 0:55:06.120
<v Speaker 4>first observations of epilepsy, which come from the ancient world.

0:55:06.880 --> 0:55:10.960
<v Speaker 4>Some researchers have speculated that trepanation, which is a practice

0:55:10.960 --> 0:55:13.680
<v Speaker 4>that's been performed for thousands of years where you make

0:55:13.719 --> 0:55:16.280
<v Speaker 4>a small hole in the skull and remove the bone,

0:55:16.800 --> 0:55:20.560
<v Speaker 4>that was done to treat epilepsy, and that ancient tripand

0:55:20.640 --> 0:55:25.440
<v Speaker 4>skulls indicate their knowledge of the disease, but this remains controversial,

0:55:25.520 --> 0:55:27.319
<v Speaker 4>and it's something that we're never going to know for

0:55:27.360 --> 0:55:32.640
<v Speaker 4>sure why people use trepanation in ancient times. The earliest

0:55:32.680 --> 0:55:36.759
<v Speaker 4>written description of epilepsy comes from Mesopotamia around twenty five

0:55:36.840 --> 0:55:42.120
<v Speaker 4>hundred BCE, in an ancient Sumerian text describing quote a

0:55:42.200 --> 0:55:45.840
<v Speaker 4>person whose neck turns left, whose hands and feet are tense,

0:55:45.960 --> 0:55:49.279
<v Speaker 4>and eyes wide open, froth flowing from the mouth, and

0:55:49.400 --> 0:55:54.480
<v Speaker 4>consciousness being lost, which pretty well describes a focal, unaware

0:55:54.520 --> 0:56:00.239
<v Speaker 4>tonic seizure. This condition was called antisubu and with to

0:56:00.280 --> 0:56:02.680
<v Speaker 4>be related to the hand of Sin, the god of

0:56:02.719 --> 0:56:07.000
<v Speaker 4>the moon. And already we have our first theme in

0:56:07.040 --> 0:56:09.520
<v Speaker 4>the history of epilepsy, a theme that kind of I

0:56:09.560 --> 0:56:12.799
<v Speaker 4>think overshadows most any other theme that I would call.

0:56:12.840 --> 0:56:16.600
<v Speaker 4>Attention to the belief that the condition had links to

0:56:16.640 --> 0:56:20.640
<v Speaker 4>the supernatural, to religion, to magic of some sort, that

0:56:20.719 --> 0:56:25.440
<v Speaker 4>it was more than a physical condition. Yep. As we'll see,

0:56:25.640 --> 0:56:29.080
<v Speaker 4>this gave epilepsy a whole host of different meanings, some

0:56:29.160 --> 0:56:33.799
<v Speaker 4>positive like oh, you are prophetic or you're a chosen genius,

0:56:34.400 --> 0:56:38.319
<v Speaker 4>and some most negative, like it being a sign that

0:56:38.360 --> 0:56:40.960
<v Speaker 4>you're possessed by an evil demon or spirit.

0:56:41.480 --> 0:56:44.480
<v Speaker 5>I feel like that is the one that I think

0:56:44.520 --> 0:56:48.160
<v Speaker 5>of the most when you think of like historical associations

0:56:48.160 --> 0:56:49.480
<v Speaker 5>with epilepsy or seizures.

0:56:49.719 --> 0:56:53.839
<v Speaker 4>Yep, for sure, and we'll get into all of it.

0:56:55.960 --> 0:56:59.239
<v Speaker 4>But a big part of this theme is that these

0:56:59.320 --> 0:57:03.959
<v Speaker 4>beliefs about the supernatural cause of epilepsy were in continuous

0:57:04.000 --> 0:57:07.879
<v Speaker 4>conflict for much of history with scientists or physicians who

0:57:07.880 --> 0:57:11.480
<v Speaker 4>believed that there was a physical, biological explanation for what

0:57:11.640 --> 0:57:17.680
<v Speaker 4>was happening. Sometimes superstition dominated popular thought and other times science.

0:57:18.840 --> 0:57:23.160
<v Speaker 4>This dichotomy is an oversimplification. It's much more nuanced than

0:57:23.160 --> 0:57:25.600
<v Speaker 4>how I'm presenting it, but I wanted to point it

0:57:25.640 --> 0:57:29.560
<v Speaker 4>out because it shapes the prevailing perception and treatment of

0:57:29.600 --> 0:57:33.000
<v Speaker 4>epilepsy over the next several thousand years, give or take.

0:57:33.800 --> 0:57:37.560
<v Speaker 4>For instance, in one of the Hippocratic texts, written around

0:57:37.600 --> 0:57:41.120
<v Speaker 4>four hundred BCE, it is said that the seat of

0:57:41.160 --> 0:57:44.400
<v Speaker 4>the disease is in the brain. It's a hereditary condition,

0:57:45.000 --> 0:57:47.520
<v Speaker 4>and that an excess of phlegm in the blood is

0:57:47.560 --> 0:57:50.640
<v Speaker 4>what leads to seizures. It's always the phlem. It's always

0:57:50.640 --> 0:57:54.160
<v Speaker 4>the phlem, and that's part of the humoral theory of disease.

0:57:55.320 --> 0:57:59.240
<v Speaker 4>In this text called on the Sacred Disease, the author

0:57:59.360 --> 0:58:05.120
<v Speaker 4>also argue against the labeling of epilepsy as a divine disease. Quote.

0:58:05.840 --> 0:58:09.320
<v Speaker 4>I am about to discuss the disease called sacred. It

0:58:09.400 --> 0:58:12.360
<v Speaker 4>is not, in my opinion, any more divine or sacred

0:58:12.440 --> 0:58:16.440
<v Speaker 4>than any other diseases, but has a natural cause, and

0:58:16.520 --> 0:58:20.200
<v Speaker 4>its supposed divine origin is due to men's inexperience and

0:58:20.240 --> 0:58:24.280
<v Speaker 4>to their wonder at its peculiar character. But if it

0:58:24.360 --> 0:58:27.840
<v Speaker 4>is to be considered divine just because it is wonderful,

0:58:28.160 --> 0:58:32.040
<v Speaker 4>there would be not one sacred disease, but many, hm,

0:58:32.480 --> 0:58:38.080
<v Speaker 4>which is kind of amazing considering that was like thousands

0:58:38.120 --> 0:58:42.040
<v Speaker 4>of years ago. Yeah, and so much happened in between

0:58:42.080 --> 0:58:43.080
<v Speaker 4>then and now.

0:58:43.640 --> 0:58:45.960
<v Speaker 5>Yeah.

0:58:46.000 --> 0:58:49.400
<v Speaker 4>And this isn't to say that the science behind what

0:58:49.600 --> 0:58:53.920
<v Speaker 4>these ancient Greek physicians believed caused epilepsy was sound by

0:58:53.960 --> 0:58:57.360
<v Speaker 4>today's standards. You know, for instance, it was caused by

0:58:57.400 --> 0:59:01.560
<v Speaker 4>the weather, hot wind, dry wind, whatever. But it was

0:59:01.600 --> 0:59:06.760
<v Speaker 4>a clear and important distinction to them, to many physicians

0:59:06.800 --> 0:59:11.920
<v Speaker 4>at that time, And I think that's really interesting. Yeah. However,

0:59:12.000 --> 0:59:14.320
<v Speaker 4>that was certainly not the case. As we move on

0:59:14.520 --> 0:59:18.640
<v Speaker 4>to ancient Rome and then especially the Middle Ages. In

0:59:18.720 --> 0:59:22.439
<v Speaker 4>Ancient Rome, the scientific lens through which many Hippocratic era

0:59:22.520 --> 0:59:26.120
<v Speaker 4>physicians viewed epilepsy shifted to one that was a bit

0:59:26.200 --> 0:59:30.480
<v Speaker 4>more supernatural, or at least one where a supernatural explanation

0:59:30.640 --> 0:59:34.640
<v Speaker 4>was more willingly considered. An epileptic seizure could be a

0:59:34.640 --> 0:59:37.240
<v Speaker 4>bad omen, and it was often thought to be brought

0:59:37.280 --> 0:59:40.800
<v Speaker 4>on by an unwelcome god or demon. A person who

0:59:40.840 --> 0:59:46.000
<v Speaker 4>had epilepsy was considered unclean and their condition contagious by

0:59:46.120 --> 0:59:51.120
<v Speaker 4>touch or by sharing food or drink. While occasionally it

0:59:51.240 --> 0:59:53.800
<v Speaker 4>was viewed as a blessing or a sign of prophecy,

0:59:54.400 --> 0:59:59.080
<v Speaker 4>by and large it was a negative, stigmatizing disease. The

0:59:59.200 --> 1:00:02.640
<v Speaker 4>meaning that eple held, or the importance with which people

1:00:02.720 --> 1:00:04.960
<v Speaker 4>viewed it, can be seen in part by looking at

1:00:04.960 --> 1:00:09.000
<v Speaker 4>the names that it has had over time. Let's start

1:00:09.000 --> 1:00:12.240
<v Speaker 4>with the word epilepsy, which has roots in the Greek

1:00:12.360 --> 1:00:20.200
<v Speaker 4>verb epilambanian I'm probably completely destroyed that, But that word

1:00:20.320 --> 1:00:24.520
<v Speaker 4>means to seize or to attack, So epilepsy seems to

1:00:24.560 --> 1:00:27.920
<v Speaker 4>have been used in these ancient texts simply to mean seizure,

1:00:28.080 --> 1:00:32.040
<v Speaker 4>a single medical event without any connotations of supernatural or

1:00:32.080 --> 1:00:36.360
<v Speaker 4>magic elements. The chronic condition was often referred to in

1:00:36.480 --> 1:00:40.000
<v Speaker 4>ancient Greece and Rome as the sacred disease or the

1:00:40.040 --> 1:00:45.360
<v Speaker 4>great disease, which eventually turned into the Latin morbis meyer

1:00:45.600 --> 1:00:48.920
<v Speaker 4>and then into the French grand mal, which is also

1:00:48.960 --> 1:00:51.320
<v Speaker 4>a term that we used to use for a certain

1:00:51.360 --> 1:00:55.400
<v Speaker 4>type of seizure. In the Middle Ages, the name most

1:00:55.480 --> 1:00:59.720
<v Speaker 4>commonly used to describe the condition was something involving falling,

1:01:00.520 --> 1:01:05.640
<v Speaker 4>the falling sickness, the falling evil catechus meaning falling something

1:01:05.680 --> 1:01:08.960
<v Speaker 4>that falls. And I will also note that the falling

1:01:09.000 --> 1:01:12.120
<v Speaker 4>sickness was what the disease was called in the first

1:01:12.120 --> 1:01:15.560
<v Speaker 4>descriptions in ancient Chinese medical texts dating back to seven

1:01:15.680 --> 1:01:19.880
<v Speaker 4>seventy BCE, but also in the Middle Ages, the disease

1:01:19.920 --> 1:01:23.960
<v Speaker 4>began to be associated with more loaded words such as

1:01:24.200 --> 1:01:29.720
<v Speaker 4>demonicus and lunaticus, referring to the belief that epilepsy was

1:01:29.720 --> 1:01:32.000
<v Speaker 4>a type of madness or that it was a sign

1:01:32.040 --> 1:01:36.360
<v Speaker 4>of possession. Speaking of lunaticus, I don't know if I'm

1:01:36.360 --> 1:01:39.320
<v Speaker 4>saying that right, probably not, which is where the word

1:01:39.400 --> 1:01:43.840
<v Speaker 4>lunatic comes from. It originates from the Latin luna, meaning moon,

1:01:44.400 --> 1:01:47.440
<v Speaker 4>since it was believed that the moon could cause bouts

1:01:47.480 --> 1:01:52.440
<v Speaker 4>of insanity or epilepsy. During this time period, people with

1:01:52.480 --> 1:01:56.360
<v Speaker 4>epilepsy were often described as being seized by quote the

1:01:56.400 --> 1:02:01.880
<v Speaker 4>disease of the moon. Why the moon, Well, perhaps it

1:02:01.920 --> 1:02:04.480
<v Speaker 4>was the vengeance of the goddess of the moon, or

1:02:04.560 --> 1:02:07.840
<v Speaker 4>you could go with a scientific explanation that quote, the

1:02:07.880 --> 1:02:12.400
<v Speaker 4>waxing moon heated the atmosphere surrounding the Earth and consequently

1:02:12.480 --> 1:02:19.240
<v Speaker 4>melted the brain, thus provoking an attack. But I mean, like,

1:02:19.360 --> 1:02:21.480
<v Speaker 4>this is something that kept occurring to me, is that

1:02:21.600 --> 1:02:24.760
<v Speaker 4>we look back at that now and we laughed. But

1:02:24.920 --> 1:02:29.520
<v Speaker 4>that was science, Like the goddess was the superstition part.

1:02:30.000 --> 1:02:34.320
<v Speaker 4>The science part was the moon melting your brain. There

1:02:34.360 --> 1:02:38.840
<v Speaker 4>are many different ways to distinguish between superstition and science,

1:02:39.040 --> 1:02:43.520
<v Speaker 4>or wishful thinking or magical thinking and science. And some

1:02:44.160 --> 1:02:47.560
<v Speaker 4>was done at the time of the writings, and some

1:02:48.560 --> 1:02:52.360
<v Speaker 4>is done from our perspective today. So we could look

1:02:52.400 --> 1:02:54.080
<v Speaker 4>at that and go, oh, well, both of those are

1:02:54.160 --> 1:02:56.880
<v Speaker 4>definitely superstitious beliefs. How could you ever think that the

1:02:56.880 --> 1:03:00.640
<v Speaker 4>moon would melt your brain? But back then that was science.

1:03:00.840 --> 1:03:05.480
<v Speaker 4>I know, something I kept thinking about. Epilepsy was also

1:03:05.560 --> 1:03:09.200
<v Speaker 4>thought to be from demotic possession or caused by the devil,

1:03:09.600 --> 1:03:12.600
<v Speaker 4>and its reputation as an evil disease gets a mention.

1:03:12.800 --> 1:03:17.600
<v Speaker 4>Even in Dante's Inferno, many people with epilepsy were forbidden

1:03:17.600 --> 1:03:20.800
<v Speaker 4>to go to church, or if they were allowed, they

1:03:20.800 --> 1:03:23.760
<v Speaker 4>could not take the Eucharist or touch anything in the

1:03:23.840 --> 1:03:28.880
<v Speaker 4>church because again, people thought it was contagious. Epilepsy was

1:03:28.920 --> 1:03:32.440
<v Speaker 4>linked to witchcraft, and in the handbook on witch hunting

1:03:33.000 --> 1:03:37.080
<v Speaker 4>Malias Meleficarum, written by two Dominican friars and published in

1:03:37.120 --> 1:03:41.360
<v Speaker 4>fourteen ninety four, it was said that seizures were characteristic

1:03:41.440 --> 1:03:46.080
<v Speaker 4>of witches, and also that witches could cause epilepsy to develop.

1:03:46.720 --> 1:03:49.640
<v Speaker 5>Huh yeah, a lot of feelings there.

1:03:51.880 --> 1:03:55.200
<v Speaker 4>But again I will say that there was no overall

1:03:55.280 --> 1:03:59.360
<v Speaker 4>consensus on epilepsy as an evil disease at any point

1:03:59.360 --> 1:04:03.120
<v Speaker 4>in time. There were also mentions of it as a

1:04:03.160 --> 1:04:08.440
<v Speaker 4>saintly disease. Saint Valentine is the patron saint of epilepsy

1:04:08.480 --> 1:04:11.800
<v Speaker 4>and one that marked you as chosen in a good

1:04:11.800 --> 1:04:16.880
<v Speaker 4>way or a genius. Continuing into the Renaissance, epilepsy was

1:04:16.920 --> 1:04:20.480
<v Speaker 4>still a disease fraught with meaning, and it was still

1:04:20.520 --> 1:04:23.600
<v Speaker 4>the doctor or the priest or society that got to

1:04:23.720 --> 1:04:28.560
<v Speaker 4>choose what that meaning was. Priests were sometimes called in

1:04:28.680 --> 1:04:32.400
<v Speaker 4>to determine whether someone was possessed or simply had epilepsy,

1:04:32.960 --> 1:04:36.040
<v Speaker 4>and people with epilepsy were believed to have the power

1:04:36.120 --> 1:04:39.120
<v Speaker 4>of prophecy, but that their prophecies should be taken with

1:04:39.160 --> 1:04:42.280
<v Speaker 4>a grain of salt. I suspect it was something along

1:04:42.320 --> 1:04:45.040
<v Speaker 4>the lines of we should believe them if it's a

1:04:45.040 --> 1:04:48.200
<v Speaker 4>favorable prophecy, and we should shun them otherwise.

1:04:50.040 --> 1:04:54.480
<v Speaker 5>I'm so curious if there was any correlation between different

1:04:54.520 --> 1:04:59.520
<v Speaker 5>seizure types and whether someone was considered to be demonic

1:04:59.640 --> 1:05:04.600
<v Speaker 5>versus saintly or possessed versus you know, a fortune teller,

1:05:04.760 --> 1:05:08.440
<v Speaker 5>Like it's it's so interesting to try and we can't know.

1:05:08.680 --> 1:05:12.680
<v Speaker 4>I guess, but we can't know. And as I'll talk about,

1:05:12.760 --> 1:05:18.000
<v Speaker 4>people did recognize many different seizure types, but I think

1:05:18.760 --> 1:05:24.600
<v Speaker 4>it was so difficult to spread this information, but also

1:05:24.400 --> 1:05:27.400
<v Speaker 4>to look back now and go, oh, that was this

1:05:27.480 --> 1:05:31.000
<v Speaker 4>type of seizure, or oh they were seeing, this was

1:05:31.080 --> 1:05:33.840
<v Speaker 4>what they were writing about, even a seizure, right, you know,

1:05:34.040 --> 1:05:38.360
<v Speaker 4>like yeah, I don't know, yeah, oh yeah. But it

1:05:38.440 --> 1:05:42.160
<v Speaker 4>is around this time during the Renaissance that scientific thought

1:05:42.320 --> 1:05:46.480
<v Speaker 4>and the medical writings of ancient physicians like Hippocrates and

1:05:46.520 --> 1:05:51.160
<v Speaker 4>Avicenna began to experience a resurgence as people became more

1:05:51.200 --> 1:05:56.560
<v Speaker 4>and more skeptical of supernatural or magical explanations, and this

1:05:56.680 --> 1:06:00.360
<v Speaker 4>led to epilepsy being viewed and researched with more of

1:06:00.400 --> 1:06:04.960
<v Speaker 4>a medical lens rather than solely with a moral one.

1:06:05.200 --> 1:06:08.520
<v Speaker 4>Which isn't to say that epilepsy became a neutral disease,

1:06:08.840 --> 1:06:13.720
<v Speaker 4>not at all. As one author put it, superstitions were exchanged,

1:06:14.000 --> 1:06:18.280
<v Speaker 4>not discarded. But before I continue onto that, I want

1:06:18.280 --> 1:06:21.320
<v Speaker 4>to go back and ask not what epilepsy meant to

1:06:21.400 --> 1:06:25.000
<v Speaker 4>people from ancient times to the Renaissance, but what people

1:06:25.120 --> 1:06:30.880
<v Speaker 4>actually knew about what epilepsy was. As I'm sure you'll

1:06:30.920 --> 1:06:34.880
<v Speaker 4>talk more about Aaron, epilepsy in its many forms is

1:06:35.000 --> 1:06:39.520
<v Speaker 4>incredibly prevalent, and this likely isn't a new phenomenon given

1:06:39.600 --> 1:06:43.480
<v Speaker 4>the extent to which epilepsy was written about historically. Even

1:06:43.560 --> 1:06:46.920
<v Speaker 4>some of the oldest descriptions of epilepsy that we have

1:06:47.960 --> 1:06:53.360
<v Speaker 4>talk about different forms of the condition, variations in seizure, appearance,

1:06:53.440 --> 1:06:56.240
<v Speaker 4>and duration, and they do a pretty good job of

1:06:56.280 --> 1:07:02.640
<v Speaker 4>recognizing patterns in its epidemiology. Instance, although descriptions of seizures vary,

1:07:03.040 --> 1:07:07.320
<v Speaker 4>the common features among them include a fall to the ground, unconsciousness,

1:07:07.320 --> 1:07:11.080
<v Speaker 4>insensibility to pain, and no recollection of the attack upon

1:07:11.200 --> 1:07:16.240
<v Speaker 4>regaining consciousness. They observed that epilepsy most often occurred early

1:07:16.280 --> 1:07:20.640
<v Speaker 4>in life, especially during teething, and that it was uncommon

1:07:20.720 --> 1:07:24.600
<v Speaker 4>for it to first show up after twenty years of age.

1:07:24.640 --> 1:07:27.720
<v Speaker 4>Some writers suggested it was hereditary, while others said it

1:07:27.760 --> 1:07:31.160
<v Speaker 4>was congenital like. One of the more popular and persistent

1:07:31.240 --> 1:07:34.640
<v Speaker 4>superstitions from the Renaissance was that if a pregnant person

1:07:34.800 --> 1:07:38.560
<v Speaker 4>saw someone having a seizure, that baby would develop epilepsy.

1:07:38.760 --> 1:07:43.520
<v Speaker 4>Oh my gosh eventually. Yeah, okay, yeah, not what happens.

1:07:45.040 --> 1:07:49.320
<v Speaker 4>Writers early on recognized that a seizure was often preceded

1:07:49.360 --> 1:07:52.320
<v Speaker 4>by what they called and what we still call, an

1:07:52.360 --> 1:07:55.960
<v Speaker 4>aura meaning breeze, which got its name when a young

1:07:56.000 --> 1:07:59.400
<v Speaker 4>boy described a sensation like a cold breeze entering his

1:07:59.520 --> 1:08:03.240
<v Speaker 4>head right before he had a seizure. A range of

1:08:03.320 --> 1:08:07.880
<v Speaker 4>pre seizure signs or symptoms was recognized slow speech, headache, dizziness,

1:08:07.920 --> 1:08:10.880
<v Speaker 4>stiff hands, ringing in the ears, just to name a few,

1:08:11.720 --> 1:08:15.000
<v Speaker 4>and beginning in the Middle Ages, major divisions in epilepsy

1:08:15.040 --> 1:08:18.160
<v Speaker 4>began to be made often associated with where it was

1:08:18.160 --> 1:08:21.200
<v Speaker 4>thought to originate in the body, which I think is

1:08:21.320 --> 1:08:24.680
<v Speaker 4>interesting knowing that that's how we characterize a lot of

1:08:25.000 --> 1:08:28.400
<v Speaker 4>seizures types as well as like where it originates in

1:08:28.439 --> 1:08:33.559
<v Speaker 4>the brain, the brain, Yeah, this was in the body.

1:08:33.600 --> 1:08:36.799
<v Speaker 4>So for instance, there was epilepsy, which was the condition

1:08:36.920 --> 1:08:40.280
<v Speaker 4>that originated in the head, and then anilepsy the form

1:08:40.360 --> 1:08:44.479
<v Speaker 4>arising from the stomach, and then catalepsy was from any

1:08:44.560 --> 1:08:48.280
<v Speaker 4>other part of the body. Epilepsy was also linked to

1:08:48.479 --> 1:08:52.200
<v Speaker 4>hysteria when the seizures were thought to originate in the uterus,

1:08:52.840 --> 1:08:56.200
<v Speaker 4>and eclampsia was also thought to be a special form

1:08:56.240 --> 1:08:59.160
<v Speaker 4>of epilepsy arising from a pregnant uterus.

1:08:59.600 --> 1:09:04.000
<v Speaker 5>Yeah that's interesting because that is still just it's not epilepsy,

1:09:04.040 --> 1:09:06.920
<v Speaker 5>but yeah, yeah, yeah, yeah, but it's a seizure. Yeah,

1:09:07.200 --> 1:09:08.040
<v Speaker 5>that's really interesting.

1:09:08.280 --> 1:09:11.679
<v Speaker 4>Yeah. And then divisions were made more along the lines

1:09:11.760 --> 1:09:16.879
<v Speaker 4>of major versus minor. Pleantarius in the twelfth century wrote quote,

1:09:16.920 --> 1:09:20.960
<v Speaker 4>major epilepsy is a complete obstruction of the principal ventricles

1:09:21.000 --> 1:09:24.400
<v Speaker 4>of the brain. People suffering from it fall down quickly,

1:09:24.560 --> 1:09:27.280
<v Speaker 4>the mouth and face are distorted, and there's also a trembling,

1:09:27.320 --> 1:09:29.559
<v Speaker 4>movement of the neck and of the whole body, and

1:09:29.640 --> 1:09:33.200
<v Speaker 4>clenching of the teeth. Sometimes they pass urine feces and

1:09:33.280 --> 1:09:37.000
<v Speaker 4>seed involuntarily, they snore and froth, and when the froth

1:09:37.040 --> 1:09:40.960
<v Speaker 4>has been wiped off, they froth again. Minor epilepsy is

1:09:41.000 --> 1:09:44.679
<v Speaker 4>an incomplete obstruction of the ventricles of the brain. People

1:09:44.720 --> 1:09:47.720
<v Speaker 4>suffering from it sometimes fall down. Sometimes they do not

1:09:47.760 --> 1:09:51.439
<v Speaker 4>fall down, but faint. The froth, once having been wiped off,

1:09:51.520 --> 1:09:53.919
<v Speaker 4>does not reappear, and they are quickly relieved.

1:09:55.120 --> 1:09:55.760
<v Speaker 5>Interesting.

1:09:56.080 --> 1:10:00.720
<v Speaker 4>Yeah. Although physicians from the Renaissance largely echoed what the

1:10:00.760 --> 1:10:06.040
<v Speaker 4>preceding generations had written about epilepsy, particularly ancient Greek physicians,

1:10:06.439 --> 1:10:10.160
<v Speaker 4>they did make one important observation that broadened the concept

1:10:10.240 --> 1:10:14.880
<v Speaker 4>of the condition, that epilepsy or seizures could result as

1:10:14.920 --> 1:10:19.240
<v Speaker 4>a complication from another illness, such as smallpox or scurvy,

1:10:19.360 --> 1:10:25.880
<v Speaker 4>or measles or the newly emerging syphilis. Essentially, the idea

1:10:26.000 --> 1:10:29.800
<v Speaker 4>that epilepsy could be a symptom or a complication and

1:10:30.080 --> 1:10:32.400
<v Speaker 4>wasn't just a disease unto itself.

1:10:32.800 --> 1:10:34.640
<v Speaker 5>That is super interesting.

1:10:34.520 --> 1:10:38.600
<v Speaker 4>Isn't that? And as this definition of epilepsy expanded, the

1:10:38.640 --> 1:10:43.000
<v Speaker 4>classification came to be more about perfect or simple epilepsy,

1:10:43.080 --> 1:10:45.799
<v Speaker 4>the most common form, the form that you see the most,

1:10:46.280 --> 1:10:49.880
<v Speaker 4>and then there was imperfect epilepsy, anything that was out

1:10:49.920 --> 1:10:53.719
<v Speaker 4>of the ordinary. And while these physician writers certainly weren't

1:10:53.800 --> 1:10:59.120
<v Speaker 4>right about everything, the extensive writings, with largely accurate representations

1:10:59.240 --> 1:11:02.720
<v Speaker 4>of programs, range of seizure types, timing of onset, and

1:11:02.760 --> 1:11:05.639
<v Speaker 4>association with certain traumatic events such as a head injury,

1:11:06.160 --> 1:11:09.880
<v Speaker 4>shows that these physicians were thinking about the disease and

1:11:09.920 --> 1:11:14.519
<v Speaker 4>writing about it in a systematic way. What they did

1:11:14.560 --> 1:11:18.519
<v Speaker 4>struggle with was the ultimate cause of epilepsy, which I

1:11:18.560 --> 1:11:22.160
<v Speaker 4>think we can empathize with, given just how many things

1:11:22.200 --> 1:11:25.200
<v Speaker 4>can cause epilepsy, how much of the time we don't

1:11:25.240 --> 1:11:28.559
<v Speaker 4>know what causes it, how many different types of seizures

1:11:28.600 --> 1:11:31.599
<v Speaker 4>there are, and how we are still struggling to understand

1:11:31.680 --> 1:11:39.000
<v Speaker 4>the pathophysiology of this condition. Scientific explanations were varied. Hot

1:11:39.040 --> 1:11:42.040
<v Speaker 4>weather or dry weather or too temperate weather, drinking too

1:11:42.080 --> 1:11:45.040
<v Speaker 4>much alcohol or not enough, exercising or lack of exercise,

1:11:45.120 --> 1:11:48.120
<v Speaker 4>too much sleep or not enough, anger, fright, bad smells.

1:11:48.320 --> 1:11:51.800
<v Speaker 4>Anything could be blamed for epilepsy. And we've already gone

1:11:51.880 --> 1:11:56.160
<v Speaker 4>through some of the moral explanations. Nothing seemed to fit,

1:11:56.720 --> 1:12:01.040
<v Speaker 4>nothing seemed to be a satisfyingly consistent answer. And so

1:12:01.280 --> 1:12:04.679
<v Speaker 4>is it any wonder really that we have a million

1:12:04.720 --> 1:12:09.360
<v Speaker 4>and one explanations for epilepsy from these times, and for

1:12:09.439 --> 1:12:13.439
<v Speaker 4>every one of those explanations, we have at least ten

1:12:13.560 --> 1:12:19.280
<v Speaker 4>cures our favorite. And that also makes complete sense, given

1:12:19.320 --> 1:12:22.120
<v Speaker 4>that epilepsy can sometimes resolve on its own. Like we

1:12:22.200 --> 1:12:26.839
<v Speaker 4>talked about, medications can work differently from person to person

1:12:27.120 --> 1:12:29.880
<v Speaker 4>and from type to type, and it can take a

1:12:30.000 --> 1:12:33.080
<v Speaker 4>long time, even today to see whether a medication for

1:12:33.160 --> 1:12:38.840
<v Speaker 4>epilepsy is actually effective. I don't know, though, if I

1:12:38.920 --> 1:12:43.000
<v Speaker 4>have ever seen as extensive a list of cures and

1:12:43.080 --> 1:12:46.560
<v Speaker 4>treatments for any illness as I have for epilepsy.

1:12:46.680 --> 1:12:46.920
<v Speaker 5>Ooh.

1:12:48.040 --> 1:12:51.559
<v Speaker 4>I loved this quote from neurologist Edward CEF King in

1:12:51.640 --> 1:12:56.559
<v Speaker 4>eighteen sixty one. Quote, there is scarcely a substance in

1:12:56.600 --> 1:12:59.800
<v Speaker 4>the world capable of passing through the gullet of man

1:13:00.200 --> 1:13:03.040
<v Speaker 4>that has not, at one time or another, enjoyed the

1:13:03.080 --> 1:13:08.120
<v Speaker 4>reputation of being an anti epileptic end quote.

1:13:08.920 --> 1:13:11.960
<v Speaker 5>That's really funny. I feel like that's honestly like still

1:13:12.000 --> 1:13:13.479
<v Speaker 5>true sometimes.

1:13:13.840 --> 1:13:19.160
<v Speaker 4>Right, And I won't go through this absolutely massive list

1:13:19.400 --> 1:13:21.640
<v Speaker 4>because I eventually just stopped writing them down. I was like,

1:13:21.680 --> 1:13:23.880
<v Speaker 4>I can't, I can't. This is all of my notes

1:13:23.920 --> 1:13:28.040
<v Speaker 4>now and it would be an entire episode. But I

1:13:28.120 --> 1:13:32.480
<v Speaker 4>did want to go through a variety of them. Mistletoe

1:13:32.560 --> 1:13:36.160
<v Speaker 4>is commonly featured, especially mistletoe collected at the New Moon.

1:13:37.160 --> 1:13:41.280
<v Speaker 4>An amulet containing coral paeony and the root of strychnose

1:13:41.520 --> 1:13:45.839
<v Speaker 4>paeony also shows up frequently. An iron nail or weapon.

1:13:46.320 --> 1:13:51.599
<v Speaker 4>Avoidance of iron, the first vertebra of a human, drinking

1:13:51.760 --> 1:13:57.560
<v Speaker 4>human blood, especially gladiator blood. Okay, h lichens of horses

1:13:57.680 --> 1:14:00.840
<v Speaker 4>or mules. I don't know exactly what that is. I

1:14:02.000 --> 1:14:07.280
<v Speaker 4>genitals of seals, Nope, testicles of the hippopotamus.

1:14:06.479 --> 1:14:07.400
<v Speaker 5>No, also no.

1:14:07.800 --> 1:14:12.160
<v Speaker 4>Also no blood of the tortoise or of the flatfish.

1:14:12.520 --> 1:14:18.120
<v Speaker 4>The skin of a lizard, this lovely combination. Feces of

1:14:18.160 --> 1:14:21.320
<v Speaker 4>the land crocodile, the heart and genitals of the hair

1:14:21.479 --> 1:14:26.280
<v Speaker 4>and blood of the sea tortoise. I uh huh. A

1:14:26.360 --> 1:14:33.280
<v Speaker 4>frog's liver, burned human bones in a cocktail. Avoidance of goats,

1:14:34.720 --> 1:14:38.160
<v Speaker 4>menstrual blood rubbed over the soles of your feet. Just

1:14:38.200 --> 1:14:42.400
<v Speaker 4>stop it, do more, kill a dog and let the

1:14:42.439 --> 1:14:47.719
<v Speaker 4>patient have its bile, and my absolute favorite is quote

1:14:48.240 --> 1:14:52.240
<v Speaker 4>to let the person who first saw him fall urinate

1:14:52.320 --> 1:14:55.600
<v Speaker 4>into his own shoe, stir the urine and give it

1:14:55.640 --> 1:14:56.839
<v Speaker 4>as a drink to the patient.

1:14:58.439 --> 1:15:04.639
<v Speaker 5>Arin Like, I know we talk about not like judging

1:15:04.720 --> 1:15:07.040
<v Speaker 5>people back then, but like, come on.

1:15:08.479 --> 1:15:11.160
<v Speaker 4>I know it's the it's really I mean, there are

1:15:11.200 --> 1:15:17.320
<v Speaker 4>lots of things like burned human bones and p shoe PI.

1:15:17.200 --> 1:15:20.920
<v Speaker 5>Shoe that's not ever going to be a thing.

1:15:21.479 --> 1:15:21.800
<v Speaker 1>M M.

1:15:24.280 --> 1:15:28.360
<v Speaker 4>I mean, I think it does demonstrate how desperate people

1:15:28.439 --> 1:15:30.760
<v Speaker 4>were for a cure.

1:15:30.640 --> 1:15:32.600
<v Speaker 5>That seems even beyond.

1:15:35.280 --> 1:15:38.800
<v Speaker 4>Yeah. I also wonder sometimes like were any of these

1:15:38.880 --> 1:15:41.680
<v Speaker 4>ever written as a joke and we're just right like

1:15:41.880 --> 1:15:45.360
<v Speaker 4>they're like, haha, these ridiculous things that people have tried,

1:15:45.800 --> 1:15:48.160
<v Speaker 4>and it's not act. No one actually has ever done

1:15:48.160 --> 1:15:48.680
<v Speaker 4>any of these.

1:15:48.840 --> 1:15:51.040
<v Speaker 5>That's what that one feels like. Oh quite honestly, it

1:15:51.080 --> 1:15:54.320
<v Speaker 5>feels like what you tell like your little brother to do,

1:15:55.000 --> 1:15:57.760
<v Speaker 5>you know, and then you're like, I didn't mean for

1:15:57.800 --> 1:15:58.080
<v Speaker 5>you to.

1:15:58.040 --> 1:16:07.120
<v Speaker 4>Actually do it, mom. Yeah, yeah, one hundred. Well, Fortunately,

1:16:07.360 --> 1:16:10.400
<v Speaker 4>as we move on to the age of Enlightenment and beyond,

1:16:10.640 --> 1:16:15.479
<v Speaker 4>so like the seventeenth eighteenth century onwards, epilepsy becomes less

1:16:15.560 --> 1:16:20.000
<v Speaker 4>about drinking someone's pee from a shoe and more about

1:16:20.160 --> 1:16:21.360
<v Speaker 4>systematic study.

1:16:21.600 --> 1:16:22.360
<v Speaker 5>Okay, I love it.

1:16:23.760 --> 1:16:26.559
<v Speaker 4>One thing that helped tremendously with this was the rise

1:16:26.600 --> 1:16:30.519
<v Speaker 4>in anatomical dissections, which I think we've talked about before.

1:16:30.800 --> 1:16:34.519
<v Speaker 4>For hundreds of years prior had been viewed as sacrilegious,

1:16:34.880 --> 1:16:37.439
<v Speaker 4>and so for the first time, anatomists were able to

1:16:37.520 --> 1:16:41.240
<v Speaker 4>link certain diseases with observable changes in the structure or

1:16:41.280 --> 1:16:45.360
<v Speaker 4>function of body parts, and that included epilepsy and changes

1:16:45.400 --> 1:16:48.200
<v Speaker 4>in the brain such as an abscess or a tumor

1:16:48.360 --> 1:16:52.200
<v Speaker 4>or a hemorrhage in someone with the condition, and the

1:16:52.320 --> 1:16:55.719
<v Speaker 4>rise of statistics had its own role to play, something

1:16:55.720 --> 1:16:59.040
<v Speaker 4>that we've talked about in several other episodes of the podcast.

1:16:59.840 --> 1:17:03.400
<v Speaker 4>In the case of epilepsy, institutions were created to house

1:17:03.439 --> 1:17:06.040
<v Speaker 4>and care for people with the disease since it was

1:17:06.120 --> 1:17:10.400
<v Speaker 4>believed that they could or should not live independently, and

1:17:10.479 --> 1:17:14.040
<v Speaker 4>these institutions were viewed as opportunities to collect medical data

1:17:14.080 --> 1:17:18.840
<v Speaker 4>for statistical purposes, which did lead to advancements in understanding

1:17:18.880 --> 1:17:22.519
<v Speaker 4>the hereditary nature of some forms, characterizing the age of

1:17:22.520 --> 1:17:27.000
<v Speaker 4>onset patterns and seizure triggers, incidents of certain forms, and

1:17:27.240 --> 1:17:30.559
<v Speaker 4>also rejecting some of the long held beliefs like the

1:17:30.600 --> 1:17:34.160
<v Speaker 4>phase of the moon affected the likelihood of a seizure.

1:17:35.320 --> 1:17:39.880
<v Speaker 4>But they were eighteenth and nineteenth century institutions, nonetheless, and

1:17:40.120 --> 1:17:44.799
<v Speaker 4>likely pretty miserable places to be forced to live. Demonic

1:17:44.920 --> 1:17:49.920
<v Speaker 4>possession or association with quote unquote insanity continued to be

1:17:50.080 --> 1:17:53.679
<v Speaker 4>used as a justification for locking someone with epilepsy away,

1:17:54.280 --> 1:17:56.479
<v Speaker 4>and it was only in the early to mid eighteen

1:17:56.600 --> 1:18:00.800
<v Speaker 4>hundreds that separate buildings were established for people with epilepsy

1:18:01.080 --> 1:18:04.960
<v Speaker 4>and people deemed quote unquote insane, with one major distinction

1:18:05.040 --> 1:18:08.280
<v Speaker 4>between the groups being that the epilepsy group could attend

1:18:08.479 --> 1:18:13.599
<v Speaker 4>mass while the quote unquote insane group could not. Clearly,

1:18:13.720 --> 1:18:17.600
<v Speaker 4>the stigmatization of epilepsy didn't lessen over time, it just

1:18:17.760 --> 1:18:21.800
<v Speaker 4>changed in flavor. Despite the many medical advancements made throughout

1:18:21.800 --> 1:18:26.560
<v Speaker 4>the eighteen hundreds, sure some completely unsupported ideas about the

1:18:26.640 --> 1:18:31.360
<v Speaker 4>underlying cause of epilepsy gained traction, specifically that masturbation led

1:18:31.360 --> 1:18:36.200
<v Speaker 4>to epilepsy, with some doctors recommending circumcision or even castration

1:18:36.920 --> 1:18:42.720
<v Speaker 4>or cletoridectomy to literally no effect. Yeah, oh gosh. But overall,

1:18:42.800 --> 1:18:47.280
<v Speaker 4>the rise of experimental observational science and the specialization of

1:18:47.360 --> 1:18:52.160
<v Speaker 4>medical branches like neurology led to tremendous progress in our

1:18:52.320 --> 1:18:57.559
<v Speaker 4>understanding of seizures and epilepsy. What had been previously divided

1:18:57.600 --> 1:19:02.200
<v Speaker 4>into two main groups, idiot pathic epilepsy originating in the

1:19:02.240 --> 1:19:07.960
<v Speaker 4>brain and sympathetic epilepsy originating anywhere else, soon became more

1:19:08.000 --> 1:19:11.840
<v Speaker 4>and more complex, with terminology developed to describe different types

1:19:11.880 --> 1:19:17.800
<v Speaker 4>of seizures like grand mal petitemol and absence. The physiology

1:19:17.840 --> 1:19:21.080
<v Speaker 4>of nerves and reflexes began to be uncovered, and that

1:19:21.240 --> 1:19:24.719
<v Speaker 4>helped to better understand why seizures looked like they did,

1:19:25.400 --> 1:19:28.759
<v Speaker 4>and experiments altering blood flow to and from the brain

1:19:29.040 --> 1:19:33.000
<v Speaker 4>showed how unconsciousness or convulsions could result from the duration

1:19:33.240 --> 1:19:38.200
<v Speaker 4>or intensity of blockage. Slowly, but surely, scientists were chipping

1:19:38.240 --> 1:19:41.599
<v Speaker 4>away at the mystery that was epilepsy and finding that

1:19:41.960 --> 1:19:47.840
<v Speaker 4>with every question answered, ten more sprung up in its place, inevitably. Inevitably,

1:19:48.280 --> 1:19:53.040
<v Speaker 4>but the questions were becoming more targeted, more detailed, revealing

1:19:53.160 --> 1:19:56.160
<v Speaker 4>just how quickly progress was being made, due in large

1:19:56.200 --> 1:19:59.600
<v Speaker 4>part to the rejection of superstitious thinking, the need for

1:19:59.640 --> 1:20:04.120
<v Speaker 4>science claims to be supported by observational or experimental data,

1:20:04.680 --> 1:20:07.920
<v Speaker 4>and a tendency to look at everything with a healthy

1:20:07.960 --> 1:20:12.440
<v Speaker 4>dose of skepticism, including the teachings of the ancient Greek physicians,

1:20:12.479 --> 1:20:15.559
<v Speaker 4>which previously had been taken more or less as gospel.

1:20:16.760 --> 1:20:20.120
<v Speaker 4>Perhaps the biggest turning point in the history of epilepsy

1:20:20.240 --> 1:20:23.040
<v Speaker 4>during this time came with the invention of the human

1:20:23.160 --> 1:20:28.040
<v Speaker 4>EEG electro and cephalogram by Hans Berger in nineteen twenty nine.

1:20:28.240 --> 1:20:30.080
<v Speaker 4>I'm not good at like this could be its like

1:20:30.160 --> 1:20:35.519
<v Speaker 4>its own episode. Really it could be maybe someday. But

1:20:35.760 --> 1:20:40.240
<v Speaker 4>what it did for epilepsy was allowed physicians to diagnose

1:20:40.280 --> 1:20:44.200
<v Speaker 4>a type of seizure or epilepsy without actually having to

1:20:44.320 --> 1:20:51.479
<v Speaker 4>observe the person having a seizure. Researchers, especially Frederick Andrews Gibbs,

1:20:51.560 --> 1:20:55.920
<v Speaker 4>Erna Lenhardt Gibbs, and William Lennox, described three major types

1:20:55.960 --> 1:21:01.839
<v Speaker 4>of clinical seizures using EEG patterns, petitemol, grandma, and psychomotor seizures.

1:21:01.880 --> 1:21:05.400
<v Speaker 4>These we all call these different things today, and this

1:21:05.520 --> 1:21:09.479
<v Speaker 4>last one's psychomotor seizures, or in today's terms, focal seizures

1:21:09.479 --> 1:21:12.400
<v Speaker 4>arising from the temporal lobe. Prior to this, most of

1:21:12.400 --> 1:21:16.280
<v Speaker 4>the people experiencing one of these seizures were labeled as hysterical,

1:21:18.000 --> 1:21:22.479
<v Speaker 4>and the application of EEG to animal models also really

1:21:22.560 --> 1:21:26.000
<v Speaker 4>opened up the world of epilepsy, making it very clear

1:21:26.240 --> 1:21:31.880
<v Speaker 4>that we desperately needed to revamp our classification system, and

1:21:31.960 --> 1:21:36.160
<v Speaker 4>so in nineteen sixty four, the International League against Epilepsy

1:21:36.560 --> 1:21:40.960
<v Speaker 4>proposed a new classification system, which has since been continually

1:21:41.000 --> 1:21:45.120
<v Speaker 4>revised and refined, with big changes occurring every few decades.

1:21:45.200 --> 1:21:47.679
<v Speaker 4>And I kind of love that it's constantly changing, because

1:21:47.680 --> 1:21:50.880
<v Speaker 4>it's like, hey, let's reconsider, maybe we should change this

1:21:50.920 --> 1:21:52.840
<v Speaker 4>word or that word. Maybe there's a you know. I

1:21:54.040 --> 1:21:57.880
<v Speaker 4>that's how progress is made. I love it. Cellular and

1:21:57.960 --> 1:22:01.920
<v Speaker 4>molecular advancements have also vastly improved our understanding of the

1:22:02.000 --> 1:22:06.000
<v Speaker 4>underlying pathophysiology of seizures and have shown some promise for

1:22:06.080 --> 1:22:09.519
<v Speaker 4>novel therapies. The late eighteen hundreds and into the nineteen

1:22:09.600 --> 1:22:14.439
<v Speaker 4>hundreds also saw innovation in effective treatments for epilepsy, beginning

1:22:14.479 --> 1:22:18.360
<v Speaker 4>with potassium bromide and the late eighteen hundreds, phenobarbital in

1:22:18.400 --> 1:22:23.360
<v Speaker 4>the early nineteen hundreds, phenetoin or dilantin in the nineteen thirties,

1:22:23.439 --> 1:22:32.599
<v Speaker 4>trimethadone carbamazepine, primidone like soval. The list goes on and

1:22:32.640 --> 1:22:37.639
<v Speaker 4>on and on, and it's still growing constantly all the time.

1:22:37.720 --> 1:22:39.439
<v Speaker 4>That and I'm sure we'll talk about some more that

1:22:39.600 --> 1:22:43.520
<v Speaker 4>are on the horizon. And then there was non pharmaceutical

1:22:43.520 --> 1:22:47.960
<v Speaker 4>treatments that were also successfully applied, including vagus nerve stimulation

1:22:48.280 --> 1:22:52.360
<v Speaker 4>and some surgical procedures. I hope that I've shown by

1:22:52.400 --> 1:22:55.559
<v Speaker 4>now that the eighteen hundreds and nineteen hundreds were a

1:22:55.600 --> 1:23:00.400
<v Speaker 4>time of incredible progress in terms of understanding and treatingplepsy.

1:23:01.520 --> 1:23:06.919
<v Speaker 4>But the rise in quote unquote scientific or rational thinking

1:23:07.439 --> 1:23:11.720
<v Speaker 4>didn't mean that the stigma of epilepsy disappeared. In the

1:23:11.760 --> 1:23:16.040
<v Speaker 4>previous centuries, epilepsy had been feared or looked upon negatively,

1:23:16.560 --> 1:23:19.840
<v Speaker 4>likely because it was a mystery. You fear what you

1:23:19.920 --> 1:23:22.280
<v Speaker 4>don't know. No one knew what caused it, no one

1:23:22.360 --> 1:23:26.400
<v Speaker 4>knew why it happened when it happened, and so science

1:23:26.439 --> 1:23:30.280
<v Speaker 4>couldn't answer it. It must be a devil, it must

1:23:30.320 --> 1:23:34.920
<v Speaker 4>be a god, it must be whatever the moon. But

1:23:35.040 --> 1:23:38.960
<v Speaker 4>when we finally gained enough concrete knowledge about epilepsy to

1:23:39.080 --> 1:23:43.679
<v Speaker 4>conclude that it wasn't demonic possession, that knowledge wasn't used

1:23:43.720 --> 1:23:48.160
<v Speaker 4>to dispel the harmful stigma surrounding epilepsy, but rather to

1:23:48.280 --> 1:23:52.439
<v Speaker 4>perpetuate it. Beginning in the late eighteen hundreds and early

1:23:52.520 --> 1:23:55.680
<v Speaker 4>nineteen hundreds, the United Kingdom and many states in the

1:23:55.760 --> 1:23:59.720
<v Speaker 4>US created laws for the sterilization of people with epilepsy

1:24:00.520 --> 1:24:06.559
<v Speaker 4>and laws forbidding marriage if you had epilepsy. I know,

1:24:07.920 --> 1:24:11.160
<v Speaker 4>I know. At the same time, I will point out

1:24:11.479 --> 1:24:16.480
<v Speaker 4>that marriage was often prescribed for women to cure their epilepsy.

1:24:16.680 --> 1:24:22.080
<v Speaker 4>Stop it not pregnancy necessarily, but just marriage. Stop it

1:24:22.120 --> 1:24:26.880
<v Speaker 4>will calm you down, God, lead you to not have seizures.

1:24:27.360 --> 1:24:30.240
<v Speaker 5>No, no, hey.

1:24:31.320 --> 1:24:34.640
<v Speaker 4>These sterilization and marriage laws were bolstered by some of

1:24:34.680 --> 1:24:38.360
<v Speaker 4>the earliest research into the genetics of epilepsy, which was

1:24:38.400 --> 1:24:41.439
<v Speaker 4>done in the early nineteen hundreds. And if all of

1:24:41.479 --> 1:24:45.920
<v Speaker 4>this screams eugenics to you, that's because it is. This

1:24:46.000 --> 1:24:51.640
<v Speaker 4>is straight from the eugenics handbook, a horrifyingly prevalent opinion

1:24:51.840 --> 1:24:56.920
<v Speaker 4>the twentieth centuries, demonic possession held by so many people

1:24:57.040 --> 1:25:00.880
<v Speaker 4>who were making the policy and healthcare decisions for these people.

1:25:01.200 --> 1:25:06.880
<v Speaker 4>It's horrific. These laws forbidding marriage and permitting sterilization of

1:25:06.920 --> 1:25:10.680
<v Speaker 4>people with epilepsy weren't repealed in some states until the

1:25:10.760 --> 1:25:11.840
<v Speaker 4>nineteen sixties.

1:25:13.080 --> 1:25:14.560
<v Speaker 5>I somehow knew that you were going to say the

1:25:14.640 --> 1:25:15.479
<v Speaker 5>nineteen sixties.

1:25:15.520 --> 1:25:22.960
<v Speaker 4>Even by nineteen sixty six, three states West Virginia, North Carolina,

1:25:23.000 --> 1:25:28.240
<v Speaker 4>and Virginia still had eugenic marriage laws, and thirteen states

1:25:28.600 --> 1:25:34.400
<v Speaker 4>still had eugenic sterilization laws against people with epilepsy. Thirteen states.

1:25:34.479 --> 1:25:40.320
<v Speaker 4>The last law was repealed only in nineteen eighty No, huh.

1:25:41.000 --> 1:25:45.080
<v Speaker 4>Only in nineteen seventy in the UK was a law

1:25:45.200 --> 1:25:50.439
<v Speaker 4>prohibiting people with epilepsy from marrying repealed. And in the US,

1:25:50.800 --> 1:25:55.000
<v Speaker 4>up until the nineteen seventies, it was legal to deny

1:25:55.120 --> 1:25:59.799
<v Speaker 4>people who had seizures into public spaces like restaurants, theaters,

1:26:00.040 --> 1:26:06.160
<v Speaker 4>recreational centers, and so on. And even though we now

1:26:06.400 --> 1:26:10.600
<v Speaker 4>have laws in much of the world prohibiting such discrimination,

1:26:11.439 --> 1:26:14.720
<v Speaker 4>that doesn't mean that it's not done, nor does it

1:26:14.800 --> 1:26:20.200
<v Speaker 4>mean that stigma disappeared overnight. In fact, people with epilepsy

1:26:20.200 --> 1:26:23.360
<v Speaker 4>today often report feelings of stigma and the negative impact

1:26:23.439 --> 1:26:26.840
<v Speaker 4>it has on overall quality of life, which I'm guessing

1:26:26.880 --> 1:26:32.360
<v Speaker 4>you might talk more about. The story of epilepsy is huge,

1:26:32.720 --> 1:26:35.840
<v Speaker 4>and it's so much more than how we learned this

1:26:36.080 --> 1:26:39.479
<v Speaker 4>or that how the EEG came to be, how we

1:26:39.560 --> 1:26:43.840
<v Speaker 4>decided that this seizure was different than this seizure. It's

1:26:43.880 --> 1:26:47.639
<v Speaker 4>a story about the meaning that diseases can hold, how

1:26:47.680 --> 1:26:52.280
<v Speaker 4>science can be manipulated to perpetuate discrimination, and how there's

1:26:52.400 --> 1:26:57.639
<v Speaker 4>never an end to the questions we ask. Speaking of questions, Aaron,

1:26:57.760 --> 1:27:00.960
<v Speaker 4>where do we stand with epilepsy today? Oh?

1:27:01.040 --> 1:27:05.920
<v Speaker 5>I can't wait to tell you right after this short break.

1:27:36.040 --> 1:27:41.000
<v Speaker 5>Epilepsy is so much more prevalent than I realized before

1:27:41.360 --> 1:27:48.680
<v Speaker 5>researching this episode. Globally, more than fifty million people worldwide

1:27:49.080 --> 1:27:58.600
<v Speaker 5>have epilepsy. What fifty million people worldwide? And overall lifetime

1:27:58.800 --> 1:28:04.320
<v Speaker 5>prevalence is thought to be about one percent on average. Wow,

1:28:04.479 --> 1:28:13.240
<v Speaker 5>I know right WHOA disproportionately epilepsy affects people living in

1:28:13.280 --> 1:28:16.920
<v Speaker 5>low and middle income countries and there's probably a whole

1:28:17.439 --> 1:28:21.400
<v Speaker 5>myriad of reasons for that, and we'll get into a

1:28:21.439 --> 1:28:24.920
<v Speaker 5>lot of issues associated with that as well. And another

1:28:25.120 --> 1:28:28.439
<v Speaker 5>statistic that I think is important is that worldwide, there's

1:28:28.439 --> 1:28:32.720
<v Speaker 5>an estimated one hundred and twenty five thousand deaths each

1:28:32.800 --> 1:28:37.479
<v Speaker 5>year related to epilepsy. And I think we often don't

1:28:37.560 --> 1:28:44.639
<v Speaker 5>think of epilepsy as a disease causing death. Yeah, because

1:28:44.800 --> 1:28:48.439
<v Speaker 5>most of the time it doesn't. But the risk of

1:28:48.520 --> 1:28:52.000
<v Speaker 5>premature death for people with epilepsy is estimated to be

1:28:52.120 --> 1:28:55.559
<v Speaker 5>three times higher than that of the general population, and

1:28:55.760 --> 1:28:58.439
<v Speaker 5>in low resource settings, this risk may be up to

1:28:58.600 --> 1:28:59.960
<v Speaker 5>seven times higher.

1:29:00.640 --> 1:29:01.400
<v Speaker 4>Can you talk.

1:29:01.240 --> 1:29:05.479
<v Speaker 5>About why it's a whole lot of different reasons. It

1:29:05.520 --> 1:29:10.320
<v Speaker 5>could be things like drownings or car accidents, like traumatic

1:29:10.360 --> 1:29:13.519
<v Speaker 5>incidences that happen in the context of a seizure.

1:29:13.960 --> 1:29:14.240
<v Speaker 4>Okay.

1:29:14.640 --> 1:29:19.920
<v Speaker 5>It could also be due to infections that result perhaps

1:29:20.160 --> 1:29:24.400
<v Speaker 5>like following a seizure that isn't adequately treated, or as

1:29:24.400 --> 1:29:28.719
<v Speaker 5>a result of status epilepticus resulting in certain brain changes

1:29:28.760 --> 1:29:31.439
<v Speaker 5>that might make you more susceptible to infection later on.

1:29:31.640 --> 1:29:34.479
<v Speaker 5>Things like that, huh, Which is why I think we

1:29:34.520 --> 1:29:37.360
<v Speaker 5>see such higher burden in low and middle income countries

1:29:37.360 --> 1:29:41.320
<v Speaker 5>where you're maybe not having as much diagnosis or access

1:29:41.320 --> 1:29:43.880
<v Speaker 5>to treatment, especially in the cases of things that get

1:29:43.920 --> 1:29:50.920
<v Speaker 5>more severe. We can look at the statistics for epilepsy

1:29:51.520 --> 1:29:55.479
<v Speaker 5>both in terms of adults versus children, as well as

1:29:55.520 --> 1:30:00.280
<v Speaker 5>by different seizure type or different epilepsy type, and so

1:30:00.320 --> 1:30:02.360
<v Speaker 5>we can just kind of briefly go over that because

1:30:02.400 --> 1:30:09.280
<v Speaker 5>I think it's always an interesting part. Prevalence overall, unsurprisingly

1:30:09.600 --> 1:30:13.760
<v Speaker 5>for a chronic disease, is highest in adults. Right, far

1:30:13.800 --> 1:30:16.599
<v Speaker 5>more adults are living with epilepsy than children, just because

1:30:16.600 --> 1:30:19.760
<v Speaker 5>of the numbers of adults that exist. But when we

1:30:19.800 --> 1:30:24.639
<v Speaker 5>look at incidents, so new diagnosis of epilepsy its highest

1:30:24.800 --> 1:30:28.960
<v Speaker 5>in the youngest and the oldest age groups, which is

1:30:28.960 --> 1:30:33.559
<v Speaker 5>really interesting. So it has kind of a bimodal incidence, yeah,

1:30:33.600 --> 1:30:37.559
<v Speaker 5>where you'll see an increase, especially in the first year

1:30:37.600 --> 1:30:41.120
<v Speaker 5>of life, although in low and middle income countries it's

1:30:41.120 --> 1:30:45.320
<v Speaker 5>maybe the first few years of life and then a

1:30:45.439 --> 1:30:49.200
<v Speaker 5>decline in the incidence, so new rates of new infection

1:30:50.040 --> 1:30:54.479
<v Speaker 5>throughout adulthood, and then a subsequent increase again in people

1:30:54.479 --> 1:30:58.840
<v Speaker 5>who are over age eighty five. Now, the types of

1:30:58.920 --> 1:31:01.120
<v Speaker 5>epilepsy are going to be very different in those two

1:31:01.120 --> 1:31:04.760
<v Speaker 5>age groups, where older adults it's more likely to be

1:31:04.880 --> 1:31:08.719
<v Speaker 5>as a consequence of something that happened, say a stroke

1:31:09.000 --> 1:31:13.600
<v Speaker 5>or a trauma or etc. If we look at epilepsy

1:31:13.640 --> 1:31:16.200
<v Speaker 5>by seizure type, one thing that I think is really

1:31:16.280 --> 1:31:20.680
<v Speaker 5>interesting is that it's actually focal seizures that are the

1:31:20.760 --> 1:31:24.680
<v Speaker 5>predominant seizure type in both children and adults, despite the

1:31:24.720 --> 1:31:28.200
<v Speaker 5>fact that popular media would make you think that it's

1:31:28.240 --> 1:31:33.080
<v Speaker 5>these generalized tonic chlonic, very extreme seizures that are the

1:31:33.080 --> 1:31:34.719
<v Speaker 5>only thing that represents the seizure.

1:31:35.520 --> 1:31:35.880
<v Speaker 4>Huh.

1:31:35.920 --> 1:31:40.960
<v Speaker 5>But the most common type overall is focal seizures, usually

1:31:41.000 --> 1:31:44.920
<v Speaker 5>focal impaired awareness seizures, which account for about thirty six

1:31:45.040 --> 1:31:48.400
<v Speaker 5>percent of people with seizures. So this would be a

1:31:48.439 --> 1:31:51.479
<v Speaker 5>seizure that starts from only one place in the brain,

1:31:52.160 --> 1:31:55.479
<v Speaker 5>may or may not have motor involvement, but does result

1:31:55.520 --> 1:31:59.559
<v Speaker 5>in the person being unaware of having the seizure at

1:31:59.560 --> 1:32:02.439
<v Speaker 5>the time of the seizure. Okay, so again, it can

1:32:02.479 --> 1:32:05.280
<v Speaker 5>look a lot of different ways, but focal seizures are

1:32:05.479 --> 1:32:13.920
<v Speaker 5>more common overall, so interesting and overall unknown ideology of

1:32:14.320 --> 1:32:18.280
<v Speaker 5>epilepsy is the most common. So even though we know

1:32:18.439 --> 1:32:22.120
<v Speaker 5>that epilepsy can be genetic, it can be from structural

1:32:22.240 --> 1:32:25.439
<v Speaker 5>or metabolic changes, it can be the result of a trauma,

1:32:26.080 --> 1:32:29.160
<v Speaker 5>most of the time we don't know what the actual

1:32:29.240 --> 1:32:34.040
<v Speaker 5>underlying cause is, which makes it really difficult. So then

1:32:34.080 --> 1:32:40.000
<v Speaker 5>that brings us to where we go from here. Yeah,

1:32:40.040 --> 1:32:42.679
<v Speaker 5>and I honestly didn't even know where to start when

1:32:42.720 --> 1:32:46.559
<v Speaker 5>thinking about this, Like current future directions because there's so

1:32:46.680 --> 1:32:50.840
<v Speaker 5>much ground to cover in terms of therapeutics. There has

1:32:50.880 --> 1:32:54.160
<v Speaker 5>been a huge amount of advancements in recent decades. There

1:32:54.160 --> 1:32:57.240
<v Speaker 5>are dozens of new medications that are safer that we

1:32:57.360 --> 1:33:01.200
<v Speaker 5>have better monitoring for, but I don't have any like,

1:33:01.400 --> 1:33:04.479
<v Speaker 5>here's the newest, most exciting thing to tell you about,

1:33:05.240 --> 1:33:08.200
<v Speaker 5>because we don't have one single mind blowing new drug.

1:33:09.200 --> 1:33:12.519
<v Speaker 5>One thing that I thought was interesting was the idea

1:33:12.680 --> 1:33:16.559
<v Speaker 5>of seizure prediction, which is something that people have been

1:33:16.600 --> 1:33:18.760
<v Speaker 5>working on for a very long time, and I think

1:33:18.840 --> 1:33:20.479
<v Speaker 5>in the eighties and nineties there was a lot of

1:33:20.600 --> 1:33:25.080
<v Speaker 5>hype around it, but then in the early two thousands

1:33:25.280 --> 1:33:27.519
<v Speaker 5>of review came out that was like, yeah, all that

1:33:27.600 --> 1:33:30.799
<v Speaker 5>data was actually really flawed and we are nowhere closer

1:33:30.800 --> 1:33:33.400
<v Speaker 5>to a model to be able to predict seizure onset

1:33:33.479 --> 1:33:37.280
<v Speaker 5>than we were like thirty years ago. But since then

1:33:37.479 --> 1:33:39.599
<v Speaker 5>people are still working on it, which I just think

1:33:39.680 --> 1:33:43.120
<v Speaker 5>is very interesting. There's a lot of kind of flaws

1:33:43.200 --> 1:33:45.439
<v Speaker 5>with the data that exists and the ways that people

1:33:45.439 --> 1:33:49.640
<v Speaker 5>are trying to do it thus far, but with advances

1:33:49.760 --> 1:33:55.040
<v Speaker 5>in EEG technology, it's more likely, I think, than it

1:33:55.080 --> 1:33:59.040
<v Speaker 5>ever has been, which is really really fascinating because so

1:33:59.360 --> 1:34:04.000
<v Speaker 5>much of the burden of epilepsy is this recurrence of

1:34:04.040 --> 1:34:07.960
<v Speaker 5>seizures that you may or may not know are coming right,

1:34:08.760 --> 1:34:12.320
<v Speaker 5>and so being able to predict seizure onset could have

1:34:12.479 --> 1:34:17.439
<v Speaker 5>huge implications for quality of life right, and speaking of

1:34:17.640 --> 1:34:21.880
<v Speaker 5>quality of life, I think one big takeaway from all

1:34:21.920 --> 1:34:25.679
<v Speaker 5>of this is just how far we have to go,

1:34:26.560 --> 1:34:29.799
<v Speaker 5>especially in low and middle income countries, when it comes

1:34:29.880 --> 1:34:34.720
<v Speaker 5>to not only the treatment but also the identification of epilepsy.

1:34:35.360 --> 1:34:35.880
<v Speaker 4>Yeah.

1:34:36.000 --> 1:34:39.960
<v Speaker 5>So just last year, in December twenty twenty two, the

1:34:40.000 --> 1:34:44.120
<v Speaker 5>World Health Organization published a brief that was titled Improving

1:34:44.120 --> 1:34:48.080
<v Speaker 5>the Lives of People with Epilepsy, and most of their

1:34:48.200 --> 1:34:52.240
<v Speaker 5>biggest points were all focused on addressing the treatment gap

1:34:52.960 --> 1:34:57.639
<v Speaker 5>and integrating the treatment of epilepsy into a primary care setting,

1:34:57.720 --> 1:35:00.120
<v Speaker 5>since so much of the world doesn't have access to

1:35:00.200 --> 1:35:04.800
<v Speaker 5>these specialized neurologists and epileptologists. So I think that that

1:35:05.000 --> 1:35:06.760
<v Speaker 5>is kind of one of the things that I'm most

1:35:06.800 --> 1:35:11.280
<v Speaker 5>excited for going forward, is just getting this knowledge to

1:35:11.360 --> 1:35:14.120
<v Speaker 5>a place where it's more applicable to people who are

1:35:14.160 --> 1:35:20.799
<v Speaker 5>already living with this. So that's epilepsy erin.

1:35:21.680 --> 1:35:28.800
<v Speaker 4>It's such I mean, we covered so much ground, Aaron, But.

1:35:27.960 --> 1:35:28.799
<v Speaker 5>But I know nothing.

1:35:29.400 --> 1:35:35.200
<v Speaker 4>I know nothing. Oh my gosh, I know. I mean

1:35:35.280 --> 1:35:39.200
<v Speaker 4>I know a lot more, the same, same, but not everything.

1:35:39.280 --> 1:35:40.960
<v Speaker 4>And I feel like that's how we could sum up

1:35:41.720 --> 1:35:43.679
<v Speaker 4>epilepsy and seizures in general.

1:35:44.280 --> 1:35:45.160
<v Speaker 5>It's so true.

1:35:45.400 --> 1:35:51.439
<v Speaker 4>Wow. Wow. Well, speaking of learning more, let's all do it.

1:35:52.840 --> 1:35:58.639
<v Speaker 4>Let's talk about sources. So I had several. I'm going

1:35:58.640 --> 1:36:01.760
<v Speaker 4>to shout out just one, and that is the book

1:36:01.800 --> 1:36:04.840
<v Speaker 4>that I already mentioned, called The Falling Sickness by Ao

1:36:04.920 --> 1:36:08.000
<v Speaker 4>Say Temkin. And I also want to shout out a

1:36:08.000 --> 1:36:10.840
<v Speaker 4>book that I have not read but is on my list,

1:36:10.880 --> 1:36:13.719
<v Speaker 4>has been for a really long time, and is supposed

1:36:13.720 --> 1:36:16.120
<v Speaker 4>to be an incredible work of nonfiction called The Spirit

1:36:16.240 --> 1:36:19.880
<v Speaker 4>Catches You and You Fall Down by Anne Fataman. And

1:36:20.200 --> 1:36:22.040
<v Speaker 4>these will both be on our website. Both be on

1:36:22.080 --> 1:36:24.080
<v Speaker 4>our list, as well as a bunch of papers that

1:36:24.520 --> 1:36:25.559
<v Speaker 4>I also drew from.

1:36:26.240 --> 1:36:29.160
<v Speaker 5>I also had quite a number of papers with so

1:36:29.400 --> 1:36:31.559
<v Speaker 5>much more detail. For those of you who want that

1:36:31.680 --> 1:36:35.400
<v Speaker 5>nitty gritty, I promise you I have it. Some of

1:36:35.400 --> 1:36:38.800
<v Speaker 5>the papers that I really loved were one that was

1:36:39.360 --> 1:36:42.200
<v Speaker 5>kind of pretty basic, but it was titled the Epidemiology

1:36:42.240 --> 1:36:45.599
<v Speaker 5>of Epilepsy. It was published in Neuroepidemiology in twenty twenty.

1:36:45.720 --> 1:36:49.240
<v Speaker 5>You can't get more effective than that. There was also

1:36:49.320 --> 1:36:51.799
<v Speaker 5>a really interesting one that has a lot more detail

1:36:51.920 --> 1:36:57.040
<v Speaker 5>on how we think epilepsy develops over time that was

1:36:57.080 --> 1:37:01.519
<v Speaker 5>published in Nature Reviews Neuroscience in twenty nineteen. And then

1:37:01.520 --> 1:37:04.800
<v Speaker 5>I've got details on ketogenic diet if you want more

1:37:04.840 --> 1:37:07.720
<v Speaker 5>of that, more on where we stand with the pharmacology

1:37:07.720 --> 1:37:10.439
<v Speaker 5>of epilepsy, and then of course a link as well

1:37:10.520 --> 1:37:14.360
<v Speaker 5>to the World Health Organization brief that I mentioned. All

1:37:14.400 --> 1:37:17.040
<v Speaker 5>of these are on our website this podcast will Kill

1:37:17.080 --> 1:37:19.400
<v Speaker 5>You dot com under the episodes tap, along with the

1:37:19.439 --> 1:37:21.800
<v Speaker 5>sources from every other one of our episodes.

1:37:23.840 --> 1:37:26.519
<v Speaker 4>Thank you again to Luise for being willing to share

1:37:26.560 --> 1:37:28.599
<v Speaker 4>your story with us with everyone.

1:37:29.200 --> 1:37:32.320
<v Speaker 5>Thank you also to Leana Skilacci for help with our

1:37:32.360 --> 1:37:34.360
<v Speaker 5>audio mixing for this episode.

1:37:35.000 --> 1:37:38.080
<v Speaker 4>And thank you to Bloodmobile for providing the music for

1:37:38.160 --> 1:37:40.280
<v Speaker 4>this episode and all of our episodes.

1:37:40.880 --> 1:37:43.800
<v Speaker 5>And thank you to Exactly Right Network.

1:37:43.560 --> 1:37:46.680
<v Speaker 4>And thank you to you listeners. So many, thank you,

1:37:46.840 --> 1:37:49.800
<v Speaker 4>so many, thank you, but we don't want to forget

1:37:49.800 --> 1:37:53.320
<v Speaker 4>about you. You allow us to make this podcast happen.

1:37:53.520 --> 1:37:57.479
<v Speaker 5>Seriously, we love it. Thanks for listening. A special shout

1:37:57.520 --> 1:38:00.760
<v Speaker 5>out to our patrons. It means so much to have

1:38:00.840 --> 1:38:01.360
<v Speaker 5>your support.

1:38:01.680 --> 1:38:08.120
<v Speaker 4>It really does. Big topic over, We're done for the season.

1:38:08.240 --> 1:38:11.679
<v Speaker 4>We're done for the season. Just kidding, Okay everyone, Well,

1:38:11.760 --> 1:38:13.240
<v Speaker 4>we'll be back in a couple of weeks of the

1:38:13.320 --> 1:38:16.919
<v Speaker 4>new episode. Until then, wash your hands

1:38:17.080 --> 1:38:18.320
<v Speaker 5>You filthy animals.