Non-epileptic seizures are difficult to diagnose and hard to treat. In this episode, we delve into the specifics of this disorder and discuss the obstacles to effective treatment. We are joined by the wonderful Dr. Laura Strom, an epileptologist at the University of Colorado who specializes in the treatment of patients with non-epileptic seizures. She went to medical school at Penn State University College of Medicine and completed her neurology residency and epilepsy fellowship at the University of Colorado. She is the head of the non-epileptic seizure clinic at the University of Colorado and is the primary investigator in an ongoing study for patients with non-epileptic seizures. Her clinic provides comprehensive neurologic and psychiatric treatment to patients with non-epileptic seizures and has treated more than 600 patients as of 2020.

For this episode, I was assisted by my first ever co-host, Jamie Moffa. Jamie is an MD PhD candidate at Washington University with an interest in the intersection between neurology and psychiatry. 

Time stamps:

• 3:49 Why neurology
• 6:28 Why functional neurological disorders?
• 9:17 How did you learn to treat patients with non-epileptic seizures?
• 14:20 Non-medical book recommendation?
• 15:45 Patient case of non-epileptic seizures (NES)
• 18:04 What should you call this disorder?
• 19:50 What are non-epileptic seizures?
• 22:25 Clinical symptoms that help distinguish between NES and epileptic seizures
• 23:45 Functional MRI in non-epileptic seizures
• 26:30 What elements of the history suggest NES?
• 29:45 Medical co-morbidities associated with NES
• 31:30 How to discuss a diagnosis of NES
• 37:10 Common misconceptions about NES
• 39:02 Treatment for NES
• 40:45 Group therapy for NES
• 45:05 Larger applicability of group therapy model
• 48:27 How do you talk with resistant patients about psychological treatment?
• 52:40 How do you help patients who can't get access to mental health resources?
• 55:10 What is the role of neurologists in the care of NES patients?
• 58:45 Insurance coverage for patients with NES
• 1:01:40 Other obstacles to treatment for patients
• 1:06:45 Patient success story

Disclosures:

Dr. Strom report no relevant financial disclosures. Brain Boy Neurology reports no relevant financial disclosures.

Links:

Neuroimaging in non-epileptic seizures:

https://academic.oup.com/brain/advance-article/doi/10.1093/brain/awab131/6179314

Clinical calculator to determine likelihood of non-epileptic (dissociative) seizures:

https://wesleykerr.shinyapps.io/Combined/?_ga=2.119397517.543235477.1603997676-716097154.1580437477

Seizures are the bread and butter of the neurological consult service. Gaining proficiency in the workup and management of first-time seizures makes a young neurologist’s life much easier. To shed some light on this topic, I sit down with the incredible Dr. Brian Day, an Epileptologist at Washington University, to discuss the ins and outs of first-time seizure management. Dr. Day got his MD and PhD at the University of Kentucky and completed his neurology training at Washington University. He then did a fellowship in Epilepsy and currently works treating patients with seizure disorders.

Time stamps:

• 1:00: My experience with epilepsy
• 5:23: Why neurology
• 12:13: What did you study for your PhD?
• 16:43: Why epilepsy?
• 21:53: What do you like to do in your free time?
• 25:53: Patient case of new onset seizure
• 27:57: What is a seizure?
• 30:16: How can you tell if shaking is a seizure?
• 37:45: Non-epileptic events
• 41:41: Provoked vs unprovoked seizures
• 42:53: Medications that can provoke a seizure
• 47:38: Can certain longstanding medications cause seizures?
• 49:25: How to counsel seizure patients about alcohol consumption
• 51:58: Acute symptomatic vs remote seizures
• 56:08: Neuroimaging for new onset seizure
• 58:43: Screening for mesial temporal sclerosis
• 59:53: What to look for on brain MRI
• 1:00:53: What to look for on EEG
• 1:05:53: Lab workup/when to get a lumbar puncture
• 1:07:46: Can a UTI provoke a seizure?
• 1:12:08: Focal vs generalized seizures
• 1:13:44: Neurological exam for seizures
• 1:16:52: Do multiple seizures in a day change prognosis?
• 1:19:13: Role of serum lactate/prolactin
• 1:21:08: When do you start antiepileptics?
• 1:23:43: What to do with an abnormal EEG
• 1:25:05: Deep vs cortical brain MRI lesions and seizure risk
• 1:28:08: How to manage unprovoked seizure patients older than 60
• 1:30:19: Benzo bridges
• 1:32:43: Follow up for patients
• 1:33:46: Counseling patients with first time seizures
• 1:37:43: Summary

Disclosures:

Dr. Day report no relevant financial disclosures. Brain Boy Neurology reports no relevant financial disclosures.

Sleep deprivation is the norm in medical training. But does it have to be? I sit down with the Dr. Gabriela De Bruin to discuss the effects of sleep deprivation on residents and patients. We review the medical literature on the topic and discuss alternative work schedules. Dr. Gabriela De Bruin is a neurologist at Washington University who specializes in the treatment of patients with sleep disorders. She completed medical school at the Federal university of Ceara in Brazil and then came to Washington University for her neurology residency. After residency she completed a fellowship in sleep medicine.

Time stamps:

- 02:40: Dr. De Bruin background

- 10:08: Non-medical book recommendation

- 11:25: Sleep deprivation during residency

- 12:23: Acute vs chronic sleep deprivation

- 14:30: How much sleep should you get each night?

- 17:30: Adverse health effects of sleep deprivation

- 22:50: Sleep deprivation and cognition, attention, and motor skills

- 25:18: Sleep deprivation compared to alcohol intoxication

- 28:17: Personal perception of sleepiness

- 31:50: Research on the impact of sleep on patient care

- 35:48: Sleep deprivation and length of stay and patient mortality

- 39:30: Duty hours reform

- 44:36: Impact of duty hours on patient safety outcomes

- 48:48: Why didn’t duty hours reform improve patient outcomes?

- 51:38: Long shifts vs a night float system

- 57:50: Strategies to reduce and mitigate the effects of sleep deprivation

Disclosures:

Dr. De Bruin report no relevant financial disclosures. Brain Boy Neurology reports no relevant financial disclosures.

Links:

1. Dawson, Drew, and Kathryn Reid. "Fatigue, alcohol and performance impairment." Nature 388.6639 (1997): 235-235 (https://www.nature.com/articles/40775)
2. Landrigan, Christopher P., et al. "Effect of reducing interns' work hours on serious medical errors in intensive care units." New England Journal of Medicine 351.18 (2004): 1838-1848 (https://www.nejm.org/doi/full/10.1056/NEJMoa041406)
3. Lockley, Steven W., et al. "Effect of reducing interns' weekly work hours on sleep and attentional failures." New England Journal of Medicine 351.18 (2004): 1829-1837. (https://www.nejm.org/doi/full/10.1056/NEJMoa041404)
4. Desai, Sanjay V., et al. "Education outcomes in a duty-hour flexibility trial in internal medicine." New England Journal of Medicine 378.16 (2018): 1494-1508. (https://www.nejm.org/doi/full/10.1056/NEJMoa1800965)