Epilepsy (updated 2023) - CRASH! Medical Review Series
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- เผยแพร่เมื่อ 27 พ.ค. 2024
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(Disclaimer: The medical information contained herein is intended for physician medical licensing exam review purposes only, and are not intended for diagnosis of any illness. If you think you may be suffering from any medical condition, you should consult your physician or seek immediate medical attention.)
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Minor correction (20:43): There's a misprint. It should say normal serum CREATINE KINASE (as I verbally say); not creatinine. Two different things!
You are releasing so many videos. Hard to keep up. But thank you!! 😊❤️💪
Always anticipating these videos without wasting time :)
Please update more videos
I think an important remark on PNES is that they can, and often do occur alongside with classic seizures in epileptic patients. This is top off my head stuff but I remember reading that around 40(!)% of patients diagnosed with epilepsy also experience a PNES at some time in their life.
Good to know when discussing the differential on the cause of an apparent seizure in a known epileptic patient.
Lifesaver. Thank you so much for your amazing explanation.
Realy sir thanks alot. Such very excellent lectures
Thankssss a lot 🌸
(On Friday of April 6, 2023). On the Matter of Epilepsy (Updated 2023) by MD Paul W. Bolin (CRASH! Medical Review Series) a Matter of Neurology Overall Subject Matter: 1) Seizure is the Manifestation of Excessive or Synchronous Neuronal CNS Activity often described as a Sudden, uncontrolled Burst of Electrical Activity with Changes in Behavior, Movements, Feelings and Levels of Consciousness (Loss of Consciousness [LOC]) and the Occurrence of Two or More Seizures at Least 24 Hours Apart without A Known Aetiology (75% Idiopathic Aetiology) Usually is Epilepsy. There are many types of Seizures, and Usually Have A Prodrome or Aura (Constellations of Sensory Effects and Fellings Prior to Catalepsy or Seizure); 2) Signs And Symptoms (SSx) within Prodrome/Aura Pre-Seizure: 1) Rising Epigastric Sensation; 2) Gustatory/Olfactory Hallucinations; 3) Visual Changes; 4) Headache; 5) Paresthesias; 6) Psychiatric Phenomena such As Deja Vu ou Jamais Vu Femme De Joie, Etcetera); 7) Otherwise the Subject is Physically Normal and Asymptomatic Between Events; 3) Epidemiology (Ex): 1) Seizure/Epilepsy is 1 in 200 US Population and a One Percent Incidence Rate Globally by Age 20 Group, 3% by Age Group Up to 75; 2) Pediatric And Geriatric Predilection and Dominance; 3) World Incidence is Tenfold and at 65 Million Prevalence; 4) Triggers and/or Risk Factors: 1) Sleep Deprivation; 2) Stress (Psychosomatic Duality Possible); 3) Alcohol is known to Lower Seizure Threshold; 4) Alcohol Withdrawal (Delirium And Tremens Complication); 5) Photosensitivity (Scintillating Photobursts described as Flashing Lights); 6) Medication Non-compliance is Usually the Cause of Seizure; 7) Tonic-Clonic Seizures Temporary Post-Ictal (Post-Seizure) SSx: 1) Somnolence; 2) Temporary Paralysis; and 3) Cognitive Impairment, better Understood as Todd's Paralysis; 5) Seizure Characterization (Morphology or MOx): 1) Focal (Partial) Seizure is Located to One Brain Site; a) Simple Focal would have one Brain Situs Involvement and Awareness is Intact (Absent LOC). This can be Sensory, Motor, Psychic or Autonomic Nervous System Symptoms (Vertigo, Diarrhea, Dysphagia, Urinary Incontinence Etcetera); b) Complex Focal has the Subject Lossing Awareness and May Appear Dazed or Confused; 2) Generalized Seizure Involves Both Cerebral Hemispheres: a) Absence (Petit Mal Type) LOC and Non-Motor; Blank Stare usually last less than 10 Seconds; Automatisms (Motor Ticks, Repetitive Lip-smacking and the like), Onset and Finale Abruptly, 3 Hz Spike And Wave; Pediatric Predilection and Tx is via Ethosuximide; b) Tonic-Clonic (Grand Mal Type) is the Stereotypical Layman Conception of Seizure with LOC, Loud Moan (Epiglottis Dilated and Forceful Expiration), Stiffening and Convulsions involving All Limbs lasting 1-3 Minutes (Any Longer Duration Status Epilepticus). Tongue Biting and Incontinence (Urinary and Fecal) are Common; c) Myoclonic is usually aware, Sudden Jerking of Body Parts or Arm/Leg, with the Possibility of Falling over; d) Atonic has LOC, Sudden Loss of Muscle Tone, Fall, 15 or Less Typical Duration, and often Misconceived as Syncope; 3) Secondary Generalized is a third Type of Seizure distinguished by the Onset of Simple Seizure and Progression to Generalized; 6) History (Hx): 1) Importance is Significant for Characterization of Pattern and Type; 2) What Happens Before/After the Event is a Historical Assessment; 3) Automatism Present allows Clinical Pathological Correlation; 4) Are Drugs, Trauma, and/or Alcohol Involvement are Aetiologic Factors Necessary and attainable Possibly with a Nitid and Sharp History Investigation; 7) Diagnosis (Dx): 1) Fingerstick Blood Glucose (Hyperglycemia/Hypoglycemia Exclusion); 2) CBC for Systemic or CNS Infection (Encephalitis, Meningitis or Encephalomeningitis); 3) BMP for Electrolyte Imbalances (Hypernatremia/Hyponatremia, Hyperkalemia/Hypokalemia or Azotemia [Nitrogen In Blood]/Uremia [Urea]); 4) Urinalysis And/or Urine Toxicology for Cocaine Hydrochloride Presence, Amphetamines (Non-catecholamine Stimulants Drug Class), Heroine Sulphate Presence (Diacetylmorphine, Diamorphine Street Version, Opioid Receptor Agonist), PCP (Phencyclidine or Phenylcyclohexyl Piperidine/NMDA Receptor Antagonist Drug Class); and Gamma-Hydroxybutyric Acid (GHB are GABA-B Receptor Weak Agonist, GHB Receptors Strong Agonist of CNS Depressant/Stimulant Club Drug Class); 5) Serum Ethanol for Alcohol Withdrawal Possibility; 6) Head Computed Tomography (CT) for Structural Lesion Assessment; and 7) Electroencephalography (EEG) for the Ultimate Diagnostic Modality Specific to Epilepsy (Not An Emergency Room [ER] Assessment but Neurology Examination by Specialty); 8) Serum Electrolyte Specificity (Calcium Levels, Magnesium are Not Part of BMP Tests) Diagnostics; 9) VITAMIN D Mnemonic: 1) Vascular Malformation (Via CT, MRI best Sensitivity); 2) Infection (Meningitis) and Inherited Diseases (EIEE,BFNIS, or BINS et al); 3) Trauma; 4) Alzheimer's Disease; 5) Metabolic Derangements (Hypocalcemia, Hyponatremia, Hypokalemia, Hypoglycemia); 6) Idiopathic (Most Common Aetiology, usually due to Medical Healthcare Unavailability); 7) Neoplasm (Cancer, Tumor within the CNS Structures); 8) Drugs (A Myriad of Medical and Non-Medical Drugs: Fluoroquinolones, Bupropion, Mipramine, Meperidine, Metronidazole, INH [Isoniazid, Mycobacterium Cell Wall Synthesis Inhibitor]); 10) In the Likely Event Subject/Patient is on Anti-Epileptic Drugs (AEDs), Drug Levels should be Ordered for Possible Toxicity or Ineffective Levels (Low Levels of Subtherapeutic State); 11) Seizure Precautions Order (Adequate Ventilation, Loosen Clothing, Ensure Airway Patency, et al); and 12) IV Access; 8) Treatment (Tx): 1) Anti-Epileptic Drugs (AEDs); 2) Excluding the First Seizure (Which is Technically not Epilepsy) with the Exception of Fosphenytoin (Voltage-Gated Sodium Channels Modulation by Increasing Refractory Time) in Status Epilepticus (SE); 3) Females of Reproductive Age Qualitative B-hCG Test for Pregnancy Status; 4) All Subjects/Patients should have a 5-7 Day Continuous Video EEG in the hope of Witnessing and Documenting Thereby Epilepsy (other for Better Characterization of Epilepsy); 5) A Normal EEG does not Rule Out Epilepsy (fMRI [Real Time Brain Activity Visualization], PET [Oxygen Metabolism within Brain], Single Photon Emission Computed Tomography [SPECT vascular Assessment], Magnetoencephalography [Allows Metrics of Magnetic Fields Within CNS]); 9) Management via Pharmacologic Agents of Anticonvulsants: 1) Ethosuximide for Absence Seizures (Pediatric Usually); 2) Carbamazepine (MOA of Fast-Sodium Antagonism), Oxcarbazepine, a Prodrug (MOA of Voltage-Sensitive Sodium Channel Antagonists), Lamotrigine (MOA of Excitatory Glutamate/Aspartate Suppression via Sodium Channel Antagonism), Topiramate, Fructose Diacetonate. The aforementioned Anticonvulsants are Indicated for Simple or Secondary Generalized First Line Agents; 3) Valproate (Valproic Acid) Anticonvulsants is First Line (FDA-Approval or what not) and First Choice (usually due to [Function of] Aggressive Pharmaceutical Propaganda Marketing) has MOA of Voltage-Gated Sodium Channel Antagonism and GABA Neurotransmitter Elevator; 4) Lamotrigine and Topiramate have the Broadest Spectrum Anticonvulsionotropy; 10) Differential Diagnosis (DDx): 1) Migraine Headache has Aura and No LOC; 2) Stroke in Older Subjects; 3) Febrile Seizure; 4) Syncope; 5) Psychogenic Non-Epileptic Syndrome (PNES) will have Psychiatric History (OCD or PTSD) can be Related to Sexual Assault/Abuse History and Female Diagnosis and Is a Diagnosis of Exclusion (DOE); Goodness my first PNES. Not Really, just Kidding. The Dame was inundated with Heaven, and she though it was an Extended Release Implanted Anti-Contraceptive (by an abusive Stud Boyfriend, loloooo). I pressed Criminal Charges of Felony Sexual Assault and Rape with Aggravated Intent to Defraud and Enslave for Prostitution Exploitation Ends. I took on the Maffia, vato. MD Paul W. Bolin, es geht sehr gut aber man muss machen die Gesundheit was sie muss Sein, Gut und Frei. Heil!
thank you so much doctor
Hello, Paul Bolin. I remember watching your videos at 15 and 16. I particularly remember the video you did about transsexualism. Somehow I am unable to find it now. Have you deleted it? You were saying a lot of fun things in this video such as transsexualism being a delusional disorder. You equated it very much to a fetish or perversion in general. You obviously disagreed with peer research at the time and decided to present your opinion as fact. I very much remember commenting under this video how I was a little confused about your opinions. I also remember wording it very politely. Then I remember your reply to my polite questions. You completely ignored the evidence I presented and shut me down. You obviously didn’t like being questioned. It’s funny how this interaction so many years ago left me so insecure up until this point. After this interaction I stopped loving to watch your videos, in fact I never watched any of your videos again. You see at the time I wrote this I had been out as transsexual for two years. My family had sent me to conversion therapy and the few friends I had didn’t bother with me either. I started learning about neuroscience and medicine to explain my condition to my parents. I read paper after paper after paper at 14 and 15 years old. They didn’t care to listen. It’s funny how somebody like you who supposedly cares about education could say such terrible things known to be untrue just to somehow feel good about some obscure ideological position you hold. I knew, of course, at the time that what you said wasn’t true. But I was too scared to speak up. My “question“ was all I could possibly muster. Your blunt reply startled me not because of the obscure nonsense you claimed, but because you repeated it. In the face of clear evidence - years of research - you still chose to ignore me, for your own personal idea, grounded in bigotry. This was perhaps the first moment in my life in which I truly understood that I can never trust anyone or anything in this world ever again. I understood that whatever I throw at people, how ever much I try, they will never listen to me. They will never take me seriously, they will never ever care about me at all. Well, my parents sent me to conversion therapy for a couple of years, until I moved out. My dysphoria swallowed up my entire youth as well as my childhood, I payed about 10 000€s or more in therapy and psychiatrists just to get a letter for a hormone perscription and after eight years of extra suffering I got them and they allow me to actually enjoy living for the first time in my life. It would have been sooner, had people like you not existed. Becausse of people like you I thought I couldn’t be anybody. Especially not a scientist. Well I did study neuroscience after all and I am continuing to get better. I have left my family and “friends“ forever. I moved away. I changed my number and my email and deleted my social media, just so I could life a life while happening to be having essentially a dsd condition. I just feel betrayed. You claim to care and yet you almost killed me. Are you going to appologize?
No, nothing has been deleted. I'm afraid you're confusing me with somebody else; I've always been a big ally of the LGBT community, and if you visit my social media, you'll find that to be true. I have had a video up for quite some time that deals with the topic of transgender in the context of sexuality, which can be found in my psychiatry videos. I'll attach a link that's bookmarked to where I talk about transgender identity. Let me know what you find problematic, if anything.
th-cam.com/video/IzSQrxF0dac/w-d-xo.html