Podcasts about Epilepsy

Dr. Hoffman continues his conversation with Dr. Bret Scher, medical director of the Coalition for Metabolic Health.

Dr. Bret Scher, medical director of the Coalition for Metabolic Health, discusses making metabolic health the foundation of medicine amid rising obesity and type 2 diabetes and reports that 93% of Americans have suboptimal metabolic health. Scher defines metabolic health using markers including glucose, insulin, triglycerides, HDL, blood pressure, and waist size, and cites evidence linking insulin resistance to heart disease, stroke, cancer, psychiatric illness, and other complications. They discuss simple self- and lab-assessments (waist-to-height ratio, fasting insulin with glucose/HOMA-IR, triglyceride-to-HDL ratio, CGMs). Scher critiques the Eat Lancet report for assuming one optimal diet, reliance on low-quality nutrition epidemiology, potential nutrient shortfalls, and environmental oversimplification, while supporting newer dietary guidelines that allow lower-carb approaches. Part two covers contradictory nutrition studies, distinctions between low-carb and ketogenic diets, emerging “metabolic psychiatry” and ketogenic therapy for mental illness and cognitive decline, limits and rebound risks of GLP-1 drugs, and Coalition efforts to improve school food and influence policy.

What makes a character so compelling that readers will forgive almost anything about the plot? How do you move beyond vague flaws and generic descriptions to create people who feel pulled from real life? In this solo episode, I share 15 actionable tips for writing deep characters, curated from past interviews on the podcast. In the intro, thoughts from London Book Fair [Instagram reel @jfpennauthor; Publishing Perspectives; Audible; Spotify]; Insights from a 7-figure author business [BookBub]. This show is supported by my Patrons. Join my Community and get articles, discounts, and extra audio and video tutorials on writing craft, author business, and AI tools, at Patreon.com/thecreativepenn This episode has been created from previous episodes of The Creative Penn Podcast, curated by Joanna Penn, as well as chapters from How to Write a Novel: From Idea to Book. Links to the individual episodes are included in the transcript below. In this episode: Master the ‘Believe, Care, Invest' trifecta, how to hook readers on the very first page Define the Dramatic Question: Who is your character when the chips are down? Absolute specificity. Why “she's controlling” isn't good enough Understand the Heroine's Journey, strength through connection, not solo action Use ‘Metaphor Families' to anchor dialogue and give every character a distinctive voice Find the Diagnostic Detail, the moments that prove a character is real Writing pain onto the page without writing memoir Write diverse characters as real people, not stereotypes or plot devices Give your protagonist a morally neutral ‘hero' status. Compelling beats likeable. Build vibrant side characters for series longevity and spin-off potential Use voice as a rhythmic tool Link character and plot until they're inseparable Why discovery writers can write out of order and still build deep character Find the sensory details that make characters live and breathe More help with how to write fiction here, or in my book, How to Write a Novel. Writing Characters: 15 Tips for Writing Deep Character in Your Fiction In today's episode, I'm sharing fifteen tips for writing deep characters, synthesised from some of the most insightful interviews on The Creative Penn Podcast over the past few years, combined with what I've learned across more than forty books of my own. I'll be referencing episodes with Matt Bird, Will Storr, Gail Carriger, Barbara Nickless, and Sarah Elisabeth Sawyer. I'll also draw on my own book, How to Write a Novel, which covers these fundamentals in detail. Whether you're writing your first novel or your fiftieth, whether you're a plotter or a discovery writer like me, these tips will help you create characters that readers believe in, care about, and invest in—and keep coming back for more. Let's get into it. 1. Master the ‘Believe, Care, Invest' Trifecta When I spoke with Matt Bird on episode 624, he laid out the three things you need to achieve on the very first page of your book or in the first ten minutes of a film. He calls it “Believe, Care, and Invest.” First, the reader must believe the character is a real person, somehow proving they are not a cardboard imitation of a human being, not just a generic type walking through a generic plot. Second, the reader must care about the character's circumstances. And third, the reader must invest in the character's ability to solve the story's central problem. Matt used The Hunger Games as his primary example, and it's brilliant. On the very first page, we believe Katniss's voice. Suzanne Collins writes in first person with a staccato rhythm—lots of periods, short declarative sentences—that immediately grounds us in a survivalist mentality. We care because Katniss is starving. She's protecting her little sister. And we invest because she is out there bow hunting, which Matt pointed out is one of the most badass things a character can do. She even kills a lynx two pages in and sells the pelt. We invest in her resourcefulness and grit before the plot has even begun. Matt was very clear that this has nothing to do with the character being “likable.” He said his subtitle, Writing a Hero Anyone Will Love, doesn't mean the character has to be a good person. He described “hero” as both gender-neutral and morally neutral. A hero can be totally evil or totally good. What matters is that we believe, care, and invest. He demonstrated this beautifully by breaking down the first ten minutes of WeCrashed, where the characters of Adam and Rebekah Neumann are absolutely not likable, but we are completely hooked. Adam steals his neighbour's Chinese food through a carefully orchestrated con involving an imaginary beer. It's not admirable behaviour, but the tradecraft involved, as Matt put it—using a term from spy movies—makes us invest in him. We see a character trying to solve the big problem of his life, which is that he's poor and wants to be rich, and we want to see if he can pull it off. Actionable step: Go to the first page of your current work in progress. Does it achieve all three? Does the reader believe this is a real person with a distinctive voice? Do they care about the character's circumstances? And do they invest in the character's ability to handle what's coming? If even one of those three is missing, that's your revision priority. 2. Define the Dramatic Question: Who Are They Really? Will Storr, author of The Science of Storytelling, came on episode 490 and gave one of the most powerful frameworks I've ever heard for character-driven fiction. He explained that the human brain evolved language primarily to swap social information—in other words, to gossip. We are wired to monitor other people, to ask the question: who is this person when the chips are down? That's what Will calls the Dramatic Question, and it's what he believes lies at the heart of all compelling storytelling. It's not a question about plot. It's a question about the character's soul. And every scene in your novel should force the character to answer it. His example of Lawrence of Arabia is unforgettable. The Dramatic Question for the entire film is: who are you, Lawrence? Are you ordinary or are you extraordinary? At the beginning, Lawrence is a cocky, rebellious young soldier who believes his rebelliousness makes him superior. Every iconic scene in that three-hour film tests that belief. Sometimes Lawrence acts as though he truly is extraordinary—leading the Arabs into battle, being hailed as a god—and sometimes the world strips him bare and he sees himself as ordinary. Because it's a tragedy, he never overcomes his flaw. He doubles down on his belief that he's extraordinary until he becomes monstrous, culminating in that iconic scene where he lifts a bloody dagger and sees his own reflection with horror. Will also used Jaws to demonstrate how this works in a pure action thriller. Brody's dramatic question is simple: are you going to be old Brody who is terrified of the water, or new Brody who can overcome that fear? Every scene where the shark appears is really asking that question. And the last moment of the film isn't the shark blowing up. It's Brody swimming back through the water, saying he used to be scared of the water and he can't imagine why. Actionable step: Write down the Dramatic Question for your protagonist in a single sentence. Is it “Are you ordinary or extraordinary?” or “Are you brave enough to love again?” or “Will you sacrifice your principles for survival?” If you can't answer this with specificity, your character might still be a sketch rather than a person. 3. Get rid of Vague Flaws, and use Absolute Specificity This was one of Will Storr's most important points. He said that vague thinking about characters is really the enemy. When he teaches workshops and asks writers to describe their character's flaw, most of them say something like “they're very controlling.” And Will's response is: that's not good enough. Everyone is controlling. How are they controlling? What's the specific mechanism? He gave the example of a profile he read of Theresa May during the UK's Brexit chaos. Someone who knew her said that Theresa May's problem was that she always thinks she's the only adult in every room she goes into. Will said that stopped him in his tracks because it's so precise. If you define a character with that level of specificity, you can take them and put them in any genre, any situation—a spaceship, a Victorian drawing room, a school playground—and you will know exactly how they're going to behave. The same applies to Arthur Miller's Willy Loman in Death of a Salesman, as Will described it: a man who believes absolutely in capitalistic success and the idea that when you die, you're going to be weighed on a scale, just as God weighs you for sin, but now you're weighed for success. That's not a vague flaw. That's a worldview you can drop into any story and watch it combust. Will made another counterintuitive point that I found really valuable: writers often think that piling on multiple traits will create a complex character, but the opposite is true. Starting with one highly specific flaw and running it through the demands of a relentless plot is what generates complexity. You end up with a far more nuanced, original character than if you'd started with a laundry list of vague attributes. Actionable step: Take your protagonist's flaw and pressure-test it. Is it specific enough that you could place this character in any situation and predict their behaviour? If you're stuck at “she's stubborn” or “he's insecure,” keep pushing. What kind of stubborn? What kind of insecure? Find the diagnostic sentence—the Theresa May level of precision. 4. Understand the Heroine's Journey: Strength Through Connection Gail Carriger came on episode 550 to discuss her nonfiction book, The Heroine's Journey, and it completely reframed how I think about some of my own fiction. Gail explained that the core difference between the Hero's Journey and the Heroine's Journey comes down to how strength and victory are defined. The Hero's Journey is about strength through solo action. The hero must be continually isolated to get stronger. He goes out of civilisation, faces strife alone, and achieves victory through physical prowess and self-actualisation. The Heroine's Journey is the opposite. The heroine achieves her goals by activating a network. She's a delegator, a general. She identifies where she can't do something alone, finds the people who can help, and portions out the work for mutual gain. Gail put it simply: the heroine is very good at asking for help, which our culture tends to devalue but which is actually a powerful form of strength. Crucially, Gail stressed that gender is irrelevant to which journey you're writing. Her go-to examples are striking: the recent Wonder Woman film is practically a beat-for-beat hero's journey—Gilgamesh on screen, as Gail described it. Meanwhile, Harry Potter, both the first book and the series as a whole, is a classic heroine's journey. Harry's power comes from his network—Dumbledore's Army, the Order of the Phoenix, his friendships with Ron and Hermione. He doesn't defeat Voldemort alone. He defeats Voldemort because of love and connection. This distinction has real practical consequences for writers. If you're writing a hero's journey and you hit writer's block, Gail said, the solution is usually to isolate your hero further and pile on more strife. But if you're writing a heroine's journey, the solution is probably to throw a new character into the scene—someone who has advice to offer or a skill the heroine lacks. The actual solutions to writer's block are different depending on which narrative you're writing. As I reflected on my own work, I realised that my ARKANE thriller protagonist, Morgan Sierra, follows a hero's journey—she's a solo operative, a lone wolf like Jack Reacher or James Bond. But my Mapwalker fantasy series follows a heroine's journey, with Sienna and her group of friends working together. I hadn't consciously chosen those paths; the stories led me there. But understanding the framework helps me write more intentionally now. Actionable step: Identify which journey your protagonist is on. Does your character gain strength by being alone (hero) or by building connections (heroine)? This will inform every plot decision you make, from how they face obstacles to how your story ends. 5. Use ‘Metaphor Families' to Anchor Dialogue and Voice One of the most practical techniques Matt Bird shared on episode 624 is the idea of assigning each character a “metaphor family”—a specific well of language that they draw from. This gives each character a distinctive voice that goes beyond accent or dialect. Matt explained how in The Wire, one of the most beloved TV shows of all time, every character has a different metaphor family. What struck him was that Omar, this iconic character, never utters a single curse word in the entire series. His metaphor family is pirate. He talks about parlays, uses language that feels like it belongs in Pirates of the Caribbean, and it creates this incredible ironic counterpoint against his urban setting. It tells us immediately that this is a character who sees himself in a tradition of people that doesn't match his immediate surroundings. Matt also referenced the UK version of The Office, where Gareth works at a paper company but aspires to the military. So all of his language is drawn from a military metaphor family. He doesn't talk about filing and photocopying; he talks about tactics and discipline and being on the front line. This tells us that the character has a life and dreams beyond the immediate scene—and it's the gap between aspiration and reality that makes him both funny and believable. He pointed out that a metaphor family sometimes comes from a character's background, but it's often more interesting when it comes from their aspirations. What does your character want to be? What world do they fantasise about inhabiting? That's where their language should come from. In Star Wars, Obi-Wan Kenobi is a spiritual hermit, but his metaphor family is military. He uses the language of generals and commanders, and that ironic counterpoint is part of what makes him feel so rich. Actionable step: Assign each of your main characters a metaphor family. It could be based on their job, their background, or—more interestingly—their secret aspirations. Then go through your dialogue and make sure each character is consistently drawing from that well of language. If two characters sound the same when you strip away the dialogue tags, this is the fix. 6. Find the Diagnostic Detail: The Diagonal Toast Avoid clichéd character tags—the random scar, the eye patch, the mysterious limp—unless they serve a deep narrative purpose. Matt Bird on episode 624 was very funny about this: he pointed out that Nick Fury, Odin, and eventually Thor all have eye patches in the Marvel Cinematic Universe. Eye patches are done, he said. You cannot do eye patches anymore. Instead, look for what I'm calling the “diagonal toast” detail, after a scene Matt described from Captain Marvel. In the film, Captain Marvel is trying to determine whether Nick Fury is who he says he is. She asks him to prove he isn't a shapeshifting alien. Fury shares biographical details—his history, his mother—but then she pushes further and says, name one more thing you couldn't possibly have made up about yourself. And Fury says: if toast is cut diagonally, I can't eat it. Matt said that detail is gold for a writer because it feels pulled from a real life. You can pull it from your own life and gift it to your characters, and the reader can tell it's not manufactured. He gave another example from The Sopranos: Tony Soprano's mother won't answer the phone after dark. The show's creator, David Chase, confirmed on the DVD commentary that this came from his own mother, who genuinely would not answer the phone after dark and couldn't explain why. Matt's practical advice was to keep a journal. Write down the strange, specific things that people do or say. Mine your own life for those hyper-specific details. You just need one per book. In my own writing, I've used this approach. In my ARKANE thrillers, my character Morgan Sierra has always been Angelina Jolie in my mind—specifically Jolie in Lara Croft or Mr and Mrs Smith. And Blake Daniel in my crime thriller series was based on Jesse Williams from Grey's Anatomy. I paste pictures of actors into my Scrivener projects. It helps with visuals, but also with the sense of the character, their energy and physicality. But visual details only take you so far. It's the behavioural quirks—the diagonal toast moments—that make a character feel genuinely alive. That said, physical character tags can work brilliantly when they serve the story. As I discuss in How to Write a Novel, Robert Galbraith's Cormoran Strike is an amputee, and his pain and the physical challenges of his prosthesis are a key part of every story—it's not a cosmetic detail, it's woven into the action and the character's psychology. My character Blake Daniel always wears gloves to cover the scars on his hands, which provides an angle into his wounded past as well as a visual cue for the reader. And of course, Harry Potter's lightning-shaped scar isn't just a mark—it's a direct connection to his nemesis and the mythology of the entire series. The rule of thumb is: if the tag tells us something about the character's interior life or connects to the plot, it's earning its place. If it's just there to make the character visually distinctive, it's probably a crutch. Game of Thrones takes character tags further with the family houses, each with their own mottos and sigils. The Starks say “Winter is coming” and their sigil is a dire wolf. Those aren't just labels—they're worldview made visible. Actionable step: Start a “diagonal toast” notebook. Every time you notice something strange and specific about someone's behaviour—something that feels too real to be made up—write it down. Then gift it to a character who needs more texture. 7. Displace Your Own Trauma into the Work Barbara Nickless shared something deeply personal on episode 732 that fundamentally changed how I think about putting pain onto the page. While starting At First Light, the first book in her Dr. Evan Wilding series, she lost her son to epilepsy—something called SUDEP, Sudden Unexplained Death in Epilepsy. One day he was there, and the next day he was gone. Barbara said that writing helped her cope with the trauma, that doing a deep dive into Old English literature and the Viking Age for the book's research became a lifeline. But here's what's important: she didn't give Dr. Evan Wilding her exact trauma. Evan Wilding is four feet five inches, and Barbara described how he has to walk through a world that won't adjust to him. That's its own form of learning to cope when circumstances are beyond your control. She displaced her genuine grief into the character's different but parallel struggle. When I asked her about the difference between writing for therapy and writing for an audience, she drew on her experience teaching creative writing to veterans through a collaboration between the US Department of Defense and the National Endowment for the Arts. She said she's found that she can pour her heartache into her characters and process it through them, even when writing professionally, and that the genuine emotion is what touches readers. We've all been through our own losses and griefs, so seeing how a character copes can be deeply meaningful. I've always found that putting my own pain onto the page is the most direct way to connect with a reader's soul. My character Morgan Sierra's musings on religion and the supernatural are often my own. Her restlessness, her fascination with the darker edges of faith—those come from me. But her Krav Maga fighting skills and her ability to kill the bad guys are definitely her own. That gap between what's mine and what's hers is where the fiction lives. Barbara also said something on that episode that I wrote down and stuck on my wall. She said the act of producing itself is a balm to the soul. I've been thinking about that ever since. On my own wall, I have “Measure your life by what you create.” Different words, same truth. Actionable step: If you're carrying something heavy—grief, anger, fear, regret—consider how you might displace it into a character's different but emotionally parallel struggle. Don't copy your exact situation; transform it. The emotion will be genuine, and the reader will feel it. 8. Write Diverse Characters as Real People When I spoke with Sarah Elisabeth Sawyer on episode 673—Sarah is Choctaw and a historical fiction author honoured by the Smithsonian's National Museum of the American Indian—she offered a perspective that every fiction writer needs to hear. The key message was to move away from stereotypes. Don't write your American Indian character as the “Wise Guide” who exists solely to dispense mystic wisdom to the white protagonist. Don't limit diverse characters to historical settings, as though they only exist in the past. Place them in normal, contemporary roles. Your spaceship captain, your forensic scientist, your small-town baker—any of them can be American Indian, or Nigerian, or Japanese, and their heritage should be a lived-in part of their identity, not the sole reason they exist in the story. I write international thrillers and dark fantasy, and my fiction is populated with characters from all over the world. I have a multi-cultural family and I've lived in many places and travelled widely, so I've met, worked with, and had relationships with people from different cultures. I find story ideas through travel, and if I set my books in a certain place, then the story is naturally populated with the people who live there. As I discuss in my book, How to Write a Novel, the world is a diverse place, so your fiction needs to be populated with all kinds of people. If I only populated my fiction with characters like me, they would be boring novels. There are many dimensions of difference—race, nationality, sex, age, body type, ability, religion, gender, sexual orientation, socio-economic status, class, culture, education level—and even then, don't assume that similar types of people think the same way. Some authors worry they will make mistakes. We live in a time of outrage, and some authors have been criticised for writing outside their own experience. So is it too dangerous to try? Of course not. The media amplifies outliers, and most authors include diverse characters in every book without causing offence because they work hard to get it right. It's about awareness, research, and intent. Actionable step: Audit the cast of your current work in progress. Have you written a mono-cultural perspective for all of them? If so, consider who could bring a different background, perspective, or set of cultural specifics to the story. Not as a token addition, but as a real person with a real life. 9. Respect Tribal and Cultural Specificity Sarah Elisabeth Sawyer on episode 673 was emphatic about one thing: never treat diverse groups as monolithic. If you're writing a Native American character, you must research the specific nation. Choctaw is not Navajo, just as British is not French. Sarah described the distinct cultural markers of the Choctaw people—the diamond pattern you'll see on traditional shirts and dresses, which represents the diamondback rattlesnake. They have distinct dances and songs. She said that if she saw someone in traditional dress at a distance, she would know whether they were Choctaw based on what they were wearing. She encouraged writers who want to write specifically about a nation to get to know those people. Go to events, go to a powwow, learn about the individual culture. She noted that a big misconception is that American Indians exist only in the past—she stressed that they are still here, still living their cultures, and fiction should reflect that present reality. I took a similar approach when writing Destroyer of Worlds, which is set mostly in India. I read books about Hindu myth, watched documentaries about the sadhus, and had one of my Indian readers from Mumbai check my cultural references. For Risen Gods, set in New Zealand with a young Maori protagonist, I studied books about Maori mythology and fiction by Maori authors, and had a male Maori reader check for cultural issues. Research is simply an act of empathy. The practical takeaway is this: if you're going to include a character from a specific cultural background, do the work. Use specific cultural details rather than generic signifiers. Sarah talked about how even she fell into stereotypes when she was first writing, until her mother pointed them out. If someone from within a culture can fall into those traps, the rest of us certainly can. Do the research, try your best, ask for help, and apologise if you need to. Actionable step: If you're writing a character from a specific culture, identify three to five sensory or behavioural details that are particular to that culture—not the generic version, but the real, researched, lived-in version. Consider hiring a sensitivity reader from that community to check your work. 10. Give Your Protagonist a Morally Neutral ‘Hero' Status Matt Bird was clear about this on episode 624: the word “hero” simply means the protagonist, the person we follow through the story. It's a functional role, not a moral label. We don't have to like them. We don't even have to root for their goals in a moral sense. We just have to find them compelling enough to invest our attention in their problem-solving. Think of Succession, where every member of the Roy family is varying degrees of awful, and yet the show was utterly compelling. Or WeCrashed, where Adam Neumann is a narcissistic con artist, but we can't look away because he's trying to solve the enormous problem of building an empire from nothing, and the tradecraft he employs is fascinating. As I wrote in How to Write a Novel, readers must want to spend time with your characters. They don't have to be lovable or even likable—that will depend on your genre and story choices—but they have to be captivating enough that we want to spend time with them. A character who is trying to solve a massive problem will naturally draw investment from the audience, even if we wouldn't want to have tea with them. Will Storr extended this idea by pointing out that the audience will actually root for a character to solve their problem even if the audience doesn't actually want the character's goal to be achieved in the real world. We don't really want more billionaires, but we invested in Adam Neumann's rise because that was the problem the story posed, and our brains are wired to invest in problem-solving. This connects to something deeper: what does your character want, and why? As I explore in How to Write a Novel, desire operates on multiple levels. Take a character like Phil, who joins the military during wartime. On the surface, she wants to serve her country. But she also wants to escape her dead-end town and learn new skills. Deeper still, her father and grandfather served, and by joining up, she hopes to finally earn their respect. And perhaps deepest of all, her father died on a mission under mysterious circumstances, and she wants to find out what happened from the inside. That layering of motivation is what turns a flat character into a three-dimensional one. The audience doesn't need to be told all of this explicitly. It can emerge through action, dialogue, and the choices the character makes under pressure. But you, the writer, need to know it. You need to know what your character really wants deep down, because that desire—more than any external plot device—is what drives the story forward. And your antagonist needs the same depth. They also want something, often diametrically opposed to your protagonist, and they need a reason that makes sense to them. In my ARKANE thriller Tree of Life, my antagonist is the heiress of a Brazilian mining empire who wants to restore the Earth to its original state to atone for the destruction caused by her father's company. She's part of a radical ecological group who believe the only way to restore Nature is to end all human life. It's extreme, but in an era of climate change, it's a motivation readers can understand—even if they disagree with the solution. Actionable step: If you're struggling to make a morally grey character work, make sure their problem is big enough and their methods are specific and interesting enough that we invest in the how, even if we're ambivalent about the what. 11. Build Vibrant Side Characters Gail Carriger made a point on episode 550 that was equal parts craft advice and business strategy. In a Heroine's Journey model, side characters aren't just fodder to be killed off to motivate the hero. They form a network. And because you don't have to kill them—unlike in a hero's journey, where allies are often betrayed or removed so the hero can be further isolated—you can pick up those side characters and give them their own books. Gail said this creates a really voracious reader base. You write one series with vivid side characters, and then readers fall in love with those side characters and want their stories. So you write spin-offs. The romance genre does this brilliantly—think of the Bridgerton books, where each sibling gets their own novel. The side character in one book becomes the protagonist in the next. Barbara Nickless experienced this firsthand with her Dr. Evan Wilding series. She has River Wilding, Evan's adventurous brother, and Diana, the axe-throwing research assistant, and her editor has already expressed interest in a spin-off series with those characters. Barbara described creating characters she wants to spend time with, or characters who give her nightmares but also intrigue her. That's the dual test: are they interesting enough for you to write, and interesting enough for readers to demand more? As I wrote in How to Write a Novel, characters that span series can deepen the reader's relationship with them as you expand their backstory into new plots. Readers will remember the character more than the plot or the book title, and look forward to the next instalment because they want more time with those people. British crime author Angela Marsons described it as readers feeling like returning to her characters is like putting on a pair of old slippers. Actionable step: Look at your supporting cast. Is there a side character who is vivid enough to carry their own story? If not, what could you add—a specific hobby, a distinct voice, a compelling backstory—that would make readers want more of them? 12. Use Voice as a Rhythmic Tool Voice is one of the most important elements of novel writing, and Matt Bird helped me think about it in a technical, mechanical way that I found really useful. He pointed out that the ratio of periods to commas defines a character's internal reality. A staccato rhythm—lots of periods, short sentences—suggests a character who is certain, grounded, or perhaps survivalist and traumatised. Katniss in The Hunger Games has a period-heavy voice. She's in survival mode. She doesn't have time for complexity or qualification. A flowing, comma-heavy style suggests someone more academic, more nuanced, or possibly more scattered and manipulative. The character who qualifies everything, who adds sub-clauses and digressions, is a different kind of person from the character who speaks in declarations. This is something you can actually measure. Pull up a passage of your character's dialogue or internal monologue and count the periods versus the commas. If the rhythm doesn't match who the character is supposed to be, you've found a mismatch you can fix. Sentence length is the heartbeat of your character's persona. And voice extends beyond rhythm to the words themselves. As I discussed in the metaphor families tip, each character should draw from a distinctive well of language. But voice also encompasses their relationship to silence. Some characters talk around the thing they mean; others say it straight. Some are self-deprecating; others are blunt to the point of rudeness. All of these choices are character choices, not just style choices. I find it useful to read my dialogue aloud—and not just to check for naturalness, but to hear whether each character sounds distinct. If you could swap dialogue lines between two characters and nobody would notice, you have a voice problem. One practical test: cover the dialogue tags and see if you can tell who's speaking from the words alone. Actionable step: Choose a key passage from your protagonist's point of view and read it aloud. Does the rhythm match the character? A soldier under fire should not sound like a philosophy professor at a wine tasting. Adjust the ratio of periods to commas until the voice feels right. 13. Link Character and Plot Until They're Inseparable Will Storr made the case on episode 490 that the number one problem he sees in the writing he encounters—in workshops, in submissions, even in published books—is that the characters and the plots are unconnected. There's a story happening, and there are people in it, but the story isn't a product of who those people are. He said a story should be like life. In our lives, the plots are intimately connected to who we are as characters. The goals we pursue, the obstacles we face, the same problems that keep recurring—these are products of our personalities, our flaws, our specific ways of being in the world. His framework is that your plot should be designed specifically to plot against your character. You've got a character with a particular flaw; the plot exists to test that flaw over and over until the character either transforms or doubles down and explodes. Jaws is the perfect example. Brody is afraid of water. A shark shows up in the coastal town he's responsible for protecting. The entire plot is engineered to force him to confront the one thing he cannot face. Will pointed out that the whole plot of Jaws is structured around Brody's flaw. It begins with the shark arriving, the midpoint is when Brody finally gets the courage to go into the water, and the very final scene isn't the shark blowing up—it's Brody swimming back through the water. Even a film that's ninety-eight percent action is, at its core, structured around a character with a character flaw. This is the standard I aspire to in my own work, even in my action-heavy thrillers. The external plot should be a mirror of the internal struggle. When those two are aligned, the story becomes irresistible. Will also made an important point about series fiction, which is where most commercial authors live. I asked him how this works when your character can't be transformed at the end of every book because there has to be a next book. His answer was elegant: you don't cure them. Episodic TV characters like Fleabag or David Brent or Basil Fawlty never truly change—and the fact that they don't change is actually the source of the comedy. But every episode throws a new story event at them that tests and exposes their flaw. You just keep throwing story events at them again and again. That's a soap opera, a sitcom, and a book series. As I wrote in How to Write a Novel, character flaws are aspects of personality that affect the person so much that facing and overcoming them becomes central to the plot. In Jaws, the protagonist Brody is afraid of the water, but he has to overcome that flaw to destroy the killer shark and save the town. But remember, your characters should feel like real people, so never define them purely by their flaws. The character addicted to painkillers might also be a brilliant and successful female lawyer who gets up at four in the morning to work out at the gym, likes eighties music, and volunteers at the local dog shelter at weekends. Character wounds are different from flaws. They're formed from life experience and are part of your character's backstory—traumatic events that happened before the events of your novel but shape the character's reactions in the present. In my ARKANE thrillers, Morgan Sierra's husband Elian died in her arms during a military operation. This happened before the series begins, but her memories of it recur when she faces a firefight, and she struggles to find happiness again for fear of losing someone she loves once more. And then there's the perennial advice: show, don't tell. Most writers have heard this so many times that it's easy to nod and then promptly write scenes that tell rather than show. Basically, you need to reveal your character through action and dialogue, rather than explanation. In my thriller Day of the Vikings, Morgan Sierra fights a Neo-Viking in the halls of the British Museum and brings him down with Krav Maga. That fight scene isn't just about showing action. It opens up questions about her backstory, demonstrates character, and moves the plot forward. Telling would be something like: “Morgan was an expert in Krav Maga.” Showing is the reader discovering it through the scene itself. Actionable step: Look at the main plot events of your novel. For each major turning point, ask: does this scene specifically test my protagonist's flaw? If not, can you redesign the scene so that it does? The tighter the connection between character and plot, the more powerful the story. 14. The ‘Maestra' Approach: Write Out of Order If you're a discovery writer like me, you may feel like the deep character work I've been describing sounds more suited to plotters. But Barbara Nickless gave me a beautiful metaphor on episode 732 that reframes it entirely. Barbara described her evolving writing process as being like a maestra standing in front of an orchestra. Sometimes you bring in the horns—a certain theme—and sometimes you bring in the strings—a certain character—and sometimes you turn to the soloist. It's a more organic and jumping-around process than linear writing, and Barbara said she's only recently given herself permission to work this way. When I told her that I use Scrivener to write in scenes out of order and then drag and drop them into a structure later, she was genuinely intrigued. And this is how I've always worked. I'll see the story in my mind like a movie trailer—flashes of the big emotional scenes, the pivotal confrontations, the moments of revelation—and I write those first. I don't know how they hang together until quite late in the process. Then I'll move scenes around, print the whole thing out, and figure out the connective tissue. The point is that discovery writers can absolutely build deep characters. Sometimes writing the big emotional scenes first is how you discover who the character is before you fill in the rest. You don't need a twenty-page character worksheet or a 200-page outline like Jeffery Deaver. You need to be willing to follow the character into the unknown and trust that the structure will emerge. As Barbara said, she writes to know what she's thinking. That's the discovery writer's credo. And I would add: I write to know who my characters are. Actionable step: If you're stuck on your current chapter, skip it. Write the scene that's burning in your imagination, even if it's from the middle or the end. That scene might be the key to unlocking who your character really is. 15. Use Research to Help with Empathy Research shouldn't just be about factual accuracy—it's a tool for finding the sensory details that create empathy. Barbara Nickless described research as almost an excuse to explore things that fascinate her, and I feel exactly the same way. I would go so far as to say that writing is an excuse for me to explore the things that interest me. Barbara and I both travel for our stories. For her Dr. Evan Wilding books, she did deep research into Old English literature and the Viking Age. For my thriller End of Days, I transcribed hours of video from Appalachian snake-handling churches on YouTube to understand the worldview of the worshippers, because my antagonist was brought up in that tradition. I couldn't just make that up. I had to hear their language, feel their conviction, understand why they would hold venomous serpents as an act of faith. Barbara also mentioned getting to Israel and the West Bank for research, and I've been to both places too. Finding that one specific sensory detail—the smell of a particular location, the specific way an expert handles a tool, the sound of a particular kind of music—makes the character's life feel lived-in. It's the difference between a character who is described as living in a place and a character who inhabits it. As I wrote in How to Write a Novel, don't write what you know. Write what you want to learn about. I love research. It's part of why I'm an author in the first place. I take any excuse to dive into a world different from my own. Research using books, films, podcasts, and travel, and focus particularly on sources produced by people from the worldview you want to understand. Actionable step: For your next piece of character research, go beyond reading. Watch a documentary, visit a location, talk to someone who lives the experience. Find one sensory detail—a smell, a sound, a texture—that you couldn't have invented. That detail will make your character feel real. Bonus: Measure Your Life by What You Create In an age of AI and a tsunami of content, your ultimate brand protection is the quality of your human creation. Barbara Nickless said that the act of producing itself is a balm to the soul, and I believe that with every fibre of my being. Don't be afraid to take that step back, like I did with my deadlifting. Take the time to master these deeper craft skills. It might feel like you're slowing down or going backwards by not chasing the latest marketing trend, but it's the only way to step forward into a sustainable, high-quality career. Your characters are your signature. No AI can replicate the specificity of your lived experience, the emotional truth of your displaced trauma, or the sensory details you've gathered from a life of curiosity and travel. Those are yours. Pour them into your characters, and they will resonate for years to come. Actionable Takeaway: Identify the Dramatic Question for your current protagonist. Can you state it in a single sentence with the kind of specificity Will Storr described? Is it as clear as “Are you ordinary or extraordinary?” or “Are you the only adult in the room?” If you can't answer it with that kind of precision, your character might still be a sketch. Give them a diagonal toast moment today. Find the one hyper-specific detail that proves they are not an imitation of life. And then ask yourself: does your plot test your character's flaw in every major scene? If you can align those two things—a precisely defined character and a plot that exists to test them—you will have a story that readers cannot put down. References and Deep Dives The episodes I've referenced today are all available with full transcripts at TheCreativePenn.com: Episode 732 — Facing Fears, and Writing Unique Characters with Barbara Nickless Episode 673 — Writing Choctaw Characters and Diversity in Fiction with Sarah Elisabeth Sawyer Episode 624 — Writing Characters with Matt Bird Episode 550 — The Heroine's Journey with Gail Carriger Episode 490 — How Character Flaws Shape Story with Will Storr Books mentioned: The Secrets of Character: Writing a Hero Anyone Will Love by Matt Bird The Science of Storytelling by Will Storr The Heroine's Journey by Gail Carriger How to Write a Novel: From Idea to Book by Joanna Penn You can find all my books for authors at CreativePennBooks.com and my fiction and memoir at JFPennBooks.com Happy writing! How was this episode created? This episode was initiated created by NotebookLM based on YouTube videos of the episodes linked above from YouTube/TheCreativePenn, plus my text chapters on character from How to Write a Novel. NotebookLM created a blog post from the material and then I expanded it and fact checked it with Claude.ai 4.6 Opus, and then I used my voice clone at ElevenLabs to narrate it. The post Writing Characters: 15 Actionable Tips For Writing Deep Character first appeared on The Creative Penn.

Dr. Halley Alexander and Dr. Abel Sandmann discuss seizure rates and risk factors in patients with cerebral cavernous malformations (CCMs) during long-term follow-up without CCM intervention.  Show citation:  Sandmann ACA, Vandertop WP, White PM, Verbaan D, Coutinho JM, Al-Shahi Salman R. Seizures and Epilepsy in Patients With Untreated Cerebral Cavernous Malformations: A Prospective, Population-Based Cohort Study. Neurology. 2025;105(11):e214387. doi:10.1212/WNL.0000000000214387  Show transcript:  Dr. Halley Alexander: Hi, this is Halley Alexander with today's Neurology Minute. I'm here with Abel Sandmann from Amsterdam University Medical Center, and we just finished recording a full-length podcast about some exciting findings related to cerebral cavernous malformations and the risk of seizures and epilepsy. Abel, can you give our listeners a rundown of the most exciting findings and how it can change practice? Dr. Abel Sandmann:  In our paper, we show that patients with a cerebral cavernous malformation who have a first unprovoked seizure should be diagnosed with epilepsy and considered for anti-seizure medication, as most of them achieve long-term seizure freedom with medical therapy alone. These findings are based on a prospective population-based cohort study in which we analyze long-term follow-up and assess the rates and risk factors for: one, a first-ever epileptic seizure; two, seizure recurrence to evaluate the updated ILAE definition of epilepsy; and three, seizure freedom over two years and five years among patients with epilepsy. We found that among patients who had never experienced a seizure before, the 10-year risk of a first-ever seizure was only 6%. This supports current recommendations against prophylactic anti-seizure medication in patients who are incidentally diagnosed with a cerebral cavernous malformation. However, following a first unprovoked seizure, the 10-year risk of recurrence was 80%, which exceeds the 60% threshold defined by the ILAE. This justifies diagnosing epilepsy after the first and provoked seizure in this population. Given that the risk of recurrence was lower in patients treated with anti-seizure medication after the first seizure, this supports early initiation of therapy, although these treatment analyses were non-randomized and should be interpreted cautiously. Most patients who met the definition of epilepsy became two year and five years seizure-free with medical management alone. But some patients with cerebral cavernous malformations develop medically intractable seizures and might benefit from surgical treatments. Dr. Halley Alexander: Excellent. Thank you so much, Abel. You can find the full-length podcast, which is available now on the Neurology Podcast, or you can also find the full article in Neurology at neurology.org, or in the December 2025 print issue. As always, thanks for tuning in for today's Neurology Minute.   

Dr. Halley Alexander talks with Dr. Abel Sandmann about seizure rates and risk factors in patients with cerebral cavernous malformations (CCMs) during long-term follow-up without CCM intervention.  Read the related article in Neurology®.  Disclosures can be found at Neurology.org. 

Mens Room Question: What is the craziest thing to happen to or at your house?

Resilience, mindset, overcoming adversity, and personal growth take center stage in this powerful conversation with bestselling author and keynote speaker Stacey Chillemi.What if your greatest challenge could become your greatest purpose?On this inspiring episode of Women Road Warriors, Shelley Johnson and Kathy Tuccaro welcome Stacey Chillemi—20-time bestselling author, keynote speaker, and mindset coach whose work has empowered millions around the world.Stacey's journey began with a life-altering diagnosis. After developing epilepsy following childhood encephalitis, she faced obstacles that could have defined her limitations. Instead, she transformed adversity into advocacy—ultimately speaking before Congresson behalf of people with epilepsy, which helped pass the Americans with Disabilities Act. She then became a global voice for resilience by helping others unlock healing, confidence, and leadership.Today, Stacey reaches millions through her books, coaching programs, and the fast-growing Advisor Series for Mindset & Self-Improvement podcast and YouTube channel. Her message has been featured across major media, including NBC Dateline, News 4, The Morning Show, The Dr. Oz Show, Psychology Today, Business Insider, and collaborations with leaders like Arianna Huffington.In this powerful conversation, Stacey shares how anyone can shift their mindset, rise above challenges, reduce stress, and step into their true potential.If you've ever faced adversity, questioned your path, or needed a reminder of your inner strength, this episode will leave you inspired and empowered.Listen now to discover:• How to transform adversity into purpose • Mindset shifts that unlock resilience and leadership • Practical ways to reduce stress and reclaim your power • Why your story—no matter how difficult—can become your greatest strength

Dr Aaron B. Bowen explores epilepsy and EEG features in succinate dehydrogenase (complex II) deficiency, focusing on refractory epilepsy and the presence of RHADS, an EEG pattern more commonly associated with POLG-related disease, and what this means for diagnosis and differential thinking in mitochondrial disorders. Epilepsy Phenotype and EEG Finding of Rhythmic High-Amplitude Delta With Superimposed Spikes (RHADS) in Succinate Dehydrogenase Deficiency Aaron B. Bowen, et al https://doi.org/10.1002/jmd2.70072

According to Matt Preston, he only has 14 more summers. And he’s determined to make the most of them.

Do you know how many seizures is too many? Or what drugs to avoid in older epilepsy patients? Credit available for this activity expires: 3/3/27 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/avoiding-common-mistakes-managing-focal-epilepsy-2026a10004kv?ecd=bdc_podcast_libsyn_mscpedu

Psychiatric symptoms are common in the epilepsies, yet they are often overlooked in clinical care. Dr. Andres M. Kanner, epileptologist and Professor of Clinical Neurology at the University of Miami, explains why mental health symptoms are central to epilepsy outcomes - not peripheral! Topics include depression, anxiety, psychosis, ADHD, suicide risk, family psychiatric history, and how these factors influence antiseizure medication choices and quality of life. This episode is sponsored by EASEE® by Precisis GmbH and had no influence over the editorial content or discussion. Learn more about EASEE® here: https://precisis.de/en   

Landis Wiedner shares her journey with adult-onset epilepsy after being diagnosed at the age of thirty-two. She describes how seizures impacted her life and work, explains how a stay in and epilepsy monitoring unit led to a life-changing medication change, and shares her experiences dating with epilepsy.

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Flash-back to our most popular episode*! Epileptologist & neurologist Dr. Ángel Aledo-Serrano talks of his review and opinion on a former paper regarding the antiseizure medication Levetiracetam/Keppra, its effectiveness in controlling seizures, but also the importance of precision medicine. He also speaks of the need to improve prescribing and avoid polypharmacy for people with an epilepsy, the need for further qualitative research into treatment and care, and convincing clinicians that epilepsy is far more than seizures alone. This episode is sponsored by EASEE® by  This episode is sponsored by EASEE® by Precisis GmbH, who had no influence over the editorial content or discussion. Learn more about EASEE® here: https://precisis.de/en  

Want to support the podcast? Join our Patreon or buy us a coffee. As an independent podcast, Shakespeare Anyone? is supported by listeners like you. In today's episode, we are exploring how Shakespeare depicts Julius Caesar's "falling sickness," commonly believed by historians and scholars to be epilepsy. First, we'll discuss how the play Julius Caesar can be read as a disability narrative and how it reflects early modern anxieties around invisible disabilities like epilepsy.  Then, we will look at how Shakespeare depicts falling sickness or epilepsy across the canon and determine whether or not the depictions are as accurate as they are often celebrated to be. Finally, we will share an alternative diagnosis for Caesar's symptoms based on what is known of historical Caesar's medical history.  Content Warning: Emetophobia, brief discussion of eating disorders Shakespeare Anyone? is created and produced by Kourtney Smith and Elyse Sharp. Music is "Neverending Minute" by Sounds Like Sander. For updates: Join our email list Follow us on Instagram at @shakespeareanyonepod Visit our website at shakespeareanyone.com Support the podcast: Become a patron at patreon.com/shakespeareanyone  Buy us a coffee Bookshop.org: Since 2020, Bookshop.org has raised more than $38 million for independent bookstores. Shop our Shakespeare Anyone? storefront to find books featured on the podcast, books by our guests, and other Shakespeare-related books and gifts. Every purchase on the site financially supports independent bookstores. Libro.fm: Libro.fm makes it possible to purchase audiobooks through your local bookshop of choice. Use our link for 2 free audiobooks when you sign up for a new Libro.fm membership using our link. Find additional links mentioned in the episode in our Linktree. Works referenced: Breuer, Horst. "Bilder Der Epilepsie Bei Shakespeare / Representations of Epilepsy in Shakespeare." Medizinhistorisches Journal, vol. 37, no. 1, 2002, pp. 5–19. JSTOR, http://www.jstor.org/stable/25805304. Accessed 16 Feb. 2026. Hamlyn, Tim. "The Nature of Caesar's Illness." Latomus, vol. 73, no. 2, 2014, pp. 360–67. JSTOR, http://www.jstor.org/stable/24858427. Accessed 16 Feb. 2026. Hobgood, Allison. (2009). Caesar Hath the Falling Sickness: The Legibility of Early Modern Disability in Shakespearean Drama. Disability Studies Quarterly. 29. 10.18061/dsq.v29i4.993. 

Dr. Halley Alexander and Dr. Alissa M. D'Gama discuss genetic testing for infantile epilepsies.  Show citation:  Nguyen JNH, Lachgar-Ruiz M, Higginbotham EJ, et al. Diagnostic Yield of Comprehensive Reanalysis After Nondiagnostic Short-Read Genome Sequencing in Infants With Unexplained Epilepsy. Neurology. 2026;106(6):e214645. doi:10.1212/WNL.0000000000214645  Show transcript:  Dr. Halley Alexander:  Hi, this is Halley Alexander with today's Neurology Minute, and I'm here with Dr. Alissa D'Gama from Boston Children's Hospital and Harvard Medical School, and we just finished recording a full-length podcast about some exciting new work in genetic testing for infantile onset epilepsies. Alissa, can you tell us what you found briefly and why it's important for neurology care? Dr. Alissa D'Gama:  Infantile epilepsies are relatively common, and they're associated with substantial burden of disease, and we know that identifying underlying genetic causes can impact clinical care. It's important for emerging precision therapies. But even after genome sequencing, which is the most comprehensive clinical genetic testing currently available, most infants remain genetically unsolved. And so what we did was take that genome sequencing data and reanalyze it for a cohort of infants who had unexplained non-acquired epilepsy and non-diagnostic genome sequencing, and in about 5% of cases, our reanalysis was able to identify a genetic diagnosis, and all of these diagnoses had impact on clinical care for their infants and their families. In some cases, we could incorporate new information, either new clinical information about the patient or new scientific methods or information about disease associations, and in other cases, we were able to incorporate new analysis methods to identify variants. And so our findings suggest that implementing reanalysis for infants or any individual with epilepsy within a year or two of non-diagnostic testing may be useful. Dr. Halley Alexander:  Thank you so much, and you can find a lot more details by listening to the full-length podcast, which is available now on the Neurology podcast, and you can find the full article in the March 10th issue of Neurology or online at neurology.org. As always, thanks for tuning in for today's Neurology Minute. 

In this episode, editor in chief Joseph E. Safdieh, MD, FAAN, highlights articles about EMG expertise, GLP-1s and epilepsy risk reduction, and combination therapy for recurrent IDH-mutant astrocytoma.

In this episode, editor in chief Joseph E. Safdieh, MD, FAAN, highlights articles about EMG expertise, GLP-1s and epilepsy risk reduction, and combination therapy for recurrent IDH-mutant astrocytoma.

Sunstone Health CEO Joshua Resnikoff joins Chris Lustrino to explain how Sunstone uses AI on healthcare claims data to proactively identify children with developmental delay—starting with epilepsy and autism—and help families reach the right specialists and diagnostics faster.They break down what claims data is, why the healthcare system is reactive by default, and how Sunstone's approach can compress what often takes years into roughly weeks by flagging high-need cases, coordinating advanced diagnostics, and delivering actionable next steps. Joshua also shares Sunstone's go-to-market strategy (positioned as an employer-paid benefit), why the pricing model is designed to reduce “point-solution bloat,” and how expansion could move across employers, TPAs, reinsurers, and large insurers. 00:00 Needle-in-a-haystack intro03:13 What Sunstone does (AI + claims data)05:32 Flagging patients vs. diagnosing07:21 Employer benefit + privacy model15:54 GTM + sales cycle reality17:57 Outcome-based pricing model20:16 Unit economics ($10k per case)22:11 Expansion paths + other diseases26:23 Fundraise use of proceeds28:03 Investor closing

To have Dr. Morse answer a question, visit: https://drmorses.tv/ask/ All of Dr. Morse's and his son's websites under one roof: https://handcrafted.health/ Facebook Page: https://www.facebook.com/handcrafted.health   00:00:00 - Intro 00:00:19 - Malabsorption 00:10:12 - Epilepsy - High Blood Pressure - Hemorrhoids - Tumor  00:29:41 - Renal Artery Stenosis 00:48:23 - Parkinson's Disease - Arthritis - Osteoporosis - Carpal Tunnel - Adrenal Fatigue - High Blood Pressure 01:10:45 - Acne - Molluscum Contagiosum 01:27:22 - Pain - Arthritis  00:00:19 - Malabsorption Should I plan to go on a longer than 3 month juice fast? 00:10:12 - Epilepsy - High Blood Pressure - Hemorrhoids - Tumor  I had epilepsy since childhood at 5 years of age. 00:29:41 - Renal Artery Stenosis I refused to take statins as I knew there was a reason for my high blood pressure. 00:48:23 - Parkinson's Disease - Arthritis - Osteoporosis - Carpal Tunnel - Adrenal Fatigue - High Blood Pressure I have muscle loss and I'm trying to gain weight.  01:10:45 - Acne - Molluscum Contagiosum My 3 1/2 year-old daughter has molluscum contagiosum and I would like to know what is best for her. 01:27:22 - Pain - Arthritis  Does my iris indicate inflammatory arthritis?

Dr. Halley Alexadner talks with Dr. Alissa M. D'Gama about genetic testing for infantile epilepsies.  Read the related article in Neurology®.  Disclosures can be found at Neurology.org. 

Join EEG legend Jay Gunkelman (500,000+ brain scans read) and host Pete Jansons for a thorough exploration of Sensorimotor Rhythm (SMR) — the calming, stabilizing brainwave discovered by Barry Sterman.From cats trained on SMR that resisted toxic rocket fuel seizures (NASA origins) to modern uses in ADHD, epilepsy, insomnia, fibromyalgia, and arousal regulation — this episode breaks down the science, circuits, and clinical realities.✅ Key Topics Covered:Barry Sterman's breakthrough: SMR-trained cats survived rocket fuel doses that caused vomiting, panting, salivating, and seizures in controls (ruined the dose-response curve)Brain circuitry: Thalamus (ventroposterior lateral nucleus) + reticular nucleus (acetylcholine bursts) → sensory-motor cortex feedback → red nucleus quieting → muscle spindle relaxationSMR as daytime "sleep spindle": Stabilizes red nucleus (Parkinsonism target), cuts sympathetic drive, deeper muscle relaxation, reduces sensory feedback to thalamusBenefits: Epilepsy stabilization, fibromyalgia (quiets sympathetic input to red nucleus), ADHD clusters (excess theta/alpha, beta compensation), arousal-performance curve centeringRisks: Overtraining SMR drops arousal too far → underarousal/grogginess/rebound giddiness (like kids pre-bedtime); counter with anterior beta (17Hz functional beta on tasks)Arousal-performance: SMR = brakes (calms overarousal); beta = accelerator (fixes underarousal); no fixed sessions (10 for mild insomnia, 24+ for severe)ADHD insights: Frontal suppressor strip → caudate/putamen/globus pallidus/thalamus loop (excess GABA inhibition); beta magnitude increases (more events, not amplitude)

What is that in the air? Could it be… love? HA! Bet you thought we'd say death! Today we recognize Valentine's Day by looking at the origins of Valentine's Day, including the grizzly execution of its namesake Saint Valentine. Sorry, we can't help ourselves, but we do what we love! We also take a look at the lost (and frankly much cooler sounding) Pagan version of the holiday known as Lupercalia with its ample displays of debauchery. Plus we take a gander at Valentine's Day mascot Cupid, that lovable cherub scamp that spreads love by shooting people with arrows; the epic poem that tied the concept of love with the death of a martyred saint; and how St. Valentine (amongst others) is the Patron Saint of Epilepsy. Love it or hate it, Valentine's Day is here, so snuggle up to that special someone, read them the entirety of Geoffrey Chaucer's “The Parliament of Fowls,” and most importantly, listen in, Land of the Living!Links for today's episode:Origins of Valentine's Dayhttps://www.history.com/articles/valentines-day-originLupercaliahttps://www.history.com/articles/lupercaliaWho is Cupid?https://www.history.com/articles/who-is-cupidTranslation of Geoffrey Chaucer's “The Parliament of Fowls”https://www.poetryintranslation.com/PITBR/English/Fowls.phpSt. Valentines and Others: The Patron Saints of Epilepsyhttps://www.epilepsy.org.uk/news/st-valentine-and-others-patron-saints-of-epilepsy#deathiseverything #DeathIsEverythingPodcast  #DIEwithMarianne #DIEwithMarianneandChris #DIEwithMCA #deathinpsiration #deathpodcast #LApodcast #takingchances #landoftheliving #ValentinesDay #StValentine #holidays #Lupercalia #cupid #loveThanks for listening, Land of the Living! Subscribe, and follow us on Instagram @die.podcast  for updates! Check out deathiseverything.com for merchandise, our mailing list, and more!

A driver has been treated in hospital after suffering a seizure at the wheel and crashing into a tree, before reportedly being dragged from his vehicle and attacked.Pictures at KentOnline show injuries suffered by Louie Watkins after it happened when he drove along New Barn Road towards Gravesend. Hear from reporter Brad Harper who has been covering the story.Also on today's podcast, a Kent MP's among those supporting the Prime Minister, as he insists he's not going anywhere.Sir Keir Starmer survived a difficult day yesterday after the Lord Mandelson scandal led to calls for his resignation. We have been speaking to East Thanet MP Polly Billington.A leading social media expert in Kent has told us it's essential young people are taught about AI and how to spot fake content online.Safer Internet Day this year is all about how to use the tech responsibly. Hear from consultant Zoe Cairns who is based in Medway.A Dartford dad has been left in intensive care for weeks after undergoing a routine tonsillectomy.Cardiff Dicdican had the procedure at Medway Maritime, but after several bleeding episodes during recovery he went to The Princess Royal University Hospital in Farnborough. Reporter Charlotte Phillips has been speaking to his wife Jessica.A new exhibition is opening at Rochester Cathedral today aiming to make us think about our human impact on the environment.Three giant whale sculptures have been created using recycled netting, and will be hanging from the nave.And, a village pub has re-opened following a £200,000 renovation.The Five Bells in Lower Halling has been closed for the past five weeks so work can be carried out. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this week's episode of High on Home Grown, we're covering major busts, powerful medical stories, and some interesting shifts in policy and public opinion: Macky starts with a huge find from the BBC, where police discovered a £7.1 million cannabis operation inside a derelict high school. It's another example of the scale some underground grows are reaching, and the strange locations they're turning up in. He also shares the touching story of a young girl whose family says medical cannabis has transformed her life, highlighting once again the real human impact behind the ongoing fight for better access. John brings political developments from the US, where Wisconsin senators have approved a Republican-led medical marijuana bill, even as Democrats continue pushing for broader recreational legalization. It's a clear sign of how the conversation is evolving, even in more conservative states. We also look at an opinion piece explaining why many law enforcement officers are supporting Trump's rescheduling move, a shift that shows attitudes are changing even within traditional enforcement circles. And Smee rounds things off with new research showing daily opioid use dropped by 9 to 11 percentage points following recreational legalization, adding to the growing evidence that legal access may play a role in reducing reliance on more dangerous substances. Another packed episode full of real-world impact, changing attitudes, and stories that show how fast the landscape continues to shift.

Interview with Emanuele Cerulli Irelli, MD, PhD, author of Comparative Effectiveness of Brivaracetam, Cenobamate,Lacosamide, and Perampanel in Focal Epilepsy. Hosted by Cynthia E. Armand, MD. Related Content: Comparative Effectiveness of Brivaracetam, Cenobamate, Lacosamide, and Perampanel in Focal Epilepsy

Send comments and feedbackCelebrating International Epilepsy Day (Feb 9) with an episode of strength and hope! Jessie Nyirenda's seizures went undiagnosed for years. She was told she was misbehaving, possessed, and bewitched. She finally diagnosed herself after reading about epilepsy in a library. Taking anti-seizure medication and joining an epilepsy support group changed Jessie's life and made her realize she was no different from anyone else. Now a mother of three and a banking sector specialist, Jessie is active in epilepsy advocacy.IBE toolkit for reducing stigma in Africa Sharp Waves episodes are meant for informational purposes only, and not as clinical or medical advice.Let us know how we're doing: podcast@ilae.org.The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Instagram, and LinkedIn.

Interview with Emanuele Cerulli Irelli, MD, PhD, author of Comparative Effectiveness of Brivaracetam, Cenobamate,Lacosamide, and Perampanel in Focal Epilepsy. Hosted by Cynthia E. Armand, MD. Related Content: Comparative Effectiveness of Brivaracetam, Cenobamate, Lacosamide, and Perampanel in Focal Epilepsy

Today (9th February) is International Epilepsy Day. With over 45,000 people living with epilepsy in Ireland, awareness and understanding of the condition has never been more important. On Monday's Morning Focus, Alan Morrissey was joined by Tommy Cassidy from Meelick, who has lived with epilepsy since childhood and Paddy McGeoghegan, Advocacy and Communications Manager with Epilepsy Ireland, who spoke about seizure first aid and how the public can be more epilepsy-aware. Photo (c) Fabián Montano via Canva

Epilepsy Ireland have released a new song to raise awareness of the condition, which affects an estimated 45,000 people in Ireland.  Twenty-eight-year-old Katie Cooke lives with epilepsy and told her story to Anton this morning.

Vuyiseka Xego from Epilepsy SA joins Wilné & Rochelle on #HFMBreakfast to chat about Epilepsy Day (9 February). This year Epilepsy South Africa is launching a bold new national campaign – Epilepsy Pledge: Epilepsy In Action – calling on all South Africans to take one meaningful step to support persons with epilepsy.

Comedian, actress, and podcaster Stanzi Potenza shares her experiences growing up and living with epilepsy while pursuing her dreams of a career in entertainment.

This episode is with my friend Sammi, she's a woman who not only has epilepsy, but has multiple diagnosis and health conditions. When we recorded this episode, she was in the hospital, and she still has a goal of soon to be released because she has been there for many years. For as much as she has gone through, she is an ultra positive and strong person, and she perseverance every day. She's one of those people when you meet them, you just say, how do you do it?    Follow her on TikTok https://www.tiktok.com/@sammie.epilepsy.warrior?_r=1&_t=ZT-93ay80A5TTR

On today's podcast I chatted with Occupational Therapist, Nerella Chauvin who lives just outside Budapest in Hungary with her family. This busy career professional who was running her own successful practice turned 50 last summer and suddenly her life was turned upside down. She lay on the bed with a cup of coffee and started checking some emails - when she woke after what felt like a nap, she had a concerned audience at the foot of her bed. She had a seizure and had just come around. Tests diagnosed that not only did she have Epilepsy but she also had a condition called Organic Amnestic Syndrome, which causes memory loss. This occupational therapist who had specialised in helping people with epilepsy was now suddenly the patient who could no longer work or drive and the simplest of life tasks carried many practical risks. While the doctors are still experimenting with drugs to stabilise her condition Nerella has had to learn how to live again and she does this through a new lens; "Happiness is Waking up" she says. Your health is everything, and we need to appreciate it Enjoy the show     Podcast Production by Greg Canty Greg's blog Greg on Twitter  Greg on LinkedIn Email Greg with feedback or suggested guests: greg@fuzion.ie   

Psychogenic nonepileptic seizures (PNES) are common, often misunderstood, and increasingly encountered in pediatric emergency care. These events closely resemble epileptic seizures but arise from abnormal brain network functioning rather than epileptiform activity. In this episode of PEM Currents, we review the epidemiology, pathophysiology, and clinical features of PNES in children and adolescents, with a practical focus on Emergency Department recognition, diagnostic strategy, and management. Particular emphasis is placed on seizure semiology, avoiding iatrogenic harm, communicating the diagnosis compassionately, and understanding how early identification and referral to cognitive behavioral therapy can dramatically improve long-term outcomes. Learning Objectives Identify key epidemiologic trends, risk factors, and semiological features that help differentiate psychogenic nonepileptic seizures from epileptic seizures in pediatric patients presenting to the Emergency Department. Apply an evidence-based Emergency Department approach to the evaluation and initial management of suspected PNES, including strategies to avoid unnecessary escalation of care and medication exposure. Demonstrate effective, patient- and family-centered communication techniques for explaining the diagnosis of PNES and facilitating timely referral to appropriate outpatient therapy. References Sawchuk T, Buchhalter J, Senft B. Psychogenic Nonepileptic Seizures in Children-Prospective Validation of a Clinical Care Pathway & Risk Factors for Treatment Outcome. Epilepsy & Behavior. 2020;105:106971. (PMID: 32126506) Fredwall M, Terry D, Enciso L, et al. Outcomes of Children and Adolescents 1 Year After Being Seen in a Multidisciplinary Psychogenic Nonepileptic Seizures Clinic. Epilepsia. 2021;62(10):2528-2538. (PMID: 34339046) Sawchuk T, Buchhalter J. Psychogenic Nonepileptic Seizures in Children - Psychological Presentation, Treatment, and Short-Term Outcomes. Epilepsy & Behavior. 2015;52(Pt A):49-56. (PMID: 26409129) Labudda K, Frauenheim M, Miller I, et al. Outcome of CBT-based Multimodal Psychotherapy in Patients With Psychogenic Nonepileptic Seizures: A Prospective Naturalistic Study. Epilepsy & Behavior. 2020;106:107029. (PMID: 32213454) Transcript This transcript was generated using Descript automated transcription software and has been reviewed and edited for accuracy by the episode's author. Edits were limited to correcting names, titles, medical terminology, and transcription errors. The content reflects the original spoken audio and was not substantively altered. Welcome to PEM Currents: The Pediatric Emergency Medicine Podcast. As always, I'm your host, Brad Sobolewski, and today we are talking about psychogenic non-epileptic seizures, or PNES. Now, this is a diagnosis that often creates a lot of uncertainty in the Emergency Department. These episodes can be very scary for families and caregivers and schools. And if we mishandle the diagnosis, it can lead to unnecessary testing, medication exposure, ICU admissions, and long-term harm. This episode's gonna focus on how to recognize PNES in pediatric patients, how we make the diagnosis, what the evidence says about management and outcomes, and how what we do and what we say in the Emergency Department directly affects patients, families, and prognosis. Psychogenic non-epileptic seizures are paroxysmal events that resemble epileptic seizures but occur without epileptiform EEG activity. They're now best understood as a subtype of functional neurological symptom disorder, specifically functional or dissociative seizures. Historically, these events were commonly referred to as pseudo-seizures, and that term still comes up frequently in the ED, in documentation, and sometimes from families themselves. The problem is that pseudo implies false, fake, or voluntary, and that implication is incorrect and harmful. These episodes are real, involuntary, and distressing, even though they're not epileptic. Preferred terminology includes psychogenic non-epileptic seizures, or PNES, functional seizures, or dissociative seizures. And PNES is not a diagnosis of exclusion, and it does not require identification of psychological trauma or psychiatric disease. The diagnosis is based on positive clinical features, ideally supported by video-EEG, and management begins with clear, compassionate communication. The overall incidence of PNES shows a clear increase over time, particularly from the late 1990s through the mid-2010s. This probably reflects improved recognition and access to diagnostic services, though a true increase in occurrence can't be excluded. Comorbidity with epilepsy is really common and clinically important. Fourteen to forty-six percent of pediatric patients with PNES also have epilepsy, which frequently complicates diagnosis and contributes to diagnostic delay. Teenagers account for the highest proportion of patients with PNES, especially 15- to 19-year-olds. Surprisingly, kids under six are about one fourth of all cases, so it's not just teenagers. We often make the diagnosis of PNES in epilepsy monitoring units. So among children undergoing video-EEG, about 15 to 19 percent may ultimately be diagnosed with PNES. And paroxysmal non-epileptic events in tertiary epilepsy monitoring units account for about 15 percent of all monitored patients. Okay, but what is PNES? Well, it's best understood as a disorder of abnormal brain network functioning. It's not structural disease. The core mechanisms at play include altered attention and expectation, impaired integration of motor control and awareness, and dissociation during events. So the patients are not necessarily aware that this is happening. Psychological and psychosocial features are common but not required for diagnosis and may be less prevalent in pediatric populations as compared with adults. So PNES is a brain-based disorder. It's not conscious behavior, it's not malingering, and it's not under voluntary control. Children and adolescents with PNES have much higher rates of psychiatric comorbidities and psychosocial stressors compared to both healthy controls and children with epilepsy alone. Psychiatric disorders are present in about 40 percent of pediatric PNES patients, both before and after the diagnosis. Anxiety is seen in 58 percent, depression in 31 percent, and ADHD in 35 percent. Compared to kids with epilepsy, the risk of psychiatric disorders in PNES is nearly double. Compared to healthy controls, it is up to eight times higher. And there's a distinct somatopsychiatric profile that strongly predicts diagnosis of PNES. This includes multiple medical complaints, psychiatric symptoms, high anxiety sensitivity, and solitary emotional coping. This profile, if you've got all four of them, carries an odds ratio of 15 for PNES. Comorbid epilepsy occurs in 14 to 23 percent of pediatric PNES cases, and it's associated with intellectual disability and prolonged diagnostic delay. And finally, across all demographic strata, anxiety is the most consistent predictor of PNES. Making the diagnosis is really hard. It really depends on a careful history and detailed analysis of the events. There's no single feature that helps us make the diagnosis. So some of the features of the spells or events that have high specificity for PNES include long duration, so typically greater than three minutes, fluctuating or asynchronous limb movements, pelvic thrusting or side-to-side head movements, ictal eye closure, often with resisted eyelid opening, ictal crying or vocalization, recall of ictal events, and rare association with injury. Younger children often present with unresponsiveness. Adolescents more commonly demonstrate prominent motor symptoms. In pediatric cohorts, we most frequently see rhythmic motor activity in about 27 percent, and complex motor movements and dialeptic events in approximately 18 percent each. Features that argue against PNES include sustained cyanosis with hypoxia, true lateral tongue biting, stereotyped events that are identical each time, clear postictal confusion or lethargy, and obviously epileptic EEG changes during the events themselves. Now there are some additional historical and contextual clues that can help us make the diagnosis as well. If the events occur in the presence of others, if they occur during stressful situations, if there are psychosocial stressors or trauma history, a lack of response to antiepileptic drugs, or the absence of postictal confusion, this may suggest PNES. Lower socioeconomic status, Medicaid insurance, homelessness, and substance use are also associated with PNES risk. While some of these features increase suspicion, again, video-EEG remains the diagnostic gold standard. We do not have video-EEG in the ED. But during monitoring, typical events are ideally captured and epileptiform activity is not seen on the EEG recording. Video-EEG is not feasible for every single diagnosis. You can make a probable PNES diagnosis with a very accurate clinical history, a vivid description of the signs and appearance of the events, and reassuring interictal EEG findings. Normal labs and normal imaging do not make the diagnosis. Psychiatric comorbidities are not required. The diagnosis, again, rests on positive clinical features. If the patient can't be placed on video-EEG in a monitoring unit, and if they have an EEG in between events and it's normal, that can be supportive as well. So what if you have a patient with PNES in the Emergency Department? Step one, stabilize airway, breathing, circulation. Take care of the patient in front of you and keep them safe. Use seizure pads and precautions and keep them from falling off the bed or accidentally injuring themselves. A family member or another team member can help with this. Avoid reflexively escalating. If you are witnessing a PNES event in front of you, and if they're protecting their airway, oxygenating, and hemodynamically stable, avoid repeated benzodiazepines. Avoid intubating them unless clearly indicated, and avoid reflexively loading them with antiseizure medications such as levetiracetam or valproic acid. Take a focused history. You've gotta find out if they have a prior epilepsy diagnosis. Have they had EEGs before? What triggered today's event? Do they have a psychiatric history? Does the patient have school stressors or family conflict? And then is there any recent illness or injury? Only order labs and imaging when clinically indicated. EEG is not widely available in the Emergency Department. We definitely shouldn't say things like, “this isn't a real seizure,” or use outdated terms like pseudo-seizure. Don't say it's all psychological, and please do not imply that the patient is faking. If you see a patient and you think it's PNES, you're smart, you're probably right, but don't promise diagnostic certainty at first presentation. Remember, a sizable proportion of these patients actually do have epilepsy, and referring them to neurology and getting definitive testing can really help clarify the diagnosis. Communication errors, especially early on, worsen outcomes. One of the most difficult things is actually explaining what's going on to families and caregivers. So here's a suggestion. You could say something like: “What your child is experiencing looks like a seizure, but it's not caused by abnormal electrical activity in the brain. Instead, it's what we call a functional seizure, where the brain temporarily loses control of movement and awareness. These episodes are real and involuntary. The good news is that this condition is treatable, especially when we address it early.” The core treatment of PNES is CBT-based psychotherapy, or cognitive behavioral therapy. That's the standard of care. Typical treatment involves 12 to 14 sessions focused on identifying triggers, modifying maladaptive cognitions, and building coping strategies. Almost two thirds of patients achieve full remission with treatment. About a quarter achieve partial remission. Combined improvement rates reach up to 90 percent at 12 months. Additional issues that neurologists, psychologists, and psychiatrists often face include safe tapering of antiseizure medications when epilepsy has been excluded, treatment of comorbid anxiety or depression, coordinating care between neurology and mental health professionals, and providing education for schools on event management. Schools often witness these events and call prehospital professionals who want to keep patients safe. Benzodiazepines are sometimes given, exposing patients to additional risk. This requires health system-level and outpatient collaboration. Overall, early diagnosis and treatment of PNES is critical. Connection to counseling within one month of diagnosis is the strongest predictor of remission. PNES duration longer than 12 months before treatment significantly reduces the likelihood of remission. Video-EEG confirmation alone does not predict positive outcomes. Not every patient needs admission to a video-EEG unit. Quality of communication and speed of treatment, especially CBT-based therapy, matter the most. Overall, the prognosis for most patients with PNES is actually quite favorable. There are sustained reductions in events along with improvements in mental health comorbidities. Quality of life and psychosocial functioning improve, and patients use healthcare services less frequently. So here are some take-home points about psychogenic non-epileptic seizures, or PNES. Pseudo-seizure and similar terms are outdated and misleading. Do not use them. PNES are real, involuntary, brain-based events. Diagnosis relies on positive clinical features, what the events look like and when they happen, not normal lab tests or CT scans. Early recognition and diagnosis, and rapid referral to cognitive behavioral therapy, change patients' lives. If you suspect PNES, get neurology and mental health professionals involved as soon as possible. Alright, that's all I've got for this episode. I hope you found it educational. Having seen these events many times over the years, I recognize how scary they can be for families, schools, and our prehospital colleagues. It's up to us to think in advance about how we're going to talk to patients and families and develop strategies to help children who are suffering from PNES events. If you've got feedback about this episode, send it my way. Likewise, like, rate, and review, as my teenagers would say, and share this episode with a colleague if you think it would be beneficial. For PEM Currents: The Pediatric Emergency Medicine Podcast, this has been Brad Sobolewski. See you next time.

What happens when epilepsy meets pregnancy planning? In this episode of The MotherToBaby Podcast, host Chris Stallman, MS, CGC—a genetic counselor, mom of four, and teratogen information specialist—talks with Dr. Kristi McIntosh from the University of British Columbia. Dr. McIntosh shares her powerful personal and professional journey—from being diagnosed with epilepsy at age ten to navigating fertility challenges, medication changes, and high-risk pregnancies. As both a scientist and a mom, she offers unique insights into:

When your child survives one medical emergency only to face another, parenting becomes a constant act of advocacy and courage. Today's guest joins us to share her daughter's journey with rare and complex medical conditions, from early respiratory failure and unexplained hospitalizations to epilepsy, lung disease, and life with medical uncertainty. As a military spouse navigating deployments, Brittany shares what it means to walk this path largely alone, trust her instincts as a mother, and fight to be believed by medical professionals. This episode explores navigating rare disease without clear answers, the life-changing impact of compassionate child life support, supporting siblings through medical trauma, and how rituals, play, and community help families find hope and meaning in the midst of chaos. Download our free Children's Hospital Passport to help empower your child and family during hospital stays. Sponsored in part by HealthWell Foundation—learn how you can help families afford life-saving medications at healthwellfoundation.org.   Resources from today's episode: Medical Support:  Stanford Children's Health  Undiagnosed Diseases Network Nonprofit & Community Support: Live Like JoJo Foundation The Meg Foundation (Pediatric Pain & Poke Plans)  Brave Bears Club (Epilepsy Support) Child Life Mommy CHYP  Connect with Brittany Follow Brittany's journey as she shares life as a medical mom, military spouse, and advocate.    Connect & Support from Child Life On Call  Subscribe: Never miss an episode on Apple Podcasts or Spotify. Visit insidethechildrenshospital.com to easily search stories and episodes Follow us on Instagram for updates and opportunities to connect with other parents Download SupportSpot: receive Child Life tools at your fingertips. Leave a Review: It helps other families find us and access our resources!   Keywords: Rare disease parenting, Medical motherhood, Medically complex child, Pediatric lung disease, Pediatric epilepsy, Intractable epilepsy, PICU parent experience, Military family healthcare, Parent advocacy in healthcare, Child life specialist support, Sibling support during hospitalization, Parenting after medical trauma, Coping with chronic illness, Undiagnosed disease journey, Hospital parent support Medical information provided is not a substitute for professional advice—please consult your care team  

EVEN MORE about this episode!Can diet, energy, and spiritual guidance play a role in healing epilepsy and chronic health challenges? Join Julie Ryan as she shares real-time medical intuitive insights, spirit guidance, and energetic scans—exploring epilepsy, healing diets, intuition, spirit messages, and the power of raising your vibration. Through energetic scanning, visualization, and spirit guidance, Julie explores how diet, intention, and frequency may support healing—sparking a deeper conversation about reclaiming personal power on any health journey.The episode continues with real-time readings and practical guidance for listeners around the world: messages from loved ones in spirit, energetic insights into digestive issues, and suggestions for supportive remedies—all woven together with compassion and clarity. From love and loss to companionship later in life, Julie shares wisdom drawn from both spirit and lived experience, reminding listeners that guidance is always available.You'll also hear moving stories involving pets as spirit guides, reassurance about a missing cat, and an honest exploration of navigating serious illness through both conventional and energetic support. This episode beautifully blends practicality with spirituality, offering hope, validation, and healing perspectives for anyone seeking answers, comfort, or a deeper connection to the unseen support all around us.Episode Chapters:(0:00:01) - Healing and Insights(0:13:45) - Messages From Beyond and Health Concerns(0:19:57) - Dating and Relationship Advice(0:23:49) - Pet Communication and Spirituality(0:28:52) - Guidance for Cancer Patient(0:43:43) - Health Insights for Pain(0:54:28) - Advice for Various Health Issues➡️Subscribe to Ask Julie Ryan YouTube➡️Subscribe to Ask Julie Ryan Español YouTube➡️Subscribe to Ask Julie Ryan Português YouTube➡️Subscribe to Ask Julie Ryan Deutsch YouTube➡️Subscribe to Ask Julie Ryan Français YouTube✏️Ask Julie a Question!

This episode covers epilepsy, particularly in children.Written notes can be found at https://zerotofinals.com/paediatrics/neurology/epilepsy/Questions can be found at https://members.zerotofinals.com/Books can be found at https://zerotofinals.com/books/The audio in the episode was expertly edited by Harry Watchman.

Welcome to the NeurologyLive® Mind Moments® podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice.In this Mind Moments episode, Benjamin Tolchin, MD, MS, FAAN, joins the podcast to provide clinical perspective on the recently published American Academy of Neurology (AAN) guidelines on functional seizures, drawing on his role as a contributing author to the recommendations. Tolchin, Director of the Center for Clinical Ethics at Yale New Haven Health and Associate Professor of Neurology at Yale School of Medicine, discusses what prompted the development of the first AAN guideline in this space and how the evidence base evolved to support formal recommendations. The conversation explores key considerations around diagnosing functional seizures, including history, semiology, EEG use, and the growing role of video documentation. Tolchin also addresses how clinicians should approach psychiatric comorbidities and co-occurring epilepsy, the evidence supporting psychological interventions, why pharmacologic therapies are not recommended for functional seizures themselves, and where major gaps remain in research to advance care in the years ahead.Looking for more Epilepsy discussion? Check out the NeurologyLive® Epilepsy clinical focus page.Episode Breakdown: 1:10 – Why growing evidence prompted the first AAN guideline on functional seizures 3:20 – Diagnostic priorities including history, semiology, EEG, and video documentation 6:15 – Assessing psychiatric comorbidities and co-occurring epilepsy in functional seizures 9:15 – Neurology News Minute 11:30 – Evidence supporting psychotherapy for functional seizures 14:50 – Pharmacological evidence and use of antiseizure medications for functional seizures 18:35 – Barriers to advancing clinical trials in functional seizures 22:05 – Research priorities to refine treatment and long-term outcomes The stories featured in this week's Neurology News Minute, which will give you quick updates on the following developments in neurology, are further detailed here: FDA Approves Subcutaneous Copper Histidinate as First Treatment for Pediatric Menkes Disease sBLA Acceptance Positions Efgartigimod as Potential First Therapy for Seronegative Myasthenia Gravis High-Dose Nusinersen Gains European Commission Approval for Spinal Muscular Atrophy Thanks for listening to the NeurologyLive® Mind Moments® podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com.

What if the very challenge you think is holding you back is actually the thing meant to launch you into your purpose?In this deeply inspirational and motivational podcast episode, Reginald D sits down with A'Santianna Austin is a 20-year-old award-winning author, speaker, poet, youth advocate and 2027 Grammy Nominated Spoken Word Artist — for a powerful, life-affirming motivational speech conversation on identity, resilience, faith, and purpose.  Less than one year after graduating college, A'Santianna published her debut book, "Melanated, Not Black," a poetic exploration of identity, culture, and self-definition.  "Melanated, Not Black," is now being used in public, private and alternative schools as well as juvenile detention centers. A'Santianna has also toured nationally and performed at HBCU's and college events.  A'Santianna leads Project 500 to empower 500 youth through literacy, mentorship and identity.Diagnosed with severe epilepsy at just eight years old, A'Santianna turned adversity into impact through storytelling, advocacy, and service. This inspirational motivational episode explores how challenges don't disqualify you—they refine you—and how faith, self-belief, and action can motivate you to rise beyond limitations and live with purpose.Many people—especially young adults—feel limited by their health, background, identity, or circumstances. This inspirational and motivational speech-driven episode speaks directly to listeners who feel unseen, unheard, or underestimated. Through.Press play now to experience this inspirational and motivational speech conversation and walk away empowered to turn your pain into purpose and your story into impact.A'Santianna's  Instagram: https://www.instagram.com/asantiannanijeanPurchase A'Santianna's book on Amazon:Amazon.com: MELANATED NOT BLACK: 9798262452439: AUSTIN, ASANTIANSend us a textSupport the showFor daily motivation and inspiration, subscribe and follow Real Talk With Reginald D on social media:Instagram: realtalkwithreginaldd TikTok: @realtalkregd Youtube: @realtalkwithreginald Facebook: realtalkwithreginaldd Twitter Real Talk With Reginald D (@realtalkRegD) / TwitterWebsite: Real Talk With Reginald D https://www.realtalkwithreginaldd.com Real Talk With Reginald D - Merchandise

 Goldstein's frustration with the medical system included long patient wait times of four to eight hours in emergency rooms and having to argue with insurance companies about necessary patient transfers to higher acuity facilities.A friend's breast cancer diagnosis and chemotherapy struggles prompted Goldstein to research cannabis in 2008, leading her to discover the endocannabinoid system and eventually work part-time in a medical cannabis practice in Los Angeles.Epilepsy and autism represent the top two conditions treated in Goldstein's pediatric cannabis practice, with one-third of pediatric epilepsy patients not responding to any pharmaceutical medications.Treatment protocols utilize primarily non-impairing cannabinoids like CBD, CBG, and CBDA, with THC used in medicinal doses that allow 70 to 80 percent of children to function without impairment.A remarkable case involved a nine-year-old patient with hundreds of daily seizures who progressed from being non-responsive in a stroller to saying "mama" at age 12-13, learning to crawl, feed herself, and use an iPad after years of cannabinoid treatment.Research demonstrates that longer treatment duration with CBD correlates with better outcomes, with patients showing optimal response rates at the two-year mark compared to one month or one year of treatment.CBD's effectiveness stems from its promiscuous nature, targeting over 75 different receptors including trip channels, adenosine enhancement, anandamide boosting, and GPR55 receptor blocking to reduce neuroexcitation and neuroinflammation.Different cannabis strains or chemovars contain varying amounts of similar compounds, requiring some patients to try 8, 10, or 15 different products before finding effective treatment, while others respond to any variety.Parents approach cannabis treatment with varying levels of apprehension, from immediate research after diagnosis to last-resort consideration after years of failed conventional treatments.Scientific literature now considers CBD an acceptable treatment for intractable pediatric seizures, with published research showing an 86% response rate for seizure reduction across multiple clinical studies.Environmental factors including increased chemical exposure, pesticide-laden foods like Cheerios, and processed foods contribute to the rising prevalence of childhood ailments compared to previous generations.Goldstein launched Goldstein Wellness in 2024, offering free comprehensive cannabis education to US licensed healthcare practitioners through 50+ videos and providing a free referral service connecting patients with educated clinicians in their states.Schedule 3 rescheduling will primarily benefit research opportunities and allow patients to cross state lines with their medicine, addressing the current problem where well children cannot travel to visit family members in other states.Research on autism patients revealed that children have lower levels of anandamide, an inner cannabis compound, and cannabinoid treatment can normalize biomarkers related to aggression, inflammation, and neuronal functioning while improving behaviors and family functioning. Visit our website: CannabisHealthRadio.comFind high-quality cannabis and CBD + get free consultations at MyFitLife.net/cannabishealthDiscover products and get expert advice from Swan ApothecaryFollow us on Facebook.Follow us on Instagram.Find us on Rumble.Keep your privacy! Buy NixT420 Odor Remover Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Send comments and feedbackAbout 1 in 5 people with an intellectual disability (ID) also have epilepsy; among those with profound ID, 1 in 2 also will have epilepsy. In general, people with an ID have higher mortality rates and more chronic conditions than people without an ID; they also face significant health care disparities. Researchers interviewed people with both epilepsy and an ID to understand what they knew about their epilepsy, how they accessed care, and what epilepsy-related information they wanted to have. Sharp Waves episodes are meant for informational purposes only, and not as clinical or medical advice.Let us know how we're doing: podcast@ilae.org.The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Instagram, and LinkedIn.

Stem cell science is reshaping treatment for complex disorders of the brain and spinal cord. Researchers develop cell based therapies to replace lost dopaminergic neurons in Parkinson's disease, fill gaps across spinal cord injuries, and calm seizure networks in refractory epilepsy by restoring the balance of inhibition and excitation. Teams test immune cell therapies against Epstein Barr virus infected B cells in multiple sclerosis and collaborate to move treatments across the blood brain barrier to reach diseased cells. Clinicians combine imaging in the operating room, surgical tools, and research on biological age and the pace of aging to understand disease and guide treatment. Patient advocates describe challenges and hopes for better options, and contemporary art reflects on perception in digital and physical worlds. Series: "Stem Cell Channel" [Health and Medicine] [Science] [Show ID: 40992]

0:30 - Epilepsy & Seizures Tangent2:30 - Westboro Baptist Church & Religious Extremism11:50 - Wrestling News: Roster Moves & Returns14:00 - Powerhouse Hobbs Leaves AEW for WWE24:00 - Tony Khan's Creative Control Comments26:50 - AEW vs WWE Perception & Talent Comparison33:00 - Tiffany Stratton's Return from Injury37:50 - Character Development Issues in WWE45:30 - Baron Corbin's Bizarre AEW Creative Pitch (Don Callis Family Biker Gang)51:30 - NWO Comparisons & Faction Building54:10 - R-Truth Retirement Plans56:30 - CM Punk Retiring at 5058:30 - WWE's Aging Roster & Future Stars1:02:00 - Cody Rhodes & Fan Interaction After Shows1:14:40 - Rikishi Complains About WWE Ticket Prices1:18:30 - Legends Contract & Complimentary Tickets1:19:00 - CJ Perry (Lana) Returns to Wrestling & Stand-Up Comedy1:28:50 - Nikki Bella's Drinking Habits Controversy1:31:20 - Wrap-Up & Patreon PlugBecome a supporter of this podcast: https://www.spreaker.com/podcast/wrestling-soup--1425249/support.

Epilepsy affects millions, but few people know about the fascinating relationship between music and epilepsy, and that research is looking at how music may help reduce seizure activity in some individuals. Dr. Phillip Pearl, Harvard neurologist and professional jazz musician, shares how sound is being studied as a tool in epilepsy care (and many other applications). Links and notes related to this episode can be found at https://mpetersonmusic.com/podcast/episode226 Connect with us: Newsletter: https://mpetersonmusic.com/subscribe Facebook: https://www.facebook.com/EnhanceLifeMusic/ Instagram: https://www.instagram.com/enhancelifemusic/ LinkedIn: https://www.linkedin.com/in/mpetersonpiano/ X: https://twitter.com/musicenhances Sponsorship information: https://mpetersonmusic.com/podcast/sponsor Leave us a review on Podchaser.com! https://www.podchaser.com/podcasts/enhance-life-with-music-909096 In-episode promo: Sheet Music Direct https://www.sheetmusicdirect.com

In the second part of this series, Dr. Neishay Ayub discusses levetiracetam and one of its most common side effects, irritability.  Show citations:  Abou-Khalil B. Levetiracetam in the treatment of epilepsy. Neuropsychiatr Dis Treat. 2008;4(3):507-523. doi:10.2147/ndt.s2937  Löscher W, Gillard M, Sands ZA, Kaminski RM, Klitgaard H. Synaptic Vesicle Glycoprotein 2A Ligands in the Treatment of Epilepsy and Beyond. CNS Drugs. 2016;30(11):1055-1077. doi:10.1007/s40263-016-0384-x Rogawski MA. Brivaracetam: a rational drug discovery success story. Br J Pharmacol. 2008;154(8):1555-1557. doi:10.1038/bjp.2008.221 Ulloa CM, Towfigh A, Safdieh J. Review of levetiracetam, with a focus on the extended release formulation, as adjuvant therapy in controlling partial-onset seizures. Neuropsychiatr Dis Treat. 2009;5:467-476. doi:10.2147/ndt.s4844 Wu PP, Cao BR, Tian FY, Gao ZB. Development of SV2A Ligands for Epilepsy Treatment: A Review of Levetiracetam, Brivaracetam, and Padsevonil. Neurosci Bull. 2024;40(5):594-608. doi:10.1007/s12264-023-01138-2 Mahmoud A, Tabassum S, Al Enazi S, et al. Amelioration of Levetiracetam-Induced Behavioral Side Effects by Pyridoxine. A Randomized Double Blind Controlled Study. Pediatr Neurol. 2021;119:15-21. doi:10.1016/j.pediatrneurol.2021.02.010 Major P, Greenberg E, Khan A, Thiele EA. Pyridoxine supplementation for the treatment of levetiracetam-induced behavior side effects in children: preliminary results. Epilepsy Behav. 2008;13(3):557-559. doi:10.1016/j.yebeh.2008.07.004 Romoli M, Perucca E, Sen A. Pyridoxine supplementation for levetiracetam-related neuropsychiatric adverse events: A systematic review. Epilepsy Behav. 2020;103(Pt A):106861. doi:10.1016/j.yebeh.2019.106861 Show transcript:  Dr. Neishay Ayub: Hello, my name is Neishay Ayub, and today we will be discussing levetiracetam and one of its most common side effects, irritability. While levetiracetam can be remarkably helpful for patients, behavioral adverse effects were noted in post-marketing analysis and open-label studies in adult and pediatric patients. For this, physicians started using vitamin B6 supplementation, particularly in the pediatric populations. Why would physicians use B6? Well, low vitamin B6 has been associated with neuropsychiatric disorders, which could be related to the fact that vitamin B6 is an essential co-factor for several neurotransmitters that affect mood and behavior, such as serotonin, dopamine, and GABA. There is an epilepsy syndrome associated with vitamin B6 deficiency. And vitamin B6 deficiency is seen with enzyme-inducing anti-seizure medications, although levetiracetam is not an enzyme-inducing seizure medication. These are some of the possibilities as to why vitamin B6 supplementation was initially explored. Some initial anecdotal evidence and case reports were suggested that it was helpful in reducing behavioral side effects and the need to discontinue levetiracetam. There was a meta-analysis reviewing pyridoxine use, which included 11 case reports and retrospective studies, as well as one prospective study, case-control study, which was not placebo controlled. While evidence was suggestive of a benefit, the quality of the evidence was poor due to selection, reporting, and assessment biases. Overall, the authors recommended a larger randomized, controlled, double-blind trial with adequate statistical power, well-defined eligibility criteria and standardized assessment tools to evaluate B6 efficacy in treating levetiracetam-induced irritability. Since then, there was one small randomized, controlled, double-blind study involving 105 children for whom neuropsychiatric adverse effects were noted after levetiracetam was introduced. Children were randomized to receive a therapeutic dose of pyridoxine, which was 10 to 15 milligrams per kilogram per day, up to 200 milligrams, or a homeopathic dose of 0.5 milligrams per kilogram per day. They were scored on a behavioral checklist and monitored for up to six months. While there was a reduction in behavioral symptoms reported in the therapeutic pyridoxine group, there was no validated assessment tools used, and there was an absence of a true placebo group. Lastly, there are a few studies reporting on adverse effects of B6 toxicity, which is possible, but it's typically seen at higher daily doses, although something to keep in mind if considering B6 supplementation. In summary, while there has been a clinical practice of prescribing pyridoxine at 50 to 100 milligrams as a low-cost, well-tolerated adjunctive supplement, there may be a modest benefit for some patients, but the overall efficacy for the treatment of neuropsychiatric side effects for levetiracetam remain unclear, and more evidence is needed. 

In part one of this two-part series, Dr. Neishay Ayub discusses the history of a novel anti-epileptic drug, levetiracetam.  Show citations:  Abou-Khalil B. Levetiracetam in the treatment of epilepsy. Neuropsychiatr Dis Treat. 2008;4(3):507-523. doi:10.2147/ndt.s2937  Löscher W, Gillard M, Sands ZA, Kaminski RM, Klitgaard H. Synaptic Vesicle Glycoprotein 2A Ligands in the Treatment of Epilepsy and Beyond. CNS Drugs. 2016;30(11):1055-1077. doi:10.1007/s40263-016-0384-x Rogawski MA. Brivaracetam: a rational drug discovery success story. Br J Pharmacol. 2008;154(8):1555-1557. doi:10.1038/bjp.2008.221 Ulloa CM, Towfigh A, Safdieh J. Review of levetiracetam, with a focus on the extended release formulation, as adjuvant therapy in controlling partial-onset seizures. Neuropsychiatr Dis Treat. 2009;5:467-476. doi:10.2147/ndt.s4844 Wu PP, Cao BR, Tian FY, Gao ZB. Development of SV2A Ligands for Epilepsy Treatment: A Review of Levetiracetam, Brivaracetam, and Padsevonil. Neurosci Bull. 2024;40(5):594-608. doi:10.1007/s12264-023-01138-2 Mahmoud A, Tabassum S, Al Enazi S, et al. Amelioration of Levetiracetam-Induced Behavioral Side Effects by Pyridoxine. A Randomized Double Blind Controlled Study. Pediatr Neurol. 2021;119:15-21. doi:10.1016/j.pediatrneurol.2021.02.010 Major P, Greenberg E, Khan A, Thiele EA. Pyridoxine supplementation for the treatment of levetiracetam-induced behavior side effects in children: preliminary results. Epilepsy Behav. 2008;13(3):557-559. doi:10.1016/j.yebeh.2008.07.004 Romoli M, Perucca E, Sen A. Pyridoxine supplementation for levetiracetam-related neuropsychiatric adverse events: A systematic review. Epilepsy Behav. 2020;103(Pt A):106861. doi:10.1016/j.yebeh.2019.106861 Show transcript:  Dr. Neishay Ayub: Hello, my name is Neishay Ayub, and today we are discussing the history of a novel anti-epileptic drug, levetiracetam. It's a story of a scientific dead end, a radical new testing method, and a mystery that took years to unravel. To set the scene, let's go back to 1974. The pharmaceutical company, UCB Pharma, was working on compounds to boost cognitive function. They were looking for a successor to their drug piracetam. During this research, levetiracetam was first synthesized, but the compound didn't show any significant brain-boosting effects. With no discernible purpose, it was filed away and largely forgotten. For nearly two decades, this medicine sat on a shelf an anonymous entry in a long list of failed drug candidates. The story could have ended there, but in the early 1990s, researchers took a different approach to drug discovery. Researchers screened their entire library of forgotten compounds against audiogenic seizure-susceptible mice. These are mice prone to seizures triggered by sound. Levetiracetam was incredibly ineffective in chronic epileptic mice. Interestingly, levetiracetam had previously failed traditional screening tests which was to prevent acute seizures in normal animals subjected to maximal electroshock or pentylenetetrazole. Levetiracetam was pushed forward to human clinical trials and was found to be efficacious in three placebo-controlled, randomized, blinded clinical trials for adults with refractory focal epilepsy. Two of the clinical trials reviewed levetiracetam three grams per day compared to placebo. They found the responder rate, i.e., 50% reduction in seizure frequency, was 39% to 42% for patients on three grams per day versus placebo at 10% to 16% when used as adjunctive therapy. One of these trials also used levetiracetam as monotherapy, noting a median percent reduction in focal seizure frequency of 73%, a responder rate of 59%, and 18% of patients achieving seizure freedom. In November 1999, the FDA gave its approval for adjunctive treatment of partial onset seizures. While levetiracetam was effective, how it worked was still unclear. It didn't affect the ion channels and neurotransmitter receptors that older, more traditional anti-epileptic drugs targeted. Eventually in 2004, scientists made another breakthrough. They identified the drug's primary molecular target, a protein called SV2A. This protein is involved in regulating the release of neurotransmitters. Instead of suppressing all neurologic activity, levetiracetam appears to bind to SV2A and selectively modulate neurotransmitter release in overactive seizing neurons. This precise mechanism is why it has such a favorable side effect profile. With the mystery solved and a novel mechanism understood, levetiracetam continues to be a popular anti-seizure medication to this day, and its use has been expanded. Further clinical trials led to FDA approvals for use in adult and pediatric patients with myoclonic epilepsy for myoclonic seizures as well as adult and pediatric patients with idiopathic generalized epilepsy for primary generalized tonic-clonic seizures. There is an off-label use for status epilepticus and seizure prophylaxis in TBI, in traumatic brain injury, subarachnoid hemorrhage, and neurosurgical cases. Formulations have also expanded to include tablets and liquid formulations for immediate release, extended-release tablets, and intravenous formulations. Today, with the original patent expired, generic versions are available, making this treatment accessible to millions. The journey of levetiracetam from an abandoned compound to a frontline treatment is a powerful reminder that in science, a failure might just be a success waiting to be tested in a different way.

Dr. Elinor Ben-Menachem, epileptologist, researcher and professor at Sweden's University of Gothenburg, shares insights and experiences from her 40-plus years working with clinical trials and providing care to refractory epilepsy patients.