Podcasts about seizures

In part one of this two-part series, Dr. Jeff Ratliff and Dr. Brin E. Freund discuss the incidence of acute symptomatic seizures during CAR T-cell therapy.  Show reference:  https://www.neurology.org/doi/10.1212/WNL.0000000000213535   

Dr. Jeff Ratliff talks with Dr. Brin E. Freund about the evaluated incidence and risk factors for acute symptomatic seizures during CAR T-cell therapy. Read the related article in Neurology®.  Disclosures can be found at Neurology.org. 

Host: Mindy McCulley, MS Family and Consumer Sciences Extension Specialist for Instructional Support, University of Kentucky  Guest: Alex Elswick, PhD Extension Specialist for Substance Use Prevention and Recovery Season 7, Episode 51 On this episode of Talking FACS we tackle a pressing issue often misunderstood—the impact of drug seizures on the addicted community.  Join host Mindy McCulley, Extension Specialist, and expert guest Dr. Alex Elswick, Assistant Extension Professor for Substance Use Prevention and Recovery, as they delve into the counterintuitive study examining the real effects of drug seizures. Discover how law enforcement actions in Indianapolis (a city very similar to Lexington) rather than reducing drug use, inadvertently lead to increased overdose rates. Through engaging discussion, learn about the unintended consequences of disrupting drug supplies, the complexities of addiction, and why current drug policies might need reevaluation. Dr. Elswick explains the necessity for pragmatic approaches and potential solutions, providing listeners with a deep understanding of this critical issue affecting our communities. Connect with FCS Extension through any of the links below for more information about any of the topics discussed on Talking FACS. Kentucky Extension Offices UK FCS Extension           Website           Facebook           Instagram           FCS Learning Channel

Dr. Halley Alexander talks with Dr. Serena Yin about the effectiveness of an electronic medical record best practice alert in preventing iatrogenic interventions for patients with a diagnosis of psychogenic nonepileptic seizures. Read the related article in Neurology® Clinical Practice.  Disclosures can be found at Neurology.org. 

Modern Low Dose Insulin For Average Lifters & The Old School Methods That Got Guys Fat Plus Steroid QA DNS Podcast Dave Crosland & Scott McNally 0:00 teaser/Insulin protocols 0:55 intro and advertisers 2:00 Your Comments on Legal Cycles From Your Doctor 5:30 Primo and Mast Are Coming Back?! 6:20 ***Insulin For Average Bros **** 9:45 Old School Insulin Protocols 14:30 Modern Insulin Protocols 18:40 Insulin Precautions 21:45 Ask Follow Up Questions On Insulin 22:50 Truenutrition.com code THINK 24:30 Face turning red on gear ? 25:50 Seizures coming off cycle 27:20 TRT “add ons” 28:20 How much bacteriostatic water in GH? 29:35 SARMs competition for the AR (Androgen Receptor) 31:15 Test/Primo to Test/EQ 37:45 MENT Sides compared to Tren 40:40 Frequency for Test Cyp shots 43:40 Insomnia from TRT? 45:10 Scott's SLU-PP-332 Update 49:15 Which is stronger? 150 Tren vs 600 Deca? 51:30 Is Retatrutide Anabolic? 52:30 Uncle Dave's Wisdom

Dr. Halley Alexander and Dr. Samuel W. Terman discuss patients' perceived seizure risk, seizure risk tolerance, and risk counseling techniques.  Show reference: https://www.neurology.org/doi/10.1212/CPJ.0000000000200475 

Today Pastor Stan shows us through Prophecies that Massive Arrests, Bank Seizures and a new Republic is possible after this coming Parade on June 14th. Could we see Trump as King? A new Flag or even a new Digital Dollar? 00:00 Watch Points 02:13 Trump’s Military Parade 07:46 Massive Arrests 11:14 Bank Seizures 13:52 Prophecies 20:37 New Republic 25:56 Our Sponsors

Today Pastor Stan shows us through Prophecies that Massive Arrests, Bank Seizures and a new Republic is possible after this coming Parade on June 14th. Could we see Trump as King? A new Flag or even a new Digital Dollar? 00:00 Watch Points 02:13 Trump’s Military Parade 07:46 Massive Arrests 11:14 Bank Seizures 13:52 Prophecies 20:37 New Republic 25:56 Our Sponsors

Dr. Halley Alexander talks with Dr. Samuel W. Terman about patients' perceived seizure risk, seizure risk tolerance, and risk counseling techniques.  Read the related article in Neurology® Clinical Practice.  Disclosures can be found at Neurology.org. 

Dr. Katie Krulisky and Dr. Leah Blank discuss the impact of outpatient follow-up on readmission rates for older adults with epilepsy or seizures.  Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000213638 

What is consciousness?! Paediatric resident Dr. Kayleigh Marcinski Nascimento invites you to take part in a new study aimed at understanding the terminology surrounding “consciousness” during focal  (formerly known as partial) seizures; emphasising the need for clear communication between clinicians and caregivers! The chat also covers the importance of diverse input in research and how the data collected will be used to improve patient care. ------------------------------------------

In this deeply personal episode of Money on My Mind, I walk you through the emotional and financial rollercoaster that followed what seemed like the perfect move for our family. We left everything behind to relocate for our daughter's specialized medical care—only to discover our dream home was poisoning her. A hidden mold and mycotoxin issue triggered severe health setbacks and cost us nearly $300,000 in recovery expenses.   From dealing with a rare epilepsy diagnosis to losing almost all our possessions and scrambling to relocate again, this episode is a raw, transparent look at how fast life can shift. More importantly, I talk about the mindset and financial preparation that allowed us to move quickly and decisively—and how this experience completely redefined my understanding of wealth.   Timeline Summary   [0:00] - Why our dream home nearly destroyed our health and finances [1:10] - Our daughter's diagnosis with Dravet syndrome [1:54] - Relocating to Texas for expert care and a miraculous 8-month stretch [2:50] - Seizures return, triggering deeper investigation [4:07] - Blood and urine tests reveal shocking mold exposure [5:56] - Emergency travel to Iowa for treatment amid chaos [7:19] - Realizing we had to abandon our home and everything in it [8:52] - Financial pressure mounts as we scramble to protect our daughter [10:00] - How years of financial planning helped us weather the storm [14:04] - Losing 99% of our belongings due to contamination [15:12] - The breakdown of the $300K cost: housing, health, and recovery [16:46] - What money can't fix—and what really matters [18:46] - How this crisis reshaped my perspective on wealth [20:25] - Preventative measures we've taken to safeguard our new home [21:37] - What are you putting off that's costing you peace of mind?   Key Takeaways   Prepare financially for the unexpected. You never know when a crisis will hit. Building financial flexibility gave us the ability to make life-saving decisions without hesitation. Health is the real wealth. No amount of money is worth more than your family's well-being. Prioritize health investments now before you're forced to later. Don't wait for crisis to force change. If something is causing you low-grade stress or health concerns today, deal with it now—because the cost of waiting can be far greater.     Links & Resources   Infinity Wellness Clinic (Josh, Iowa location) Dravet Syndrome Foundation: dravetfoundation.org Home air quality resources: AirDoctor, dehumidifiers, air scrubbers   If this episode made you think twice about how you define wealth, I'd love for you to rate, follow, and review the show. And if you know someone who could benefit from this story, share it with them. See you next week!

Dr. Katie Krulisky talks with Dr. Leah Blank about the impact of outpatient follow-up on readmission rates for older adults with epilepsy or seizures. Read the related article in Neurology®.  Disclosures can be found at Neurology.org. 

In the concluding segment of this series, Dr. Halley Alexander and Dr. Coral M. Stredny delve into the essential components of seizure action plans and identify the individuals who should have one. Show reference:  https://www.neurology.org/doi/10.1212/CPJ.0000000000200449  

Synthetic drugs including artificial substances that mimic cannabis, heroin and stimulants pose an emerging threat to Europe. That is the warning coming from the EU drug agency, which has documented “unprecedented imports and seizures” of synthetic cathinones. These are chemically similar to cathinone, a stimulant. The “rising availability” of fake medicines containing highly potent nitazenes - a synthetic opioid that led to overdose outbreaks in Dublin and Cork at the end of 2023 and in several Irish prisons last year – are also being highlighted by the EU Drug Agency in its European Union Drug Report 2025. The agency is also pointing to a doubling in the strength of cannabis resin over the last decade, the risks posed by high-potency cannabis extracts and edibles, and the rapid spread of semi-synthetic cannabinoids. To discuss this further, Alan Morrissey was joined by TD, Donna McGettigan and Addiction Counsellor, Michael Guerin.

In part one of this two-part series, Dr. Halley Alexander and Dr. Coral M. Stredny discuss the importance of seizure action plans and how this might translate into our clinical care.  Show reference:  https://www.neurology.org/doi/10.1212/CPJ.0000000000200449   

Dr. Halley Alexander talks with Dr. Coral M. Stredny about the management of pediatric convulsive status epilepticus, focusing on the importance of seizure action plans and adherence to treatment protocols.  Read the related article in Neurology® Clinical Practice.  Disclosures can be found at Neurology.org. 

In the final episode of this three-part series, Dr. Jodie Roberts and Dr. Urs Fisch discuss functional/dissociative seizures and driving risk.  Learn more about the Neurology® Practice Current section and fill out the current survey on functional/dissociative seizures and driving. 

In part two of this three-part series, Dr. Jodie Roberts and Dr. Barbara A. Dworetzky discuss how often seizure-like or seizure-resembling episodes lead to a diagnosis of functional neurologic disorder.  Learn more about the Neurology® Practice Current section and fill out the current survey on functional/dissociative seizures and driving. 

Dr Mrinmayee Takle and Dr Kuntal Sen discuss the challenging dilemma of a child, presenting from infancy with recurrent seizures and three different (wrong) diagnoses including opsoclonus-myoclonus-ataxia syndrome. Read the article: https://doi.org/10.1002/cns3.20098 Mrinmayee Takle, Dhwani Sahjwani, Diana Bharucha-Goebel, Tyler Rapp, Cecilia Bouska, Alexandra Kornbluh, Kuntal Sen

In part one of this three-part series, Dr. Jodie Roberts and Dr. Barbara A. Dworetzky discuss the term "functional seizures" and clarify the terminology.  Learn more about the Neurology® Practice Current section and fill out the current survey on functional/dissociative seizures and driving. 

Gráinne Power, Director of Compliance, HPRA discusses seizures by the Revenue Commissioners of what are purporting to be weight-loss products.

Unlocking Peak Health & Performance with Zoe KarliWhat if the key to optimizing your health, energy, and performance lies in precision? In this episode, I sit down with Zoe Karli, founder of Zeta Body and president of Greyledge Technologies, to discuss how targeted lifestyle choices and high-quality supplements can transform your well-being.Zoe shares her personal journey of managing grand mal (tonic-clonic) seizures through exact medication formulations—where even the slightest variation could impact effectiveness. This understanding of precision is reflected in Zeta Body supplements.  Alongside her husband, Dr. David Karli, a world-renowned regenerative medicine specialist, Zoe is reshaping the future of health. Together, they combine science and passion to empower people to unlock their full potential.Connect with Zoe Karli:

On this episode of Talk About It, we break out the Gold Jacket to chat with Alan Faneca, retired NFL offensive lineman and NFL Hall of Fame Inductee! Alan and Greg have become friends through advocacy for epilepsy awareness over the years, because Alan was diagnosed with epilepsy when he was a teenager and played at the highest levels of football with the condition. He also has a daughter with a rare form of epilepsy, so this cause is really close to his heart. Ironically, Nick also has a connection to Alan through his time with the Pittsburgh Steelers and hosting events together, so this is really a friend reunion show! They discuss his diagnosis, how his family helps him deal with the condition, going through the process again with his daughter, and - of course - his induction into the NFL Hall of Fame in Canton, OH. This is an episode that you are seriously not going to want to miss! The Talk About It podcast is excited to be sponsored in part by Neurelis. The Talk About It podcast is excited to also be sponsored in part by Seizures Are Signs — dedicated to educating families on the importance of early and specific diagnosis by providing an assessment to help get the conversation started, educational information, stories from families who have found a diagnosis, links to advocacy groups, and more. For more information, go to SeizuresAreSigns.com. Seizures are Signs is made available by Jazz Pharmaceuticals.

In this episode of The Jerich Show, Erich Kron and Javvad Malik dive headfirst into the week's most curious, cringeworthy, and critical cybersecurity stories. First up: a global honeypot powered by over 5,300 compromised Cisco devices—courtesy of the ViciousTrap botnet. Then, it's schadenfreude central as the developers of DanaBot malware accidentally infect themselves. Karma, meet keyboard. We'll also unpack Europol's massive takedown of ransomware infrastructure, which led to the seizure of 300 servers and €3.5 million in crypto. Not to be outdone, two ATM heist suspects made their arrest even easier... by taking selfies mid-crime. And finally, the UK's NCSC shows us how to securely retire old tech—because tossing servers in the skip just isn't secure policy. Join Erich and Javvad for sharp takes, security snark, and the cybersecurity fails you'll want to learn from (or at least laugh at).

In this conversation, Joel Evan interviews Don Dillon, the CEO and founder of Sound Foods, who shares his remarkable journey from a Navy veteran facing severe health challenges to an innovator in the health and wellness market. Don discusses the unique technology behind his nutrient-rich food bars, which utilize ultrasonic technology and microencapsulation to preserve nutrients and enhance flavor. He emphasizes the importance of clean ingredients and the potential for his products to address nutritional deficiencies in various populations, including military personnel and those in need globally. The conversation also touches on the misconceptions surrounding nutrition, the impact of toxins, and the future of food innovation.Chapters00:00 Introduction to Don Dillon and Sound Foods03:04 Don's Journey: From Navy to Health Innovator06:00 The Impact of Seizures and Recovery Journey09:00 The Birth of Sound Foods and Healthy Snack Bars11:45 Innovative Technology in Food Production15:00 Microencapsulation and Nutrient Preservation18:05 Future of Food: Integrating Supplements into Snacks19:54 Innovative Nutritional Solutions26:35 Addressing Global Nutritional Needs32:33 Personal Health Journeys and Insights34:17 Challenging Nutritional Myths39:28 Future of Food Technology

What can you do to protect yourself from the IRS and their actions? This may just be the solution you are looking for! Do you have tax debt? Call us at 866-8000-TAX or fill out the form at https://choicetaxrelief.com/If you want to see more…-YouTube:    / @loganallec  -Instagram: @ChoiceTaxRelief @LoganAllec -TikTok: @loganallec-Facebook: Choice Tax Relief // Logan Allec, CPA -Reddit: u/Logan_Allec

Last year, both Belgium and the Netherlands, home to the key ports of Antwerp-Bruges and Rotterdam, reported a dramatic decline in the volume of cocaine seized. As the traditional gateways into Europe for legal as well as illegal cargo, this is surely cause for celebration, or at the very least a pat on the back. The only problem? Seizures in Portugal, Italy, Greece and other southern European countries increased. Which begs the question, how on earth do you stop smuggling? Lloyd's List reporter Joshua Minchin again speaks to four experts at the very frontline in the fight against smuggling to understand how public-private cooperation can identify high-risk containers and push back against what can seem like an incessant tide. Plus, UNODC's Bob van den Berghe explains how work in source countries can prevent illegal cargo ever getting on board a commercial vessel and strengthen relationships between law enforcement agencies at opposite sides of an ocean. Joining Joshua on the podcast are: • Joe Kramek, chief executive, World Shipping Council • Bob Van den Berghe, deputy head PCCP, UN Office on Drugs and Crime • Niels Vanlaer, harbour master at the port of Antwerp-Bruges • Robert Campbell, programme director, United for Wildlife

This lecture provides a comprehensive overview of the constitutional foundations of criminal procedure law, focusing on the Fourth Amendment. It explores the sources of criminal procedure, the significance of judicial interpretation, and the balance between law enforcement and individual rights. Key topics include the definitions of searches and seizures, warrant requirements, exceptions to these requirements, and the implications of modern technology on privacy rights. The lecture concludes with a discussion on the exclusionary rule and its impact on the justice system.TakeawaysThe Fourth Amendment establishes protections against unreasonable searches and seizures.Judicial decisions play a crucial role in interpreting constitutional provisions.The concept of reasonable expectation of privacy is central to Fourth Amendment analysis.Warrants must be issued by a neutral magistrate based on probable cause.Exceptions to the warrant requirement include searches incident to arrest and exigent circumstances.The exclusionary rule prevents illegally obtained evidence from being used in court.The good faith exception allows some leeway for law enforcement actions.Modern technology poses new challenges to Fourth Amendment protections.The open fields doctrine limits privacy rights in areas outside the home.Policy debates continue regarding the balance between law enforcement and individual rights.Criminal Procedure, Fourth Amendment, Searches, Seizures, Warrant Requirements, Exclusionary Rule, Privacy Rights, Law Enforcement, Constitutional Law, Judicial Interpretation

What happens when your brain betrays you with seizures that arrive without warning and leave you depressed for days? Meet Landis, a writer and podcaster who developed epilepsy after brain tumor surgery at age 32. In this illuminating conversation, she breaks down the reality of living with seizures that arrive without warning, including the four-day depression cycle that follows each episode. From creating a post-seizure self-care system complete with personal reminders, to experiencing fascinating "auras" where her brain conjures fictional characters like "Mrs. Bit Binder," Landis shares it all with remarkable honesty and humor. She also discusses how epilepsy affected her dating life (including having a seizure during some hanky panky sexy times!), the service dog who detects her seizures before they happen, and how this condition has simultaneously limited her independence while deepening her appreciation for life's small moments. A powerful reminder of resilience in the face of chronic illness.You can watch this entire episode over on YouTube!Check out Landis' podcast "What The Ef"Follow Sickboy on Instagram, TikTok and Discord.

What happens when your brain betrays you with seizures that arrive without warning and leave you depressed for days? Meet Landis, a writer and podcaster who developed epilepsy after brain tumor surgery at age 32. In this illuminating conversation, she breaks down the reality of living with seizures that arrive without warning, including the four-day depression cycle that follows each episode. From creating a post-seizure self-care system complete with personal reminders, to experiencing fascinating "auras" where her brain conjures fictional characters like "Mrs. Bit Binder," Landis shares it all with remarkable honesty and humor. She also discusses how epilepsy affected her dating life (including having a seizure during some hanky panky sexy times!), the service dog who detects her seizures before they happen, and how this condition has simultaneously limited her independence while deepening her appreciation for life's small moments. A powerful reminder of resilience in the face of chronic illness.You can watch this entire episode over on YouTube!Check out Landis' podcast "What The Ef"Follow Sickboy on Instagram, TikTok and Discord.

Dr. Halley Alexander discusses the Neurology Today article, “The AAN Updates Its Position Statement on Seizures, Driver Licensure, and Medical Reporting,” by Gina Shaw, available in the latest issue of Neurology Today or at neurologytoday.com.  Show reference: The AAN Updates Its Position Statement on Seizures, Driver Licensure, and Medical Reporting

In V.E. Shwab's bestselling novel, A Conjuring of Light, she wrote, "Kings need not raise their voices to be heard." But on this episode of Talk About It, Greg talks to a King who is being heard not by raising his voice, but by writing a book of his own! That book is called Be There When I Return, and it is out NOW everywhere books are sold. Michael King seemed to have everything going his way as a young bartender in 1980's Los Angeles until his friends began to notice a bizarre quirk in his behavior, but he is not aware of it happening. After the closest people in his life convince him to see a doctor, he is hit with the reality of an epilepsy diagnosis and drags through years of not being able to control his seizures. He ends up becoming a candidate for an experimental surgery, but his family doesn't know if he will remember them when he wakes up. We'll let Michael fill in the rest of this story, but you don't want to miss this episode!  The Talk About It podcast is excited to be sponsored in part by Neurelis. The Talk About It podcast is excited to also be sponsored in part by Seizures Are Signs — dedicated to educating families on the importance of early and specific diagnosis by providing an assessment to help get the conversation started, educational information, stories from families who have found a diagnosis, links to advocacy groups, and more. For more information, go to SeizuresAreSigns.com. Seizures are Signs is made available by Jazz Pharmaceuticals.

A teenager who collapsed in a park in Ashford has been diagnosed with rare heart disorder after previous seizures were blamed on ‘anxiety'. The 16-year-old survived the ordeal but she has been left brain damaged – her family say her illness should have been detected much sooner. Also in today's podcast, dogs will be kicked off many of Kent's most popular beaches from today to make way for visitors coming to the coast this summer.The rules, in place until September 30, could see any dog walker caught breaking the rules risking a £100 fine – we've been on the coast to get reaction. Free rape alarms are being offered to all residents in a village after multiple flashing incidents were reported.One perpetrator is said to have exposed themselves to terrified women on several occasions near Whitstable last year.A village pub is set to have its licence reviewed over alleged fire safety failings.Kent Fire and Rescue Service has made a formal request to Medway Council to review the licence of the boozer in High Halstow over inadequate fire safety assessments and warning systems.And a pregnant Orangutan at at Kent animal park has been trained to have ultrasound scans like a human. Awan is critically endangered and the imminent arrival at Wingham near Canterbury is being seen as significant for the conservation of the species.

In this episode, the moms discuss the complex relationship between seizures and autism, sharing personal stories and insights. They explore how seizures can manifest in individuals with autism and discuss various coping strategies for families affected by these challenges. Listeners will better understand the neurological aspects at play and treatment options. The episode aims to foster awareness, encouraging open dialogue about the struggles and triumphs of those navigating this journey. We hope you listen and share it with others. Thank you for connecting with us!If you like our podcast, please share, review, and subscribe! You can find us at:⁠⁠⁠⁠⁠⁠⁠⁠Navigating Adult Autism on Facebook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Navigatingadultautismpodcast on Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Navigatingadultautism.com⁠⁠⁠⁠⁠⁠⁠⁠You can also find Heather Woodring write about her son Zachary at⁠⁠⁠⁠⁠⁠⁠⁠Everyday Adventures with Zachary on Facebook

Toddlerhood comes with lots of surprises, and some can be a little scary.  Have you ever noticed your little one zoning out or holding their breath and that made you pause and question, “Is that normal?” You're not alone. Toddler spells can be alarming for parents, and it can be hard to tell the difference between a harmless toddler spell and a seizure.   In this episode, we're joined by two pediatric neurologists, Dr. Marissa Vawter-Lee and Dr. Barbara Hallinan, to break down toddler spells vs. seizures. We talk about common toddler spells—like breath-holding or staring spells— what they look like, and what to do in the moment. We also cover how to tell a spell from a seizure, including signs and symptoms of seizures and what you should and shouldn't do if your child is having a seizure. 

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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 episode, "Sleep and Seizures: Emerging Insights From AAN 2025," Nancy Foldvary-Schaefer, DO, director of the Sleep Disorders Center at Cleveland Clinic, reflected on key sleep-related topics presented at this year's AAN Annual Meeting. She highlighted the growing clinical interest in underrecognized conditions like idiopathic hypersomnia and narcolepsy, stressing the need for better awareness and earlier diagnosis. Foldvary-Schaefer also detailed the development of the Sleep by Cleveland Clinic mobile app, designed to improve screening for common sleep disorders with validated tools and real-time resources. Additionally, she discussed new findings on the prevalence of obstructive sleep apnea in adults with epilepsy, pointing to the importance of routine sleep screening in this population, regardless of seizure severity. Finally, she shared exploratory data on SSRI use and peri-ictal respiratory patterns in epilepsy, offering new perspectives on potential protective mechanisms tied to SUDEP risk. Looking for more neuromuscular discussion? Check out the NeurologyLive® Sleep disorders clinical focus page. Episode Breakdown: 1:00 – Key sleep topics discussed at AAN 2025 and the growing interest in hypersomnia 5:45 – Development and purpose of the SLEEP mobile app by Cleveland Clinic 10:35 – Findings on obstructive sleep apnea prevalence in adults with epilepsy 15:05 – Neurology News Minute 17:10 – The need for sleep disorder screening in epilepsy clinical trials 19:45 – Exploratory findings on SSRI use and respiratory patterns in patients with epilepsy 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 Pre-Filled Syringe Administration for FcRn Modulator Efgartigimod FDA Approves CT-132 as First Digital Therapeutic for Preventive Treatment of Episodic Migraine FDA Expands Diazepam Nasal Spray Indication to Treat Ages 2 to 5 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.

Prof. Jon Stone, Dr. Laura Strom, and Meagan Watson discuss functional seizures and healthcare costs related to the functional seizure program at the University of Colorado. Show reference: https://www.neurology.org/doi/10.1212/CPJ.0000000000200393 

Prof. Jon Stone talks with Dr. Laura Strom and Meagan Watson about changes in total emergency department and inpatient visits and costs before and after referral to a specialized, comprehensive functional seizure treatment clinic. Read the related article with Neurology® Clinical Practice. Disclosures can be found at Neurology.org.   

Diagnosing and differentiating among the many possible localizations and causes of vision loss is an essential skill for neurologists. The approach to vision loss should include a history and examination geared toward localization, followed by a differential diagnosis based on the likely location of the pathophysiologic process.  In this episode, Aaron Berkowitz, MD, PhD, FAAN speaks with Nancy J. Newman, MD, FAAN, author of the article “Approach to Vision Loss” in the Continuum® April 2025 Neuro-ophthalmology issue.  Dr. Berkowitz is a Continuum® Audio interviewer and a professor of neurology at the University of California San Francisco in the Department of Neurology and a neurohospitalist, general neurologist, and clinician educator at the San Francisco VA Medical Center at the San Francisco General Hospital in San Francisco, California.  Dr. Newman is a professor of ophthalmology and neurology at the Emory University School of Medicine in Atlanta, Georgia.  Additional Resources Read the article: Approach to Vision Loss Subscribe to Continuum®: shop.lww.com/Continuum  Earn CME (available only to AAN members): continpub.com/AudioCME  Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com  Social Media facebook.com/continuumcme  @ContinuumAAN  Host: @AaronLBerkowitz  Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Berkowitz: This is Dr Aaron Berkowitz, and today I'm interviewing Dr Nancy Newman about her article on the approach to visual loss, which she wrote with Dr Valerie Biousse. This article appears in the April 2025 Continuum issue on neuro-ophthalmology. Welcome to the podcast, Dr Newman. I know you need no introduction, but if you wouldn't mind introducing yourself to our listeners. Dr Newman: Sure. My name's Nancy Newman. I am a neurologist and neuro-ophthalmologist, professor of ophthalmology and neurology at the Emory University School of Medicine in Atlanta, Georgia. Dr Berkowitz: You and your colleague Dr Biousse have written a comprehensive and practical article on the approach to visual loss here. It's fantastic to have this article by two of the world's leading experts and best-known teachers in neuro-ophthalmology. And so, readers of this article will find extremely helpful flow charts, tables and very nuanced clinical discussion about how to make a bedside diagnosis of the cause of visual loss based on the history exam and ancillary testing. We'll talk today about that important topic, and excited to learn from you and for our listeners to learn from you. To begin, let's start broad. Let's say you have a patient presenting with visual loss. What's your framework for the approach to this common chief concern that has such a broad differential diagnosis of localizations and of causes? Where do you start when you hear of visual loss? How do you think about this chief concern? Dr Newman: Well, it's very fun because this is the heart of being a neurologist, isn't it? Nowhere in the nervous system is localization as important as the complaint of vision loss. And so, the key, as any neurologist knows, is to first of all figure out where the problem is. And then you can figure out what it is based on the where, because that will limit the number of possibilities. So, the visual system is quite beautiful in that regard because you really can exquisitely localize based on figuring out where things are. And that starts with the history and then goes to the exam, in particular the first localization. So, you can whittle it down to the more power-for-your-buck question is, is the vision lost in one eye or in two eyes? Because if the vision loss clearly, whether it's transient or persistent, is in only one eye, then you only have to think about the eyeball and the optic nerve on that side. So, think about that. Why would you ever get a brain MRI? I know I'm jumping ahead here, but this is the importance of localization. Because what you really want to know, once you know for sure it's in one eye, is, is it an eyeball problem---which could be anything from the cornea, the lens, the vitreous, the retina---or is it an optic nerve problem? The only caveat is that every once in a while, although we trust our patients, a patient may insist that a homonymous hemianopia, especially when it's transient, is only in the eye with the temporal defect. So that's the only caveat. But if it's in only one eye, it has to be in that side eyeball or optic nerve. And if it's in two eyes, it's either in both eyeballs or optic nerves, or it's chiasmal or retrochiasmal. So that's the initial approach and everything about the history should first be guided by that. Then you can move on to the more nuanced questions that help you with the whats. Once you have your where, you can then figure out what the whats are that fit that particular where. Dr Berkowitz: Fantastic. And your article with Dr Biousse has this very helpful framework, which you alluded to there, that first we figure out, is it monocular or binocular? And we figure out if it's a transient or fixed or permanent deficit. So, you have transient monocular, transient binocular, fixed monocular, fixed binocular. And I encourage our listeners to seek out this article where you have a table for each of those, a flow chart for each of those, that are definitely things people want to have printed out and at their desk or on their phone to use at the bedside. Very helpful. So, we won't be able to go through all of those different clinical presentations in this interview, but let's focus on monocular visual loss. As you just mentioned, this can be an eye problem or an optic nerve problem. So, this could be an ophthalmologic problem or a neurologic problem, right? And sometimes this can be hard to distinguish. So, you mentioned the importance of the history. When you hear a monocular visual loss- and with the caveat, I said you're convinced that this is a monocular visual problem and not a visual field defect that may appear. So, the patient has a monocular deficit, how do you approach the history at trying to get at whether this is an eye problem or an optic nerve problem and what the cause may be? Dr Newman: Absolutely. So, the history at that point tends not to be as helpful as the examination. My mentor used to say if you haven't figured out the answer to the problem after your history, you're in trouble, because that 90% of it is history and 10% is the exam. In the visual system, the exam actually may have even more importance than anywhere else in the neurologic examination. And we need as neurologists to not have too much hubris in this. Because there's a whole specialty on the eyeball. And the ophthalmologists, although a lot of their training is surgical training that that we don't need to have, they also have a lot of expertise in recognizing when it's not a neurologic problem, when it's not an optic neuropathy. And they have all sorts of toys and equipment that can very much help them with that. And as neurologists, we tend not to be as versed in what those toys are and how to use them. So, we have to do what we can do. Your directive thalmoscope, I wouldn't throw it in the garbage, because it's actually helpful to look at the eyeball itself, not just the back of the eye, the optic nerve and retina. And we'll come back to that, but we have in our armamentarium things we can do as neurologists without having an eye doctor's office. These include things like visual acuity and color vision, confrontation, visual fields. Although again, you have to be very humble. Sometimes you're lucky; 30% of the time it's going to show you a defect. It has to be pretty big to pick it up on confrontation fields. And then as we say, looking at the fundus. And you probably know that myself and Dr Biousse have been on somewhat of a crusade to allow the emperor's new clothes to be recognized, which is- most neurologists aren't very comfortable using the direct ophthalmoscope and aren't so comfortable, even if they can use it, seeing what they need to see. It's hard. It's really, really hard. And it's particularly hard without pupillary dilation. And technology has allowed us now with non-mydriatic cameras, cameras that are incredible, even through a small pupil can take magnificent pictures of the back of the eye. And who wouldn't rather have that? And as their cost and availability- the cost goes down and their availability goes up. These cameras should be part of every neurology office and every emergency department. And this isn't futuristic. This is happening already and will continue to happen. But over the next five years or so… well, we're transitioning into that. I think knowing what you can do with the direct ophthalmoscope is important. First of all, if you dial in plus lenses, you can't be an ophthalmologist, but you can see media opacities. If you can't see into the back of the eye, that may be the reason the patient can't see out. And then just seeing if someone has central vision loss in one eye, it's got to be localized either to the media in the axis of vision; or it's in the macula, the very center of the retina; or it's in the optic nerve. So, if you get good at looking at the optic nerve and then try to curb your excitement when you saw it and actually move a little temporally and take a look at the macula, you're looking at the two areas. Again, a lot of ophthalmologists these days don't do much looking with the naked eye. They actually do photography, and they do what's called OCT, optical coherence tomography, which especially for maculopathies, problems in the macula are showing us the pathology so beautifully, things that used to be considered subtle like central serous retinopathy and other macula. So, I think having a real healthy respect for what an eye care provider can do for you to help screen away the ophthalmic causes, it's very, very important to have a patient complaining of central vision loss, even if they have a diagnosis like multiple sclerosis, you expect that they might have an optic neuritis… they can have retinal detachments and other things also. And so, I think every one of these patients should be seen by an eye care provider as well. Dr Berkowitz: Thank you for that overview. And I feel certainly as guilty as charged here as one of many neurologists, I imagine, who wish we were much better and more comfortable with fundoscopy and being confident on what we see. But as you said, it's hard with the direct ophthalmoscope and a non-dilated exam. And it's great that, as you said, these fundus photography techniques and tools are becoming more widely available so that we can get a good look at the fundus. And then we're going to have to learn a lot more about how to interpret those images, right? If we haven't been so confident in our ability to see the fundus and analyze some of the subtle abnormalities that you and your colleagues and our ophthalmology colleagues are more familiar with. So, I appreciate you acknowledging that. And I'm glad to hear that coming down the pipeline, there are going to be some tools to help us there. So, you mentioned some of the things you do at the bedside to try to distinguish between eye and optic nerve. Could you go into those in a little bit more detail here? How do you check the visual fields? For example, some people count fingers, some people wiggle fingers, see when the patient can see. How should we be checking visual fields? And what are some of the other bedside tasks you use to decide this is probably going to end up being in the optic nerve or this seems more like an eye? Dr Newman: Of course. Again, central visual acuity is very important. If somebody is older than fifty, they clearly will need some form of reading glasses. So, keeping a set of plus three glasses from cheapo drugstore in your pocket is very helpful. Have them put on their glasses and have them read an ear card. It's one of the few things you can actually measure and examine. And so that's important. The strongest reflex in the body and I can have it duke it out with the peripheral neurologists if they want to, it's not the knee jerk, it's looking for a relative afferent pupillary defect. Extremely important for neurologists to feel comfortable with that. Remember, you cut an optic nerve, you're not going to have anisocoria. It's not going to cause a big pupil. The pupils are always equal because this is not an efferent problem, it's an afferent problem, an input problem. So basically, if the eye has been injured in the optic nerve and it can't get that information about light back into the brain, well, the endoresfol nuclei, both of them are going to reset at a bigger size. And then when you swing over and shine that light in the good optic nerve, the good eye, then the brain gets all this light and both endoresfol nuclei equally set those pupils back at a smaller size. So that's the test for the relative afferent pupillary defect. When you swing back and forth. Of course, when the light falls on the eye, that's not transmitting light as well to the brain, you're going to see the pupil dilate up. But it's not that that pupil is dilating alone. They both are getting bigger. It's an extremely powerful reflex for a unilateral or asymmetric bilateral optic neuropathy. But what you have to remember, extremely important, is, where does our optic nerve come from? Well, it comes from the retinal ganglion cells. It's the axons of the retinal ganglion cells, which is in the inner retina. And therefore inner retinal disorders such as central retinal artery occlusion, ophthalmic artery occlusion, branch retinal artery occlusion, they will also give a relative afferent pupillary defect because you're affecting the source. And this is extremely important. A retinal detachment will give a relative afferent pupillary defect. So, you can't just assume that it's optic nerve. Luckily for us, those things that also give a relative afferent pupillary defect from a retinal problem cause really bad-looking retinal disease. And you should be able to see it with your direct ophthalmoscope. And if you can't, you definitely will be able to see it with a picture, a photograph, or having an ophthalmologist or optometrist take a look for you. That's really the bedside. You mentioned confrontation visual fields. I still do them, but I am very, very aware that they are not very sensitive. And I have an extremely low threshold to- again, I have something in my office. But if I were a general neurologist, to partner with an eye care specialist who has an automated visual field perimeter in their office because it is much more likely to pick up a deficit. Confrontation fields. Just remember, one eye at a time. Never two eyes at the same time. They overlap with each other. You're going to miss something if you do two eyes open, so one eye at a time. You check their field against your field, so you better be sure your field in that eye is normal. You probably ought to have an automated perimetry test yourself at some point during your career if you're doing that. And remember that the central thirty degrees is subserved by 90% of our fibers neurologically, so really just testing in the four quadrants around fixation within the central 30% is sufficient. You can present fingers, you don't have to wiggle in the periphery unless you want to pick up a retinal detachment. Dr Berkowitz: You mentioned perimetry. You've also mentioned ocular coherence tomography, OCT, other tests. Sometimes we think about it in these cases, is MRI one of the orbits? When do you decide to pursue one or more of those tests based on your history and exam? Dr Newman: So again, it sort of depends on what's available to you, right? Most neurologists don't have a perimeter and don't have an OCT machine. I think if you're worried that you have an optic neuropathy, since we're just speaking about monocular vision loss at this point, again, these are tests that you should get at an office of an eye care specialist if you can. OCT is very helpful specifically in investigating for a macular cause of central vision loss as opposed to an optic nerve cause. It's very, very good at picking up macular problems that would be bad enough to cause a vision problem. In addition, it can give you a look at the thickness of the axons that are about to become the optic nerve. We call it the peripapillary retinal nerve fiber layer. And it actually can look at the thickness of the layer of the retinal ganglion cells without any axons on them in that central area because the axons, the nerve fiber layer, bends away from central vision. So, we can see the best we can see. And remember these are anatomical measurements. So, they will lag, for the ganglion cell layer, three to four weeks behind an injury, and for the retinal nerve fiber, layer usually about six weeks behind an entry. Whereas the functional measurements, such as visual acuity, color vision, visual fields, will be immediate on an injury. So, it's that combination of function and anatomy examination that makes you all-powerful. You're very much helped by the two together and understanding where one will be more helpful than the other. Dr Berkowitz: Let's say we've gotten to the optic nerve as our localization. Many people jump to the assumption it's the optic nerve, it's optic neuritis, because maybe that's the most common diagnosis we learn in medical school. And of course, we have to sometimes, when we're teaching our students or trainees,  say, well, actually, not all optic nerve disease, optic neuritis, we have to remember there's a broader bucket of optic neuropathy. And I remember, probably I didn't hear that term until residency and thought, oh, that's right. I learned optic neuritis. Didn't really learn any of the other causes of optic nerve pathology in medical school. And so, you sort of assume that's the only one. And so you realize, no, optic neuropathy has a differential diagnosis beyond optic neuritis. Neuritis is a common cause. So how do you think about the “what” once you've localized to the optic nerve, how do you think about that? Figure out what the cause of the optic neuropathy is? Dr Newman: Absolutely. And we've been trying to convince neuro-radiologists when they see evidence of optic nerve T2 hyperintensity, that just means damage to the optic nerve from any cause. It's just old damage, and they should not put in their read consistent with optic neuritis. But that's a pet peeve. Anyway, yes, the piece of tissue called the optic nerve can be affected by any category of pathophysiology of disease. And I always suggest that you run your categories in your head so you don't leave one out. Some are going to be more common to be bilateral involvement like toxic or metabolic causes. Others will be more likely unilateral. And so, you just run those guys. So, in my mind, my categories always are compressive-slash-infiltrative, which can be neoplastic or non-neoplastic. For example, an ophthalmic artery aneurysm pressing on an optic nerve, or a thyroid, an enlarged thyroid eye muscle pressing on the optic nerve. So, I have compressive infiltrative, which could be neoplastic or not neoplastic. I have inflammatory, which can be infectious. Some of the ones that can involve the optic nerve are syphilis, cat scratch disease. Or noninfectious, and these are usually your autoimmune such as idiopathic optic neuritis associated with multiple sclerosis, or MOG, or NMO, or even sarcoidosis and inflammation. Next category for me would be vascular, and you can have arterial versus venous in the optic nerve, probably all arterial if we're talking about causes of optic neuropathy. Or you could have arteritic versus nonarteritic with the vascular, the arteritic usually being giant cell arteritis. And the way the optic nerve circulation is, you can have an anterior ischemic optic neuropathy or a posterior ischemic optic neuropathy defined by the presence of disc edema suggesting it's anterior, the front of the optic nerve, or not, suggesting that it's retrobulbar or posterior optic nerve. So what category am I- we mentioned toxic, metabolic nutritional. And there are many causes in those categories of optic neuropathy, usually bilateral. You can have degenerative or inherited. And there are causes of inherited optic neuropathies such as Leber hereditary optic neuropathy and dominant optic atrophy. And then there's a group I call the mechanical optic neuropathies. The obvious one is traumatic, and that can happen in any piece of tissue. And then the other two relate to the particular anatomy of the eyeball and the optic nerve, and the fact that the optic nerve is a card-carrying member of the central nervous system. So, it's not really a nerve by the way, it's a tract. Think about it. Anyway, white matter tract. It is covered by the same fluid and meninges that the rest of the brain. So, what mechanically can happen? Well, you could have an elevated intraocular pressure where that nerve inserts. That's called glaucoma, and that would affect the front of the optic nerve. Or you can have elevated intracranial pressure. And if that's transmitted along the optic nerve, it can make the front of the optic nerve swell. And we call that specifically papilledema, optic disk edema due specifically to raised intracranial pressure. We actually even can have low intraocular pressure cause something called hypotony, and that can actually even give an optic neuropathy the swelling of the optic nerve. So, these are the mechanical. And if you were to just take that list and use it for any piece of tissue anywhere, like the heart or the kidney, you can come up with your own mechanical categories for those, like pericarditis or something like that. And then all those other categories would fit. But of course, the specific causes within that pathophysiology are going to be different based on the piece of tissue that you have. In this case, the optic nerve. Dr Berkowitz: In our final moments here, we've talked a lot about the approach to monocular visual loss. I think most neurologists, once we find a visual field defect, we breathe a sigh of relief that we know we're in our home territory here, somewhere in the visual task base that we've studied very well. I'm not trying to distinguish ocular causes amongst themselves or ocular from optic nerve, which can be very challenging at the bedside. But one topic you cover in your article, which I realized I don't really have a great approach to, is transient binocular visual loss. Briefly here, since we're running out of time, what's your approach to transient binocular visual loss?  Dr Newman: We assume with transient binocular vision loss that we are not dealing with a different experience in each eye, because if you have a different experience in each eye, then you're dealing with bilateral eyeball or optic nerve. But if you're having the same experience in the two eyes, it's equal in the two eyes, then you're located. You're located, usually, retro chiasmally, or even chiasm if you have pituitary apoplexy or something. So, all of these things require imaging, and I want to take one minute to talk about that. If you are sure that you have monocular vision loss, please don't get a brain MRI without contrast. It's really useless. Get a orbital MRI with contrast and fat suppression techniques if you really want to look at the optic nerve. Now, let's say you you're convinced that this is chiasmal or retrochiasmal. Well then, we all know we want to get a brain MRI---again, with and without contrast---to look specifically where we could see something. And so, if it's persistent and you have a homonymous hemianopia, it's easy, you know where to look. Be careful though, optic track can fool you. It's such a small little piece, you may miss it on the MRI, especially in someone with MS. So really look hard. There's very few things that are homonymous hemianopias MRI negative. It may just be that you didn't look carefully enough. And as far as the transient binocular vision loss, again, remember, even if it's persistent, it has to be equal vision in the two eyes. If there's inequality, then you have a superimposed anterior visual pathway problem, meaning in front of the chiasm on the side that's worse. The most common cause of transient binocular vision loss would be a form of migraine. The visual aura of migraine usually is a positive phenomenon, but sometimes you can have a homonymous hemianopic persistent defect that then ebbs and flows and goes away. Usually there's buildup, lasts maybe fifteen minutes and then it goes away, not always followed by a headache. Other things to think of would be transient ischemic attack in the vertebra Basler system, either a homonymous hemianopia or cerebral blindness, what we call cortical blindness. It can be any degree of vision loss, complete or any degree, as long as the two eyes are equal. That should last only minutes. It should be maximum at onset. There should be no buildup the way migraine has it. And it should be gone within less than ten minutes, typically. After fifteen, that's really pushing it. And then you could have seizures. Seizures can actually be the aura of a seizure, the actual ictal phenomenon of a seizure, or a postictal, almost like a todd's paralysis after a seizure. These events are typically bright colors and flashing, and they last usually seconds or just a couple of minutes at most. So, you can probably differentiate them. And then there are the more- less common but more interesting things like hyperglycemia, non-ketonic hyperglycemia can give you transient vision loss from cerebral origin, and other less common things like that. Dr Berkowitz: Fantastic. Although we've talked about many pearls of clinical wisdom here with you today, Dr Newman, this is only a fraction of what we can find in your article with Dr Biousse. We focused here on monocular visual loss and a little bit at the end here on binocular visual loss, transient binocular visual loss. But thank you very much for your article, and thank you very much for taking the time to speak with us today. Again, today I've been interviewing Dr Nancy Newman about her article with Dr Valerie Biousse on the approach to visual loss, which appears in the most recent issue of Continuum on neuro-ophthalmology. Be sure to check out Continuum audio episodes from this and other issues. Thank you so much to our listeners for joining us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Contributor: Taylor Lynch, MD Educational Pearls: Pediatric febrile seizures are defined as seizures that occur between the ages of six months to five years in the presence of a fever greater than or equal to 38.0 ºC (100.4 ºF). It is the most common pediatric convulsive disorder, with an incidence between 2-5% What are the types of seizures? Simple: Tonic-clonic seizure, duration