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Hi, everyone. Thank you for joining today. Could I just, I'll give it a few more minutes for people to join. But could I just get a thumbs up or something in the chart to see if you can see and hear me on the screen, please? Thank you. Yeah. Ok. I think let's make a start. Um Could you guys please confirm if you could see or hear me because otherwise I will fix the screen slash mic, whichever one is not working. Just a message in the chat, please. Thank you. Ok, so welcome to this teaching session about seizures. I'm guessing a lot of you are like in the pits of exam revision right now. So I hope you find this helpful. It's teaching things presentations. So we do cool presentations on teaching diagnostic techniques. It's all run by medical students. Everything is reviewed by doctors and sign up to find out about more events. Ok, so let's get started in this session. We'll be covering what a seizure is, the different types that exist, how we classify them, the history taking skills that go along with seizures. So it will be very similar to a fool's history. But how do we rule in a seizure? Basically? Um We'll be talking about status epilepticus, the management surrounding a seizure. And another very relevant, a key thing is the D VLA rules for people who have seizures slash have epilepsy. Ok. So, starting off with the basics, what is a seizure? A seizure is a sudden uncontrolled burst of electrical activity in the brain and it causes changes in behavior in movement, in feelings or in consciousness. This is very commonly um and interchangeably used with epilepsy, but they are not the same thing. Epilepsy is one of the reasons why people get a seizure, you can have a seizure without having epilepsy. So yeah, just be careful with the language. So how do we classify a seizure? It's based on three key things and that is which side of the brain it began on or which side of the brains? It involves basically what the level of awareness is like during the seizure and any other features which we will go into. Um as we go along. So let's start off with a focal seizure. You'll begin to understand that there are two types of seizures, focal seizures and general seizures. We're gonna start off with a focal seizure and then move on to general. So where in the brain does it begin? Does anyone have any ideas like is it one side or both sides? Just pop it in the chat if you can? That also is completely fine if you don't know, this is a learning experience. OK. Let's see. So a focal seizure starts on one specific area on one specific side of the brain. So you'll see in this diagram and we'll go into it a bit later on as well. This includes the temporal lobe or the frontal lobe, parietal or occipital and obviously the other sections of, well, the level of awareness in a focal seizure, it can be impaired awareness, focal aware or awareness unknown. And it's fairly self explanatory what those terms mean. But just in case impaired awareness, obviously, it means you are not aware of what's going on during the seizure. Focal aware, it means that you know that the seizure is happening like or you at least you might not know it's a seizure but you know that there's some change in your activity, your contras during the whole thing and awareness unknown is perhaps when it's unwitnessed. So there's really no one to say whether it's aware or unaware and what are the other features of a focal seizure. So for focal seizures, like I mentioned before, it's to do with which side of the brain or which lobe of the brain is affected. So if the frontal lobe is affected, then the kind of um extra symptoms that you'll see is motor jerking or twitching. This is sometimes referred to as a Jacksonian March. If you've heard that term before, it's kind of the same thing, speech disturbance will also be seen if the frontal lobe is affected. Um if the temporal lobe is affected, then there's deja vu feelings, rising epigastric sensations. So people sometimes describe it as like a feeling of butterflies in their stomach and also strange smells or hallucinations. Burnt toast is a really common one for this. Like people describe that they smell something burning or like hear weird buzzing sounds before they have the seizure. Um we call all of this auras. So oral symptoms like that you get before the seizure. If the parietal lobe is affected, then paresthesia and body image distortions are also just also reported by people. The occipital lobe is probably easiest to remember because it's to do with vision and the auras you get are visual auras for out of all of these, the ones that are boxed in red are the most important to remember and the most high yield because they're asked about the most. So frontal lobe seizures with speech and motor disturbance and temporal lobe seizures with epigastric sensations and smells and sounds is yeah, the most important to remember. Ok. Now, generalized seizures. Ok. Can anyone have a go at this? So focal seizures start on one side of the brain. Does anyone know where generalized seizures start? Like does it involve one hemisphere or both? You just pop it in the truck? Both. Yeah, perfect. So generalized seizures, both sides of the brain are gonna be engaged from the onset of it and you can kind of see it in this diagram how it plays out. So focal seizures, one part, generalized seizures, different parts from both hemispheres will be um engaged from the beginning awareness. What do you guys think A B or C? It A depends on the type of seizure B always impaired.