AED | Audio Epilepsy Digest

Erafat D. Rehim, MD
  • 0.0 (0)
  • Medicine
  • Updated Weekly

Audio Epilepsy Digest (AED) is a colleague-level podcast briefing on epilepsy research, controversies, and practice-shaping signals for epileptologists, epilepsy fellows, and surgical epilepsy teams.

  1. Sep 1

    Episode 19: The Implantation Honeymoon—Who Gets the Credit: Implant, Stimulation, or Time?

    NOTE: This podcast is an evolving collaboration between human and AI. While we strive for accuracy, AI hosts may misinterpret or oversimplify source material. Always refer to the original published articles for clinical decision-making. If you find any claims made by the AI hosts to be inaccurate, please let us know. Your feedback directly improves future episodes. Episode 19: The Implantation Honeymoon—Who Gets the Credit: Implant, Stimulation, or Time? When seizures change after intracranial electrodes are implanted but before stimulation begins, what can we actually attribute to the implant—and what remains time, sampling, treatment, or expectation? The newest adult SEEG study leads this episode with results first. From there, we move from clinical seizure reports to scheduled RNS ECoG, rare no-stimulation observations, a disclosed single-center abstract from our own group, and an implanted-sham randomized trial. The evidence supports a real postimplant observation problem, not one proven mechanism or a universal treatment effect. AED Quiz for this episode: https://audioepilepsydigest.com/episode-019-aed-quiz.html Listen and follow Audio Epilepsy Digest: https://audioepilepsydigest.com/ Key takeaways: - Roy-Chowdhury's adult SEEG cohort is a set of distinct last-follow-up groups, not one 51-patient longitudinal curve. - The paper reports early responder and seizure-freedom counts, but its six-month denominator differs between the narrative and Table 1. - Lane found a modest delay to first seizure during intracranial monitoring after adjustment for prior-day medication load; daily seizure frequency was not significantly reduced. - Sun documented months of scheduled ECoG signal evolution after RNS implantation, an electrographic endpoint that does not establish clinical seizure benefit or one cause. - Exceptional RNS and DBS observations show that changes can occur without active stimulation, but small samples and concurrent care prevent causal attribution. - The editor's AES abstract suggests a predictive association, not proof that implantation caused later response or a validated biomarker. - NAUTILUS compared active with sham stimulation on a shared implanted background. Its prespecified effectiveness endpoint was negative; later findings are supportive and cannot replace that endpoint. Papers discussed: - Roy-Chowdhury et al. Post-SEEG seizure-frequency study. Epilepsia. 2026. PMID: 42474247. - Lane et al. Implantation effect during intracranial monitoring. Acta Neurol Scand. 2017. PMID: 27531652. - Sun et al. Postimplant ECoG evolution in RNS. Clin Neurophysiol. 2018. PMID: 29233473. - Thuberg et al. DBS insertional effect without stimulation. Neuromodulation. 2021. PMID: 33577139. - Rumschlag et al. Extended RNS implantation-effect case. Epileptic Disord. 2024. PMID: 38787629. - McCarthy and Burdette. RNS programming review. Neurotherapeutics. 2026. PMID: 42302539. - Uysal et al. NAUTILUS randomized trial. Epilepsia. 2026. PMID: 42233958. Editorial reference and disclosure: - Rehim et al. “Does Honeymoon Lead to Happily Ever After? Single Center Experience with Implantation Effect in RNS Therapy.” AES Annual Meeting abstract 1.251. 2025. Erafat Rehim is the presenting author and AED editor. This author-involved, retrospective single-center abstract is treated as an unvalidated hypothesis, not independent confirmation. AI-assisted editorial/source review: https://audioepilepsydigest.com/episode-019-ai-review.html Editorial review disclosure: The final draft cleared two independent source-fidelity and clinical-safety reviews with minor listening notes. Earlier drafts were withheld for causal overstatement, endpoint confusion, unsupported mechanisms, or narrative imbalance. The clinician-editor completed listening QA and authorized release for Tuesday, September 1, 2026 at 7:00 AM EDT.

    Episode 19: The Implantation Honeymoon—Who Gets the Credit: Implant, Stimulation, or Time?

  2. Aug 24

    Episode 18: How Safe Is Safe? The Long-Term Tradeoffs of Common Anti-Seizure Medications

    NOTE: This podcast is an evolving collaboration between human and AI. While we strive for accuracy, AI hosts may misinterpret or oversimplify source material. Always refer to the original published articles for clinical decision-making. If you find any claims made by the AI hosts to be inaccurate, please let us know. Your feedback directly improves future episodes. Episode 18: How Safe Is Safe? The Long-Term Tradeoffs of Common Anti-Seizure Medications When a patient asks, “You say Keppra is safe long term. Exactly how safe is it?”, the honest answer is not one lifetime percentage. This episode separates years of clinical experience from years of structured observation, then compares levetiracetam, lamotrigine, and lacosamide across common burden, rare serious harm, cumulative toxicity, changing susceptibility, and seizure-control benefit. Long follow-up can be reassuring, but selected continuers are not the same denominator as everyone who starts treatment. Episode infographic AED Quiz for this episode: https://audioepilepsydigest.com/episode-018-aed-quiz.html Listen and follow Audio Epilepsy Digest: https://audioepilepsydigest.com/ Key takeaways: - “Safe long term” means a changing benefit-risk profile, not zero risk or a lifetime guarantee. - Approval history gives decades of signal-detection experience; it does not provide a controlled lifetime denominator. - Maximum structured observation reached beyond seven years for levetiracetam, six years for lamotrigine, and up to eight years for lacosamide in selected continuation cohorts. - Levetiracetam's ongoing reassessment targets include mood or behavioral effects, fatigue, and renal-dose dependence. - Lamotrigine's defining serious-rash risk is front-loaded during initiation and titration, while neurologic effects may persist or recur with dose or interaction changes. - Lacosamide's dizziness and imbalance profile must be considered alongside conduction susceptibility, cardiac disease, and interacting drugs. - Comparative tolerability depends on population, comparator, endpoint, and seizure-control benefit; this is not a universal drug ranking. Papers discussed: - Marson et al. SANAD II focal-epilepsy trial. Lancet. 2021. PMID: 33838757. - Fröling et al. Levetiracetam/brivaracetam adverse-event meta-analysis. 2026. PMID: 41824075. - Depondt et al. Long-term levetiracetam retention. JNNP. 2006. PMID: 16361605. - Bauer et al. Long-term levetiracetam follow-up. 2006. PMID: 16911344. - Faught et al. Six-year lamotrigine continuation. 2004. PMID: 14751204. - Li et al. Three-year real-world LTG-LEV comparison. 2020. PMID: 32679487. - Ben-Menachem et al. Lacosamide versus carbamazepine-CR extension. Epilepsia. 2019. PMID: 31755090. - Rosenfeld et al. Lacosamide extension up to eight years. 2014. PMID: 25461210. - Buoso et al. Antiseizure medications and bone health. 2024. PMID: 40530090. AI-assisted editorial/source review: https://audioepilepsydigest.com/episode-018-ai-review.html Editorial disclosure: The final fifth draft cleared two independent source-fidelity and clinical-safety reviews with minor notes. Earlier expanded drafts were withheld for causal overstatement, an incorrect study attribution, loss of the direct Keppra question, and unsupported conversion of heterogeneous bone-health evidence into individual risk and treatment advice. The clinician-editor completed listening QA and authorized release for Monday at 7:00 AM EDT.

    Episode 18: How Safe Is Safe? The Long-Term Tradeoffs of Common Anti-Seizure Medications

  3. Aug 17

    Episode 17: What Counts as Neuromodulation Success?

    NOTE: This podcast is an evolving collaboration between human and AI. While we strive for accuracy, AI hosts may misinterpret or oversimplify source material. Always refer to the original published articles for clinical decision-making. If you find any claims made by the AI hosts to be inaccurate, please let us know. Your feedback directly improves future episodes. Episode 17: What Counts as Neuromodulation Success? Should the 50% responder rate remain the primary definition of neuromodulation success? This episode stages the strongest case for a simple common benchmark against the strongest case for a multidimensional clinical verdict. VNS, pediatric thalamic DBS and RNS, long-term RNS, ESTEL, CONNECTiVOS, PuLsE, and two biomarker studies are used to test what the threshold captures—and what it hides. AED Quiz for this episode: https://audioepilepsydigest.com/episode-017-aed-quiz.html Listen and follow Audio Epilepsy Digest: https://audioepilepsydigest.com/ Key takeaways: - Keep the 50% responder rate as a standardized anchor, but never let it stand alone. - Pair any threshold with the underlying reduction distribution, seizure freedom, denominator, and time horizon. - Similar 12-month responder proportions do not prove similar early experience or device superiority. - Quality of life, harms, and treatment burden are core counseling domains rather than decorative secondary outcomes. - ESTEL preserved a negative diary primary comparison alongside a positive secondary ambulatory-EEG responder signal; objective detection and patient importance are not synonyms. - A high AUC in a tiny held-out split or a post-treatment blood-marker association is hypothesis-generating, not a patient-selection tool. Papers discussed: - Zhao et al. Vagus nerve stimulation as an add-on therapy in patients with epilepsy. Acta Epileptologica. 2026. doi:10.1186/s42494-026-00272-4. - Tenhoeve et al. Comparative multicenter evaluation of thalamic neuromodulation for treatment-resistant epilepsy in children. Epilepsia. 2026. doi:10.1002/epi.70402. - Zhou et al. Nonlinear neurodynamics of N2 sleep EEG predict outcomes of ANT-DBS in epilepsy. Journal of Neural Engineering. 2026. doi:10.1088/1741-2552/ae94b2. - Tang et al. Peripheral blood inflammatory biomarkers and response to VNS in pediatric drug-resistant epilepsy. European Journal of Pediatrics. 2026. doi:10.1007/s00431-026-07256-z. - Niazi et al. What defines response to VNS in children with drug-resistant epilepsy? Epilepsia. 2025. doi:10.1111/epi.18520. - Dalic et al. DBS of Thalamic Centromedian Nucleus for Lennox-Gastaut Syndrome (ESTEL Trial). Annals of Neurology. 2022. doi:10.1002/ana.26280. - Nair et al. Nine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy. Neurology. 2020. doi:10.1212/WNL.0000000000010154. - Ryvlin et al. The long-term effect of VNS on quality of life: The PuLsE trial. Epilepsia. 2014. doi:10.1111/epi.12611. AI-assisted editorial/source review: https://audioepilepsydigest.com/episode-017-ai-review.html Editorial disclosure: Two independent AI-assisted reviews cleared the final candidate with minor notes and no blocking source-fidelity or clinical-safety finding. The first draft was withheld after it confused an electrographic responder proportion with seizure-reduction magnitude and described interval seizure freedom as cure. The corrected final draft preserves endpoint hierarchy, denominators, design limits, and the research-stage status of proposed biomarkers. The clinician-editor authorized shipment for Monday at 7:00 AM EDT.

    Episode 17: What Counts as Neuromodulation Success?

  4. Aug 13

    Episode 16: Signals, Silence, and Zero Events

    NOTE: This podcast is an evolving collaboration between human and AI. While we strive for accuracy, AI hosts may misinterpret or oversimplify source material. Always refer to the original published articles for clinical decision-making. If you find any claims made by the AI hosts to be inaccurate, please let us know. Your feedback directly improves future episodes. Episode 16: Signals, Silence, and Zero Events What can an observational association, the absence of a consistent reported pattern, and zero observed events actually justify in medication counseling? This episode compares three very different medication-safety evidence systems: a nationwide prenatal antiseizure-medication cohort, a global eslicarbazepine pregnancy safety database, and a small selected cohort restarting cenobamate after short interruptions. The practical method is simple: identify the denominator, comparator, missingness, exposure measurement, outcome ascertainment, and selection process before translating any memorable conclusion into care. AED Quiz for this episode: https://audioepilepsydigest.com/episode-016-aed-quiz.html Listen and follow Audio Epilepsy Digest: https://audioepilepsydigest.com/ Key takeaways: - The Korean cohort found adjusted associations with selected neurodevelopmental outcomes; it did not establish a causal medication effect. - Only 48.2% of exposed mothers in that cohort had epilepsy, so indication, disease severity, familial factors, and prescription-based exposure remain central limitations. - The eslicarbazepine database collected reports across miscarriage, congenital anomaly, neonatal adverse effect, and premature birth, but substantial missingness and the lack of a valid denominator or comparator prevent incidence and comparative-risk claims. - Zero attributed hypersensitivity events among 32 previously tolerant cenobamate patients is reassuring within that selected setting, but an approximate upper uncertainty bound remains near 9%. - Residual drug exposure is a proposed pharmacokinetic explanation, not proof of immune tolerance or authorization for a universal maintenance-dose restart protocol. Papers discussed: - Kim et al. Prenatal exposure to Antiseizure Medications for all indications and the risk of neurodevelopmental disorders in offspring. Seizure. 2026. doi:10.1016/j.seizure.2026.05.030. - Lopes et al. Pregnancy outcomes following Eslicarbazepine acetate exposure in women with epilepsy. Seizure. 2026. doi:10.1016/j.seizure.2026.05.027. - Feldman et al. Hypersensitivity reaction risk when restarting cenobamate after discontinuation. Epilepsia Open. 2026. doi:10.1002/epi4.70288. AI-assisted editorial/source review: https://audioepilepsydigest.com/episode-016-ai-review.html Editorial disclosure: Two independent AI-assisted reviews cleared the final candidate with minor notes and no blocking source-fidelity or clinical-safety finding. The remaining notes concerned prior-rash-history wording, complete reporting of pregnancy outcome categories, pronunciation of selected technical terms, separation of two rash observations, and maintaining the restart mechanism as a hypothesis. The clinician-editor listened to and approved the release candidate.

    Episode 16: Signals, Silence, and Zero Events

  5. Jul 24

    Episode 15: Fellow Bootcamp: OSA Is Not Just a Comorbidity

    NOTE: This podcast is an evolving collaboration between human and AI. While we strive for accuracy, AI hosts may misinterpret or oversimplify source material. Always refer to the original published articles for clinical decision-making. If you find any claims made by the AI hosts to be inaccurate, please let us know. Your feedback directly improves future episodes. Episode 15: Fellow Bootcamp: OSA Is Not Just a Comorbidity When should obstructive sleep apnea be treated as more than a passive comorbidity in epilepsy care? This special uses the nine Bradford Hill viewpoints to examine whether OSA may modify epilepsy outcomes. The hosts keep three evidence lanes separate: seizure and interictal-discharge burden, incident or late-onset epilepsy, and surrogate SUDEP-risk markers. They also examine what the current CPAP studies can—and cannot—support. AED Quiz for this episode: https://audioepilepsydigest.com/episode-015-aed-quiz.html Listen and follow Audio Epilepsy Digest: https://audioepilepsydigest.com/ Key takeaways: - Bradford Hill viewpoints organize causal reasoning; they are not a checklist, vote, or proof score. - OSA is commonly reported in people with epilepsy, but prevalence estimates are heterogeneous and do not establish causation. - Prospective and claims-based studies support an incident-epilepsy and late-onset-epilepsy hypothesis, with residual confounding and exposure measurement still important. - Associations with revised SUDEP risk scores concern surrogate markers, not observed SUDEP events or evidence of prevention. - Treat confirmed OSA for established sleep-medicine indications and track epilepsy outcomes without promising an epilepsy-specific response. Sources include Rehim, Vendrame, and Devinsky 2026; Lin et al. 2017; Harnod et al. 2017; Carosella et al. 2023; Soontornpun et al. 2024; Pornsriniyom et al. 2014; Malow et al. 2008; and McCarter et al. 2018. AI-assisted editorial/source review: https://audioepilepsydigest.com/episode-015-ai-review.html Editorial disclosure: Two independent AI-assisted reviews cleared the episode with minor notes and no blocking source-fidelity or clinical-safety finding. Minor notes concern a few contextual certainty words, process-like language near the opening, an over-categorical effect-size heuristic, the ARIC sleep-substudy denominator, and author-name pronunciation. The clinician-editor listened to and approved the release candidate.

    Episode 15: Fellow Bootcamp: OSA Is Not Just a Comorbidity

  6. Jul 14

    Episode 14: Fellow Bootcamp: From EMU to SEEG to Surgery

    NOTE: This podcast is an evolving collaboration between human and AI. While we strive for accuracy, AI hosts may misinterpret or oversimplify source material. Always refer to the original published articles for clinical decision-making. If you find any claims made by the AI hosts to be inaccurate, please let us know. Your feedback directly improves future episodes. Episode 14: Fellow Bootcamp: From EMU to SEEG to Surgery How should an epilepsy fellow turn EMU findings, imaging, neuropsychology, and other phase 1 data into a defensible surgical hypothesis? This special reviews the cortical concepts used in presurgical reasoning, how phase 1 findings become a testable hypothesis, when stereoelectroencephalography may resolve an actionable uncertainty, the limitations of sparse intracranial sampling, and how teams orient among resection, ablation, disconnection, neuromodulation, or no procedure. AED Quiz for this episode: https://audioepilepsydigest.com/episode-014-aed-quiz.html Listen and follow Audio Epilepsy Digest: https://audioepilepsydigest.com/ Key takeaways: - Phase 1 evaluation should build a coherent electroclinical hypothesis and expose meaningful contradictions. - Symptomatogenic, irritative, seizure-onset, epileptogenic-lesion, functional-deficit, eloquent-cortex, and epileptogenic zones may overlap but are not interchangeable. - A visible lesion can strengthen a hypothesis but does not independently establish causality. - S-E-E-G is spatially limited sampling and is most useful when it tests bounded alternatives that could change treatment. - Treatment choice integrates targetability, network distribution, functional risk, expected benefit, residual uncertainty, and patient goals. Sources include Schuele et al. 2025, Jayakar et al. 2016, Miller and Fine 2022, Simpson et al. 2022, and Jehi et al. 2022. AI-assisted editorial/source review: https://audioepilepsydigest.com/episode-014-ai-review.html Editorial disclosure: The clinician-editor selected this audio through an explicit human override after two independent AI-assisted reviews advised targeted revision. The central framework was substantially grounded, while some examples and mechanisms remain teaching simplifications. The final AI passage is intentionally speculative and does not describe current clinical capability.

    Episode 14: Fellow Bootcamp: From EMU to SEEG to Surgery

  7. Jul 6

    Episode 13: Temporal Encephaloceles: Lesion, Network, and How Much to Resect?

    NOTE: This podcast is an evolving collaboration between human and AI. While we strive for accuracy, AI hosts may misinterpret or oversimplify source material. Always refer to the original published articles for clinical decision-making. If you find any claims made by the AI hosts to be inaccurate, please let us know. Your feedback directly improves future episodes. Episode 13: Temporal Encephaloceles: Lesion, Network, and How Much to Resect? This monthly special debate asks how epilepsy surgery teams should reason about temporal encephaloceles: as a leading surgical target, as a clue to broader temporal network involvement, or both. The episode uses surgical series, systematic reviews, imaging studies, EEG source-localization work, and a direct sEEG case to frame a conference-style question: when is a tailored mesial-sparing approach reasonable, and when should discordant data prompt broader mapping or a wider surgical hypothesis? AED Quiz for this episode: https://audioepilepsydigest.com/episode-013-aed-quiz.html Listen and follow Audio Epilepsy Digest: https://audioepilepsydigest.com/ AI editorial/source review for this episode: https://audioepilepsydigest.com/episode-013-ai-review.html Key takeaways: - Temporal encephaloceles can be missed on routine review and may require deliberate skull-base re-review or additional imaging. - Finding a temporal encephalocele is not the same as proving seizure onset from the herniated tissue. - Concordant imaging, semiology, EEG, PET, neuropsychology, and invasive recordings can support a lesion-centered hypothesis in selected cases. - Surgical extent should follow the full presurgical picture, not a default rule for or against hippocampectomy. - The evidence base is mainly retrospective and selected, so the episode frames conference reasoning rather than a guideline. Papers discussed include Smith 2023, Tsalouchidou 2025, Khoudari 2025, Zhou 2024, Garcia-Gracia 2024, Kondylis 2026, Ortiz 2025, Tsalouchidou 2023, Cox 2024, and Agashe 2023. Caveats: - Temporal encephaloceles are treated as potentially important surgical clues, not automatic proof of epileptogenicity. - MRI metrics, PET patterns, CT defects, and postprocessing are supportive data, not direct proof of seizure onset. - The direct sEEG case is illustrative and should not be generalized beyond a selected single-patient report. - The practical framework is intended as conference reasoning, not a rigid surgical algorithm.

    Episode 13: Temporal Encephaloceles: Lesion, Network, and How Much to Resect?

  8. Jul 1

    Episode 12: Care Pathways Shape Epilepsy Outcomes

    NOTE: This podcast is an evolving collaboration between human and AI. While we strive for accuracy, AI hosts may misinterpret or oversimplify source material. Always refer to the original published articles for clinical decision-making. If you find any claims made by the AI hosts to be inaccurate, please let us know. Your feedback directly improves future episodes. Episode 12: Care Pathways Shape Epilepsy Outcomes This weekly recent-studies episode asks what happens when epilepsy outcomes are shaped not only by medications, procedures, or devices, but by the care pathway around the patient. The episode follows five care-delivery signals: rural inpatient outcomes, inpatient video-EEG access after repeated seizure-related emergency visits, pediatric-to-adult transition, brain tumor-related epilepsy coordination, and a UK roadmap for technology-enabled service redesign. AED Quiz for this episode: https://audioepilepsydigest.com/episode-012-aed-quiz.html Listen and follow Audio Epilepsy Digest: https://audioepilepsydigest.com/ AI editorial/source review for this episode: https://audioepilepsydigest.com/episode-012-ai-review.html Key takeaways: - Care pathways are measurable parts of epilepsy care, not just background logistics. - Rural-urban inpatient differences, vEEG access, transition care, and tumor-epilepsy coordination all point to pathway-level gaps. - The studies are mostly observational or service-mapping work, so they support careful questions rather than practice-changing mandates. - Technology can support redesign, but the roadmap source is not proof that specific digital tools improve outcomes. - Repeated ED visits, transition handoffs, and multidisciplinary tumor care are moments to ask whether the patient reached the right diagnostic and longitudinal services. Papers discussed include: 1. Rural-urban disparities in epilepsy hospitalizations in the United States. PMID: 42234954. PMCID: PMC13239426. 2. Kozak et al. Access to inpatient video-EEG monitoring for patients with frequent seizure-related emergency visits. Epilepsy Research (2026). PMID: 42349236. 3. Modi et al. Measuring transition success from paediatric to adult epilepsy services and its association with seizure outcomes. Archives of Disease in Childhood (2026). PMID: 42082329. 4. Anghileri et al. Mapping integrated care for brain tumour-related epilepsy in the Italian RIN-IRCCS network. Neurological Sciences (2026). PMID: 42350833. PMCID: PMC13303563. 5. Terry and Shankar. The future of epilepsy care in the United Kingdom: A roadmap for technology-enabled transformation. Epilepsia Open (2026). PMID: 41964582. PMCID: PMC13238867. Caveats: - Rurality, vEEG access, transition success, and pathway gaps are discussed as associations or service-design signals, not causal proof. - Private-insurance examples in the audio should be heard as illustrative possibilities, not findings directly tested by the rural-urban study. - The wearable false-alarm scenario is a hypothetical service-design concern, not an observed outcome in the technology-roadmap paper.

    Episode 12: Care Pathways Shape Epilepsy Outcomes
See All (19)

About

Audio Epilepsy Digest (AED) is a colleague-level podcast briefing on epilepsy research, controversies, and practice-shaping signals for epileptologists, epilepsy fellows, and surgical epilepsy teams.

Information

  • Creator
    Erafat D. Rehim, MD
  • Years Active
    2026
  • Episodes
    19
  • Rating
    Clean
  • Copyright
    © Copyright 2026 Erafat D. Rehim, MD
  • Show Website
    AED | Audio Epilepsy Digest

You Might Also Like