AED | Audio Epilepsy Digest – Details, episodes & analysis

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AED | Audio Epilepsy Digest

Erafat D. Rehim, MD

Medicine

Frequency: 1 episode/9d. Total Eps: 22

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.

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Data updated on 09/10/2026

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Episode 22: The Epilepsy Follow-Up: Continue, Adjust, Switch—or Refer?

Episode 22

Thursday, October 1, 2026 • Duration 18:50

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 22: The Epilepsy Follow-Up: Continue, Adjust, Switch—or Refer?

An adult outpatient special prompted by a nurse practitioner's request: three everyday visits, from breakthrough seizures to treatment burden and repeated medication trials. The August 2025 Xcopri liver-label update provides a concrete example of checking medication-specific safety requirements.

In this episode:
- Reassessing events, actual medication use and barriers before automatic escalation.
- Asking how a patient feels and functions, even when seizures have stopped.
- Reviewing adequacy of previous treatments and explaining comprehensive epilepsy referral.

Clinical context:
- Liver-warning symptoms include unexplained nausea, vomiting, right upper quadrant pain, fatigue, anorexia, jaundice or dark urine. Seek prompt clinical assessment. Early DRESS may occur without an evident rash.
- Xcopri labeling specifies baseline ALT, AST and total bilirubin unless available within three months. Follow-up testing is clinically indicated; no universal monthly schedule or liver-failure incidence is supplied.
- SANAD II studied newly diagnosed focal epilepsy, not switching stable patients or comparing cenobamate.
- Individualize emergency plans within local protocols and prescribing standards. NICE is UK guidance, not US regulation.
- Jehi’s surgical-referral consensus recommends offering evaluation up to age 70 and considering older patients without surgical contraindications. Comprehensive care remains individualized. Referral evaluates options and does not commit a patient to surgery.
- The label specifies ALT, AST and total bilirubin; other urgent tests are clinician-directed, not universal label requirements. Clinically indicated follow-up is broader than symptoms alone.

Sources:
- Xcopri US prescribing information, revised August 2025.
- NICE NG217, chapters 4, 7 and 10.
- Marson et al. SANAD II focal epilepsy. Lancet 2021. DOI: 10.1016/S0140-6736(21)00247-6.
- Jehi et al. Timing of referral for epilepsy surgery evaluation. Epilepsia 2022. DOI: 10.1111/epi.17350.

AED Quiz (non-accredited self-assessment):
https://audioepilepsydigest.com/episode-022-aed-quiz.html

AED website:
https://audioepilepsydigest.com/

AI-assisted editorial/source review:
https://audioepilepsydigest.com/episode-022-ai-review.html

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Episode 21: FCD: What Does the Diagnosis Actually Tell Us?

Episode 21

Monday, September 21, 2026 • Duration 18:38

Episode 21: FCD: What Does the Diagnosis Actually Tell Us?

A monthly special on focal cortical dysplasia: what an integrated diagnosis explains, what anatomy and electrophysiology add, and where AI detection and targeted treatment remain uncertain.

Key takeaways:
- MRI impression, histopathology and molecular findings are connected but distinct. FCD type is not a severity ladder.
- Selected bottom-of-sulcus studies do not establish a universal resection rule.
- Mechanistic promise and exploratory subgroup signals do not establish a prescribing rule.

Editorial clarifications:
- MTOR variants were not detected in the available blood or saliva samples in Lim’s study; negative peripheral testing does not exclude brain-restricted mosaicism.
- Regional surgical-outcome differences are observational and may reflect surgical constraints; they are not individual predictions.
- No washout in the everolimus crossover trial allows potential carryover and limits interpretation. The trial did not demonstrate overall superiority.
- Independent AI testing evaluates performance under different conditions; detection is not a resection map.

Papers discussed:
- Najm et al. (2022). DOI: 10.1111/epi.17301
- Wagstyl et al. (2022). DOI: 10.1111/epi.17130; correction retained.
- Macdonald-Laurs et al. (2023). DOI: 10.1111/epi.17495
- Ripart et al. Corrected MELDGraph study; correction retained.
- Kaas et al. (2026). DOI: 10.1016/j.eplepsyres.2026.107778
- Lim et al. (2015). DOI: 10.1038/nm.3824
- Kim et al. (2025). DOI: 10.1002/epi4.13104

AED website:
https://audioepilepsydigest.com/

Episode 20: Who Decides on Epilepsy Surgery?

Episode 20

Monday, September 14, 2026 • Duration 21:29

Episode 20: Who Decides on Epilepsy Surgery?

From identifying people who have not reached evaluation to center-level recommendations and estimates of seizure benefit and visual harm, five papers examine how the path to epilepsy surgery is shaped—and what these studies cannot decide for an individual.

The opening welcomes Timon, the editor’s new Sheltie puppy, before the research discussion.

AED Quiz for this episode:
https://audioepilepsydigest.com/episode-020-aed-quiz.html

Listen and follow Audio Epilepsy Digest:
https://audioepilepsydigest.com/

Key takeaways:
- Caraway: recommendations varied across 29 pediatric centers after adjustment. A recommendation included invasive monitoring; it did not establish an operation, outcome, or inappropriate decision.
- Simmons: an EHR rule flagged possible cases for chart review. Among 84 confirmed cases of drug-resistant epilepsy, 48 had no evaluation initiated; the rule did not itself diagnose drug resistance.
- Coordinator tracking was associated with evaluation status. This observational finding establishes neither benefit nor lack of benefit from a coordinator intervention.
- Karpychev: MRI network measures showed an exploratory long-term outcome signal, with external AUC 0.65. The model is not a surgical exclusion rule or a resection map.
- Wreghitt: probabilistic tractography better delineated optic-radiation anatomy and estimated injury correlated with visual-field loss in 33 adults. It did not establish guaranteed safe margins or prevention of visual deficits.- Englot supplies historical review-based referral context. Referral, recommendation, prediction, treatment, and patient preferences remain distinct decisions.

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

Episode 19

Tuesday, September 1, 2026 • Duration 24:16

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.

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

Episode 18

Monday, August 24, 2026 • Duration 21:35

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.

Episode 17: What Counts as Neuromodulation Success?

Episode 17

Monday, August 17, 2026 • Duration 47:05

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.

Episode 16: Signals, Silence, and Zero Events

Episode 16

Thursday, August 13, 2026 • Duration 21:48

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.

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

Episode 15

Friday, July 24, 2026 • Duration 29:01

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.

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

Episode 14

Tuesday, July 14, 2026 • Duration 19:55

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.

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

Episode 13

Monday, July 6, 2026 • Duration 24:03

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.

AED | Audio Epilepsy Digest – Details, episodes & analysis

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