Good. So, good morning everybody. So, my task for this morning is to give you a brief introduction

into the clinical scenario, the clinical realm of epileptology and also the

histopathology, histopathological examination of brain tissue obtained from epilepsy surgery.

As this is a part of our EBM project, in particular the A2, and I'm very thankful that

Anne Dörfler and Friedrich Pausen joined us this morning so they can hopefully assist and help me

in case there are any questions that I may not answer. So, just to be honest,

you know, I don't see patients myself. So, what I have prepared here is the first part

a presentation of a seizure by a patient video that I have access to from the International

League's new teaching platform, the so-called ILE Academy, and it happened that I myself,

I'm the chair of this project. So, I have free access to that. However, so this is the first

part to give you an insight of what a seizure could look like, in particular the distinction

between what is a generalized and what is a focused seizure and then how it might be diagnosed.

And then I will switch gears and come to our own clinical work where we review these

those specimens that were obtained from patients that are drug resistant, that do not respond well

to anti-seizure medication and went to surgery. And then how histopathology takes place itself,

and I have prepared some live microscopy. I don't know if that is, if we get there in time,

but if you would like to do to read this together with me, I'm happy to offer. And then just, you

know, a brief conclusion. So, let me see if I can. Oh, sorry. So, I have to move here. Yeah, I have

two screens. So, this was my roadmap. And this is now, there are two videos that we can review.

I'm just saying that epilepsy is recognized as a very common severe neurological disorder by the

WHO. We have probably 50 million people worldwide. And unfortunately, at least one third of them do

not respond well to anti-epileptic drugs. Okay. So, what is now called anti-seizure medication.

And that is this rate is probably much higher in those patients that have a focal onset. And so,

the broad distinction in epileptology is whether your patient has a generalized seizure,

which is most often genetic in course, or if there is a focal onset. And focal onset is often

suggestive for some lesion inside the brain, some area. It could be a tumor. It could be a

malformation. It could be a tumor. It could be a tumor. It could be a tumor. It could be a tumor.

It could be a malformation. It could be a traumatic brain injury, a scar, whatever, an inflammation,

and so forth. But the patient cannot tell you. So, they present with a seizure first. And this is

why I want to share with you these videos. So, I don't know if you hear that voice.

No. Okay. So, it is just, you know, a sonar

person explaining what's going to see. But you see here, this person, she has a generalized

seizure. So, that works with this tonic-clonic jerking, involuntary movement. And that is what

most people would probably recognize as a seizure, right? And that is involuntary.

And that takes probably about 30 seconds to less than a minute.

And you see that people really respond to that emotionally. And this is interesting because

the word epilepsy comes from the Greek epilepsyos. And that means in German,

ergriffen sein. I don't know what that is in English. But you know, you are engaged

into that. And you pay attention to that right away. And this is another example of a

focal seizure that is completely different in its presentation. These guys sitting there at a table,

and then you see that this person now holds all the whole action. And now he has an anxiety or

some aura. And it starts to involuntarily move his arms and lip smacking and whatever,

and walk around. And he might not be aware of this. This can be completely unaware.

So, random purposeless movements where he has no control over.

So, in other words, there is a huge spectrum of what can be a seizure. And it's not that it's

always this jerking, tonic-clonic movements that can be as minute as just an absence or just a

little movement. Okay. And these focal seizures are much rarer. I think they often even fall under

the term of a rare disease. And we tried to estimate that recently with Javier Lopez-Sivera

from the Cleveland Clinic. And they come up with the estimation about, let's say, 30 people in about

100,000 would suffer from a focal and often drug-resistant epilepsy. Okay. So, this is another