Epilepsy and Seizures - Complete Clinical Reference

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pres.title = "Epilepsy and Seizures - Complete Clinical Reference";
pres.author = "Orris Medical";

// ─── COLOR PALETTE ──────────────────────────────────────────────
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// ─── HELPERS ────────────────────────────────────────────────────
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// ═══════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════
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  s.addText("🧠", { x: 7.1, y: 0.7, w: 2.5, h: 2.5, fontSize: 72, align: "center", valign: "middle" });
  // Main title
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  s.addText("& SEIZURES", { x: 0.5, y: 1.75, w: 6.3, h: 0.9, fontSize: 40, bold: true, color: C.accentTeal, fontFace: "Calibri", margin: 0 });
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  s.addText("Complete Clinical Reference", { x: 0.5, y: 2.88, w: 6.3, h: 0.5, fontSize: 18, color: C.textLight, fontFace: "Calibri", margin: 0 });
  s.addText("Definition  •  Epidemiology  •  Pathophysiology  •  Classification\nInvestigation  •  Management  •  Treatment  •  Prevention", {
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  s.addText("Sources: Adams & Victor | Bradley & Daroff | Katzung | WHO 2024 | ILAE 2017", {
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// ═══════════════════════════════════════════════════════
// SLIDE 2 — CONTENTS
// ═══════════════════════════════════════════════════════
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  const topics = [
    ["01", "Definitions"],
    ["02", "Epidemiology"],
    ["03", "Etiology"],
    ["04", "Classification of Seizures"],
    ["05", "Pathophysiology"],
    ["06", "Clinical Presentation"],
    ["07", "Investigations"],
    ["08", "Management & Treatment"],
    ["09", "Antiseizure Medications"],
    ["10", "Non-Pharmacological Treatment"],
    ["11", "Prevention & Prognosis"],
    ["12", "References"],
  ];
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// ═══════════════════════════════════════════════════════
// SLIDE 3 — DEFINITIONS
// ═══════════════════════════════════════════════════════
{
  const s = pres.addSlide();
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  sectionBar(s, "01 | Definitions");
  // Seizure card
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  s.addText("SEIZURE", { x: 0.55, y: 0.98, w: 3, h: 0.38, fontSize: 15, bold: true, color: C.accentTeal, fontFace: "Calibri", margin: 0 });
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    "A transient event of signs/symptoms due to abnormal, excessive, and hypersynchronous neuronal activity in the brain. May manifest as involuntary movements, altered consciousness, sensory disturbance, autonomic phenomena, or psychic symptoms.",
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  // Epilepsy card
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  s.addText("EPILEPSY  (ILAE 2014 Definition)", { x: 0.55, y: 2.44, w: 8.8, h: 0.38, fontSize: 15, bold: true, color: C.accentGold, fontFace: "Calibri", margin: 0 });
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    { text: "A disease of the brain defined by any ONE of:\n", options: { bold: true, color: C.white, breakLine: false } },
    { text: "1.  At least two unprovoked (or reflex) seizures > 24 hours apart\n", options: { color: C.textLight } },
    { text: "2.  One unprovoked seizure + ≥60% probability of recurrence over next 10 years\n", options: { color: C.textLight } },
    { text: "3.  Diagnosis of an epilepsy syndrome", options: { color: C.textLight } },
  ], { x: 0.55, y: 2.85, w: 9.0, h: 1.05, fontSize: 12, fontFace: "Calibri", margin: 0 });
  // Status card
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  s.addText("STATUS EPILEPTICUS", { x: 0.55, y: 4.17, w: 3.5, h: 0.38, fontSize: 14, bold: true, color: C.red, fontFace: "Calibri", margin: 0 });
  s.addText("Prolonged seizures (>5 min) or repeated seizures without recovery between episodes. Life-threatening emergency.", {
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// ═══════════════════════════════════════════════════════
// SLIDE 4 — EPIDEMIOLOGY
// ═══════════════════════════════════════════════════════
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  sectionBar(s, "02 | Epidemiology");
  const stats = [
    { val: "50M",   label: "People worldwide\nhave epilepsy",        col: C.accentTeal },
    { val: "80%",   label: "Cases in low/middle-\nincome countries",  col: C.accentGold },
    { val: "70%",   label: "Can be seizure-free\nif treated",         col: C.green },
    { val: "3×",    label: "Higher premature\ndeath risk",            col: C.red },
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    ["Annual incidence (US)", "~44 new cases per 100,000 persons/year"],
    ["Lifetime prevalence (US)", "~3% lifetime risk of receiving an epilepsy diagnosis"],
    ["Active epilepsy prevalence", "~0.8% of the general population"],
    ["Age of onset peaks", "Early childhood (first year of life) and after age 60"],
    ["First seizure lifetime risk", "~9% of all people will have at least one seizure in their lifetime"],
    ["Treatment gap (low-income)", "Up to 75% of patients receive no treatment"],
    ["Most common cause after 60", "Cerebrovascular disease"],
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// ═══════════════════════════════════════════════════════
// SLIDE 5 — ETIOLOGY
// ═══════════════════════════════════════════════════════
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  sectionBar(s, "03 | Etiology");
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    { title: "Genetic", color: "1A4731", items: ["SCN1A mutation → Dravet syndrome", "KCNQ2/3 → Benign neonatal epilepsy", "CHRNA4 → Nocturnal frontal lobe epilepsy", "Monozygotic twin concordance: 70%", "Familial incidence: 5-10% of primary epilepsies", "Polygenic contributions common"] },
    { title: "Metabolic", color: "4A1942", items: ["Hypoglycemia, hyponatremia, hypocalcemia", "Hypomagnesemia, hypernatremia", "Renal failure (uremia)", "Hepatic encephalopathy, thyrotoxicosis", "Porphyria", "Alcohol/BZD withdrawal"] },
    { title: "Immune / Infectious", color: "4A2E0A", items: ["Anti-NMDAR, anti-LGI1, anti-CASPR2", "Autoimmune encephalitis", "Neurocysticercosis (global leading cause)", "Cerebral malaria, HIV", "Bacterial meningitis", "Viral encephalitis"] },
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// ═══════════════════════════════════════════════════════
// SLIDE 6 — CLASSIFICATION (ILAE 2017)
// ═══════════════════════════════════════════════════════
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  sectionBar(s, "04 | Classification of Seizures (ILAE 2017)");
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    ["Focal Impaired", "Complex partial — consciousness impaired; automatisms"],
    ["Focal → Bilateral", "Formerly 'secondarily generalized'; starts focal, spreads bilaterally"],
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  const genItems = [
    ["Tonic-Clonic (Grand Mal)", "LOC → tonic stiffening → clonic jerking; <3 min; postictal confusion"],
    ["Absence (Petit Mal)", "4-20 sec staring; no postictal state; 3 Hz spike-wave; onset 5-7 yr"],
    ["Myoclonic", "Brief (<100 ms) muscle jerks; juvenile myoclonic epilepsy, Dravet"],
    ["Atonic (Drop Attacks)", "Sudden loss of muscle tone; Lennox-Gastaut syndrome"],
    ["Epileptic Spasms", "Sudden flexion/extension; West syndrome (infantile spasms)"],
  ];
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  // Unknown
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  s.addText("UNKNOWN ONSET", { x: 7.92, y: 0.94, w: 1.76, h: 0.38, fontSize: 11, bold: true, color: C.green, fontFace: "Calibri", align: "center", margin: 0 });
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  s.addText("Seizure onset cannot be determined from available information.", {
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  s.addText("Insufficient information or unusual presentation.", { x: 7.92, y: 3.1, w: 1.76, h: 0.8, fontSize: 10, color: C.textLight, fontFace: "Calibri", margin: 0 });
  s.addText("Source: ILAE 2017 Operational Classification", { x: 0.35, y: 5.25, w: 9.3, h: 0.28, fontSize: 9, color: "607080", fontFace: "Calibri", margin: 0 });
}

// ═══════════════════════════════════════════════════════
// SLIDE 7 — PATHOPHYSIOLOGY
// ═══════════════════════════════════════════════════════
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  sectionBar(s, "05 | Pathophysiology");
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  s.addText("Core Mechanism:", { x: 0.42, y: 0.94, w: 2.2, h: 0.38, fontSize: 13, bold: true, color: C.accentTeal, fontFace: "Calibri", margin: 0 });
  s.addText("Sudden imbalance between excitation (glutamate ↑) and inhibition (GABA ↓) in cortical neuronal networks → Excessive, abnormal, synchronous discharge", {
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    { title: "PDS — Paroxysmal Depolarization Shift", color: "152A40", text: "Large sustained neuronal depolarization with burst of action potentials, followed by hyperpolarization. In normal tissue, inhibitory surround contains the discharge. When inhibition fails → seizure spreads." },
    { title: "Ion Channel Dysfunction", color: "152A40", text: "Persistent Na+ currents (SCN1A mutation = Dravet), T-type Ca²+ channels (absence seizures via thalamocortical loops), voltage-gated K+ channel dysfunction (KCNQ2/3 = benign neonatal epilepsy)." },
    { title: "Hippocampal Sclerosis", color: "152A40", text: "Neuronal loss in CA1 sector (Sommer sector) + gliosis. Most common substrate in temporal lobe epilepsy. Detected by MRI. Surgical resection achieves 70% seizure freedom." },
    { title: "Consequences of Chronic Seizures", color: "1A1A0A", text: "Accelerated cortical thinning (neurodegeneration), hippocampal atrophy, memory/cognitive impairment, SUDEP risk (Sudden Unexpected Death in Epilepsy)." },
  ];
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}

// ═══════════════════════════════════════════════════════
// SLIDE 8 — CLINICAL PRESENTATION
// ═══════════════════════════════════════════════════════
{
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  darkSlide(s);
  sectionBar(s, "06 | Clinical Presentation");
  // Left: Phases
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  s.addText("Tonic-Clonic Seizure Phases", { x: 0.38, y: 0.95, w: 4.44, h: 0.35, fontSize: 13, bold: true, color: C.accentTeal, fontFace: "Calibri", margin: 0 });
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    { phase: "PRODROME", desc: "Hours before: irritability, apathy, or ecstasy (not the aura itself)", col: "7A9CC0" },
    { phase: "AURA", desc: "Initial focal seizure; olfactory (mesial temporal), visual (occipital), déjà vu (temporal), fear/formed hallucinations (amygdalo-hippocampal)", col: C.accentGold },
    { phase: "TONIC PHASE", desc: "Sudden cry, loss of consciousness, tonic extension of limbs (~10-30 sec)", col: C.red },
    { phase: "CLONIC PHASE", desc: "Rhythmic jerking, tongue biting, incontinence (~1-2 min)", col: C.orange },
    { phase: "POSTICTAL", desc: "Confusion, headache, fatigue, Todd's paresis (transient focal weakness)", col: C.green },
  ];
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  });
  // Right: Aura localization table
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  s.addText("Aura → Seizure Focus Localization", { x: 5.32, y: 0.95, w: 4.3, h: 0.35, fontSize: 13, bold: true, color: C.accentGold, fontFace: "Calibri", margin: 0 });
  accentLine(s, 5.32, 1.33, 4.3);
  const auras = [
    ["Somatosensory", "Contralateral post-rolandic"],
    ["Visual (unformed)", "Occipital cortex"],
    ["Olfactory", "Mesial temporal"],
    ["Gustatory", "Insula"],
    ["Auditory", "Heschl gyri"],
    ["Déjà vu / dreamy state", "Temporal lobe"],
    ["Fear / formed hallucination", "Amygdalo-hippocampal"],
    ["Vertigo", "Superior temporal"],
    ["Automatisms", "Temporal / frontal"],
  ];
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  });
}

// ═══════════════════════════════════════════════════════
// SLIDE 9 — INVESTIGATIONS
// ═══════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkSlide(s);
  sectionBar(s, "07 | Investigations");
  const invCols = [
    {
      title: "EEG (Most Important)",
      color: "0D2545",
      accentC: C.accentTeal,
      items: [
        "Interictal EEG: epileptiform discharges (spikes, sharp waves)",
        "3 Hz spike-wave → Childhood Absence Epilepsy",
        "Hypsarrhythmia → West Syndrome (Infantile Spasms)",
        "Centrotemporal spikes → BECTS",
        "Video-EEG: gold standard for presurgical evaluation",
        "Continuous EEG: after paralytics in ICU for non-convulsive status",
      ]
    },
    {
      title: "Neuroimaging",
      color: "0D2545",
      accentC: C.accentGold,
      items: [
        "MRI brain (epilepsy protocol) — preferred",
        "Detects hippocampal sclerosis, cortical dysplasia, tumors",
        "Sequences: T1 volumetric, FLAIR, T2, DWI, gadolinium",
        "CT brain: acute hemorrhage, trauma, MRI unavailable",
      ]
    },
    {
      title: "Blood Tests",
      color: "0D2545",
      accentC: C.green,
      items: [
        "Glucose, electrolytes (Na⁺, Ca²⁺, Mg²⁺), BUN, creatinine",
        "LFTs, TFTs, FBC",
        "Toxicology screen (alcohol, drugs, bupropion, tramadol)",
        "ASM drug levels if on treatment",
        "Pregnancy test in women of childbearing age",
      ]
    },
    {
      title: "Other Investigations",
      color: "0D2545",
      accentC: C.red,
      items: [
        "LP: if CNS infection suspected (NOT during active seizure)",
        "Autoimmune panel: anti-NMDAR, anti-LGI1, anti-CASPR2",
        "Genetic testing: whole exome for suspected genetic epilepsy",
        "Neuropsychological testing: cognitive/memory lateralization",
        "PET, SPECT, intracranial EEG for presurgical planning",
      ]
    },
  ];
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}

// ═══════════════════════════════════════════════════════
// SLIDE 10 — STATUS EPILEPTICUS MANAGEMENT
// ═══════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkSlide(s);
  sectionBar(s, "08 | Status Epilepticus — Emergency Management");
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    { time: "5-20 min", title: "BENZODIAZEPINES (1st Line)", color: "1A2E1A", textC: C.green, items: ["IV Lorazepam 2-4 mg (preferred; duration 12-24 h)", "IM Midazolam 10 mg (if no IV access; non-inferior)", "IV Diazepam 5-10 mg (faster onset; shorter duration)", "Goal: terminate seizure activity immediately"] },
    { time: "20-40 min", title: "2nd LINE AEDs", color: "2E2A10", textC: C.accentGold, items: ["Fosphenytoin IV 20 mg/kg (preferred over phenytoin)", "Valproate IV 20-40 mg/kg", "Levetiracetam IV 60 mg/kg (up to 4.5 g)", "Lacosamide IV 200-400 mg"] },
    { time: ">40-60 min", title: "REFRACTORY — ICU", color: "2E1010", textC: C.red, items: ["Intubation + general anesthesia", "Propofol IV infusion OR Midazolam infusion OR Pentobarbital", "Continuous EEG monitoring (mandatory post-paralytics)", "Do NOT perform LP during active status epilepticus", "CT/MRI once seizures controlled"] },
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}

// ═══════════════════════════════════════════════════════
// SLIDE 11 — ANTISEIZURE MEDICATIONS TABLE
// ═══════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkSlide(s);
  sectionBar(s, "09 | Antiseizure Medications (ASMs)");
  // Table header
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  const rows = [
    ["Valproic Acid", "Depakote", "1,000-3,000 mg/d", "6-15 h", "50-100 µg/mL", "GTC, Absence, Myoclonic — broad spectrum"],
    ["Phenytoin", "Dilantin", "300-400 mg/d", "12-36 h", "10-20 µg/mL", "Focal, GTC"],
    ["Carbamazepine", "Tegretol", "600-1,200 mg/d", "14-25 h", "4-12 µg/mL", "Focal seizures"],
    ["Oxcarbazepine", "Trileptal", "900-2,400 mg/d", "1-5 h", "—", "Focal seizures"],
    ["Lamotrigine", "Lamictal", "300-500 mg/d", "15-60 h", "2-7 µg/mL", "Focal, Absence, GTC — broad spectrum"],
    ["Levetiracetam", "Keppra", "500-3,000 mg/d", "6-8 h", "—", "Focal, GTC — broad spectrum"],
    ["Ethosuximide", "Zarontin", "750-1,500 mg/d", "20-60 h", "50-100 µg/mL", "Absence seizures ONLY"],
    ["Lacosamide", "Vimpat", "300-400 mg/d", "13 h", "—", "Focal seizures"],
    ["Topiramate", "Topamax", "400 mg/d", "20-30 h", "—", "Focal, GTC"],
    ["Phenobarbital", "Luminal", "90-200 mg/d", "40-120 h", "15-40 µg/mL", "GTC, Focal (older agent)"],
  ];
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}

// ═══════════════════════════════════════════════════════
// SLIDE 12 — MECHANISMS OF ACTION
// ═══════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkSlide(s);
  sectionBar(s, "09b | Mechanisms of Action of ASMs");
  const mechs = [
    { title: "Na⁺ Channel Blockade", color: "0D2545", drugs: "Phenytoin, Carbamazepine,\nOxcarbazepine, Lamotrigine,\nLacosamide", text: "Reduces sustained high-frequency neuronal firing by blocking voltage-gated sodium channels in their inactivated state. Effective for focal and tonic-clonic seizures." },
    { title: "GABA Enhancement", color: "1A2E1A", drugs: "Benzodiazepines, Barbiturates,\nValproate, Vigabatrin,\nClobazam", text: "Potentiates GABAergic inhibition. BZDs and barbiturates act on GABA-A receptor. Valproate increases GABA synthesis/reduces catabolism. Vigabatrin irreversibly inhibits GABA-T." },
    { title: "T-type Ca²⁺ Channel Block", color: "2E2A10", drugs: "Ethosuximide, Valproate", text: "Specifically targets thalamocortical circuits underlying absence seizures. T-type calcium channels generate rhythmic 3 Hz spike-wave activity; their blockade abolishes absence seizures." },
    { title: "SV2A Modulation", color: "2E1010", drugs: "Levetiracetam, Brivaracetam", text: "Binds synaptic vesicle protein 2A — unique mechanism not shared by other ASMs. Reduces neurotransmitter release from presynaptic terminals." },
    { title: "AMPA Receptor Antagonism", color: "1A1A30", drugs: "Perampanel", text: "Non-competitive AMPA glutamate receptor antagonist. Reduces glutamate-mediated excitation. Approved for focal and generalized tonic-clonic seizures." },
    { title: "HCN Channel Modulation", color: "1A2040", drugs: "Lamotrigine, Gabapentin,\nPregabalin", text: "Gabapentin/pregabalin bind α2δ subunit of voltage-gated Ca²+ channels, reducing excitatory neurotransmitter release." },
  ];
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// ═══════════════════════════════════════════════════════
// SLIDE 13 — NON-PHARMACOLOGICAL TREATMENT
// ═══════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkSlide(s);
  sectionBar(s, "10 | Non-Pharmacological Treatment");
  const nonPharm = [
    {
      title: "Epilepsy Surgery",
      icon: "🔬",
      color: "0D2545",
      textC: C.accentTeal,
      items: [
        "For pharmacoresistant epilepsy (failed ≥2 ASMs)",
        "Temporal lobectomy: 70% seizure-free",
        "Extratemporal resection: lower success",
        "Lesionectomy: curative for structural lesions",
        "Presurgical: Video-EEG, MRI, neuropsychology, PET, SPECT",
      ]
    },
    {
      title: "Neuromodulation",
      icon: "⚡",
      color: "1A2E1A",
      textC: C.green,
      items: [
        "VNS (Vagus Nerve Stimulator): open-loop; refractory focal seizures + LGS",
        "RNS (Responsive Neurostimulator): closed-loop intracranial device",
        "DBS (Deep Brain Stimulation): bilateral anterior thalamic nuclei",
        "All three devices approved for drug-refractory epilepsy",
      ]
    },
    {
      title: "Ketogenic Diet",
      icon: "🥑",
      color: "2E2A10",
      textC: C.accentGold,
      items: [
        "High fat, low carbohydrate, controlled protein",
        "First-line for GLUT1 deficiency syndrome",
        "Especially effective: myoclonic epilepsies, infantile spasms,",
        "Dravet syndrome, tuberous sclerosis, LGS",
        "Benefits both children and adults (Chen et al., 2023)",
      ]
    },
    {
      title: "Immunotherapy",
      icon: "💉",
      color: "2E1010",
      textC: C.red,
      items: [
        "For autoimmune/paraneoplastic epilepsy",
        "1st line: Corticosteroids, IVIG, Plasmapheresis",
        "2nd line: Rituximab, Mycophenolate, Azathioprine",
        "ACTH or Vigabatrin for West syndrome",
      ]
    },
  ];
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    });
  });
}

// ═══════════════════════════════════════════════════════
// SLIDE 14 — PREVENTION
// ═══════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkSlide(s);
  sectionBar(s, "11 | Prevention");
  const prevLevels = [
    {
      level: "PRIMARY PREVENTION",
      subtitle: "Avoiding the first seizure",
      color: "0D2545",
      textC: C.accentTeal,
      items: [
        "Prevent/treat CNS infections promptly",
        "Prevention of head trauma (helmets, seat belts)",
        "Good prenatal care (prevent birth injuries, HIE)",
        "Control cardiovascular risk factors → prevent stroke",
        "Avoid precipitants: sleep deprivation, alcohol excess",
        "Lead/heavy metal poisoning prevention (children)",
      ]
    },
    {
      level: "SECONDARY PREVENTION",
      subtitle: "Preventing seizure recurrence",
      color: "1A2E1A",
      textC: C.green,
      items: [
        "After 2 unprovoked seizures: ASM strongly recommended",
        "After 1 seizure + high recurrence risk: start ASM",
        "(structural lesion, epileptiform EEG, prior brain injury)",
        "AAN 2015 guideline (reaffirmed Feb 2024)",
        "Febrile seizures: prophylactic ASMs NOT routinely recommended",
        "Medication adherence: most important factor for seizure control",
      ]
    },
    {
      level: "TERTIARY PREVENTION",
      subtitle: "Reducing the impact of chronic epilepsy",
      color: "2E2A10",
      textC: C.accentGold,
      items: [
        "Regular follow-up, medication optimization",
        "SUDEP awareness: nocturnal supervision, detection devices",
        "Driving restriction counseling (seizure-free period required)",
        "Rescue benzodiazepines: intranasal midazolam, diastat",
        "Mental health support (anxiety/depression 2-3x higher)",
        "Seizure action plans for patients and caregivers",
      ]
    },
  ];
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}

// ═══════════════════════════════════════════════════════
// SLIDE 15 — SPECIAL POPULATIONS & PROGNOSIS
// ═══════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkSlide(s);
  sectionBar(s, "11b | Special Populations & Prognosis");
  // Special populations
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    { title: "Pregnancy", color: "1A2545", textC: C.accentTeal, items: ["Continue ASMs — uncontrolled seizures risk fetal hypoxia", "Valproate: highest teratogenicity — avoid if alternatives exist", "Lamotrigine / Levetiracetam: relatively safer", "Folic acid supplementation mandatory pre-conception"] },
    { title: "Elderly", color: "1A2545", textC: C.accentGold, items: ["Most common new-onset cause: cerebrovascular disease", "Drug interactions + polypharmacy hazards increased", "Enzyme-inducing ASMs accelerate bone metabolism", "Start low, go slow — increased drug sensitivity"] },
    { title: "Children", color: "1A2545", textC: C.green, items: ["Wide variety of age-specific syndromes", "West, Dravet, LGS, CAE, BECTS", "Many benign childhood epilepsies remit spontaneously", "ACTH/Vigabatrin first-line for infantile spasms"] },
  ];
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// ═══════════════════════════════════════════════════════
// SLIDE 16 — REFERENCES
// ═══════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkSlide(s);
  sectionBar(s, "12 | References");
  const refs = [
    "1.  Adams and Victor's Principles of Neurology, 12th Ed. — Chapter 15: Epilepsy and Other Seizure Disorders",
    "2.  Bradley and Daroff's Neurology in Clinical Practice — Chapter 100: Seizures and Epilepsy Definitions",
    "3.  Katzung's Basic and Clinical Pharmacology, 16th Ed. — Chapter 24: Antiseizure Medications",
    "4.  Tintinalli's Emergency Medicine: A Comprehensive Study, 9th Ed. — Chapter 171: Treatment of Status Epilepticus",
    "5.  Eric Kandel's Principles of Neural Science, 6th Ed. — Seizure Focus and Surgical Treatment",
    "6.  Harriet Lane Handbook, 23rd Ed. — Status Epilepticus Treatment Guidelines",
    "7.  Fisher RS et al. ILAE Official Report: A practical clinical definition of epilepsy. Epilepsia 2014; 55(4):475-482",
    "8.  Scheffer IE et al. ILAE classification of the epilepsies. Epilepsia 2017; 58(4):512-521",
    "9.  WHO Epilepsy Fact Sheet, February 2024",
    "10. AAN/AES Practice Guideline: Management of an Unprovoked First Seizure in Adults. Neurology 2015; 84(16):1705. Reaffirmed Feb 2024",
    "11. Pressler RM et al. Treatment of seizures in the neonate: ILAE Task Force. Epilepsia 2023 Oct [PMID: 37655702]",
    "12. Chu H et al. Antiseizure medications for idiopathic generalized epilepsies. J Neurol 2023 [PMID: 37378757]",
    "13. Chen S et al. Ketogenic Diet and Multiple Health Outcomes: Umbrella Review. Nutrients 2023 [PMID: 37836444]",
    "14. NAEC 2023 Guidelines for Specialized Epilepsy Centers. Neurology 2024 Feb",
    "15. Hauser WA, Annegers JF. Epidemiology of epilepsy. Textbook of Epilepsy, 1992",
  ];
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// ═══════════════════════════════════════════════════════
// SLIDE 17 — CLOSING
// ═══════════════════════════════════════════════════════
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  const takeaways = [
    ["50 million people", "worldwide have epilepsy; 80% in low/middle-income countries"],
    ["ILAE 2014 definition", "requires ≥2 unprovoked seizures or 1 seizure with ≥60% recurrence risk"],
    ["Core mechanism", "is glutamate excess + GABA deficit → excessive synchronized neuronal discharge"],
    ["EEG + MRI", "are the cornerstone investigations for all seizure presentations"],
    ["Monotherapy first", "achieves seizure control in ~2/3 of patients; pharmacoresistance in ~30%"],
    ["Status epilepticus", "lorazepam → fosphenytoin/levetiracetam → anesthesia within 30 minutes"],
    ["Surgery, VNS, RNS/DBS", "and ketogenic diet are options for drug-refractory epilepsy"],
    ["Prevention", "addresses primary (avoid first seizure), secondary (prevent recurrence), tertiary (reduce impact)"],
  ];
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}

// ─── WRITE FILE ─────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/epilepsy-ppt/Epilepsy_and_Seizures.pptx" })
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  .catch(e => { console.error("ERROR:", e); process.exit(1); });

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/epilepsy-ppt/epilepsy.js'