AANEM Presents Nerve and Muscle Junction

Do you know what neuromuscular condition Spock from Star Trek may have had? Tune in to this Lessons from the Lab to learn!

In this AANEM podcast, Dr. Chilvana Patel interviews Dr. Devin Rubin and Dr. Nortina Shahrizaila about global disparities in EMG and nerve conduction study training. They discuss challenges such as inconsistent educational program standards, limited resources, and lack of mentorship, especially in developing countries. The experts are discussing the current efforts to improve access to hands-on training and standardized education.

Dr. Kelly Gwathmey interviews Dr. Corey Bacher from the University of Toronto, Dr. Charles Kassardjian from the University of Toronto, both in Toronto, Ontario, Canada. We also have Dr. Ruple Laughlin from the Mayo Clinic in Rochester, Minnesota, and Dr. Puspha Narayanswami from Beth Israel Deaconess Medical Center in Boston, Massachusetts. They will all be discussing recommendations for monitoring and managing glucocorticoid related systemic complications from the recently published: “International Consensus Guidance for the Management of Glucocorticoid Related Complications in Neuromuscular Disease."

This AANEM podcast features Dr. Joome Suh, a neurologist and neuromuscular specialist at Brigham and Women's Hospital, interviewed by neuromuscular fellow Dr. Nadia Khalil. They discuss HMG-CoA reductase immune-mediated necrotizing myopathy (HMGCR IMNM), a rare autoimmune muscle disease often associated with statin use. The discussion covers clinical presentation, epidemiologic considerations, histopathologic findings, and treatment approaches, with special focus on Dr. Suh's recent research published in Muscle and Nerve with co-author Dr. Anthony Amato. Their study found that patients receiving maintenance IVIG as part of their regimen were more likely to have a normal CK at 6 months and the daily prednisone-equivalent was lower. A sub-group analysis suggested IVIG as monotherapy is effective.

How did you fare on your March Madness brackets? Did you win your EMG lab pool? Did you pick any upsets? Tune in and you will be sure to win this Lessons from the Lab March Madness bracket. It's full of surprises and successes, and you won't be “upset".

In this podcast, host Carrie Ford, CNCT, R.NCS.T., interviews 4 nerve conduction technologists: Candy Dolan, CNCT, R.NCS.T, R.EEGT, Pati Ramsey, CNCT, R.NCS.T, Nicole Wiley, CNCT, and Nathaniel Dickey, CNCT.They discuss how AANEM transformed their field by establishing the Certified Nerve Conduction Technologist (CNCT) credential in 2011. The technologists share insights about AANEM membership benefits, certification challenges, employer support and offer advice to newcomers on mentorship and continuous learning. All emphasize the importance of certification and community involvement in maintaining professional standards.

The podcast explores the AANEM Training Program Partnership (TPP), an educational resource designed for neurology and PM&R training programs. The discussion features current neuromuscular fellows, Sukhraj Gill & Praveen Attele, along with hosts Bhaskar Roy (an associate professor at Yale) and Carrie Ford (a technologist at University of Utah).

Enjoy this Valentine's Day edition of Lessons From the Lab! Drs. Rubin and Levin work through a case with some twists and turns and a variety of teaching points – it's just like not knowing what you are going to get when you open a box of Valentine's Day chocolates!

Grab your hot chocolate and cozy up to your fireplace as you warm up with an educational discussion about a patient who lost his voice. Drs. Rubin and Munin will help teach you how to help patients find their voice (or at least find some muscles contributing to their voice with needle EMG) as they figure out the best way to approach this patient.

In this AANEM podcast, Dr. Stino interviews Dr. Allen on the groundbreaking ADHERE study, published in Lancet Neurology in 2024, which investigated efgartigimod for treating chronic inflammatory demyelinating polyneuropathy (CIDP). As the largest CIDP trial to date with 322 patients across 146 sites, it marked the first major study of a targeted biologic therapy in CIDP. The trial featured a unique two-stage design: An open-label response phase followed by a randomized controlled phase for responders. Dr. Allen explains the rationale behind targeting IgG in CIDP, despite its less clear antibody-mediated mechanism compared to myasthenia gravis. The study demonstrated a 66-70% response rate in the open-label phase, with significantly lower relapse rates compared to placebo in the randomized phase. This research represents a significant advancement in CIDP treatment options, offering a weekly subcutaneous administration that could reduce treatment burden compared to traditional therapies.

In this AANEM podcast, Dr. Andrés De León interviews neuromuscular pathology experts Dr. Aziz Shaibani and Dr. Marcus Pinto about the current state and value of muscle and nerve biopsies in clinical practice. The discussion covers essential topics including proper indications for biopsies, technical considerations in choosing biopsy sites, staining techniques, and the impact of advancing genetic testing on diagnostic approaches. Dr. Shaibani emphasizes that while genetic testing has reduced some muscle biopsy indications, biopsies remain crucial for certain conditions like inflammatory myopathies and mitochondrial disorders. Dr. Pinto details specific scenarios where nerve biopsies are invaluable, particularly in diagnosing vasculitic neuropathy and amyloidosis. Both experts share insights on the complementary role of muscle and nerve biopsies in conditions like systemic vasculitis and discuss how modern diagnostic tools like myositis antibody testing and genetic panels are changing but not eliminating the need for tissue diagnosis.

In this AANEM podcast, Carrie Ford, a CNCT and R.NCS.T. from the University of Utah's Jack Pedegon EMG Lab, interviews Dr. Kyle Mahoney, an associate professor at the University of Utah, who provides a comprehensive explanation of neuromuscular junction transmission and the critical concept of the "safety factor." He breaks down complex neurophysiological concepts using accessible analogies, explaining how the safety factor serves as a built-in buffer that ensures reliable nerve-to-muscle signal transmission. The discussion covers normal neuromuscular junction function, the impact of various pathological conditions such as Lambert-Eaton Myasthenic Syndrome, myasthenia gravis, and ALS on neuromuscular transmission, and the clinical significance of repetitive nerve stimulation testing. Dr. Mahoney's clear explanations make these technically challenging concepts more approachable for healthcare professionals, particularly EMG technicians who may be less familiar with the underlying mechanisms of neuromuscular transmission.

Sit back and reminisce about the old oral EMG board examination as two former examiners discuss their thought process on an interesting case. See if Dr. Chiodo passes his Lessons From the Lab examination (he does with flying colors!). You are sure to learn good, practical knowledge when you listen to this episode.

In this AANEM podcast, Dr. Kelly Gwathmey interviews Dr. Aziz Shaibani and Dr. Yasser Hussain, two experienced neuromuscular specialists who run successful private practice clinical research programs in Texas. They discuss the motivations for conducting clinical trials, including expanding treatment options for patients and contributing to medical advancement. The experts share valuable insights about building research infrastructure, recruiting patients, managing competing trials, and balancing clinical duties with research responsibilities. They emphasize the importance of having well-trained research coordinators, efficient databases, and proper facility space. Both physicians stress the need for more clinical trial training in medical education and encourage young physicians to enter the field, noting that while only 5% of physicians participate in clinical trials, there are over 200,000 trials currently listed in the USA, presenting significant opportunities for new researchers.

Join in to this episode of Lessons From the Lab as Drs. Rubin and Hobson-Webb discuss a challenging case filled with many things to ponder. Is the arm finding related to the neuropathy? Are the findings indicative of demyelination? Is there conduction block? Is Dr. Rubin good at ultrasound scanning? You will be sure to learn quite a bit during this discussion!

In this comprehensive discussion, four prominent neuromuscular experts—Drs. Bhaskar Roy, Jeff Allen, Diana Castro, and Luis Querol—explore recent developments in Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). The conversation centers on the new European Academy of Neurology and Peripheral Nerve Society guidelines, highlighting significant changes in diagnostic criteria and disease classification. The experts discuss the challenges of diagnosing CIDP, particularly in pediatric cases and variant forms, while emphasizing the importance of proper electrodiagnostic testing and the role of supportive criteria like CSF studies and MRI. They delve into the emerging field of autoimmune neuropathies and the significance of specific antibody testing. The podcast concludes with a discussion of treatment options, including traditional approaches (IVIG, corticosteroids, plasmapheresis) and newer therapies such as FcRn inhibitors and complement-targeting drugs, while also addressing the controversial role of rituximab in CIDP treatment. Throughout the discussion, the experts stress the importance of regular diagnostic reassessment and the need for more personalized treatment approaches based on patient profiles.

This podcast discusses paraproteinemic neuropathies, featuring experts Dr. Michelle Maruman and Dr. Eli Naddaf. They explore the definition and clinical significance of monoclonal proteins, the necessary tests for diagnosing these conditions, and the various types of paraproteinemic neuropathies. The discussion covers IgM-associated neuropathies, including DADS, CANOMAD, and Waldenstrom's acroglobulinemia-associated neuropathies, as well as non-IgM neuropathies such as POEMS syndrome and light chain amyloidosis. The experts detail the clinical features, diagnostic criteria, and management approaches for these conditions, emphasizing the importance of accurate diagnosis and appropriate treatment. They conclude by reminding clinicians that the co-occurrence of peripheral neuropathy and monoclonal gammopathy in aging populations is often coincidental, and a careful evaluation is necessary to establish a causal relationship.

Despite its recognition for nearly 40 years, anti-MAG neuropathy continues to have limited therapeutic options. The emergence of bruton tyrosine kinase inhibition as a new therapeutic pathway appears promising. In this interview, Dr. Amro Stino interviews Dr. Chiara Briani on her 2023 paper exploring the prevalence of the MYD 88 mutation among patients with anti-MAG neuropathy. This is discussed within the broader context of disease presentation, current treatment landscape, and future drug development.

Dr. Andrés De León interviews Drs. Simon Podnar and Gregor Omejec about their research on recovery of ulnar nerve conduction block at the elbow. 

Dr. Chilvana Patel interviews Dr. Khadilkar on the article titled "Acquired Hyperexcitable Peripheral Nerve Disorders: Clinical and Laboratory Features, Therapeutic Responses, and Long-Term Follow-Up." This study examines the clinical and laboratory characteristics of acquired hyperexcitable peripheral nerve disorders, evaluates therapeutic responses, and provides insights from long-term follow-up observations.

Did you miss Lessons From the Lab LIVE 2? Watch the recording now and see the fun you missed as Drs. Devon Rubin and Christopher Lamb present and discuss a unique case of a young rock climber with arm weakness.

Carrie Ford, CNCT, RNSCT, REPT (Emeritus) interviews Peter Grant, MD who is a fraud and abuse expert for the FBI Office of Inspector General, US Attorney's Office, private insurers, and state medical boards. During this podcast, Peter discusses AANEM lab accreditation—how and when it got started. Dr. Grant explains how to apply for lab accreditation, the benefits of being an accredited lab, exemplary accreditation status vs regular accreditation, and how the HB2639 will affect lab accreditation.

Carrie Ford, CNCT, RNSCT, REPT (Emeritus) interviews Peter Grant, MD who is a fraud and abuse expert for the FBI, Office of Inspector General, US Attorney's Office, private insurers, and state medical boards. In this podcast Dr. Grant discusses promoting quality electrodiagnostic medicine through legislation—HB2639 explaining the history and need for this legislation, as well as explaining EDX “fraudsters,” and roadblocks that have occurred with this legislation. Dr. Grant also discusses the AANEM's state liaisons, lobbying in Washington, DC, and meetings with congressman Pete Sessions for support of HB2639.

Join this Lessons From the Lab as Dr. Devon Rubin picks the amazing brains of Drs. Donald Sanders and Janice Massey on the approach to a patient with weakness. Learn what it means when a patient walks into the office sucking on hard candy as well as what tools should be used to think about and assess for an uncommon neuromuscular disorder.

Carrie Ford interviews Dr. Peter Grant on fraud and abuse.

Dr. Nadia Khalil interviews Dr. Collin Grant on his experience in private practice. He shares his take on the highlights, challenges, and keys for success.

Have you ever encountered a patient with progressive patchy weakness in various muscles throughout the body? Have you ever performed an EMG in which the findings don't always fit perfectly into what you were expecting?  Have you ever wondered whether you even need to perform an EMG in a patient with weakness? Have you ever wondered how much fun it would be to listen to a new episode of Lessons From the Lab? Well, you have come to the right place to find some answers to these questions! Join Drs. Rubin and Narayanaswami as they ponder and discuss many clinical, electrodiagnostic, and practical approaches to an interesting patient with progressive weakness.

Dr. Nadia Khalil interviews Dr. Ileana Howard and Dr. Kelly Gwathmey on their careers in neuromuscular medicine. They define a neuromuscular practice and highlight how meaningful, challenging, and exciting this field of medicine is.

Dr. Nadia Khalil interviews Dr. Nicholas Johnson on a career in research. He describes what research in practice looks like, his inspiration, and pearls for success. 

Dr. Nadia Khalil interviews Dr. Milind Kothari and Dr. Sandra Hearn on academic practice. They define what life as a clinician educator looks like and share pearls from their own journeys for success.

If you had to evaluate a patient with hand numbness on a deserted island and could only take one EDX item with you, what would it be? Tune in to this episode to see what Drs. Devon Rubin and Michael Cartwright would choose! And learn many more tips of the trade as they discuss a common yet sometimes complicated problem in the EMG laboratory.

Dr. Kelly Gwathmey interviews Dr. Juerd Wijntjes on The Comparison of Muscle Ultrasound and Needle Electromyography Findings in Neuromuscular Disorders.

Drs. Mohamed Taha and John Morren speak with Andy Galbreath about their recent Muscle & Nerve paper on Artificial Intelligence in NM and EDX Medicine.  The authors discuss concepts of machine learning, deep learning, and artificial neural networks as they relate to NM and EDX medicine. Limitations and regulatory challenges are also discussed.  Muscle & Nerve. 2024;69:260-272.

Dr. Devon Rubin challenges the father-son combination of Drs. Peter Dyck and Jim Dyck with a case of peripheral neuropathy. Watch to find out whether the patient's diabetes was the culprit or whether there was another cause. You will not be disappointed as you learn many pearls in the clinical and EDX evaluation of peripheral neuropathy. Visit our website for more information and educational materials ⁠education.aanem.org⁠.

Did you miss the first-ever Lessons From the Lab LIVE? Listen and watch what fun you missed now! Hear Devon Rubin, MD, and Ruple Laughlin, MD, as they discuss a case on unilateral leg numbness.

This podcast is a discussion of three challenging electrodiagnostic cases with three neuromuscular and electrodiagnostic experts. The first case explores the challenges of routine electrodiagnostic testing in someone with a chronic, underlying brachial plexopathy. The second case discusses the expected electrophysiological changes in a patient with a presynaptic neuromuscular junction disorder. In the third case, electrophysiological features of a patient with Hirayama's Disease (i.e. monomelic amyotrophy) are discussed.

Listen to this episode to see if Dr. Grant thinks that Dr. Rubin appropriately evaluated a patient with suspected polyneuropathy – is one NCS too few, are 22 NCS too many? Tune in to find out the answer, and much more!

Dr. Devon Rubin presents Dr. David Preston with a challenging case of a man with subacute lower extremity weakness. Enjoy the potpourri of information about anticoagulation, A waves, F waves, demyelination, ultrasound, Siri, and so much more! Visit our website for more information and educational materials ⁠education.aanem.org⁠.

This episode of Lessons From the Lab should make you laugh, think, and maybe cry as Drs. Devon Rubin and Danna Quan discuss various approaches to the evaluation of patients with suspected motor neuron disease. Visit our website for more information and educational materials education.aanem.org.

Chilvana Patel, Associate Professor and Neurology Residency Program Director at University of Texas Medical Branch Galveston, Texas, interviewing Dr. Bhai who is an Assistant Professor in the Department of Neurology at UT Southwestern Medical Center and the Director of the Neuromuscular Center in the Institute of Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas and Dr. Vissing  who is a professor in Department of Neurology  at university of Copenhagen, Denmark and Director of Copenhagen Neuromuscular Center at the National Hospital about their  recently published articles in Muscle and Nerve in April 2023 on Diagnosis and management of metabolic myopathies.

Dr. Rothman interviews Drs. Stratton and Yang to discuss the treatment landscape of Duchenne Muscular Dystrophy, highlighting Elevidys, the newly approved recombinant gene therapy.

Join us in this episode as Devon Rubin, MD, challenges Professor Erik Stalberg with an unknown case and discusses various EMG approaches to a patient with suspected neuromuscular junction disease. Watch Professor Stalberg grade Dr. Rubin's single fiber pairs and hearing about single fiber EMG on dogs will surely make you smile!

Hear from Andrew D. Galbreath, DO, as he meets with Ileana Howard, MD, to discuss her recent paper: Respiratory Considerations in Patients With Neuromuscular Disorders.

In Episode 6 of Lessons From the Lab, we have a fun, educational discussion with Dr. Robert Irwin, current president of AANEM, about an interesting patient with scapular winging. Learn about clinical, electrodiagnostic, and neuromuscular ultrasound assessment of scapular winging, and approaches to managing these patients. Visit our website for more information and educational materials education.aanem.org.

Elie Nadaff, MD, meets with Nicholis Maragakis, MD to discuss the ALS treatment landscape.

Devon Rubin, MD, is joined by John Kincaid, MD, to discuss which is the most important tool in the neurologist's bag, the largest wad of cotton, and interesting findings in a patient with foot numbness. Visit our website for more information and educational materials education.aanem.org.

Devon Rubin, MD, is joined by Andrea Boon MD, to discuss EDX and NMUS approaches, intricacies, and difficulties of a patient who presented with respiratory weakness. Visit our website for more information and educational materials education.aanem.org.

Dr. Amro Stino interviews Dr. Larry Robinson about the role of electrodiagnosis in nerve transfers for focal neuropathies and brachial plexopathies.

Dr. Amro Stino interviews Dr. Larry Robinson about the role of electrodiagnosis in nerve transfers for focal neuropathies and brachial plexopathies.

Devon Rubin, MD, is joined by Holli Horak, MD, to discuss the topic: How do we approach suspected ulnar neuropathy in the EMG laboratory?

Dr. Chilvana Patel interviews Dr. Jeffrey Allen about the diagnosis and treatment of chronic inflammatory demyelinating polyneuropathy (CIDP).