The Neurology Lounge

Linda Gask joins me in this episode to explore her dual perspectives of depression as a sufferer, and as a psychiatrist. Emerita Professor of Primary Care Psychiatry, Linda chronicles her history of depression which first reared its head when she was in medical school, and dogged her career as a junior doctor and then as a consultant. Linda described the manifestations of her depression, from low mood and poor motivation to physical pain and suicidality. She also highlighted her co-morbid performance anxiety, obsessiveness, and ruminative thoughts. We also explored her biopsychosocial vulnerabilities to depression, such as a strong family history of mental illness, and the life events that trigger her breakdowns. The podcast also discussed Linda's double-edged experience of antidepressants, and of psychological therapies. She also highlighted the importance of having healthy relationships and being open about the disorder. Other themes of the conversation are the vulnerability of doctors, especially psychiatrists, to depression and suicide; the practical approaches to managing depression; and the inadequacies of current anti-depressant therapies.Linda has worked as an advisor to WHO and has been on the Board of the World Psychiatric Association. She co-founded the STORM suicide prevention training organisation, and she now serves as Vice-Chair of the Blide Trust, a mental health voluntary organisation. Her latest book is ‘Out of Her Mind: How We are Failing Women's Mental Health and What Must Change'.

In this episode I take an exhaustive look at the diverse perspectives of depression, that pervasive mood disorder that afflicts far too many people. I explore its gradual onset and chronic, often life-long course, and highlight the overwhelming features of depression, from low mood and poor appetite to poor sleep and loss of interest in pleasurable activities. I also explore the less appreciated dimension of the pain of depression.I illustrate the lived experience of depression with such fascinating patient accounts as that of Sally Brampton titled Shoot the Damned Dog, of Lewis Wolpert titled Malignant Sadness, of Andrew Solomon titled The Noonday Demon, and of William Styron titled Darkness Visible. Significantly, the memoirs stress the difficulty people have in recognising that their low mood has crossed the threshold into depression.The interplay of familial and environmental risk factors of depression is also a major theme of the podcast which emphasised such critical provoking life events as divorce and loss of income. I also discussed the risk of suicide that may complicate depression, a theme that I explored by relying on the book When It is Darkest by psychologist and suicide expert Rory O'Connor.I also discuss the different treatment modalities of depression, from antidepressants and psychotherapy to somatic therapy, the long road to recovery, and the ever-present risk of treatment resistance and relapse. Other themes the podcast covers are the shame and stigma that accompany depression.The historical themes of the podcast highlight the insights of Abu Zayd Al Balkhi in depression and cognitive behaviour therapy, that roles played by Sigmund Freud and Joseph Breuer in establishing psychoanalysis, and that of Nathan Kline in the development of the first antidepressant.

This brief podcast reviews the top ten causes of persistent impairment of consciousness.

I am joined in this podcast by Joanne Hedger to discuss her lifelong experience of aphantasia, something she has written about in her memoir titled Aphantasia: Journeying Through Mind Blindness and Embracing Our Unique Neurodiversity with Passion and Purpose. Our conversation delved into how she discovered she had aphantasia when she alone was unable to understand a joke with friends in a camp site. We also explored the emotions this discovery evoked in her, from loneliness and regret to relief and understanding.Beyond her inability to imagine visually, Joanne also reflected on other lifelong characteristics, such as with dreaming and memory. Other themes we covered in the conversation are the history of our understanding of aphantasia, its acquired and familial causes, its impact on her perception of herself and on her relationships, and the advantages of having aphantasia.We also explored the strategies she has adopted to compensate, even before she knew she had aphantasia, from relying on lists and spreadsheets to taking a lot of photographs and notes. Joanne also highlighted practical recommendations for parents, teachers and students which included identifying aphantasia early, using memory aids, accepting it as a feature of normal neurodiversity, and making educational adaptations to accommodate it.Joanne spent her early years growing up on a dairy farm in south-east England where her fascination with nature began. After a corporate career in software consultancy, which spanned 25 years, several continents, and numerous bouts of stress and exhaustion, Joanne quit the rat race in 2017 to follow her passions for wildlife and photography. Despite being mind-blind and left-handed, Joane stressed that she is hugely creative and sees her own level of aphantasia as a quirky fascination, not a hindrance or a disability.Following graduation, she worked as a guide and later became the manager of a luxury bush camp in the Kafue National Park, Zambia, where she still freelances for a few months each year. She lives in the UK and, when she's not writing, she spends her time rewilding a small piece of ancient woodland, making handmade nature-inspired jewellery and taking photographs. You can find her on Facebook or visit her website, www.elementalretail.com

In this episode, I explore the fascinating phenomenon of aphantasia, the inability to imagine. I discuss the manifestations of the condition which primarily affects visual imagination, but which also affects the ability to imagine sounds, smells, tastes, touch, and even feelings. The podcast also illustrates how aphantasia influences recollection of memories, and how it impacts of education and career.I illustrate aphantasia with such fascinating memoirs as that of Charlotte Langlais, titled 'Aphantasia Club', and of Alan Kendle titled 'Discover the Fascinating World of Aphantasia'. These show the different ways by which people with aphantasia discover that they have the condition, and the emotions that accompany this knowledge.Importantly, the podcast also highlights how people with the condition adapt by using alternative strategies, and how they have found such advantages of aphantasia, from the better ability to remember facts and meditate to the lesser risk of reliving painful memories.The podcast also traces the history of our understanding of aphantasia, starting with Francis Galton who first described, to Adam Zeman who resuscitated its study. This theme also narrated how Zeman came to coin the name aphantasia. Also covered in the podcast is the epidemiology of the condition, its familial and acquired causes, and its associated features, from impaired facial recognition to difficulty recollecting dreams.

In this episode, I explore 10 disorders that manifest during sleep, or are considered sleep disorders. These range from the more familiar REM sleep behaviour disorder, to the lesser-known exploding head syndrome.

I am joined in this podcast by Holly Frances to discuss her experience of Guillain Barre syndrome as she narrated in her illness memoir titled Life Support: Surviving Guillain-Barre Syndrome. Holly is a mother in a blended family of five, and the face behind Holly After GBS on social media, where her recovery videos have inspired millions of people around the world. Our conversation traced Holly's illness from onset with mild sensory symptoms through to complete paralysis within a short time. Importantly, she highlighted less appreciated symptoms of the disease that she experienced, particularly neck pain, a major early symptom that initially indicated a different diagnosis, and which exacerbated and spread as her illness progressed.Holly chronicled how her weakness progressed rather rapidly to complete paralysis and requirement for ventilation on the intensive care unit. We also discussed the spinal fluid analysis and electromyogram tests she had to confirm the clinical diagnosis of GBS, and the various treatments she received. Our conversation also detailed her long rehabilitation course, interspersed by relapses, and her long and slow journey to complete recovery. Significantly, Holly also explored the emotional and psychological burden that the illness placed on her, ranging from fear and anxiety to resentment and depression, and the uncertainty that plagued her mind regarding outcome. We also covered how her life and relationships changed on account of her experience of GBS, what the illness has taught her, and the advocacy work that is now the focus of her work.

In this episode, I delve into Guillain Barre syndrome, a relatively common neurological disorder. I discuss the clinical manifestations of the disease which range from fairly rapid weakness and sensory impairment to pain and breathing difficulty. I also detail the long road to recovery from the disease. The podcast also discusses the almost limitless triggers for GBS, from infections and vaccinations to trauma and childbirth. I also review the pathology of the disease, explaining how a wide range of antibodies target the fatty myelin covering of the nerves to reduce the efficiency of electrical nerve transmission. The podcast also highlights the investigations of GBS, particularly spinal fluid analysis and nerve conduction studies, and the treatment of the disease, which canter around immune modulating agents. I also chronicle the history of the terminology of GBS, following the work of the three French physicians, Georges Guillain, Jean Alexandre Barré, and André Strohl. I refer in this theme to the book 'Guillain-Barre Syndrome: From Diagnosis to Recovery', by Gareth Parry and Joel Steinberg.I illustrate the clinical aspects of GBS with such graphic patient memoirs as those of Carole Williams, titled 'Chaos in Body and Mind', of Meg Lumsden, titled 'Unknown', of Wenesday Ketron titled 'Geeyahn What?', of Scott Earle titled 'The Wave of Guillain Barre Syndrome', and of Robin Sheppard titled 'A Solitary Confinement'.

In this episode, Amanda Ellison joins me to explore the intersection of brain science and clinical practice as it relates to cluster headache. Amanda is a neuroscientist and physiologist, professor in the Psychology Department in Durham University and former Director of the Wolfson Research Institute for Health and Wellbeing, and she is interested in understanding how different brain regions communicate to create our behaviour and experience of the world around us. Our conversation on the history of the understanding of cluster headache used the monickers that have been applied over time as fulcrum, and these included migrainous neuralgia as proposed by Wilfred Harris, and Horton's cephalalgia. We also explored the emergence of the name cluster headache, and how this coincided with the establishment of the International Headache Society.The podcast also exhaustively reviewed the biological mechanisms driving cluster headache with references to the emerging role of the hypocretin system in generating the disease, as well as its tendency to manifest in men and in smokers. We also delved into the clinical manifestations of the disease, with Amanda noting both the classical and the non-classical presentations. She also explored the circadian periodicity of the disease in the context of the role played by the suprachiasmatic nucleus and serotonin-melatonin pathway.The discussion also covered the acute treatment of alcohol especially with triptans and alcohol, a theme that reviewed the scientific contributions of Lisa Kudrow, the star of the television show Friends, and her father – both neuroscientists. We also looked at the history of the use of verapamil and lithium, the main prophylactic drugs of cluster headache. Amanda also explored the how coffee, chocolates and sex are biologically able to mitigate the severity of headaches, and the research into the place of deep brain stimulation of in the treatment of the disorder.

In this episode I explore the unbearable headache disorder that is cluster headache. The podcast revolves around the risk factors and causes of cluster headache, and the triggers for the attacks. It also reviews the characteristic features of the headache, and its typical accompanying cranial autonomic and behavioural symptoms. I illustrate the agonising manifestations of cluster headache using such patient illness memoirs as those of John Niven titled O Brother, Howard fast titled Being Red, and Rafael Haussler titled You Can't See What I Feel. These narratives illustrate the characteristic features of cluster headache, from its abrupt onset, its diurnal pattern, its severity, and its tendency to recur in clusters.I also review the potential causes and familial tendency of cluster headache, its diverse triggers, and its impact on the lives of its sufferers. The podcast also covers the acute, transitional and preventative treatments of the disease which include the use of such interventions as triptans, oxygen, prednisolone, verapamil, and lithium.Using Mervyn Eadie's enlightening book titled Headache Through the Centuries, I narrate the history of its scientific understanding noting the contributions of physicians from Nicholas Tulp in the 16th century, to Wilfred Harris and Bayard Horton in the 19th century.

In this short podcast, I count down 10 unusual variants of migraine which illustrate the challenging diversity of what is otherwise a common and well-recognised disease.

In this episode I am in conversation with Dr Robert Baloh to explore his insightful perspective of mass psychogenic illness specifically, and functional neurological disorders generally. Our conversation explored the general principles of medically unexplained symptoms and why most people have symptoms but only in some do these progress to become psychosomatic. We delved into the patterns, expectations and cultural beliefs that predispose to psychosomatic problems, highlighting such concepts as the placebo and nocebo effects.In our exploration of mass psychogenic illness, we reviewed such examples as the Belgian Coca Cola epidemic and Havana syndrome. This discussion looks at the factors that lead to the emergence and spread of mass psychogenic illness. Dr Baloh also outlines the mechanisms driving mass psychogenic illness, and the appropriate approaches to their assessment and management.Dr Baloh also discusses the history of hysteria with reference to such personalities as neurologist Jean-Martin Charcot and psychoanalysis founder Sigmund Freud. He also reviewed the history of such established disorders as multiple chemical hypersensitivity, myalgic encephalopathy and chronic fatigue syndrome. We discussed the uncertainties about the biology of these disorders, and the general ignorance of the medical fraternity and society at large about their nature.Dr Baloh is the author of 15 books, over 350 articles in peer-reviewed scientific journals, and over 100 book chapters. He also has an interest in the boundary between neurology and psychology, and in the history of neurology. Among his many honours, Dr Baloh received the Hallpike/Nylen Prize at the Bárány Society Meeting in Prague, Czechoslovakia in 1992 and had an international Dizziness and Balance Symposium in his honor at the 2014 American Academy of Neurology meeting in Philadelphia. His book Clinical Neurophysiology of the Vestibular System written with Vicente Honrubia, is currently in the fourth edition and is the standard in the field.

In this podcast, I explore the theme of mass hysteria or mass psychogenic illness. I discuss the triggers, the clinical manifestations, and the management.I use a global perspective and narrate examples of mass hysteria manifesting in different parts of the world. These included hysterical outbreaks of toxic gas anxiety in schools in Singapore, Hong Kong, and Bangladesh.Amongst the relatively contemporary conditions the podcast covers are the Havana syndrome, TikTok tics, and the epidemics of sleeping narrated by Suzanne O'Sullivan's in her book titled The Sleeping Beauties.I also discuss the historical background of mass hysteria such as demonic possession in nunneries in Europe, and the mass dancing hysteria described by John Waller in his book titled The Dancing Plague.The podcast also covers the culture bound syndromes, such as Hwa-Byung - a Korean anger syndrome; Amok - bouts of mass murder in the Malay Peninsula; and Koro - genital retraction in Asia and Africa. Also included are cultural startle syndromes such as the Jumping French Canadians in Maine, and Miryiachit in Siberia.

I am joined in this episode by Robert Wilson Thomas to discuss his diverse perspectives of functional neurological disorder. This includes his experience as a patient, as narrated in his illness memoir FND: Lessons form a Rather Eventful Life, and his insights as an advocate for the disorder.Our discussion covered the triggers and vulnerabilities that led to Robert's FND, a theme that went back to his childhood and which covered the role of emotions. We also reviewed the manifestations of his FND, from seizures to gait difficulty and falls. We also reviewed the convoluted path he took to getting a diagnosis, and how the disorder has progressed over the years.Also relevant is Robert's exploration of the interventions that have been helpful, the unsatisfactory attitude of many in healthcare towards the disorder, and the prospects that research and better understanding are promising. The conversation also explored the importance of peer supports, and the prospects of the disease, and the impact of the disease on his career and relationships, and the stigma and myths that permeates society about FND.We also reviewed Robert's advocacy work for FND. Robert retired from formal employment in 2017, and since mid-2018, he has been a Director, Co-chair and Legal Advisor to FND Hope International, the global charity dedicated to support and advocate on behalf of people with FND, and their families.Robert is Welsh by birth, but as he had lived in Ireland since 2001, he now tends to identify as Irish-Welsh although native Irish people still regard him as a ‘blow-in'. He is a practicing Buddhist, and has been a barrister since 1977, although his first degree was in chemical engineering. He describes himself as autistic, bipolar, diabetic, an alcoholic in recovery, vegetarian, and a cancer survivor. His latest book is titled A Box of Frogs: Dwells On and Delves into my Neurodivergent Nature.

In this podcast episode, I tackle the theme of functional neurological disorders, and I explore their almost endless types and diverse presentations. I particularly highlight functional seizures, noting their risk factors, their characteristic, even if diverse, presentations, the ways by which they may be distinguished from organic seizures. I also review functional movement disorders with a special emphasis on functional tremors. I also highlight the negative attitudes by which people with FND are treated by medical staff, who are themselves often poorly trained in the condition, and the tendency for FND to be misdiagnosed. I highlight the principles of communicating the diagnosis of FND and the often negative emotions the diagnosis elicits in many patients and their families on account of the stigma associated with it. I also review the challenges that doctors face with making a diagnosis of FND, and the management approach to the disorder. I illustrate functional neurological disorders with the books The Shaking Woman or A History of My Nerves by Siri Hustvedt, FiNDing Hope, by Jocelyn Bystrom, and FND Stories by Greg Rawlings and colleagues. The podcast also discussed the evolving scientific understanding of functional neurological disorders, and for this I cited the book by neurologist Suzanne O'Sullivan titled It's All in Your Head. I also explore the fascinating history of the study of functional neurological disorders with reference to the role played by Jean-Martin Charcot, the acknowledged father of clinical neurology. In this context, I cited the book Medical Muses, written be Asti Hustvedt, which vividly captured the nature of hysteria, and the personalities of the famous hysterics that Charcot studied in Paris. This especially reviewed Blanche Wittman, Charcot's most famous patient, and factors of her life that predisposed her to developing hysteria. I also used this text to highlight the less well-known positive contributions that Charcot made to the subject.

In this brief podcast, I explore 10 reversible neurological disorders that manifest as dementia. These range from HIV associated dementia and autoimmune encephalitis to Hashimoto encephalopathy and cerebral vasculitis.

I am joined by Kate Allatt to discuss her experience of, and advocacy for, locked-in state as she narrated in her book Running Free: Breaking out of Locked in Syndrome.Kate has an extraordinary journey of resilience after being ‘buried alive', the result of a brainstem stroke when she was just 39. She described this as a condition where you can feel, think, hear and see completely normally but are unable to move a single muscle. She explored the transformation from being an active and passionate runner to being helpless and requiring help for every need.Kate chronicled the onset of her symptoms with a headache and slurred speech, and the subsequent progression of her symptoms with loss of consciousness that culminated in being completely locked-in. She also recalled the thoughts and emotions that dominated her mind in the subsequent stages of her illness.Our conversation also covered such concepts as the pessimism that permeates the attitude to the care of people in locked-in, the potential for completely recovery even the most extreme cases, the role of intense rehabilitation and determination in recovering from locked-in state, and the concept of neuroplasticity. She particularly highlighted how she brought her passionate attitude to running to her rehabilitation.Kate is an inspirational speaker and will also discuss the impact her advocacy and peer mentoring has made to thousands of families around the world. Running Free has been showcased on BBC Jeremy Vine, ITV This Morning, BBC Breakfast, The One Show, Women's Hour, Newsnight, Loose Women, BBC Worldwide, India, South Africa, USA, South America etc. In addition, she founded a charity just three months from leaving hospital in 2011.

The theme of this podcast episode is the disabling condition of locked-in state. I discuss the typical causes that lead to locked-in state, particularly large strokes in the brainstem, and highlighting cervical dissection is an important mechanism for this. I also review its main clinical manifestations, noting how blinking and eye movements are often the only preserved motor functions, along with the emotional burden it imposes on patients and their families.I particularly highlight the uncertainty that dominates the early stages when the patient is aware, but family and healthcare personnel assume they are brain dead. Similarly harrowing are the discussions that flavour the management about continuing supportive treatment, and the fearful thoughts that dominate the victims' experience, from the fear of dying from the condition, or being taken off life support. The podcast also explores the investigations of locked-in, and the acute care which typically requires ventilation and support of all vegetative functions.Other themes the podcast covers are the devices that enable people in locked-in state to communicate, the rehabilitation which is usually slow and long-term, and outcome which is often poor. I illustrate the issues I cover in the podcast with such memoirs as The Diving Bell and the Butterfly by Jean-Dominique Bauby, Locked-In by Richard Marsh, Blink by Sandra Nett, A Return to Duty by Clodagh Dunlop, In the Blink of an Eye by Mia Austin, and Ghost Boy by Martin Pistorius.

I am joined in this podcast by Barbara Ludwig to discuss her experience of CJD, the disease that her husband Jürgen died from, and which she narrated in her excellent memoir No Time To Cry. She explained how and why she was able to assume and convey her husband's perspective of his illness experience, and how she used the title of the book to convey the importance of time in context of illness.Barbara explored Jürgen's early symptoms with walking difficulty and anxiety, and how this progressed to disorientation and paranoid jealousy. She also captured the uncertainty that trailed his early diagnostic process as all investigations initially failed to confirm a diagnosis, and the uncertainty of how long he had to live. She discussed how he was initially thought to have multiple sclerosis and then a psychological disorder, and how the diagnosis of sporadic CJD was eventually confirmed by spinal fluid analysis, and later by post-mortem examination.Barbara also explored the burdensome care that Jürgen required, initially provided by her, but eventually by a nursing home where his terminal illness played out. We also discussed how she has coped since the death of Jurgen.Barbara Ludwig grew up in the western part of Berlin. She met Jürgen during her training in local government. They went to Australia after their wedding, and then to Lake Constance in the south of Germany near the border to the Swiss. She worked at the university there whilst Jürgen studied. They then moved to Munich where she worked for many years at the Goethe Institute as head of human resources. Today she writes Mallorca crime novels with passion, and she has been living for five years with her new partner in Bad Orb in the Spessart, near Frankfurt. Her latest book is 'Do You Love the Sea?'

The focus of this podcast is the enigmatic theme of prion disorders. I trace the history of our understanding of this neurodegenerative disorder with how Nobel laureate D. Carleton Gajdusek, described the transmission of kuru - the first pathologically defined human prion disease. I also narrate how the similarities in the clinical and pathological features of kuru and scrapie, the disease of sheep, opened the way to this breakthrough. I also chronicled how the efforts of another Nobel laureate, Stanley Prusiner, characterised the pathology, genetics and transmission of scrapie, and how he succeeded in a bitter scientific race that transformed the field of transmissible spongiform encephalopathies which he named prion diseases. I also explored the pathology of prions, their normal functions, and how they cause disease when they become misfolded. In this theme, I discussed Creutzfeldt Jakob disease extensively, with reference to the roles played by Alfons Jakob and Hans Gerherdt Creutzfeldt, and depicting its classical manifestations and investigations. I illustrated the lived experience of CJD with such memoirs as Howie V CJD, by Sandy Bosman. I also exhaustively covered the clinical and management aspects of new variant CJD, and I illustrated this with the memoir Who Killed My Son, by Christine Lord. The podcast also reviewed the other established human prion diseases such as fatal familial insomnia, and it explored the similarities between prion diseases and other neurodegenerative diseases that are also related to misfolded proteins, such as Alzheimer's, Parkinson's, and motor neurone diseases. I also covered mad cow and other prion disorders of animals. I cited other helpful books such as Collectors of Lost Souls by Warwick Anderson, Fatal Flaws by Jay Ingram, Madness and Memory by Stanley Prusiner, and Consciousness: A User's Guide by Adam Zeman.

In this short podcast, I count down 10 neurological disorders that can be associated with sexual activity. Whilst this list covers the usual suspects like HIV and neurosyphilis, it also includes less familiar disorders such as Lemiere's and Elsberg syndromes.

I am joined in this podcast by Jamie Ward to explore synaesthaesia as he depicted in his book titled The Frog Who Croaked Blue: Synaesthesia and the Mixing of the Senses. Jamie Ward is Professor of Cognitive Neuroscience at the University of Sussex, UK. His principal research interest lies in the cognitive neuroscience of synaesthesia, although he has published on many other topics, including frontal lobe function, memory and disorders of reading and spelling. We explored the history of synaesthesia and why the scientific interest has waxed and waned over time, and how the understanding of the condition has evolved. Jamie Ward also narrated how a chance observation by neurologist Richard Cytowic at a dinner launched the scientific study of synaesthesia. We also reviewed the defining features of synaesthesia, and its familial and acquired causes. The conversation also discussed the different types of synaesthesia, and what Jamie referred to as the fringes of synaesthesia. Other themes that the podcast reviewed are the ways by which the knowledge of synaesthesia has challenged the traditional concepts of our senses, how much control people with synaesthesia have over their experiences, and the possible evolutionary advantages of synaesthesia, such as heightened memory and creativity. We also reviewed the gaps in the scientific understanding of synaesthesia and the prospects for unravelling its complete picture .Jamie Ward's research uses several methods in cognitive neuroscience, including human neuropsychology, functional imaging, EEG and TMS. He is the founding editor of the journal, Cognitive Neuroscience, and is currently President of the British Association of Cognitive Neuroscience (BACN). His other books include The Student's Guide to Cognitive Neuroscience and The Student's Guide to Social Neuroscience.

In this podcast I explore the fascinating phenomenon of synaesthesia. Using the enlightening book by Richard Cytowic and David Eagleman titled Wednesday is Indigo Blue as template, I discuss the different types and manifestations of the condition, and I highlight the current understanding of its genesis. As I review its associated advantages, such as a superior memory, I also discuss its downsides, such as physical pain. To illustrate the lived experience of synaesthesia, I deploy such historical anecdotes as that of Solomon Shereshevky as narrated by neurologist Alexander Luria in his book titled The Mind of a Mnemonist. This remarkable case showed how synaesthesia contributes to superior memory. I also use contemporary memoirs of syanesthesia, such as that of Daniel Tammett titled Born on a Blue Day, and that of physician Joel Salinas titled Mirror Touch. Other helpful sources for the podcast are Cytowic's The Man Who Tasted Shapes, and Guy Leschziner's The Man Who Tasted Words.

I am joined in this podcast by Christine Miskelly to discuss her experience of witnessing how a brain tumour manifested in her husband Ivor. Christine narrated the subtle symptoms that Ivor first manifested, such as poor planning, social withdrawal, excessive slowness, impassivity and easy distractibility. We also discussed how the brain tumour altered Ivor's personality, particularly reducing his empathy, and how it impacted on their relationship. The podcast also explores the shock of getting a brain tumour diagnosis for Ivor, but also how this brought them together to face the challenges ahead. We also discussed the brain biopsy and the treatment plan which included surgery and radiotherapy. Our conversation also explored Ivor's sad progression, his post-treatment initial improvement before the subsequent progression as he developed seizures, and as his scan showed further tumour growth. Christine explored the emotional turmoil she went through this period, and how family, friends, and the kindness of strangers helped her to cope. Her perspectives also included how the whole experience included finding beauty and love. Other themes we covered were Ivor's advance directive, his terminal decline in a care home, and the aftermath of his death. Christine did her first degree in Psychology at the University of Durham back in the 1970s, and the bulk of her career was spent teaching Psychology at A-level. In more recent years, she studied Consciousness and Transpersonal Psychology with the Alef Trust. She said supporting students through this period of their lives has been one of her great joys.

In this podcast I explore the diverse perspectives of brain tumours, from their pathology and clinical manifestations to their complications and management. The podcast discusses the common primary brain tumours, particularly highlighting the usually benign meningioma, and the typically aggressive glioblastoma. I illustrate these themes with such graphic illness memoirs as The Iceberg by Marion Coutts, All in My Head by Jessica Norris, and Difficult Gifts by Courtney Burnett. I also discussed secondary brain tumours using the illustrative memoir of Barbara Lipska titled The Neuroscientist Who Lost Her Mind. These memoirs helped to demonstrate the sinister and the subtle symptoms of brain tumours, their investigations, and their treatments – chemotherapy, radiotherapy and surgery. This theme also explored the risk factors for brain tumours, and their investigational treatments. I also explored the fascinating history of brain tumour surgery which chronicled the contributions of such pioneering neurosurgeons as William McEwan, Rickman Godlee and Victor Horsley, and I cited such accounts as that of Andrew Wickens titled A History of the Brain, and that of Michael Aminoff titled Victor Horsley.

In this short podcast, I count down 10 routine everyday things that can surprisingly be triggers for epileptic seizures.

In this episode I am joined by Lone Frank to talk about her book, The Pleasure Shock, in which she narrated the work of Robert Galbraith Heath, the unacknowledged pioneer of deep brain stimulation. We talked about how she got interested in the subject when she was writing about Parkinson's disease, and how her exploration revealed that he developed the technique of deep brain stimulation, initially as a treatment for schizophrenia. She painted a vivid portrait of his personality and his ideas, and she explained why his contemporaries resisted his innovation, and how history forgot him. Lone has a Ph.D. in neurobiology and is the author of several books on neuroscience. As a staff writer at Weekendavisen, Denmark's leading newspaper, she is a well-known voice in debates about science, technology, and society. Lone Frank is frequently invited as a public speaker, and she regularly appears as a commentator on Danish radio and television. She has written and presented several science documentaries, and she produces a weekly one-hour podcast about science and culture.

In this episode, I am joined by Leslie Davidson to discuss her husband, Lincoln's illness with Lewy body dementia, and her experience of caring for him whilst she was herself struggling with the symptoms of Parkinson's disease. Leslie chronicled the onset of his symptoms with night terrors and its progression to delusions, hallucinations, confusion, and memory impairment, and eventually culminating in motor difficulties. She explores the challenges of managing his fluctuating symptoms, his night-time confusion, and his tendency to think she was her own twin. The discussion also covered what Leslie referred to as the most difficult thing she has ever had to do – the decision to put Lincoln into care. Leslie Davidson started writing nonfiction to make sense of the hard changes in her life. Spilling thoughts and feelings on to the page helped her see that she was richly blessed, life can be hard, family and friends are everything, sorrow does not deny joy, and our stories matter. Leslie Davidson has also written two very well received picture books for children, In the Red Canoe and The Sun Is A Shine.

In this episode, I review the four main mimics of Parkinson's disease, also called the Parkinson's Plus syndromes. These are multiple system atrophy (MSA), dementia with Lewy bodies (DLB), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD). I explore the clinical manifestations, investigations, and treatments of these disorders, highlighting such striking features as autonomic dysfunction in MSA, unusual eye movements in PSP, fluctuating cognition in DLB, and alien hand syndrome with CBD. I also illustrate the patient perspectives of the disorders with such illness memoirs as those of Kimberly Bohannon titled The Beautiful Destruction of My Life, of Bill Sydnor titled Living Day by Day With MSA, that of Claire Verney titled Notes of a Love Song, that of Steve Dagnell titled You, Me & PSP, and that of Evelyn Walsh titled Parkinson's Plus: A Woman's Struggle Battling Alien Movements.

I am joined in this exploration of narcolepsy by Julie Flygare, an internationally recognized patient-perspective leader, and an accomplished advocate, to discuss her patient perspective of the disease as narrated in her award-winning memoir, Wide Wake and Dreaming. Julie has advanced her leadership in the sleep and healthcare space through speaking engagements, publications, earned media, collaborations, and advocacy and awareness initiatives. Our conversation explored Julie's onset of narcolepsy with excessive sleepiness long before she was diagnosed with narcolepsy after she developed cataplexy. She discussed her on-going struggles with the diverse symptoms of the disease, as well as here validating investigations, and indispensable medical treatments. Our conversation also covered what her diagnosis has taught her regarding prioritising time and appreciating the moment. Prior to accepting her current role as President & CEO of Project Sleep, Julie Flygare served as President of Project Sleep's Board of Directors, while also gaining invaluable experience in marketing and philanthropy at the Pancreatic Cancer Action Network and City of Hope. Julie served on the National Institutes of Health's Sleep Disorders Research Advisory Board from 2012 – 2015, and she delivered the TEDx Talk, “What Can You Learn from a Professional Dreamer? on March 22, 2022,

In this episode, I explore the curious sleep disorder narcolepsy. With apt patient memoirs, I describe its clinical manifestations, from sleep attacks and cataplexy, to sleep paralysis and sleep-related hallucinations. I also review its association with other sleep disorders, and its non-sleep related manifestations. The podcast also discusses the genetic and acquired causes of narcolepsy, its association with hypocretin deficiency, and its risk factors. I also explore the investigations of narcolepsy, such as multiple sleep latency test, and its treatments, such as modafinil and sodium oxybate. I also discussed the history of narcolepsy, such as anecdotes its discovery by Jean-Baptiste Édouard Gélineau. I also narrate the history of how sleep researcher Eugene Aserinsky discovered the two sleep phases, REM and non-REM. To illustrate the lived experience of narcolepsy, I cite such insightful patient memoirs as that of Corrina Wetzel titled The Journey Beneath Her Heavy Feet, by Henry Nicholls titled Sleepyhead, and of Claire Crisp titled Waking Mathilda. To support the historical themes, I cite such works as When Brains Dream, by Antonio Zadra and Robert Stickgold, and A Portrait of the Brain by Adam Zeman.

I am joined in this episode by journalist Lauren Aguirre, an award-winning science journalist, to explore the neuroepidemiology work of neurologist Jed Barash and colleagues which revealed the existence of a silent epidemic of what is now named opioid associated amnestic syndrome. Lauren chronicled the onset and progress of the epidemic using the two index cases she described in her book. She narrated the way Barash and colleagues went about convincing the public health authorities and the CDC about the existence of the epidemic, and how they got the neurology community to pay attention to it. We discussed the related anecdotes that Lauren used to complement her book, especially that of Patient HM, just as we explored the way that the research in opioid associated amnesia has progressed since it was established as a neurological entity. Apart from The Memory Thief, Lauren Aguirre is also the author of Secrets Behind How We Remember, a 2022 PEN/EO Wilson Science Literary Award finalist. And as a staff member for the PBS series NOVA, she produced documentaries, short-form video series, podcasts, interactive games, and blogs. Lauren Aguirre's articles on memory and addiction have appeared in STAT, The Boston Globe, Undark, The Atlantic, The Scientist, and PBS. She is currently at work on a historical novel set in the early 1900s at a colony for epileptics in upstate New York.

In this brief podcast, I count down 10 unusual but unique headaches that may be perplexing for patients, and challenging for doctors to diagnose.

In this episode, I explore the intriguing condition of amnesia, the isolated loss of memory with the preservation of other cognitive disorders. I use remarkable patient anecdotes, such as those of musician Clive Wearing, and of Jimmie G, a patient of neurologist Oliver Sacks, to illustrate the diverse causes of amnesia, from herpes virus encephalitis to chronic alcoholism. I also narrate the clinical spectrum of amnesia with an emphasis on Korsakoff's syndrome and transient global amnesia or TGA. The podcast also goes back in time to review the case of Henry Molaison, the man whose profound amnesia, the consequence of experimental surgery for epilepsy, opened the way to our understanding of how memory works.

In this podcast, I am joined by Susan Mockler to discuss her harrowing experience of traumatic spinal cord injury, which she narrated in 'Fractured'. This is her memoir that detailed her experiences with acquired disability following a car accident which left her with a spinal cord injury. She recalls how she sustained a cervical spinal injury as the front seat passenger of a car that hit a moose, and the devastating near-total paralysis that followed. She also explored her emotional response to the injury, and the mental attitude she adopted to help her through a reasonably successful, and on-going rehabilitation. Susan Mockler is a writer and retired clinical psychologist living in Kingston, Ontario, Canada. Her essays and stories have a appeared in a range of American and Canadian publications.

In this episode, I explore the two catastrophic forms of traumatic neurological injury, brain and spinal cord. I discuss the life-changing physical consequences of traumatic neurological injury, and the equally harrowing but often invisible emotional fallouts. I particularly highlight the often incomprehensible ways by which neurological injuries result – from riding horses and diving into pools, to boat and road traffic accidents. I illustrate the diverse features of traumatic brain injury with prominent historical cases which highlight its causes and manifestations and complications. One is the case of Phineas Gage, as described by Antonio Damasio in his classic book 'Descarte's Error'. Damasio narrated the astonishing head injury Gage sustained when a tamping rod penetrated his head when he was setting charges as part of his railroad work, a case that demonstrates the impact of traumatic brain injury on personality and judgement.I also use more recent graphic patient memoirs, such as those of Cathy Crimmins titled 'Where is the Mango Princess', to portray the diverse dimensions of traumatic brain injury, and that of Melanie Reid titled 'The World I Fell Out Of', to show the mechanism and devastation of traumatic spinal cord injury. I also discuss the modern acute management of neurological injury, the short- and long-term complications, and the arduous rehabilitation process that follows.

In this episode I count down 10 top causes of insomnia, and these range from the habitual to the pathological. I also highlight the treatment approaches to these.

I am joined in this podcast by Randye Kaye to discuss the patient and family perspectives of schizophrenia as she narrated in her memoir titled Ben Behind His Voices. Randye is a radio and podcast host, actress, singer, teacher, mental health advocate, and motivational speaker who speaks to groups of doctors, nurses, medical students, families, providers, and legislators regarding the family experience when mental illness hits.Our conversation chronicled her experience of witnessing and managing her son's struggles with schizophrenia. She highlighted the long prodrome of adolescent behavioural and mood changes which she pointed out typifies the onset of the illness in boys as opposed to girls. She discussed many of the other early indicators of the illness which the family and his teachers normalised and explained away as adolescent adjustment, and these included social isolation, paranoid and grandiose ideas, odd behaviours.We also discussed the progression of Ben's illness as he performed poorly academically and dropped out of school, and as he struggled to maintain his family relationships and friendships. Randy also explored the long journey they took to getting a diagnosis, and longer still to get effective treatments, delays she argues contribute to poorer outcomes in schizophrenia. She discussed his different treatments, and his struggles to adhere to them.Other themes we covered are the familial and environmental vulnerabilities to schizophrenia, its social triggers, the stigma of mental illness, how to support families coping with schizophrenia, and the importance of maintaining hope. Randye also leads fun and interactive workshops on teamwork, customer service, self-esteem, presentation skills, and humour, and gives inspiring keynotes about connection and communication. She has narrated almost 190 audiobooks to date.

In this podcast episode, I explore the diverse facets of the debilitating mental illness schizophrenia. I particularly highlight its varied manifestations such as delusions, hallucinations, disorganised thoughts and abnormal behaviours.I illustrate these concepts with insightful illness memoirs, such as the classics Is There No Place on Earth for Me, by Susan Sheehan, The Centre Cannot Hold, by Ellen Saks, and A Beautiful Mind by Sylvia Nasar'. These especially demonstrate the frequent manifestation of the disease as paranoid schizophrenia with grandiose and paranoid delusions. I use these memoirs to explore the genetic, environmental and maternal risks factors of schizophrenia, the long-term and frequently relapsing course of the disease, and the requirement for treating with a combination of drug and psychological therapies. I also use illness memoirs to highlight other dimensions of schizophrenia. For example, I use the memoir by Lori Schiller titled A Quiet Room, to show how schizophrenia can present first with mood changes, the book by Patrick Cockburn titled Henry's Demons, to illustrate the extreme behavioural abnormalities that can accompany the illness, and the story of Douglas Goncalves titled A Journey Through a Psychotic Breakdown, to show how a confluence of life events serve as a trigger for the disease to emerge.I also explore the mimics of schizophrenia, and I illustrate these with such memoirs as that of Esme Weijun-Wang titled The Collected Schizophrenias, to illustrate schizoaffective disorder, and Inferno by Catherine Cho, to demonstrate post-partum psychosis. Other relevant themes of the podcast are the impact of the diagnosis on family and careers, the risk of suicide, and the importance of admission to hospital in recovery.

In this episode, I explore the diverse clinical and pathogenic dimensions of migraine with neurologist Mark Weatherall whose interests are the diagnosis and management of chronic migraine, facial pain, visual snow syndrome, and secondary headaches associated with systemic disorders.Our discussion covered the distinction between primary and secondary headaches, the distinctive features of the migraine aura and headache, and the non-headache manifestations of migraine. Mark Weatherall also traced the history of the development, and of the use, of the current acute and preventative migraine treatments, and highlighting the role of the CGRP pathway. He also explores the research into emerging drugs that work via the PACAP pathway.Mark is former Chair of the British Association for the Study of Headache and Trustee of The Migraine Trust, and who was a highly regarded historian of medicine before studying clinical medicine at Cambridge. His other interests are the historical, social, and cultural aspects of headache and facial pain disorders.

I am joined in this podcast by Danielle Newport Fancher to explore the patient perspective of migraine as portrayed in her illness memoir titled 10: A Memoir of Migraine Survival. Danielle Fancher is a writer, migraine advocate, and speaker who has received awards from the National Headache Foundation and The Association of Migraine Disorders for her writing and advocacy. She is also a member of the Patient Leadership Council for the National Headache Foundation and a Board Member for the Migraine Science Collaborative. Our discussion traces the onset of her migraine at the age if 16 and how it evolved to become recalcitrant. Danielle narrates how her migraines manifest, from prodrome through aura to headache.She also explores the unusual symptoms she experiences, from heaviness to numbness, which makes her remark that migraine is more than just a headache. We also review the various medications she has tried in her desperate attempt to overcome the disease that she has eventually had to come to terms with it, particularly finding solace in the company of her large community of migraine sufferers.

In this episode, I review the pathological and clinical dimensions of migraine, the most common disabling neurological disorder. I tried to capture migraine's diverse disabling recurrent symptoms, from its risk factors, triggers and prodrome to the aura, the headache, and multiple heightened sensitivities.To illustrate the lived experience of migraine, its classical manifestations, and its curious variants, I refer to such vivid patient memoirs as those of Monica Nelson titled Mere Sense, and Abby Reed titled The Color of Pain. I also cited Oliver Sacks classical book titled 'Migraine'.I also flavour the podcast with historical migraine patient anecdotes, such as those of Ann Conway, the enlightenment writer who was treated by the great physicians William Harvey and Thomas Willis, of Annie, who was treated with an astounding number of therapies by the famous Queen Square neurologist William Gowers, and of Alexander Pope who treated his migraines in a most unconventional way.In this regard, I relied on Migraine: A History, Katherine Foxhall's magnificent historical account of the medieval ideas and treatments of the disorder, and Soul Made Flesh, Carl Zimmer's exhilarating biography of Thomas Willis.The podcast also explores and the evolution of migraine's acute and preventative treatments, and how a better understanding of its pathology is leading to treatments such as those that influence the CGRP pathway.

In this episode, I am joined by Nicholas Silvestri, Professor of Neurology at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences, where he is also Associate Dean for Student and Academic Affairs. He is board-certified in neurology, neuromuscular medicine, and electrodiagnostic medicine.Over the past several years, Nicholas Silvestri's research interests have included myasthenia gravis and inflammatory neuropathies, and he has authored over 60 peer-reviewed articles, book chapters, and textbooks.Our conversation covers the full spectrum of myasthenia gravis – from its pathology and pathogenesis to its clinical features, investigations and treatments. He explains such tricky areas of myasthenia gravis, such as why the antibody levels do not correlate with clinical severity of the disease, and why the disease frequently starts in the ocular muscles.We also explored such themes as why anti MUSK myasthenia gravis favours Black people and those living around the equator, and why steroid treatment may worsen myasthenic symptoms.Nicholas Silvestri also discussed the newer and more effective treatments of refractory myasthenia gravis, and how he manages the different facets of the disease.

In this episode I explore the autoimmune neurological disorder, myasthenia gravis. I review its classical manifestations as ocular and generalised myasthenia, and I highlight its complications such as refractory myasthenia and myasthenic crisis.The podcast also discusses the pathogenesis and triggers of the disease, its various mimics, and its indispensable investigations. I also review its treatments which include acetylcholine esterase inhibitors, steroids, immunosuppressants, IVIg and plasma exchange.I complement the podcast with historical anecdotes regarding the discoveries, frequently serendipitous, of the various treatments of myasthenia gravis. This narrative includes such stories as Mary Walker's miracle of Alfege's, the dream insight of Otto Loewi, the mystery of the headless torso in the Thames, and the role played by the Calabar bean in the history of myasthenia gravis. Other relevant historical themes were the role played by Alfred Blalock in introducing thymectomy for myasthenia gravis, and the first serendipitous self-treatment of myasthenia gravis by medical student Harriet Edgeworth.I rely on such illustrative patient memoirs as those of Kemi Olawaiye-Dampson titled Living with Myasthenia Gravis, of Howard Caras titled Permanent Detour, and of Ronald Henderson titled Attacking Myasthenia Gravis.I also cited such enlightening academic sources as Coping with Myasthenia Gravis, by Aziz Shaibani and colleagues, and The Spark of Life by Frances Ashcroft.

I am joined in this episode by neurologist Thomas Bird to discuss his long professional experience of managing Huntington's disease.Thomas Bird is Professor Emeritus of Neurology and Medical Genetics at the University of Washington in Seattle. He was previously Chief of Neurology at the Seattle VA Medical Center, and founder of the Neurogenetics Clinic at the University of Washington. He was also former director of the Huntington's disease Centre at University of WashingtonWe discussed the diverse manifestations of the disease, from chorea to impaired judgement to psychosis. With anecdotes from the book, we also reviewed the links between the disease and criminality, and with increased socioeconomic vulnerability and trauma. Dr Bird also highlighted the unusual manifestations of the disease in children, and the similarity of the pathogenesis to other neurodegenerative diseases such as motor neurone disease and Alzheimer's disease.Our discussion also covered the genetic testing of the disease, particularly highlighting the ethical conundrums leading up to the testing, and the uncertainties that the test result throws up. Other themes we covered are the therapeutic and preventative prospects for Huntington's disease, and the need for society to understand and support people with the disease.

In this short podcast, I count down 10 clinical features that accompany tremors which indicate that the tremor is not the result of Parkinson's disease.

In this episode, I explore one of the most visually dramatic neurological disorders, along with its diverse and debilitating symptoms. I use graphic patient anecdotes, including that of musician Woody Guthrie, to illustrate the onset and progression of the disease, its strongly familial inheritance, and the disruption it causes to relationships and families.I also trace the history of its scientific understanding, from its first documentation by neurologist George Huntington, to the efforts of psychologist Nancy Wexler to find the gene responsible.The podcast also highlights the mimics of Huntington disease, which include a host of other causes of chorea. I also review its limited treatments.

I am joined in this podcast by Anne Fadiman to discuss her classical book The Spirit Catches You and You Fall Down, her account of the cross-cultural conflicts between a Hmong family and the American medical system. The book won a National Book Critics Circle Award, a Los Angeles Times Book Prize, and a Salon Book Award.Published in 1997, the book has attained classic status within medicine. Its contents and lessons remain relevant for contemporary medical practice, and this is why I listed it amongst the important book's this podcast explores.Anne explored the tragedy that evolved when Hmong refugees in the United States interacted with their health centre. At the centre of the saga is their young daughter with refractory epilepsy. Anne explores the transcultural failures that marred the interactions between the two sides, and almost fatally compromised the girl's life.Anne Fadiman is Professor in the Practice of Creative Writing, and Francis Writer-in-Residence at Yale University. The former editor of The American Scholar and a fellow of the American Academy of Arts and Sciences, Fadiman is also the author of two essay collections, Ex Libris and At Large and At Small, and a memoir, The Wine Lover's Daughter.

In this episode, I trace the history of the development of EEG and MRI, the two key investigation tools of epilepsy. This explores the roles played by neuroscientists Hans Berger and Edgar Adrian, and physicists Paul Lauterbur, Peter Mansfield, and Raymond Damadian.I also use the fascinating memoir, The Letter E, to demonstrate the importance of the genetic diagnosis of epilepsy, and A Mind Unravelled to demonstrate the complications of anti-seizure medications.I also trace the history of the use of chemical treatments of epilepsy, from chance discoveries to rational approaches.The podcast also covers the interventional treatments of epilepsy, such as vagus nerve stimulation and epilepsy brain surgery.

In this episode, I am joined by Franziska Thomas to explore her almost life-long history of experiencing epilepsy. She traces the onset of her epilepsy and the daily seizures she experiences since her first seizure in 1992, when she said her whole world literally turned upside down. Franziska describes 'Fits and Starts' as a story, not just of her fits, but also of injuries and of memory loss. She also sees the book as a compelling personal description of living with epilepsy, an illness she said is shrouded in secrecy and antiquated myths. She also intended it to be a memoir which is set inside the wider story of epilepsy and society. Franziska describes a vivid picture of how her illness has influenced her career choices and continues to define her daily life. We also discuss her depiction of epilepsy as a messy illness, and her concepts and experience of stigma. Laden with self-deprecating humour, it is also a story of her own coming of age as someone with epilepsy, a teacher, and ultimately, a mother. Franziska Thomas has previously worked as a journalist and history teacher, and she is currently working as an author and GCSE English tutor. She lives in London with her husband Tim, their children Oskar and Kurt, two misbehaving Maine Coones, and a Labrador called Magnus who never stops eating.

In this short episode, I count down 10 neurological occupational risks. The podcast explores how the activities involved, and the exposures associated with the jobs, can threaten the nervous system.