Podcasts about lancet neurol

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: September 20, 2018 Apomorphine has a more than 20-year history as a therapeutic adjunct in the management of idiopathic Parkinson disease. And yet, no randomized, placebo-controlled clinical trial to show for it. As of July 2018, now there is. In this week's episode of BrainWaves, Dr. Siegler discusses the relevance, strengths, and weaknesses of the TOLEDO trial. Produced by James E. Siegler. Music by Ondrosik and Rod Hamilton. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCESKatzenschlager R, Poewe W, Rascol O, et al. Apomorphine subcutaneous infusion in patients with Parkinson's disease with persistent motor fluctuations (TOLEDO): a multicentre, double-blind, randomised, placebo-controlled trial. Lancet Neurol 2018;17(9):749-59. PMID 30055903 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: May 20, 2018 It's the age of thrombectomy. The DAWN of a new era. But should we give up on intravenous thrombolysis for acute ischemic stroke? In this installment of the Quanta series (typically shorter episodes, this one happens to be 19 minutes), we review the latest data on fibrinolytic agents and anticipate the upcoming paradigm shift in the management of patients with cerebral infarction. Produced by James E Siegler. Music by Hyson and Jon Watts. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. REFERENCESAssessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-2) Investigators; Van De Werf F, Adgey J, et al. Single-bolus tenecteplase compared with front-loaded alteplase in acute myocardial infarction: the ASSENT-2 double-blind randomised trial. Lancet 1999;354(9180):716-22. PMID 10475182Campbell BC, Mitchell PJ, Churilov L, et al. Tenecteplase versus alteplase before thrombectomy for ischemic stroke. N Engl J Med 2018;378(17):1573-82. PMID 29694815Haley EC Jr, Lyden PD, Johnston KC, Hemmen TM; TNK in Stroke Investigators. A pilot dose-escalation safety study of tenecteplase in acute ischemic stroke. Stroke 2005;36(3):607-12. PMID 15692126Haley EC Jr, Thompson JL, Grotta JC, et al. Phase IIB/III trial of tenecteplase in acute ischemic stroke: results of a prematurely terminated randomized clinical trial. Stroke 2010;41(4):707-11. PMID 20185783Huang X, Cheripelli BK, Lloyd SM, et al. Alteplase versus tenecteplase for thrombolysis after ischaemic stroke (ATTEST): a phase 2, randomised, open-label, blinded endpoint study. Lancet Neurol 2015;14(4):368-76. PMID 25726502Logallo N, Novotny V, Assmus J, et al. Tenecteplase versus alteplase for management of acute ischaemic stroke (NOR-TEST): a phase 3, randomised, open-label, blinded endpoint trial. Lancet Neurol 2017;16(10):781-8. PMID 28780236Parsons M, Spratt N, Bivard A, et al. A randomized trial of tenecteplase versus alteplase for acute ischemic stroke. N Engl J Med 2012;366(12):1099-107. PMID 22435369 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: September 12, 2019 We just used clinical trial data regarding eculizumab in myasthenia gravis as an example of how to critically appraise the literature, and in this week's program...MORE data on the efficacy of eculizumab in another neurologic condition. This week on BrainWaves, the exciting results of the PREVENT trial, and the future treatment of NMO spectrum disorder!  Produced by James E Siegler. Special thanks to Dr. Olga Rosenveld Thon. Music courtesy of Unheard Music Concepts, TRG Banks, and Aitua. Sound effects by Mike Koenig and baby Sofia Joan Siegler. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCESFDA News Release: FDA approved first treatment for neuromyelitis optica spectrum disorder, a rare autoimmune disease of the central nervous system. 27 June 2019. Available online at https://www.fda.gov/news-events/press.... Accessed 30 Aug 2019.Pittock SJ, Berthele A, Fujihara K, et al. Eculizumab in aquaporin-4-positive neuromyelitis optica spectrum disorder. N Engl J Med 2019;381(7):614-25. PMID 31050279Pittock SJ, Lennon VA, McKeon A, et al. Eculizumab in AQP4-IgG-positive relapsing neuromyelitis optica spectrum disorders: an open-label pilot study. Lancet Neurol 2013;12(6):554-62. PMID 23623397 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

Un nouvel épisode du Pharmascope est maintenant disponible! Dans de ce 138ème épisode, Nicolas, Isabelle et Olivier discutent d'un problème pas reposant : le syndrome des jambes sans repos. Les objectifs pour cet épisode sont les suivants: Expliquer la présentation clinique, les critères diagnostics et les facteurs de risque du syndrome des jambes sans repos. Conseiller des mesures non-pharmacologiques pour aider les personnes avec un syndrome des jambes sans repos. Discuter des bénéfices et des désavantages associés aux principaux traitements pharmacologiques du syndrome des jambes sans repos Ressources pertinentes en lien avec l'épisode Manconi M, Garcia-Borreguero D, Schormair B, Videnovic A, Berger K, Ferri R, Dauvilliers Y. Restless legs syndrome. Nat Rev Dis Primers. 2021 Nov 3;7(1):80. Trotti LM, Becker LA. Iron for the treatment of restless legs syndrome. Cochrane Database Syst Rev. 2019 Jan 4;1(1):CD007834. Earley CJ, García-Borreguero D, Falone M, Winkelman JW. Clinical Efficacy and Safety of Intravenous Ferric Carboxymaltose for Treatment of Restless Legs Syndrome: A Multicenter, Randomized, Placebo-controlled Clinical Trial. Sleep. 2024 Apr 16:zsae095. Short V, Allen R, Earley CJ, Bahrain H, Rineer S, Kashi K, Gerb J, Auerbach M. A randomized double-blind pilot study to evaluate the efficacy, safety, and tolerability of intravenous iron versus oral iron for the treatment of restless legs syndrome in patients with iron deficiency anemia. Am J Hematol. 2024 Jun;99(6):1077-1083. Wilt TJ, MacDonald R, Ouellette J, Khawaja IS, Rutks I, Butler M, Fink HA. Pharmacologic therapy for primary restless legs syndrome: a systematic review and meta-analysis. JAMA Intern Med. 2013 Apr 8;173(7):496-505. Allen RP, Chen C, Garcia-Borreguero D, Polo O, DuBrava S, Miceli J, Knapp L, Winkelman JW. Comparison of pregabalin with pramipexole for restless legs syndrome. N Engl J Med. 2014 Feb 13;370(7):621-31. Trenkwalder C, Benes H, Grote L, Happe S, Högl B, Mathis J, Saletu-Zyhlarz GM, Kohnen R; CALDIR Study Group. Cabergoline compared to levodopa in the treatment of patients with severe restless legs syndrome: results from a multi-center, randomized, active controlled trial. Mov Disord. 2007 Apr 15;22(5):696-703. Trenkwalder C, Beneš H, Grote L, García-Borreguero D, Högl B, Hopp M, Bosse B, Oksche A, Reimer K, Winkelmann J, Allen RP, Kohnen R; RELOXYN Study Group. Prolonged release oxycodone-naloxone for treatment of severe restless legs syndrome after failure of previous treatment: a double-blind, randomised, placebo-controlled trial with an open-label extension. Lancet Neurol. 2013 Dec;12(12):1141-50. Carlos K, Prado GF, Teixeira CD, Conti C, de Oliveira MM, Prado LB, Carvalho LB. Benzodiazepines for restless legs syndrome. Cochrane Database Syst Rev. 2017 Mar 20;3(3):CD006939. Jadidi A, Rezaei Ashtiani A, Khanmohamadi Hezaveh A, Aghaepour SM. Therapeutic effects of magnesium and vitamin B6 in alleviating the symptoms of restless legs syndrome: a randomized controlled clinical trial. BMC Complement Med Ther. 2022 Dec 31;23(1):1. Wali SO, Abaalkhail B, Alhejaili F, Pandi-Perumal SR. Efficacy of vitamin D replacement therapy in restless legs syndrome: a randomized control trial. Sleep Breath. 2019 Jun;23(2):595-601.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: November 13, 2017 How often do you call the plumber and say, "My faucet is leaking," and then the plumber REMOVES your faucet? Problem solved, right? Ironically, this simplistic approach works extremely well in a variety of epileptic conditions. In this week's show, Dr. Myriam Abdennadher and Danielle Becker comment on the protocol and efficacy for surgery in patients with drug-resistant epilepsy. Produced by James E. Siegler. Music by Little Glass Men, Montplaisir, Three Chain Links, and Squire Tuck. Voiceover by Isa Smrstik. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. REFERENCESDeGiorgio CM, Krahl SE. Neurostimulation for drug-resistant epilepsy. Continuum (Minneap Minn) 2013;19(3 Epilepsy):743-55. PMID 23739108Engel J Jr, Wiebe S, French J, et al. Practice parameter: temporal lobe and localized neocortical resections for epilepsy: report of the Quality Standards Subcommittee of the American Academy of Neurology, in association with the American Epilepsy Society and the American Association of Neurological Surgeons. Neurology 2003;60(4):538-47. Erratum in: Neurology 2003;60(8):1396. PMID 12601090Englot DJ, Wang DD, Rolston JD, Shih TT, Chang EF. Rates and predictors of long-term seizure freedom after frontal lobe epilepsy surgery: a systematic review and meta-analysis. J Neurosurg 2012;116(5):1042-8. PMID 22304450Jobst BC, Cascino GD. Resective epilepsy surgery for drug-resistant focal epilepsy: a review. JAMA 2015;313(3):285-93. PMID 25602999Schwartz TH, Spencer DD. Strategies for reoperation after comprehensive epilepsy surgery. J Neurosurg 2001;95(4):615-23. PMID 11596956Spencer S, Huh L. Outcomes of epilepsy surgery in adults and children. Lancet Neurol 2008;7(6):525-37. PMID 18485316 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: January 22, 2018 Did anyone else catch the 2017 update to the diagnostic criteria for multiple sclerosis? Me neither. Hopefully this episode will catch you up on it. Produced by James E Siegler. Music by Daniel Birch and Chris Zabriskie. The BrainWaves' podcast and online content are intended for medical education and entertainment purposes only. REFERENCESPolman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011;69(2):292-302. PMID 21387374Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 2018;17(2):162-173. PMID 29275977 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.Originally released: December 26, 20192019 was a big year. The year of the Mueller report. The American college admissions scandals. Brexit. But it was also the year the US Women's team won the World Cup and lobbied for the equal pay of women and men in sports. It was the year of NMO, in which several pivotal trials showed the benefit of disease-modulating therapy in this condition. The year Will Smith played Genie in Aladdin.2019 was a great year. And as we wrap up 2019, this week's episode includes some of the highlights. Enjoy!Produced by James E Siegler with support from Erika Mejia, Rajat Dhar, and the entire Siegler family. Music courtesy of Axletree, Chris Zabriskie, John Paston, Kevin Mcleod, Josh Woodward, Steve Combs, Lee Rosevere, Scott Holmes, Advent Chamber Orchestra, Coldnoise, and Pachyderm. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.REFERENCES[BRAIN FOOD]Devore EE, Kang JH, Breteler MM, Grodstein F. Dietary intakes of berries and flavonoids in relation to cognitive decline. Ann Neurol 2012;72(1):135-43. PMID 22535616Kennedy DO, Wightman EL, Reay JL, et al. Effects of resveratrol on cerebral blood flow variables and cognitive performance in humans: a double-blind, placebo-controlled, crossover investigation. Am J Clin Nutr 2010;91(6):1590-7. PMID 20357044Lefèvre-Arbogast S, Gaudout D, Bensalem J, et al. Pattern of polyphenol intake and the long-term risk of dementia in older persons. Neurology 2018;90(22):e1979-e1988. PMID 29703769Liu QP, Wu YF, Cheng HY, et al. Habitual coffee consumption and risk of cognitive decline/dementia: A systematic review and meta-analysis of prospective cohort studies. Nutrition 2016;32(6):628-36. PMID 26944757Miller MG, Hamilton DA, Joseph JA, Shukitt-Hale B. Dietary blueberry improves cognition among older adults in a randomized, double-blind, placebo-controlled trial. Eur J Nutr 2018;57(3):1169-80. PMID 28283823Morris MC, Tangney CC, Wang Y, et al. MIND diet slows cognitive decline with aging. Alzheimers Dement 2015;11(9):1015-22. PMID 26086182Newman JC, Covarrubias AJ, Zhao M, et al. Ketogenic diet reduces midlife mortality and improves memory in aging mice. Cell Metab 2017;26(3):547-57.e8. PMID 28877458Norton S, Matthews FE, Barnes DE, Yaffe K, Brayne C. Potential for primary prevention of Alzheimer's disease: an analysis of population-based data. Lancet Neurol 2014;13(8):788-94. Erratum in: Lancet Neurol 2014;13(11):1070. PMID 25030513Okkersen K, Jimenez-Moreno C, Wenninger S, et al. Cognitive behavioural therapy with optional graded exercise therapy in patients with severe fatigue with myotonic dystrophy type 1: a multicentre, single-blind, randomised trial. Lancet Neurol 2018;17(8):671-80. PMID 29934199Radd-Vagenas S, Duffy SL, Naismith SL,

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities. Episodes originally aired from 2016 to 2021.Originally released: November 14, 2019The FDA label for ACTEMRA® (tocilizumab)--the first medication approved for use in giant cell arteritis in 2017--is 40 pages long. Of the information provided in this document, which includes important dosing information, dose adjustments based on leukocyte count, clinical trial and epidemiologic data, there is a box of text on the first page of the insert. "WARNING: RISK OF SERIOUS INFECTIONS," it reads.What do you make of this warning? And with such a clear and broad-sweeping statement stamped on the medication, how do you mitigate the medico-legal risk of using this drug?This week on the program we launch into a two-part series focused on some of the events that follow major clinical trials. In part 1, we cover the three major classifications of FDA alerts for medical treatments using two examples from the neurologic pharmacopoeia. In part 2, we emphasize the importance of post-publication peer review. And both are equally instrumental in our medical decision-making.Produced by James E Siegler with the support of Michael Rubenstein (University of Pennsylvania) and Zachary Newcomer (University of Florida). Music courtesy of Coldnoise, Cuicuitte, Doctor Turtle, Jahzzar, and Peter Rudenko under a CC license. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. None of what is discussed here should be misconstrued as medical advice, so don't just go prescribing drugs off-label! (Or willy nilly, as my grandmother might say) Be sure to follow us on Twitter (now X) @brainwavesaudio for the latest updates to the podcast.REFERENCESBallard C, Hanney ML, Theodoulou M, et al. The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurol 2009;8(2):151-7. PMID 19138567Dorsey ER, Beck CA, Darwin K, et al. Natural history of Huntington disease. JAMA Neurol 2013;70(12):1520-30. PMID 24126537Hubers AA, van Duijn E, Roos RA, et al. Suicidal ideation in a European Huntington's disease population. J Affect Disord 2013;151(1):248-58. PMID 23876196Moore TJ, Singh S, Furberg CD. The FDA and new safety warnings. Arch Intern Med 2012;172(1):78-80. PMID 22232155Rose RV, Kass JS. Prescribing antipsychotic medications to patients with dementia: boxed warnings and mitigation of legal liability. Continuum (Minneap Minn) 2019;25(1):254-9. PMID 30707196Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA 2005;294(15):1934-43. PMID 16234500Schultz JL, Killoran A, Nopoulos PC, Chabal CC, Moser DJ, Kamholz JA. Evaluating depression and suicidality in tetrabenazine users with Huntington disease. Neurology 2018;91(3):e202-7. PMID 29925548Shen V, Clarence-Smith K, Hunter C, Jankovic J. Safety and efficacy of tetrabenazine and use of concomitant medications during long-term, open-label treatment of chorea associated with Huntington's an

A brief overview of the neurologist's role in the diagnosis and treatment of functional neurological disorders, with Drs. Vanessa Veloso and Jeremy Moeller.Note: This podcast is intended solely as an educational tool for learners, especially neurology residents. The contents should not be interpreted as medical advice.Further ReadingHallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol. 2022 Jun;21(6):537-550. doi: 10.1016/S1474-4422(21)00422-1. Stone J, Smyth R, Carson A, Lewis S, Prescott R, Warlow C, Sharpe M. Systematic review of misdiagnosis of conversion symptoms and "hysteria". BMJ. 2005 Oct 29;331(7523):989. doi: 10.1136/bmj.38628.466898.55. Stone J, Carson A, Duncan R, Coleman R, Roberts R, Warlow C, Hibberd C, Murray G, Cull R, Pelosi A, Cavanagh J, Matthews K, Goldbeck R, Smyth R, Walker J, Macmahon AD, Sharpe M. Symptoms 'unexplained by organic disease' in 1144 new neurology out-patients: how often does the diagnosis change at follow-up? Brain. 2009 Oct;132(Pt 10):2878-88. doi: 10.1093/brain/awp220. Kutlubaev MA, Xu Y, Hackett ML, Stone J. Dual diagnosis of epilepsy and psychogenic nonepileptic seizures: Systematic review and meta-analysis of frequency, correlates, and outcomes. Epilepsy Behav. 2018 Dec;89:70-78. doi: 10.1016/j.yebeh.2018.10.010.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities. Episodes originally aired from 2016 to 2021. Originally released: August 8, 2019 Clean up on aisle 4! Or should it be IL-4? In this week's installment of the BrainWaves Podcast, we immerse ourselves into the microscopic environment of Alzheimer disease pathology. It's interesting, it's messy, and whoever made this mess is also responsible for the clean-up. Produced by James E Siegler. Music courtesy of Andy Cohen, Brendan Kinsella, Cuicuitte, Damiano Baldoni, Kai Engel, Nctrnm. Sound effects by Mike Koenig, Blastfx.com, Caroline Ford, Robertv, and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter (now X) @brainwavesaudio for the latest updates to the podcast. REFERENCES Arranz AM, De Strooper B. The role of astroglia in Alzheimer's disease: pathophysiology and clinical implications. Lancet Neurol 2019;18(4):406-14. PMID 30795987Breitner JC, Baker LD, Montine TJ, et al. Extended results of the Alzheimer's disease anti-inflammatory prevention trial. Alzheimers Dement 2011;7(4):402-11. PMID 21784351Chun H, Lee CJ. Reactive astrocytes in Alzheimer's disease: a double-edged sword. Neurosci Res 2018;126:44-52. PMID 29225140Heneka MT, Carson MJ, El Khoury J, et al. Neuroinflammation in Alzheimer's disease. Lancet Neurol 2015;14(4):388-405. PMID 25792098Kumar A, Singh A, Ekavali. A review on Alzheimer's disease pathophysiology and its management: an update. Pharmacol Rep 2015;67(2):195-203. PMID 25712639Maragakis NJ, Rothstein JD. Mechanisms of disease: astrocytes in neurodegenerative disease. Nat Clin Pract Neurol 2006;2(12):679-89. PMID 17117171Mattsson N, Zetterberg H, Hansson O, et al. CSF biomarkers and incipient Alzheimer disease in patients with mild cognitive impairment. JAMA 2009;302(4):385-93. PMID 19622817Wisniewski T, Konietzko U. Amyloid-beta immunisation for Alzheimer's disease. Lancet Neurol 2008;7(9):805-11. PMID 18667360Yan R, Vassar R. Targeting the β secretase BACE1 for Alzheimer's disease therapy. Lancet Neurol 2014;13(3):319-29. PMID 24556009 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities. Episodes originally aired from 2016 to 2021. Originally released: May 16, 2019 It would be an understatement to say that endovascular thrombectomy has revolutionized acute stroke management. As of 2018, the American Heart Association recommends treatment up to 24 hours after time last seen normal for select patients. This week on the BrainWaves podcast, Dr. Tudor Jovin--PI for the DAWN and REVASCAT clinical trials--summarizes the history of thrombectomy trials and what it is about our current strategies that have breathed new life into a technique that has historically fizzled. Produced by James E Siegler and Jesse Thon. Music courtesy of Cuicuitte, Coldnoise, Medyn, Jon Watts, Lee Rosevere, and Mystery Mammal. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter (now X) @brainwavesaudio for the latest updates to the podcast. REFERENCES Campbell BC, Majoie CB, Albers GW, et al. Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data. Lancet Neurol 2019;18(1):46-55. Erratum in: Lancet Neurol 2019 Mar;18(3):e2. PMID 30413385Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016;387(10029):1723-31. PMID 26898852Gross BA, Jadhav AP, Jankowitz BT, Jovin TG. The ongoing revolution in thrombectomy: expanding inclusion criteria to larger cores. World Neurosurg 2018;120:393-94. PMID 30292027Heit JJ, Wintermark M. Perfusion computed tomography for the evaluation of acute ischemic stroke: strengths and pitfalls. Stroke 2016;47(4):1153-8. PMID 26965849Jadhav AP, Molyneaux BJ, Hill MD, Jovin TG. Care of the post-thrombectomy patient. Stroke 2018;49(11):2801-07. PMID 30355218Konstas AA, Goldmakher GV, Lee TY, Lev MH. Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 2: technical implementations. AJNR Am J Neuroradiol 2009;30(5):885-92. PMID 19299489Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018;378(1):11-21. PMID 29129157Román LS, Menon BK, Blasco J, et al. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. Lancet Neurol 2018;17(10):895-904. PMID 30264728 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: November 22, 2018 Of the "reversible" causes of dementia, normal pressure hydrocephalus may be the most controversial. But there is something to be said about how surgical intervention alters the physiology of patients who present with gait impairment, ventriculomegaly, and normal CSF pressure. This week on the show, we discuss the clinical features and the controversy behind this diagnosis. Produced by James E Siegler. Music by Ghost, Jon Watts, Julie Maxwell, Komiku, and Kevin McLeod. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Gallia GL, Rigamonti D, Williams MA. The diagnosis and treatment of idiopathic normal pressure hydrocephalus. Nat Clin Pract Neurol 2006;2(7):375-81. PMID 16932588Kazui H, Miyajima M, Mori E, Ishikawa M; SINPHONI-2 Investigators. Lumboperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (SINPHONI-2): an open-label randomised trial. Lancet Neurol 2015;14(6):585-94. PMID 25934242Klassen BT, Ahlskog JE. Normal pressure hydrocephalus: how often does the diagnosis hold water? Neurology 2011;77(12):1119-25. PMID 21849644Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM. Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery 2005;57(3 Suppl):S4-16; discussion ii-v. PMID 16160425Williams MA, Relkin NR. Diagnosis and management of idiopathic normal-pressure hydrocephalus. Neurol Clin Pract 2013;3(5):375-85. PMID 24175154 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: October 11, 2018 As the name suggests, "evidence-based medicine" is dependent on published evidence to support our clinical practice and medical decision-making. Implicit in this is the notion that all published evidence reflects the truth that underlies the biology, pathophysiology, and pharmacology of our health. This is not the case. Clinical research and published findings can be extremely limited, and what you read in Lancet and NEJM should be interpreted with caution. In this week's episode of the "I wonder" series, where Jim Siegler speaks with Ali Hamedani on various topics in medicine and neurology, the speakers review the major biases inherent to the practice and interpretation of clinical research. Produced by James E Siegler. Music by Jahzzar, Kai Engel, and Lee Rosevere. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. REFERENCES Anonymous. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Lancet 1988;2(8607):349-60. PMID 2899772Kazui H, Miyajima M, Mori E, Ishikawa M; SINPHONI-2 Investigators. Lumboperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (SINPHONI-2): an open-label randomised trial. Lancet Neurol 2015;14(6):585-94. PMID 25934242Montalban X, Hauser SL, Kappos L, et al. Ocrelizumab versus placebo in primary progressive multiple sclerosis. N Engl J Med 2017;376(3):209-20. PMID 28002688Smith GC, Pell JP. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ 2003;327(7429):1459-61. PMID 14684649 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

Un nouvel épisode du Pharmascope est maintenant disponible! Dans de ce 133ème épisode, Nicolas, Sébastien, Isabelle discutent de quelques nouveautés pharmacothérapeutiques. Au menu: la clascotérone, les phytostérols, daridorexant et vaccin contre le RSV. Les objectifs pour cet épisode sont les suivants: Résumer les bénéfices et les risques associés à ces nouvelles thérapies Expliquer les avantages et les inconvénients de ces thérapies Discuter de la place des nouvelles thérapies dans l'arsenal thérapeutique Ressources pertinentes en lien avec l'épisode Clascotérone 1%Hebert A et coll. Efficacy and Safety of 1% Clascoterone Cream in Patients Aged > 12 Years With Acne Vulgaris. J Drugs Dermatol. 2023;22:174-81. Eichenfield LF et coll. Long-Term Safety and Efficacy of Twice-Daily Topical Clascoterone Cream 1% in Patients Greater Than or Equal to 12 Years of Age With Acne Vulgaris. J Drugs Dermatol. 2023;22:810-6. Hebert A et coll. Efficacy and Safety of Topical Clascoterone Cream, 1%, for Treatment in Patients With Facial Acne: Two Phase 3 Randomized Clinical Trials. JAMA Dermatol. 2020;156:621-30. Phytostérols pursShaghaghi MA, et coll. Water dispersible plant sterol formulation shows improved effect on lipid profile compared to plant sterol esters. J Functional Foods. 2014;6:280-9. Palmeiro-Silva YK et coll. Effects of Daily Consumption of an Aqueous Dispersion of Free-Phytosterols Nanoparticles on Individuals with Metabolic Syndrome: A Randomised, Double-Blind, Placebo-Controlled Clinical Trial. Nutrients. 2020;12:2392. DaridorexantMignot E et coll. Safety and efficacy of daridorexant in patients with insomnia disorder: results from two multicentre, randomised, double-blind, placebo-controlled, phase 3 trials. Lancet Neurol. 2022;21:125-39. Dauvilliers Y et coll. Daridorexant, a New Dual Orexin Receptor Antagonist to Treat Insomnia Disorder. Ann Neurol. 2020;87:347-56. Vaccin contre le RSVPapi A et coll; AReSVi-006 Study Group. Respiratory Syncytial Virus Prefusion F Protein Vaccine in Older Adults. N Engl J Med. 2023;388:595-608.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: June 14, 2018 As a pupil of neurology and medicine, I feel like it is my responsibility to cover this topic at least once on the podcast. This topic came to me in a vision. But not one of phosphenes or impaired stereopsis--both of which we'll cover today. This week, we're discussing inflammation of the optic nerve, from the historical aspects to current concepts. And while you're listening, there's no need to lash out at my puns. You can stop rolling your eyes now. Produced by James E Siegler. Music by Lee Rosevere, Kevin McLeod, Steve Combs, and Unheard Music Concepts. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. REFERENCES Balcer LJ. Clinical practice. Optic neuritis. N Engl J Med 2006;354(12):1273-80. PMID 16554529Beck RW, Cleary PA, Anderson MM Jr, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group. N Engl J Med 1992;326(9):581-8. PMID 1734247Hickman SJ, Dalton CM, Miller DH, Plant GT. Management of acute optic neuritis. Lancet 2002;360(9349):1953-62. PMID 12493277Liu GT, Volpe NJ, Galetta SL. Neuro-Ophthalmology: Diagnosis and Management. 2nd Ed. Elsevier, 2010.O'Doherty M, Flitcroft DI. An unusual presentation of optic neuritis and the Pulfrich phenomenon. J Neurol Neurosurg Psychiatry 2007;78(8):906-7. PMID 17635984Toosy AT, Mason DF, Miller DH. Optic neuritis. Lancet Neurol 2014;13(1):83-99. PMID 24331795Volpe NJ. Optic neuritis: historical aspects. J Neuroophthalmol 2001;21(4):302-9. PMID 11756864  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.Originally released: Jan 18, 2018When it comes to stroke, treatment is dependent on the stroke mechanism. But most patients wind up on aspirin anyway. Or Plavix (clopidogrel). And sometimes both. The question this week is, Why? I hope you're hungry for some fruit because we're comparing a bunch of apples to oranges in this episode of the BrainWaves podcast.Produced by James E Siegler. Music by William Ross Chernoff's Nomads, Steve Combs, Rui, Little Glass Men, and Peter Rudenko. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision-making. Even if this episode is all about choosing aspirin or clopidogrel when you're treating stroke patients. Always talk with your doctor, and if you are a doctor, you should rely on institutional policies and your own clinical judgment when treating patients.REFERENCESAntithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002;324(7329):71-86. Erratum in: BMJ 2002;324(7330):141. PMID 11786451Bhatt DL, Fox KA, Hacke W, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med 2006;354(16):1706-17. PMID 16531616CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. CAST (Chinese Acute Stroke Trial) Collaborative Group. Lancet 1997;349(9066):1641-9. PMID 9186381Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration. BMJ 1994;308(6921):81-106. Erratum in: BMJ 1994;308(6943):1540. PMID 8298418CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet 1996;348(9038):1329-39. PMID 8918275Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 2004;364(9431):331-7. PMID 15276392Hong KS, Lee SH, Kim EG, et al. Recurrent ischemic lesions after acute atherothrombotic stroke: clopidogrel plus aspirin versus aspirin alone. Stroke 2016;47(9):2323-30. PMID 27418597Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44(3):870-947. PMID 23370205Kennedy J, Hill MD, Ryckborst KJ, et al. Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial. Lancet Neurol 2007;6(11):961-9.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: November 23, 2017 This week on BrainWaves, we build on concepts introduced in episode 65 regarding the non-pharmacologic management of drug-resistant epilepsy. In the next two episodes, you'll hear from Dr. Danielle Becker (Penn) and Dr. Myriam Abdennadher (NIH) on the minimally invasive procedures that can drastically impact the lives of patients with refractory seizures. Produced by James E Siegler. Music by Steve Combs, Jason Shaw, and Josh Woodward. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. REFERENCES Kwan P, Arzimanoglou A, Berg AT, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia 2010;51(6):1069-77. Erratum in: Epilepsia 2010;51(9):1922. PMID 19889013Nilsson L, Farahmand BY, Persson PG, Thiblin I, Tomson T. Risk factors for sudden unexpected death in epilepsy: a case-control study. Lancet 1999;353(9156):888-93. PMID 10093982Tomson T, Nashef L, Ryvlin P. Sudden unexpected death in epilepsy: current knowledge and future directions. Lancet Neurol 2008;7(11):1021-31. PMID 18805738Willie JT, Laxpati NG, Drane DL, et al. Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Neurosurgery 2014;74(6):569-84; discussion 584-5. PMID 24618797  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: November 30, 2017 Last week was all about how destroying bad brain can help patients with epilepsy. This week, in a stimulating discussion with Dr. Becker, we're reviewing the ways we can activate the nervous system in order to prevent future seizures: the vagus nerve stimulator, deep brain stimulation, and the responsive neurostimulation system. Produced by James E Siegler. Music by Chris Zabriskie, Josh Woodward, and Kevin McLeod. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. REFERENCES A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. The Vagus Nerve Stimulation Study Group. Neurology 1995;45(2):224-30. PMID 7854516Ben-Menachem E. Vagus-nerve stimulation for the treatment of epilepsy. Lancet Neurol 2002;1(8):477-82. PMID 12849332DeGiorgio CM, Krahl SE. Neurostimulation for drug-resistant epilepsy. Continuum (Minneap Minn) 2013;19(3 Epilepsy):743-55. PMID 23739108Fisher R, Salanova V, Witt T, et al. Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. Epilepsia 2010;51(5):899-908. PMID 20331461Handforth A, DeGiorgio CM, Schachter SC, et al. Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial. Neurology 1998;51(1):48-55. PMID 9674777Lanska DJ. JL Corning and vagal nerve stimulation for seizures in the 1880s. Neurology 2002;58(3):452-9. PMID 11839848Morrell MJ; RNS System in Epilepsy Study Group. Responsive cortical stimulation for the treatment of medically intractable partial epilepsy. Neurology 2011;77(13):1295-304. PMID 21917777Morris GL 3rd, Gloss D, Buchhalter J, Mack KJ, Nickels K, Harden C. Evidence-based guideline update: vagus nerve stimulation for the treatment of epilepsy: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2013;81(16):1453-9. PMID 23986299Penry JK, Dean JC. Prevention of intractable partial seizures by intermittent vagal stimulation in humans: preliminary results. Epilepsia 1990;31 Suppl 2:S40-3. PMID 2121469Yuan H, Silberstein SD. Vagus nerve and vagus nerve stimulation, a comprehensive review: Part II. Headache 2016;56(2):259-66. PMID 26381725  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 18, 2017 This Thanksgiving, amidst all the turkey, the stuffing, the cranberry sauce, the ham, and the cornucopia of dessert options, you may be inclined to let the food coma sink in. But for those interested in the science behind this fanciful feast, listen to what Dr. Jason Maley has to say about the neurologic complications of some of the common dishes served at your holiday spread. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. REFERENCES Caruana M, Cauchi R, Vassallo N. Putative role of red wine polyphenols against brain pathology in Alzheimer's and Parkinson's disease. Front Nutr 2016;3:31. PMID 27570766Clauss HE, Lorber B. Central nervous system infection with Listeria monocytogenes. Curr Infect Dis Rep 2008;10(4):300-6. PMID 18765103Garcia HH, Del Brutto OH; Cysticercosis Working Group in Peru. Neurocysticercosis: updated concepts about an old disease. Lancet Neurol 2005;4(10):653-61. PMID 16168934Hillbom M, Saloheimo P, Fujioka S, Wszolek ZK, Juvela S, Leone MA. Diagnosis and management of Marchiafava-Bignami disease: a review of CT/MRI confirmed cases. J Neurol Neurosurg Psychiatry 2014;85(2):168-73. PMID 23978380Richard DM, Dawes MA, Mathias CW, Acheson A, Hill-Kapturczak N, Dougherty DM. L-tryptophan: basic metabolic functions, behavioral research and therapeutic indications. Int J Tryptophan Res 2009;2:45-60. PMID 20651948Sobel J. Botulism. Clin Infect Dis 2005;41(8):1167-73. PMID 16163636Williams ES. Chronic wasting disease. Vet Pathol 2005;42(5):530-49. PMID 16145200 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: March 14, 2019 In 2016, we heard the results of the MGTX trial--a pivotal investigation that demonstrated the efficacy of thymectomy for select patients with non-thymomatous myasthenia gravis. This spring, we saw the long-term follow-up data from the MGTX investigators. In this week's re-run, we summarize these data, critique it, and reflect on how it may change clinical practice. Produced by James E Siegler. Music courtesy of Scott Holmes and Lee Rosevere. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @BrainWaves audio for the latest updates to the podcast. REFERENCES Blalock A, Harvey AM, Ford FR, Lilienthal JL. The treatment of myasthenia gravis by removal of the thymus gland. JAMA 1941;117:1529-33.Oosterhuis HJ. Observations of the natural history of myasthenia gravis and the effect of thymectomy. Ann N Y Acad Sci 1981;377:678-90. PMID 6951492Wolfe GI, Kaminski HJ, Aban IB, et al. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med 2016;375(6):511-22. Erratum in: N Engl J Med 2017;376(21):2097. [Dosage error in article text]. PMID 27509100Wolfe GI, Kaminski HJ, Aban IB, et al. Long-term effect of thymectomy plus prednisone versus prednisone alone in patients with non-thymomatous myasthenia gravis: 2-year extension of the MGTX randomised trial. Lancet Neurol 2019;18(3):259-68. PMID 30692052  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 18, 2017 If you have sickle cell disease, you have a 1 in 10 chance of experiencing a stroke before college. And if you don't think that's going to hold you back, you don't know stroke. This week on BrainWaves, Dr. Erica Jones shares her experience with the neurologic complications of sickle cell anemia and the latest guidelines for managing patients with this condition. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. REFERENCES Bang OY, Fujimura M, Kim SK. The pathophysiology of Moyamoya disease: an update. J Stroke 2016;18(1):12-20. PMID 26846756“Data & Statistics." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/datastatistics/index.html. 2016.Gueguen A, Mahevas M, Nzouakou R, et al. Sickle-cell disease stroke throughout life: a retrospective study in an adult referral center. Am J Hematol 2014;89(3):267-72. PMID 24779035Lionnet F, Hammoudi N, Stojanovic KS, et al. Hemoglobin sickle cell disease complications: a clinical study of 179 cases. Haematologica 2012;97(8):1136-41. PMID 22315500Motulsky AG. Frequency of sickling disorders in U.S. blacks. N Engl J Med 1973;288(1):31-3. PMID 4681897Ohene-Frempong K, Weiner SJ, Sleeper LA, et al. Cerebrovascular accidents in sickle cell disease: rates and risk factors. Blood 1998;91(1):288-94. PMID 9414296Scott RM, Smith ER. Moyamoya disease and moyamoya syndrome. N Engl J Med 2009;360(12):1226-37. PMID 19297575Strouse JJ, Lanzkron S, Urrutia V. The epidemiology, evaluation and treatment of stroke in adults with sickle cell disease. Expert Rev Hematol 2011;4(6):597-606. PMID 22077524Switzer JA, Hess DC, Nichols FT, Adams RJ. Pathophysiology and treatment of stroke in sickle-cell disease: present and future. Lancet Neurol 2006;5(6):501-12. PMID 16713922Verduzco LA, Nathan DG. Sickle cell disease and stroke. Blood 2009;114(25):5117-25. PMID 19797523Wang WC, Dwan K. Blood transfusion for preventing primary and secondary stroke in people with sickle cell disease. Cochrane Database Syst Rev 2013;(11):CD003146. PMID 24226646Ware RE, Helms RW; SWiTCH Investigators. Stroke With Transfusions Changing to Hydroxyurea (SWiTCH). Blood 2012;119(17):3925-32. PMID 22318199 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 18, 2017 Trauma and hypertension account for the overwhelming majority of cases of intracerebral hemorrhage. Today, we address the minority. In this week's episode, Dr. Steven Messe discusses the atypical causes of intracerebral hemorrhage and how they are managed. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. REFERENCES Biffi A, Greenberg SM. Cerebral amyloid angiopathy: a systematic review. J Clin Neurol 2011;7(1):1-9. PMID 21519520Gilden D, Cohrs RJ, Mahalingam R, Nagel MA. Varicella zoster virus vasculopathies: diverse clinical manifestations, laboratory features, pathogenesis, and treatment. Lancet Neurol 2009;8(8):731-40. PMID 19608099Mast H, Young WL, Koennecke HC, et al. Risk of spontaneous haemorrhage after diagnosis of cerebral arteriovenous malformation. Lancet 1997;350(9084):1065-8. PMID 10213548Ruíz-Sandoval JL, Cantú C, Barinagarrementeria F. Intracerebral hemorrhage in young people: analysis of risk factors, location, causes, and prognosis. Stroke 1999;30(3):537-41. PMID 10066848Siegler JE, Ichord RN. Teaching neuroimages: multicompartmental intracranial hemorrhage in a pediatric patient. Neurology 2016;87(23):e284. PMID 27920292  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 12, 2018 It seems like a new antibody in autoimmune central nervous system disorders is being discovered every day. Well, maybe not that frequently. But autoimmune encephalitis may now be as common as infectious encephalitis. In this week's program, we revisit an episode from 2016 where Dr. Ramani Balu (neurocritical care) shares his experience in evaluating and managing patients with these conditions. Produced by James E Siegler. Music by Three Chain Links, Lee Rosevere, and Kevin McLeod. Sound effects by Mike Koenig. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. REFERENCES Anderson NE, Barber PA. Limbic encephalitis - a review. J Clin Neurosci 2008;15(9):961-71. PMID 18411052Dubey D, Pittock SJ, Kelly CR, et al. Autoimmune encephalitis epidemiology and a comparison to infectious encephalitis. Ann Neurol 2018;83(1):166-177. PMID 29293273Irani SR, Michell AW, Lang B, et al. Faciobrachial dystonic seizures precede Lgi1 antibody limbic encephalitis. Ann Neurol 2011;69(5):892-900. PMID 21416487Lancaster E, Martinez-Hernandez E, Dalmau J. Encephalitis and antibodies to synaptic and neuronal cell surface proteins. Neurology 2011;77(2):179-89. PMID 21747075Rosenfeld MR, Dalmau JO. Paraneoplastic disorders of the CNS and autoimmune synaptic encephalitis. Continuum (Minneap Minn) 2012;18(2):366-83. PMID 22810133Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J, Friedman D. Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology 2012;79(11):1094-100. PMID 22933737Titulaer MJ, McCracken L, Gabilondo I, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol 2013;12(2):157-65. PMID 23290630 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 18, 2017 Myasthenia gravis is a disorder characterized by proximal weakness, ptosis, and antibody formation against proteins at the neuromuscular junction. Most commonly, the protein targeted by antibodies is the nicotinic acetylcholine receptor. However, research in the last 2 decades has identified a number of other antibody targets, which we have reviewed here in this BrainWaves brief. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health-identifying information. The content in this episode was vetted and approved by Grant T Liu. REFERENCES Dalmau J, Rosenfeld MR. Paraneoplastic syndromes of the CNS. Lancet Neurol 2008;7(4):327-40. PMID 18339348Evoli A, Lancaster E. Paraneoplastic disorders in thymoma patients. J Thorac Oncol 2014;9(9 Suppl 2):S143-7. PMID 25396312Gilhus NE, Verschuuren JJ. Myasthenia gravis: subgroup classification and therapeutic strategies. Lancet Neurol 2015;14(10):1023-36. PMID 26376969Hurst RL, Gooch CL. Muscle-specific receptor tyrosine kinase (MuSK) myasthenia gravis. Curr Neurol Neurosci Rep 2016;16(7):61. PMID 27170368Koneczny I, Cossins J, Vincent A. The role of muscle-specific tyrosine kinase (MuSK) and mystery of MuSK myasthenia gravis. J Anat 2014;224(1):29-35. PMID 23458718 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 18, 2017 Although physicians use medications to treat headaches, the mind can become tolerant. In fact, many otherwise helpful medications may even aggravate a pre-existing headache syndrome. In this BrainWaves brief, we discuss the concept of medication-overuse headache and its treatment, which may be counterintuitive and is often challenging for patients. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health-identifying information. The content in this episode was vetted and approved by Roderick Spears. REFERENCES Diener HC, Limmroth V. Medication-overuse headache: a worldwide problem. Lancet Neurol 2004;3(8):475-83. PMID 15261608Dodick DW. Clinical practice. Chronic daily headache. N Engl J Med 2006;354(2):158-65. Erratum in: N Engl J Med 2006;354(8):884. PMID 16407511Tomkins GE, Jackson JL, O'Malley PG, Balden E, Santoro JE. Treatment of chronic headache with antidepressants: a meta-analysis. Am J Med 2001;111(1):54-63. PMID 11448661 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.Originally released: July 18, 2017Once heralded as "benign" essential tremor, this movement disorder is anything but. And you can see this when you talk with your neurology patients about the difficulties they encounter with dressing, eating, and even speaking--not to mention the social stigmata and cognitive dysfunction. In this BrainWaves episode, we start by describing the fundamentals of tremor and move on to the clinical features, pharmacology, and prognosis of essential tremor. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health-identifying information. REFERENCES Deuschl G, Raethjen J, Hellriegel H, Elble R. Treatment of patients with essential tremor. Lancet Neurol 2011;10(2):148-61. PMID 21256454Louis ED. Diagnosis and management of tremor. Continuum (Minneap Minn) 2016;22(4 Movement Disorders):1143-58. PMID 27495202Sandvik U, Koskinen LO, Lundquist A, Blomstedt P. Thalamic and subthalamic deep brain stimulation for essential tremor: where is the optimal target? Neurosurgery 2012;70(4):840-5; discussion 845-6. Erratum in: Neurosurgery 2021;88(3):707. PMID 22426044Zesiewicz TA, Elble R, Louis ED, et al. Practice parameter: therapies for essential tremor: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2005;64(12):2008-20. PMID 15972843 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

A review of neuromyelitis optic spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein associated disease (MOGAD) with Drs. Kevin Yan and Aaron Bower. Note: This podcast is intended solely as an educational tool for learners, especially neurology residents. The contents should not be interpreted as medical advice.Further Reading:Costello F. Neuromyelitis Optica Spectrum Disorders. Continuum (Minneap Minn). 2022 Aug 1;28(4):1131-1170. doi: 10.1212/CON.0000000000001168. Erratum in: Continuum (Minneap Minn). 2022 Dec 1;28(6):1859. PMID: 35938660. Longbrake E. Myelin Oligodendrocyte Glycoprotein-Associated Disorders. Continuum (Minneap Minn). 2022 Aug 1;28(4):1171-1193. doi: 10.1212/CON.0000000000001127. PMID: 35938661; PMCID: PMC9523511.Banwell B, Bennett JL, Marignier R, et al. Diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease: International MOGAD Panel proposed criteria. Lancet Neurol. 2023 Mar;22(3):268-282. doi: 10.1016/S1474-4422(22)00431-8. Epub 2023 Jan 24. PMID: 36706773.

A review of the selected mitochondrial diseases that affect the nervous system, with Drs. Aaron Bower and Jeremy Moeller.Note: This podcast is intended solely as an educational tool for learners, especially neurology residents. The contents should not be interpreted as medical advice.References1. Davis RL, Liang C, Sue CM. Mitochondrial diseases. Handb Clin Neurol 2018;147:125-141.2. Ng YS, Bindoff LA, Gorman GS, et al. Mitochondrial disease in adults: recent advances and future promise. Lancet Neurol 2021;20:573-584.3. Orsucci D, Caldarazzo Ienco E, Rossi A, Siciliano G, Mancuso M. Mitochondrial Syndromes Revisited. J Clin Med 2021;10.4. Buajitti E, Rosella LC, Zabzuni E, Young LT, Andreazza AC. Prevalence and health care costs of mitochondrial disease in Ontario, Canada: A population-based cohort study. PLoS One 2022;17:e0265744.5. Tetsuka S, Ogawa T, Hashimoto R, Kato H. Clinical features, pathogenesis, and management of stroke-like episodes due to MELAS. Metab Brain Dis 2021;36:2181-2193.6. Shemesh A, Margolin E. Kearns Sayre Syndrome. StatPearls. Treasure Island FL: © 2022, StatPearls Publishing LLC., 2022.7. Davila-Siliezar P, Carter M, Milea D, Lee AG. Leber hereditary optic neuropathy: new and emerging therapies. Curr Opin Ophthalmol 2022;33:574-578.8. Shemesh A, Sood G, Margolin E. Leber Hereditary Optic Neuropathy (LHON). StatPearls. Treasure Island FL: © 2022, StatPearls Publishing LLC., 2022.9. Velez-Bartolomei F, Lee C, Enns G. MERRF. In: Adam MP, Everman DB, Mirzaa GM, et al., eds. GeneReviews(®). Seattle WA: © 1993-2023, University of Washington, Seattle. GeneReviews is a registered trademark of the University of Washington, Seattle, 1993.10. Hameed S, Tadi P. Myoclonic Epilepsy and Ragged Red Fibers. StatPearls. Treasure Island FL: © 2022, StatPearls Publishing LLC., 2022.11. Hirano M, Carelli V, De Giorgio R, et al. Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE): Position paper on diagnosis, prognosis, and treatment by the MNGIE International Network. J Inherit Metab Dis 2021;44:376-387.12. Rahman S, Copeland WC. POLG-related disorders and their neurological manifestations. Nat Rev Neurol 2019;15:40-52.

Les gépants sont maintenant arrivés au Canada et un nouvel épisode du Pharmascope est disponible! Coïncidence? Probablement pas! Dans ce 118ème épisode, Nicolas et Sébastien discutent donc du rôle de l'atogépant et de l'ubrogépant pour la prévention et le soulagement des migraines.    Les objectifs pour cet épisode sont les suivants: Discuter de l'efficacité et de l'innocuité de l'atogepant en prophylaxie des migraines Discuter de l'efficacité et de l'innocuité de l'ubrogepant en traitement aigu des migraines Positionner l'atogepant dans l'arsenal thérapeutique en prophylaxie des migraines Positionner l'ubrogepant dans l'arsenal thérapeutique du traitement aigu des migraines Ressources pertinentes en lien avec l'épisode Références portant sur le QuliptaMCCorporation AbbVie. Monographie de produit: QuliptaMC. Saint-Laurent. 2022. Goadsby PJ et coll. Safety, tolerability, and efficacy of orally administered atogepant for the prevention of episodic migraine in adults: a double-blind, randomised phase 2b/3 trial. Lancet Neurol. 2020;19:727-37. Ailani J et coll; ADVANCE Study Group. Atogepant for the Preventive Treatment of Migraine. N Engl J Med. 2021;385:695-706. AbbVie. AbbVie Announces Late-Breaking Results from Phase 3 Trial Evaluating Atogepant (QULIPTA®) for the Preventive Treatment of Episodic Migraine Among Patients with Prior Treatment Failure at the 2023 AAN Annual Meeting. Avril 2023. Allergan. Efficacy, Safety, and Tolerability of Atogepant for the Prevention of Chronic Migraine. ClinicalTrials.gov. Février 2023. Références portant sur l'UbrelvyMCCorporation AbbVie. Monographie de produit: UbrelvyMC. Saint-Laurent. 2022. Dodick DW et coll. Ubrogepant for the Treatment of Migraine. N Engl J Med. 2019;381:2230-41. Lipton RB et coll. Effect of Ubrogepant vs Placebo on Pain and the Most Bothersome Associated Symptom in the Acute Treatment of Migraine: The ACHIEVE II Randomized Clinical Trial. JAMA. 2019;322:1887-98. Ailani J et coll. Long-Term Safety Evaluation of Ubrogepant for the Acute Treatment of Migraine: Phase 3, Randomized, 52-Week Extension Trial. Headache. 2020;60:141-52.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.Originally released: September 19, 2019In this week's clinical case, Dr. Mike Bradshaw (Chicago Medical School and Billings Clinic) walks us through the case of a young woman with HSV encephalitis. With a twist. SPOILER ALERT: If you don't want to know the answer, DON'T LOOK AT THE SHOWNOTES!Produced by James E Siegler and Mike Bradshaw. Music courtesy of Yan Terrien, Unheard Music Concepts, Steve Combs, and Montplaisir. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.REFERENCESArmangue T, Leypoldt F, Dalmau J. Autoimmune encephalitis as differential diagnosis of infectious encephalitis. Curr Opin Neurol 2014;27(3):361-8. PMID 24792345Armangue T, Leypoldt F, Málaga I, et al. Herpes simplex virus encephalitis is a trigger of brain autoimmunity. Ann Neurol 2014;75(2):317-23. PMID 24318406Armangue T, Spatola M, Vlagea A, et al. Frequency, symptoms, risk factors, and outcomes of autoimmune encephalitis after herpes simplex encephalitis: a prospective observational study and retrospective analysis. Lancet Neurol 2018;17(9):760-72. PMID 30049614Bacon TH, Boon RJ, Schultz M, Hodges-Savola C. Surveillance for antiviral-agent-resistant herpes simplex virus in the general population with recurrent herpes labialis. Antimicrob Agents Chemother 2002;46(9):3042-4. PMID 12183267Dubey D, Pittock SJ, Kelly CR, et al. Autoimmune encephalitis epidemiology and a comparison to infectious encephalitis. Ann Neurol 2018;83(1):166-77. PMID 29293273Gable MS, Sheriff H, Dalmau J, Tilley DH, Glaser CA. The frequency of autoimmune N-methyl-D-aspartate receptor encephalitis surpasses that of individual viral etiologies in young individuals enrolled in the California Encephalitis Project. Clin Infect Dis 2012;54(7):899-904. PMID 22281844Granerod J, Ambrose HE, Davies NW, et al. Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis 2010;10(12):835-44. PMID 20952256Linnoila JJ, Binnicker MJ, Majed M, Klein CJ, McKeon A. CSF herpes virus and autoantibody profiles in the evaluation of encephalitis. Neurol Neuroimmunol Neuroinflamm 2016;3(4):e245. PMID 27308306Prüss H, Finke C, Höltje M, et al. N-methyl-D-aspartate receptor antibodies in herpes simplex encephalitis. Ann Neurol 2012;72(6):902-11. PMID 23280840Steiner I, Budka H, Chaudhuri A, et al. Viral meningoencephalitis: a review of diagnostic methods and guidelines for management. Eur J Neurol 2010;17(8):999-e57. PMID 20236175Venkatesan A, Benavides DR. Autoimmune encephalitis and its relation to infection. Curr Neurol Neurosci Rep 2015;15(3):3. PMID 25637289We belie

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 18, 2017 In our first episode with neurology content, we will discuss my research interest in neurologic deterioration after stroke. Enjoy! BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. The case discussed in this episode is fictional and does not contain any patient health-identifying information. REFERENCES Balami JS, Chen RL, Grunwald IQ, Buchan AM. Neurological complications of acute ischaemic stroke. Lancet Neurol 2011;10(4):357-71. PMID 21247806 Kwan J, Hand P. Early neurological deterioration in acute stroke: clinical characteristics and impact on outcome. QJM 2006;99(9):625-33. PMID 16905751 Siegler JE, Boehme AK, Albright KC, et al. A proposal for the classification of etiologies of neurologic deterioration after acute ischemic stroke. J Stroke Cerebrovasc Dis 2013;22(8):e549-56. PMID 23867039 Thanvi B, Treadwell S, Robinson T. Early neurological deterioration in acute ischaemic stroke: predictors, mechanisms and management. Postgrad Med J 2008;84(994):412-7. PMID 18832401  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: May 14, 2020 Can you hear that too? You can't? Well, that doesn't mean I'm having auditory hallucinations. It could just be tinnitus, which describes the irritating sound of ringing, buzzing, clicking, or hissing that affects 10% to 20% of the world's population. But is this a ringing in the ears or a ringing in the brain? Produced by James E Siegler. Music courtesy of Andrew Sacco, Jon Watts, Kai Engel, Lovira, Patches, and Kevin McLeod. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Arenberg IK, Countryman LF, Bernstein LH, Shambaugh GE Jr. Van Gogh had Menière's disease and not epilepsy. JAMA 1990;264(4):491-3. PMID 2094236 Crummer RW, Hassan GA. Diagnostic approach to tinnitus. Am Fam Physician 2004;69(1):120-6. PMID 14727828 Dobie RA. A review of randomized clinical trials in tinnitus. Laryngoscope 1999;109(8):1202-11. PMID 10443820 Han BI, Lee HW, Kim TY, Lim JS, Shin KS. Tinnitus: characteristics, causes, mechanisms, and treatments. J Clin Neurol 2009;5(1):11-9. PMID 19513328 Langguth B, Kreuzer PM, Kleinjung T, De Ridder D. Tinnitus: causes and clinical management. Lancet Neurol 2013;12(9):920-30. PMID 23948178 Lockwood AH. Tinnitus. Neurol Clin 2005;23(3):893-900, viii. PMID 16026681 Lockwood AH, Salvi RJ, Burkard RF, Galantowicz PJ, Coad ML, Wack DS. Neuroanatomy of tinnitus. Scand Audiol Suppl 1999;51:47-52. PMID 10803913 Mattox DE, Hudgins P. Algorithm for evaluation of pulsatile tinnitus. Acta Otolaryngol 2008;128(4):427-31. PMID 18368578 Palomar García V, Abdulghani Martínez F, Bodet Agustí E, Andreu Mencía L, Palomar Asenjo V. Drug-induced otoxicity: current status. Acta Otolaryngol 2001;121(5):569-72. PMID 11583387 Sullivan M, Katon W, Russo J, Dobie R, Sakai C. A randomized trial of nortriptyline for severe chronic tinnitus. Effects on depression, disability, and tinnitus symptoms. Arch Intern Med 1993;153(19):2251-9. PMID 8215728  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date. 

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: March 21, 2019 Nobody is getting any younger, which is too bad. Muscle cramping...fatigue...stiffness... you'll be dealing with it more and more. “It's probably nothing,” you tell yourself. But what if it's not? Every once in a while, you might come across a case of myotonia. And you won't want to miss it. This week on BrainWaves, Dr. Noah Levinson provides a brief overview of myotonia and the conditions that are associated with it. Produced by James E Siegler. Music courtesy of Yshwa, Steve Combs, MMFFF, and Scott Holmes. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Miller TM. Differential diagnosis of myotonic disorders. Muscle Nerve 2008;37(3):293-9. PMID 18067134 Okkersen K, Jimenez-Moreno C, Wenninger S, et al. Cognitive behavioural therapy with optional graded exercise therapy in patients with severe fatigue with myotonic dystrophy type 1: a multicentre, single-blind, randomised trial. Lancet Neurol 2018;17(8):671-80. PMID 29934199 Sansone VA. The dystrophic and nondystrophic myotonias. Continuum (Minneap Minn) 2016;22(6, Muscle and Neuromuscular Junction Disorders):1889-1915. PMID 27922499 Thornton CA, Wang E, Carrell EM. Myotonic dystrophy: approach to therapy. Curr Opin Genet Dev 2017;44:135-40. PMID 28376341  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.Originally released: March 4, 2021As many as 1% of the world has epilepsy, but far more will have a seizure in their lifetime. Not everyone needs a seizure medication, some people are even harmed by them. So who warrants treatment, and what do you start with? Consider today's program an intro to antiepileptic drug decision-making. For educational purposes only, of course. Not to guide any healthcare provider's decision-making.Produced by James E Siegler. Music courtesy of Lee Rosevere, Cellophane Sam, Jon Watts, Josh Woodward, and Rafael Archangel. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.REFERENCESAnonymous. Randomized clinical trial on the efficacy of antiepileptic drugs in reducing the risk of relapse after a first unprovoked tonic-clonic seizure. First Seizure Trial Group (FIR.S.T. Group). Neurology 1993;43(3 Pt 1):478-83. PMID 8450987Bouma HK, Labos C, Gore GC, Wolfson C, Keezer MR. The diagnostic accuracy of routine electroencephalography after a first unprovoked seizure. Eur J Neurol 2016;23(3):455-63. PMID 26073548Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia 2014;55(4):475-82. PMID 24730690Fountain NB. Choosing among antiepileptic drugs. Continuum (Minneap Minn) 2010;16(3 Epilepsy):121-35. PMID 22810318Hauser WA, Rich SS, Annegers JF, Anderson VE. Seizure recurrence after a 1st unprovoked seizure: an extended follow-up. Neurology 1990;40(8):1163-70. PMID 2381523Hui AC, Tang A, Wong KS, Mok V, Kay R. Recurrence after a first untreated seizure in the Hong Kong Chinese population. Epilepsia 2001;42(1):94-7. PMID 11207791Koepp MJ, Woermann FG. Imaging structure and function in refractory focal epilepsy. Lancet Neurol 2005;4(1):42-53. PMID 15620856Krumholz A, Wiebe S, Gronseth GS, et al. Evidence-based guideline: management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2015;84(16):1705-13. PMID 25901057Leone MA, Giussani G, Nolan SJ, Marson AG, Beghi E. Immediate antiepileptic drug treatment, versus placebo, deferred, or no treatment for first unprovoked seizure. Cochrane Database Syst Rev 2016;2016(5):CD007144. Update in: Cochrane Database Syst Rev 2021;5:CD007144. PMID 27150433Manjunath R, Davis KL, Candrilli SD, Ettinger AB. Association of antiepileptic drug nonadherence with risk of seizures in adults with epilepsy. Epilepsy Behav 2009;14(2):372-8. PMID 19126436Marson A, J

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: September 13, 2018 In 2012, more than 13,000 Americans were inadvertently exposed to contaminated medical equipment, resulting in one of the largest fungal outbreaks in United States history. Despite rapid mobilization by the CDC and FDA, 751 patients died from complications of fungal brain infections. But this is more the exception than the rule when it comes to fungal infections of the central nervous system. This week on the BrainWaves podcast, we review the common (and uncommon) clinical, radiographic, and diagnostic features of fungal brain disease. Enjoy! Produced by James E Siegler. Music by Jahzzar, Swelling, The Insider, and Chris Zabriskie. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. REFERENCES Baddley JW, Salzman D, Pappas PG. Fungal brain abscess in transplant recipients: epidemiologic, microbiologic, and clinical features. Clin Transplant 2002;16(6):419-24. PMID 12437621 Benedict K, Park BJ. Invasive fungal infections after natural disasters. Emerg Infect Dis 2014;20(3):349-55. PMID 24565446 Brouwer MC, Tunkel AR, McKhann GM 2nd, van de Beek D. Brain abscess. N Engl J Med 2014;371(5):447-56. PMID 25075836 Kainer MA, Reagan DR, Nguyen DB, et al. Fungal infections associated with contaminated methylprednisolone in Tennessee. N Engl J Med 2012;367(23):2194-203. PMID 23131029 McCotter OZ, Smith RM, Westercamp M, et al. Update on multistate outbreak of fungal infections associated with contaminated methylprednisolone injections, 2012-2014. MMWR Morb Mortal Wkly Rep 2015;64(42):1200-1. PMID 26513534 Schwartz S, Kontoyiannis DP, Harrison T, Ruhnke M. Advances in the diagnosis and treatment of fungal infections of the CNS. Lancet Neurol 2018;17(4):362-72. PMID 29477506 Smith RM, Schaefer MK, Kainer MA, et al. Fungal infections associated with contaminated methylprednisolone injections. N Engl J Med 2013;369(17):1598-609. PMID 23252499 Wilson MR, O'Donovan BD, Gelfand Jmet al. Chronic meningitis investigated via metagenomic next-generation sequencing. JAMA Neurol 2018;75(8):947-55. PMID 29710329  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: May 28, 2020 Lewy body dementia may be the second most common neuropathologic cause of dementia behind Alzheimer disease, but it remains largely a clinical diagnosis with limited treatment options. This week on BrainWaves, Dr. Amy Colcher (Cooper University Hospital) reviews the diagnostic criteria and management strategies for patients and their caregivers who suffer from this condition. Plus, a sort of tribute to Robin Williams. Produced by James E Siegler and Amy Colcher. Music courtesy of Andrew Sacco, Axletree, Damiano Baldoni, Josh Woodward, and Julie Maxwell. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Armstrong MJ. Lewy body dementias. Continuum (Minneap Minn) 2019;25(1):128-46. PMID 30707190 Desmarais P, Massoud F, Filion J, Nguyen QD, Bajsarowicz P. Quetiapine for psychosis in Parkinson disease and neurodegenerative parkinsonian disorders: a systematic review. J Geriatr Psychiatry Neurol 2016;29(4):227-36. PMID 27056066 Frieling H, Hillemacher T, Ziegenbein M, Neundörfer B, Bleich S. Treating dopamimetic psychosis in Parkinson's disease: structured review and meta-analysis. Eur Neuropsychopharmacol 2007;17(3):165-71. PMID 17070675 Galvin JE, Duda JE, Kaufer DI, Lippa CF, Taylor A, Zarit SH. Lewy body dementia: the caregiver experience of clinical care. Parkinsonism Relat Disord 2010;16(6):388-92. PMID 20434939 Koga S, Aoki N, Uitti RJ, et al. When DLB, PD, and PSP masquerade as MSA: an autopsy study of 134 patients. Neurology 2015;85(5):404-12. PMID 26138942 McKeith IG, Boeve BF, Dickson DW, et al. Diagnosis and management of dementia with Lewy bodies: fourth consensus report of the DLB Consortium. Neurology 2017;89(1):88-100. PMID 28592453 McKeith IG. Spectrum of Parkinson's disease, Parkinson's dementia, and Lewy body dementia. Neurol Clin 2000;18(4):865-902. PMID 11072265 Stinton C, McKeith I, Taylor JP, et al. Pharmacological management of Lewy body dementia: a systematic review and meta-analysis. Am J Psychiatry 2015;172(8):731-42. PMID 26085043 Taylor JP, McKeith IG, Burn DJ, et al. New evidence on the management of Lewy body dementia. Lancet Neurol 2020;19(2):157-69. PMID 31519472  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 18, 2017 Posterior reversible encephalopathy syndrome: not always posterior, or reversible, or with associated encephalopathy. These and other clinical and neuroimaging factoids are reviewed in this week's edition of BrainWaves where we discuss the various--and often disparate--features of PRES. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health-identifying information. The content in this episode was vetted and approved by Amy Pruitt. REFERENCES Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am J Neuroradiol 2008;29(6):1036-42. PMID 18356474 Bartynski WS. Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema. AJNR Am J Neuroradiol 2008;29(6):1043-9. PMID 18403560 Casey SO, Sampaio RC, Michel E, Truwit CL. Posterior reversible encephalopathy syndrome: utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical and subcortical lesions. AJNR Am J Neuroradiol 2000;21(7):1199-206. PMID 10954269 Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol 2015;14(9):914-25. Erratum in: Lancet Neurol 2015;14(9):874. PMID 26184985 Hefzy HM, Bartynski WS, Boardman JF, Lacomis D. Hemorrhage in posterior reversible encephalopathy syndrome: imaging and clinical features. AJNR Am J Neuroradiol 2009;30(7):1371-9. PMID 19386731 Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334(8):494-500. PMID 8559202  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.Originally released: April 4, 2019A low-salt diet can reduce your risk of hypertension. A low-carb diet can reduce your risk of diabetes. But is there a diet out there, which can lower your risk of neurologic disease? Specifically, dementia? The answer is...maybe? This week on the program we work our way up the food chain describing the vital micronutrients, food groups, and fad diets out there that may promote brain health--and could even lower your risk of dementia. Sit back, grab some blueberries, and enjoy!Produced by James E Siegler. Music courtesy of Axeltree, Chris Zabriskie, John Pazdan, Josh Woodward, Kevin McLeod, and Pachyderm. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.REFERENCESDevore EE, Kang JH, Breteler MM, Grodstein F. Dietary intakes of berries and flavonoids in relation to cognitive decline. Ann Neurol 2012;72(1):135-43. PMID 22535616Kennedy DO, Wightman EL, Reay JL, et al. Effects of resveratrol on cerebral blood flow variables and cognitive performance in humans: a double-blind, placebo-controlled, crossover investigation. Am J Clin Nutr 2010;91(6):1590-7. PMID 20357044Lefèvre-Arbogast S, Gaudout D, Bensalem J, et al. Pattern of polyphenol intake and the long-term risk of dementia in older persons. Neurology 2018;90(22):e1979-88. PMID 29703769Liu QP, Wu YF, Cheng HY, et al. Habitual coffee consumption and risk of cognitive decline/dementia: a systematic review and meta-analysis of prospective cohort studies. Nutrition 2016;32(6):628-36. PMID 26944757Miller MG, Hamilton DA, Joseph JA, Shukitt-Hale B. Dietary blueberry improves cognition among older adults in a randomized, double-blind, placebo-controlled trial. Eur J Nutr 2018;57(3):1169-80. PMID 28283823Morris MC, Tangney CC, Wang Y, et al. MIND diet slows cognitive decline with aging. Alzheimers Dement 2015;11(9):1015-22. PMID 26086182Newman JC, Covarrubias AJ, Zhao M, et al. Ketogenic diet reduces midlife mortality and improves memory in aging mice. Cell Metab 2017;26(3):547-57. PMID 28877458Norton S, Matthews FE, Barnes DE, Yaffe K, Brayne C. Potential for primary prevention of Alzheimer's disease: an analysis of population-based data. Lancet Neurol 2014;13(8):788-94. Erratum in: Lancet Neurol 2014;13(11):1070. PMID 25030513Okkersen K, Jimenez-Moreno C, Wenninger S, et al. Cognitive behavioural therapy with optional graded exercise therapy in patients with severe fatigue with myotonic dystrophy type 1: a multicentre, single-blind, randomised trial. Lancet Neurol 2018;17(8):671-80. PMID 29934199Radd-Vagenas S, Duffy SL, Naismith SL, Brew BJ, Flood VM, Fiatarone Singh MA. Effect of the Mediterranean diet on cognition and brain morphology and function: a systematic review of randomized contro

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: January 23, 2020 In a patient with isolated, progressive hand numbness and weakness, there is much to be learned about the clinical exam. Often, it's all you need. Dr. Aakriti Kothiwal of Cooper University Hospital presents this week's clinical case and helps localize the lesion. Produced by James E Siegler and Aakriti Kothiwal. Music courtesy of Jazzar, Lee Rosevere, and Loyalty Freak Music. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Aamodt WW, Siegler JE, Elman L. Teaching Neuro Images: acute infarction of the left medial lemniscus masquerading as a peripheral neuropathy. Neurology 2017;88(17):e178. PMID 28438850 Bouche P. Compression and entrapment neuropathies. Handb Clin Neurol 2013;115:311-66. PMID 23931789 Gross PT, Jones HR Jr. Proximal median neuropathies: electromyographic and clinical correlation. Muscle Nerve 1992;15(3):390-5. PMID 1313546 Gross PT, Tolomeo EA. Proximal median neuropathies. Neurol Clin 1999;17(3):425-45, v. PMID 10393747 Hobson-Webb LD, Juel VC. Common entrapment neuropathies. Continuum (Minneap Minn) 2017;23(2, Selected Topics in Outpatient Neurology):487-511. PMID 28375915 Padua L, Coraci D, Erra C, et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol 2016;15(12):1273-84. PMID 27751557 Peters N, Müller-Schunk S, Freilinger T, Düring M, Pfefferkorn T, Dichgans M. Ischemic stroke of the cortical "hand knob" area: stroke mechanisms and prognosis. J Neurol 2009;256(7):1146-51. PMID 19353229  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 11, 2019 In this week's Teaching through Clinical Cases, Dr. Olga Rosenveld Thon (Drexel) walks us through the challenging management decisions that emerge in the care of women with demyelinating disease. Why are women prone to multiple sclerosis? How do pregnancy, breastfeeding, and menopause influence the disease course--and should these events alter the course of their therapy? Produced by James E Siegler and Olga Thon. Music courtesy of Cellophane Sam, Chris Zabriskie, Jon Watts, Kai Engel, and Lee Rosevere. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. DISCLOSURESDr. Rosenveld Thon reports relevant financial interests in Ocrevus, as a consultant. REFERENCESBove R, Chitnis T, Houtchens M. Menopause in multiple sclerosis: therapeutic considerations. J Neurol 2014;261(7):1257-68. PMID 24101131 Bove R, Chitnis T. The role of gender and sex hormones in determining the onset and outcome of multiple sclerosis. Mult Scler 2014;20(5):520-6. PMID 24561324 Bove R. Women's issues in multiple sclerosis. Semin Neurol 2016;36(2):154-62. PMID 27116722 Confavreux C, Hutchinson M, Hours MM, Cortinovis-Tourniaire P, Moreau T. Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in Multiple Sclerosis Group. N Engl J Med 1998;339(5):285-91. PMID 9682040 Correale J, Farez MF, Ysrraelit MC. Increase in multiple sclerosis activity after assisted reproduction technology. Ann Neurol 2012;72(5):682-94. PMID 23034952 Michel L, Foucher Y, Vukusic S, et al. Increased risk of multiple sclerosis relapse after in vitro fertilisation. J Neurol Neurosurg Psychiatry 2012;83(8):796-802. PMID 22693287 Nielsen NM, Westergaard T, Rostgaard K, et al. Familial risk of multiple sclerosis: a nationwide cohort study. Am J Epidemiol 2005;162(8):774-8. PMID 16120694 Ramagopalan SV, Dobson R, Meier UC, Giovannoni G. Multiple sclerosis: risk factors, prodromes, and potential causal pathways. Lancet Neurol 2010;9(7):727-39. PMID 20610348 Rankin K, Bove R. Caring for women with multiple sclerosis across the lifespan. Curr Neurol Neurosci Rep 2018;18(7):36. PMID 29789964  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

If you haven't thought about copper in a while, you're overdue! Wilson's Disease is one of the rare conditions with nutrition implications. The condition impacts how the body processes copper. Join Sara and Lyndel to dust off nutrition recommendations for this not-too-common condition. Show Notes: Bandmann O, Weiss KH, Kaler SG. Wilson's disease and other neurological copper disorders. Lancet Neurol. 2015;14(1):103-113. Brewer GJ. Wilson disease. NORD website. Accessed October 10, 2022: https://bit.ly/2G7drf8 Low copper diet for Wilson's disease. GI Resources website. Accessed October 10, 2022: https://bit.ly/3G37YCp Teufel-Schäfer U, Forster C, Schaefer N. Low copper diet—a therapeutic treatment option for Wilson's Disease? Children. 2022;9(8):1132.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 18, 2017 The human body only has enough thiamine to last 2-3 weeks, so what happens when we run out? In this BrainWaves brief, we review the consequences of acute thiamine deficiency on the nervous system. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health-identifying information. The content in this episode was approved and vetted by Michael Rubenstein. REFERENCES Caine D, Halliday GM, Kril JJ, Harper CG. Operational criteria for the classification of chronic alcoholics: identification of Wernicke's encephalopathy. J Neurol Neurosurg Psychiatry 1997;62(1):51-60. PMID 9010400Galvin R, Bråthen G, Ivashynka A, et al. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol 2010;17(12):1408-18. PMID 20642790Sechi G, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol 2007;6(5):442-55. PMID 17434099Zuccoli G, Pipitone N. Neuroimaging findings in acute Wernicke's encephalopathy: review of the literature. AJR Am J Roentgenol 2009;192(2):501-8. PMID 19155417We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date. 

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: January 17, 2019 For such a thrilling time in a woman's life, pregnancy can be a frightening experience for some. As a physician, I'm always a little more on edge when dealing with these patients. This week on BrainWaves, Dr. Jonathan Edlow (Emergency Medicine) of Beth Israel Deaconness Medical Center shares his experience in treating neuromedical complications in this unique patient population. Produced by Jonathan Edlow and James E Siegler. Music by Daniel Birch, Ian Southerland, Kevin McLeod, and John Bartmann. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @BrainWavesaudio for the latest updates to the podcast. REFERENCES Chen MM, Coakley FV, Kaimal A, Laros RK Jr. Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstet Gynecol 2008;112(2 Pt 1):333-40. PMID 18669732Edlow AG, Edlow BL, Edlow JA. Diagnosis of acute neurologic emergencies in pregnant and postpartum women. Emerg Med Clin North Am 2016;34(4):943-65. PMID 27741996Edlow JA, Caplan LR, O'Brien K, Tibbles CD. Diagnosis of acute neurological emergencies in pregnant and post-partum women. Lancet Neurol 2013;12(2):175-85. PMID 23332362Kranick SM, Mowry EM, Colcher A, Horn S, Golbe LI. Movement disorders and pregnancy: a review of the literature. Mov Disord 2010;25(6):665-71. PMID 20437535Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL. Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA 2016;316(9):952-61. PMID 27599330We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: January 28, 2021 To quote Donald Rumsfeld, “there are things we know we know…. we know there are some things we do not know... But there are also unknown unknowns—the ones we don't know we don't know…it is the latter category that tends to be the difficult ones.” In neurology, the agnosias are not that dissimilar from Rumsfeld's 'unknown unknowns.' In this week's program, we discuss the nosology and nomenclature for the agnosias, the localization, and the importance of recognizing one. Produced by James E Siegler. Music courtesy of Dr. Turtle, Grossman, Ewell and Grainger, Marco Trovatelli, and Purple Planet Music. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @BrainWavesaudio for the latest updates to the podcast. REFERENCES Biran I, Coslett HB. Visual agnosia. Curr Neurol Neurosci Rep 2003;3(6):508-12. PMID 14565906Coslett HB. Apraxia, neglect, and agnosia. Continuum (Minneap Minn) 2018;24(3, Behavioral Neurology And Psychiatry):768-82. PMID 29851877Dhont S, Derom E, Van Braeckel E, Depuydt P, Lambrecht BN. The pathophysiology of 'happy' hypoxemia in COVID-19. Respir Res 2020;21(1):198. PMID 32723327Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol 2020;92(6):552-55. PMID 32104915Matschke J, Lütgehetmann M, Hagel C, et al. Neuropathology of patients with COVID-19 in Germany: a post-mortem case series. Lancet Neurol 2020;19(11):919-29. PMID 33031735Milner AD, Perrett DI, Johnston RS, et al. Perception and action in 'visual form agnosia'. Brain 1991;114 (Pt 1B):405-28. PMID 2004249Zeki S, Ffytche DH. The Riddoch syndrome: insights into the neurobiology of conscious vision. Brain 1998;121 ( Pt 1):25-45. PMID 9549486We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 27, 2017 The first seizure of life is a common presentation requiring a neurology consultation. In this episode, Dr. Brian Hanrahan of the University of Pittsburgh Medical Center, discusses his approach to counseling an adult patient with a first-ever seizure, with a particular emphasis on driving safety.  Produced by James E Siegler. Music by Axletree, Josh Woodward, and Kevin McLeod. Voiceover by Emma Smrstik. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Think responsibly. Podcasts are no excuse NOT to treat a patient who is seizing. REFERENCES Deutschman CS, Haines SJ. Anticonvulsant prophylaxis in neurological surgery. Neurosurgery.1985;17(3):510-7. PMID 2864654Hemphill JC, Greenberg SM, Anderson CS, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015;46(7):2032-60. PMID 26022637Krumholz A. Driving issues in epilepsy: past, present, and future. Epilepsy Curr 2009;9(2):31-5. PMID 19421374Krumholz A, Shinnar S, French J, Gronseth G, Wiebe S. Evidence-based guideline: management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2015;85(17):1526-7. PMID 26503589Maganti RK, Rutecki P. EEG and epilepsy monitoring. Continuum (Minneap Minn) 2013;19(3 Epilepsy):598-622. PMID 23739100Richards KC. Patient page. The risk of fatal car crashes in people with epilepsy. Neurology 2004;63(6):E12-3. PMID 15452331Smith SJ. EEG in the diagnosis, classification, and management of patients with epilepsy. J Neurol Neurosurg Psychiatry 2005;76 Suppl 2(Suppl 2):ii2-7. PMID 15961864Sofat P, Teter B, Kavak KS, Gupta R, Li P. Time interval providing highest yield for initial EEG in patients with new onset seizures. Epilepsy Res 2016;127:229-32. PMID 27639127Temkin NR, Dikmen SS, Wilensky AJ, Keihm J, Chabal S, Winn HR. A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures. N Engl J Med 1990;323(8):497-502. PMID 2115976Thompson K, Pohlmann-Eden B, Campbell LA, Abel H. Pharmacological treatments for preventing epilepsy following traumatic head injury. Cochrane Database Syst Rev 2015;2015(8):CD009900. PMID 26259048van Breemen MS, Wilms EB, Vecht CJ. Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. Lancet Neurol 2007;6(5):421-30. PMID 17434097 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released July 18, 2017 Dr. Pouya Khankhanian describes his experience with "worst headache of life." A harbinger of head pathology, thunderclap headache should be quickly and meticulously addressed in order to prevent life-threatening neurologic disease. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health-identifying information. The content in this episode was vetted and approved by Roderick Spears. REFERENCESEdlow JA, Caplan LR. Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage. N Engl J Med. 2000 Jan 6;342(1):29-36. doi: 10.1056/NEJM200001063420106. PMID 10620647Linn FH, Wijdicks EF, van der Graaf Y, Weerdesteyn-van Vliet FA, Bartelds AI, van Gijn J. Prospective study of sentinel headache in aneurysmal subarachnoid haemorrhage. Lancet 1994;344(8922):590-3. PMID 7914965Misra UK, Kalita J, Chandra S, Kumar B, Bansal V. Low molecular weight heparin versus unfractionated heparin in cerebral venous sinus thrombosis: a randomized controlled trial. Eur J Neurol 2012;19(7):1030-6. PMID 22416902Muehlschlegel S, Kursun O, Topcuoglu MA, Fok J, Singhal AB. Differentiating reversible cerebral vasoconstriction syndrome with subarachnoid hemorrhage from other causes of subarachnoid hemorrhage. JAMA Neurol 2013;70(10):1254-60. PMID 23939614Sames TA, Storrow AB, Finkelstein JA, Magoon MR. Sensitivity of new-generation computed tomography in subarachnoid hemorrhage. Acad Emerg Med 1996;3(1):16-20. PMID 8749962Schwedt TJ, Matharu MS, Dodick DW. Thunderclap headache. Lancet Neurol 2006;5(7):621-31. PMID 16781992van der Wee N, Rinkel GJ, Hasan D, van Gijn J. Detection of subarachnoid haemorrhage on early CT: is lumbar puncture still needed after a negative scan? J Neurol Neurosurg Psychiatry 1995;58(3):357-9. PMID 7897421Vergouwen MD, Rinkel GJ. Clinical suspicion of subarachnoid hemorrhage and negative head computed tomographic scan performed within 6 hours of headache onset--no need for lumbar puncture. Ann Emerg Med 2013;61(4):503-4. PMID 23522819Vermeulen M, Hasan D, Blijenberg BG, Hijdra A, van Gijn J. Xanthochromia after subarachnoid haemorrhage needs no revisitation. J Neurol Neurosurg Psychiatry 1989;52(7):826-8. PMID 2769274We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date. 

About our Guest:Dr. Bortcosh is an Assistant Professor in the Division of Pediatric Critical Care and a practicing pediatric intensivist at the University of Florida. How to support PedsCrit:Please share, like, rate and review on Apple Podcasts or Spotify!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Objectives for this series:The participant will be able to discuss unique physiology of the neuromuscular patient and how it relates to work of breathingThe participant will be able to define obstacles to effective ventilation in patients with neuromuscular diseaseThe participant will be able to describe ventilation strategies to utilize in patients with neuromuscular diseaseFor a deeper dive on Disability Studies, check out Alice Wong's Disability Visibility Podcast: https://podcasts.apple.com/us/podcast/disability-visibility/id1282878324References1.Bushby K, Finkel R, Birnkrant DJ, Case LE, Clemens PR, Cripe L, et al. Diagnosis and management of Duchenne muscular dystrophy, part 2: implementation of multidisciplinary care. Lancet Neurol. 2010;9(2):177-89.2.Mercuri E, Finkel RS, Muntoni F, Wirth B, Montes J, Main M, et al. Diagnosis and management of spinal muscular atrophy: Part 1: Recommendations for diagnosis, rehabilitation, orthopedic and nutritional care. Neuromuscul Disord. 2018;28(2):103-15.3.Finkel RS, Mercuri E, Meyer OH, Simonds AK, Schroth MK, Graham RJ, et al. Diagnosis and management of spinal muscular atrophy: Part 2: Pulmonary and acute care; medications, supplements and immunizations; other organ systems; and ethics. Neuromuscul Disord. 2018;28(3):197-207.4.Marino PL SK. The ICU Book. Wilkins LW, editor. Philadelphia: Lippincott Williams & Wilkins; 2007.5.Machado DL, Silva EC, Resende MB, Carvalho CR, Zanoteli E, Reed UC. Lung function monitoring in patients with duchenne muscular dystrophy on steroid therapy. BMC Res Notes. 2012;5:435.6.Wheeler DS, Wong HR, Zingarelli B. Pediatric Sepsis - Part I: "Children are not small adults!". Open Inflamm J. 2011;4:4-15.7.Lo Mauro A, Aliverti A. Physiology of respiratory disturbances in muscular dystrophies. Breathe (Sheff). 2016;12(4):318-27.8.Diaz CE, Deoras KS, Allen JL. Chest wall motion before and during mechanical ventilation in children with neuromuscular disease. Pediatr Pulmonol. 1993;16(2):89-95.9.Perez A, Mulot R, Vardon G, Barois A, Gallego J. Thoracoabdominal pattern of breathing in neuromuscular disorders. Chest. 1996;110(2):454-61.10.Testa MB, Pavone M, Bertini E, Petrone A, Pagani M, Cutrera R. Sleep-disordered breathing in spinal muscular atrophy types 1 and 2. Am J Phys Med Rehabil. 2005;84(9):666-70.11.Aboussouan LS. Sleep-disordered Breathing in Neuromuscular Disease. Am J Respir Crit Care Med. 2015;191(9):979-89.12.Hull J, Aniapravan R, Chan E, Chatwin M, Forton J, Gallagher J, et al. British Thoracic Society guideline for respiratory management of children with neuromuscular weakness. Thorax. 2012;67 Suppl 1:i1-40.13.Mayer O PH, Rhodes H, Dominick C, Wolfe H,  Martin K, Craig N,  Waxler M. . PICU Pathway for SMA Patient Admitted with Acute Respiratory Failure https://www.chop.edu/clinical-pathway/spinal-muscular-atrophy-sma-acute-respiratory-failure-clinical-pathway201914.Petrone A, Pavone M, Testa MB, Petreschi F, Bertini E, Cutrera R. Noninvasive ventilation in children with spinal muscular atrophy types 1 and 2. Am J Phys Med Rehabil. 2007;86(3)Support the show

Ventilation of the Neuromuscular Patient with Dr. Bill Bortcosh--Part 1: physiology and noninvasive ventilationAbout our Guest:Dr. Bortcosh is an Assistant Professor in the Division of Pediatric Critical Care and a practicing pediatric intensivist at the University of Florida. How to support PedsCrit:Please share, like, rate and review on Apple Podcasts or Spotify!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Objectives for this series:The participant will be able to discuss unique physiology of the neuromuscular patient and how it relates to work of breathingThe participant will be able to define obstacles to effective ventilation in patients with neuromuscular diseaseThe participant will be able to describe ventilation strategies to utilize in patients with neuromuscular diseaseReferences1.Bushby K, Finkel R, Birnkrant DJ, Case LE, Clemens PR, Cripe L, et al. Diagnosis and management of Duchenne muscular dystrophy, part 2: implementation of multidisciplinary care. Lancet Neurol. 2010;9(2):177-89.2.Mercuri E, Finkel RS, Muntoni F, Wirth B, Montes J, Main M, et al. Diagnosis and management of spinal muscular atrophy: Part 1: Recommendations for diagnosis, rehabilitation, orthopedic and nutritional care. Neuromuscul Disord. 2018;28(2):103-15.3.Finkel RS, Mercuri E, Meyer OH, Simonds AK, Schroth MK, Graham RJ, et al. Diagnosis and management of spinal muscular atrophy: Part 2: Pulmonary and acute care; medications, supplements and immunizations; other organ systems; and ethics. Neuromuscul Disord. 2018;28(3):197-207.4.Marino PL SK. The ICU Book. Wilkins LW, editor. Philadelphia: Lippincott Williams & Wilkins; 2007.5.Machado DL, Silva EC, Resende MB, Carvalho CR, Zanoteli E, Reed UC. Lung function monitoring in patients with duchenne muscular dystrophy on steroid therapy. BMC Res Notes. 2012;5:435.6.Wheeler DS, Wong HR, Zingarelli B. Pediatric Sepsis - Part I: "Children are not small adults!". Open Inflamm J. 2011;4:4-15.7.Lo Mauro A, Aliverti A. Physiology of respiratory disturbances in muscular dystrophies. Breathe (Sheff). 2016;12(4):318-27.8.Diaz CE, Deoras KS, Allen JL. Chest wall motion before and during mechanical ventilation in children with neuromuscular disease. Pediatr Pulmonol. 1993;16(2):89-95.9.Perez A, Mulot R, Vardon G, Barois A, Gallego J. Thoracoabdominal pattern of breathing in neuromuscular disorders. Chest. 1996;110(2):454-61.10.Testa MB, Pavone M, Bertini E, Petrone A, Pagani M, Cutrera R. Sleep-disordered breathing in spinal muscular atrophy types 1 and 2. Am J Phys Med Rehabil. 2005;84(9):666-70.11.Aboussouan LS. Sleep-disordered Breathing in Neuromuscular Disease. Am J Respir Crit Care Med. 2015;191(9):979-89.12.Hull J, Aniapravan R, Chan E, Chatwin M, Forton J, Gallagher J, et al. British Thoracic Society guideline for respiratory management of children with neuromuscular weakness. Thorax. 2012;67 Suppl 1:i1-40.13.Mayer O PH, Rhodes H, Dominick C, Wolfe H,  Martin K, Craig N,  Waxler M. . PICU Pathway for SMA Patient Admitted with Acute Respiratory Failure https://www.chop.edu/clinical-pathway/spinal-muscular-atrophy-sma-acute-respiratory-failure-clinical-pathway2019 [updated Feb 2019.]14.Petrone A, Pavone M, Testa MB, Petreschi F, Bertini E, Cutrera R. Noninvasive ventilation in children with spinal muscular atrophy types 1 and 2. Am J Phys Med Rehabil. 2007;86(3):216-21.Support the show

Dr. David Perlmutter is a Board-Certified Neurologist and five-time New York Times bestselling author. His books have been published in 32 languages and include the #1 New York Times bestseller Grain Brain, The Surprising Truth About Wheat, Carbs, and Sugar, with over 1 million copies in print. Other New York Times bestsellers include Brain Maker, The Grain Brain Cookbook, The Grain Brain Whole Life Plan, and Brain Wash, co-written with Austin Perlmutter, M.D. He serves on the Board of Directors and is a Fellow of the American College of Nutrition.  His latest book, Drop Acid, focuses on the pivotal role of uric acid in metabolic diseases and will be published on February 15, 2022. Join us as we explore:The direct relationship of uric acid's relationship to “metabolic mayhem” includes diabetes, obesity, heart disease, and even neurological diseases The reason sugar's role in metabolic diseases was long hidden – spoiler its corruption and politicsThat metabolic issues like obesity are not aesthetic issues, they are “life-threatening” That health is about epigenetics NOT geneticsA uric acid master-class – what it is, what's the optimal range, what you can do to improve your uric acid levelDr Perlmutter's specially formulated LUV program to reduce uric acid levelsIncredible practical advice for those “letting your hair down days” and a final inspiring message all of you need to hear! "Schedule a 15 min discovery call with me (it's entirely free) and let's get started on your journey to thriving: https://bit.ly/3BcTsFw" CONTACT:Website - https://www.drperlmutter.comMENTIONS:Study - Kanbay M, Jensen T, Solak Y, Le M, Roncal-Jimenez C, Rivard C, Lanaspa MA, Nakagawa T, Johnson RJ. Uric acid in metabolic syndrome: From an innocent bystander to a central player. Eur J Intern Med. 2016 Apr;29:3-8. doi: 10.1016/j.ejim.2015.11.026. Epub 2015 Dec 15. PMID: 26703429; PMCID: PMC4826346.Letter – “The Bitter Truth of USDA's Sugar Guidelines – President Biden need to ‘follow the science' and act now”. 19.02.2021. https://www.medpagetoday.com/primarycare/dietnutrition/91281Study - Kamei K, Konta T, Ichikawa K, Sato H, Suzuki N, Kabasawa A, Suzuki K, Hirayama A, Shibata Y, Watanabe T, Kato T, Ueno Y, Kayama T, Kubota I. Serum uric acid levels and mortality in the Japanese population: the Yamagata (Takahata) study. Clin Exp Nephrol. 2016 Dec;20(6):904-909. doi: 10.1007/s10157-016-1228-1. Epub 2016 Jan 16. PMID: 26779905.Study - Hadjivassiliou M, Sanders DS, Grünewald RA, Woodroofe N, Boscolo S, Aeschlimann D. Gluten sensitivity: from gut to brain. Lancet Neurol. 2010 Mar;9(3):318-30. doi: 10.1016/S1474-4422(09)70290-X. PMID: 20170845.Dr. Steven Gundry - Your Definitive Guide to Lectins (what are lectins and how to shield yourself from lectins). https://drgundry.com/lectin-guide/SUPPORT THE SHOW ON PATREON:As much as we love doing it, there are costs involved and any contribution will allow us to keep going and keep finding the best guests in the world to share their health expertise with you. I'd be grateful and feel so blessed by your support: https://www.patreon.com/MadeToThriveShowCONTACT Steve Stavs and join our community:Made to Thrive - Facebook: https://www.facebook.com/MadeToThriveZA/     Steve Stavs - Facebook: https://www.facebook.com/SteveStavsZA/Steve Stavs - Instagram: https://www.instagram.com/stevestavsza/  To make it easier for you to engage with me, send me a WhatsApp to +27 64 871 0308. This is not a group, but a private direct line. I would love to hear your feedback, answer your questions, and walk a health journey with you. Thanks!

Joanne apresenta um caso de AVC Hemorrágico para o Kaue e José Marcos, com um foco mais em abordagem, falamos um pouco sobre manifestações clínicas, etiologias, qual imagem pedir para o diagnóstico e como manejar. Tem interesse em ser nosso estagiário? Inscreva-se aqui: http://gg.gg/estagiotdc Referências: 1. Hemphill JC 3rd, Greenberg SM, Anderson CS, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2015; 46:2032. 2. Gross BA, Jankowitz BT, Friedlander RM. Cerebral Intraparenchymal Hemorrhage: A Review. JAMA 2019; 321:1295. 3. Baharoglu MI, Cordonnier C, Al-Shahi Salman R, et al. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Lancet 2016; 387:2605. 4. Brott T, Broderick J, Kothari R, et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 1997; 28:1. 5. Manning L, Hirakawa Y, Arima H, et al. Blood pressure variability and outcome after acute intracerebral haemorrhage: a post-hoc analysis of INTERACT2, a randomised controlled trial. Lancet Neurol 2014; 13:364. 6. Qureshi AI, Palesch YY, Foster LD, et al. Blood Pressure-Attained Analysis of ATACH 2 Trial. Stroke 2018; 49:1412. 7. Cordonnier C, Demchuk A, Ziai W, Anderson CS. Intracerebral haemorrhage: current approaches to acute management. Lancet 2018; 392:1257. 8. Kuramatsu JB, Biffi A, Gerner ST, et al. Association of Surgical Hematoma Evacuation vs Conservative Treatment With Functional Outcome in Patients With Cerebellar Intracerebral Hemorrhage. JAMA 2019; 322:1392. 9. Hanley DF, Thompson RE, Rosenblum M, et al. Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial. Lancet 2019; 393:1021. 10. Mendelow AD, Gregson BA, Rowan EN, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet 2013; 382:397.

Brought to US Healthcare professionals by Acorda Therapeutics  Dr. Ron Pfeiffer, Professor, Department of Neurology, Oregon Health & Science University, discusses gastrointestinal complications in patients with Parkinson's disease.     Brudek T, et al. J Parkinsons Dis. 2019;9(s2):S331-S344., Camci G, et al. J clin neurol. 2016;12(2):147-150., Chaing HL, et al. J Mov Disord. 2019;12(2):67-83., Chandra R, et al. JCI Insight. 2017;2(12)., Chou KL, et al. Parkinsonism Relat Disord. 2018;51:9-16., Deleu D, et al. Clin Pharmacokinet.  2002;41(4):261-309., Dutta SK, et al. J Neurogastroenterol Motil. 2019;25(3):363-376., Fasano A, et al. Lancet Neurol. 2015;14(6):625-639., Goetze O, et al. Neurogastroenterol Motil. 2006;18(5):369-375., Keshavarzian A, et al. Prog Brain Res. 2020;252:357-450., Killinger B, et al. J Parkinsons Dis 2019;  9(Suppl 2): S345–S358., Liddle RA, et al. Brain Res. 2018;1693(Pt B):201-206., Maini Rekdal V, et al. Science. 2019;364(6445)., Marsden CD, et al. Lancet. 1976;1(7954):292-296., McGee DJ, et al. J Parkinsons Dis. 2018;8(3):367-374., Miraglia F, et al. Cells. 2019;8(3)., Nyholm D, et al. Opin Drug Metab Toxicol. 2008;4(2):193-203., Pfeiffer RF, et al. Parkinsonism Relat Disord. 2020;S1353- 8020(20)30110-3., Pfeiffer RF, et al. Curr Treat Options Neurol. 2018;20(12):54., Rietdijk CD, et al. Front Neurol. 2017;8(37)., Safirstein BE, et al. Clin Ther. 2020;42(6):1034-1046., Svensson E, et al. Mov Disord. 2016;31(12):1918-1922., Unger MM, et al. Parkinsonism Relat Disord. 2016;32:66-72.  

Welcome to the NeurologyLive Mind Moments podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice. In this episode, we spoke with Scott D. Newsome, DO, president, Consortium of Multiple Sclerosis Centers (CMSC), director, Neurosciences Consultation and Infusion Center at Green Spring Station, and associate professor of neurology, Johns Hopkins Medicine; and David Li, MD, FRCPC, professor of radiology, associate member in neurology, and director, Multiple Sclerosis/MRI Research Group, University of British Columbia. The pair spoke about the recent consensus guidelines that were published and developed by the Magnetic Resonance Imaging in Multiple Sclerosis study group; the CMSC working group; and the North America Imaging in Multiple Sclerosis MRI Guidelines working group, in partnership, that marked a massive undertaking in the field of MS care. Thanks for listening to the NeurologyLive Mind Moments podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com. To learn more about the process behind developing these international guidelines, watch our NeurologyLive Peer Exchange: “Updates to the MRI Protocol and Clinical Guidelines for MS: CMSC Working Group.” REFERENCE Wattjes MP, Ciccarelli O, Reich DS, et al; on behalf of the Magnetic Resonance Imaging in Multiple Sclerosis study group, the Consortium of Multiple Sclerosis Centers, and North American Imaging in Multiple Sclerosis Cooperative MRI guidelines working group. 2021 MAGNIMS-CMSC-NAIMS consensus recommendations on the use of MRI in patients with multiple sclerosis. Lancet Neurol. Published online June 14, 2021. doi: 10.1016/S1474-4422(21)00095-8

Professor Chris Imray is a consultant vascular, renal transplant and trauma surgery at the University Hospitals Coventry & Warwickshire NHS Trust in Coventry, UK. He is also an Honorary Professor at Warwick Medical School, Coventry and Exeter Universities and immediate Past President of the Vascular Society of Great Britain and Ireland. Professor Imray has combined his love of mountaineering with clinical vascular surgery - he is involved in a number of polar medicine societies and is a world expert on the management of frostbite and non-freezing cold injuries. He has conducted research into hypoxia and ischemia at altitude and has published extensively. His personal accomplishments include a wide range of expeditions across the globe, from the sea cliffs of the Outer Hebrides in Scotland to the volcanoes of Chile and, most notably, to the summit of Everest. Useful links: Selected papers about altitude / extreme medicine: Femoral stabs at 8400m with the lowest recorded ABGs: Grocott et al. Arterial blood gases and oxygen content in climbers on Mount Everest. N Engl J Med. 2009 Jan 8;360(2):140-9. Transcranial Doppler at 8000m, with novel insights: Wilson et al Cerebral artery dilatation maintains cerebral oxygenation at extreme altitude and in acute hypoxia--an ultrasound and MRI study. J Cereb Blood Flow Metab. 2011 Oct;31(10):2019-29. Novel insights from Everest (8000m) confirmed: Sagoo et al. The use of MR to investigate the potential mechanisms involved in the development of high altitude cerebral oedema. J Cereb Blood Flow Metab. 2016 Jan 8. pii Wilson et al.  The cerebral venous system and anatomical predisposition to high altitude headache. Annals of Neurology 2013 Wilson and Imray. The Cerebral Venous System and Hypoxia. J Appl Physiol. 2015 Aug 20:jap.00327.2015. The effect of altitude on the brain: Wilson et al.  The cerebral effects of ascent to high altitudes. Lancet Neurol. 2009 Feb;8(2):175-91. Women are at least as strong as men on hyper-endurance events: Hattersley et al.  A comparison of the metabolic effects of sustained strenuous activity in polar environments on men and women. Sci Rep. 2020 Aug 17;10(1):13912. Evidence-based guidelines on the management of frostbite: McIntosh et al. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Frostbite: 2019 Update. Wilderness Environ Med. 2019 Jul 17. pii: S1080-6032(19)30097-3. Handford et al. Frostbite: a practical approach to hospital management. Extrem Physiol Med. 2014 Apr 22;3:7. Collaborative teamwork gives the best results: Fisher et al. Pedicled Abdominal Flaps for Enhanced Digital Salvage After Severe Frostbite Injury. Wilderness Environ Med. 2019 Mar;30(1):59-62. Other useful resources Information on the management of frostbite:  https://www.thebmc.co.uk/how-to-get-expert-frostbite-advice Oxford Handbook of Wilderness and Expedition Medicine: https://oxfordmedicine.com/view/10.1093/med/9780199688418.001.0001/med-9780199688418 Media appearances by Prof Imray: Radio: http://news.bbc.co.uk/today/hi/today/newsid_9722000/9722707.stm Television: BBC Panorama: Horizon Doctors in the death zone: http://www.bbc.co.uk/sn/tvradio/programmes/horizon/broadband/tx/everest/ Polar medicine / extreme environment and research organisations: https://worldextrememedicine.com/products/courses/polar-medicine/polar-medicine-norway/ https://www.rgs.org/in-the-field/advice-training/expedition-medicine-(1)/committee-members/ https://www.rgs.org/in-the-field/advice-training/resources-for-expeditions/global-polar-altitudemetabolic-research-registr/ https://bmrescouk.wordpress.com https://www.xtreme-everest.co.uk/Scientific-Strategy-Group The Vascular and Endovascular Research Network (VERN) COVER Study (COVID-19 Vascular sERvice Study): https://vascular-research.net/projects/cover-study-covid-19-vascular-service-study/ To learn more about The Rouleaux Club, visit http://rouleauxclub.com

Dosyć długo zbierałam się do nagrania tego odcinka, ale z uwagi na coraz większe zainteresowanie dietą ketogenną i powstałych w związku z tym różnych teorii (wielokrotnie nieprawdziwych) postanowiłam trochę naprostować te informacje i wyjaśnić:- na czym polega dieta ketogeniczna,- dlaczego ja stosowałam się do jej zasad,- ile czasu zajmuje ketoadaptacja,- co suplementować na diecie ketogenicznejNie jestem fanatykiem diety keto, nie uważam, że to lek na wszystkie dolegliwości tego świata. Nie uważam też, że jest totalnym złem. Jest dla mnie po prostu narzędziem, które może być pomocne w osiągnięciu Twojego celu, jakim może być redukcja masy ciała, lepsze samopoczucie czy poprawa koncentracji. Podobnie jak z użyciem młotka - albo wbijesz nim gwóźdź, albo zrobisz komuś krzywdę. W obydwu przypadkach z tego narzędzia trzeba korzystać umiejętnie i właśnie w tym odcinku tłumaczę jak to zrobić (odnośnie diety, nie młotka :)) Zapraszam do słuchania.Jeżeli podobał Ci się ten odcinek albo masz jakieś uwagi, pytania bądź chcesz zaproponować temat odcinka napisz na malgorzata@pielichowska.plKorzystałam z publikacji: 1. Volek J.S., Phinney S.D., The Art and Science of Low Carbohydrate Living. An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable, Beyond Obesity (2011), LLC.2. https://dietetycy.org.pl/dieta-ketogeniczna-w-ciazy-czy-bezpieczna/ 3. Puchalska P., Crawford P.A., Multi-dimensional Roles of Ketone Bodies in Fuel Metabolism, Signalling, and Therapeutics. Cell Metabolism (2017) 25: 262.4. Augustin K., Khabbush A., Williams S., Mechanisms of action for the medium-chain triglyceride ketogenic diet in neurological and metabolic disorders. Lancet Neurol (2018) 17: 84-93.5. Wilson J., Lowery R., The Ketogenic Bible. The Authoritative Guide to Ketosis. Victory Belt Publishing Inc. Canada, 2017.6. https://pielichowska.pl/skad-sie-wziela-dieta-ketogenna/Odwiedź moją stronę: https://pielichowska.pl Odwiedź mojego Facebooka: https://www.facebook.com/pielichowska.dietetyk Odwiedź mojego Instagrama: https://www.instagram.com/diet.and.mindfulness/

FDA 批准降钙素基因相关肽单抗用于预防偏头痛和丛集性头痛的发作JAMA Neurology 妊娠与临床孤立综合征发病的关系J Am Coll Cardiol 复杂的颈动脉斑块是引起隐源性卒中的一个原因Nature子刊 颅内恶性肿瘤的无创检测Nature子刊 合成纳米颗粒治疗胶质母细胞瘤加那珠单抗（galcanezumab）降钙素基因相关肽（CGRP）受体位于疼痛信号通路、颅内动脉和肥大细胞中，其活化被认为在偏头痛的病理生理学中起着因果作用。加那珠单抗（galcanezumab）是一种CGRP单克隆抗体。和此前在《神经科星期四 Episode 4》中介绍的治疗急性偏头痛的CGRP受体拮抗剂包括：瑞美吉泮（rimegepant）和乌布吉泮（ubrogepant）；以及《神经科星期四 Episode 14》中介绍的预防偏头痛发作的依替尼单抗（eptinezumab）属于一类药物。2018年9月，FDA批准加那珠单抗用于预防偏头痛发作；2019年6月，FDA批准加那珠单抗用于预防丛集性头痛发作。《CONQUER研究：加那珠单抗预防偏头痛的安全性和有效性的3b期临床研究》Lancet Neurology，2020年10月 (1)这项多中心、随机、双盲、安慰剂对照的3b期研究，纳入2到4类偏头痛预防药物无效的患者655例，患者年龄在18-75岁之间，有发作性或慢性偏头痛，在50岁之前发生偏头痛，入组后随机接受安慰剂或加那珠单抗（120mg q1m * 3m）。在1-3个月期间，加那珠单抗治疗的患者偏头痛发作天数比安慰剂显著减少。与基线相比，加那珠单抗组每月平均少4·1天，而安慰剂组每月平均少1·0天（p < 0·0001）。加那珠单抗和安慰剂之间治疗紧急不良事件的类型和数量相似。结论：加那珠单抗在偏头痛的预防治疗方面优于安慰剂，并且在以前的多个标准预防治疗失败的患者中有良好的耐受性。 《加那珠单抗预防发作性丛集性头痛的临床研究》New England Journal of Medicine，2019年7月(2)阵发性丛集性头痛是一种神经功能障碍，其特征是每天头痛发作，持续数周或数月。共招募患者106人，随机分配接受加那珠单抗（300mg）或安慰剂组。基线期每周丛集性头痛的平均发作次数，加那珠单抗组为17.8，安慰剂组为17.3。在第1至3周中，加那珠单抗组每周平均减少为8.7次，而安慰剂组为5.2次（P =0.04）。在第3周，头痛频率降低≥50%的患者，加那珠单抗组为71%，安慰剂组为53%。除了加那珠单抗组8%的患者有注射部位疼痛外，不良事件发生率在组间没有实质性差异。结论：与安慰剂相比，在首次注射后的1-3周内，加那珠单抗300mg ip降低了偶发性丛集性头痛的发作频率。多发性硬化多发性硬化（multiple sclerosis，MS）是以中枢神经系统白质炎性脱髓鞘病变为主要特点的自身免疫病。本病最常累及的部位为脑室周围白质、视神经、脊髓、脑干和小脑，主要临床特点为中枢神经系统白质散在分布的多病灶与病程中呈现的缓解复发，症状和体征的空间多发性和病程的时间多发性。 多发性硬化症主要的模式和病程可以分为以下几种临床亚型：临床孤立综合征（CIS）、复发缓解型（RR）、继发进展型（SP）、和原发进展型（PP）。 《前瞻性队列研究：妊娠与临床孤立综合征发病的关系》JAMA Neurology，2020年12月 (3)多发性硬化症常诊断于育龄妇女，但妊娠是否能延迟脱髓鞘或临床孤立综合征（CIS）的首次发作尚无共识。研究的目的是探讨妊娠与CIS发病时间的关系。这个国际、多中心、前瞻性研究纳入2557名女性，CIS发病的平均年龄为31岁，发病前46%至少有1次怀孕，43%至少有1次分娩。首次怀孕的平均年龄为23.3岁，首次分娩的平均年龄为23.8岁。与从未怀孕过的女性相比，有过怀孕和分娩经历的女性发生CIS的时间较晚，延迟3.3年（P < 0.001）。与从未分娩过的女性相比，分娩过的女性发病年龄也较晚，延迟3.4年（P < 0.001）。孕产次数与发病延迟无关。结论：发病前怀孕和分娩与CIS发病时间之间存在关联，但与次数无关。需要进一步的研究来帮助解释怀孕和多发性硬化症发病之间关联的机制。《前瞻性观察性队列研究：持续免疫治疗与活动性继发进展性多发性硬化症患者残疾结果的相关性》JAMA Neurology，2020年11月 (4)研究旨在评价继发进展性多发性硬化的患者中残疾累计发生率，及是否能够通过治疗延缓残疾累积的进展。这项观察性队列研究中， 招募53680例多发性硬化的患者，其中4997例继发进展型，在1621例符合纳入条件的患者中，女性患者68.0%，发病时的平均年龄为33.9岁。共有661例（40.8%）患者在继发进展性多发性硬化期间经历了叠加性复发。早期治疗方案和残疾累计发生无关。继发进展期的高复发率与轮椅依赖的残疾风险增加有关（P = 0.009）。在继发进展性多发性硬化期间经历反复复发的患者中，抑制疾病进展的治疗与残疾进展率的降低和轮椅依赖风险的降低显著相关。结论： 继发进展型多发性硬化症患者中，残疾进展率与早期病程和治疗方案无关，但是与疾病复发相关。多发性硬化的治疗多发性硬化治疗的主要目的是抑制炎性脱髓鞘病变进展，防止急性期病变恶化及缓解期复发，晚期采取对症和支持疗法，减轻神经功能障碍带来的痛苦。疾病修正治疗（disease-modifying therapy，DMT）主要包括：抗整合素α-4单抗（那他珠单抗 natalizumab），抗CD20单抗（奥瑞珠单抗 ocrelizumab、奥法木单抗 ofatumumab、利妥昔单抗 rituximab），抗CD52单抗（阿伦单抗 alemtuzumab）、干扰素（干扰素β-1a、干扰素β1-b）、富马酸类（富马酸二甲酯 dimethyl fumarate、富马酸单甲酯 monomethyl fumarate）、鞘氨醇调节剂（芬戈莫德 fingolimod、西尼莫德 siponimod、奥扎莫德 ozanimod）、免疫抑制剂（克拉屈滨 cladribine），还可使用其他免疫抑制剂如特立氟胺（teriflunomide）、硫唑嘌呤、环磷酰胺、米托蒽醌等。《OPERA I和OPERA II研究：复发相关的恶化与复发无关的进展对典型复发性多发性硬化症总体确认残疾积累的贡献》JAMA Neurology，2020年9月 (5)奥瑞珠单抗（ocrelizumab）是一种靶向CD20+B细胞的单克隆抗体，于2017年被批准用于多发性硬化的治疗。研究旨在评价复发相关的恶化（relapse-associated worsening，RAW）和复发无关的进展（progression independent of relapse，PIRA）对证实的残疾累积（confirmed disability accumulation，CDA）的影响，并评估两种治疗方法对预后的影响。这2个相同的、3期、多中心、双盲随机临床试验中，1656人纳入分析，两组平均年龄37.2-37.1岁，随机奥瑞珠单抗组（奥瑞珠单抗 600mg ivgtt q24w）或干扰素组（干扰素 ip q3w）共96周。12周后，干扰素组和奥瑞珠单抗组的残疾累积事件发生率分别为29.6%和21.1%；24周发生率分别为22.7%和16.2%。复发无关的进展事件是12周和24周复合残疾累积事件的主要影响因素，分别占干扰素组的78.0%和80.6%，占奥瑞珠单抗组的88.0%和89.1%。结论：大部分的残疾积累事件与明显的疾病复发无关，这挑战了目前多发性硬化复发和进展形式的临床区别。《ORATORIO研究的事后分析：奥瑞珠单抗治疗原发性进行性多发性硬化症的长期随访》Lancet Neurology，2020年12月 (6)ORATORIO研究是一项国际、多中心、双盲、随机对照的3期试验，招募年龄18-55岁的、原发性进行性多发性硬化症患者，随机分配奥瑞珠单抗（600mg ivgtt q24w）或安慰剂，至少120周，之后可以选择进入开放标签阶段。共451人进入完成6.5年的随访。在早期使用奥瑞珠单抗的患者，残疾进展比例较低（51.7% vs 64.8%，P=0.0018），复合进展率较低（73.2% vs 83.3%；p = 0.0023）；需要轮椅的比例较低（11.5% vs 18.9%；p = 0.0274）。在研究结束时，奥瑞珠单抗组患者T2病变体积更小（0.45% vs 13.00%， p

FDA 批准降钙素基因相关肽单抗用于预防偏头痛和丛集性头痛的发作JAMA Neurology 妊娠与临床孤立综合征发病的关系J Am Coll Cardiol 复杂的颈动脉斑块是引起隐源性卒中的一个原因Nature子刊 颅内恶性肿瘤的无创检测Nature子刊 合成纳米颗粒治疗胶质母细胞瘤加那珠单抗（galcanezumab）降钙素基因相关肽（CGRP）受体位于疼痛信号通路、颅内动脉和肥大细胞中，其活化被认为在偏头痛的病理生理学中起着因果作用。加那珠单抗（galcanezumab）是一种CGRP单克隆抗体。和此前在《神经科星期四 Episode 4》中介绍的治疗急性偏头痛的CGRP受体拮抗剂包括：瑞美吉泮（rimegepant）和乌布吉泮（ubrogepant）；以及《神经科星期四 Episode 14》中介绍的预防偏头痛发作的依替尼单抗（eptinezumab）属于一类药物。2018年9月，FDA批准加那珠单抗用于预防偏头痛发作；2019年6月，FDA批准加那珠单抗用于预防丛集性头痛发作。《CONQUER研究：加那珠单抗预防偏头痛的安全性和有效性的3b期临床研究》Lancet Neurology，2020年10月 (1)这项多中心、随机、双盲、安慰剂对照的3b期研究，纳入2到4类偏头痛预防药物无效的患者655例，患者年龄在18-75岁之间，有发作性或慢性偏头痛，在50岁之前发生偏头痛，入组后随机接受安慰剂或加那珠单抗（120mg q1m * 3m）。在1-3个月期间，加那珠单抗治疗的患者偏头痛发作天数比安慰剂显著减少。与基线相比，加那珠单抗组每月平均少4·1天，而安慰剂组每月平均少1·0天（p < 0·0001）。加那珠单抗和安慰剂之间治疗紧急不良事件的类型和数量相似。结论：加那珠单抗在偏头痛的预防治疗方面优于安慰剂，并且在以前的多个标准预防治疗失败的患者中有良好的耐受性。 《加那珠单抗预防发作性丛集性头痛的临床研究》New England Journal of Medicine，2019年7月(2)阵发性丛集性头痛是一种神经功能障碍，其特征是每天头痛发作，持续数周或数月。共招募患者106人，随机分配接受加那珠单抗（300mg）或安慰剂组。基线期每周丛集性头痛的平均发作次数，加那珠单抗组为17.8，安慰剂组为17.3。在第1至3周中，加那珠单抗组每周平均减少为8.7次，而安慰剂组为5.2次（P =0.04）。在第3周，头痛频率降低≥50%的患者，加那珠单抗组为71%，安慰剂组为53%。除了加那珠单抗组8%的患者有注射部位疼痛外，不良事件发生率在组间没有实质性差异。结论：与安慰剂相比，在首次注射后的1-3周内，加那珠单抗300mg ip降低了偶发性丛集性头痛的发作频率。多发性硬化多发性硬化（multiple sclerosis，MS）是以中枢神经系统白质炎性脱髓鞘病变为主要特点的自身免疫病。本病最常累及的部位为脑室周围白质、视神经、脊髓、脑干和小脑，主要临床特点为中枢神经系统白质散在分布的多病灶与病程中呈现的缓解复发，症状和体征的空间多发性和病程的时间多发性。 多发性硬化症主要的模式和病程可以分为以下几种临床亚型：临床孤立综合征（CIS）、复发缓解型（RR）、继发进展型（SP）、和原发进展型（PP）。 《前瞻性队列研究：妊娠与临床孤立综合征发病的关系》JAMA Neurology，2020年12月 (3)多发性硬化症常诊断于育龄妇女，但妊娠是否能延迟脱髓鞘或临床孤立综合征（CIS）的首次发作尚无共识。研究的目的是探讨妊娠与CIS发病时间的关系。这个国际、多中心、前瞻性研究纳入2557名女性，CIS发病的平均年龄为31岁，发病前46%至少有1次怀孕，43%至少有1次分娩。首次怀孕的平均年龄为23.3岁，首次分娩的平均年龄为23.8岁。与从未怀孕过的女性相比，有过怀孕和分娩经历的女性发生CIS的时间较晚，延迟3.3年（P < 0.001）。与从未分娩过的女性相比，分娩过的女性发病年龄也较晚，延迟3.4年（P < 0.001）。孕产次数与发病延迟无关。结论：发病前怀孕和分娩与CIS发病时间之间存在关联，但与次数无关。需要进一步的研究来帮助解释怀孕和多发性硬化症发病之间关联的机制。《前瞻性观察性队列研究：持续免疫治疗与活动性继发进展性多发性硬化症患者残疾结果的相关性》JAMA Neurology，2020年11月 (4)研究旨在评价继发进展性多发性硬化的患者中残疾累计发生率，及是否能够通过治疗延缓残疾累积的进展。这项观察性队列研究中， 招募53680例多发性硬化的患者，其中4997例继发进展型，在1621例符合纳入条件的患者中，女性患者68.0%，发病时的平均年龄为33.9岁。共有661例（40.8%）患者在继发进展性多发性硬化期间经历了叠加性复发。早期治疗方案和残疾累计发生无关。继发进展期的高复发率与轮椅依赖的残疾风险增加有关（P = 0.009）。在继发进展性多发性硬化期间经历反复复发的患者中，抑制疾病进展的治疗与残疾进展率的降低和轮椅依赖风险的降低显著相关。结论： 继发进展型多发性硬化症患者中，残疾进展率与早期病程和治疗方案无关，但是与疾病复发相关。多发性硬化的治疗多发性硬化治疗的主要目的是抑制炎性脱髓鞘病变进展，防止急性期病变恶化及缓解期复发，晚期采取对症和支持疗法，减轻神经功能障碍带来的痛苦。疾病修正治疗（disease-modifying therapy，DMT）主要包括：抗整合素α-4单抗（那他珠单抗 natalizumab），抗CD20单抗（奥瑞珠单抗 ocrelizumab、奥法木单抗 ofatumumab、利妥昔单抗 rituximab），抗CD52单抗（阿伦单抗 alemtuzumab）、干扰素（干扰素β-1a、干扰素β1-b）、富马酸类（富马酸二甲酯 dimethyl fumarate、富马酸单甲酯 monomethyl fumarate）、鞘氨醇调节剂（芬戈莫德 fingolimod、西尼莫德 siponimod、奥扎莫德 ozanimod）、免疫抑制剂（克拉屈滨 cladribine），还可使用其他免疫抑制剂如特立氟胺（teriflunomide）、硫唑嘌呤、环磷酰胺、米托蒽醌等。《OPERA I和OPERA II研究：复发相关的恶化与复发无关的进展对典型复发性多发性硬化症总体确认残疾积累的贡献》JAMA Neurology，2020年9月 (5)奥瑞珠单抗（ocrelizumab）是一种靶向CD20+B细胞的单克隆抗体，于2017年被批准用于多发性硬化的治疗。研究旨在评价复发相关的恶化（relapse-associated worsening，RAW）和复发无关的进展（progression independent of relapse，PIRA）对证实的残疾累积（confirmed disability accumulation，CDA）的影响，并评估两种治疗方法对预后的影响。这2个相同的、3期、多中心、双盲随机临床试验中，1656人纳入分析，两组平均年龄37.2-37.1岁，随机奥瑞珠单抗组（奥瑞珠单抗 600mg ivgtt q24w）或干扰素组（干扰素 ip q3w）共96周。12周后，干扰素组和奥瑞珠单抗组的残疾累积事件发生率分别为29.6%和21.1%；24周发生率分别为22.7%和16.2%。复发无关的进展事件是12周和24周复合残疾累积事件的主要影响因素，分别占干扰素组的78.0%和80.6%，占奥瑞珠单抗组的88.0%和89.1%。结论：大部分的残疾积累事件与明显的疾病复发无关，这挑战了目前多发性硬化复发和进展形式的临床区别。《ORATORIO研究的事后分析：奥瑞珠单抗治疗原发性进行性多发性硬化症的长期随访》Lancet Neurology，2020年12月 (6)ORATORIO研究是一项国际、多中心、双盲、随机对照的3期试验，招募年龄18-55岁的、原发性进行性多发性硬化症患者，随机分配奥瑞珠单抗（600mg ivgtt q24w）或安慰剂，至少120周，之后可以选择进入开放标签阶段。共451人进入完成6.5年的随访。在早期使用奥瑞珠单抗的患者，残疾进展比例较低（51.7% vs 64.8%，P=0.0018），复合进展率较低（73.2% vs 83.3%；p = 0.0023）；需要轮椅的比例较低（11.5% vs 18.9%；p = 0.0274）。在研究结束时，奥瑞珠单抗组患者T2病变体积更小（0.45% vs 13.00%， p

FDA 连续批准2个单抗治疗视神经脊髓炎JAMA 服用维生素D3或阿斯匹林均不能降低抑郁症的风险Nature Neuroscience 夜间光照诱导的类抑郁行为在《神经科星期四 Episode 24》中，和大家介绍了抗补体蛋白C5单克隆抗体依库珠单抗（eculizumab），2019年6月被批准用于治疗水通道蛋白阳性的神经脊髓炎谱系障碍。2020年，又有两个新型的单克隆抗体上市用于治疗视神经脊髓炎。简单回顾一下：视神经脊髓炎谱系障碍（Neuromyelitis Optica Spectrum Disorder，NMOSD）是一种复发性自身免疫性炎症性疾病，通常影响视神经和脊髓。至少三分之二的病例水通道蛋白-4抗体（AQP4-IgG）和补体介导的中枢神经系统损伤有关。沙利珠单抗（satralizumab）沙丽珠单抗（satralizumab）是抗IL-6受体的单克隆抗体，当联用免疫抑制剂治疗时，可降低视神经脊髓炎谱系障碍患者复发的风险。2020年8月，沙利珠单抗被FDA批准用于治疗水通道蛋白-4抗体阳性的、视神经脊髓炎患者。《随机双盲对照研究：沙利珠单抗单药治疗视神经脊髓炎的安全性和有效性的3期试验》Lancet Neurology，2020年5月 (1)这项研究评估了沙丽珠单抗单药治疗视神经脊髓炎患者的安全性和有效性。在这个III期、双盲、安慰剂对照、平行组试验中，纳入了水通道蛋白-4抗体阳性或阴性的成年患者，参与者被随机分配（2:1）在第0、2、4周接受沙丽珠单抗120mg皮下注射或安慰剂，此后每4周接受一次注射。同时停止服用免疫抑制剂。共纳入168名参与者，随访期间，30%治疗组患者和50%对照组患者出现复发。两组间严重不良事件和导致停药的不良事件发生率相似。结论：与安慰剂相比，沙丽珠单抗单药治疗降低了视神经脊髓炎的复发率，具有良好的安全性。英必珠单抗（inebilizumab）英必珠单抗是CD19单克隆抗体，本研究旨在研究CD19单抗在降低视神经脊髓炎中的有效性和安全性。2020年6月，FDA已批准英必珠单抗上市，用于治疗视神经脊髓炎。《N-MOmentum研究：英必珠单抗治疗视神经脊髓炎谱系障碍的2/3期试验》Lancet，2019年10月 (2)这是一项多中心、双盲、随机安慰剂对照2/3期研究。参与者被随机分配到300mg 英必珠单抗或安慰剂组，在第1天和第15天接受用药。共招募230名参与者治疗组中12%的患者随访期间复查，安慰剂组39%出现复发（p < 0·0001）。治疗组中72%的患者和安慰剂组73%的患者出现不良反应。结论：与安慰剂相比，英必珠单抗降低了视神经脊髓炎的复发的风险，具有潜在的应用价值。出血性脑卒中出血性脑卒中一般来源于微动脉或小动脉，出血直接进入脑组织，形成局限性血肿。最常见的原因包括：高血压、脑外伤、全身出血倾向、淀粉样脑血管病及血管畸形。不常见的原因包括：肿瘤内出血、动脉瘤破裂及血管炎。《ARUBA研究：未破裂脑动静脉畸形的介入治疗与单独药物治疗的试验的最终随访》Lancet Neurology，2020年7月(3)是一项多国、多中心的随机试验，旨在评估被诊断为未破裂脑动静脉畸形的成年患者中，病变经过评估适合通过介入手术可以根除病变的情况下，介入治疗还是单独药物治疗效果更好。在预先指定的中期分析：显示在预防症状性卒中或死亡方面，单独药物治疗优于药物治疗和介入治疗的联合治疗组，在平均33·3个月的随访中停止了随机化。研究继续随访平均50.4个月后，单纯药物治疗组的死亡或症状性卒中发生率（3.39/每100人年）低于介入治疗的患者（12·32/100人年）。药物治疗组2例，介入治疗组4例死亡。与介入治疗相比，分配到药物治疗的患者的不良事件较少。结论：经过长期的随访，ARUBA显示在预防未破裂的脑动静脉畸形患者的死亡或症状性卒中方面，单纯的医疗管理仍优于介入治疗。《评论：未破裂的脑动静脉畸形的治疗策略》Lancet Neurology，2020年7月 (4)动静脉畸形是青壮年脑出血的主要原因。当它还没有引起癫痫、局灶性神经缺损的时候，有时偶然在影像学检查中被发现，在这些未破裂的病例中，通过介入治疗栓塞或切除动静脉畸形以及相关动脉瘤，可能可以降低颅内出血的长期风险，但是在随机试验中缺乏风险和收益平衡的证据。《随机对照研究：院外氨甲环酸治疗对中重度外伤性脑损伤患者神经功能预后的影响》JAMA，2020年9月 (5)研究的目的是评估中重度外伤性脑损伤2小时内，院外予氨甲环酸治疗对神经学结果的影响。研究纳入年龄≥15岁、Glasgow昏迷评分19mmHg与死亡率相关，而颅内压

FDA 连续批准2个单抗治疗视神经脊髓炎JAMA 服用维生素D3或阿斯匹林均不能降低抑郁症的风险Nature Neuroscience 夜间光照诱导的类抑郁行为在《神经科星期四 Episode 24》中，和大家介绍了抗补体蛋白C5单克隆抗体依库珠单抗（eculizumab），2019年6月被批准用于治疗水通道蛋白阳性的神经脊髓炎谱系障碍。2020年，又有两个新型的单克隆抗体上市用于治疗视神经脊髓炎。简单回顾一下：视神经脊髓炎谱系障碍（Neuromyelitis Optica Spectrum Disorder，NMOSD）是一种复发性自身免疫性炎症性疾病，通常影响视神经和脊髓。至少三分之二的病例水通道蛋白-4抗体（AQP4-IgG）和补体介导的中枢神经系统损伤有关。沙利珠单抗（satralizumab）沙丽珠单抗（satralizumab）是抗IL-6受体的单克隆抗体，当联用免疫抑制剂治疗时，可降低视神经脊髓炎谱系障碍患者复发的风险。2020年8月，沙利珠单抗被FDA批准用于治疗水通道蛋白-4抗体阳性的、视神经脊髓炎患者。《随机双盲对照研究：沙利珠单抗单药治疗视神经脊髓炎的安全性和有效性的3期试验》Lancet Neurology，2020年5月 (1)这项研究评估了沙丽珠单抗单药治疗视神经脊髓炎患者的安全性和有效性。在这个III期、双盲、安慰剂对照、平行组试验中，纳入了水通道蛋白-4抗体阳性或阴性的成年患者，参与者被随机分配（2:1）在第0、2、4周接受沙丽珠单抗120mg皮下注射或安慰剂，此后每4周接受一次注射。同时停止服用免疫抑制剂。共纳入168名参与者，随访期间，30%治疗组患者和50%对照组患者出现复发。两组间严重不良事件和导致停药的不良事件发生率相似。结论：与安慰剂相比，沙丽珠单抗单药治疗降低了视神经脊髓炎的复发率，具有良好的安全性。英必珠单抗（inebilizumab）英必珠单抗是CD19单克隆抗体，本研究旨在研究CD19单抗在降低视神经脊髓炎中的有效性和安全性。2020年6月，FDA已批准英必珠单抗上市，用于治疗视神经脊髓炎。《N-MOmentum研究：英必珠单抗治疗视神经脊髓炎谱系障碍的2/3期试验》Lancet，2019年10月 (2)这是一项多中心、双盲、随机安慰剂对照2/3期研究。参与者被随机分配到300mg 英必珠单抗或安慰剂组，在第1天和第15天接受用药。共招募230名参与者治疗组中12%的患者随访期间复查，安慰剂组39%出现复发（p < 0·0001）。治疗组中72%的患者和安慰剂组73%的患者出现不良反应。结论：与安慰剂相比，英必珠单抗降低了视神经脊髓炎的复发的风险，具有潜在的应用价值。出血性脑卒中出血性脑卒中一般来源于微动脉或小动脉，出血直接进入脑组织，形成局限性血肿。最常见的原因包括：高血压、脑外伤、全身出血倾向、淀粉样脑血管病及血管畸形。不常见的原因包括：肿瘤内出血、动脉瘤破裂及血管炎。《ARUBA研究：未破裂脑动静脉畸形的介入治疗与单独药物治疗的试验的最终随访》Lancet Neurology，2020年7月(3)是一项多国、多中心的随机试验，旨在评估被诊断为未破裂脑动静脉畸形的成年患者中，病变经过评估适合通过介入手术可以根除病变的情况下，介入治疗还是单独药物治疗效果更好。在预先指定的中期分析：显示在预防症状性卒中或死亡方面，单独药物治疗优于药物治疗和介入治疗的联合治疗组，在平均33·3个月的随访中停止了随机化。研究继续随访平均50.4个月后，单纯药物治疗组的死亡或症状性卒中发生率（3.39/每100人年）低于介入治疗的患者（12·32/100人年）。药物治疗组2例，介入治疗组4例死亡。与介入治疗相比，分配到药物治疗的患者的不良事件较少。结论：经过长期的随访，ARUBA显示在预防未破裂的脑动静脉畸形患者的死亡或症状性卒中方面，单纯的医疗管理仍优于介入治疗。《评论：未破裂的脑动静脉畸形的治疗策略》Lancet Neurology，2020年7月 (4)动静脉畸形是青壮年脑出血的主要原因。当它还没有引起癫痫、局灶性神经缺损的时候，有时偶然在影像学检查中被发现，在这些未破裂的病例中，通过介入治疗栓塞或切除动静脉畸形以及相关动脉瘤，可能可以降低颅内出血的长期风险，但是在随机试验中缺乏风险和收益平衡的证据。《随机对照研究：院外氨甲环酸治疗对中重度外伤性脑损伤患者神经功能预后的影响》JAMA，2020年9月 (5)研究的目的是评估中重度外伤性脑损伤2小时内，院外予氨甲环酸治疗对神经学结果的影响。研究纳入年龄≥15岁、Glasgow昏迷评分19mmHg与死亡率相关，而颅内压

Prikking og stikking i fingrene? Dette kan vere en Karpal-Tunnel Syndrom. Denne lidelsen kommer av en trang tunnel i håndroten der en nerve lett kan komme i klem mellom sener, leddbånd og knokler. I denne episoden snakker vi om det fantastiske nervesystemet i kroppen vår og forskjellen mellom det sentrale og perifere nervesystemet. Litteratur: Carpal Tunnel Syndrome: Diagnosis and Management. Wipperman J, Goerl K.Am Fam Physician. 2016 Dec 15;94(12):993-999.PMID: 28075090. Review.   Carpal tunnel syndrome: clinical features, diagnosis, and management. Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, Caliandro P, Hobson-Webb LD.Lancet Neurol. 2016 Nov;15(12):1273-1284. doi: 10.1016/S1474-4422(16)30231-9. Epub 2016 Oct 11.PMID: 27751557 Review.   Current approaches for carpal tunnel syndrome. Kim PT, Lee HJ, Kim TG, Jeon IH.Clin Orthop Surg. 2014 Sep;6(3):253-7. doi: 10.4055/cios.2014.6.3.253. Epub 2014 Aug 5.

FDA 批准抗补体蛋白C5的单克隆抗体治疗视神经脊髓炎Lancet 2020年关于痴呆的预防、干预和护理的报告Nature Medicine 阿尔茨海默病的血液学监测视神经脊髓炎谱系疾病（Neuromyelitis Optica Spectrum Disorder，NMOSD）是中枢神经系统炎症性疾病，特征为严重脱髓鞘和轴突损伤，主要累及视神经和脊髓，但也可以累及脑和脑干。女性发病率可高达男性的10倍，中位发病年龄为32-41岁。典型症状包括：双侧同时或短时间内相继出现的视神经炎（可致视力丧失）、横贯性脊髓炎（可致肢体无力和膀胱功能障碍）、以及最后区综合征（顽固性呃逆或恶心呕吐）。对于视神经脊髓炎急性发作或复发的患者，可使用大剂量激素冲击治疗或血浆置换。因为视神经脊髓炎的自然病程是反复发作、逐步恶化、最终致残，所以患者需尽快开始长期免疫治疗，降低复发风险。可选用的药物包括：硫唑嘌呤、利妥昔单抗、吗替麦考酚酯等。依库珠单抗（eculizumab）依库珠单抗（eculizumab），抗补体蛋白C5单克隆抗体，2019年6月被批准用于治疗水通道蛋白阳性的NMOSD。《PREVENT研究：依库珠单抗治疗水通道蛋白4阳性的、视神经脊髓炎谱系障碍的临床研究》New England Journal of Medicine，2019年8月 (1)这项随机、双盲、对照试验中，143名、水通道蛋白4阳性的、视神经脊髓炎患者，被随机分配接受是静脉依库珠单抗组或安慰剂组。研究过程中，允许患者继续使用稳定剂量免疫抑制治疗。入组前，患者24个月的平均年化复发率为1.99次，76%的患者在试验期间继续接受先前的免疫抑制治疗。随访期间，依库珠单抗组和安慰剂组中，复发的比例分别为3%和43%（P < 0.001）；年复发率分别为0.02和0.35（P < 0.001）；扩大致残状况量表（EDSS）评分的平均变化分别降低了0.18和增加了0.12。依库珠单抗组上呼吸道感染和头痛更常见，有1例患者死于脓胸。结论：在水通道蛋白4阳性的、视神经脊髓炎患者中，依库珠单抗可以显著降低疾病复发率，两组间在残疾进展指标上无显著差异。阿尔茨海默病的预防和治疗阿尔茨海默病（Alzeimer's Disease，AD）的预防包括：（1）生活方式和活动，如身体锻炼、认知训练、教育和认知储备；（2）纠正血管性危险因素，如降压；（3）饮食改变仍有争议，如ω-3脂肪酸、维生素、他汀、地中海饮食。AD的药物治疗包括：（1）胆碱酯酶抑制剂，如多奈哌齐、卡巴拉汀、加兰他敏；（2）NMDA受体拮抗剂，如美金刚；（3）单胺氧化酶抑制剂：司来吉兰；抗氧化剂，如维生素E，仍有争议。非药物治疗：（1）照顾行为障碍的患者；（2）营养支持；（3）认知康复；（4）锻炼计划；（5）技能训练；（6）控制危险因素。《Rush研究：早期生活认知丰富与AD病理改变和认知衰退的关系》JAMA Neurology，2020年10月 (2)早期认知丰富的指标与较慢的认知衰退和晚年痴呆症的减少有关，该研究的目的是探讨早期认知丰富与AD的关系。对参与者进行了平均7.0年的随访，每年进行认知和临床评估。22年间，共有2044名参与者参与，其中1018人死亡，813人的尸检数据。四个早期认知丰富的指标，包括早期社会经济地位、12岁时认知资源的可用性、参与认知刺激活动的频率和早期外语教学。最终纳入分析的813名参与者，死亡时的平均年龄90.1岁，69%为女性。校正年龄、性别和教育水平后的线性回归模型中，较高的早期认知丰富水平与较低的总体AD病理评分相关（P = 0. 01）；较高的早期认知丰富水平与认知下降缓慢相关。通过AD病理改变的间接影响，占早期认知丰富与老年认知能力下降率相关性的20%，80%为直接相关性。结论：早期认知丰富与更好的晚年认知健康有关，部分与AD的病理改变较少有关。《AD队列研究：重复消极性思维与淀粉样蛋白、tau蛋白和认知能力下降有关》Alzheimers & Dementia，2020年7月 (3)重复消极性思维也称为认知固着，主要包括对过往发生的事情的持续反思，重点是产生情绪的思维模式。通常认为重复性消极思维通过多种心理因素增加AD的风险；目前认知债务假说提出重复性消极思维本身就会增加老年痴呆的风险。研究中把重复性消极思维和焦虑症、抑郁症相比较。参与者中292名老年人来自（他们在55岁以上，且父母之一或至少两个兄弟姐妹有AD）。研究通过问卷调查和PET扫描等手段发现，重复性消极性思维与认知能力下降、短期及长期记忆能力下降有显著相关，而且与脑内淀粉样蛋白和Tau蛋白沉积相关。调整了潜在的混杂因素后，关系仍然存在。结论：重复消极性思维与AD早期认知功能下降，以及神经影像学生物标记物相关，未来需探讨改善消极思维是否有预防作用。《健康退休研究：美国中老年人中少量或中度饮酒与认知功能的关系》JAMA Network Open，2020年6月 (4)适量饮酒与认知功能衰退之间有关吗？这一项前瞻性队列研究，从1996年到2008年，共有19887名参与者接受了认知功能测试，他们至少参加了3次两年一次的调查，平均年龄61.8岁，研究随访9.1年。研究评估了参与者的心理状态、单词回忆和词汇量等认知领域的变化轨迹和年变化率，以及总分。根据认知功能的轨迹测量和整个研究期间持续的表现，参与者被分为低认知水平和高认知水平两组。少量或适量饮酒（女性每周饮酒少于8杯，男性每周饮酒少于15杯）与持续的高认知功能轨迹和较低的认知衰退率显著相关。与从不饮酒的人相比，少量到中度饮酒的人中与心理状态、单词记忆、词汇量相关的认知评分更高，各领域的认知能力的下降率更低。而且这种关联在白人参与者中似乎比黑人参与者更强。另外，饮酒剂量与所有参与者的所有认知功能区域呈U形关系，最佳剂量为每周10到14杯。结论：目前中老年人中少量或中度饮酒可能与更好的整体认知功能有关，有必要对其机制进行研究。《REWIND研究：杜拉鲁肽对2型糖尿病认知功能的影响》Lancet Neurology，2020年7月 (5)杜拉鲁肽是一种胰高血糖素样肽-1 (GLP-1)受体激动剂，2014年上市，一周一次皮下注射用于治疗2型糖尿病。该项研究旨在研究杜拉鲁肽与认知障碍之间的关系，这是一项随机、双盲、安慰剂对照试验，参与者年龄>50岁、糖化血红蛋白>9.5%、体重指数>23 kg/m2，共9901人参加，中位随访5.4年。研究使用蒙特利尔认知评估（MoCA）和数字符号替代测试（DSST）评估认知功能。在对个体标准化基线评分进行事后调整后，杜拉鲁肽治疗组患者相比安慰剂，实质性认知障碍的风险降低了14% （p = 0·0018）。结论：长期使用杜拉鲁肽可能减少2型糖尿病患者的认知障碍。《2020年关于痴呆的预防、干预和护理的报告》Lancet，2020年8月 (6)报告认为调节整个生命历程中的12种危险因素或能延缓或预防40%的痴呆病例发生。该报告已经在AD协会国际会议（AAIC 2020）上进行了报告。为了降低罹患痴呆的风险，作者向政策制定者和个人提出了9项积极建议：（1）从40岁左右的中年开始，将收缩压维持在130mmHg及以下；（2）鼓励听力受损者使用助听器，并通过避免强噪声来减轻听力损失；（3）停止吸烟并支持身边人戒烟；（4）为所有儿童提供初等和中等教育；（5）减少中年时期的肥胖；（6）减少糖尿病；（7）减少抑郁症；（8）在中年时期甚至老年时期尽量保持积极的运动和体力劳动；（9）保持社交活动；作者估计，这9种危险因素与35%的痴呆病例发生相关，而在中国40%的病例归因于这些因素；这份报告还把预防建议从9种增加到了12种；（10）减少对于空气污染和二手烟的暴露；（11）防止头部损伤（特别是从事高风险行业和运输行业的人群）；（12）防止酒精滥用并将每周饮酒量摄入量限制在21单位以内。癫痫癫痫是指间隔24小时以上出现2次或2次以上无诱因的癫痫发作的综合征。首次非诱发性癫痫发作的成人中，约1/3将在未来5年内复发。根据电活动的起源分布在大脑的一个局灶区域或同时涉及整个皮质，癫痫可以进一步分为局灶性发作或全面性发作。癫痫的病因可分为遗传性、结构性、代谢性、免疫性、感染性等。大多数癫痫在发作2分钟内自行终止。癫痫的治疗有三个目的：控制癫痫发作、避免治疗副作用和恢复维持生活质量。抗癫痫药分为：（1）影响钙电流的药物，如乙琥胺、加巴喷丁、普瑞巴林和拉考沙胺；（2）影响钠电流的药物，如苯妥英、卡马西平、奥卡西平、艾司利卡西平、卢非酰胺、丙戊酸；（3）同时影响钠通道和钙通道的药物，如唑尼沙胺；（4）影响γ-氨基丁酸（GABA）活性的药物，如苯二氮卓类（氯巴占、氯硝西泮、氯拉卓酸、地西泮和劳拉西泮）、苯巴比妥、扑米酮、噻加宾、氨己烯酸；（5）影响谷氨酸受体的药物，如吡仑帕奈、非尔氨酯和托吡酯；（6）调节突触传递的药物，如左乙拉西坦和布瓦西坦；（7）其他药物，如大麻二酚、拉莫三嗪。耐药性局灶性癫痫可考虑手术治疗：内侧颞叶硬化继发的内侧颞叶癫痫是最常见的可手术治疗的癫痫综合征。最常用的手术操作是前颞叶切除术，一并切除颞极、海马和部分杏仁核。《回顾性队列研究：根据组织病理学诊断癫痫手术后癫痫发作的结果和抗癫痫药物的使用》Lancet Neurology，2020年9月 (7)手术是广泛接受的治疗方案耐药性局灶性癫痫，研究的目的是分析组织病理学和癫痫发作的结果以及癫痫手术后5年的药物自由之间的联系，以改善术前的决策和咨询。这项回顾性、多中心、纵向、队列研究中，纳入欧洲18国37个中心9147例、行癫痫手术的患者。其中，89·5%的患者有至少2年癫痫病史，61·0%的患者有5年的癫痫病史。神经上皮肿瘤、血管畸形和海马硬化引起的轻度癫痫发作患者手术效果最好，术后2年分别有77.5%、74·0%和71·5%的患者没有癫痫复发。局灶性皮质发育不良I型、皮质畸形发育、无病理损伤的患者手术效果最差，术后2年分别有50·0%、52·3%和53.5%的患者没有癫痫复发。术后第一年，Engel1类患者不再服药的比例为0-14%；术后第五年，增加到14-51%。儿童术后不再服药的比例较高；颞叶手术效果较好；癫痫持续时间越长，手术效果越差。结论：组织病理学诊断，手术年龄和癫痫持续时间是癫痫手术结果的重要预后因素。《多中心随机临床试验：意识改变且近期无癫痫发作的危重症成人连续与常规脑电图》JAMA Neurology，2020年10月 (8)在意识改变的危重病人中，连续脑电图（cEEG）可以提高了对癫痫发作的检测，研究的目的是探讨cEEG与常规脑电图（rEEG）是否具有降低死亡率的作用。研究实际招募了Glasgow评分≤11分、反应性完全评分≤12分、近期无癫痫发作的危重症患者。不论是否有基础脑部疾病，被随机分为30~48小时的cEEG和2个20分钟的rEEG。6个月时，cEEG组和rEEG组患者死亡率没有统计学差异（P = 0.85)，多个亚组间的探索性比较后，结果仍没有差异。cEEG与癫痫检出率增加相关（P = 0.004），cEEG也和更频繁的抗癫痫治疗相关（P = 0. 01)。结论：在意识受损且近期无癫痫发作的危重成人患者中，cEEG可提高癫痫发作的检出率，改善抗癫痫治疗，但不改善预后。《ESETT研究：左乙拉西坦、福苯妥英和丙戊酸钠对癫痫持续状态的疗效》Lancet，2020年4月 (9)研究的目的是比较左乙拉西坦、福苯妥英和丙戊酸钠在不同年龄患者中的、癫痫持续状态的有效性和安全性。这项多中心、双盲、疗效适应性、随机对照试验中，招募了≥2岁的、苯二氮卓难治性的、持续性或复发性癫痫患者。根据年龄分组（65岁51人）后，被随机分配到左乙拉西坦、福苯妥英、丙戊酸盐组。在儿童、成人和老年人中，左乙拉西坦组治疗成功率分别为52%、44%和37%；福苯妥因治疗的成功率分别为49%、46%和35%；丙戊酸钠治疗成功率分别为52%、46%和47%。各年龄组药物在疗效或主要安全性方面均无差异。结论：癫痫持续状态的儿童、成人和老年人，对左乙拉西坦、福苯妥英和丙戊酸钠的反应相似，约半数患者的治疗成功。对于苯二氮卓难治性癫痫持续状态，这三种药物中的任何一种都可以被认为是潜在的首选二线药物。阿尔茨海默病（AD）的血液检测多年来，AD的诊断的金标准是尸检中的脑内淀粉样斑块和tau蛋白缠结。淀粉样蛋白和tau蛋白在脑脊液和PET中的生物学标志物已经能够很准确的用于诊断AD，但使用起来仍有局限性。《血磷酸化-tau181蛋白用于AD和额颞叶痴呆的诊断》Nature Medicine，2020年3月 (10)目前认为磷酸化-tau181蛋白有望成为高度特异性的生物标志物，用于AD。加州大学旧金山分校的研究人员检测了血磷酸化-tau181蛋白在临床诊断的、或尸检证实的，AD和额颞叶痴呆患者中的浓度。研究发现AD患者血浆磷酸化-tau181蛋白的浓度较比对照组升高3.5倍，而且可以用于与额颞叶痴呆进行鉴别诊断。在不考虑临床症状的情况下，血磷酸化-tau181蛋白与PET检测β-淀粉样蛋白、皮质tau蛋白沉积相关性很好。结论：血磷酸化-tau181蛋白有望用于ADtau蛋白相关病理的筛查。《血磷酸化-tau181蛋白用于AD的诊断》Lancet Neurology，2020年5月(11)研究旨在评估血液中磷酸化-tau181蛋白用于AD的诊断的价值。研究在四个前瞻性队列中开展，研究对象包括老年痴呆症患者和年龄匹配的对照组。研究发现血磷酸化-tau181蛋白最低的人群包括：β-淀粉样蛋白阴性的认知正常的年轻人和认知正常的老年人。血磷酸化-tau181蛋白最高的人群包括：β-淀粉样蛋白阳性的认知障碍人群和已诊断为AD患者。磷酸化-tau181蛋白能用于区别AD引起的痴呆和其他疾病神经退行性病变引起的痴呆：比如额颞叶痴呆、血管性痴呆、进行性核上性麻痹、皮质基底节综合征、帕金森病或多发性硬化（准确性可以达到81-99%）。同时，血磷酸化-tau181蛋白与PET脑内tau蛋白和和淀粉样蛋白的检测相关性在76-93%；与1年认知能力下降（p=0·0015）和海马萎缩（p=0·015）相关。在人群筛查中，血磷酸化-tau181蛋白可以用于区分青壮年和无认知障碍的老年人，但无法区分轻度认知功能障碍的人群。结论：血磷酸化-tau181蛋白可以预测脑内tau蛋白和淀粉样蛋白的病理变化，与其他神经退行性疾病区分，有望成为筛查、诊断AD的测试。《血磷酸化-tau217蛋白鉴别AD和其他神经退行性疾病的准确性》JAMA，2020年8月 (12)根据这项新的研究发现tau蛋白之一的磷酸化tau217蛋白（p-tau217）的测量可以提供敏感而准确的的淀粉样斑块和tau蛋白缠结的信息，并与阿尔茨海默氏症的诊断相对应。研究对3个队列研究的参与者均进行分别研究（亚利桑那州的神经病理学组群、瑞典BioFINDER-2队列和哥伦比亚常染色体显性AD亲属），主要目的是研究血浆P-tau217对临床或神经病理诊断的AD的鉴别准确性，以及这个检查结果与tau病理相关性。在这3个队列，共1402名参与者中，血磷酸化-tau217蛋白可以用于鉴别阿尔茨海默症和其他神经退行性疾病，其准确性可达到89-98%，明显高于其他血浆和MRI的生物标志物，与基于脑脊液或基于PET的测量结果没有显著差异。在对于有早发AD家族史的的患者中，600名参与者有60%携带PSEN1基因突变，不携带基因突变的参与者的磷酸化tau217蛋白浓度为1.9pg/ml，携带基因突变但认知功能正常的参与者升高至4.5pg/ml，携带基因突变同时出现认知功能障碍的参与者高达16.8pg/ml；而且，携带基因突变的参与者25岁时就会出现磷酸化tau-217蛋白显著升高，比出现症状早了20年。结论：这一项大型国际研究发现的新型血液测试最早可以在认知障碍发病前20年预测阿尔茨海默氏症。 参考文献1.Pittock SJ, Berthele A, Fujihara K, Kim HJ, Levy M, Palace J, et al. Eculizumab in Aquaporin-4-Positive Neuromyelitis Optica Spectrum Disorder. N Engl J Med. 2019;381(7):614-25.2.Oveisgharan S, Wilson RS, Yu L, Schneider JA, Bennett DA. Association of Early-Life Cognitive Enrichment With Alzheimer Disease Pathological Changes and Cognitive Decline. JAMA Neurol. 2020.3.Marchant NL, Lovland LR, Jones R, Pichet Binette A, Gonneaud J, Arenaza-Urquijo EM, et al. Repetitive negative thinking is associated with amyloid, tau, and cognitive decline. Alzheimers Dement. 2020;16(7):1054-64.4.Zhang R, Shen L, Miles T, Shen Y, Cordero J, Qi Y, et al. Association of Low to Moderate Alcohol Drinking With Cognitive Functions From Middle to Older Age Among US Adults. JAMA Netw Open. 2020;3(6):e207922-e.5.Cukierman-Yaffe T, Gerstein HC, Colhoun HM, Diaz R, García-Pérez LE, Lakshmanan M, et al. Effect of dulaglutide on cognitive impairment in type 2 diabetes: an exploratory analysis of the REWIND trial. Lancet Neurol. 2020;19(7):582-90.6.Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet. 2020;396(10248):413-46.7.Lamberink HJ, Otte WM, Blümcke I, Braun KPJ, Aichholzer M, Amorim I, et al. Seizure outcome and use of antiepileptic drugs after epilepsy surgery according to histopathological diagnosis: a retrospective multicentre cohort study. The Lancet Neurology. 2020;19(9):748-57.8.Rossetti AO, Schindler K, Sutter R, Ruegg S, Zubler F, Novy J, et al. Continuous vs Routine Electroencephalogram in Critically Ill Adults With Altered Consciousness and No Recent Seizure: A Multicenter Randomized Clinical Trial. JAMA Neurol. 2020.9.Chamberlain JM, Kapur J, Shinnar S, Elm J, Holsti M, Babcock L, et al. Efficacy of levetiracetam, fosphenytoin, and valproate for established status epilepticus by age group (ESETT): a double-blind, responsive-adaptive, randomised controlled trial. The Lancet. 2020;395(10231):1217-24.10.Thijssen EH, La Joie R, Wolf A, Strom A, Wang P, Iaccarino L, et al. Diagnostic value of plasma phosphorylated tau181 in Alzheimer's disease and frontotemporal lobar degeneration. Nature Medicine. 2020;26(3):387-97.11.Karikari TK, Pascoal TA, Ashton NJ, Janelidze S, Benedet AL, Rodriguez JL, et al. Blood phosphorylated tau 181 as a biomarker for Alzheimer's disease: a diagnostic performance and prediction modelling study using data from four prospective cohorts. Lancet Neurol. 2020;19(5):422-33.12.Palmqvist S, Janelidze S, Quiroz YT, Zetterberg H, Lopera F, Stomrud E, et al. Discriminative Accuracy of Plasma Phospho-tau217 for Alzheimer Disease vs Other Neurodegenerative Disorders. JAMA. 2020.

FDA 批准抗补体蛋白C5的单克隆抗体治疗视神经脊髓炎Lancet 2020年关于痴呆的预防、干预和护理的报告Nature Medicine 阿尔茨海默病的血液学监测视神经脊髓炎谱系疾病（Neuromyelitis Optica Spectrum Disorder，NMOSD）是中枢神经系统炎症性疾病，特征为严重脱髓鞘和轴突损伤，主要累及视神经和脊髓，但也可以累及脑和脑干。女性发病率可高达男性的10倍，中位发病年龄为32-41岁。典型症状包括：双侧同时或短时间内相继出现的视神经炎（可致视力丧失）、横贯性脊髓炎（可致肢体无力和膀胱功能障碍）、以及最后区综合征（顽固性呃逆或恶心呕吐）。对于视神经脊髓炎急性发作或复发的患者，可使用大剂量激素冲击治疗或血浆置换。因为视神经脊髓炎的自然病程是反复发作、逐步恶化、最终致残，所以患者需尽快开始长期免疫治疗，降低复发风险。可选用的药物包括：硫唑嘌呤、利妥昔单抗、吗替麦考酚酯等。依库珠单抗（eculizumab）依库珠单抗（eculizumab），抗补体蛋白C5单克隆抗体，2019年6月被批准用于治疗水通道蛋白阳性的NMOSD。《PREVENT研究：依库珠单抗治疗水通道蛋白4阳性的、视神经脊髓炎谱系障碍的临床研究》New England Journal of Medicine，2019年8月 (1)这项随机、双盲、对照试验中，143名、水通道蛋白4阳性的、视神经脊髓炎患者，被随机分配接受是静脉依库珠单抗组或安慰剂组。研究过程中，允许患者继续使用稳定剂量免疫抑制治疗。入组前，患者24个月的平均年化复发率为1.99次，76%的患者在试验期间继续接受先前的免疫抑制治疗。随访期间，依库珠单抗组和安慰剂组中，复发的比例分别为3%和43%（P < 0.001）；年复发率分别为0.02和0.35（P < 0.001）；扩大致残状况量表（EDSS）评分的平均变化分别降低了0.18和增加了0.12。依库珠单抗组上呼吸道感染和头痛更常见，有1例患者死于脓胸。结论：在水通道蛋白4阳性的、视神经脊髓炎患者中，依库珠单抗可以显著降低疾病复发率，两组间在残疾进展指标上无显著差异。阿尔茨海默病的预防和治疗阿尔茨海默病（Alzeimer's Disease，AD）的预防包括：（1）生活方式和活动，如身体锻炼、认知训练、教育和认知储备；（2）纠正血管性危险因素，如降压；（3）饮食改变仍有争议，如ω-3脂肪酸、维生素、他汀、地中海饮食。AD的药物治疗包括：（1）胆碱酯酶抑制剂，如多奈哌齐、卡巴拉汀、加兰他敏；（2）NMDA受体拮抗剂，如美金刚；（3）单胺氧化酶抑制剂：司来吉兰；抗氧化剂，如维生素E，仍有争议。非药物治疗：（1）照顾行为障碍的患者；（2）营养支持；（3）认知康复；（4）锻炼计划；（5）技能训练；（6）控制危险因素。《Rush研究：早期生活认知丰富与AD病理改变和认知衰退的关系》JAMA Neurology，2020年10月 (2)早期认知丰富的指标与较慢的认知衰退和晚年痴呆症的减少有关，该研究的目的是探讨早期认知丰富与AD的关系。对参与者进行了平均7.0年的随访，每年进行认知和临床评估。22年间，共有2044名参与者参与，其中1018人死亡，813人的尸检数据。四个早期认知丰富的指标，包括早期社会经济地位、12岁时认知资源的可用性、参与认知刺激活动的频率和早期外语教学。最终纳入分析的813名参与者，死亡时的平均年龄90.1岁，69%为女性。校正年龄、性别和教育水平后的线性回归模型中，较高的早期认知丰富水平与较低的总体AD病理评分相关（P = 0. 01）；较高的早期认知丰富水平与认知下降缓慢相关。通过AD病理改变的间接影响，占早期认知丰富与老年认知能力下降率相关性的20%，80%为直接相关性。结论：早期认知丰富与更好的晚年认知健康有关，部分与AD的病理改变较少有关。《AD队列研究：重复消极性思维与淀粉样蛋白、tau蛋白和认知能力下降有关》Alzheimers & Dementia，2020年7月 (3)重复消极性思维也称为认知固着，主要包括对过往发生的事情的持续反思，重点是产生情绪的思维模式。通常认为重复性消极思维通过多种心理因素增加AD的风险；目前认知债务假说提出重复性消极思维本身就会增加老年痴呆的风险。研究中把重复性消极思维和焦虑症、抑郁症相比较。参与者中292名老年人来自（他们在55岁以上，且父母之一或至少两个兄弟姐妹有AD）。研究通过问卷调查和PET扫描等手段发现，重复性消极性思维与认知能力下降、短期及长期记忆能力下降有显著相关，而且与脑内淀粉样蛋白和Tau蛋白沉积相关。调整了潜在的混杂因素后，关系仍然存在。结论：重复消极性思维与AD早期认知功能下降，以及神经影像学生物标记物相关，未来需探讨改善消极思维是否有预防作用。《健康退休研究：美国中老年人中少量或中度饮酒与认知功能的关系》JAMA Network Open，2020年6月 (4)适量饮酒与认知功能衰退之间有关吗？这一项前瞻性队列研究，从1996年到2008年，共有19887名参与者接受了认知功能测试，他们至少参加了3次两年一次的调查，平均年龄61.8岁，研究随访9.1年。研究评估了参与者的心理状态、单词回忆和词汇量等认知领域的变化轨迹和年变化率，以及总分。根据认知功能的轨迹测量和整个研究期间持续的表现，参与者被分为低认知水平和高认知水平两组。少量或适量饮酒（女性每周饮酒少于8杯，男性每周饮酒少于15杯）与持续的高认知功能轨迹和较低的认知衰退率显著相关。与从不饮酒的人相比，少量到中度饮酒的人中与心理状态、单词记忆、词汇量相关的认知评分更高，各领域的认知能力的下降率更低。而且这种关联在白人参与者中似乎比黑人参与者更强。另外，饮酒剂量与所有参与者的所有认知功能区域呈U形关系，最佳剂量为每周10到14杯。结论：目前中老年人中少量或中度饮酒可能与更好的整体认知功能有关，有必要对其机制进行研究。《REWIND研究：杜拉鲁肽对2型糖尿病认知功能的影响》Lancet Neurology，2020年7月 (5)杜拉鲁肽是一种胰高血糖素样肽-1 (GLP-1)受体激动剂，2014年上市，一周一次皮下注射用于治疗2型糖尿病。该项研究旨在研究杜拉鲁肽与认知障碍之间的关系，这是一项随机、双盲、安慰剂对照试验，参与者年龄>50岁、糖化血红蛋白>9.5%、体重指数>23 kg/m2，共9901人参加，中位随访5.4年。研究使用蒙特利尔认知评估（MoCA）和数字符号替代测试（DSST）评估认知功能。在对个体标准化基线评分进行事后调整后，杜拉鲁肽治疗组患者相比安慰剂，实质性认知障碍的风险降低了14% （p = 0·0018）。结论：长期使用杜拉鲁肽可能减少2型糖尿病患者的认知障碍。《2020年关于痴呆的预防、干预和护理的报告》Lancet，2020年8月 (6)报告认为调节整个生命历程中的12种危险因素或能延缓或预防40%的痴呆病例发生。该报告已经在AD协会国际会议（AAIC 2020）上进行了报告。为了降低罹患痴呆的风险，作者向政策制定者和个人提出了9项积极建议：（1）从40岁左右的中年开始，将收缩压维持在130mmHg及以下；（2）鼓励听力受损者使用助听器，并通过避免强噪声来减轻听力损失；（3）停止吸烟并支持身边人戒烟；（4）为所有儿童提供初等和中等教育；（5）减少中年时期的肥胖；（6）减少糖尿病；（7）减少抑郁症；（8）在中年时期甚至老年时期尽量保持积极的运动和体力劳动；（9）保持社交活动；作者估计，这9种危险因素与35%的痴呆病例发生相关，而在中国40%的病例归因于这些因素；这份报告还把预防建议从9种增加到了12种；（10）减少对于空气污染和二手烟的暴露；（11）防止头部损伤（特别是从事高风险行业和运输行业的人群）；（12）防止酒精滥用并将每周饮酒量摄入量限制在21单位以内。癫痫癫痫是指间隔24小时以上出现2次或2次以上无诱因的癫痫发作的综合征。首次非诱发性癫痫发作的成人中，约1/3将在未来5年内复发。根据电活动的起源分布在大脑的一个局灶区域或同时涉及整个皮质，癫痫可以进一步分为局灶性发作或全面性发作。癫痫的病因可分为遗传性、结构性、代谢性、免疫性、感染性等。大多数癫痫在发作2分钟内自行终止。癫痫的治疗有三个目的：控制癫痫发作、避免治疗副作用和恢复维持生活质量。抗癫痫药分为：（1）影响钙电流的药物，如乙琥胺、加巴喷丁、普瑞巴林和拉考沙胺；（2）影响钠电流的药物，如苯妥英、卡马西平、奥卡西平、艾司利卡西平、卢非酰胺、丙戊酸；（3）同时影响钠通道和钙通道的药物，如唑尼沙胺；（4）影响γ-氨基丁酸（GABA）活性的药物，如苯二氮卓类（氯巴占、氯硝西泮、氯拉卓酸、地西泮和劳拉西泮）、苯巴比妥、扑米酮、噻加宾、氨己烯酸；（5）影响谷氨酸受体的药物，如吡仑帕奈、非尔氨酯和托吡酯；（6）调节突触传递的药物，如左乙拉西坦和布瓦西坦；（7）其他药物，如大麻二酚、拉莫三嗪。耐药性局灶性癫痫可考虑手术治疗：内侧颞叶硬化继发的内侧颞叶癫痫是最常见的可手术治疗的癫痫综合征。最常用的手术操作是前颞叶切除术，一并切除颞极、海马和部分杏仁核。《回顾性队列研究：根据组织病理学诊断癫痫手术后癫痫发作的结果和抗癫痫药物的使用》Lancet Neurology，2020年9月 (7)手术是广泛接受的治疗方案耐药性局灶性癫痫，研究的目的是分析组织病理学和癫痫发作的结果以及癫痫手术后5年的药物自由之间的联系，以改善术前的决策和咨询。这项回顾性、多中心、纵向、队列研究中，纳入欧洲18国37个中心9147例、行癫痫手术的患者。其中，89·5%的患者有至少2年癫痫病史，61·0%的患者有5年的癫痫病史。神经上皮肿瘤、血管畸形和海马硬化引起的轻度癫痫发作患者手术效果最好，术后2年分别有77.5%、74·0%和71·5%的患者没有癫痫复发。局灶性皮质发育不良I型、皮质畸形发育、无病理损伤的患者手术效果最差，术后2年分别有50·0%、52·3%和53.5%的患者没有癫痫复发。术后第一年，Engel1类患者不再服药的比例为0-14%；术后第五年，增加到14-51%。儿童术后不再服药的比例较高；颞叶手术效果较好；癫痫持续时间越长，手术效果越差。结论：组织病理学诊断，手术年龄和癫痫持续时间是癫痫手术结果的重要预后因素。《多中心随机临床试验：意识改变且近期无癫痫发作的危重症成人连续与常规脑电图》JAMA Neurology，2020年10月 (8)在意识改变的危重病人中，连续脑电图（cEEG）可以提高了对癫痫发作的检测，研究的目的是探讨cEEG与常规脑电图（rEEG）是否具有降低死亡率的作用。研究实际招募了Glasgow评分≤11分、反应性完全评分≤12分、近期无癫痫发作的危重症患者。不论是否有基础脑部疾病，被随机分为30~48小时的cEEG和2个20分钟的rEEG。6个月时，cEEG组和rEEG组患者死亡率没有统计学差异（P = 0.85)，多个亚组间的探索性比较后，结果仍没有差异。cEEG与癫痫检出率增加相关（P = 0.004），cEEG也和更频繁的抗癫痫治疗相关（P = 0. 01)。结论：在意识受损且近期无癫痫发作的危重成人患者中，cEEG可提高癫痫发作的检出率，改善抗癫痫治疗，但不改善预后。《ESETT研究：左乙拉西坦、福苯妥英和丙戊酸钠对癫痫持续状态的疗效》Lancet，2020年4月 (9)研究的目的是比较左乙拉西坦、福苯妥英和丙戊酸钠在不同年龄患者中的、癫痫持续状态的有效性和安全性。这项多中心、双盲、疗效适应性、随机对照试验中，招募了≥2岁的、苯二氮卓难治性的、持续性或复发性癫痫患者。根据年龄分组（65岁51人）后，被随机分配到左乙拉西坦、福苯妥英、丙戊酸盐组。在儿童、成人和老年人中，左乙拉西坦组治疗成功率分别为52%、44%和37%；福苯妥因治疗的成功率分别为49%、46%和35%；丙戊酸钠治疗成功率分别为52%、46%和47%。各年龄组药物在疗效或主要安全性方面均无差异。结论：癫痫持续状态的儿童、成人和老年人，对左乙拉西坦、福苯妥英和丙戊酸钠的反应相似，约半数患者的治疗成功。对于苯二氮卓难治性癫痫持续状态，这三种药物中的任何一种都可以被认为是潜在的首选二线药物。阿尔茨海默病（AD）的血液检测多年来，AD的诊断的金标准是尸检中的脑内淀粉样斑块和tau蛋白缠结。淀粉样蛋白和tau蛋白在脑脊液和PET中的生物学标志物已经能够很准确的用于诊断AD，但使用起来仍有局限性。《血磷酸化-tau181蛋白用于AD和额颞叶痴呆的诊断》Nature Medicine，2020年3月 (10)目前认为磷酸化-tau181蛋白有望成为高度特异性的生物标志物，用于AD。加州大学旧金山分校的研究人员检测了血磷酸化-tau181蛋白在临床诊断的、或尸检证实的，AD和额颞叶痴呆患者中的浓度。研究发现AD患者血浆磷酸化-tau181蛋白的浓度较比对照组升高3.5倍，而且可以用于与额颞叶痴呆进行鉴别诊断。在不考虑临床症状的情况下，血磷酸化-tau181蛋白与PET检测β-淀粉样蛋白、皮质tau蛋白沉积相关性很好。结论：血磷酸化-tau181蛋白有望用于ADtau蛋白相关病理的筛查。《血磷酸化-tau181蛋白用于AD的诊断》Lancet Neurology，2020年5月(11)研究旨在评估血液中磷酸化-tau181蛋白用于AD的诊断的价值。研究在四个前瞻性队列中开展，研究对象包括老年痴呆症患者和年龄匹配的对照组。研究发现血磷酸化-tau181蛋白最低的人群包括：β-淀粉样蛋白阴性的认知正常的年轻人和认知正常的老年人。血磷酸化-tau181蛋白最高的人群包括：β-淀粉样蛋白阳性的认知障碍人群和已诊断为AD患者。磷酸化-tau181蛋白能用于区别AD引起的痴呆和其他疾病神经退行性病变引起的痴呆：比如额颞叶痴呆、血管性痴呆、进行性核上性麻痹、皮质基底节综合征、帕金森病或多发性硬化（准确性可以达到81-99%）。同时，血磷酸化-tau181蛋白与PET脑内tau蛋白和和淀粉样蛋白的检测相关性在76-93%；与1年认知能力下降（p=0·0015）和海马萎缩（p=0·015）相关。在人群筛查中，血磷酸化-tau181蛋白可以用于区分青壮年和无认知障碍的老年人，但无法区分轻度认知功能障碍的人群。结论：血磷酸化-tau181蛋白可以预测脑内tau蛋白和淀粉样蛋白的病理变化，与其他神经退行性疾病区分，有望成为筛查、诊断AD的测试。《血磷酸化-tau217蛋白鉴别AD和其他神经退行性疾病的准确性》JAMA，2020年8月 (12)根据这项新的研究发现tau蛋白之一的磷酸化tau217蛋白（p-tau217）的测量可以提供敏感而准确的的淀粉样斑块和tau蛋白缠结的信息，并与阿尔茨海默氏症的诊断相对应。研究对3个队列研究的参与者均进行分别研究（亚利桑那州的神经病理学组群、瑞典BioFINDER-2队列和哥伦比亚常染色体显性AD亲属），主要目的是研究血浆P-tau217对临床或神经病理诊断的AD的鉴别准确性，以及这个检查结果与tau病理相关性。在这3个队列，共1402名参与者中，血磷酸化-tau217蛋白可以用于鉴别阿尔茨海默症和其他神经退行性疾病，其准确性可达到89-98%，明显高于其他血浆和MRI的生物标志物，与基于脑脊液或基于PET的测量结果没有显著差异。在对于有早发AD家族史的的患者中，600名参与者有60%携带PSEN1基因突变，不携带基因突变的参与者的磷酸化tau217蛋白浓度为1.9pg/ml，携带基因突变但认知功能正常的参与者升高至4.5pg/ml，携带基因突变同时出现认知功能障碍的参与者高达16.8pg/ml；而且，携带基因突变的参与者25岁时就会出现磷酸化tau-217蛋白显著升高，比出现症状早了20年。结论：这一项大型国际研究发现的新型血液测试最早可以在认知障碍发病前20年预测阿尔茨海默氏症。 参考文献1.Pittock SJ, Berthele A, Fujihara K, Kim HJ, Levy M, Palace J, et al. Eculizumab in Aquaporin-4-Positive Neuromyelitis Optica Spectrum Disorder. N Engl J Med. 2019;381(7):614-25.2.Oveisgharan S, Wilson RS, Yu L, Schneider JA, Bennett DA. Association of Early-Life Cognitive Enrichment With Alzheimer Disease Pathological Changes and Cognitive Decline. JAMA Neurol. 2020.3.Marchant NL, Lovland LR, Jones R, Pichet Binette A, Gonneaud J, Arenaza-Urquijo EM, et al. Repetitive negative thinking is associated with amyloid, tau, and cognitive decline. Alzheimers Dement. 2020;16(7):1054-64.4.Zhang R, Shen L, Miles T, Shen Y, Cordero J, Qi Y, et al. Association of Low to Moderate Alcohol Drinking With Cognitive Functions From Middle to Older Age Among US Adults. JAMA Netw Open. 2020;3(6):e207922-e.5.Cukierman-Yaffe T, Gerstein HC, Colhoun HM, Diaz R, García-Pérez LE, Lakshmanan M, et al. Effect of dulaglutide on cognitive impairment in type 2 diabetes: an exploratory analysis of the REWIND trial. Lancet Neurol. 2020;19(7):582-90.6.Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet. 2020;396(10248):413-46.7.Lamberink HJ, Otte WM, Blümcke I, Braun KPJ, Aichholzer M, Amorim I, et al. Seizure outcome and use of antiepileptic drugs after epilepsy surgery according to histopathological diagnosis: a retrospective multicentre cohort study. The Lancet Neurology. 2020;19(9):748-57.8.Rossetti AO, Schindler K, Sutter R, Ruegg S, Zubler F, Novy J, et al. Continuous vs Routine Electroencephalogram in Critically Ill Adults With Altered Consciousness and No Recent Seizure: A Multicenter Randomized Clinical Trial. JAMA Neurol. 2020.9.Chamberlain JM, Kapur J, Shinnar S, Elm J, Holsti M, Babcock L, et al. Efficacy of levetiracetam, fosphenytoin, and valproate for established status epilepticus by age group (ESETT): a double-blind, responsive-adaptive, randomised controlled trial. The Lancet. 2020;395(10231):1217-24.10.Thijssen EH, La Joie R, Wolf A, Strom A, Wang P, Iaccarino L, et al. Diagnostic value of plasma phosphorylated tau181 in Alzheimer's disease and frontotemporal lobar degeneration. Nature Medicine. 2020;26(3):387-97.11.Karikari TK, Pascoal TA, Ashton NJ, Janelidze S, Benedet AL, Rodriguez JL, et al. Blood phosphorylated tau 181 as a biomarker for Alzheimer's disease: a diagnostic performance and prediction modelling study using data from four prospective cohorts. Lancet Neurol. 2020;19(5):422-33.12.Palmqvist S, Janelidze S, Quiroz YT, Zetterberg H, Lopera F, Stomrud E, et al. Discriminative Accuracy of Plasma Phospho-tau217 for Alzheimer Disease vs Other Neurodegenerative Disorders. JAMA. 2020.

Contributor: Aaron Lessen, MD Educational Pearls: Hand raising test: a simple but effective tool to diagnose carpal tunnel  Patients hold their hands over their head and if symptoms of carpal tunnel develop within 2 minutes, it is considered positive, meaning they likely have carpel tunnel Symptom included numbness and dull pain in the distribution of the median nerve Treatment for carpal tunnel in the ED can include splinting in a neutral position and oral steroids with possible follow up for steroid injections or surgery References Padua L, Coraci D, Erra C, et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol. 2016;15(12):1273-1284. doi:10.1016/S1474-4422(16)30231-9 Ma H, Kim I. The diagnostic assessment of hand elevation test in carpal tunnel syndrome. J Korean Neurosurg Soc. 2012;52(5):472-475. doi:10.3340/jkns.2012.52.5.472 Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD

Contributor: Jared Scott, MD Educational Pearls: Cerebellar strokes make up a disproportionate number of missed or delayed diagnosis for stroke likely due to the subtle nature of the presentation Cerebellar strokes can present with vomiting, dizziness, and ataxia.  Unlike anterior circulation stroke, exam findings in a cerebellar stroke are ipsilateral to the lesion  On neuro exam, findings may include: Dysmetria: lack of coordination with overshooting/undershooting intended position of limb Dysdiadochokinesia: difficulty with rapid alternating movements Ataxia Nystagmus Consider a cerebellar stroke in patients presenting with vomiting and dizziness without an alternative diagnosis References Edlow JA, Newman-Toker DE, Savitz SI. Diagnosis and initial management of cerebellar infarction. Lancet Neurol. 2008 Oct;7(10):951-64. doi: 10.1016/S1474-4422(08)70216-3. Review. PubMed PMID: 18848314. Datar S, Rabinstein AA. Cerebellar infarction. Neurol Clin. 2014 Nov;32(4):979-91. doi: 10.1016/j.ncl.2014.07.007. Epub 2014 Sep 13. Review. PubMed PMID: 25439292. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

'Patients with GCS scores of 8 or less require prompt intubation', that's what ATLS tells us. The mantra of GCS 8, intubate has pervaded teaching for those involved in the management of patients with a reduced GCS (Glasgow Coma Scale). But on reflection it would seem slightly odd that the gain or loss of a single point on the Glasgow Coma Scale could simply account for a change in the decision as to whether a patient would benefit from intubation and ventilation. So should the patient with a GCS of 9 be best managed without a definitive airway, but when that slips to 8 we should reach for the portex®? In this podcast we take a deeper look at the GCS, we have a think about the role that it was designed to perform and consider how it should best be applied to acutely ill patients when considering protecting their airway. The podcast is based upon the blog from the TEAM Course blog(Training in Emergency Airway Management), make sure to go and have a look at the post and other resources available on that site. Enjoy! Simon, Rob & James References GCS 8 intubate; TEAMcourse Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg.2013;74(5):1363-6.Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2(7872):81-4. Teasdale G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G.The Glasgow Coma Scale at 40 years: standing the test of time.Lancet Neurol. 2014;13(8):844-54. Duncan R, Thakore S. Decreased Glasgow Coma Scale score does not mandate endotracheal intubation in the emergency department. J Emerg Med. 2009;37(4):451-5. Green SM. Cheerio, laddie! Bidding farewell to the Glasgow Coma Scale.Ann Emerg Med. 2011;58(5):427-30. Healey C, Osler TM, Rogers FB, et al. Improving the Glasgow Coma Scale score: motor score alone is a better predictor.J Trauma. 2003;54(4):671-8. Isbister GK, Downes F, Sibbritt D, Dawson AH, Whyte IM. Aspiration pneumonitis in an overdose population: frequency, predictors, and outcomes.Crit Care Med. 2004;32(1):88-93. Adnet F, Baud F. Relation between Glasgow Coma Scale and aspiration pneumonia.Lancet. 1996;348(9020):123-4. Kulig K, Rumack BH, Rosen P. Gag reflex in assessing level of consciousness.Lancet. 1982;1(8271):565. Rotheray KR, Cheung PS, Cheung CS, et al. What is the relationship between the Glasgow coma scale and airway protective reflexes in the Chinese population?.Resuscitation. 2012;83(1):86-9. Moulton C, Pennycook A, Makower R. Relation between Glasgow coma scale and the gag reflex.BMJ. 1991;303(6812):1240-1.

Author: Sam Killian, MD Educational Pearls: Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) occurs in 1:100000 individuals The disease is caused by a defect in the NOTCH3 gene on chromosome 19 It is an important cause of stroke in young patients Features include ischemia, cognitive deficits, migraines, psychiatric disease, coma, and seizure, all of which is worse with pregnancy Migraine with aura is often the first presenting symptom with onset by age 30 Strokes typically can occur by age 50 Diagnosis is with MRI for characteristic lesions Unfortunately there is no cure, and treatment is focused on stroke prevention with aspirin and statins References: Chabriat H, Joutel A, Dichgans M, Tournier-Lasserve E, Bousser MG. Cadasil. Lancet Neurol. 2009 Jul;8(7):643-53. doi: 10.1016/S1474-4422(09)70127-9. Review. PubMed PMID: 19539236. Summarized by Will Dewispelaere, MS3 | Edited by Erik Verzemnieks, MD  

Author: Don Stader, MD Educational Pearls: Vertebral artery dissection (VAD) contributes to just 2% of strokes overall but ~25% of strokes for patients < 30 VAD is associated with minor trauma (chiropractic manipulation, yoga), typically with neck extension and rotation. VAD can cause posterior stroke symptoms (vertigo, diplopia, Horner’s Syndrome, Wallenberg Syndrome) Overall a good prognosis with around 50% of patients recovering without lasting neurologic deficits. References: Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol. 2009 Jul;8(7):668-78. doi: 10.1016/S1474-4422(09)70084-5. Review. PubMed PMID: 19539238. Gottesman RF, Sharma P, Robinson KA, et al. Clinical characteristics of symptomatic vertebral artery dissection: a systematic review. Neurologist. 2012;18(5):245-54. Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med. 2001 Mar 22;344(12):898-906. Review. PubMed PMID: 11259724.   Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD  

Please support us on https://www.patreon.com/MinuteEarth or as a YouTube Sponsor! Thanks to everyone who already does! Shocking the brain has come and gone as a medical treatment, but it’s currently resurging, as it often provides the best form of relief for severe depression and advanced Parkinson’s disease. ___________________________________________ To learn more, start your googling with these keywords: Electroshock therapy: the original name for treating severe depression with a series of brief electrical shocks to the brain Electroconvulsive therapy: the current name for electroshock therapy Deep brain stimulation: a treatment for advanced Parkinson’s that uses pulsed electrical signals to targeted brain regions ___________________________________________ Subscribe to MinuteEarth on YouTube: http://goo.gl/EpIDGd Support us on Patreon: https://goo.gl/ZVgLQZ And visit our website: https://www.minuteearth.com/ Say hello on Facebook: http://goo.gl/FpAvo6 And Twitter: http://goo.gl/Y1aWVC And download our videos on itunes: https://goo.gl/sfwS6n ___________________________________________ Credits (and Twitter handles): Script Writer: Peter Reich Script Editor: Alex Reich (@alexhreich) Video Illustrator: Arcadi Garcia Video Director: Kate Yoshida (@KateYoshida) Video Narrator: Kate Yoshida (@KateYoshida) With Contributions From: Henry Reich, Ever Salazar, Emily Elert, David Goldenberg Music by: Nathaniel Schroeder: http://www.soundcloud.com/drschroeder ___________________________________________ References: Arlotti M, et al 2016. The adaptive deep brain stimulation challenge. Parkinsonism and Related Disorders 28: 12-17 Benabid AL, S Chabardes, J Mitrofanis, P Polla. 2009. Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson’s disease. Lancet Neurol. 8:67-81 Leiknes KA, Jarosh-von Schweder L, Høie B. 2012. Contemporary use and practice of electroconvulsive therapy worldwide. Brain and Behavior 2(3):283-344 Pagnin D, et al. 2004. Efficacy of ECT in Depression: A Meta-Analytic Review. J ECT 20:13-20 Sienaert P, K Vansteeland, K Demyttenaere, J Peuskens. 2010. Randomized comparison of ultra-brief bifrontal and unilateral electroconvulsive therapy for major depression: cognitive side-effects. J Affective Disorders 122:60-67 UK ECT Review Group, 2003. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 361, 799–808.

Ep #21 Ketamine Induced Rapid Sequence Intubation with Faizan H. Arshad, MD @emscritcare Happy #EMSWeek #EMSStrong #EMSNation   SKEPTIC = Safety & Efficacy of Ketamine in Emergent Prehospital Tracheal Intubation – a Case Series   Brand new paper from Sydney HEMS on Ketamine and Shock Index in Annals of EM! http://www.annemergmed.com/article/S0196-0644(16)30002-6/abstract   Additional References: Carlson JN, Karns C, Mann NC, et al. Procedures performed by emergency medical services in the united states.Prehosp Emerg Care. 2015. Jacobs PE, Grabinsky A. Advances in prehospital airway management.International Journal of Critical Illness & Injury Science. 2014;4:57-64. Prekker ME, Kwok H, Shin J, Carlbom D, Grabinsky A, Rea TD. The process of prehospital airway management: Challenges and solutions during paramedic endotracheal intubation.Crit Care Med. 2014;42:1372-1378. Wang HE, Kupas DF, Greenwood MJ, et al. An algorithmic approach to prehospital airway management.Prehospital Emergency Care. 2005;9:145-155. Mace SE. Challenges and advances in intubation: Airway evaluation and controversies with intubation.Emerg Med Clin North Am. 2008;26:977-1000. Combes X, Jabre P, Jbeili C, et al. Prehospital standardization of medical airway management: Incidence and risk factors of difficult airway.Acad Emerg Med. 2006;13:828-834. Drummond GB. Comparison of sedation with midazolam and ketamine: effects on airway muscle activity. Br J Anaesth. 1996;76:663-667. Jackson APF, Dhadphale PR, callaghan ML, Alseri S. Haemodynamic studies during induction of anaesthesia for open-heart surgery using diazepam and ketamine. Br J Anaesth. 1978;50:375-378. Price B, Arthur AO, Brunko M, et al. Hemodynamic consequences of ketamine vs etomidate for endotracheal intubation in the air medical setting. Am J Emerg Med. 2013;31:1124-1132. Scherzer D, Leder M, Tobias JD. Pro-Con Debate: Etomidate or Ketamine for Rapid Sequence Intubation in Pediatric Patients. J Pediatr Pharmacol Ther. 2012;17:142-149. Bruder Eric A, Ball Ian M, Ridi S, Pickett W, Hohl C. Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients.Cochrane Database of Systematic Reviews. 2015 Thompson Bastin ML, Baker SN, Weant KA. Effects of Etomidate on Adrenal Suppression: A Review of Intubated Septic Patients.Hospital Pharmacy. 2014;49:177-183. Arnold C. The promise and perils of ketamine research Ketamine began its life as an anaesthetic , but has enjoyed a recent renaissance as a potential. Lancet Neurol. 2013;12:940-941. Craven R. Ketamine. Anaesthesia. 2007;62:48-53. Perkins ZB, Gunning M, Crilly J, Lockey D, O’Brien B. The haemodynamic response to pre-hospital RSI in injured patients. Injury. 2013;44:618-623. Aroni F, Iacovidou N, Dontas I, Pourzitaki C, Xanthos T. Pharmacological Aspects and Potential New Clinical Applications of Ketamine: Reevaluation of an Old Drug. J Clin Pharmacol. 2009;49:957-964. Manthous CA. Avoiding circulatory complications during endotracheal intubation and initiation of positive pressure ventilation.J Emerg Med. 2010;38:622-631. Kohrs R, Durieux ME. Ketamine. Anesth Analg. 1998;87:1186-1193. Moy RJ, Clerc S Le. Trends in Anaesthesia and Critical Care Ketamine in prehospital analgesia and anaesthesia. Trends Anaesth Crit Care. 2011;1:243-245. Reich DL, Silvay G. Ketamine: an update on the first twenty-five years of clinical experience. Can J Anaesth. 1989;36(2):186-197. Porter K. Ketamine in prehospital care. Emerg Med J. 2004;21:351-354. Svenson JE, Abernathy MK. Ketamine for prehospital use: new look at an old drug. Am J Emerg Med. 2007;25:977-980. Johansson J, Sjöberg J, Nordgren M, Sandström E, Sjöberg F, Zetterström H. Prehospital analgesia using nasal administration of S-ketamine--a case series. Scand J Trauma Resusc Emerg Med. 2013;21:38. Filanovsky Y, Miller P, Kao J. Myth: Ketamine should not be used as an induction agent for intubation in patients with head injury. Can J Emerg Med. 2010;12:154-201. Himmelseher S, Durieux ME. Revising a Dogma: Ketamine for Patients with Neurological Injury? Anesth Analg. 2005;101:524-534. Kropf J a., Grossman MD, Genzlinger M a., Stoltzfus J, Stehly CD. 328 Ketamine versus Etomidate for Rapid Sequence Intubation in Traumatically Injured Patients: An Exploratory Study. Ann Emerg Med. 2012;60:S117. Angus DC, van dP. Severe sepsis and septic shock.N Engl J Med. 2013;369:840-851. Jabre P, Avenel A, Combes X, et al. Morbidity related to emergency endotracheal intubation-A substudy of the KETAmine SEDation trial. Resuscitation. 2011;82:517-522. Shafi S, Gentilello L. Pre-Hospital Endotracheal Intubation and Positive Pressure Ventilation Is Associated with Hypotension and Decreased Survival in Hypovolemic Trauma Patients: An Analysis of the National Trauma Data Bank. The Journal of Trauma: Injury, Infection, and Critical Care. 2005;59:1140–1147. Seymour CW, Band RA, Cooke CR, et al. Out-of-hospital characteristics and care of patients with severe sepsis: A cohort study.J Crit Care. 2010;25:553-562. Williams E, Arthur a., Price B, Banister NJ, Goodloe JM, Thomas SH. 175 Ketamine versus Etomidate for Use in Helicopter Emergency Medical Services Endotracheal Intubation. Ann Emerg Med. 2012;60:S63-S64 Bruns, B, Gentilello, L, Elliott, A, Shafi, S. Prehospital Hypotension Redefined. The Journal of Trauma: Injury, Infection, and Critical Care. 2008;65:1217–1221. Seymour, CW, Cooke, CR, Heckbert, SR, et al. Prehospital Systolic Blood Pressure Thresholds: A Community-based Outcomes Study. Acad Emerg Med Academic Emergency Medicine. 2013;20:597–604. Kristensen AKB, Holler JG, Mikkelsen S, Hallas J, Lassen A. Systolic blood pressure and short-term mortality in the emergency department and prehospital setting: a hospital-based cohort study.Critical Care. 2015;1:158. Heffner AC, Swords DS, Neale MN, Jones AE. Incidence and factors associated with cardiac arrest complicating emergency airway management. Resuscitation. 2013;84:1500-1504. Salt PJ, Baranes PK, Beswick FJ. Inhibition of neuronal and extraneuronal uptake of noradrenaline by ketamine in the isolated perfused rat heart. Br J Anaesth. 1979;51:835-838. Sprung J, Schuetz SM, Stewart RW, Moravec CS. Effects of Ketamine on the Contractility of Failing and Nonfailing Human Heart Muscles in Vitro. Surv Anesthesiol. 1999;43:230-231. Kunst G, Martin E, Graf BM, Hagl S, Vahl CF. Actions of Ketamine and Its Isomers on Contractility and Calcium Transients in Human Myocardium. Anesthesiology. 1999;90:1363-1371. Lundy PM, Lockwood PA, Thompson G, Frew R. Differential Effects of Ketamine Isomers on Neuronal and Extraneuronal Catecholamine Uptake Mechanisms. Anesthesiology. 1986;64:359-363. Selde W. Push dose epinephrine. A temporizing measure for drugs that have the side-effect of hypotension.JEMS. 2014;39:62-63.   Sponsored by @PerfectCPR Apple Watch App with Audio and Haptic Feedback to Optimize Cardiac Arrest Training and Improve Quality of CPR Delivery PerfectCPR.com     Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org  

Dr. Stephen Goutman interviews Dr. Nadine Attal about the article she coauthored in Lancet Neurology on pharmacotherapy for neuropathic pain in adults. Drs. Goutman and Attal discuss the evidence and limitations supporting each class of medication aimed at the treatment of neuropathic pain and how these recommendations can be incorporated into clinical practice. Lancet Neurol. 2015 Feb;14:162-173.

Dr. Stephen Goutman interviews Dr. Nadine Attal about the article she coauthored in Lancet Neurology on pharmacotherapy for neuropathic pain in adults. Drs. Goutman and Attal discuss the evidence and limitations supporting each class of medication aimed at the treatment of neuropathic pain and how these recommendations can be incorporated into clinical practice. Lancet Neurol. 2015 Feb;14:162-173.

Dr. Stephen Goutman interviews Dr. Nadine Attal about the article she coauthored in Lancet Neurology on pharmacotherapy for neuropathic pain in adults. Drs. Goutman and Attal discuss the evidence and limitations supporting each class of medication aimed at the treatment of neuropathic pain and how these recommendations can be incorporated into clinical practice. Lancet Neurol. 2015 Feb;14:162-173.

Kevin Biese describes the signs and symptoms of delirium in older adults, and drops some pearls on how to manage it safely. For the shownotes and blog site, see: http://gempodcast.com/2015/11/11/diagnosing-and-managing-delirium-in-older-adults/ Welcome to GEMCAST! In this inaugural episode, first published 09/2015, Kevin Biese talks us through some practical tips for preventing, identifying, and managing delirium in older adults in the Emergency Department. Delirium is incredibly common among older adults in the ED, but is easy to miss. It is also an independent predictor of 6 month mortality. How is it diagnosed? Why does it matter that we identify it? How can you prevent it? How do you safely treat symptoms of agitation in an older adult? How can you differentiate it from dementia in the acute care setting? – Take a listen. References: 1. Barrio K, Biese K. Delirium, dementia, and other mental health disorders of older adults. In: Tintinalli JE, Stapczynski JS, Ma OJ, et al, eds. Tintinalli’s emergency medicine: A comprehensive study guide. 8th ed. ; 2011. Accessed 07/23/2015. 2. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911-922. PMID: 23992774 3. Fong TG, Davis D, Growdon ME, Albuquerque A, Inouye SK. The interface between delirium and dementia in elderly adults. Lancet Neurol. 2015;14(8):823-832. PMID: 26139023 4. Han JH, Eden S, Shintani A, et al. Delirium in older emergency department patients is an independent predictor of hospital length of stay. Acad Emerg Med. 2011;18(5):451-457. PMID: 21521405 5. Han JH, Shintani A, Eden S, et al. Delirium in the emergency department: An independent predictor of death within 6 months. Ann Emerg Med. 2010;56(3):244-252.e1. PMID: 20363527 6. Han JH, Wilson A, Vasilevskis EE, et al. Diagnosing delirium in older emergency department patients: Validity and reliability of the delirium triage screen and the brief confusion assessment method. Ann Emerg Med. 2013;62(5):457-465. PMID: 23916018 7. Marcantonio ER. Delirium. In: Pacal JT, Sullivan GM, eds. Geriatrics review syllabus: A core curriculum in geriatric medicine. 7th ed. New York, NY: American Geriatrics Society; 2010 This podcast uses sound 173181 from freesound.com by jobro

Do you have a plan for your little patient when he just won’t stop seizing?  What do you do when your typical treatment is not enough? Get up-to-date in the understanding and management of pediatric status epilepticus. Definition of status epilepticus:Continuous seizure activity of 5 minutes or greater – OR – Recurrent activity without recovery between intervals.  (This definition includes clinically apparent seizures as well as those seen only on EEG.) During a seizure, GABA receptors in the neuron’s membrane are internalized and destroyed.  Seizure activity itself starts this self-defeating process – this is the first reason we need to act as quickly as possible and take advantage of the GABA receptors that are still recruitable. Excitatory receptors – the NMDA receptors – are acutely upregulated and mobilize to the neuron’s surface.  This is the second reason to act quickly and avoid this kindling effect. In other words – time is brain. Or… is it something else as well? Pediatric status epilepticus is analogous to the multi-organ dysfunction syndrome in severe sepsis.  Status epilepticus affects almost every organ system.  Cardiac – dysrhythmias, high output failure, and autonomic dysregulation resulting in hypotension or hypertension.  Respiratory – apnea and hypoxia, ARDS, and potentially aspiration pneumonia.  Renal – rhabdomyolysis, myoglobinuria, and acute renal failure. Metabolic – lactic acidosis, hypercapnia, hyperglycemia, sometimes hypoglycemia, hyperkalemia, and leukocytosis. Autonomic – hyperpyrexia and breakdown of cerebral circulation.  DeLorenzo et al.: Mortality correlated with time seizing.  Once the seizure has met the 30 min mark, Delorenzo reported a jump from 4.4% mortality to 22%!  If the seizure lasts greater than 2 hours, 45%.  Time spent seizing is a vicious cycle: it’s harder to break the longer it goes on, and the longer it goes on, the higher the mortality. Think about treatment of pediatric status epilepticus in terms of time: prehospital care, status epilepticus (greater than 5 min), initial refractory status epilepticus (greater than 10 min), later refractory status (at 20 min), and coma induction (at 25 minutes). Case 1: Hyponatremic Status Epilepticus Give 3 mL/kg of 3% saline over 30 min. Stop the infusion as soon as the seizure stops. Case 2: INH toxicity Empiric treatment -- you are the test.  If we know the amount of ingestion in adults or children, we give a gram-for-gram replacement, up to 5 grams.  If a child under 2 years of age arrives to you in stats epilepticus, give 100 mg of IV pyridoxime for potentially undiagnosed congenital deficiency. Case 3: Headache and Arteriovenous Malformation Unlike in adults, stroke in children is divided evenly between hemorrhagic and ischemic etiologies.  The differential is vast: cardiac, hematologic, infectious, vascaulr, syndromic, metabolic, oncologic, traumatic, toxic.  Treatment: stabilization, embolization by interventional radiology, elective extirpation when more stable.  Other options for stable patients include an endovascular flow-directed microcatheter using cyanoacrylate. Radiosurgery is an options for others. Non-convulsive Status Epilepticus Risk factors include age < 18, especially age < 1, no prior history of seizures, and traumatic brain injury.  This would prompt you to ask for continuous EEG monitoring for non-convulsive status epilepticus, especially when there is a change in mental status for no other reason.  Also, a prolonged post-ictal state or prolonged altered mental status.  Other considerations are those who had a seizure and cardiac arrest -  ROSC without RONF, those with traumatic brain injury, and those needing ECMO – all within the context of seizures. SUMMARY POINTS The longer the seizure lasts, the harder it is to break – act quickly Have a plan for normal escalation of care, and Search for an underlying cause Recognize when the routine treatment is not enough.Before You Go “Healing is a matter of time, but it is sometimes also a matter of opportunity.” “Extreme remedies are very appropriate for extreme diseases.”  – Hippocrates of KosSelected References Abend NS et al. Nonconvulsive seizures are common in critically ill children. Neurology. 2011; 76(12):1071-7 Baren J. Pediatric Seizures and Strokes: Beyond Benzos and Brain Scans. ACEP Scientific Assembly. October 8th, 2009. Boston, MA. Brophy et al. Guidelines for the Evaluation and Management of Status Epilepticus. Neurocrit Care. 2012; DOI 10.1007/s12028-012-9695-z Capovilla G et al. Treatment of convulsive status epilepticus in childhood: Recommendations of the Italian League Against Epilepsy. Epilepsia. 2013; 54 Suppl 7:23-34 Chin RFM et al., for the NLSTEPSS Collaborative Group. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet. 2006; 368: 222–29. Chen JW, Chamberlain CG. Status epilepticus: pathophysiology and management in adults. Lancet Neurol. 2006; 5:246-256. DeLorenzo RJ. Comparison of status epilepticus with prolonged seizure episodes lasting from 10 to 29 minutes. Epilepsia. 1999 Feb;40(2):164-9. LaRoche SM, Helmers SL. The New Antiepileptic Drugs: Scientific Review. JAMA. 2004;291:605-614. Minns AB, Ghafouri N, Clark RF. Isoniazid-induced status epilepticus in a pediatric patient after inadequate pyridoxine therapy. Pediatr Emerg Care. 2010; 26(5):380-1. Ogilvy CS et al. Recommendations for the Management of Intracranial Arteriovenous Malformations: A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Stroke Council. Stroke. 2001; 32: 1458-1471 Rosati A et al. Efficacy and safety of ketamine in refractory status epilepticus in children. Neurology. 2012; 79:2355-2358. Schwartz ID. Hyponatremic seizure in a child using desmopressin for nocturnal enuresis.  Arch Pediatr Adolesc Med. 1998 Oct;152(10):1037-8 Trommer BL, Pasternak JF.  NMDA receptor antagonists inhibit kindling epileptogenesis and seizure expression in developing rats. Brain Res Dev Brain Res. 1990 May 1;53(2):248-52. Waterhouse EJ et al. Prospective population-based study of intermittent and continuous convulsive status epilepticus in Richmond, Virginia. Epilepsia. 1999 Jun;40(6).

This podcast discusses information from the article "Vasculitic Neuropathies" in Lancet Neurology. The vasculitic neuropathies are a diverse group of disorders characterized by the acute-to-subacute onset of painful sensory and motor deficits that result from inflammatory destruction of nerve blood vessels and subsequent ischaemic injury. They are common in patients with primary systemic vasculitis and are seen in vasculitis secondary to disorders such as rheumatoid arthritis, viral infections, and diabetic inflammatory neuropathies. It is imperative that neurologists recognize these disorders to initiate treatment promptly and thereby prevent morbidity and mortality. Lancet Neurol. 2014 Jan;13(1):67-82. doi: 10.1016/S1474-4422(13)70236-9.

This podcast discusses information from the article "Vasculitic Neuropathies" in Lancet Neurology. The vasculitic neuropathies are a diverse group of disorders characterized by the acute-to-subacute onset of painful sensory and motor deficits that result from inflammatory destruction of nerve blood vessels and subsequent ischaemic injury. They are common in patients with primary systemic vasculitis and are seen in vasculitis secondary to disorders such as rheumatoid arthritis, viral infections, and diabetic inflammatory neuropathies. It is imperative that neurologists recognize these disorders to initiate treatment promptly and thereby prevent morbidity and mortality. Lancet Neurol. 2014 Jan;13(1):67-82. doi: 10.1016/S1474-4422(13)70236-9.

An interview with Joshua Burns, PhD, about the paper, Ascorbic acid for Charcot–Marie–Tooth disease type 1A in children: a randomized, double-blind, placebo-controlled, safety and efficacy trial in Lancet Neurol. 2009 Jun;8(6):537-44. Interviewed by Ted Burns, MD.

An interview with Joshua Burns, PhD, about the paper, Ascorbic acid for Charcot–Marie–Tooth disease type 1A in children: a randomized, double-blind, placebo-controlled, safety and efficacy trial in Lancet Neurol. 2009 Jun;8(6):537-44. Interviewed by Ted Burns, MD.

An interview with Joshua Burns, PhD, about the paper, Ascorbic acid for Charcot–Marie–Tooth disease type 1A in children: a randomized, double-blind, placebo-controlled, safety and efficacy trial in Lancet Neurol. 2009 Jun;8(6):537-44. Interviewed by Ted Burns, MD.