Podcasts about neuro oncology

Dr. Iyad Alnahhas interviews Dr. Peter LaViolette about his and his team's recent manuscript entitled: "Multi-Site Retrospective Analysis of Diffusion and Perfusion MRI Correlates to Glioma Characteristics Derived from Radio-Pathomic Maps", published online in Neuro-Oncology in February 2025.

Send us a textDr. Ashley Aaroe joins us today to talk all about Neuro-oncology, from brain tumor classification, to complications of chemotherapy and immunotherapy, to the importance of patient advocacy.Find her on X/Twitter.  Check out our website at www.theneurotransmitters.com to sign up for emails, classes, and quizzes! Would you like to be a guest or suggest a topic? Email us at contact@theneurotransmitters.com Follow our podcast channel on

Description: Dr. Evan Noch interviews Drs. Cecile Riviere-Cazaux and Terry Burns about their recent manuscript entitled: "A field resource for the glioma cerebrospinal fluid proteome: impacts of resection and location on biomarker discovery", published online in Neuro-Oncology in December 2024.   Link: https://doi.org/10.1093/neuonc/noae277  

Israel Gasperin is a visionary entrepreneur, engineering scientist and the founder of Zentrela, a company dedicated to transforming cannabis research through advanced neurotechnology and AI. Under Israel's leadership, Zentrela developed the Psychoactive Effect Level (PEL) metric, an innovative EEG-based measure capable of objectively assessing cannabis products' psychoactive potency. By combining wearable EEG technology with AI-driven EEG analysis, the PEL metric provides cannabis producers, researchers, and regulators with a non-invasive and cost-effective way to quantify product effects and maintain quality control.  At CannMed 25, Israel will share results from over 10,000 EEG scans of consumers using a wide range of cannabis products in his oral presentation titled “Cannabis Effect Research Driven by EEG Technology and Machine Learning”. During our conversation, we discuss:  How Zentrela's wearable EEG technology got its start measuring drowsiness in truck drivers   The unreliability of consumer feedback with regards to cannabis product effects  How the PEL metric was created to measure the unique psychoactive effects of cannabis How producers can use PEL to objectively measure the quality and effectiveness of cannabis products beyond cannabinoid percentages  Research findings that show THC% and PEL% are not directly correlated  and more  Thanks to This Episode's Sponsor: The DENT Institute With more than 300,000 patient visits per year, the DENT Neurologic Institute ranks among the largest neuroscience centers in North America. Its 24 subspecialty clinics often treat the most challenging neurologic conditions including but not limited to Migraine, Chronic pain, ALS, MS, Parkinson's, Dementia, and Neuro-Oncology. With their mission of advancing neuroscience, the Dent Institute established a cannabis clinic in 2016 to aid in the treatment of these chronic conditions seen throughout the institute. Learn more at dentinstitute.com Additional Resources Zentrela Website Israel Gasperin on LinkedIn Use of a Novel EEG-Based Objective Test, the Cognalyzer®, in Quantifying the Strength and Determining the Action Time of Cannabis Psychoactive Effects and Factors that May Influence Them Within an Observational Study Framework Sensitivity, Specificity and Accuracy of a Novel EEG-Based Objective Test, the Cognalyzer®, in Detecting Cannabis Psychoactive Effects Register for CannMed 25 Meet the CannMed 25 Speakers and Poster Presenters Review the Podcast CannMed Archive

Send us a textDr. Mahmoud Alyamany, MD is Health And Wellbeing Sector Head, at NEOM ( https://www.neom.com/en-us/our-business/sectors/health-wellbeing-and-biotech ), where he is responsible for overseeing a revolution in healthcare delivery at Saudi Arabia's accelerator of human progress and hub for innovation.Dr. Alyamany brings a vast understanding of health and wellbeing issues facing the wider population being on many of the Boards driving the healthcare transformation in the Kingdom including:  Co-Chairman of the Founding Board of Directors, Western Healthcare Clusters Board, Member of the Founding Board of Directors Northern Healthcare Clusters Board, Member of the Board of Advisors King Khalid Eye Specialist Hospital, and Healthcare Transformation Advisor to the Minister of Health. Previous roles for Dr. Alyamany have also included chairing the Board for Madinah Health Cluster and CEO of Riyadh 2nd Health Cluster and King Fahad Medical City.  This vast experience, combined with his medical background in practice, gives him a unique understanding of the population health management and impacts of operational and clinical practice to drive sustainable solutions delivering improvements in patient outcomes.Dr. Alyamany gained master's degrees in health administration, and health management from Washington University, bachelor's degrees in medicine, and surgery from King Saud University's college of medicine in Riyadh.Dr. Alyamany also did Fellowships in Cerebrovascular Surgery and Neuro-Oncology & Skull-Base Surgery, University of Toronto, and a Fellowship, Pediatric Neurosurgery, Western University.Dr. Alyamany has also served as director of the National Neuroscience Institute, chairman of the board of directors of the Scientific Committee for Neurosurgery, medical director of neurology and head of the department of neurosurgery, both at King Fahd Medical City, and as a consultant of neurosurgery at the Riyadh Medical Complex. #Neom #SaudiArabia #DigitalTwins #AI #DigitalHealth #SmartCities #Genetics #Epigenetics #Neuroscience #HealthyAging  #CerebrovascularSurgery #NeuroOncology #PediatricNeurosurgery #ProgressPotentialAndPossibilities #IraPastor #Podcast #Podcaster #Podcasting #ViralPodcast #STEM #Innovation #Science #Technology #ResearchSupport the show

Description: Dr. Ankush Bhatia interviews Drs. Macarena de la Fuente and Mehdi Touat about their recent manuscript entitled: "The role of vorasidenib in the treatment of isocitrate dehydrogenase-mutant glioma" published online in Neuro-Oncology in December 2024.   Link: https://doi.org/10.1093/neuonc/noae259

Dr. Iyad Alnahhas interviews Dr. Craig Horbinski about his and his team's recent manuscript entitled "The novel DNA cross-linking agent KL-50 is active against patient-derived models of new and recurrent post-temozolomide mismatch repair-deficient glioblastoma", published online in Neuro-Oncology in December 2024.

Dr. Iyad Alnahhas interviews Dr. Nathalie Albert about her and her team's recent manuscript entitled: "Measurable disease as baseline criterion for response in glioblastoma: A comparison of PET-based (PET RANO 1.0) and MRI-based (RANO) assessments", published online in Neuro-Oncology in January 2025.

Send us a textIn this episode we welcome Dr. Na Tosha Gatson, Director of Neuro-Oncology & Professor of Neurology and Medicine at IU Health. A leader in the field, Dr. Gatson shares insights on advancements in neuro-oncology, the impact of brain tumors on women's health, addressing health disparities, and the importance of quality-of-life care. Support the show

In a conversation with CancerNetwork®, Shewetal Mehta, PhD, spoke about her research team's focuses in moving novel brain cancer therapies down the pipeline as part of an early phase clinical trials program at the Ivy Brain Tumor Center. Mehta, the deputy director and pre-clinical core leader at the Ivy Brain Tumor Center of Barrow Neurological Institute in Phoenix, Arizona, underscored a scientifically rigorous, patient-driven philosophy that drives her team members to deliver timely answers to those with brain cancer via work in a clinical lab and a pre-clinical arm. This collaboration helps identify therapeutic agents that may demonstrate activity in the brain while determining patient populations who are suitable to enroll on clinical trials. As part of her institution's early phase trial program, Mehta specifically highlighted work associated with a phase 0/1 clinical trial (NCT06072586) evaluating BDTX-1535, a brain-penetrant fourth-generation EGFR inhibitor, for those with recurrent high-grade glioma harboring oncogenic EGFR alterations or fusions.1 Investigators are incorporating liquid biopsy, sampling cerebrospinal fluid from patients on treatment to monitor potential evolutions or changes in brain tumors. Regarding biomarker testing, Mehta described the roles that gene sequencing and immunohistochemistry can play in identifying targetable alterations in patients with brain cancer. She mentioned vorasidenib (Voranigo), which received approval from the FDA in August 2024, as an example of a targeted therapy that may be suitable for use in patients who are found to have actionable IDH mutations. “Over the last year, we've seen that we were capable of not just doing these early phase clinical trials [but of entering] this phase of moving drugs into phase 3 [studies]. That's exciting,” Mehta stated regarding her outlook on the current state of brain cancer treatment. “Right now, we are excited about these new classes of agents that are within the space, like the proteolysis targeting chimeras, protein degraders, and antibody-drug conjugates, which have shown amazing promise in the rest of the oncology space.” References 1.        Study of BDTX-1535 in recurrent high-grade glioma (HGG) participants with EGFR alterations or fusions. ClinicalTrials.gov. Updated January 15, 2025. Accessed January 15, 2025. https://tinyurl.com/m6kwr2b3 2.        FDA approves vorasidenib for grade 2 astrocytoma or oligodendroglioma with a susceptible IDH1 or IDH2 mutation. News release. FDA. August 6, 2024. Accessed January 20, 2025. https://tinyurl.com/25r9fkvy

Drs Camidge and Boire discuss Dr Boire's journey to becoming a physician-scientist, moments in her career that shaped her fascination with neurology, and how studying human biology at the cellular level can ultimately help improve the lives of patients with cancer.

Dr. Iyad Alnahhas interviews Dr. Danielle Bazer about her and her team's recently published manuscript, entitled: Using a Pre-Radiation Window to Identify Potentially Active Cytotoxic Agents in Adults with Newly Diagnosed Glioblastoma", published online in Neuro-Oncology in November 2024.

Dr. Rachna Malani interviews Drs. Felix Sahm and Arie Perry about their recent manuscript entitled: "cIMPACT-NOW Update 8: Clarifications on molecular risk parameters and recommendations for WHO grading of meningiomas", published online in Neuro-Oncology in August 2024   Read More

Dr. Iyad Alnahhas interviews Drs. Thomas Zeyen and Johannes Weller about their recent manuscript entitled: "Quantitative assessment of residual tumor is a strong and independent predictor of survival in methylated glioblastoma following radiochemotherapy with CCNU/TMZ", published online in Neuro-Oncology in October 2024.

Dr. Trisha Larkin is the Director of Pediatric Neuro-Oncology at St. Joseph's Children's Hospital. She is dual-board certified in pediatrics and pediatric hematology-oncology. Dr. Larkin earned her medical degree from Florida International University College of Medicine, followed by a Master of Business Administration in healthcare. She completed her postdoctoral training at Nicklaus Children's Hospital and at the University of Florida Shands Children's Hospital, where she completed a fellowship in pediatric hematology-oncology and bone marrow transplantation. She went on to complete a prestigious advanced fellowship in neuro-oncology at St. Jude Children's Research Hospital in Tennessee. While at St. Jude, she worked on a team of world-renowned physicians to care for children diagnosed with complex brain and spinal tumors. Dr. Larkin is passionate about discovering innovative strategies to improve the care of children with brain tumors and serves as a lead investigator for the Sunshine Project consortium through the National Pediatric Cancer Foundation.  She has been awarded numerous grants for her research in early-phase clinical trials and has authored several peer-reviewed publications in leading oncology journals such as the Journal of Clinical Oncology and Neuro-Oncology. Dr. Larkin has been invited to present her research around the world, including in Germany and Japan.  She serves as associate editor for Neuro-Oncology on the MedNet, an interactive platform for physicians around the world to gather insight about treating complex oncologic diagnoses.  Dr. Larkin is deeply involved in the pediatric cancer community and enjoys volunteering her time to support childhood cancer.for more information on how to be involved go to noraswarriors.com or nationalpcf.org

Send us a textAnd just like that, we have made it to the last episode of the IM Board Review Series! In this episode, we talk about all things neuro-oncology including:Presentation Primary CNS tumors Metastatic Brain TumorsMedical Management of Complications of CNS TumorsParaneoplastic Syndromes Check out our website at www.theneurotransmitters.com to sign up for emails, classes, and quizzes! Would you like to be a guest or suggest a topic? Email us at contact@theneurotransmitters.com Follow our podcast channel on

Dr. Evan Noch interviews Drs. Nathan Leclair, David Raleigh and Olga Anczukow about their recent manuscript entitled: "RNA splicing as a biomarker and phenotypic driver of meningioma DNA methylation groups", published online in Neuro-Oncology in August 2024.  

Dr. Evan Noch interviews Drs. Pravesh Gupta and Krishna Bhat about their recent manuscript entitled "Immune landscape of isocitrate dehydrogenase-stratified primary and recurrent human gliomas", published online in Neuro-Oncology in August 2024 Read Paper

Patients with newly diagnosed, surgically resected MGMT-unmethylated glioblastoma may benefit from treatment with a therapeutic mRNA vaccine called CVGBM, according to findings from a first-in-human, Phase I safety and dose-escalation study from Tübingen, Germany, reported at the ESMO Congress 2024 held in Barcelona. The CVGBM vaccine encodes multiple molecular features derived from tumor-associated antigens, all of which were judged to be potentially relevant in glioblastoma. After reporting her group’s findings to the ESMO Barcelona meeting, first author Ghazaleh Tabatabai, MD, PhD, a neurologist, Professor of Neuro-Oncology, and Chair of the Department of Neurology and Interdisciplinary Neuro-Oncology at the University Hospital, Tübingen, Germany, talked about the findings with Oncology Times reporter Peter Goodwin.

With a BSc. in molecular biology and an MSc. in physiology, Liz has studied the human body through many lenses. The focus of her PhD program (Pharmacy) is to explore disorders that have directly impacted her life in the world of professional contact sports, and how cannabinoid products could potentially play a role in these.  As a member of the clinical trial team that was recently awarded funding from the NFL to study cannabinoids in concussion and pain, she is excited to bring new data to the literature exploring cannabinoids and athletics. Liz and her team recently published an extensive literature review titled Cannabinoid Therapy in Athletics: A Review of Current Cannabis Research to Evaluate Potential Real‑World Cannabinoid Applications In Sport, which establishes a foundation for their future research.   During our conversation, we discussed:  How Liz became interested in the therapeutic potential of cannabinoids Published literature that supports using cannabinoids for neuroinflammation and neurodegenerative disorders Her team's collaboration with the NFL and ongoing clinical trials focused on neuroinflammation and recovery in athletes, particularly after concussions Current use of cannabis in athletics and how sports organizations are changing their policies  Future directions of research  and more  Thanks to This Episode's Sponsor: The DENT Institute With more than 300,000 patient visits per year, the DENT Neurologic Institute ranks among the largest neuroscience centers in North America. Its 24 subspecialty clinics often treat the most challenging neurologic conditions including but not limited to Migraine, Chronic pain, ALS, MS, Parkinson's, Dementia, and Neuro-Oncology. With their mission of advancing neuroscience, the Dent Institute established a cannabis clinic in 2016 to aid in the treatment of these chronic conditions seen throughout the institute. Learn more at dentinstitute.com Additional Resources Cannabinoid Therapy in Athletics: A Review of Current Cannabis Research to Evaluate Potential Real‑World Cannabinoid Applications In Sport trainwithmaryjane.com Train with Mary Jane on Instagram Submit Your Abstract for CannMed 25 Review the Podcast CannMed Archive

Dr. Iyad Alnahhas interviews Dr. Mulki Mehari about her and her team's recent manuscript entitled: "Enhancing neuro-oncology care through equity-driven applications of artificial intelligence", published online in Neuro-Oncology in August 2024.

In a conversation with CancerNetwork®, Yoshie Umemura, MD, offered various perspectives on progressing in the brain cancer treatment field. In addition to detailing institution-level advances in delivering multidisciplinary care, she highlighted her personal growth as she advanced in the neuro-oncology field while giving key advice to aspiring researchers who are in the early stages of their careers. Umemura, the chief medical officer of the Ivy Brain Tumor Center, division chief of Neuro-Oncology, and the William and Joan Shapiro chair of Neuro-Oncology at Barrow Neurological Institute, first described what drew her to studying neurology and eventually specializing in neuro-oncology, emphasizing the potential to form close connections with patients during treatment. Additionally, her collaborative approach to care and her institution's emphasis on multidisciplinary practice have helped in yielding various accomplishments, which included expediting the development of an investigator-initiated trial during the COVID-19 pandemic. The conversation also focused on the personal aspects of Umemura's neuro-oncology career. Delving into her experiences with immigrating to the United States when she was a high school student, she recalled feeling like an outsider as she learned to speak English and began to study neurology. However, she noted how several role models and mentors in the field have offered her guidance, which helped her grow and take on more leadership positions over time. Continuing to build upon the theme of collaboration in brain cancer research, Umemura emphasized the necessity of finding mentors even outside of one's institution to advance in the field. Additionally, as part of paying it forward to a new generation of neuro-oncologists, researchers should also become open to guiding others once they have gained enough experience.  “When you are at a conference and you meet someone you think you might click with, you're intrigued about, or you're impressed with, you can shoot an email and ask them if they would be open to chatting with you about a question or mentoring you,” Umemura said. “[You should also] pay it forward. Always be open to mentoring others; I think that's the only way to move forward….It [speaks] to the collaborative aspect and how to operate as an outsider. You're not an outsider as long as you make the connection; you can just wedge yourself in.”

On this episode of Health 411, Neuro-Oncologist Dr. Mike Salacz joins host Dr. Jonathan Karp and student producer Marina JB in an engaging conversation about the ups and downs of working with brain and spinal cord tumors.

Treating brain cancers such as glioblastoma can be complex as many of these cancers are difficult to treat and deadly. Soma Sengupta, MD, PhD, MBA, is an accomplished physician-scientist who specializes in brain tumor treatment and research. During this interview, she talks about her innovative research work, including the use of art and music therapy.   About the Author Soma Sengupta, MD, PhD, MBA, is a professor of neurology and vice chair of neurosurgery research at the University of North Carolina, Chapel Hill. She completed her PhD and medical degree at the University of Cambridge, with fellowship training in neuro-oncology and integrative medicine. A physician-scientist with over 90 publications, she is also a creative writer and patient advocate. Dr. Sengupta recently earned an MBA from the University of Cincinnati.

Dr. Maya Graham interviews Drs. Mary Jane Lim-Fat and Kee Kiat Yeo about their recent manuscript entitled "A comparative analysis of IDH-mutant glioma in pediatric, young adult, and older adult patients", published online in Neuro-Oncology in July 2024. Link: https://doi.org/10.1093/neuonc/noae142

Dr. Schwartz received his undergraduate and medical degrees from Harvard University, where he graduated Magna Cum Laude. After completing his residency and chief residency in Neurosurgery at The Neurological Institute of NewYork at Columbia-Presbyterian Medical Center, Dr. Schwartz spent a year at Yale-New Haven Medical Center receiving advanced fellowship training. Dr. Schwartz specializes in the surgical treatment of brain tumors, pituitary tumors, and epilepsy using the latest techniques in computer-guided surgical navigation, minimally invasive endoscopy, and microsurgery. Dr. Schwartz was recently named David and Ursel Barnes Professor in Minimally Invasive Surgery, the first endowed professorship in the department.Dr. Schwartz has provided commentary for numerous television shows on ABC, NBC, CBS, and Larry King, in addition to national radio shows. His expertise has been sought through interviews, quoted and published, in the Wall Street Journal, The New York Post, The New York Daily News, and Crain's New York Business; he is asked to lecture throughout the country and world. Dr. Schwartz has published many scholarly articles for the Journal of Neurosurgery, Neurosurgery, Epilepsia, Clinical Neurosurgery the Journal of Neuro-Oncology, Nature Medicine, NeuroImage and the Journal of Neuroscience.Dr. Schwartz has been named one of New York's Super Doctors, Best Doctors in New York Magazine, America's Top Surgeons, America's Best Doctors and America's Best Doctors for Cancer. He is the co-author of two books on endoscopic skull base surgery and endoscopic pituitary surgery.

Dr. Iyad Alnahhas interviews Dr. Linda Bi, Hia Ghosh and Ruchit Patel about their recent manuscript entitled: "Contemporary Prognostic Signatures and Refined Risk Stratification of Gliomas: An Analysis of 4400 Tumors", published online in Neuro-Oncology in August 2024. More Information: https://academic.oup.com/neuro-oncology/advance-article/doi/10.1093/neuonc/noae164/7737688

Send us a Text Message.Meet Simon Khagi, MD, Medical Director of Neuro-Oncology at Hoag Family Cancer Institute and a triple-board-certified oncologist.  He specializes in primary brain, spine, lung, and advanced skin cancers and has extensive experience with glioblastoma, astrocytoma, oligodendroglioma, meningioma, ependymoma, medulloblastoma, brain metastases, and rare brain tumors.  

Dr. Iyad Alnahhas interviews Drs. Minyoung Oh and Hyungwoo Cho about their recent manuscript entitled: "Enhancing Prognostication and Treatment Response Evaluation in Primary CNS Lymphoma with 18F-FDG PET/CT", published online in Neuro-Oncology in August 2024.   Link to manuscript

Join Dr. Sanjay Juneja as he talks with Dr. Sam Blackman about advancements in Pediatric Neuro-Oncology. Dr. Blackman shares his journey from philosophy to medicine, discusses innovative treatments for pediatric brain cancer, and explores the role of AI in neuro-oncology. Discover insights into the latest therapies and the future of brain cancer treatment for children in this episode. Gain a deeper understanding of the challenges and breakthroughs in treating pediatric brain tumors.

Dr. Jasmin Jo interviews Dr. Monika Hegi about her and her team's recent manuscript entitled: "No benefit from TMZ treatment in GB with truly unmethylated MGMT promoter: Reanalysis of the CE.6 and the pooled Nordic/NOA-08 trials in elderly GB patients", published online in Neuro-Oncology in (I will fill in through Libsyn)

Do you know anyone with dementia? If you don't, you will. We humans are living longer and healthier lives. There are more healthy 75 year old people alive now than there ever have been. However, the number of people with dementia is sky rocketing as well. Enter Dr. Mechtler…Dr. Lazslo Mechtler is the Medical Director of Dent Neurologic Institute, the Chief of Neuro-Oncology at Roswell Park Cancer Institute and is also the Director of the DENT Headache Center, Neuro-Oncology Center, and Cannabis Clinic.Dr. Mechtler gives us a fantastic review of dementia, and Alzheimer's disease. Then he talks about the work they are doing at the DENT Institute to treat dementia with cannabinoids.DENT Neurologic Institute - Cannabis Clinic - WebsiteLazlo Mechtler - LinkedInLazlo Mechtler - DENT-website profileMusic by:Christopher Cros - Sailing -YouTubeAdditional Music:Desiree Dorion desireedorion.comMarc Clement - FacebookTranscripts, papers and so much more at: reefermed.ca

Dr. Maya Graham interviews Dr. Martin van den Bent about his and his team's recent review article entitled "The biological significance of age, enhancement, extent of resection and tumor grade in IDH mutant gliomas: how should they inform treatment decision in the era of IDH inhibitors? Invited review", published online in Neuro-Oncology in

 Dr. John Fortunato interviews Dr. Adrienne Boirre about her and her team's recent manuscript entitled "Leptomeningeal metastases from solid tumors: A SNO and ASCO consensus review on clinical management and future directions", published online in Neuro-Oncology on 

Dr. Iyad Alnahhas interviews Drs. Justin Lathia and Marco Gallo about their recent manuscript entitled "Cancer stem cell hypothesis 2.0 in glioblastoma: where are we now and where are we going?", published online in Neuro-Oncology in May 2024.

Dr. Ankush Bhatia interviews Dr. Keaton Piper about his and his team's manuscript, entitled "Consensus Review on Strategies to Improve Delivery Across the BBB Including Focused Ultrasound", published online in Neuro-Oncology in May 2024 Read Paper

Dr. Evan Noch interviews Dr. Gunther Nussbaumer about his recent paper entitled: "Gliomatosis cerebri in children: a poor prognostic phenotype of diffuse gliomas with a distinct molecular profile" published online in Neuro-Oncology in May 2024.

After finishing her training in neurology at Mayo Clinic, Dr. Svetlana Blitshteyn started a Dysautonomia Clinic in 2009. Little did she know what was in store many years later when Covid hit!Ground Truths podcasts are on Apple and Spotify. The video interviews are on YouTubeTranscript with audio and external linksEric Topol (00:07):Well, hello, it's Eric Topol from Ground Truths, and I have with me a really great authority on dysautonomia and POTS. We will get into what that is for those who aren't following this closely. And it's Svetlana Blitshteyn who is a faculty member at University of Buffalo and a neurologist who long before there was such a thing as Covid was already onto one of the most important pathways of the body, the autonomic nervous system and how it can go off track. So welcome, Svetlana.Svetlana Blitshteyn (00:40):Thank you so much, Eric for having me. And I want to say it's a great honor for me to be here and just to be on the list with your other guests. It's remarkable and I'm very grateful and congratulations on being on the TIME100 Health list for influential people in 2024. And I am grateful for everything that you've done. As I mentioned earlier, I'm a big fan of your work before the pandemic and of course with Covid I followed your podcast and posts because you became the best science communicator and I'm very happy to see you being a strong advocate and thank you for everything you've done.Eric Topol (01:27):Well, that's so kind to you. And I think talking about getting things going before the pandemic, back in 2011, you published a book with Jodi Epstein Rhum called POTS - Together We Stand: Riding the Waves of Dysautonomia. And you probably didn't have an idea that there would be an epidemic of that more than a decade later, I guess, right?Svetlana Blitshteyn (01:54):Yeah, absolutely. Of course, SARS-CoV-2 is a new virus and we can technically say that Long Covid and post Covid complications could be viewed as a new entity. But practically speaking, we know that post-infectious syndromes have been happening for many decades. And so, the most common trigger for POTS happened to be infection, whether it was influenza or mononucleosis or Lyme or enterovirus. We knew this was happening. So I think it didn't take long for me and my colleagues to realize that we're going to be seeing a lot of patients with autonomic dysfunction after Covid.On the Front LineEric Topol (02:40):Well, one of the things that's important for having you on is you're in the front lines taking care of lots of patients with Long Covid and this postural orthostatic tachycardia syndrome (POTS). And I wonder if you could tell us what it's care for these patients because so many of them are incapacitated. As a cardiologist, I see of course some because of the cardiovascular aspects, but you are dealing with this on a day-to-day basis.Svetlana Blitshteyn (03:14):Yeah, absolutely. As early as April 2020 when everything was closed, I got a call from a young doctor in New York City saying that he had Covid and he couldn't recover, he couldn't return to the hospital. And his colleagues and cardiology attendants also had the same symptoms and the symptoms were palpitations, orthostatic intolerance, tachycardia, fatigue. Now, how he knew to contact me is that his sister was my patient with POTS before Covid pandemic. So he kind of figured this looked like my sister, let me check this out. And it didn't take long for me to have a lot of patience from the early wave. And then fairly soon, I think within months I was thinking, we have to write this up because this is important. And to some of us it was not news, but I was sure that to many physicians and public health officials, this would be something new.Svetlana Blitshteyn (04:18):So because I'm a busy clinician and don't have a lot of time for publications, I had to recruit a graduate student from McMasters and together we had this paper out, which was the first and largest case series on post Covid POTS and other autonomic disorders. And interestingly, even though it came out I think in 2021, by the time it was published, it became the most citable paper for me. And so I think from then on organizations and societies became interested in the work that I do because prior to that, I must say in the kind of a niche specialty was I don't think it was very popular or of interest to me.How Did You Get Interested in Dysautonomia?Eric Topol (05:06):Yeah, so that's why I wanted to just take a step back with you Svetlana, because you had the foresight to be the founder and director of the Dysautonomia Clinic when a lot of people weren't in touch with this as an important entity. What prompted you as a neurologist to really zoom in on dysautonomia when you started this clinic?Svetlana Blitshteyn (05:28):Sure. So the reasons are how I ended up in this field is kind of a convoluted road and the reasons are many, but one, I will say that I trained at Mayo Clinic where we received very good training on autonomic disorders and EMG and coming back to returning back to Buffalo, I began working at the large multiple sclerosis clinic because Western New York has a high incidence MS. And so, what they quickly realized in that clinic is that there was a subset of women who did not qualify for the diagnostic criteria of multiple sclerosis, yet they had a lot of the same symptoms and they were certainly very disabled. Now I recognize that these women had autonomic disorders of all sorts and small fiber neuropathy, and I think this population sort of grew and eventually I realized there is no one not only in Buffalo but the entire Western New York who is doing this work.Svetlana Blitshteyn (06:34):So I kind of fell into that. But another reason is actually more personal that I haven't talked about. So years ago I was traveling to Toronto, Canada for a neurology meeting to present my big study on meningioma and hormone replacement therapy using Mayo Clinic database. And so, in that year, the study received top 10 noteworthy studies of the year award from the Society of Neuro-Oncology, and it was profiled in Reuters Health. Now, on the way back from the conference, I had the flu, and when they returned I could no longer walk the same hallways of the hospital where I walked previously. And no matter how hard I try to push my body, we all do this in medicine, we push through, I just couldn't do it. No amount of wishing or positive thinking. And so, I think that's how I came to know personally the post-infectious syndromes. And I think it almost became a duality of experiencing this and also practicing it.Eric Topol (07:52):No, that's really striking and it wasn't so common to hear about this post flu, but certainly it changed in 2020. So how does a person with POTS typically present to you?Clinical PresentationSvetlana Blitshteyn (08:08):So these are very important questions because what I want to stress is though POTS is one of the most common autonomic disorders. Even if you don't have POTS by the diagnostic criteria, you may still have autonomic dysfunction and significant autonomic symptoms. How do they present? Well, they present like most Long Covid patients, the most common symptoms are orthostatic intolerance, fatigue, exercise intolerance, post exertional malaise, dizziness, tachycardia, brain fog. And these are common themes across the board in Long Covid patients, but also in pre-Covid post-acute infection syndrome patients. And you have to recognize because I think what I tell my colleagues is that oftentimes patients are not going to present to you saying, I have orthostatic intolerance. Many times they will say, I'm very tired. I can no longer go to the gym or when I go to the store, I have to be out of there in 15 minutes because the orthostatic intolerance symptoms come up.Svetlana Blitshteyn (09:22):So sometimes the patients themselves don't recognize that and it's up to us physicians to ask the right questions to get the information down. History is very important, knowing the pattern. And then of course, as I always say in all of my papers and lectures, you have to do a 10-minute stand test by measuring supine and standing blood pressure and heart rate on every Long Covid patients. And that's how you spot those that have excessive postural tachycardia or their blood pressure dropping or so forth. So we have the tools. We don't need fancy autonomic labs. We don't even need a tilt table test. The diagnostic criteria for POTS is that you need to have either a 10-minute stand test or a tilt table test to get the diagnosis for POTS, orthostatic hypotension or even neurocardiogenic syncope. Now I think it's important to stress that even if a patient doesn't qualify, and let's say many patients with Long Covid will not elevate their heart rate by at least 30 beats per minute, it could be 20, it could be 25. These criteria are of course essential when we do research studies. But I think practically speaking, in patient care where everything is gray and nothing is black or white, especially in autonomic disorders, you really have to make a diagnosis saying, this sounds like autonomic dysfunction. Let me treat the patient for this problem.Eric Topol (11:07):Well, you brought up something that's really important because doctors don't have much time and they're inpatient. They don't wait 10 minutes to do a test to check your blood pressure. They send the patients for a tilt table, which nobody likes to have that test done, and it's unnecessary added appointment and expense and whatnot. So that's a good tip right there that you can get the same information just by checking the blood pressure and heart rate on standing for an extended period of time, which 10 minutes is a long time in the clinic of course. Now, what is the mechanism, what do you think is going on with the SARS-CoV-2 virus and its predilection to affect the autonomic nervous system? As you know, so many studies have questioned whether you even actually infect neurons or alternatively, which is more likely this an inflammation of the neural tissue. But what do you think is going on here?UnderpinningsSvetlana Blitshteyn (12:10):Right, so I think it's important to say we don't have exact pathophysiology of what exactly is going on. I think we can only extrapolate that what's going on in Long Covid is possibly what's going on in any post infectious onset dysautonomia. And so there are many hypothesis and there are many suggestions, and we share this disorder with cardiologist and immunologist and rheumatologist. The way I view this is what I described in my paper from a few years ago is that this is likely a central nervous system disorder with multisystemic involvement and it involves the cardiovascular system, immunologic, metabolic, possibly prothrombotic. The pathophysiology of all POTS closely parallels to pathophysiology of Long Covid. Now we don't know if it's the same thing and certainly I see that there may be more complications in Long Covid patients in the realm of cardiovascular manifestations in the realm of blood clots and things like that.Svetlana Blitshteyn (13:21):So we can't say it's the same, but it very closely resembles and I think at the core is going to be inflammation, autoimmunity and immunologic dysfunction. Now there are also other things that are very important and that would be mitochondrial dysfunction, that would be hypercoagulable state, it would be endothelial dysfunction. And I think the silver lining of Long Covid and having so many people invested in research and so many funds is that by uncovering what Long Covid is, we're now going to be uncovering what POTS and other autonomic disorders are. And I think we also need to mention a couple of other things. One is small fiber neuropathy, small fiber neuropathy and POTS are very much comorbid conditions. And similarly, small fiber neuropathy frequently occurs in patients with Long Covid, so that's a substrate with the damaged small nerve fibers that they're everywhere in our bodies and also innervate the organs as well.Svetlana Blitshteyn (14:34):The second big thing is that needs to be mentioned is hyperactive mast cells. So mast cells, small nerve fibers and capillaries are very much located in proximity. And what I have usually is a slide from an old paper in oral biology that gives you a specimen where you see a capillary vessel, a stain small nerve fiber, and in between them there is a mass cell with tryptase in it stained in black. And so there is a close communication between small nerve fibers between endothelial wall and between mast cells, and that's what we commonly see as a triad. We see this as a triad in Long Covid patients. We see that as a triad in patients with joint hypermobility syndrome and hypermobile EDS, and you also see this in many of the autoimmune disorders where people develop new allergies and new sensitivities concurrent or preceding the onset of autoimmune disease.Small Fiber NeuropathyEric Topol (15:49):Yeah, no, it's fascinating. And I know you've worked with this in Ehlers-Danlos syndrome (EDS) as you mentioned, the hypermobility, but just to go back on this, when you want to entertain the involvement of small fiber neuropathy, is that diagnosable? I mean it's obvious that you can get the tachycardia, the change in position blood pressure, but do you have to do other tests to say there is indeed a small fiber neuropathy or is that a clinical diagnosis?Svetlana Blitshteyn (16:20):Absolutely. We have the testing and the testing is skin biopsy. That is simply a punch biopsy that you can do in your clinic and it takes about 15 minutes. You have the free kit that the company of, there are many companies, I don't want to name specific ones, but there are several companies that do this kind of work. You send the biopsy back to them, they look under the microscope, they stain it. You can also stain it with amyloid stain to rule out amyloidosis, which we do in neurology, and I think that's quite accessible to many clinicians everywhere. Now we also have another test called QSART (quantitative sudomotor axon reflex test), and that's a test part of autonomic lab. Mayo Clinic has it, Cleveland Clinic has it, other big labs have it, and it's hard to get there because the wait time is big.Svetlana Blitshteyn (17:15):Patients need to travel. Insurance doesn't always authorize, so access is a big problem, but more accessible is the skin biopsy. And so, by doing skin biopsy and then correlating with neurologic exam findings, which oftentimes involved reduce pain and temperature sensation in the feet, sometimes in the hands you can conclude that the patient has small fiber neuropathy and that's a very tangible and objective diagnosis. There again, with everything related to diagnostics, some neuropathy is very patchy and the patchy neuropathy is the one that may not be in your feet where you do the skin biopsy. It may be in the torso, it may be in the face, and we don't have biopsy there. So you can totally miss it. The results can come back as normal, but you can have patchy type of small fiber neuropathy and there are also diagnostic tests that might be not sensitive to pick up issues. So I think in everything Long Covid, it highlights the fact that many tests that we use in medicine are outdated perhaps and not targeted towards these patients with Long Covid. Therefore we say, well, we did the workup, everything looks good. MRI looks good, cardiac echo looks great, and yet the patient is very sick with all kinds of Long Covid complications.Pure Post-Viral POTS?Eric Topol (18:55):Right. Now, before we get into the treatments, I want to just segment this a bit. Can you get pure POTS that is no Long Covid just POTS, or as you implied that usually there's some coalescence of symptoms with the usual Long Covid symptoms and POTS added to that?Svetlana Blitshteyn (19:21):So the studies have shown for us that about 40% of patients with POTS have post-infectious onset, which means more than a half doesn't. And so of course you can have POTS from other causes and the most common is puberty, hormonal change, the most common age of onset is about 13, 14 years old and 80% of women of childbearing age and other triggers or pregnancy, hormonal change again, surgery, trauma like concussion, post-concussion, autonomic dysfunction is quite common.Eric Topol (20:05):So these are pure POTS without the other symptoms. Is that what you're saying in these examples?Svetlana Blitshteyn (20:12):Well, it's a very good question. It depends what you mean by pure POTS, and I have seen especially cardiologists cling to this notion that there is pure POTS and then there is POTS plus. Now I think majority of people don't have pure POTS and by pure POTS I think you mean those who have postural tachycardia and nothing else. And so most patients, I think 80% have a number of symptoms. So in my clinic I almost never see someone who is otherwise well and all they have is postural tachycardia and then they're having a great time. Some patients do exist like that, they tend to be athletic, they can still function in their life, but majority of patients come to us with symptoms like dizziness, like fatigue, like exercise intolerance, decline in functioning. So I think there is this notion that while there is pure POTS, let me just fix the postural tachycardia and the patient will be great and we all want that. Certainly sometimes I get lucky and when I give the patient a beta blocker or ivabradine or a calcium channel blocker, sometimes we use it, certainly they get better, but most patients don't have that because the disability that drives POTS isn't actually postural tachycardia, it's all that other stuff and a lot of it's neurologic, which is why I put this as a central nervous system disorder.TreatmentsEric Topol (21:58):Yeah, that's so important. Now you mentioned the treatments. These are drug treatments, largely beta blockers, and can you tell us what's the success rate with the various treatments that you use in your clinic?Svetlana Blitshteyn (22:13):So the first thing we'll have to mention is that there are no FDA approved therapies for POTS, just like there are no FDA approved therapies for Long Covid. And so, everything we use is off label. Now, oftentimes people think that because it wasn't evidence-based and there are no big trials. We do have trials, we do have trials for beta blockers and we know they work. We have trials for Midodrine and we know that's working. We also have fludrocortisone, which is a medication that improves sodium and water resorption. So we know that there are certain things we've used for decades that have been working, and I think that's what I was trying to convey in this paper of post Covid autonomic dysfunction assessment and treatment is that when you see these patients, and you can be of any specialty, you can be in primary care, you can be a physiatrist, a cardiologist, there are things to do, there are medications to use.Svetlana Blitshteyn (23:20):Oftentimes colleagues would say, well, you diagnose them and then what do you treat them with? And then I can refer them to table six in that paper and say, look at this list. You have a lot of options to try. We have the first line treatment options, which are your beta blockers and Midodrine and Florinef and Mestinon. And then we have the second line therapies you can choose from the stimulants are there Provigil, Nuvigil, Wellbutrin, Droxidopa is FDA approved for neurogenic orthostatic hypotension. Now we don't use it commonly, but it can still be tried in people whose blood pressures are falling on your exam. So we have a number of medications to choose from in addition to non-pharmacologic therapies.Eric Topol (24:14):Right now, I'm going to get to the non-pharmacologic in a moment, but the beta blocker, which is kind of the first one to give, it's a little bit paradoxical. It makes people tired, and these people already are, don't have much energy. Is the success rate of beta blocker good enough that that should be the first thing to try?Svetlana Blitshteyn (24:35):Absolutely. The first line medication treatment options are beta blockers. Why? Okay, why are they working? They're not only working to reduce heart rate, but they may also decrease sympathetic overactivity, which is the driving mechanism of autonomic dysfunction. And when you reduce that overactivity, even your energy level can improve. Now, the key here is to use a low dose. A lot of the time I see this mistake being done where the doctor is just prescribing 25 milligrams of metoprolol twice a day. Well, this is too high. And so, the key is to use very low doses and to use them and then increase them as needed. We have a bunch of beta blockers to choose from. We have the non-selective propranolol that you can use when someone maybe has a migraine headache or significant anxiety, they penetrate the brain, and we have non-selected beta blockers like atenolol, metoprolol and others that you can use at half a tablet. Sometimes I start my patients at quarter of tablet and then go from there. So low doses will block tachycardia, decrease sympathetic overactivity, and in many cases will allow the patient to remain upright for longer periods of time.Eric Topol (26:09):That's really helpful. Now, one of the other things, I believe it's approved in Canada, not in the US, is a vagal neuromodulation device. And I wonder, it seems like it would be nice to avoid drugs if there was a device that worked really well. Is there anything that is in the hopper for that?Svetlana Blitshteyn (26:32):Yeah, absolutely. Non-invasive vagus nerve stimulator is in clinical trials for POTS and other autonomic disorders, but we have it FDA for treatment of migraine and cluster headaches, so it's already approved here and it can also be helpful for chronic pain and gastroparesis. So there are studies on mice that show that with the application of noninvasive vagus nerve stimulator, there is reduction of pro-inflammatory cytokines. So here is this very important connection that comes from Kevin Tracey's work that showed inflammatory reflex, and that's a reflex between the vagus nerve and the immune system. So when we talk about sympathetic overactivity, we need to also think about that. That's a mechanism for pro-inflammatory state and possibly prothrombotic state. So anything that decreases sympathetic overactivity and enhancing parasympathetic tone is going to be good for you.Eric Topol (27:51):Now, let's go over to, I mean, I'm going to get into this body brain axis in a moment because there's another part of the story here that's becoming more interesting, fascinating, in fact every day. But before I do that, you mentioned the small fiber neuropathy. Is there a specific treatment for that or is that just something that is just an added dimension of the problem without a specific treatment available?Svetlana Blitshteyn (28:21):Yeah, we certainly have treatment for small fiber neuropathy. We have symptomatic treatment for neuropathic pain, and these medications are gabapentin, pregabalin, amitriptyline and low dose naltrexone that have been gaining popularity. We used that before the pandemic. We used low dose naltrexone for people with chronic pain related to joint hypermobility. And so, we have symptomatic, we also have patches and creams and all kinds of topical applications for people with neuropathic pain. Then we also have, we try to go for the root cause, right? So the number one cause of small fiber neuropathy in the United States is diabetes. And certainly, you need to control hyperglycemia and in some patients you only need a pre-diabetic state, not even full diabetes to already have peripheral neuropathy. So you want to control blood glucose level first and foremost. Now then we have a big category of autoimmune and immune mediated causes, and that's where it gets very interesting because practical experience from many institutions and many neurologists worldwide have shown that when you give a subset of patients with autoimmune small fiber neuropathy, immunotherapy like IVIG, a lot of patients feel significantly better. And so, I think paralleling our field in dysautonomia and POTS, we are looking forward to immunotherapy being more mainstream rather than exception from the rule because access and insurance coverage is a huge barrier for clinicians and patients, but that may be a very effective treatment options for treatment refractory patients whose symptoms do not improve with symptomatic treatment.Eric Topol (30:38):Now, with all these treatments that are on the potential menu to try, and of course sometimes it really is a trial and error to get one that hopefully works for Covid, Long Covid, what is the natural history? Does this persist over years, or can it be completely resolved?Svetlana Blitshteyn (31:00):That's a great question. Everyday Long Covid patients ask me, and I think what we are seeing is that there is a good subset of patients for whom Long Covid is going to be temporary and they will improve and even recover close to normal. Now remember that original case series of patients that I reported in early 2021 based on my 2020 experience in that 20 patient case series, very few recovered, three patients recovered back to normal. Most patients had lingering ongoing chronic symptoms. So of course mine is a kind of a referral bias where I get to see the sickest patients and it looks to be like it's a problem of chronic illness variety. But I also think there is going to be a subset of patients and then we have to study them. We need to study who got better and who didn't. And people improve significantly and some even recover close to normal. But I think certain symptoms like maybe fatigue and heat intolerance could persist because those are very heavily rooted in autonomic dysfunction.Vaccination and POTSEric Topol (32:26):Yeah, well, that's something that's sobering and why we need trials and to go after this in much more intensity and priority. Now the other issue here is while with Covid, this is almost always the virus infection, there have been reports of the vaccine inducing POTS and Long Covid, and so what does that tell us?Svetlana Blitshteyn (32:54):Well, that's a big, big topic. Years ago, I was the first one to report a patient with POTS that was developed after HPV vaccine Gardasil. Now, at that time I was a young neurologist. Then the patient came to me saying she was an athlete saying two weeks after Gardasil vaccine, she developed these very disabling symptoms. And I thought it was very interesting and unique and I thought, well, I'll just publish it. I never knew that this would be the start of a whole different discussion and debate on HPV vaccines. There were multiple reports from numerous countries, Denmark, Mexico, Japan. Japan actually suspended their mass HPV vaccination program. So somehow it became a big deal. Now many people, including my colleagues didn't agree that POTS can begin POTS, small fiber neuropathy, other adverse neurologic events can begin after vaccination in general. And so, this was a topic that was widely debated and the European medical agencies came back saying, we don't have enough evidence.Svetlana Blitshteyn (34:20):Of course, we all want to have a good cancer vaccine. And it was amazing to watch this Covid vaccine issue unfolding where more than one study now have shown that indeed you can develop POTS after Covid vaccines and that the rate of POTS after Covid vaccines is actually slightly higher than before vaccination. So I think it was kind of interesting to see this unfold where I was now invited by Nature Journal to write an editorial on this very topic. So I think it's important to mention that sometimes POTS can begin after vaccination and however, I've always advised my patients to be vaccinated even now. Even now, I have patients who are unvaccinated and I say, I'm worried about you getting a second Covid or third without these vaccines, so please get vaccinated. Vaccines are very important public health measure, but we also have to acknowledge that sometimes people develop POTS, small fiber neuropathy and other complications after Covid vaccines.Prominence of the Vagus Nerve Eric Topol (35:44):Yeah, I think this is important to emphasize here because of all vaccinations can lead to neurologic sequelae. I mean look at Guillain-Barre, which is even more worrisome and that brings in the autoimmune component I think. And of course, the Covid vaccines and boosters have a liability in a small, very small percentage of people to do this. And that can't be discounted because it's a small risk and it's always this kind of risk benefit story when you're getting vaccinated that you are again spotlighting. Now gets us to the biggest thing of all besides the practical pearls you've been coming up with to help everyone in patients and clinicians. In recent weeks, there's been explosion of these intra body circuits. There was a paper from Columbia last week that taught us about the body-brain circuits between the vagus nerve and the caudal Nucleus of the Solitary Tract (cNST) of the brain and how this is basically a master switch for the immune system. And so, the vagus nerve there and then you have this gut to brain story, which is the whole gut microbiome is talking to the brain through the vagus nerve. I mean, everything comes down to the vagus nerve. So you've been working all your career and now everything's coming into this vagus nerve kind of final common pathway that's connecting all sorts of parts of the body that we didn't truly understand before. So could you comment about this because it's pretty striking.Svetlana Blitshteyn (37:34):Absolutely. I think this pandemic is highlighting the pitfalls of everything we didn't know but should have in the past. And I think this is one of them. How important is the autonomic nervous system and how important is the vagus nerve that is the longest nerve in the body and carries the parasympathetic outflow. And I think this is a very important point that we have to move forward. We cannot stop at the autonomic knowledge that we've gained thus far. Autonomic neurology and autonomic medicine has always been the field with fellowship, and we have American Autonomic Society as well. But I think now is a great time to move forward and study how the autonomic nervous system communicates with the immunologic system. And again, Kevin Tracey's work was groundbreaking in the sense that he connected the dots and realized that if you stimulate the vagus nerve and the parasympathetic outflow, then you can reduce pro-inflammatory cytokines and that he has shown that you can also improve or significantly such disorders like rheumatoid arthritis and other autoimmune inflammatory conditions.Svetlana Blitshteyn (39:03):Now we have the invasive vagus nerve stimulation procedures, and quite honestly, we don't want that to be the mainstream because you don't want to have a neurosurgery as you go to treatment. Of course, you want the non-invasive vagus nerve stimulation being the mainstream therapy. But I think a lot of research needs to happen and it's going to be a very much a multidisciplinary field where we'll have immunology, translational sciences, we'll have neurosurgeons like Kevin Tracey, we'll have rheumatologists, neurologists, cardiologists. We'll have a multidisciplinary collaborative group to further understand what's going on in these autoimmune inflammatory disorders, including those of post-infectious origin.Eric Topol (40:02):I certainly agree with all of your points there. I mean, I'm really struck now because the immune system is front and center with so much of what we're seeing with of course Long Covid, but also things like Alzheimer's and Parkinson's and across the board with metabolic diseases. And here we have this connection with your sweet spot of the autonomic nervous system, and we have these pathways that had not been delineated before. I didn't know too much about the cNST of the brain to be such an important connect point for this. And I wonder, so here's another example. Concurrently the glucagon-like peptide 1 (GLP-1) drugs have this pronounced effect on reducing inflammation in the body before the weight loss and in the brain through the gut-brain axis, as we recently discussed with Dan Drucker, have you ever tried a GLP-1 drug or noticed that GLP-1 drugs help people with Long Covid or the POTS problem?Svetlana Blitshteyn (41:12):So I have heard anecdotally people with Long Covid using these drugs for other reasons, saying I feel much better. In fact, I recently had a woman who said, I have never been more productive than I am now on this medication. And she used the word productive, which is important because non-productive implies so many things. It's the brain fog, it's the physical fatigue, it's the mental fatigue. So I think we are, first of all, I want to say, I always said that the brain is not separate from the body. And neurologic manifestations of systemic disease is a very big untapped area. And I think it's not going to be surprising for me to see that these drugs can improve many brain parameters and possibly even neuroinflammation. We don't know, but we certainly need to study this.Eric Topol (42:15):Yeah, it's interesting because statins had been tried for multiple sclerosis, I think maybe not with very clear cut benefit effects, but here you have a new class of drugs which eventually are going to be in pills and not just one receptor but triple receptor, much more potent than what we're seeing in the clinic today. And you wonder if we're onto an anti-inflammatory for the brain and body that could help in this. I mean, we have a crisis here with Long Covid in POTS without a remedy, without adequate resources that are being dedicated to the clinical trials that are so vital to execute and find treatments. And that's just one candidate of many. I mean, obviously there's so many possible ones on the list. So if you could design studies now based on your extraordinary rich experience with Long Covid and POTS, what would you go after right now? What do you think is the thing that's, would it be to evaluate more of these noninvasive, non-pharmacologic treatments like the vagal nerve stimulation, or are there particular drugs that you find intriguing?Svetlana Blitshteyn (43:33):Well, a few years ago we published a case series of patients with severe POTS and nothing helped them, but they improved significantly and some even made close to recovery improvement and were able to return to their careers because they were treated with immunotherapy. So the paper is a subcutaneous immunoglobulin and plasmapheresis and the improvement was remarkable. I say there was one physician there who could not start her residency. She got sick in medical school and could not start her residency due to severe POTS and no amount of beta blockers, Midodrine or Florinef helped her get out the house and out of bed. And therefore, sheer luck, she was able to get subcutaneous immunoglobulin and she improved significantly, finished her residency and is now a practicing physician. So I think when we have these cases, it's important to bring them to scientific community. And I think I'm very excited that hopefully soon we're going to have trials of immunotherapy and immunomodulating treatment options for patients with Long Covid and hopefully POTS in general, I believe in novel, but also repurposed, repurposed treatment.Svetlana Blitshteyn (45:01):IVIG has been used for decades, so it's not a new medication. And contrary to popular belief, it's actually quite safe. It is expensive, it's a blood product, but we are very familiar with it in medicine and neurology. So I think we have to look forward to everything. And as I tell my patients, I'm always aggressive with medications when they come to me and their doctor said something like, well, let's see, it's going to go away on its own or keep doing your salt and fluids intake or wear compression sucks. Well, they're already doing it. It's not helping. And now it's a good time to try everything we have. And I would like to have more. I would like to have immunotherapy available. I would like to have immunosuppressants even tried potentially, and maybe we'll be able to try medication for possible viral persistence. Let's see how that works out. We have other inflammatory modalities out there that can potentially give us the tools. You see, I think being that it's a multifactorial disorder, that I don't think it's going to be one thing for everyone. We need to have a toolbox where we're going to choose what's best for your specific case because when we talk about Long Covid, we have to remember there are many different phenotypes under that umbrella.A Serious MatterEric Topol (46:40):Now, before we wrap up, I mean I guess I wanted to emphasize how there are clinicians out there who discount Long Covid in POTS. They think it's something that is a figment of imagination. Now, on the other hand, you and I especially, you know that people are totally disabled. Certain days they can't even get out of bed, they can't get back to their work, their life. And this can go on and on as we've been discussing. So can you set it straight about, I mean, you are seeing these people every day. What do you have to say to our fellow colleague physicians who tend to minimize and say, this is extremely rare, if it even exists, and that these people have some type of psychiatric problem. And it's really, it's distressing of course, but could you speak to that?Svetlana Blitshteyn (47:39):Absolutely. So as I always say, Long Covid is not a psychiatric or psychological disorder, and it's also not a functional neurologic disorder. Now, having said that, as I just mentioned, brain is not separate from the body. And neurologic manifestations of systemic disease are numerous. We just had a paper out on neurologic manifestations of mast cell activation syndrome. So certainly some patients will develop psychiatric manifestations and some patients will develop major depression, anxiety, OCD or functional neurologic disorder. But those are complications of systemic disease, meaning that you cannot diagnose a patient with anxiety and send them off to a psychologist or a psychiatrist without diagnosing POTS and treating it. And in many cases, when you approach an underlying systemic disorder with the right medications, like dysautonomia for example, all of the symptoms including psychological and psychiatric, tend to improve as well. And certainly, there is going to be a small subset of Long Covid patients whose primary problem is psychiatric.Svetlana Blitshteyn (49:01):And I think that's totally fine. That is not to say that all Long Covid is psychiatric. Some will have significant psychiatric manifestations. I mean, there are cases of post Covid psychosis and autoimmune encephalitis and all kinds of psychiatric problems that people may develop, but I think we can't really stratify well, this is physiologic and this word functional that I'm not a fan of. This is physiologic as we see it on MRI. But here, because we don't see anything on MRI, it means you are fine and can just exercise your way out of it. So I think with this Long Covid, hopefully we'll get answers as to the pathophysiology, but also most importantly, hopefully we'll get these therapies that millions of people before Covid pandemic were looking for.Eric Topol (50:02):Well, I just want to thank you because you were onto this well over 10, 15 years before there was such a thing as Covid, you've dedicated your career to this. These are some of the most challenging patients to try to help and has to be vexing, that you can't get their symptoms resolved no less the underlying problem. And we're indebted to you, Svetlana, because you've really been ahead of the curve here. You were writing a patient book before there were such things as patient activists in Long Covid, as we've seen, which have been so many of the heroes of this whole problem. But thank you for all the work you do. We'll continue to follow. We learned from you about POTS and Long Covid from your work and really appreciate everything you've done. Thank you.Svetlana Blitshteyn (50:58):Thank you so much, Eric, for having me. As I said, it's a great honor for me to be here. Remarkable, amazing. And thank you for all this work that you're doing and being an advocate for our field because we always need great champions to help us move forward in these complicated disorders.********************************The Ground Truths newsletters and podcasts are all free, open-access, without ads.Voluntary paid subscriptions all go to support Scripps Research. Many thanks for that—they greatly helped fund our summer internship programs for 2023 and 2024.Thanks to my producer Jessica Nguyen and Sinjun Balabanoff tor audio and video support at Scripps ResearchNote: you can select preferences to receive emails about newsletters, podcasts, or all I don't want to bother you with an email for content that you're not interested in. Get full access to Ground Truths at erictopol.substack.com/subscribe

Dr. Maya Graham interviews Drs. Josephine Hendriksen and Joachim Weischenfeldt about their recent manuscript, "Immunotherapy drives mesenchymal tumour cell state shift and TME immune response in glioblastoma patients," published online in Neuro-Oncology in May 2024.

Dr. Iyad Alnahhas interviews Drs. Alice Morin, Samuel Abbou and Brice Fresneau about their recent manuscript entitled "Very long-term outcomes of pediatric patients treated for optic pathway gliomas: a longitudinal cohort study" published online in Neuro-Oncology in March 2024. Read Paper

The May 2024 replay features four episodes on neuro-oncology for brain cancer awareness month. The episode begins with Dr. Philipp Karschnia discussing the assessment of whether MTHFR polymorphisms affect the risk for leukoencephalopathy. The episode continues with Dr. Ingo Mellinghoff discussing new treatment opinions for isocitrate dehydrogenase (IDH)–mutant grade 2 gliomas. The third interview leads into a conversation with Dr. Linda Liau on the study of vaccine-based therapy for GBM. The episode concludes with Dr. Teddy Totimeh talking about brain tumor programs in Asia and Africa. Podcast Links: MTHFR Polymorphisms and Leukoencephalopathy Risk in CNS Lymphoma Patients   New Treatment for IDH mt Gliomas  Study of Vaccine-Based Therapy for GBM Brain Tumor Programs in Asia and Africa  Article Links: https://doi.org/10.1212/WNL.0000000000207670  https://www.nejm.org/doi/full/10.1056/NEJMoa2304194 https://jamanetwork.com/journals/jamaoncology/fullarticle/2798847 https://doi.org/10.1016/j.wneu.2023.04.067 Disclosures can be found at Neurology.org.

About our guest … Dr. Lasky joined the Cure the Kids Foundation in 2017. He attended medical school at the University of Illinois in Chicago and did his pediatric residency at the University of Chicago. He completed his Pediatric Hematology Oncology fellowship at UCLA in 2006 and was director of the Pediatric Neuro-Oncology Program at UCLA until 2009 when he moved to Harbor-UCLA Medical Center in Torrance, CA, and was named Chief of the Division of Pediatric Hematology Oncology. While there, Dr. Lasky became involved with a number of clinical trials for patients with bleeding disorders (including hemophilia and von Willebrand disease) as well as sickle cell anemia. While continuing to have research interests in pediatric brain tumors and immunology, he also is interested in running and developing clinical trials for patients with bleeding disorders and sickle cell anemia. Dr. Lasky is a member of several professional societies including the Children's Oncology Group, Society for Neuro-Oncology, the American Society of Hematology, and the American Academy of Pediatrics. He enjoys watching sports, reading, music, and outdoor activities with his family. In September of 2022, Dr. Lasky is now the Medical Director at Cure 4 The Kids (C4K).

What I learned (or relearned?) at HOPA's 2024 Annual Conference: updates in Neuro Oncology, fedratinib toxicity, and bispecific antibodies in multiple myeloma. Also, fam-trastuzumab deruxtecan (T-DXd) garnered a site-agnostic approval for HER2 amplified solid tumors. Finally, the ALINA study, adjuvant alectinib in ALK+ NSCLC, was published in this week's NEJM.

Dr. Rachna Malani interviews Dr. Hrishikesh Suresh about his and his team's recent manuscript entitled "Postoperative cerebellar mutism syndrome is an acquired Autism-like network disturbance", published online in Neuro-Oncology in December 2023. Read the paper

Dr. Evan Noch interviews Dr. Chunzhang Yang about his and his team's recent manuscript entitled "Abrogation of the G2/M checkpoint as a chemo sensitization approach for alkylating agents" published online in Neuro-Oncology in December 2023 Read Paper

Dr. Iyad Alnahhas interviews Dr. Ricardo Soffietti about the recent RANO review entitled "Liquid biopsy for improving diagnosis and monitoring of CNS lymphomas: a RANO review" published online in Neuro-Oncology in March 2024.

There is a saying that goes, "The mind is the Devil's playground." Though this particularly refers to thoughts, mindsets, and emotions, the organ that houses the mind also seems to be an abode to nefarious diseases that have long been regarded as death sentences. Brain tumors and cancers, like meningioma and glioblastoma, are the most-feared adversaries of the nervous system, but there is an array of brain diseases that also creep up over time and claim their power over someone's life, its quality, and even the people around them. Memory loss has long been regarded as the hallmark presentation of Alzheimer's Disease and dementia. and it leads to the question of how possible it is to evade the malady that wipes the mental records of love and happiness clear. Can one surpass the ultimatum set by brain cancer? How can one ease their mind in the face of imminent demise? Can memory loss be prevented? What does "brain health" mean? Is social interaction really necessary to keep our brains safe?We are joined today by Joon Myung, a neuro-oncology nurse practitioner, Alzheimer's disease and dementia educator, and brain health and mental health advocate. She received her BS in Nursing from California State University in 2002 and MS in Family Practitioner Nursing from UCLA in 2005. Joon has been a nurse practitioner for almost two decades, spending the bulk of her advanced provider role in Internal Medicine and Urgent Care. Over the past six years, she has been diagnosing and treating brain cancers and providing treatment plans for post-surgical patients. Online, Joon generously shares her passion for brain health education, focused on brain-boosting, activities, meditation, mindsets, and supplements. She also shares her advocacy for Alzheimer's disease and dementia prevention, rooted in her own journey with her mother, who had the progressive brain disease.Livestream Air Date: May 25, 2023Follow Joon Myung, MS, FNP-C: InstagramFollow Friends of Franz Podcast: Website, Instagram, FacebookFollow Christian Franz Bulacan (Host): Instagram, YouTubeThankful to the season's brand partners: Covry, House of M Beauty, Nguyen Coffee Supply, V Coterie, Skin By Anthos, Halmi, By Dr Mom, LOUPN, Baisun Candle Co., RĒJINS, Twrl Milk Tea, 1587 Sneakers

Dr. John Fortunato interviews Dr. Antonio Chiocca about his and his team's recent manuscript entitled "Lessons learned from phase 3 trials of immunotherapy for glioblastoma: time for longitudinal sampling?" published online in Neuro-Oncology in February 2024. Get paper.

Dr. Maya Graham interviews Dr. Joseph Costello about his and his team's recent manuscript entitled "Whole tumor analysis reveals early origin of the TERT promoter mutation and intracellular heterogeneity in TERT expression", published online in Neuro-Oncology in December 2023.

Bonni Goldstein is one of the country's most respected and experienced medical cannabis physicians, having treated thousands of patients with medical cannabis. She is the owner and medical director of Canna-Centers Wellness & Education. She is Clinical Advisor to Cannformatics, and she is the author of the book titled “Cannabis is Medicine: How Medical Cannabis and CBD Are Healing Everything from Anxiety to Chronic Pain”.  Bonni has participated in every CannMed event since we started in 2016, she is a perennial Advisory Board Member, and she will lead the CannMed Medical practicum again in 2024. During our conversation we talked about:  What attendees can expect from CannMed Medical Practicum New research that she is excited about concerning THCA and CBDA  Her method for customizing cannabinoid formulations for her patients   The many barriers preventing patients from using cannabis  How the cannabinoid medicine options have expanded over the last decade  The difficulty of keeping up with the cannabis medicine literature  Thank You to This Episode's Sponsor: The DENT Institute With more than 300,000 patient visits per year, the DENT Neurologic Institute ranks among the largest neuroscience centers in North America. Its 24 subspecialty clinics often treat the most challenging neurologic conditions including but not limited to Migraine, Chronic pain, ALS, MS, Parkinson's, Dementia, and Neuro-Oncology. With their mission of advancing neuroscience, the Dent Institute established a cannabis clinic in 2016 to aid in the treatment of these chronic conditions seen throughout the institute. Learn more at dentinstitute.com Additional Resources Cannabis is Medicine by Bonni Goldstein, MD [Book] @bonnigoldsteinmd on Instagram Bonni Goldstein, MD on LinkedIn Request an Invitation to CannMed 23 Review the Podcast! CannMed Archive CannMed Community Board [Facebook Group] Healthcare Provider Medical Cannabis Research Study