Podcasts about neurologic

Episode 198: Fatigue.  Future doctors Redden and Ibrahim discuss with Dr. Arreaza the different causes of fatigue, including physical and mental illnesses. Dr. Arreaza describes the steps to evaluate fatigue. Some common misconceptions are explained, such as vitamin D deficiency and “chronic Lyme disease”. Written by Michael Ibrahim, MSIV, and Jordan Redden, MSIV, Ross University School of Medicine. Edits and comments by Hector Arreaza, MDYou are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Dr. Arreaza: Today is a great day to talk about fatigue. It is one of the most common and most complex complaints we see in primary care. It involves physical, mental, and emotional health. So today, we're walking through a case, breaking down causes, red flags, and how to work it up without ordering the entire lab catalog.Michael:Case: This is a 34-year-old female who comes in saying, "I've been feeling drained for the past 3 months." She says she's been sleeping 8 hours a night but still wakes up tired. No recent illnesses, no weight loss, fever, or night sweats. She denies depression or anxiety but does report a lot of work stress and taking care of her two little ones at home. She drinks 2 cups of coffee a day, doesn't drink alcohol, and doesn't use drugs. No medications, just a multivitamin. Regular menstrual cycles—but she's noticed they've been heavier recently.Jordan:Fatigue is a persistent sense of exhaustion that isn't relieved by rest. It's different from sleepiness or muscle weakness.Classification based on timeline:    •   Acute fatigue: less than 1 month    •   Subacute: 1 to 6 months    •   Chronic: more than 6 monthsThis patient's case is subacute—going on 3 months now.Dr. Arreaza:And we can think about fatigue in types:    •   Physical fatigue: like muscle tiredness after activity    •   Mental fatigue: trouble concentrating or thinking clearly (physical + mental when you are a medical student or resident)    •    Pathological fatigue: which isn't proportional to effort and doesn't get better with restAnd of course, there's chronic fatigue syndrome, also called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which is a diagnosis of exclusion after 6 months of disabling fatigue with other symptoms.Michael:The differential is massive. So, we can also group it by systems.Jordan:Let's run through the big ones.Endocrine / Metabolic Causes    • Hypothyroidism: A classic cause of fatigue. Often associated with cold intolerance, weight gain, dry skin, and constipation. May be subtle and underdiagnosed, especially in women.    • Diabetes Mellitus: Both hyperglycemia and hypoglycemia can cause fatigue. Look for polyuria, polydipsia, weight loss, or blurry vision in undiagnosed diabetes.    • Adrenal Insufficiency: Think of this when fatigue is paired with hypotension, weight loss, salt craving, or hyperpigmentation. Can be primary (Addison's) or secondary (e.g., due to long-term steroid use).Michael: Hematologic Causes    • Anemia (especially iron deficiency): Very common, especially in menstruating women. Look for fatigue with pallor, shortness of breath on exertion, and sometimes pica (craving non-food items).     • Vitamin B12 or Folate Deficiency: B12 deficiency may present with fatigue plus neurologic symptoms like numbness, tingling, or gait issues. Folate deficiency tends to present with megaloblastic anemia and fatigue.    • Anemia of Chronic Disease: Seen in patients with chronic inflammatory conditions like RA, infections, or CKD. Typically mild, normocytic, and improves when the underlying disease is treated.Michael: Psychiatric Causes    • Depression: A major driver of fatigue, often underreported. May include anhedonia, sleep disturbance, appetite changes, or guilt. Sometimes presents with only somatic complaints.    • Anxiety Disorders: Mental fatigue, poor sleep quality, and hypervigilance can leave patients feeling constantly drained.    • Burnout Syndrome: Especially common in caregivers, healthcare workers, and educators. Emotional exhaustion, depersonalization, and reduced personal accomplishment are key features.Jordan: Infectious Causes    • Epstein-Barr Virus (EBV):Mononucleosis is a well-known cause of fatigue, sometimes lasting weeks. May also have sore throat, lymphadenopathy, and splenomegaly.    • HIV:Consider it in high-risk individuals. Fatigue can be an early sign, along with weight loss, recurrent infections, or night sweats.    • Hepatitis (B or C):Can present with chronic fatigue, especially if liver enzymes are elevated. Screen at-risk individuals.    • Post-viral Syndromes / Long COVID:Fatigue that lingers for weeks or months after viral infection. Often, it includes brain fog, muscle aches, and post-exertional malaise.Important: Chronic Lyme disease is a controversial term without a consistent clinical definition and is often used to describe patients with persistent, nonspecific symptoms not supported by objective evidence of Lyme infection. Leading medical organizations reject the term and instead recognize "post-treatment Lyme disease syndrome" (PTLDS) for persistent symptoms following confirmed, treated Lyme disease, emphasizing that prolonged antibiotic therapy is not effective. Research shows no benefit—and potential harm—from extended antibiotic use, and patients with unexplained chronic symptoms should be thoroughly evaluated for other possible diagnoses.Michael: Cardiopulmonary Causes    •   Congestive Heart Failure (CHF): Fatigue from poor perfusion and low cardiac output. Often comes with dyspnea on exertion, edema, and orthopnea.    •   Chronic Obstructive Pulmonary Disease (COPD): Look for a smoking history, chronic cough, and fatigue from hypoxia or the work of breathing.    •   Obstructive Sleep Apnea (OSA): Daytime fatigue despite adequate hours of sleep. Patients may snore, gasp, or report morning headaches. High suspicion in obese or hypertensive patients.Jordan:Autoimmune / Inflammatory Causes    •   Systemic Lupus Erythematosus (SLE): Fatigue is often an early symptom. May also see rash, arthritis, photosensitivity, or renal involvement.    •   Rheumatoid Arthritis (RA): Fatigue from systemic inflammation. Morning stiffness, joint pain, and elevated inflammatory markers point to RA.    •   Fibromyalgia: A chronic pain syndrome with widespread tenderness, fatigue, nonrestorative sleep, and sometimes cognitive complaints ("fibro fog").Cancer / Malignancy    •   Leukemia, lymphoma, or solid tumors: Fatigue can be the first symptom, often accompanied by weight loss, night sweats, or unexplained fevers. Consider when no other cause is evident.Michael:Medications:Common culprits include:    ◦   Beta-blockers: Can slow heart rate too much.    ◦   Antihistamines: Sedating H1 blockers like diphenhydramine.    ◦   Sedatives or sleep aids: Can cause grogginess and daytime sedation.    •   Substance Withdrawal: Fatigue can be seen in withdrawal from alcohol, opioids, or stimulants. Caffeine withdrawal, though mild, can also contribute.Dr. Arreaza:Whenever we evaluate fatigue, we need to keep an eye out for red flags. These should raise suspicion for something more serious:    •   Unintentional weight loss    •   Night sweats    •   Persistent fever    •   Neurologic symptoms    •   Lymphadenopathy    •   Jaundice    •   Palpitations or chest painThis patient doesn't have these—but that doesn't mean we stop here.Dr. Arreaza:Those are a lot of causes, we can evaluate fatigue following 7 steps:Characterize the fatigue.Look for organic illness.Evaluate medications and substances.Perform psychiatric screening.Ask questions about quantity and quality of sleep.Physical examination.Undertake investigations.So, students, do we send the whole lab panel?Michael:Not necessarily. Labs should be guided by history and physical. But here's a good initial panel:    •   CBC: To check for anemia or infection    • TSH: Screen for hypothyroidism    • CMP: Look at electrolytes, kidney, and liver function    • Ferritin and iron studies    • B12, folate    • ESR/CRP for inflammation (not specific)    • HbA1c if diabetes is on the radarJordan:And if needed, consider:    • HIV, EBV, hepatitis panel    • ANA, RF    • Cortisol or ACTH stimulation testImaging? Now that's rare—unless there are specific signs. Like chest X-ray for possible cancer or TB, or sleep study if you suspect OSA.Dr. Arreaza:Unaddressed fatigue isn't just inconvenient. It can impact on quality of life, affect job performance, lead to mood disorders, delay diagnosis of serious illness, increase risk of accidents—especially driving. So, don't ignore your patients with fatigue!Jordan:And some people—like women, caregivers, or shift workers—are especially at risk.Michael:The cornerstone of treatment is addressing the underlying cause.Jordan:If it's iron-deficiency anemia—treat it. If it's depression—get mental health involved. But there's also: Lifestyle Support: Better sleep hygiene, light physical activity, mindfulness or CBT for stress, balanced nutrition—especially iron and protein, limit caffeine and alcoholDr. Arreaza:Sometimes medications help—but rarely. And for chronic fatigue syndrome, the current best strategies are graded exercise therapy and CBT, along with managing specific symptoms. Beta-alanine has potential to modestly improve muscular endurance and reduce fatigue in older adults, but more high-quality research is needed.SSRI: fluoxetine and sertraline. Iron supplements: Even without anemia, but low ferritin [Anecdote about low ferritin patient]Jordan:This case reminds us to take fatigue seriously. In her case, it may be multifactorial—work stress, caregiving burden, and possibly iron-deficiency anemia. So, how would we wrap up this conversation, Michael?Michael:We don't need to order everything under the sun. A focused history and exam, targeted labs, and being alert to red flags can guide us.Jordan:And don't forget the basics—sleep, stress, and nutrition. These are just as powerful as any prescription.Dr. Arreaza:We hope today's episode on fatigue has given you a clear framework and some practical tips. If you enjoyed this episode, share it and subscribe for more evidence-based medicine!Jordan:Take care—and get some rest~___________________________Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:DynaMed. (2023). Fatigue in adults. EBSCO Information Services. https://www.dynamed.com (Access requires subscription)Jason, L. A., Sunnquist, M., Brown, A., Newton, J. L., Strand, E. B., & Vernon, S. D. (2015). Chronic fatigue syndrome versus systemic exertion intolerance disease. Fatigue: Biomedicine, Health & Behavior, 3(3), 127–141. https://doi.org/10.1080/21641846.2015.1051291Kroenke, K., & Mangelsdorff, A. D. (1989). Common symptoms in ambulatory care: Incidence, evaluation, therapy, and outcome. The American Journal of Medicine, 86(3), 262–266. https://doi.org/10.1016/0002-9343(89)90293-3National Institute for Health and Care Excellence. (2021). Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: Diagnosis and management (NICE Guideline No. NG206). https://www.nice.org.uk/guidance/ng206UpToDate. (n.d.). Approach to the adult patient with fatigue. Wolters Kluwer. https://www.uptodate.com (Access requires subscription)Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

In this episode of the American Shoulder and Elbow Surgeons Podcast, host Dr. Peter Chalmers interviews Dr. Thibault Lafosse about his approach to periscapular neurologic lesions. 

Laura Head, MT-BC, NMT-F, shares how she helps individuals with neurologic conditions regain speech, movement, and cognitive function through the power of rhythm and melody. From stimulating neuroplasticity to co-treating alongside other therapists, Laura explains how personalized, evidence-based music interventions can transform recovery. From gait training to memory exercises, learn how client-preferred music and interdisciplinary collaboration can transform the recovery process. Tune in to explore the science behind the sound—and why music is more than just a mood booster in neurorehab. Support the showNew episodes drop every other Thursday everywhere you listen to podcasts.

In this episode, editor-in-chief Joseph E. Safdieh, MD, FAAN, highlights articles studies showing persistent fatigue after TIA, the neurologic complications of measles, and the impact of the dismantling of a CDC surveillance program of epilepsy.

In this episode we discuss the topic of dual tasking. We explore: The definition of dual tasking How we can utilise dual tasking in sports, orthopaedic and return to work with our patients Dosage & delivery of dual tasking Dual tasking vs multitasking  Want to learn more about dual tasking? Dr Mike Studer recently did a brilliant Masterclass with us called “Uniting Cognitive and Physical Fitness with Dual Tasking” where he goes into further depth on this topic. 

In this episode, editor-in-chief Joseph E. Safdieh, MD, FAAN, highlights articles studies showing persistent fatigue after TIA, the neurologic complications of measles, and the impact of the dismantling of a CDC surveillance program of epilepsy.

Aarti Sarwal, MD, FAAN, FNCS, FCCM, professor of neurology at Virginia Commonwealth University Health System, explores the nuanced intersection of neurology and critical care, offering practical insights for clinicians across disciplines. Dr. Sarwal shares her perspective on the unique challenges of managing neurocritically ill patients, particularly when impairment presents challenges in administering a neurologic examination. She emphasizes that “the brain is the barometer of critical illness,” urging clinicians to prioritize daily neurologic evaluations and integrate neuromonitoring even in non-neurologic ICU populations. Listeners will gain an overview of tools such as continuous EEG, transcranial Doppler, emboli monitoring, and multimodal neuromonitoring platforms, including the role of neuro-ultrasound in expanding point-of-care capabilities. This episode also highlights the need for multidisciplinary collaboration and a shared decision-making model that extends across the continuum of care—from early ICU admission to post-discharge recovery. Listeners will appreciate Dr. Sarwal's reflections on neuroprognostication and the ethical dimensions of care withdrawal, particularly the danger of therapeutic nihilism in patients whose outcomes are uncertain. Referencing a 2023 review she coauthored (Crit Care Med. 2023;51:525-542), Dr. Sarwal outlines a practical framework for neuromonitoring that integrates structural, electrical, vascular, and metabolic insights. This conversation provides a timely and inclusive look at the future of neurocritical care—where technology, teamwork, and training converge to support better patient outcomes.

We dive into the recognition and management of blast crisis. Hosts: Sadakat Chowdhury, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Blast_Crisis.mp3 Download Leave a Comment Tags: Hematology, Oncology Show Notes Topic Overview Blast crisis is an oncologic emergency, most commonly seen in chronic myeloid leukemia (CML). Defined by: >20% blasts in peripheral blood or bone marrow. May include extramedullary blast proliferation. Without treatment, median survival is only 3–6 months. Pathophysiology & Associated Conditions Usually occurs in CML, but also in: Myeloproliferative neoplasms (MPNs) Myelodysplastic syndromes (MDS) Transition from chronic to blast phase often reflects disease progression or treatment resistance. Risk Factors 10% of CML patients progress to blast crisis. Risk increased in: Patients refractory to tyrosine kinase inhibitors (e.g., imatinib). Those with Philadelphia chromosome abnormalities. WBC >100,000, which increases risk for leukostasis. Clinical Presentation Symptoms often stem from pancytopenia and leukostasis: Anemia: fatigue, malaise. Functional neutropenia: high WBC count, but increased infection/sepsis risk. Thrombocytopenia: bleeding, bruising. Leukostasis/hyperviscosity effects by system: Neurologic: confusion, visual changes, stroke-like symptoms. Cardiopulmonary: ARDS, myocardial injury. Others: priapism, limb ischemia, bowel infarction.

This week's episode of Brain & Life Podcast was recorded live at the American Academy of Neurology's annual meeting! Hosts Dr. Daniel Correa and Dr. Katy Peters were joined by Joel Salinas, MD, MBA, MSc, FAAN, Andrea Lendaris, MD, MS, Andrew M. Southerland, MD, FAAN, and Eric J. Seachrist, MD to share what it's like living and practicing neurology with their own neurological condition(s) and neurodiverse perspectives, and explore how their experiences serve as a window into the patient and community perspective.   Additional Resources Neurology®Podcast Switching Roles: A Neuro-oncologist Reflects on his Own Experience with a Brain Tumor   We want to hear from you! Have a question or want to hear a topic featured on the Brain & Life Podcast? ·       Record a voicemail at 612-928-6206 ·       Email us at BLpodcast@brainandlife.org   Social Media:   Hosts: Dr. Daniel Correa @neurodrcorrea; Dr. Katy Peters @KatyPetersMDPhD

The podcast explores comprehensive recommendations for managing patients with non-cardiac implantable electrical devices during surgical procedures, emphasizing preoperative assessment, device interaction prevention, and safety protocols.• Types of devices include vagal nerve stimulators, deep brain stimulators, and spinal cord stimulators• Preoperative evaluation is crucial for identifying devices and contacting managing clinicians• Algorithm provided for assessing potential interactions with electrocautery, MRI, and neuromonitoring • Diathermy is absolutely contraindicated in patients with non-cardiac implantable devices• Critical information needed includes device type, manufacturer, lead locations, and latest interrogation results• Recent urgent safety alert issued about medication vial coring risks with specific interim recommendationsIf you have any questions or comments, please email us at podcast@apsf.org. Visit apsf.org for detailed information and check out the show notes for links to all topics discussed.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/252-managing-neurologic-stimulators-a-critical-guide-for-safe-anesthesia/© 2025, The Anesthesia Patient Safety Foundation

Dr. Connie Tomaino, music therapist and co-founder of the Institute for Music and Neurologic Function, discusses how music therapy is used to treat neurologic conditions and explains what we know about the power of music to heal the brain.

Neurologic Physical Therapist Mike Studer, author of The Brain That Chooses Itself, reveals how our daily choices shape our health, longevity and independence as we age.

In this episode, Jonathan Sackier welcomes Andrew Southerland, a distinguished neurologist and academic leader in the field of vascular neurology. They explore how machine learning is revolutionising prehospital stroke diagnosis, and how innovative strategies like telemedicine can reduce disparities in stroke care.   Timestamps: (00:00) – Introduction (03:00) – Neurologic lessons from the wild turkey (05:10) – Linking COVID-19 and stroke (10:28) – How can AI revolutionise prehospital stroke diagnosis? (18:39) – Stroke management in underserved populations (23:38) – Google Glass in medical education (29:06) – What is the i-corps programme? (33:24) – Wearable devices as diagnostic tools (37:08) – Andrew's three wishes for healthcare

Welcome to season 6 of Hope for the Agora Podcast.Karen Kleine Deters shares her story of journeying with FND -- Functional Neurologic Disorder.Functional neurologic disorder (FND) refers to a neurological condition caused by changes in how brain networks work, rather than changes in the structure of the brain itself, as seen in many other neurological disorders. Physical symptoms of FND are genuine but cannot be explained by changes in the brain structure. The exact cause of FND is unknown.Resources:National Institute of Neurological Disorders and Stroke (NINDS). Functional Neurological Disorder Information Page. https://www.ninds.nih.gov/health-information/disorders/functional-neurological-disorderStone, J., Carson, A., & Sharpe, M. (2005). Functional symptoms and signs in neurology: assessment and diagnosis. *Journal of Neurology, Neurosurgery & Psychiatry, 76*(Suppl I), i2–i12. https://jnnp.bmj.com/content/76/suppl_1/i2Support & Awareness OrganizationsFND Hope International – https://fndhope.orgThe Functional Neurological Disorder Society (FNDS) – https://www.fndsociety.orgMayo Clinic: Functional Neurological Disorder – https://www.mayoclinic.org/diseases-conditions/conversion-disorder/symptoms-causes/syc-20355197Podscasts and storiesNeurology Podcast by the American Academy of Neurology (AAN) – https://www.aan.com/podcastFND Portal Podcast (FND Hope International) – https://fndhope.org/fnd-portal-podcast

Text Light Pollution News!This month, host Bill McGeeney is joined by Mark Baker, founder of the Soft Lights Foundation, Nick Mesler, civil engineer, and, Isa Mohammed, President of the Caribbean Institute of Astronomy!See Full Show Notes, Lighting Tips and more at LightPollutionNews.com. Like this episode, share it with a friend!Bill's Picks:Why Soccer Players Are Training in the Dark, RM Clark, Wired. Light Pollution Control: Comparative Analysis of Regulations Across Civil and Common Law Jurisdictions, Laws. ‘Neurologic hazard': Group sues over Bay Bridge lights, Phil Mayer, KRON4. Outdoor light at night, air pollution and risk of incident type 2 diabetes, Environmental Research. Cartographic Visualisation of Light Pollution Measurements, Urban Science.  Support the showLike what we're doing? Your support helps us reach new audiences and help promote positive impacts. Why not consider becoming a Paid Supporter of Light Pollution News?

In part two of a two-part series, Dr. Justin Abbatemarco and Dr. Nicolás Lundahl Ciano-Petersen discuss the associated paraneoplastic syndromes they saw from a neurologic perspective. Show reference: https://www.neurology.org/doi/10.1212/NXI.0000000000200260 

In part one of a two-part series, Dr. Justin Abbatemarco and Dr. Nicolás Lundahl Ciano-Petersen break down Merkel cell carcinoma and discuss what all neurologists need to know about it. Show reference: https://www.neurology.org/doi/10.1212/NXI.0000000000200260 

Dr. Justin Abbatemarco talks with Dr. Nicolás Lundahl Ciano-Petersen about the clinical and immunologic profile of patients with paraneoplastic neurologic syndromes associated with Merkel cell carcinoma. Read the related article in Neurology: Neuroimmunology & Neuroinflammation. Disclosures can be found at Neurology.org.

In this episode, Brain & Life Podcast co-hosts Dr. Daniel Correa and Dr. Katy Peters discuss some of their favorite articles from the most recent edition of Brain & Life magazine! They give tips to feel healthy during the holidays, discuss career changes after a neurologic condition diagnosis, and explain what Sunflower Syndrome is. Check out the articles and more here.   We invite you to participate in our listener survey! By participating in the brief survey, you will have the opportunity to enter your name and email address for a chance to win one of five $100 Amazon gift cards.   Additional Resources         Three People Share How They Changed Career Course After a Neurologic Disorder Diagnosis Smart Ways to Eat Well During the Holidays What Is Sunflower Syndrome? Thriving in the Kitchen with Chef Dan Jacobs Part One: Community Stories of Navigating a Rare Epilepsy Diagnosis   We want to hear from you! Have a question or want to hear a topic featured on the Brain & Life Podcast? ·       Record a voicemail at 612-928-6206 ·       Email us at BLpodcast@brainandlife.org   Social Media:   Hosts: Dr. Daniel Correa @neurodrcorrea; Dr. Katy Peters @KatyPetersMDPhD

Dr. Shuvro Roy and Dr. Marisa Patryce McGinley discuss outpatient telemedicine utilization for neurologic conditions and identify potential disparities. Show reference: https://www.neurology.org/doi/10.1212/CPJ.0000000000200407

Dr. Shuvro Roy talks with Dr. Marisa Patryce McGinley about outpatient telemedicine utilization for neurologic conditions and identify potential disparities. Read the related article in Neurology: Clinical Practice.  Disclosures can be found at Neurology.org.  

Dr. Derek Stitt and Dr. Reece Hass discuss the neuroanatomy of the cough reflex, the relationship between cough and pain, and specific neurological conditions that can lead to neurogenic cough. Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000210064  

Dr. Derek Stitt talks with Dr. Reece Hass about the neuroanatomy of the cough reflex, the relationship between cough and pain, and specific neurological conditions that can lead to neurogenic cough. Read the related article in Neurology. Disclosures can be found at Neurology.org.

In this episode of the Healthy, Wealthy, and Smart Podcast, host Dr. Karen Litzy welcomes Dr. Mike Studer, the author of "The Brain That Chooses Itself." Dr. Studer shares his extensive background as a physical therapist with 33 years of experience, focusing primarily on neurologic therapy while also engaging in pediatrics and geriatrics. They discuss behavioral economics and how it is a powerful tool that can be effectively utilized in physical therapy to create personalized care plans that motivate patients. By understanding how individuals make decisions, physical therapists can implement strategies such as nudges, gamification, and temptation bundling to enhance patient engagement and adherence to treatment plans.   Time Stamps:  [00:03:05] Unique consulting opportunities for PTs. [00:05:22] Behavioral economics in decision-making. [00:10:50] Temptation bundling in therapy. [00:14:55] Health span versus lifespan. [00:18:32] Lactate's effect on brain health. [00:21:52] The importance of choice in health. [00:27:35] Find your passion.   More About Dr. Studer: Mike Studer,PT, DPT, MHS, NCS, CEEAA, CWT, CSST, CBFP, CSRP, FAPTA, has been a PT since 1991, a board-certified in neurologic PT in 1995, and a private practice owner since 2005.  Dr. Studer has been an invited speaker covering 50 states, ten countries, and four continents, speaking on topics ranging from cognition and psychology in rehabilitation, aging, stroke, motor learning, motivation in rehabilitation, balance, dizziness, neuropathy, and Parkinson's Disease.  Dr. Studer co-founded and is co-owner of Spark Rehabilitation and Wellness in Bend, OR. He is an adjunct professor at adjunct professor at Touro University in Las Vegas as well as a part-time instructor at UNLV. Mike has led classes in the DPT program at Oregon State University (motor control) and frequently serves in a guest-lecture capacity at several other DPT and residency programs. In 2011, Mike was recognized as Clinician of the Year in the Neurologic and (in 2014) the Geriatric Academies of the APTA.  He received the highest honor available in PT in 2020, being distinguished as a Catherine Worthingham Fellow of the APTA in 2020, joining a group of under 300 persons at the time for the profession's history.  Mike's professional honors additionally reflect his service at the state and national level, including the Vice President of the Academy of Neurologic PT and the Mercedes Weiss award for service to the Oregon chapter of APTA.  He holds a trademark in dual-task rehabilitation and has a patent pending on the same. Over his career, Mike has presented courses in all 50 states, four continents, and 10 countries. He has authored over 35 articles and 6 book chapters and routinely has clinical research projects in affiliation with one of many universities. He is a consultant to Major League Baseball on the motor control of pitching and hitting. As a very fun and lighthearted note, Mike is the four-time and current WR holder for the fastest underwater treadmill marathon, a mark set most recently in January 2022.    Resources from this Episode: Mike's Website Mike on Instagram The Brain That Chooses Itself   Jane Sponsorship Information: Book a one-on-one demo here Mention the code LITZY1MO for a free month   Follow Dr. Karen Litzy on Social Media: Karen's Twitter Karen's Instagram Karen's LinkedIn   Subscribe to Healthy, Wealthy & Smart: YouTube Website Apple Podcast Spotify SoundCloud Stitcher iHeart Radio

Learn more about Fetch Long Beach and register here today!  Of French origin and raised in equatorial Africa and Canada, Anne Chauvet, DVM, DACVIM, CHT-V, graduated from the Uni­versity of Saskatchewan Western College of Veteri­nary Medicine, Saskatoon, in 1990. She completed a 1-year small animal rotating internship at the University of Illinois School, Urbana, and pursued a residency in neurology/neurosurgery at the university of California, Davis from 1991-1993. While on staff at the University of Wisconsin from 1994-1999, Madison, Chauvet creat­ed the Basic Science Course in Veterinary and Compar­ative Neurology & Neuro­surgery that is now known as “brain camp”. She later moved to Florida's gulf coast where she grew her practice until its sale in 2016. Since, Chauvet has worked in practice in both Canada and the United States. She is trained in rehabilitation and certified in hyperbaric medicine.  Over her career, Chauvet has obtained multiple business and veterinary awards, served on ACVIM and not-for-profit local committees and boards, lectured in multiple countries, authored and co-authored numerous articles and book chapters, created a educational video in rehabilitation for clients, and written a children's book. She embraces integrating medicine styles to support the need of the patient.

Creutzfeldt-Jakob disease or CJD is a rare neurological condition that may initially look like dementia and that is ultimately fatal. It's caused by something called a prion, which is smaller than a virus. Now a new study demonstrates that a skin … Diagnosing some neurologic diseases may now use a skin biopsy, Elizabeth Tracey reports Read More »

In this episode of the Brain & Life podcast, co-host Dr. Katy Peters is joined by Christina Coates, president and founding member of an organization called Hypertrophic Olivary Degeneration Association (HODA). Christina shares about her own journey with hypertrophic olivary degeneration and how she was inspired to found HODA and build an advocacy community. Dr. Peters is then joined by Dr. Vikram Shakkottai, professor of neurology at UT Southwestern Medical Center in Dallas, Texas and Dedman Family Distinguished Chair in Neurologic Disease. Dr. Shakkottai discusses cerebellar ataxia, hypertrophic olivary degeneration, how these disorders are treated, and what upcoming research there is to look forward to.   We invite you to participate in our listener survey! By participating in the brief survey, you will have the opportunity to enter your name and email address for a chance to win one of five $100 Amazon gift cards.   Additional Resources HODA - Working to make HOD History Forming a Foundation Bolsters Hope After a Rare Diagnosis Advice for Caregivers of People with Rare Diseases What is ataxia and cerebellar or spinocerebellar degeneration?   Other Brain & Life Episodes on this Topic Neurofibromatosis Advocacy and Community Building with the Gilbert Family Foundation Making a Lasting Impact with The Brain Donor Project's Tish Hevel We Are Brave Together with Jessica Patay Strength in Unity: Advocating and Advancing Research for Brain Tumors   We want to hear from you! Have a question or want to hear a topic featured on the Brain & Life Podcast? ·       Record a voicemail at 612-928-6206 ·       Email us at BLpodcast@brainandlife.org   Social Media:   Guests: Christina Coates @hodassoc; Dr. Vikram Shakkottai @utswmedcenter Hosts: Dr. Daniel Correa @neurodrcorrea; Dr. Katy Peters @KatyPetersMDPhD  

One of the great medical accomplishments of our time is the evolution of precision medicine. The ability to understand a patient's unique genetic profile has become more accessible to our patients, and now, there are multiple mechanisms for using that information to overcome disease. One of the specialties leading the way in precision medicine is pediatric neurology. According to the World Health Organization, more than one in three people are affected by some type of neurological condition. They are a leading cause of ill health and disability worldwide. This subset of precision medicine will not only help us decrease those numbers but also allow us to treat some of these conditions in ways we have never done before. To detail this exciting work, we're joined by two experts. Scott Demarest, MD, and Julie Parsons, MD, are both pediatric neurologists at Children's Hospital Colorado and faculty at the University of Colorado School of Medicine. Dr. Demarest focuses on rare epilepsy conditions, and Dr. Parsons specializes in neuromuscular disease. Dr. Demarest is the Clinical Director of the Precision Medicine Institute at Children's Colorado. Some highlights from this episode include:  Understanding precision neurology within the context of precision medicine  Why precision neurology positively impacts diagnosis and treatment options  How families are more easily accessing important genetic testing  The role primary care providers play with caring for these rare diseases  For more information on Children's Colorado, visit: childrenscolorado.org.    

In this episode, Dr Camidge sits down with Douglas Ney, MD, a professor of neurology and neurosurgery, program director of the Neurology Residency Program, and vice-chair of Education in the Department of Neurology at the University of Colorado Cancer Center in Aurora.  Drs Camidge and Ney discuss Dr Ney's journey to becoming a neurologic oncologist, how the management of primary brain tumors differs from that of brain metastases in his practice, and his experience as a physician with Tourette syndrome.

Dr. Rae Bacharach talks with Dr. Manon Auffret about her NeuroByte titled, "How to Respond to a Request for Hastened Death from a Person Living with Neurologic Illness".  Show reference: https://learning.aan.com/courses/74069

Dr. Farrah Mateen and Dr. Katrin Seeher discuss the significant global burden of neurologic conditions, which affects over 3.4 billion people worldwide, and the strategies the WHO is implementing to improve care and awareness. Show reference: https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(24)00038-3/fulltext#seccestitle10  

Dr. Farrah Mateen talks with Dr. Katrin Seeher about the significant global burden of neurologic conditions, which affects over 3.4 billion people worldwide, and the strategies the WHO is implementing to improve care and awareness. Read the related article in The Lancet Neurology. Disclosures can be found at Neurology.org.  

Welcome to today's podcast, where Pam and I are joined by Dr. Donese Worden. Dr. Worden is a world renowned expert in integrative healthcare. Her recent focus is on the metabolic treatment of cancer and neurologic diseases using hyperbaric oxygen therapy, specialized ketogenic diets and other natural approaches. She consults internationally and is personal physician to motivational speak, Les Brown. She's here to share her insights on the wellness industry, her innovative work in cancer care, and how naturopathy can work alongside conventional treatments for better outcomes. So whether you are someone with a chronic disease, a scary diagnosis, or you are just someone who wants to learn ways to stay healthy as you age, stay tuned as we dive into her unique approach to healing.

In this episode, Tammy Boyd, Chief Revenue Officer at Lakeside Neurologic, discusses the organization's holistic approach to neurorehabilitation, the challenges of staffing and payer systems, and key growth opportunities in post-acute care.

In this episode, Tammy Boyd, Chief Revenue Officer at Lakeside Neurologic, discusses the organization's holistic approach to neurorehabilitation, the challenges of staffing and payer systems, and key growth opportunities in post-acute care.

Basic knowledge of the common CNS manifestations of rheumatologic diseases and sarcoidosis is important. In the context of many systemic inflammatory diseases, CNS disease may be a presenting feature or occur without systemic manifestations of the disease, making familiarity with these diseases even more important. In this episode, Kait Nevel, MD speaks with Jennifer A. McCombe, MD, author of the article “Neurologic Manifestations of Rheumatologic Disorders,” in the Continuum® August 2024 Autoimmune Neurology issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. McCombe is an associate professor in the Division of Neurology, Department of Medicine at the University of Alberta, Edmonton in Alberta, Canada. Additional Resources Read the article: Neurologic Manifestations of Rheumatologic Disorders Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Guest: @Div_Dubey Transcript Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology.  Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME.   Dr Nevel: Hello. This is Dr Kait Nevel. Today, I'm interviewing Dr Jennifer McCombe about her article on neurosarcoidosis and neurologic involvement of rheumatological disorders, which appears in the August 2024 Continuum issue on autoimmune neurology. Welcome to the podcast, and I would love to have you introduce yourself to the audience.   Dr McCombe: Well, thank you, and thank you for having me. As you said, my name is Jen McCombe. I'm a neurologist in Edmonton, Alberta, Canada, where I spend kind of a third of my time in teaching roles (I coordinate the undergraduate block for our medical school there), I spend about a third of my time in a neuroinflammatory clinic in Edmonton, Alberta, and then about a third of my time doing clinical research.   Dr Nevel: Wonderful. Well, thank you so much for being here today and for chatting with me about your article on this topic.   Dr McCombe: Thank you for having me.   Dr Nevel: To start off, can you share with the listeners a little bit about your career path?   Dr McCombe: Absolutely. Yeah. So, I've had, uh, a bit of a circuitous career path. I did my medical school in Queens (which is in Eastern Canada, in Kingston, Ontario) and then went back to Edmonton, Alberta, for my residency (in Canada, we have a five-year residency program, so a little bit different than the US), but finished my residency and then did a master's degree in Public Health at Johns Hopkins while completing clinical research in HIV, actually, and did this thing we call the Clinical Scholar Training Program – so, kind of like a fellowship, but a little bit more, you know, research and academic-based. So, when I first started, I was focused more on neuroinfectious diseases, and that's kind of what my career path looked like at the time - but, actually, shortly after I finished my residency program, I also had my first child, and he, unfortunately, developed opsoclonus-myoclonus syndrome, and at the time (this was in 2010), it was a rather rare condition, so, I ended up finding myself having to become a bit of a neuroinflammatory disease specialist at the same time. So, at that point, I transitioned into working in the neuroinflammatory clinic with some mentorship but was getting all of the kind of weird and wonderful referrals and diagnostic dilemmas from my colleagues who recognized I kind of developed some expertise, and so decided (actually, mid-career) to take a sabbatical, and in 2021, completed a fellowship in autoimmune neurology at the Mayo Clinic. So, I finished that quite recently and then went back, and now I'm feeling much more, I guess, confident, too. Sometimes, you wonder about, you know, the choices you're making. I recognize most of the conditions I'm dealing with don't have, in fact, any evidence for their treatment, and that was confirmed when I went to the Mayo Clinic and found that, really, it was just trying to gain an understanding of the disease process to make a rational choice to medications and treatments. So, now, I'm back and kind of trying to focus a little bit more on some clinical research in that area since I've kind of solidified that expertise.   Dr Nevel: Wow. Well, thank you for sharing with us your career path and how, you know, unexpected life events kind of changed your interests or molded your interests (changed kind of the things that you became expert in, you know), and being fluid in your career path and willing to kind of take a break and reassess and get additional training. That's really inspiring to, I think, to me, and probably to a lot of listeners, that you can always, you know, develop more expertise in the more niche area or additional area no matter where you are in your stage of life or career path.   Dr McCombe: Yeah.   Dr Nevel: So, can you tell us a little bit more about - you know, you shared with us kind of autoimmune inflammatory disorders and how you became interested in that, neurosarcoidosis, specifically (you know the article focuses on that), and what's your background in neurosarcoidosis, how you became interested in that specifically and in neurologic manifestations of rheumatologic disorders?   Dr McCombe: I started in our neuroinflammatory clinic over a decade ago, and, you know, at the time, a lot of the expertise in any of these neuroinflammatory disorders was quite spread out over the country, and so, as I kind to alluded to before, often some of the more complicated patients where there wasn't necessarily clear-cut evidence or even, you know, a fellowship path to get there, I would end up getting referrals for - and so, I developed quite a cohort of patients with central nervous system primarily, but other types of neuroinflammatory and autoimmune neurologic diseases, and part of that cohort was a rather large (and still growing) group of patients with neurosarcoidosis. And so, I kind of developed some practical expertise, although, as you can see in the article (and as I'm sure you all know), the approach to the treatment is extremely variable. One of the most telling things is when we were at the Mayo Clinic, one of my co-fellows actually pulled all of the neurologists in neuroinflammation at all of the Mayo Clinic sites and asked them, you know, what is your treatment approach to a patient with neurosarcoidosis, and I think got twelve completely different responses as to the medications chosen and the length of time for the tapers and things like that. So, you know, it is very much a part of neurologic disease treatment that we still really don't have great evidence for, and although we do have some kind of rational choices that we can make based on other types of evidence, so -   Dr Nevel: Yeah.   Dr McCombe: And I enjoy working with patients with these types of diseases where we can kind of work together to come up with a treatment plan that makes sense for them and also makes sense based on whatever evidence we do have at this time.   Dr Nevel: Yeah. So, moving on to the article a little bit, knowing that this is a area of neurology where there's a lot of, you know, maybe personal expertise and experience but not a ton of data or evidence to necessarily guide our standardization to our treatments and approach, what do you think is the most important clinical takeaway from your article for our listeners?   Dr McCombe: Well, I mentioned before I coordinate the neuro block for our undergraduate program here, so I've developed over the years (I've been doing that for a number of years) a curriculum that's all based on, kind of, that approach to - and I like to do it that way because it's very practical. I like the students to be able to basically take their class notes and then go to the emergency department on their first shift as a clerk and, you know, use their approach to headache that I've developed for them to kind of take a clinical history and examine a patient with that sort of problem. And so, similar to that, I tried to do an approach to, you know, a couple of the more common presentations that would make you think of a rheumatologic condition or neurosarcoidosis in looking at the approach to CNS vasculitis and the approach to, uh, pachymeningitis - and these are difficult differentials for lots of neurologists, because it really relies on a lot of medicine knowledge, and we graduate from our residencies slightly more confident in our medicine knowledge, because we get a lot of that in our residencies. But as neurologists, as we go through our careers, we get much more confident in our areas of specialty, and at least for myself and many of my colleagues, much less confident in other things like general medicine. And so, it's difficult, because you have to face your areas of potentially less confident knowledge and really think about that in the differential - and so, I think, you know, I put those two big “approach to” sections in there, because they're the most relevant for the conditions that I was covering. But, I think also what I would say to a learner or a more experienced neurologist who might be reading the article, kind of pick out the little things that you might add to your own kind of approach to - you know, when you see that person with an ataxia, remember that Sjogren syndrome is one of the things you might consider that could be a treatable cause, or you want to see a sensory neuronopathy, don't just think paraneoplastic – again, Sjogren syndrome. So, kind of pick out those little pearls and add them to your approach to that patient that we all see, and I think that would be my biggest takeaway.   Dr Nevel: Yeah. Thank you. So, kind of like, keep this information from the article in mind so that you keep rheumatologic disorders in mind as a possibility when you're approaching a patient with whatever neurologic symptoms they're presenting with. So, what do you think is challenging? You kind of already mentioned a little bit, you know, just that it stretches us maybe into the medicine arena and so maybe stretches our medical knowledge, especially as we become more subspecialized or focused in neurology - but what is challenging about identifying, diagnosing neurologic symptoms as being related or due to an underlying rheumatologic disorder?   Dr McCombe: Absolutely. Yeah. Well, as you said, you know, it forces us to kind of face that medicine stuff that we might not be as comfortable with, but I think what else is challenging is that, sometimes, those medical clues aren't there. For the rheumatologic disorders for the most part, they are. Sjogren's is potentially a little bit different in that, potentially, the symptoms are less obvious or a little bit more subtle. But, in particular, with neurosarcoidosis, there's a distinct proportion of the patients that won't, in fact, have any systemic complications of their underlying disease, and so, you have to think about it even when the clues aren't there. That's why you have to add it to those kind of differential diagnoses where it might be considered, because those systemic clues that we all rely on when we do our review of systems and we ask about rashes and joint pain and lung issues, and these sorts of things may not be there - and so, you still have to think about it even when it might be completely isolated to the central nervous system.   Dr Nevel: What is our understanding of why some patients with rheumatologic disorders develop neurologic involvement? Do we have an understanding? Do we know why some patients do and some patients don't? I know that's, you know, kind of, uh - that's a tough question, but that was something that I thought of as I was reading your article, like, why does this happen to some people?   Dr McCombe: Absolutely. I mean, I think, potentially, it's a little bit more clear for some of them, like rheumatoid arthritis, because, typically, if you develop a CNS complication of this, it's, in fact, just because you've had the disease for a very long time, and often, it's uncontrolled, and so you think about the disease “spreading” now to the central nervous system - but for other conditions, like neurosarcoidosis, it is much less clear, and even if you look at the epidemiologic patterns for that, it makes it even more muddied in that in some populations, it appears that they develop more central nervous system disease, whereas in others, less. And so, why that is the case and why certain individuals might develop this complication of these diseases I think is yet to be seen.   Dr Nevel: Yeah, that's always the crux of things if we can figure out the why, then maybe we could prevent it, right?   Dr McCombe: Million-dollar question always.   Dr Nevel: Always. So, what do you find the most intriguing about neurologic involvement of rheumatologic disorders?   Dr McCombe: Well, I think one of the things that, really, I mean, for neurosarcoidosis in particular, so many patients do so well, and that's what I really like about it. You know, you see patients who present with an incredible burden of disease radiologically, and yet, don't look nearly as sick as they should when they're sitting in front of you. And then, you start them on therapies and some of them do so well, and even those with relatively devastating deficits, or moderate disease who do have neurologic symptoms, have a remarkable improvement in their neurologic symptoms with treatment. And so, that's always something that's quite rewarding when you get to see these patients in follow-up, and they're generally quite thankful because they're doing so well. And it's different from many of the neurologic diseases that we treat. I mean, in autoimmune neurology, we're lucky because we do have a number of diseases that are quite treatable and patients can have wonderful outcomes. But, you know, it's always scary when we see patients with devastating neurologic signs and it's great to see improvement with treatment. And so, that really draws me to it.   Dr Nevel: Yeah, absolutely. That's really rewarding when you're able to help somebody get better in such a profound way.   Dr McCombe: Mm hmm.   Dr Nevel: What is one common misconception about neurologic manifestations of rheumatologic disorders? Or what do you think is not well understood by treating clinicians?   Dr McCombe: I think probably one of the things I see the most is, sometimes, an undertreatment of the patient. And so, I see patients who, you know, other clinicians may have seen and have made the diagnosis, and perhaps it's a lack of confidence in the diagnosis and so they kind of want somebody else with a subspecialty to kind of confirm the diagnosis, but that treatment hasn't been initiated despite pathological confirmation on biopsy of another tissue. And these patients, like I alluded to before, they do well, but you need to treat them and you need to treat them adequately, and when their symptoms are quite impairing, you need to treat them adequately now. And so I think, sometimes, that delay in starting a second-line therapy and relying on steroids for too long - those sorts of things can really expose a patient to a lot of different side effects and to a lot of different complications that they may not have had, too. So, that's why I spent some time focusing on the treatment, because I think just gaining a little bit of comfort with some of these more common second-line medications is a good thing, because starting those early, I think, makes sense because you can really save the patient a lot. And then, the other thing, too, is that when you're using steroids, think about all of the systemic things that you're causing - think about the increased risk of infection and the fact that you need to prophylax for certain infections, think about bone health, think about protecting the lining of someone's stomach - so not only kind of thinking about your disease in isolation and what you need to do for treatment, but that you need to ensure that you're appropriately prescribing the patient all of the things they need to do to protect themselves during these times.   Dr Nevel: Yeah. I think that's so important. And I'm glad that you brought that up, because I think, unfortunately, many of us have seen a patient who ended up having PJP pneumonia (or something like that) because they weren't put on antibiotic coverage for prolonged steroid use or, you know, bone health - all of that is really important to think about. So, this may be entering a territory where there's no, you know, great evidence, but you mentioned, you know, starting kind of that maintenance or second-line agent - when do you decide to do that in patients? And maybe we can focus (since it gets a little broad), but, you know, in a patient with neurosarcoidosis, let's say - when you're starting the steroids, when do you decide, okay, this person is also going to need a maintenance therapy? Is that something that you do at the beginning when you're starting the steroids, or is that something that you think about later on depending on how their course goes?   Dr McCombe: Yeah. In my practice, I do it at the outset - again, because I'm quite focused on, you know, as soon as I get them on it, getting people off steroids - and so I start essentially almost all of my patients on it unless there's some other contraindication or complication to their disease. And because I deal with central nervous system complications in the vast majority of my patients, I'm starting a TNF-a inhibitor as well as methotrexate, and that's because I see a lot of patients with cord disease and significant brain disease, and so I want to treat them kind of more aggressively from the outset. And so, typically, they'll be on steroids, um, a TNF-a inhibitor, as well as methotrexate, and then I just back off, actually, as they do well. And so, I try to taper the steroids quite quickly over the course of just a number of weeks, or kind of two to three months at most. I maintain the TNF-a inhibitor, and then in some patients, depending on how they're doing, I might eventually stop the methotrexate. Some patients tolerate it so well that we don't for a number of months - other patients want to try to minimize their medications as quick as they can. So, that's my personal practice. In the province where I live, we don't have to worry about access to these medications, and so I understand that that might be an issue in some centers where people practice and have different access and different funding. Of course, I live in a country where we have universal healthcare, and in our province, I have very good access to these medications and they're funded from my patients regardless of socioeconomic status, and so I have the luxury of making these choices and I understand that other people might not, but that's my personal practice and I find it works quite well in the vast majority of patients.   Dr Nevel: Yeah. And you bring up a really good point that, you know, access to some of these medications for patients with CNS manifestations of sarcoidosis, neurosarcoidosis, sometimes can be challenging to treating the patient with medications that you feel like would be best for them. But that's wonderful that you don't have those access issues where you live. How long do you typically continue the TNF-a inhibitor in patients, since you mentioned, you know, tapering off the steroids, tapering off the methotrexate, potentially depending on patient tolerance and course. What's your approach to the TNF-a inhibitor?   Dr McCombe: Yeah, so, of course I follow them clinically, and then radiologically as well, and it's really satisfying if you can see the resolution of their symptoms as well as resolution of the abnormalities and the MRI, so I let that guide me a little bit. But, in most patients, I keep them on therapy for about one to two years, and then at that point, see if I can cease it in some patients. And I, again, continue to follow them radiologically and clinically after I cease it so that I can ensure that I'm catching their disease more quickly if it does come back and then can just reinitiate therapy, but in lots of patients you're able to stop the medication and they have persisting, kind of, disease freedom after that, and so they don't need to be on anything.   Dr Nevel: Yeah, great. And I'm almost hesitant to focus so much on neurosarcoidosis. (It was the rheumatologic manifestation that you talked about the most in your article.) I'm going to put in a plug for everybody to read your article so that they can read about neurologic manifestations of rheumatoid arthritis, Sjogren's, lupus, Behcet's - many more things. But focusing on neurosarcoidosis, it can be difficult in my experience to definitively diagnose, and people who have neurosarcoidosis particularly, and people who don't seem to have any systemic manifestations or, you know, imaging findings consistent with sarcoidosis - can you share your approach with us? And you outlined this in your article nicely, too, but your personal approach to patients with suspected neurosarcoidosis, and how you make that clinical decision to treat somebody with possible neurosarcoidosis, somebody who maybe you're not able to get pathologic evidence on?   Dr McCombe: Absolutely. Yeah, those ones are difficult. And, you know, whenever possible (as I mentioned in my article), I think pathological evidence of a diagnosis is important, because then when you find yourself a year down the road and a treatment path and you have uncertainty, it's much more difficult to consider continuing medications that can have quite a number of side effects when you're not absolutely certain about that diagnosis. But, in some patients, you know, I've had patients who might have nondiagnostic biopsies (if you attempt to do a biopsy), or they have disease in a site that really just isn't amenable to biopsy, or they have some other reason they can't have a biopsy. So, how I approach that is that, you know, if you think about possible neurosarcoidosis similar to any other nondiagnosed, you know, blow out-like lesion (for lack of a better term) in the CNS, if it's steroid-responsive, I think that kind of going down a path of treating it as a steroid-responsive lesion is kind of the approach that I take - so the diagnosis in the chart might be possible neurosarcoidosis, but in the back of my mind, I'm just thinking of kind of a steroid-responsive nondiagnostic or idiopathic lesion. So, I then follow that up typically with something like methotrexate (so, a more broader- spectrum immunosuppressant-type medication), and if the methotrexate is able to maintain the response that the steroids initiated, then eventually get them off the steroids. And so, you know, if I think about my patients that I've treated in the past, if they have a diagnosis of possible neurosarcoidosis, I probably don't start a TNF-a inhibitor as quickly in them, because in the back of my mind, I'm always wondering what type of inflammatory lesion this is, but that steroid responsiveness really helps me decide to start a second-line or maintenance therapy and then, typically, in those patients, as I mentioned, I'll start something like methotrexate a little bit more soon.   Dr Nevel: Yeah, great. Thanks for sharing that with us. So, what do you think comes next in this field? What excites you? Where do you think our next kind of development or understanding or breakthrough, whether it's diagnostic or treatment-wise?   Dr McCombe: I think, in the field, you know, any immunologic diseases, we've been really gaining a much better understanding of pathophysiology, and that's honestly what excites me the most, when you can know precisely what part of the immune system is at play here (whether it's, you know, complement-mediated or antibody-mediated) and then being able to then rationally choose medications based on a really clear understanding of the disease is something that I think is kind of novel in a way. For so many years, we would use kind of big broad-spectrum immunosuppression - even in multiple sclerosis, still, we use medications that, historically, we've found to be helpful - but we don't have a great understanding sometimes of why the medicines work. So, kind of going at it from the other way, where we're actually determining what is the exact pathophysiology of disease and then making a rational approach to a therapy, or choosing a therapy based on that, I think is what excites me the most, and I think we'll gain a better understanding of even a broader swath of diseases and be able to make those choices more often. That's what I like about this field.   Dr Nevel: Great. Well, thank you so much for sharing that - and looking forward to the future in this area of neurology. And thanks so much for talking with me today and sharing your story and your expertise and knowledge.   Dr McCombe: Well, thank you for having me. It's been fun.   Dr Nevel: And I encourage all the listeners to read your article. Again, today, I've been interviewing Dr Jennifer McCombe, whose article on neurosarcoidosis and neurologic involvement of rheumatologic disorders appears in the most recent issue of Continuum on autoimmune neurology. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today.   Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at Continpub.com/AudioCME. Thank you for listening to Continuum Audio.

Send us a Text Message (please include your email so we can respond!)Episode 47! In this episode we talk about a prospective observational study examining cognitive motor dissociation by Bodien et al published in the New England Journal of Medicine and then we pair that talking about the guidelines for death by neurologic criteria published in SCCM! An episode of somber but important topics!Cognitive Motor Dissociation (pubmed): https://pubmed.ncbi.nlm.nih.gov/39141852/Cognitive Motor Dissociation (NEJM): https://www.nejm.org/doi/10.1056/NEJMoa2400645 DBNC Guidelines (pubmed): https://pubmed.ncbi.nlm.nih.gov/37921516/DBNC Guidelines (CCM): https://journals.lww.com/ccmjournal/fulltext/2024/03000/the_2023_american_academy_of_neurology,_american.3.aspx If you enjoy the show be sure to like and subscribe, leave that 5 star review! Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!

Have you ever been confused about the concept of brain death, or struggled to explain brain death to a patient's family or your fellow clinicians? Join the Behind the Knife Surgical Palliative Care team and our special guest, neurologist & neurointensivist Dr. Sarah Wahlster, as we explore the 2023 Pediatric & Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline and what this updated guideline means for our practice in surgical palliative care! Hosts: Dr. Katie O'Connell (@katmo15) is an Associate Professor of Surgery at the University of Washington in the division of Trauma, Burn, and Critical Care Surgery. She is a trauma surgeon, palliative care physician, Director of Surgical Palliative Care, and founder of the Advance Care Planning for Surgery Clinic at Harborview Medical Center in Seattle, WA. Dr. Virginia Wang is a PGY-3 General Surgery resident at the University of Washington. Guest: Dr. Sarah Wahlster (@SWahlster) is an Associate Professor of Neurology at the University of Washington. She is a neurologist, neurointensivist, and Program Director of the Neurocritical Care Fellowship at Harborview Medical Center in Seattle, WA. Learning Objectives: ·      Understand the concept of assent and how it can be helpful in communicating with families of patients who have sustained brain death ·      Explain the main steps required for diagnosis of brain death (prerequisites, clinical exam, apnea testing, ancillary testing) ·      Understand key differences between the 2023 guideline and previous (2010 & 2011) guidelines ·      Be able to name the 3 accepted modalities of ancillary testing for brain death ·      Know basic communication best practices with families of patients who have sustained brain death from the surgical palliative care perspective (consistency of language & messaging; avoidance of phrases such as “life-sustaining treatment”, “comfort-focused measures”) References: 1.     Greer, D. M., Kirschen, M. P., Lewis, A., Gronseth, G. S., Rae-Grant, A., Ashwal, S., Babu, M. A., Bauer, D. F., Billinghurst, L., Corey, A., Partap, S., Rubin, M. A., Shutter, L., Takahashi, C., Tasker, R. C., Varelas, P. N., Wijdicks, E., Bennett, A., Wessels, S. R., & Halperin, J. J. (2023). Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline. Neurology, 101(24), 1112–1132. https://doi.org/10.1212/WNL.0000000000207740 2.     Lewis, A., Kirschen, M. P., & Greer, D. (2023). The 2023 AAN/AAP/CNS/SCCM Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline: A Comparison With the 2010 and 2011 Guidelines. Neurology. Clinical practice, 13(6), e200189. https://doi.org/10.1212/CPJ.0000000000200189 3.     AAN Interactive Brain Death/Death by Neurologic Criteria Evaluation Tool – https://www.aan.com/Guidelines/BDDNC 4.     AAN Brain Death/Death by Neurologic Criteria Checklist – https://www.aan.com/Guidelines/Home/GetGuidelineContent/1101 5.     Kirschen, M. P., Lewis, A., & Greer, D. M. (2024). The 2023 American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society, and Society of Critical Care Medicine Pediatric and Adult Brain Death/Death by Neurologic Criteria Determination Consensus Guidelines: What the Critical Care Team Needs to Know. Critical care medicine, 52(3), 376–386. https://doi.org/10.1097/CCM.0000000000006099 6.     Greer, D. M., Shemie, S. D., Lewis, A., Torrance, S., Varelas, P., Goldenberg, F. D., Bernat, J. L., Souter, M., Topcuoglu, M. A., Alexandrov, A. W., Baldisseri, M., Bleck, T., Citerio, G., Dawson, R., Hoppe, A., Jacobe, S., Manara, A., Nakagawa, T. A., Pope, T. M., Silvester, W., … Sung, G. (2020). Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project. JAMA, 324(11), 1078–1097. https://doi.org/10.1001/jama.2020.11586 7.     Lele, A. V., Brooks, A., Miyagawa, L. A., Tesfalem, A., Lundgren, K., Cano, R. E., Ferro-Gonzalez, N., Wongelemegist, Y., Abdullahi, A., Christianson, J. T., Huong, J. S., Nash, P. L., Wang, W. Y., Fong, C. T., Theard, M. A., Wahlster, S., Jannotta, G. E., & Vavilala, M. S. (2023). Caseworker Cultural Mediator Involvement in Neurocritical Care for Patients and Families With Non-English Language Preference: A Quality Improvement Project. Cureus, 15(4), e37687. https://doi.org/10.7759/cureus.37687 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Chiropractor Kim Bruno furthered her training with the Institute of Functional Medicine, ILADS, Horowitz Lyme Master Classes and holds a board-certification as a Certified Clinical Nutritionist. She owned a private practice for 17 years and was the functional medicine medical director for the largest immunology clinic in Colorado. She comes to us today as the Senior Medical Science liaison for Vibrant Wellness Labs. Today we discuss their panel of 48 neurologically-oriented antibodies: the Neural Zoomer Plus. We start by discussing the lab technology itself, which is somewhat unique in the testing world- it's an 'Immunochip', also called a protein-peptide microarray as viewed through chemiluminescence which can be more sensitive than historical Eliza testing. The sensitivity (the ability to find the needle in the haystack) ranges from 95-98% and the specificity (it's definitely a needle, and not a pin or nail or something similar that is not actually a needle) is 96-100%. The range is because each analyte has its own metrics. Here, we take a tangent into describing the limitations of Eliza & Western Blot testing, especially in light of tick-borne testing for Lyme disease & co-infections. Then we touch on PCR- polymerase chain reaction testing and the use of glass beads to break up biofilms in test samples for even more accurate results.   Our next chapter (around 14:30) focuses on the immune system itself. Listen in for some helpful analogies for the immunoglobulins-IgM for ‘marines vs IgG for ‘ground troops', IgA with affiliation with mucus membranes like the gut or respiratory linings, and IgE for anaphylactic allergic reaction. This gives the total pool from which the Neural Zoomer Plus antibodies are pulling from as a sort of clinical calibration to weigh the presence of the specific antibodies.   At 22:20, we dive into the Neural Zoomer Plus test itself. Dr Bruno shares her brilliant ‘hierarchy of consideration' for putting these antibodies into a context. While she states outright ‘this is not a diagnostic test', the larger truth is that this test cannot be used for diagnosis by clinicians who don't have the scope to make diagnostic conclusions, for example dieticians or health coaches. For our purposes at Neuroveda Health, we absolutely use this test for clinical decision making and diagnosis. Dr Bruno calls out molecular mimicry against pathogens or even foods or toxins that can confuse the immune system. We consider the Cunningham Panel (recently renamed the Autoimmune Brain Panel), which has been used longer for PANDAS evaluation. And we walk through each category of antibody included on this test.   We finish with a discussion about treatment approaches based on results from this test, including the Neuroveda Health approach to evaluating and addressing neuroimmune disease. FOR MORE INFORMATION: To look at a sample report of this test: https://hello.vibrant-wellness.com/hubfs/Sample%20Reports/MK-0072-01NeuralZoomerPlusSampleReport.pdf To find out more about the Neural Zoomer Plus test: https://www.vibrant-wellness.com/test/NeuralZoomerPlus To get testing, contact us to schedule an appointment with a clinician at Neuroveda Health: - Phone: 206-379-1213 - Email Reception@neurovedahealth.com To find out more about our clinic (and request a call back): https://www.neurovedahealth.com/

In this week's podcast, Neurology Today's editor-in-chief discusses data on the complex interaction between body composition, vascular health, and neurodegenerative disease, Tenecteplase in an extended treatment window and stroke-related disability, and gene expression in cormorbid cancer and stroke.

In the final part of this two-part series, Dr. Andy Southerland and Dr. Lidia Moura discuss strategies on how clinicians can mitigate bias when using large language models. Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000209497 

We're coming together to talk about the connection the brain has to the immune system under the effects of excess #stress and #weight gain.Two amazing experts — Dr. Fatima Cody Stanford @askdrfatima at Harvard Medical School and Dr. Ellen Mowry at @hopkinsmedicine join us Monday for #BrainChat with #thenerdyneurologist to get into it.Stress unfortunately isn't avoidable, and impacts Black women disproportionally in the United States, similarly to MS.Together, we're spreading awareness by talking about how the brain physically reacts to stress, weight gain, and MS.

In part one of the part-two series, Dr. Andy Southerland and Dr. Lidia Moura discuss the major findings related to large language models (LLMs) for neurologic care. Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000209497 

Dr. Andy Southerland talks with Dr. Lidia Moura about the implications of large language models (LLMs) for neurologic care. Read the related article in Neurology. Disclosures can be found at Neurology.org.

Audio Commentary by Dr. Valentin Fuster, Emeritus Editor in Chief

In this enlightening discussion, we have an open conversation with physical therapist Lauren Young, PT, DPT, CSRS, NCS, who reached out to Claire with a number of questions. She was willing to come on the podcast so everyone can benefit from the information. Lauren started a mobile neuro practice in February 2024 and is looking to develop group wellness classes to increase access to specialty services.  Claire answers the following questions: 1. How do you make exercise classes accessible for all levels of abilities in a group setting? 2. How did you start your wellness program, particularly regarding staffing and class structure? 3. How do you structure her membership model and pricing? 4. Looking back, is there anything Claire wishes she had done differently when first starting?  Key takeaways include: 1. Renting space from existing gyms or studios is a smart way to start without heavy upfront costs. 2. Structuring classes for different ability levels is crucial for safety and effectiveness. 3. A monthly membership model provides consistent revenue and commitment from clients. 4. Pricing should reflect the premium nature of specialized services, even if it feels uncomfortable at first. 5. Slow, steady growth allows for learning and adaptation as the business evolves. This conversation offers a wealth of practical advice for PTs looking to expand into wellness programming for neurological patients, emphasizing the importance of adaptability, client-focused services, and sustainable business practices. Find out more about Lauren Young here: NeuroElite Physical Therapy  www.NeuroElitePT.com @NeuroElitePT (Instagram)  Have a neuro biz and want a place to ask questions of other biz owners? Request to join the NeuroBiz Besties free Slack group here

Dr. Shuvro Roy and Dr. Alexander Gill discuss his paper  "Neurologic Outcomes in People with Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder Exposed To Immune Checkpoint Inhibitors." Show reference:  https://www.aan.com/conferences-community/summer-conference/abstracts/ This podcast is sponsored by argenx. Visit www.vyvgarthcp.com for more information.

Dr. Kim Waddell is an Assistant Professor in Physical Medicine and Rehabilitation at the University of Pennsylvania's Perelman School of Medicine as well as a faculty member with the Center for Health Incentives and Behavioral Economics, a Senior Fellow in the Leonard Davis Institute of Health Economics, and Research and Innovation Manager in the Penn Medicine Nudge Unit at the University of Pennsylvania. In addition, Kim is a Research Health Scientist at the VA Center for Health Equity Research and Promotion. Kim's research focuses on behavior change and how to help motivate people to make decisions that are more aligned with their longer term goals. She is particularly interested in physical activity and using approaches from behavioral science to motivate adults who have had a stroke or have Parkinson's disease to increase their daily activity. Another area that Kim is interested in is designing clinical decision support systems and ways to improve decision making to make sure that people are getting the right amount of the right kind of rehabilitation after stroke. When she's not working, Kim tries to go running as often as possible to clear her head and disconnect from technology. She also enjoys cooking, particularly trying new recipes, as well as watching local sports teams and traveling. Kim received her BS in Health Science from Truman State University and her Master's degree in Occupational Therapy from the University of North Carolina at Chapel Hill. She then attended Washington University in St. Louis where she earned her PhD in Movement Science and her Master's degree in Clinical Investigation. Kim conducted postdoctoral research at the VA and Penn before joining the faculty there. Recently, she was awarded the 2024 Academy of Behavioral Medicine Research's Early-Stage Investigator Award, and in our interview, she shares more about her life and science.

In this episode, we'll delve into a variety of Perioperative Neurologic Complications, exploring topics such as substance abuse, dementia, emergence delirium, post-operative visual loss, and peripheral nerve injuries.We'll discuss how these complications can impact our anesthetic plan, patient positioning, and the specific considerations we need to address to ensure the best possible care for our patients. Join us as we navigate through these crucial aspects of perioperative care, focusing on the nuances that can make all the difference in patient outcomes.Support the Show.To access all of our content, download the CORE Anesthesia App available here on the App Store and here on Google Play. Want to connect? Check out our instagram or email us at info@coreanesthesia.com

Dr. Derek Stitt talks with Dr. Adam de Havenon about the burden of neurologic health care and incident neurologic diagnoses in the year after COVID-19 vs influenza. Read the related article in Neurology.  This podcast is sponsored by argenx. Visit www.vyvgarthcp.com for more information. Disclosures can be found at Neurology.org.