Podcasts about neurologic disorders

Dr. Tesha Monteith discusses the Brain & Life article, “Could GLP-1 Receptor Agonists Reduce the Risk of Neurologic Disorders?” by Hallie Levine, available in the latest issue of Brain & Life or at brainandlife.org.  Show reference: https://www.brainandlife.org/articles/new-weight-loss-drugs-may-help-neurologic-disorders 

Covid Shots Likely Accelerate Cancer, Neurologic Disorders, Dementia, Crohn's disease and moreSpecial Guest: Larry Logsdon, Exotic & Medicinal Fruit Researcher - Chemist - Can Noni help your battle with Cancer?Hear the story of an 18-year Survivor.

Over the past 20 years, more than 50 antibodies have been identified and associated with autoimmune neurologic disorders. Although advances in diagnostic testing have allowed for more rapid diagnosis, the therapeutic approach to these disorders has largely continued to rely on expert opinion, case series, and case reports. In this episode, Allison Weathers, MD, FAAN, speaks with Tammy L. Smith, MD, PhD, an author of the article “Therapeutic Approach to Autoimmune Neurologic Disorders,” in the Continuum® August 2024 Autoimmune Neurology issue. Dr. Weathers is a Continuum® Audio interviewer and associate chief medical information officer at the Cleveland Clinic in Cleveland, Ohio. Dr. Smith is a GRECC investigator and staff neurologist at George E. Wahlen Veteran Affairs Medical Center and an assistant professor of neurology, at the University of Utah in Salt Lake City, Utah. Additional Resources Read the article: Therapeutic Approach to Autoimmune Neurologic 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 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 Weathers: This is Dr Allison Weathers. Today, I'm interviewing Dr Tammy Smith about her article on therapeutic approach to autoimmune neurologic disorders, which she wrote with Dr Stacey Clardy. This article is a part of the August 2024 Continuum issue on autoimmune neurology. Although, one of the things I love most about being an interviewer for Continuum is getting the opportunity to meet new neurologists and learn all about their areas of expertise, there's something really special when I get the chance to interview and catch up with old colleagues - and today, I'm fortunate to do just that. I had the privilege of working with Dr Smith when she was a resident at Rush, and I'm so excited to be able to speak to her today about her fantastic and really comprehensive article on this very timely topic. Welcome to the podcast, Dr Smith, and please introduce yourself to our audience.   Dr Smith: Hi. Yeah, thank you for inviting me to participate in the podcast and to write this article. So, I'm Tammy Smith. I am a neurologist who practices in Salt Lake City. I primarily work at the Salt Lake City VA Medical Center where I get to treat veterans with all sorts of neurologic diseases. I'm also an assistant professor of neurology at the University of Utah in the division of Neuroimmunology and Autoimmune Neurology, and I serve as a Clinical Consultant for ARUP Laboratories to help improve diagnostic testing for immune-mediated neurologic diseases.   Dr Weathers: Wow. That is a lot of different roles and things that you have on your plate. I want to start, actually, by talking about the article. Again, you cover so much ground (you and Dr Clardy) in this really comprehensive article, but if you had to choose the one most important message - if you wanted our listeners to walk away remembering one key point, what would it be?   Dr Smith: I think the key point I want our listeners to think about is just to use the resources that are available to you. Nobody can have all of these drugs (as we're talking about treatment of autoimmune neurologic diseases in this article) - no one can have all of those drugs memorized, all of the mechanisms of action, all of the approved treatments and off-label treatments, and all of the symptomatic therapies. But that's why resources like the Continuum exist - so that we can provide those resources to clinicians who are busy at that touch of, er, hopefully - or when they open their issue - to get the information they need to make decisions to take good care of their patients.   Dr Weathers: I think that is so reassuring. As I was reading this article, that was, like, one of the things that really struck me is that, you know, thinking about even being a resident and studying for something like the rate exam, you know, how much easier it used to be when there was such a limited number of drugs thinking about the autoimmune diseases or epilepsy, where just the number of drugs has just, kind of, multiplied so manyfold since I was in training, that it's really overwhelming. And I think you make a great (and as I said, a very reassuring) point that we don't have to memorize these, that there are these incredible resources (like Continuum) where it's not any longer about kind of memorization and keeping it in our heads, that it's more about knowing where to look and thinking about what's the right thing for the patient - knowing how to go and get the information is the more important knowledge there. And, actually, thinking about that and moving on, given your expertise, how do you personally approach the management of a patient with an autoimmune neurologic disorder? Again, in the article, you speak about all the different things to keep in mind, both from a therapeutic (really, treatment) standpoint, as well as a symptomatic standpoint - but what is your personal approach?   Dr Smith: My personal approach really involves considering whether the diagnosis of an autoimmune neurologic disorder is correct, first and foremost, and gathering the information to help support that diagnosis - and I think that's something that often gets overlooked in the excitement of a patient coming in with a rare-looking syndrome. Someone sends off diagnostic testing, rules out a few things, decides it's autoimmune, and starts down a pathway and keeps pushing forward. And I understand that inclination on a busy neurology service or in a busy clinic to just decide on one path and move forward, but I'm always questioning the diagnosis, even in the presence of positive antibody results sometimes. If my patient doesn't respond to the treatment that I'm giving them based on their presentation and the antibody results, I reassess and wonder if there's something else going on, are there two syndromes going on, or was that antibody result really not the right answer for some reason. So, I think my approach, really, is to always have a healthy amount of skepticism around the diagnosis, and even when I'm fairly confident in the diagnosis, to continually reassess that patient and their unique response to treatment. And then, also, their unique circumstances - so, everyone will need different symptomatic management, as well as different rehabilitation resources and other resources mobilized to help them maximize their recovery. And so, there's just not a “one size fits all” approach, but always keep talking to the patient, keep re-evaluating, stay curious, and don't be afraid to change paths when things aren't making sense.   Dr Weathers: I think that is incredibly sound, really thoughtful advice. So, I can imagine how incredibly challenging those cases must be when you think you have the right answer, it looks like it's lining up, the antibodies are pointing you in the right direction, and then, they're not responding. What else do you feel is the most challenging aspect of the management of these conditions? Is there some other kind of aspect that you also feel is really challenging in the treatment of these patients?   Dr Smith: Yeah, I think other challenges are really access to state-of-the-art therapies due to financial barriers - I think that's a pretty significant challenge for a lot of these patients, and I think we need to continue to work on advocacy efforts to make sure all patients have access to the medications they need to treat the disorders they are diagnosed with. And it's a real challenge, even when there's FDA-approved therapeutics - a lot of them are quite expensive, and then we end up playing the insurance game, and we learned that AI is automatically denying people's insurance claims, and so, we're battling computers as well as insurance companies. And I think that's a really significant challenge for a lot of these patients. And then, really, just the fact that a lot of immune-mediated neurologic disorders have a long tale. So, we don't treat a patient the same way we do for an infection and expect a dramatic and rapid recovery - a lot of the recovery for these patients happens over months to years. It's a process, and I think it's really important to be counseling patients and caregivers and other providers and educating them about this that we continue to mobilize resources to help our patients long past their inpatient hospitalization and the most dramatic part of their recovery.   Dr Weathers: Again, you raised some really insightful points there. No, I think they're really key. And I think, to your point, that even for some of these patients, that even if we can get over the economic barriers of the medications themselves and get them authorized, get them covered, you're left with, for a lot of patients, all of the other limitations of some of their social determinants of health challenges, right? So, the transportation challenges to even kind of get them to the appointments, and some of the other challenges they face, which makes some of these treatments very, very hard for them to be able to accomplish. So, it is very challenging - I think that's a very important call-out. What do you think is the easiest mistake to make when treating patients with autoimmune neurologic disorders, and how should our listeners avoid it?   Dr Smith: Yeah, that's an excellent question. One of the most common mistakes I see is either overvaluing diagnostic testing or not ordering the appropriate diagnostic testing for the clinical syndrome in any given patient. And where this comes into play, really, is the fact that when we order diagnostic testing in the United States for immune-mediated neurologic disorders, these autoantibody panels are available to us that test for a multitude of autoantibodies all at the same time, and if we don't choose the appropriate test for the clinical syndrome that the patient is there with, we run the risk of getting a positive result for an antibody that's unrelated to the syndrome we're seeing in the patient – and no test is 100% specific (or 100% sensitive, for that matter), but these low-specificity issues when you indiscriminately test really can cloud the clinical picture and delay getting the appropriate diagnosis. And so, I really think that one of the biggest mistakes is seeing maybe a low-positive result for an antibody that does not match the clinical syndrome if you go back to the books and use your resources to figure out if that result is meaningful - overvaluing that antibody result and maybe plowing forward with a treatment plan that involves a long course of immunomodulatory therapy is a pretty significant mistake. And then, on the flip side is that because these panel tests, you order them as a block, and you think that you ordered the right thing - or you think that whoever you asked to order the order for you ordered the right thing – and so often, people say the panel was negative, and they don't look at the individual results of the antibodies that were tested in the panel, and because different antibody panels are designed to test for different clinical phenotypes. I see the error where a clinician thinks that all of the antibodies necessary to test for were tested for and negative, and now they feel like their hands are tied. And so, it's both this overvaluing the diagnostic testing and forgetting to question the testing results if they're not what you expect once you get more clinical data - I think both of those are pretty big mistakes. And continuing, again, always be curious, always recheck results, and don't take laboratory values in an EMR that are in black and white as the stone-cold truth that tells you your answer - you have to stay curious about the patient, their history, their neurologic presentation, their response to treatment over time, and really keep assessing. My other soap box here about diagnostic testing is that, historically, a lot of the antibodies that we test for were called paraneoplastic (and that's because they were some of the first antibodies discovered, so, they were some of the earliest ones that we developed tests for), and clinical reference laboratories continue to offer paraneoplastic panels for historical reasons and because a lot of people think that that's what they want. But, paraneoplastic panels, in and of themselves, are not representative of a specific clinical phenotype - they just diagnose patients who have a high risk of malignancy associated with an antineural antibody. And so, most of the clinical reference labs I know of - certainly at ARUP, we have a notice on our testing page, I know Mayo Clinical Laboratories also has a notice that says, “Paraneoplastic panels are not generally the recommended panel to test for antineural antibodies. Consider ordering the phenotype-specific panel that fits the patient's clinical syndrome”. And I think that's super important – we still have paraneoplastic stuck in our head for historical reasons, and it is almost never the right answer.   Dr Weathers: It's really interesting. At my organization, you know, we actually have had some really thoughtful conversations about, do we really restrict it (you know, as part of lab stewardship efforts) - and, you know, these are expensive, and to your point, they can be frankly, really dangerous, you know, to really send somebody down this wrong path with a lot of surveillance, committing them to immunomodulatory therapies, and take you in completely the wrong direction when, actually, your low test probability was very low. So, I think that is an excellent one to really call out and for people to be very thoughtful of - and the way, again, to avoid it is to be very thoughtful about the panels. And for people, certainly, they are very convenient, but people need to be really aware of what's in them and what they are ordering and how to interpret them. And I love that advice about not just thinking about the wholesale as negative - really, you know, for many of us, they are still coming in as scan documents, you know, click into them, read every line, really understand what those results mean.   Dr Smith: And I would also say that I think people don't realize, but clinical reference laboratories would love for you to reach out when there are questions. So, if you don't understand the diagnostic testing that was performed or result, you pretty much all have hotlines. You can call and reach out to an expert in the testing and ask them some questions, and don't be afraid to reach out to your colleagues who might have more experience. We love hearing from people with questions and helping to direct them to the right testing and help them get the answers that they really want to for their patients.   Dr Weathers: I think that is a great plug. Before you order, preferably, before you send in.   Dr Smith: I do like when I hear from people before mistakes were made. Yes. That's nice.   Dr Weathers: It's a great point.   Dr Smith: When you order these panels, you do run the risk of having these low positive results that may or may not be clinically meaningful. And we do recommend that most of the diagnostic testing be ordered in both serum and CSF. And so, a good example of a mistake that can be made is a very low-positive NMDA-receptor antibody in serum - maybe it was ordered for a patient with cognitive decline or confusion (maybe not under the ideal clinical scenario for ordering), and then it's negative in the CSF. So, an NMDA-receptor positive, negative in the CSF, not the right clinical picture, people can get really jazzed and want to treat an NMDA-receptor encephalitis, that in that case, really isn't meeting diagnostic criteria, and there are excellent diagnostic criteria that have been developed and published for that disorder and for several other autoimmune neurologic disorders, and I think going back to those criteria and really questioning yourself before you start blindly down a path based on a lab result is really important.   Dr Weathers: I think that's excellent advice, too, always keeping that in mind that just because you have gone down this path and gotten that result doesn't mean that you are stuck and committed to it. Always keeping that criteria in mind, always going back, always checking it is really important as well. Moving on from mistakes to kind of an adjacent question, what do you think is the biggest controversy right now when it comes to the treatment of patients with autoimmune neurologic disorders?   Dr Smith: You know, one of the big controversies that I see and I'm concerned about is that we've gotten into a habit of treating the way we've always treated based on expert opinion, and while experts have their opinions based on a lot of experience, they don't take the place of well-designed randomized controlled clinical trials - and in rare diseases (like autoimmune neurologic diseases), it can be really challenging to conduct those trials, especially in the face of people who have a pathway that they always do with their patients. If they have a NMDA-receptor encephalitis patient, they feel very comfortable doing their standard of care with IV steroids and then either plasma exchange or IVIG, and then possibly (and very often), I see following with a B-cell inhibitor, like rituximab, as sort of just a “kitchen-sink” approach to treatment. And while I understand the passion and the desire to make a really sick patient sitting in front of us better as fast as possible, I don't think we have adequate evidence to support that being the “one-size-fits-all kitchen-sick” approach for treatment. And I really am passionate about all clinicians all over the world, supporting randomized controlled clinical trials that are well-designed with the backing of experts in the community, so that when we look at a patient and tell them that we recommend a course of treatment, we're recommending it based on the best quality evidence available, not just what everyone's always done before. I think we can do better than that. And I think there's some controversy in this. Some people think that it doesn't make sense, we already know the answer, but I would say we haven't asked the right question and thoroughly investigated enough. And this is especially important with children, right? We know pediatric patients often don't have well-designed clinical trials to guide their treatments - but in NMDA-receptor encephalitis, many of the patients are children, and I think that they deserve to be involved in well-designed clinical trials in order to support the recommendations that we make for treatment.   Dr Weathers: And in addition to children, think about all of the other patient populations that have traditionally not been well represented in trials, right - pregnant patients, patients of color (historically very underrepresented in trials) - many, many other patient populations that have not been adequately represented.   Dr Smith: Absolutely. Yeah. I think we need to really care about that and face that problem head on and speak to it. We can't just say this is the way we've always done things, so we're going to keep doing it that way. I think we owe it to our patients and ourselves, when we look our patients in the eye, to say that we have good evidence to support the recommendations we're making.   Dr Weathers: I think we have already answered this question in many ways with each of the questions we've already talked about, but is there any other strong arguments that you can make for why it's important for neurology clinicians to read your article?   Dr Smith: Dr Clardy and I spent a lot of time working on this article, trying to put together a piece that will be a resource that people could turn to again and again. I don't think that this article is something that you should read from top to bottom and think that you've absorbed and digested everything, right? So, what we work to do was to really provide a structure and a framework to think about the treatment of immune-mediated neurologic diseases. So, rather than memorizing specific drugs for specific conditions, we developed sort of a space where you could talk about B-cell targeting therapies and the different ways we can target B-cells, we talked about complement inhibitors, neonatal FC receptors, and, really, just at a high level, how these drugs work and how they're targeted, so that going forward in three, four, five years, what I believe we'll know more about each of the individual diseases mediated by antineural antibodies. When we understand what causes that disease, we'll be able to go to a resource like this and choose rationally based on mechanism of action, a drug to treat our patient - even if it's in a patient with such a rare disease that we don't have the luxury of a clinical trial to guide our choices.   Dr Weathers: That's a really excellent point - and I know I've said it a few times, but I think you guys did such a really excellent job at really laying it out in a way that makes it this really comprehensive, really easy-to-use resource at that point of care for providers to be able to do exactly that. Well, I always like to end on a hopeful note, so, this is always my favorite last question – but, what do you think is the next breakthrough coming in the treatment of patients with autoimmune neurologic diseases?   Dr Smith: Yeah, I think in the near future (I certainly hope, at least) that the next breakthrough is going to be in really being able to deliver personalized care based on what we understand about the mechanisms of a patient's rare disease. So, again, right now, I find we're kind of left with the “kitchen-sink” approach because we know so little about the mechanisms that drive each of these unique neurologic diseases and we don't have enough information from clinical trials to inform rational treatment decisions, so we go with these broad approaches - and I really think that in the near future, with work being done by a lot of people (dedicated people over the world) on biomarkers and things that predict either onset of disease or relapse or disease severity or really looking at basic fundamental mechanisms that drive disease, we're going to be able to make more rational choices in the treatment of these patients and mobilize the resources that are expensive, but valuable for the right patient at the right time.   Dr Weathers: That is a very exciting and hopeful future to look towards. Thank you, Dr Smith, for joining me on Continuum Audio. It was wonderful to get to spend this time with you again. Again, today, I've been interviewing Dr Tammy Smith, whose article on therapeutic approach to autoimmune neurologic disorders, written with Dr Stacey Clardy, 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.

Paraneoplastic neurologic syndromes can present with manifestations at any level of the neuraxis. In patients with high clinical suspicion of a paraneoplastic neurologic syndrome, cancer screening and treatment should be undertaken, regardless of the presence of a neural antibody. In this episode, Katie Grouse, MD, FAAN, speaks with Anastasia Zekeridou, MD, PhD, author of the article “Paraneoplastic Neurologic Disorders,” in the Continuum August 2024 Autoimmune Neurology issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California San Francisco in San Francisco, California. Dr. Zekeridou a senior associate consultant in the departments of neurology, laboratory medicine, and pathology, and for the Center for Multiple Sclerosis and Autoimmune Neurology at Mayo Clinic in Rochester, Minnesota. Additional Resources Read the article: Paraneoplastic Neurologic 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 Guest: @ANASTASIA_ZEK Transcript Full 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 Grouse: This is Dr Katie Grouse. Today, I'm interviewing Dr Anastasia Zekeridou about her article on classical paraneoplastic neurologic disorders, which is part of the August 2024 Continuum issue on autoimmune neurology. Welcome to the podcast, and please introduce yourself to our audience.   Dr Zekeridou: Hi. Thank you, Dr Grouse. I'm always excited to talk about paraneoplastic neurological diseases. So, I'm an autoimmune neurologist at Mayo Clinic in Rochester, and I spend my time between the lab and seeing patients in the autoimmune neurology clinic.   Dr Grouse: Thank you so much for joining us, and we're really excited to talk about this really important topic. So, to start, I'd like to ask what, in your opinion, is the key message from this article.   Dr Zekeridou: That's a good question - there are a lot of messages, but maybe if I can distill it down. For me, one of the first things is that paraneoplastic neurological diseases can actually affect any level of the neuraxis. It can manifest with different types of presentations. If we do suspect a paraneoplastic neurological syndrome, then we need to look for the cancer, and then if we're not certain, even do an immunotherapy trial. A negative antibody does not make for an absence of a paraneoplastic neurological disease (because, often, we depend a lot on them), but you can see patients with paraneoplastic disease that do not have neural antibodies. And then, we always need to be thinking that if we have a paraneoplastic neurological disease, we actually need to be thinking of both the cancer and the immune response together - so, we need to be treating the cancer, we need to be treating the immune response – because, essentially, paraneoplastic neurological syndrome is evidence of this antitumor immune response. So, the main (if I can distill this down in one) is probably that we need to be discussing all of these patients with the treating oncologist, because they have complicated care.   Dr Grouse: Great. Thank you so much for that summary. It's very helpful. While many of our listeners are likely familiar with paraneoplastic disorders in their workup (which you've mentioned just now), the concept of neurologic autoimmunity in the context of immune checkpoint inhibitor therapy has more recently become widely recognized. Can you summarize this briefly for our listeners who may be less familiar with this?   Dr Zekeridou: I think that we learn more and more about this and we see more and more patients with immune checkpoint inhibitor-related neurological immunity, so, I always think about it in a very straightforward way. So, I think the way we think about immune responses is a balance between tolerance and regulation and immune activations. And then, immune checkpoints are the molecules that help us maintain self-tolerance. So, our immune system - it's probably the best tool that we have to fight against cancer. So, essentially, when we inhibit the immune checkpoints, we actually use our own immune system to fight cancer, but taking the breaks of the immune system essentially can lead to a lot of complications that are immune-mediated. Some of them are neurological - the neurological complications are rare, especially the ones that we need to do something about (so, it's 1% to 4%, in some cases up to 14%), and they do increase when you use multiple immune checkpoint inhibitors together. The main thing for me with the neurological complications is that, sometimes, they are difficult to recognize, they can (again) affect every level of the neuraxis - like, it can be the neuromuscular or the central nervous system (even though neuromuscular complications are much more common than central nervous system complications) - and then a lot of them (the vast majority) will happen within the first three months, but they can also happen even after you stop the immune checkpoint inhibitor. But this three-month interval, it's sometimes useful when you're in a diagnostic silence - it kind of helps you make the decision more towards an immune-related adverse event affecting the nervous system. And then, I think that, practically, once we have diagnosed this patients, we still are not very certain how to treat. All of them will get steroids upfront, but some of them will be difficult to treat, so then, we have to decide on the next treatment depending on evolution. And then, I will just say that (I mentioned it previously, but) these are the patients that the coordination with other subspecialties is one of the main things that we need to do (eg, oncologists) - they often have immune-related adverse events from other systems, so, there is a lot of coordination of care. And, always, the question at the end comes up, Should we be putting these patients back to their immune checkpoint inhibitor cancer immunotherapy that might help them with the cancer? And I think that this is difficult sometimes, and it needs to be decided - most cases - in a case-by-case basis, even though there are some recommendations that I've been discussing in the Continuum article.   Dr Grose: That's great, and I encourage everyone to read more about this, because it is a very complex and fascinating topic. On the note of the immune checkpoint inhibitor neurologic dysfunction - I would imagine these are pretty rare - how common are these? And I would suspect they're getting missed a lot - is that correct?   Dr Zekeridou: I think it's a very good question. Essentially, what we say for the neurological immune-related adverse events (the ones that we need intervention) - so, they are at least of grade two. (I think that there are less than 4%, mostly, probably close to 1.5%.) There was a study where they used double immune checkpoint inhibitors (so CTLA-4 and PD-1, PD-L1) - they were up to 14%, but this was any grade (so, a little bit of tingling, a little bit of headache), while the ones that we actually need to act upon and we need to actually do something about, they are probably closer to 1.5%. So, are they being missed? I am certain that some of them never make it to the neurologist. So, the ones that we know that we are underestimating is definitely the meningitis - because I think it's more common – but, often, when the patients present, they have something else as well. So, the oncologists will put them on steroids and then they will get better - so, we don't really see them in the neurology clinic (the ones with the very mild side effects). And then, also, these patients are often very sick, and they have a lot of things going for them, so they sometimes do not make it to the diagnosis.   Dr Grouse: So then, I want to just take a step back and ask you, what's the most challenging aspect of paraneoplastic neurologic disorders in your opinion?   Dr Zekeridou: I think, for me, one of the main things, the classic paraneoplastic disorders - and when I say “classic paraneoplastic disorders”, they are the ones that we think more of with antibodies that are mostly biomarkers of the immune response, and they suggest a cytotoxic T-cell mediated disorder (so, like PCA1 [or anti-Yo] or ANNA-1 [or anti-Hu]) - these patients are very sick often, and we don't have a lot of good treatments for them. And then, even if we treat them, we actually sometimes do not manage to reverse their course - the best that we can do is stabilize. So, I think that this is part of the discussion that we have upfront with these patients - but it is quite challenging, because most of them, we will be giving them a cancer diagnosis ourselves, because we recognize the paraneoplastic neurological syndrome, and we look for the cancer, and then we'll be giving them a cancer diagnosis. And even if we treat their cancer and we treat the immune system, sometimes, then, we don't make a real improvement – like, we stabilize their disease and we sometimes get improvement, but there are cases that we do not and they continue to progress – so, that has been the most challenging aspect of this, and I think that's kind of where we really need more things coming – like, we need more treatments, we need to better understand these diseases and get more straightforward.   Dr Grouse: I agree. I think that's absolutely, uh, what we all hope for these types of disorders, and I can imagine we all can remember at least one case just like this where someone had this type of problem and just didn't respond to treatment. So, strong hopes that there will be improvement with this in the years coming. Another question I have for you is, what in your article do you think would come as the biggest surprise to our listeners?   Dr Zekeridou: I think that, because we discussed that immune checkpoint inhibitors (maybe we don't know as well), so one of the main things for me is when we first started thinking of neurological complications of immune checkpoint inhibitors, there was a lot of myasthenia gravis mentioned (patients presenting with myasthenia gravis), and then some of them antibody-positive, some of them antibody-negative. Now, with the time that has passed by, we recognize that myasthenia gravis is very rare. Like, I've seen tons of patients (probably more than that, actually) – and then, maybe I've seen one patient with de novo myasthenia gravis. We realize that the immune checkpoint inhibitor myasthenia gravis that we were thinking of are – they're mostly the immune checkpoint inhibitor myocytes cases - so, then, this is one of these myopathies that looks like no other. So, it really has a very predominant oculobulbar involvement (that's why everybody was thinking that this is myasthenia gravis), but, practically, the EMGs are negative, the patients do not respond to pyridostigmine - so, practically, these are really myopathy cases. And why is that important? Because 30% to 40% of these cases might also have a cardiomyopathy, for example, and then we're putting all these patients on pyridostigmine and medications that they do not necessarily need. So, I think one of the chains in concepts that we have in the later years is that, really (and this is one of the most common immune-related adverse events that we see in our clinic), that these patients with ICI myositis really present with the oculobulbar involvement and proximal involvement that we can see in myasthenia, but they do not have a neuromuscular junction problem.   Dr Grouse: Now, we've all struggled with identifying a primary malignancy in patients where a paraneoplastic syndrome was strongly suspected. Do you have any tips on how to make this workup as high yield as possible?   Dr Zekeridou: Yeah, I think that's a difficult question. I think it depends a little bit on your patient as well. So, if you have an antibody that makes things easier (and we can discuss about that, but), practically, for me, a patient that I have a high suspicion, that we get a CT chest, abdomen, and pelvis upfront - and often, we don't get PET scans, right, directly, because we have insurance companies maybe playing a role in what we would do. So, I would get this for a woman - she has to have a mammogram. For a man, they have to have a testicular ultrasound. That's the basics for me. And then, when we see more younger women or when we suspect an MDA, then they will need to have the ultrasound to look for the ovarian teratomas or an MRI of the abdomen - so, the PET scan for me, if I have a high suspicion, it will always be the next step. Like, we have increased diagnostic yield with PET scans, but we also need to remember, what are the tumors that you will not find on a PET scan? Teratomas are not PET-avid, and, often we say, “Oh, we found the lesion in the ovary and the PET scan was negative.” That doesn't matter. In an NMDA-receptor antibody patient, if you find the lesion in the ovary, you need to make certain it's not a teratoma, because PET scans will not necessarily pick up a teratoma - it's not an avid malignancy. So, if the patient is a smoker and I suspect small-cell lung cancer, so I would always get the PET scan. If I have a patient with a high-risk antibody like PCA1 (or anti-Yo) and I didn't really find the tumor with the CT chest, abdomen, and pelvis and the mammogram, I will always get the PET scan. Same for the patients with the smoking history. I will also say that, sometimes, we forget other malignancies. So, for example, we have neuronal intermediate filament antibodies (so, ANNA-3 antibodies), and some of them will have Merkel cell. So, depending on the patient, on the antibody, and if we didn't find anything else, I would do a skin check. If they have GI symptoms, I would look for the GI tumor as well. So, even though the basics are what I mentioned, I will adapt depending on the patient symptoms. And all of these patients should have age-appropriate cancer screening, so if they didn't have a colonoscopy, they will have to have a colonoscopy. So, this is part of the main things. And then, the question for me that always comes up is, “Who is the person that you're going to keep on repeating the screen?” And then, practically, if you have a low-risk paraneoplastic antibody that comes (let's say LGI1), we know it's a low risk, so I would actually do the cancer screening - I will look for the thymoma once, and then that would be it. But if you have a patient with a high-risk paraneoplastic antibody (let's say ANNA-1 [or anti-Hu] or anti-Yo [anti-PCA1]), these are the patients that I will keep on screening - and then I will do every four to six months for two years (that's the current recommendation), but I will probably continue yearly after. And then, we need to also remember that whenever you have a neurological relapse, that's exactly when you need to be looking for the cancer as well - so, you must be thinking that the idea is that maybe you have the immunological relapse because there is cancer somewhere. So, these are the types of things that I kind of adapt to specific patients. But I think when we're not certain, broad screening is what we need. And then, again, the PET scan - for me, it's a great test, but we need to know its limitations. So, that's the other thing that comes up a lot in the phone calls or in the patients that I see that we do a PET scan - but practically, it's not good for some of the malignancies that we're looking for.   Dr Grouse: That's really great to point out, and I'm glad you brought up the risk level of the particular syndrome. You have a great table in your article that summarizes the risk level of some of the various syndromes - so, you know, just a reminder for everyone to check that out if you want to have more information about this and how this applies to the screening - so very helpful. What is the easiest mistake to make, and also maybe to avoid, when treating patients with paraneoplastic neurologic disorders?   Dr Zekeridou: That's a great question, actually. So, there are two things here. One is that we need to be thinking about paraneoplastic neurological syndromes, because if you don't think about them, then you don't look for them. So that's the one thing. So, patients that come with a subacute onset of neurological dysfunction - they have systemic features, or they are smokers, they have autoimmunity in the family (all those things) – like, we need to be thinking about paraneoplastic neurological syndromes. On the other side, we also see a little bit more of overdiagnosis that's coming in the later years. So, one of the things that we see a lot is that we kind of have difficulties with the interpretation of the neural antibodies - so, sometimes, we will get a neural antibody, and then it will not fit, but we will base our diagnosis on the neural antibody presence. And then, some neural antibodies are great - we don't really see false-positives - but some of them are not great and we do see false-positives. So, for me, the main thing that I would say is that we need to have a clinical suspicion - we're treating the patient and the clinical syndrome if it is compatible with a paraneoplastic neurological disorder, and then the neural antibodies are the ones that are going to help us, like, diagnose or point to a cancer - but we are really treating the patient. And then, if we give a treatment and it doesn't make sense how the patient evolves, we actually need to reassess the diagnosis, because we do have both overdiagnosis, but also we have underdiagnosed in patients that it's not suspected - so I think it's kind of the increased awareness that helps, but we also need to be going back always to the clinical manifestations of the patient.   Dr Grouse: Really great points to make, and thank you so much for that. What is the most common misconception you've encountered in treating patients with paraneoplastic disorders?   Dr Zekeridou: So, one of the things that we see a lot is that patients wait to be treated - even with high suspicion of paraneoplastic neurological syndromes - until we have the neural antibodies, and sometimes, if the neural antibodies are negative, we have patients that are not given a paraneoplastic neurological syndrome or autoimmune neurological syndrome diagnosis because of the negativity of the antibodies. So, for me, one of the main things is that the patients actually fit clinically with a paraneoplastic neurological syndrome - and there are scores that can help us, clinical manifestations that can actually help us make this diagnosis. We need to be looking for the cancer and treating them, regardless of the presence of the antibody. Some patients will not have the antibodies for weeks. The second aspect to this is that, often, we want to say, “Oh, it's a paraneoplastic neurological syndrome. They will treat the cancer and, like, that's the oncologist's job.” But, practically, I think that the neurologist will really need to be involved with this. I think the patients need treatment of the immune response and treatment of the tumor. So, I think we are part of the treatment team for these patients and it's not only the oncologists that are treating the tumor.   Dr Grouse: Where do you think the next big breakthrough in this area will be?   Dr Zekeridou: Where I hope it would be - and I'm hoping that it's actually what it is going to be – is, really, better understanding and treating the classic paraneoplastic neurological diseases, that they are T-cell mediated disorders that lead to neural cell distraction, and we don't have good treatments for these patients and we cannot get any improvement. So, there is a lot of research going on there. How can we prevent? How can we treat? But, I think that would be the next big milestone for us, because the antibody-mediated diseases - so we now have a lot of good treatments. Like NMDA-receptor encephalitis, AMPAR encephalitides - these antibody-mediated disorders, we have good treatments. The disorders that the antibodies are biomarkers  - and they are the cytotoxic diseases, the effectors of the autoimmunity - we don't. So, that's where I hope and think our breakthrough will be.   Dr Grouse: Definitely hoping to see more advancements in this area and already, I think, very quickly developing field. So, I wanted to talk a little bit more about you and what brought you to this area of neurology I think which most of us find to be a very fascinating field  that would love to hear more about what brought you to it. How did you become interested in this area of neurology?   Dr Zekeridou: I did my medical school in Greece. So, in Greece, towards the end of the sixth year, you need to decide what your specialty would be, and for the life of me, I could not decide between oncology and neurology - I was changing my mind all the time. And then, I decided that the diagnosis is more important to me in terms of a physician - that's why I went more with neurology and I was clear on my choice. So, practically, then, I went and did my residence in Switzerland, and something happened and I found myself in the outpatient autoimmune neurology multiple sclerosis clinic for a year, and it was evident to me that this is my passion. Like, the multiple sclerosis, I thought was a great disease, but it was the cases that they were not multiple sclerosis, that they were the ones that they were the most fascinating for me. So, then, I did my peripheral nerve year - so even more, it was clear for me that this is the immune system interactions, the cancer, and the neurological symptoms - that's what I wanted to do. And practically, I pursued a fellowship in Lyon in the French Reference Center for Paraneoplastic Diseases, and I was sold. There was nothing else for me. So, eventually I came here at Mayo (and then I stayed) - but it was very clear, even since the beginning - and I really found something that combined both of my passions even from medical school.   Dr Grouse: What are you most excited about in this field? And, specifically, you know, what might you impart to other trainees who are thinking about choosing this field for themselves?   Dr Zekeridou: So, I think that there are many things. So, autoimmune neurology or paraneoplastic neurological syndromes, they can affect every level of the neuraxis, so, practically, your clinician, that we see everything - we'll see central nervous system, peripheral nervous system, neuromuscular junction – so, that's actually very fascinating for me. The second part of it is that we have diseases that we can actually treat. We see differences in patients that we will intervene and we will really change their disease course. And the other thing for me is all the research that is ongoing. So, practically, the research in paraneoplastic syndromes or neurological immunity is directly translational to the patient - like, we have kind of a bed-to-bedside type of research that is going on. And basic research is important and there is a lot of advances, but you can see them directly, like, being translated in patients - so, essentially, the research is directly translational to clinic, and that makes it very exciting.   Dr Grouse: I think that your excitement about this field is very inspirational and will hopefully inspire many future trainees who are interested in this field. So, when you're not learning more about paraneoplastic syndromes and their treatment and diagnosis, what else do you like to do? Tell us something about your outside interests.   Dr Zekeridou: So, again, I come from a very diverse background and the way that I arrived in the states, but, I really like traveling. So, we would travel a lot lately. We travel more in Greece, because when you're coming from Greece and you're not living there, your summers are always there - but we try to explore different places there. And one of my main things and passions that I like is, essentially, cooking. So that relaxes me, that helps me - cooking and having friends over – so, that's my favorite thing of doing outside of work.   Dr Grouse: Well, I have to say it's hard right now to imagine anything more fun than traveling and enjoying good food and Greece. So, I think your hobby seems like one we can all get behind.   Dr Zekeridou: It's relaxing the mind.   Dr Grouse: Yes, yes. This has been a really great discussion on what I think is a very interesting area of neurology, and we really appreciate you taking the time to talk with us today.   Dr Zekeridou: Thank you so much for having me. It was great talking to you.   Dr Grouse: Again, today, I've been interviewing Dr Anastasia Zekeridou, whose article on classical paraneoplastic neurologic disorders appears in our 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 so much for joining us 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. Full transcript available at URL to come

Neurological Problems Too Common in Pets ... What are the causes? Why does the animal health experts advise using products that cause these problems? Follow or trail to solving these mysteries. Why let your pet suffer? We help you here!Pet Health Cafe' is broadcast live at Thursdays 8PM ET and Music on W4HC Radio – Health Café Live (www.w4cs.com) part of Talk 4 Radio (www.talk4radio.com) on the Talk 4 Media Network (www.talk4media.com). Pet Health Cafe' TV Show is viewed on Talk 4 TV (www.talk4tv.com).Pet Health Cafe' Podcast is also available on Talk 4 Media (www.talk4media.com), Talk 4 Podcasting (www.talk4podcasting.com), iHeartRadio, Amazon Music, Pandora, Spotify, Audible, and over 100 other podcast outlets.

How can primary care providers better educate themselves about functional neurologic disorders to reduce stigma and support quicker treatment for their patients?Ever wondered why some neurologic symptoms defy typical diagnostic tests? This week's episode of Pediatric Meltdown will talk about this mystery with guests Dr. Sarah Dixon and Dr. Alex Gamber, two experts in pediatric neurology. Through their expert insights, you'll learn about the difference between epileptic seizures and FND spells, and the importance of therapeutic approaches like cognitive behavioral therapy. With actionable advice for primary care providers and families alike, this episode is a treasure trove of knowledge. Learn about innovative treatment strategies and why understanding both the psychological and neurobiological aspects is so essential. Curious to know the ultimate strategies for tackling FND symptoms? tap on PLAY to discover the key clinical pearls now! [04:31 -14:11] Defining Pediatric Functional Neurologic Disorders (FND)FND is a group of conditions causing nervous system symptoms without structural abnormalities.They result from malfunctions in how information is transmitted and received in the brain.The symptoms do not arise due to any other neurologic disorder.It represents an undamaged brain experiencing processing issues.[14:12 - 25:52] Diagnostic Approaches for Functional Neurologic Disorders in Pediatrics Subconscious learned motor patterns play a significant role in FND.Resting state functional connectivity MRI studies show increased connectivity between emotional processing centers and motor control networks in FND patients.Functional movement disorders, including functional tremor and tics, exhibit distinct physical exam findings.Neurologists heavily rely on physical exam findings to diagnose functional disorders.[25:53 - 34:46] Understanding Psychogenic Non-Epileptic Spells in FND ManagementAddressing the need for effective treatment interventions.Ensuring that patient and family concerns are acknowledged and managed.Importance of patient education in understanding their condition.Strategies for managing subacute subconscious pressure or stress in patients.[34:47 - 45:48] Effective Communication in Diagnosing Pediatric FNDEmphasize the importance of clear and compassionate communication when suspecting Functional Neurologic Disorder (FND) in pediatric patients.Highlight how setting the stage correctly can significantly influence the patient's treatment, prognosis, and overall improvement.Include educational information in the referral note to neurology, detailing the basics of FND diagnosis and the treatment plan.Use the referral note to walk through clinical reasoning and explain the natural history of FND.[45:49 - 54:16] Closing segment TakeawaysLinks to resources mentioned on the showTaking Control of Your Seizures: Workbook Joel M. Reiter, Donna Andrews, Charlotte Reiter, W. Curt LaFrance, JRhttps://www.amazon.com/Taking-Control-Your-Seizures-Treatments/dp/019933501X Neurosymptoms.orgFNDhope.orgEpilepsy Foundation:

In this week's episode, Brain & Life Podcast co-hosts Dr. Daniel Correa and Dr. Katy Peters introduce their pets and answer a listener question about ALS. Then, Dr. Peters discusses neurologic disorders in pets with Dr. Ann Tilton. With more than 30 years of experience as a pediatric neurologist, Dr. Ann Tilton is a Professor of Neurology and Pediatrics at LSU Health New Orleans. She has also loaned her expertise to other species! She tells stories from her time diagnosing pangolins and monkeys at the zoo and shares her insights and experiences with neurologic disorders in pets.   Additional Resources Can Pets Have Neurologic Disorders? Pets May Be Good for Brain Health Phineas the Cat Spreads Awareness of a Rare Neurologic Disorder I am ALS   Other Brain & Life Podcast Episodes on These Topics Finding Strength in ALS Advocacy with Podcaster Lorri Carey Hop on a Cure for ALS with John Driskell Hopkins The Campaign to Cure ALS with Brian Wallach and Sandra Abrevaya   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. Stacey Clardy and Aaron Baldwin discuss how access to genetic testing may vary based on various factors such as race, ethnicity, sex, socioeconomic status, and insurance status. Reference:  https://www.neurology.org/doi/10.1212/WNL.0000000000209161

Dr. Stacey Clardy talks with Aaron Baldwin about how access to genetic testing may vary based on various factors such as race, ethnicity, sex, socioeconomic status, and insurance status. Read the related article in Neurology.  Disclosures can be found at Neurology.org.

The August 2023 replay of past episodes showcases four interviews on functional neurologic disorders with Prof. Jon Stone. The episode begins with an interview by Prof. Jon Stone and Dr. Tamara Pringsheim with Wall Street Journal columnist Julie Jargon about the increased incidence of teen girls presenting with physical tics. The Recall episode continues with an interview with Drs. Tamara Pringsheim and Davide Martino about the latest updates on those functional tics and new diagnostic criteria. The third interview is with Dr. Tjerk Lagrand about how the diagnosis of functional seizures affects health care costs. The August Recall concludes with Dr. Mahinda Yogarajah about the importance of diagnosing and not misdiagnosing functional neurologic disorders.   Related Podcast Links: Tik Tok Tics - https://directory.libsyn.com/episode/index/id/21928034 Functional Tic Update - https://directory.libsyn.com/episode/index/id/26601993 Health Care Utilization in FND - https://directory.libsyn.com/episode/index/id/25624821 Economic Cost of Functional Neurologic Disorders - https://directory.libsyn.com/episode/index/id/27225606 Related Article Links: How Teens Recovered from the 'Tik Tok Tics' - https://www.nytimes.com/2023/02/13/health/tiktok-tics-gender-tourettes.html Economic Cost of Functional Neurologic Disorders: A Systematic Review: https://n.neurology.org/content/early/2023/06/20/WNL.0000000000207388 

Dr. Mahinda Yogarajah discusses the importance of diagnosing and not misdiagnosing functional neurologic disorders.  Show references: https://n.neurology.org/content/early/2023/06/20/WNL.0000000000207388  This podcast is sponsored by argenx. Visit www.vyvgarthcp.com for more information.

Prof. Jon Stone talks with Dr. Mahinda Yogarajah about the importance of diagnosing and not misdiagnosing functional neurologic disorders. Read the related article in Neurology. This podcast is sponsored by argenx. Visit www.vyvgarthcp.com for more information. DOI: 10.1212/WNL.0000000000207388

Cases of functional tic-like disorder skyrocketed during the pandemic across the world, and experts believe the culprit is social media. Though classic tic disorders are mostly diagnosed in boys, this condition mainly affects women aged 18 to 21. Our experts explain the cause and how to successfully recover from the disorder. Learn More: https://radiohealthjournal.org/tiktok-tics-can-social-media-cause-neurologic-disorders

Join me as I have a discussion about Functional Neurologic Disorders with FND Life , the host of "Talking it out about..." where she discusses her life with FND. In this episode we discuss how her symptoms began, what her diagnostic journey looked like, and the treatments that have helped her the most. Find her podcast here:https://podcasts.apple.com/us/podcast/talking-it-out-about/id1549539189Find her on Twitter @FndLifewith Find me on Twitter @Drkentris (https://twitter.com/DrKentris) Email me at theneurotransmitterspodcast@gmail.com https://linktr.ee/DrKentris The views expressed do not necessarily represent those of any associated organizations. The information in this podcast is for educational and informational purposes only and does not represent specific medical/health advice. Please consult with an appropriate health care professional for any medical/health advice.

Dr. Rae Bacharach discusses the Neurology Today article, "Mounting Evidence on the Effects of Climate Change on Neurologic Disorders". Show references: https://journals.lww.com/neurotodayonline/Fulltext/2022/11030/Mounting_Evidence_on_the_Effects_of_Climate_Change.5.aspx This episode is brought to you by Mass General Brigham Department of Neurology, please visit us at www.massgeneralbrigham.org.

Dr. Jon Stone talks with Dr. Tjerk Lagrand, about how the diagnosis of functional seizures affects health care costs. 

The January 2023 replay of past episodes showcases a selection of interviews covering a variety of topics in Autoimmune Neurologic Disorders. This episode features conversations with Dr. Marinos Dalakas on IVIg efficacy in GAD65 positive SPS patients , followed by an interview with Prof. Bart Jacobs about the association of preceding infections with the clinical variation of Guillain-Barré syndrome across geographical regions, leading into an interview with Prof. Sarosh Irani on the use of corticosteroids as a first-line agent in the treatment of LGI1-antibody encephalitis. January's Neurology Recall concludes with an interview with Dr. Ming Lim on the diagnosis and management of Opsoclonus Myoclonus Ataxia Syndrome (OMAS) in children.   Articles referenced in this episode: Long-term Effectiveness of IVIg Maintenance Therapy in 36 Patients With GAD Antibody–Positive Stiff-Person Syndrome | Neurology Neuroimmunology & Neuroinflammation An International Perspective on Preceding Infections in Guillain-Barré Syndrome | Neurology  Improving clinical practice with an old friend from the neuroimmunology toolkit: acute corticosteroids in LGI1 antibody encephalitis | Journal of Neurology, Neurosurgery & Psychiatry (bmj.com) Diagnosis and Management of Opsoclonus-Myoclonus-Ataxia Syndrome in Children | Neurology Neuroimmunology & Neuroinflammation

In this week's podcast, Neurology Today's editor-in-chief discusses data suggesting allergic disease is associated with an increased risk of dementia, an increased risk of cancer in children born to women with epilepsy who took high-dose folic acid in pregnancy, and the impact of climate change on people with neurologic disorders.

Zachary Grin, a doctor of physical therapy, joins me to discuss what kinds of physical therapy treatments are available for those dealing with functional neurologic disorders or FND (functional movements/gait/seizures/etc.) and how those differ from more "traditional" approaches to physical therapy.Find Zachary Grin online:His website: https://www.rewire-pt.com/On Twitter: @ZacharyGrinDPTFind me on Twitter @DrKentris or send me an email at theneurotransmitterspodcast@gmail.com-----------------------------------------------------The views expressed do not necessarily represent those of any associated organizations. The information in this podcast is for educational and informational purposes only and does not represent specific medical/health advice. Please consult with an appropriate health care professional for any medical/health advice.

PT, PTA, OT, OTA – this podcast may help you meet your continuing education requirements. Access Relias Academy to review course certificate information. Have you ever worked with a patient that just doesn't fit the diagnosis? The symptoms, they are not following the expected pattern. In this episode, we talk with Mike Studer about functional neurologic disorder (FND), what it is, common clinical presentation, assessment options, and treatment strategies. (00:30) Introduction (05:25) What Is an FND? (08:50) Common Presentations of FND: Two Case Examples  (14:01) Prevalence  (14:51) Assessment Options to Confirm Diagnosis  (19:25) Case Example Revisited: Whole Body Dyskinesia – Is it FND?  (23:18) Triggers  (25:41) Using Outcome Measures to Enhance Patient Engagement  (28:06) Treatment Strategies for Our Young Athlete  (33:30) Educating Referral Providers About FND  (36:31) Thorough Work-Up: Recommended or Not?  (41:10) Additional Treatment Strategies for Our Older Adult with Dyskinesia  (44:28) Load, Remove, and Celebrate: Details are in the Dosage  (47:23) Benefits of “Little Wins”  (49:15) The Home Exercise Program: Intensity and Functionality  (51:23) FND and Chronic Pain  (58:46) Summary  (1:02:05) Conclusion  The content for this course was created by Mike Studer, PT, MHS, NCS, CEEAA, CWT, CSST, FAPTA. The content for this course was created by Tiffany Shubert, PT, PhD. Here is how Relias can help you earn continuing education credits:  Access your Relias Library offered by your employer to see course certificate information and exam;  or  Access the continuing education library for clinicians at Relias Academy Review the course certificate information, and if eligible, you can purchase the course to access the course exam and receive your certificate. Learn more about Relias at www.relias.com.   Legal Disclaimer: The content of Stretch: Relias Rehab Therapy Education is provided only for educational and training purposes for healthcare professionals. The educational material provided in this podcast should not be used as medical advice to treat any medical condition in either yourself or others. Resources http://neurosymptoms.org/

I'm joined for a conversation on functional neurologic disorders (FND) by the host of FND Portal, a website and twitter account which provides information about, and advocacy for, FND.  We talk about the various manifestations of FND, challenges the FND community face when seeking help from the healthcare system, and various theories as to the nature of the development of FND. Find FND Portal at: Twitter: @FndPortalWebsite: https://fndportal.org/Other resources for FND:https://www.fndsociety.org/https://www.neurosymptoms.org/en_GB/Find me on Twitter @DrKentris or send me an email at theneurotransmitterspodcast@gmail.com-----------------------------------------------------The views expressed do not necessarily represent those of any associated organizations. The information in this podcast is for educational and informational purposes only and does not represent specific medical/health advice. Please consult with an appropriate health care professional for any medical/health advice.

Discussing the pathophysiology , diagnosing and treatment of functional neurologic disorders by neurologists and psychiatrists

Autoimmune encephalitis and other autoimmune neurologic disorders are increasingly identified causes of unexplained dementia and other neurologic symptoms. In this episode, Amy Kunchok, MD shares insights around the rapidly advancing subspecialty of autoimmune neurology and research in the field.

Francis O. Walker, MD, Professor of Neurology and Director of the Movement Disorder Clinic at Wake Forest University, has had significant involvement in clinical care and research in Huntington's Disease for over 30 years. Following residency training in Neurology at the University of Iowa and fellowship training in Movement Disorders at the University of Michigan, he joined the faculty of Wake Forest University in 1984. HD has been his primary clinical and research interest throughout his career. Before retiring, he used to provide clinical care for 150 HD patients per year and was actively involved in several HD-related clinical trials.

MyLiquitab, is the world's first innovative product that uses ultrasonic technology converting solid dose medications to liquids. At its core It is revolutionary and can positively impact millions of people in the United States from the youngest child to the oldest adult. The number of people who cannot swallow solid dose medications is growing annually and statistics indicate that 1 in 3 older adults has some difficulty swallowing solid dose medications. For anyone who has every visited a nursing home or hospital, the disruptive and jarring metal clang, clang, clanging of the pill crushing device used to crush medications is inescapable. Crushing medication is a common occurrence in all care settings, as 30% of all people admitted to hospitals and those residing in nursing homes have difficulty swallowing solid dose medications. Manually grinding medication is time consuming, and healthcare workers can attest to the stress and resulting physical discomfort on their hands, wrists and shoulders. In addition, there is also a risk of inhaling aerosols from the medication being transformed. With the increasing number of older adults who choose to remain in their own homes as they age, so the number of people experiencing swallow difficulties with concomitant difficulty swallowing solid dose medication will also increase. Every ill-health category has a component that affects a person's ability to swallow from the common cold and sore throat to most serious conditions (throat and neck cancer, Neurologic Disorders, Strokes, Parkinson's Disease, dementia, Brain Injuries, as well as persons with with Intellectual Disabilities and psychiatric illnesses. Keith Dobson has invented a game changing device. The use of ultrasonic technology includes toothbrushes, measuring babies in utero, locating people's veins and now MyLiquitab uses ultrasonic technology for medication delivery.

MyLiquitab, is the world's first innovative product that uses ultrasonic technology converting solid dose medications to liquids. At its core It is revolutionary and can positively impact millions of people in the United States from the youngest child to the oldest adult. The number of people who cannot swallow solid dose medications is growing annually and statistics indicate that 1 in 3 older adults has some difficulty swallowing solid dose medications. For anyone who has every visited a nursing home or hospital, the disruptive and jarring metal clang, clang, clanging of the pill crushing device used to crush medications is inescapable. Crushing medication is a common occurrence in all care settings, as 30% of all people admitted to hospitals and those residing in nursing homes have difficulty swallowing solid dose medications. Manually grinding medication is time consuming, and healthcare workers can attest to the stress and resulting physical discomfort on their hands, wrists and shoulders. In addition, there is also a risk of inhaling aerosols from the medication being transformed. With the increasing number of older adults who choose to remain in their own homes as they age, so the number of people experiencing swallow difficulties with concomitant difficulty swallowing solid dose medication will also increase. Every ill-health category has a component that affects a person's ability to swallow from the common cold and sore throat to most serious conditions (throat and neck cancer, Neurologic Disorders, Strokes, Parkinson's Disease, dementia, Brain Injuries, as well as persons with with Intellectual Disabilities and psychiatric illnesses. Keith Dobson has invented a game changing device. The use of ultrasonic technology includes toothbrushes, measuring babies in utero, locating people's veins and now MyLiquitab uses ultrasonic technology for medication delivery.

Functional Neurological Disorder (FND) is a medical condition in which there is a problem with the functioning of the nervous system and how the brain and body sends and/or receives signals, rather than a structural disease process such as multiple sclerosis or stroke. FND can encompass a wide variety of neurological symptoms, such as limb weakness or seizures. FND is a condition at the interface between the specialties of neurology and psychiatry. It is not as well-known in modern U.S. culture as many other medical conditions, and is still being evaluated and explained today. Tonight, we will discuss: The History of Functional Neurologic Disorders. Functional Neurologic Disorders today. Controversies and Misconceptions. Resources for Support. We'll start off the evening with some topic-relevant Classic Rock played by Dr. Mathis, followed by Classic Rock trivia in "The Rock & Roll Shrink Recalls," followed by our topic discussion. Please follow our bi-weekly, Wednesday evening shows, at 11 pm EST/EDT. We will have a new topic for you in two weeks!

In Episode 25, we hear from Dr. Ramon R. Diaz-Arrastia, Professor of Neurology at the University of Pennsylvania. He discusses biological research regarding brain injury. Dr. Diaz-Arrastia also tells us about research projects that are currently being worked on, as well as what we can look forward to in the future. Dr. Diaz-Arrastia is Professor of Neurology at the University of Pennsylvania, where he leads the Traumatic Brain Injury Clinical Research Initiative. Dr. Diaz-Arrastia received his MD and PhD degrees from Baylor College of Medicine, and completed post-graduate training at Harvard and Columbia. Prior to coming to Penn, he served on the faculty at the University of Texas Southwestern, the Uniformed Services University of the Health Sciences, and the National Institute of Neurologic Disorders and Stroke (NINDS). Dr. Diaz-Arrastia has published over 200 primary research papers, as well as over 40 invited reviews and book chapters. He has also served in several national committees related to traumatic brain injury, epilepsy, and dementia, convened by the Institute of Medicine, the National Institutes of Health, the Department of Defense, and the Veterans Administration. He was a member of the Institute of Medicine Committee on the Public Health Dimensions of the Epilepsies.

Mary R. Rensel, MD, is a Staff Neurologist in Neuroimmunology at Cleveland Clinic's Mellen Center for Multiple Sclerosis Treatment and Research. She is also Board Certified in Integrative Holistic Medicine. She directs the Pediatric MS and the Wellness programming at the Mellen Center. She is an Assistant Professor at the Cleveland Clinic Learner College of Medicine where she serves as an instructor for the medical students. www.Instagram.com/MRenselMD www.linkedin.com/in/mary-rensel-94844b1a You Tube: https://www.youtube.com/channel/UCg7lbnRJz9RImUaVG_qMkvQ/about?view_as=subscriber https://www.facebook.com/mary.rensel.9 @the_brain_fresh Brainfresh.org Keep your sex life in your life! She is a brain doc, a mom, and a coach! Welcome! I first saw her at the Brave Enough 2019 conference when you were talking about brain health! For people who don't know…what is Multiple Sclerosis? How does it affect one's sex life – male and female? Segway into overactive bladder for a bit….formal physical therapy versus googling “kegels”. How do you incorporate integrative medicine into people's lives living with neurologic disabilities? What do we do about fatigue in neurologic conditions? What do we do about decreased sensations? Talk to me about coaching. When did you get interested and how do you use it in your life? https://www.Instagram.com/MRenselMD www.linkedin.com/in/mary-rensel-94844b1a You Tube: https://www.youtube.com/channel/UCg7lbnRJz9RImUaVG_qMkvQ/about?view_as=subscriber https://www.facebook.com/mary.rensel.9 Brainfresh.org --- Send in a voice message: https://anchor.fm/kj-casperson/message

Dr. Jennifer Frontera discusses her paper, "A Prospective Study of Neurologic Disorders in Hospitalized COVID-19 Patients in New York City". Show references: https://n.neurology.org/content/early/2020/10/05/WNL.0000000000010979

In the first segment, Dr. David Lapides talks with Dr. April Zehm about her Neurology: Clinical Practice paper regarding Framing Discussions on Palliative Care in Neurology. In the second part of the podcast, you’ll hear Dr. Lapides’ interview with Dr. David Perez on Diagnosing Functional Neurologic Disorders.  

On Episode #10, here are the main topics:1. The 2020 Nobel prize in Chemistry was awarded for the discovery of a genetic engineering technique. With all its benefits, the technique has some seriously concerned about its ethical implications.2. Studies suggest that coronavirus could lead to neurological illnesses3. New research reveals why coronavirus that once lived harmlessly in bats and other wildlife – has become uncontrollable once it jumped the species barrier and entered humans.ReferencesDoudna, J. A., & Charpentier, E. (2014). The new frontier of genome engineering with CRISPR-Cas9. Science, 346(6213).Frontera, J. A., Sabadia, S., Lalchan, R., Fang, T., Flusty, B., Millar-Vernetti, P., ... & Morgan, N. (2020). A Prospective Study of Neurologic Disorders in Hospitalized COVID-19 Patients in New York City. Neurology.Alejandro Berrio, Valerie Gartner, Gregory A. Wray. Positive selection within the genomes of SARS-CoV-2 and other Coronaviruses independent of impact on protein function. PeerJ, 2020; 8: e10234

This month’s Delayed Recall highlights 13 interviews on functional neurologic disorders from the series interviewer David Lapides conducted with Jon Stone for the Neurology Minute podcast. The episodes aired between September 2019 and March 2020. In this series, Jon Stone discusses who is susceptible to FNDs, diagnosis of nonepileptic spells, the myth of FND as psychological disorders with psychological origins, the various treatments available to patients with functional neurologic disorders, and other topics.

In this week’s episode, I discuss different causes and management of hypo- and hyperkinetic neurologic disorders of the larynx.

In the twelfth part of an extended series with interviewer Dr. David Lapides, Dr. Jon Stone discusses who should treat patients with functional neurologic disorders.

Botox can benefit people with neurological disorders. Dr. Parul Aneja, neurologist, discusses how botox is used in neurology.

In the eleventh part of an extended series with interviewer Dr. David Lapides, Dr. Jon Stone discusses the current research on functional neurologic disorders.

In the tenth part of an extended series with interviewer Dr. David Lapides, Dr. Jon Stone discusses the various treatments available to patients with functional neurologic disorders.

In the ninth part of an extended series with interviewer Dr. David Lapides, Dr. Jon Stone discusses the documentation of findings and how to wrap up a patient visit when working with functional neurologic disorders.

In the eighth part of an extended series with interviewer Dr. David Lapides, Dr. Jon Stone discusses the common pitfalls that occur in conversation with a patient when making a diagnosis of a FND.

In the seventh part of an extended series with interviewer Dr. David Lapides, Dr. Jon Stone discusses the myth of FND as psychological disorders with psychological origins.

In the sixth part of an extended series with interviewer Dr. David Lapides, Dr. Jon Stone discusses how to discuss FND diagnosis with patients in clinic.

In the fifth part of an extended series with interviewer Dr. David Lapides, Dr. Jon Stone discusses differentiating FNDs and malingering symptoms in patients.

Dr. Kiran Thakur and Dr. Greer Waldrop give the main takeaways from their paper on the World Health Organization’s essential diagnostics list.

In the fourth part of an extended series with interviewer Dr. David Lapides, Dr. Jon Stone discusses diagnosis of nonepileptic spells.

In this podcast, Mark Hallett, MD, talks about his upcoming session at the American Neurological Association's Annual Meeting about functional neurologic disorders, how to deliver the diagnosis to patients, and how to better integrate care. More at: www.consultant360.com/neurology.

In the third part of an extended series with interviewer Dr. David Lapides, Dr. Jon Stone discusses diagnosis of functional movement disorders.

Dr. Jon Stone discusses who is susceptible to functional neurologic disorders in the first of a 13-part series.

This episode of CRACKCast covers Chapter 174 in Rosen's 9th Edition. Today, we will go over common topics in paediatric neurology and emergency medicine that will help you on your next shift! Knowledge of neurologic disorders is essential for any practitioner of emergency medicine, so strap in for a high-yield post. Core Questions List ten causes of provoked (acutely symptomatic) seizures. List four episodic disorders that may mimic seizures in neonates and four in non-neonates. How does it differ if you are unable to obtain IV or IO access? Give an approach to acute seizure control in a 9-month-old and in a 5-year-old. What is the definition of status epilepticus? List 6 medical treatments for status epilepticus. What is the definition of a simple febrile seizure? Describe the management of febrile seizure. Which patients should have outpatient imaging and neurology follow-up? Which children with seizure should be admitted to hospital? List 5 reasons for CT Head after seizure and describe management after the 1st peds seizure. List 10 differential diagnoses for headache in peds. List 8 indications for radiologic imaging in patients with headache. With regards to presentation and management, how are migraines different in children? Describe the criteria which define migraine headache (review). List 10 causes of pediatric ataxia. Describe an approach to the pediatric patient with ataxia. List 5 central and 5 peripheral causes of vertigo. Which is the more common cause of vertigo in children? List 8 risk factors for pediatric stroke. Wisecracks Describe each of the following: Infantile Spasms Absence Epilepsy Benign Rolandic Epilepsy of Childhood Lennox-Gastaut Syndrome What is the most common cause of status epilepticus in children? In adults? List five side effects of therapeutic dilantin use. When is LP indicated in children with febrile seizures? Give causes of acute, acute recurrent, chronic progressive and chronic non-progressive headaches. Describe the presentation of infantile botulism.

This episode of CRACKCast covers Chapter 174 in Rosen's 9th Edition. Today, we will go over common topics in paediatric neurology and emergency medicine that will help you on your next shift! Knowledge of neurologic disorders is essential for any practitioner of emergency medicine, so strap in for a high-yield post. Core Questions List ten causes of provoked (acutely symptomatic) seizures. List four episodic disorders that may mimic seizures in neonates and four in non-neonates. How does it differ if you are unable to obtain IV or IO access? Give an approach to acute seizure control in a 9-month-old and in a 5-year-old. What is the definition of status epilepticus? List 6 medical treatments for status epilepticus. What is the definition of a simple febrile seizure? Describe the management of febrile seizure. Which patients should have outpatient imaging and neurology follow-up? Which children with seizure should be admitted to hospital? List 5 reasons for CT Head after seizure and describe management after the 1st peds seizure. List 10 differential diagnoses for headache in peds. List 8 indications for radiologic imaging in patients with headache. With regards to presentation and management, how are migraines different in children? Describe the criteria which define migraine headache (review). List 10 causes of pediatric ataxia. Describe an approach to the pediatric patient with ataxia. List 5 central and 5 peripheral causes of vertigo. Which is the more common cause of vertigo in children? List 8 risk factors for pediatric stroke. Wisecracks Describe each of the following: Infantile Spasms Absence Epilepsy Benign Rolandic Epilepsy of Childhood Lennox-Gastaut Syndrome What is the most common cause of status epilepticus in children? In adults? List five side effects of therapeutic dilantin use. When is LP indicated in children with febrile seizures? Give causes of acute, acute recurrent, chronic progressive and chronic non-progressive headaches. Describe the presentation of infantile botulism.

Welcome to another Expert Interviews Series podcast. This episode we met with Dr. Benjamin Hampstead, an Associate Professor in Psychiatry, University of Michigan, Staff Neuropsychologist, VA Ann Arbor Healthcare System, and Clinical Core Leader of the NIA funded Michigan Alzheimer’s Disease Core Center. Dr. Hampstead is a licensed Psychologist and board certified Clinical Neuropsychologist who specializes in aging and dementia. His research is funded by the National Institutes of Health and Department of Veterans Affairs and examines the neuroanatomical bases of age- and disease-related cognitive change using structural and functional neuroimaging. Additionally, Dr. Hampstead investigates the neurorehabilitation of cognitive impairment using both cognitive rehabilitation and non-invasive electrical brain stimulation. He has authored multiple studies and co-edited a book entitled, “Cognitive Plasticity in Neurologic Disorders” on these topics. This podcast was recorded on Monday, November 6th, 2017 at the Kessler Foundation Conference Center, 120 Eagle Rock Ave, East Hanover, New Jersey and was hosted by CarolAnn Murphy, Communications Manager at the Foundation. It was created and produced by Joan Banks-Smith, Creative Producer for Kessler Foundation.

Welcome to the 2017 Baird Visiting Educational Professorship Lecture. Dr. Benjamin Hampstead presented by “Non-pharmacologic Treatment of Memory Impairment in Older Adults” =================================== In 1957, William Torrey Baird, Jr., started a family tradition of giving to Kessler that has spanned across three generations. A veteran of the First World War, Mr. W. Baird, Jr., saw the power of rehabilitation after an injury and felt compelled to help. Joining Kessler’s Board of Trustees, he began a lifelong commitment of support to medical rehabilitation—a value that he passed down to his nephew, Collier W. Baird, Jr. Mr. C. Baird, Jr. furthered that commitment by establishing a trust to benefit Kessler Foundation and expand its research. A portion of the funds established the Baird Visiting Educational Professorship at Kessler Foundation. The Baird lecture continues to educate the next generation of researchers on innovative medical rehabilitation research and treatment options. Guest speakers frequently form collaborations with Foundation scientists to bring research advances around the globe. This years Baird lecturer is Dr. Benjamin Hampstead an Associate Professor in Psychiatry, University of Michigan, Staff Neuropsychologist, VA Ann Arbor Healthcare System, and Clinical Core Leader of the NIA funded Michigan Alzheimer’s Disease Core Center Dr. Hampstead is a licensed Psychologist and board certified Clinical Neuropsychologist who specializes in aging and dementia. His research is funded by the National Institutes of Health and Department of Veterans Affairs and examines the neuroanatomical bases of age- and disease-related cognitive change using structural and functional neuroimaging. Additionally, Dr. Hampstead investigates the neurorehabilitation of cognitive impairment using both cognitive rehabilitation and non-invasive electrical brain stimulation. He has authored multiple studies and co-edited a book entitled, “Cognitive Plasticity in Neurologic Disorders” on these topics. Dr. Hampstead presented “Non-pharmacologic Treatment of Memory Impairment in Older Adults” on Monday, November 6th, 2017 at the Kessler Foundation Conference Center, 120 Eagle Rock Ave, West Orange, NJ. This podcast was edited and produced by Joan Banks-Smith, Creative Producer for Kessler Foundation.

Dr. Sidney Kurn is the co-author of the book, Herbs and Nutrients for Neurologic Disorders, with Sheryl Shook PhD.

Dr. Sidney Kurn is the co-author of the book, Herbs and Nutrients for Neurologic Disorders, with Sheryl Shook PhD.

A chronic neurologic disorder is a disease of the nervous system. In the show Dr. Mary Anne will discuss a few of the better known neurologic disorders, like parkinsons and MS, what their unhealthy source may be and end with a Custom Healing Code for the listener to use on their own or to give to someone else.

Numerous medical journals have published studies supporting the use of herbs and nutrients in the treatment of neurodegenerative disorders. Yet in practice most neurologists rarely include them as part of their protocols. In this practical guide, Sidney Kurn, M.D., and … Continue reading →

1) Multiple cranial nerve impairment and 2) Topic of the month: Encephalopathy caused by systemic disease. This podcast for the Neurology Journal begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the print issue of Neurology. In the second segment Dr. Stephen Donahue interviews Dr. Vincent Roubeau about his paper on multiple cranial nerve impairment. Dr. Chafic Karam is reading our e-Pearl of the week about neurosyphilis presenting as mesial temporal encephalitis. In the next part of the podcast Dr. Ted Burns interviews Drs. Steven Lewis and Allison Weathers about vitamin deficiency, infection and autoimmunity. The participants had nothing to disclose except Drs. Karam, Burns, Lewis and Weathers.Dr. Karam serves on the editorial team for the Neurology® Resident and Fellow Section. Dr. Burns serves as Podcast Editor for Neurology®; performs EMG studies in his neuromuscular practice (35% effort); and has received research support for consulting activities with CSL Behring and Alexion Pharmaceuticals.Dr. Lewis serves as CME Section Co-Editor for Neurology® and as Associate Editor for Continuum: Lifelong Learning in Neurology®; receives royalties for the books: Field Guide to the Neurologic Examination and Neurology for the Non-Neurologist and anticipates receiving royalties for the book: Neurologic Disorders due to Systemic Disease.Dr. Weathers receives honoraria as an AAN speaker.

1) Orexin receptor antagonism and 2) Topic of the month: Encephalopathy caused by systemic disease. This podcast for the Neurology Journal begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the print issue of Neurology. In the second segment Dr. Ted Burns interviews Drs. Tom Roth and Joe Herring about their paper on orexin receptor antagonism for treatment of insomnia.Dr. Chafic Karam is reading our e-Pearl of the week about central fourth nerve palsies. In the next part of the podcast Dr. Ted Burns interviews Drs. Steven Lewis and Allison Weathers about drugs that can cause encephalopathy. All participants have disclosures.Dr. Burns serves as Podcast Editor for Neurology®; performs EMG studies in his neuromuscular practice (35% effort); and has received research support for consulting activities with CSL Behring and Alexion Pharmaceuticals.Dr. Roth serves on the scientific advisory boards for Merck, Jazz and Transcept; serves as an editorial board member for Sleep and Sleep Medicine; receives research support from Transcept Pharmaceuticals, Impax Pharmaceuticals, Linguflex LLC and APnes, serves on the speakers' bureau of Purdue Pharma L.P. and is a consultant for Abbott Laboratories, Accadia, Acogolix Inc., Acorda, Actelion Pharmaceuticals Ltd, Addrenex Pharmaceuticals, Inc, Alchemers, Alza Corporation, Ancel, Arena, AstraZeneca, Aventis, AVER, Bayer Schering Pharma, BMS, BTG, Cephalon, Inc., Cypress, Dove, Eisai Inc., Elan Corporation, Eli Lilly and Company, Evotec, Forest Laboratories, Inc., GlaxoSmithKline, Hypnion Inc, Impax Pharmaceuticals, Intec, Intra-Cellular Therapies, Jazz, Johnson & Johnson, King Pharmaceuticals, Lundbeck, Inc., McNeil, MediciNova, Merck, Neurim Pharmaceuticals Ltd, Neurocrine, Neurogen, Novartis, Orexo, Organon Pharmaceuticals, Otsuka Pharmaceuticals, Inc., Prestwick, Proctor & Gamble Pharmaceuticals, Pfizer Inc, Purdue Pharma L.P., Resteva, Roche, Sanofi-aventis, Schoering-Plough Corp., Sepracor Inc., Servier Laboratories, Shire plc, Somaxon Pharmaceuticals, Syrex, Takeda Pharmaceutical Company Limited, TransOral, Yanda, VivoMetrics Inc, Wyeth, Yamanuchi Pharmaceutical, and XenoPort.Dr. Herring is Executive Director, Clinical Neuroscience at Merck; receives research support as an employee at Merck and holds stock options with Merck.Dr. Karam serves on the editorial team for the Neurology® Resident and Fellow Section. Dr. Lewis serves as CME Section Co-Editor for Neurology® and as Associate Editor for Continuum: Lifelong Learning in Neurology®; receives royalties for the books: Field Guide to the Neurologic Examination and Neurology for the Non-Neurologist and anticipates receiving royalties for the book: Neurologic Disorders due to Systemic Disease.Dr. Weathers receives honoraria as an AAN speaker.

1) Bell's palsy and 2) Topic of the month: Encephalopathy caused by systemic disease. This podcast for the Neurology Journal begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the print issue of Neurology. In the second segment Dr. Elliot Dimberg interviews Dr. Gary Gronseth about the guideline update on Bell's palsy. Dr. Stacey Clardy is reading our e-Pearl of the week about catathrenia (sleep related groaning). In the next part of the podcast Dr. Ted Burns interviews Drs. Steven Lewis and Allison Weathers about encephalopathy caused by other organ failure. In concluding, there is a brief statement where to find other up-to date patient information and current Patient Page. The participants had nothing to disclose except Drs. Gronseth, Clardy, Burns, Lewis and Weathers.Dr. Gronseth serves on the editorial board of Neurology Now; received speakers' fees from Boehringer Ingelheim (resigned December 2011) and receives research support from the American Academy of Neurology.Dr. Clardy serves on the editorial team for the Neurology® Resident and Fellow Section. Dr. Burns serves as Podcast Editor for Neurology®; performs EMG studies in his neuromuscular practice (35% effort); and has received research support for consulting activities with CSL Behring and Alexion Pharmaceuticals.Dr. Lewis serves as CME Section Co-Editor for Neurology® and as Associate Editor for Continuum: Lifelong Learning in Neurology®; receives royalties for the books: Field Guide to the Neurologic Examination and Neurology for the Non-Neurologist and anticipates receiving royalties for the book: Neurologic Disorders due to Systemic Disease.Dr. Weathers receives honoraria as an AAN speaker.

1) Paroxysmal dyskinesia and hemiplegic migraine and 2) Topic of the month: Encephalopathy caused by systemic disease. This podcast for the Neurology Journal begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the print issue of Neurology. In the second segment Dr. Jeff Waugh interviews Drs. Renzo Guerrini and Alice Gardiner about their papers on paroxysmal dyskinesia and hemiplegic migraine. Dr. Stacey Clardy is reading our e-Pearl of the week about plus-minus lid syndrome. In the next part of the podcast Dr. Ted Burns interviews Drs. Steven Lewis and Allison Weathers about encephalopathy caused by liver and kidney dysfunction. The participants had nothing to disclose except Drs. Waugh, Guerrini, Gardiner, Clardy, Burns, Lewis and Weathers.Dr. Waugh serves on the editorial board of the Journal of Pediatric Biochemistry.Dr. Guerrini serves as an Associate Editor for Epilepsia, serves on the editorial boards for Seizure, BMC Medical Genetics, Topics in Epilepsy, Journal of Pediatric Epilepsy, Epileptic Disorders and European Neurological Journal, serves on the International Advisory Board for Progress in Epileptic Disorders; has received honoraria from Biocodex, UCB, Eisai Inc, ValueBox, Viropharma and EMA (European Medicine Agency), received funding for travel from Japanese Epilepsy Society and Weill Cornell Medical College; receives research support from the Italian Ministry of Health, the European Community Sixth Framework Thematic Priority Life Sciences, Genomics and Biotechnology for Health, the Italian Ministry of Education, University and Research, the Tuscany Region, the Telethon Foundation, and the Mariani Foundation; receives royalties for the books: Epilepsy and Movement disorders, Aicardi's Epilepsy in children, Progress in epileptic spasms and West syndrome, Epilepsy and migraine, The causes of epilepsy and Dravet syndrome.Dr. Gardiner receives research support from The Muscular Dystrophy Campaign.Dr. Clardy serves on the editorial team for the Neurology® Resident and Fellow Section. Dr. Burns serves as Podcast Editor for Neurology®; performs EMG studies in his neuromuscular practice (35% effort); and has received research support for consulting activities with CSL Behring and Alexion Pharmaceuticals.Dr. Lewis serves as CME Section Co-Editor for Neurology® and as Associate Editor for Continuum: Lifelong Learning in Neurology®; receives royalties for the books: Field Guide to the Neurologic Examination and Neurology for the Non-Neurologist and anticipates receiving royalties for the book: Neurologic Disorders due to Systemic Disease.

1) Parkinson disease and driving and 2) Topic of the month: Encephalopathy caused by systemic disease. This podcast for the Neurology Journal begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the print issue of Neurology. In the second segment Dr. John Morgan interviews Dr. Alex Crizzle about his paper on Parkinson disease and driving. Dr. Stacey Clardy is reading our e-Pearl of the week about tumarkin attacks-the otolithic catastrophe. In the next part of the podcast Dr. Ted Burns interviews Drs. Steven Lewis and Allison Weathers about electrolytes and other metabolic disorders. The participants had nothing to disclose except Drs. Morgan, Crizzle, Clardy, Burns, Lewis and Weathers.Dr. Morgan has served as a consultant or received speaking honoraria for work with Chelsea Therapeutics, GlaxoSmithKline, Oakstone, Teva Pharmaceuticals, UCB Pharma, GE Healthcare, Impax Laboratories and Veloxis; has received compensation for review of medical records and expert witness testimony in multiple cases of litigation involving neurologic conditions and his clinical group receives funding from the National Parkinson Foundation as a Center of Excellence. Dr. Crizzle receives research support from the National Parkinson's Foundation.Dr. Clardy serves on the editorial team for the Neurology® Resident and Fellow Section. Dr. Burns serves as Podcast Editor for Neurology®; performs EMG studies in his neuromuscular practice (35% effort); and has received research support for consulting activities with CSL Behring and Alexion Pharmaceuticals.Dr. Lewis serves as CME Section Co-Editor for Neurology® and as Associate Editor for Continuum: Lifelong Learning in Neurology®; receives royalties for the books: Field Guide to the Neurologic Examination and Neurology for the Non-Neurologist and anticipates receiving royalties for the book: Neurologic Disorders due to Systemic Disease.Dr. Weathers receives honoraria as an AAN speaker.

1) Neurodegenerative causes of death and 2) Topic of the month: Encephalopathy caused by systemic disease. This podcast for the Neurology Journal begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the print issue of Neurology. In the second segment Dr. Jeff Kutcher interviews Dr. Everett Lehman about his paper on National Football League players. Dr. Stacey Clardy is reading our e-Pearl of the week about the palmonental reflex: Beyond the pain. In the next part of the podcast Dr. Ted Burns interviews Drs. Steven Lewis and Allison Weathers about encephalopathies caused by endocrine disorders. All participants have disclosures.Dr. Kutcher is a consultant for the National Hockey League Players' Association and receives research support from ElMindA, Ltd..Dr. Lehman serves as an editorial board member for Public Health Reports and is Deputy Division Director for the Centers for Disease Control and Prevention (U. S. Federal government).Dr. Clardy serves on the editorial team for the Neurology® Resident and Fellow Section. Dr. Burns serves as Podcast Editor for Neurology®; performs EMG studies in his neuromuscular practice (35% effort); and has received research support for consulting activities with CSL Behring and Alexion Pharmaceuticals.Dr. Lewis serves as CME Section Co-Editor for Neurology® and as Associate Editor for Continuum: Lifelong Learning in Neurology®; receives royalties for the books: Field Guide to the Neurologic Examination and Neurology for the Non-Neurologist and anticipates receiving royalties for the book: Neurologic Disorders due to Systemic Disease.Dr. Weathers receives honoraria as an AAN speaker.

Andrew Knight, MA, MT-BC, NMT Fellow, is assistant professor of music therapy at the University of North Dakota. He instructs courses in music therapy and jazz improvisation, while overseeing clinical placements of students in the Grand Forks community. Mr. Knight holds a Bachelor of Arts degree from the University of Wisconsin-La Crosse in percussion performance with a jazz emphasis, and a Master of Arts degree in Music Education, emphasis in music therapy from the University of Minnesota. His post-graduate training includes a Fellowship in the Academy of Neurologic Music Therapy from Colorado State University and has studied with noted music therapists Charles Furman and Michael Thaut.

Andrew Knight, MA, MT-BC, NMT Fellow, is assistant professor of music therapy at the University of North Dakota. He instructs courses in music therapy and jazz improvisation, while overseeing clinical placements of students in the Grand Forks community. Mr. Knight holds a Bachelor of Arts degree from the University of Wisconsin-La Crosse in percussion performance with a jazz emphasis, and a Master of Arts degree in Music Education, emphasis in music therapy from the University of Minnesota. His post-graduate training includes a Fellowship in the Academy of Neurologic Music Therapy from Colorado State University and has studied with noted music therapists Charles Furman and Michael Thaut.