Podcasts about neurological sciences

Guest: Andrew J. Solomon, MD Accurately diagnosing multiple sclerosis (MS) involves understanding the diagnostic criteria, recognizing red flags to avoid misdiagnosis, and keeping up with new tools. Dr. Andrew Solomon, Professor and Interim Chair of the Department of Neurological Sciences and Chief of the Multiple Sclerosis Division at the University of Vermont, walks through the most difficult aspects of diagnosing patients with MS and potential breakthroughs reshaping how we approach these challenges. Dr. Solomon also spoke about this topic at the 2025 American Academy of Neurology Annual Meeting.

Guest: Andrew J. Solomon, MD Accurately diagnosing multiple sclerosis (MS) involves understanding the diagnostic criteria, recognizing red flags to avoid misdiagnosis, and keeping up with new tools. Dr. Andrew Solomon, Professor and Interim Chair of the Department of Neurological Sciences and Chief of the Multiple Sclerosis Division at the University of Vermont, walks through the most difficult aspects of diagnosing patients with MS and potential breakthroughs reshaping how we approach these challenges. Dr. Solomon also spoke about this topic at the 2025 American Academy of Neurology Annual Meeting.

Nonepileptic events are prevalent and highly disabling, and multiple pathophysiologic mechanisms for these events have been proposed. Multidisciplinary care teams enable the efficient use of individual expertise at different treatment stages to address presentation, risk factors, and comorbidities.   In this episode, Kait Nevel, MD, speaks with Adriana C. Bermeo-Ovalle, MD, an author of the article “A Multidisciplinary Approach to Nonepileptic Events,” in the Continuum® February 2025 Epilepsy issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Bermeo-Ovalle is a professor and vice-chair for Faculty Affairs in the Department of Neurological Sciences at Rush University Medical Center in Chicago, Illinois. Additional Resources Read the article: A Multidisciplinary Approach to Nonepileptic Events Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @IUneurodocmom Full episode transcript available here Dr. Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum Journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Nevel: Hello, this is Dr Kait Nevel. Today I'm interviewing Dr Adriana Bermeo about her article on a multidisciplinary approach to nonepileptic events, which she wrote with Dr Victor Petron. This article appears in the February 2025 Continuum issue on epilepsy. Welcome to the podcast, and please introduce yourself to our audience. Dr Bermeo-Ovalle: Hello Dr Neville, it's a pleasure to be here. Thank you very much for inviting me. My name is Adriana Bermeo and I'm an adult epileptologist at Rush University Medical Center in Chicago, and I am also the codirector of the NEST clinic, which is a treatment clinic for patients with nonepileptic seizures within our level four epilepsy center. Dr Nevel: Wonderful. Well, thank you so much for being here, and I can't wait to talk to you about your article and learn a little bit about NEST, maybe, during our conversation, and how you approach things. To start us off talking about your article today, could you share with us what you think is the most important takeaway from your article for the practicing neurologist? Dr Bermeo-Ovalle: Wonderful. There's some messages that I would like people to get from working with patients with functional neurologic disorders in general. The first one is that functional neurologic disorders are very common in presentation in the neurologic clinic, almost no matter what your practice of self-specialty care is. The second is that for people who treat patients primarily with seizures or epilepsy, they account for between 5 to 10% of our patients in the clinic, but about 30% of our patients in our epilepsy monitoring unit because the seizures typically do not respond to anti-seizure medication management. Also, that in order to diagnose them, you don't need to have a neuropsychological stress already be available for the patient or the clinician. And the most important thing is that there are available treatments for these patients and that there are options that we can offer them for them to have less seizures and to be more integrated to whatever activities they want to get integrated. Dr Nevel: Wonderful. What do you think a practicing neurologist might find surprising after reading your article? Dr Bermeo-Ovalle: I think still many neurologists feel very hopeless when they see patients with these conditions. They do not have very good answers right away for the patients, which is frustrating for the neurologist. And they don't think there's too much they can do to help them other than send them somewhere else, which is very difficult for the neurologist and is crushing to the patients to see these doctors that they're hoping to find answers to and then just find that there's not much to do. But what I want neurologists to know is that we are making strides in our understanding of the condition and that there are effective treatments available. And I hope that after reading this and engaging with this conversation, they will feel curious, even hopeful when they see the next patient in the clinic. Dr Nevel: Yeah, absolutely. I find the history of nonepileptic seizures really interesting and I enjoyed that part of your article. How has our understanding of nonepileptic seizures evolved over the centuries, and how does our current understanding of nonepileptic seizures inform the terminology that we use? Dr Bermeo-Ovalle: Yeah. The way we name things and the way we offer treatment goes along to how we understand things. So, the functional seizures and epileptic seizures were understood in ancient times as possession from the spirits or the demons or the gods, and then treatments were offered to those kind of influences and that continues to happen with functional seizures. So, we go through the era when this was thought to be a women-only condition that was stemming from their reproductive organs and then treatments accordingly were presented. And later on with Charcot and then Freud, they evolved to even conversion disorders, which is one understanding the most conversion disorders, which is one of the frameworks where this condition has been treated with psychotherapy, psychoanalytic psychotherapy. And in our current understanding, we understand functional neurologic disorders in general as a more like a connection, communication network disorder, between areas of the brain that modulate emotional processing and movement control. And therefore, our approach these days is much more geared towards rehabilitation. You know, I think that's the evolution of thinking in many different areas. And as we learn more, we will be acquiring more tools to help our patients. Dr Nevel: Yeah, great. Thanks so much for that answer. Just reading the historical information that you have in your article, you can imagine a lot of stigma with this diagnosis too over time, and that- I think that that's lessening. But I was wondering if you could talk about that a little bit. How do we approach that with our patients and loved ones, any stigma that they might feel or perceive from being diagnosed with nonepileptic seizures? Dr Bermeo-Ovalle: Thank you for asking that question. Stigma is actually an important problem even for people living with epilepsy. There's still a lot of misunderstanding of what epilepsy is and how it affects people, and that people living with epilepsy can live normal, healthy lives and do everything they want to do with appropriate treatment. And if a stigma is still a problem with epilepsy, it is a huge problem for patients living with functional neurologic symptoms in general, but particularly with functional seizures or nonepileptic seizures. Because the stigma in this population is even perpetuated by the very people who are supposed to help them: physicians, primary care doctors, emergency room doctors. Unfortunately, the new understanding of this condition has not gotten to everybody. And these patients are often even blamed for their symptoms and for the consequences of their symptoms and of their seizures in their family members, in their job environment, in their community. Living with that is really, really crushing, right? Even people talk about, a lot about malingering. They come back about secondary gain. I can tell you the patients I see with functional seizures gain nothing from having this condition. They lose, often, a lot. They lose employment, they lose ability to drive. They lose their agency and their ability to function normally in society. I do think that the fight- the fighting of stigma is one that we should do starting from within, starting from the healthcare community into our understanding of what these patients go through and what is causing their symptoms and what can we do to help them. So there's a lot of good work to be done. Dr Nevel: Absolutely. And it starts, like you said, with educating everybody more about nonepileptic seizures and why this happens. The neurobiology, neurophysiology of it that you outlined so nicely in your article, I'm going to encourage the listeners to look at Figure 1 and 4 for some really nice visualization of these really complex things that we're learning a lot about now. And so, if you don't mind for our listeners, kind of going over some of the neurobiology and neurophysiology of nonepileptic seizures and what we're learning about it. Dr Bermeo-Ovalle: Our understanding of the pathophysiology of functional neurologic seizure disorder is in its infancy at this point. The neurobiological processes that integrate emotional regulation and our responses to it, both to internal stimuli and to external stimuli and how they affect our ability to have control over our movement---it's actually amazing that we as neurologists know so little about these very complex processes that the brain do, right? And for many of us this is the reason why we're in neurology, right, to be at the forefront of this understanding of our brain. So, this is in that realm. It is interesting what we have learned, but it's amazing all that we have to learn. There is the clear relationship between risk factors. So, we know patients with functional neurologic symptom disorder and with functional seizures, particularly in many different places in the world with many different beliefs, relationship to their body, to their expression of their body, have this condition no matter how different they are. And also, we know that they have commonalities. For example, traumatic experiences that are usually either very strong traumatic experiences or very pervasive traumatic experiences or recurrent over time of different quality. So, we are in the process of understanding how these traumatic experiences actually inform brain connectivity and brain development that result in this lack of connections between brain areas and the expression of them, and that result in this kind of disorder. I wish I can tell you more about it or that I would understand more about it, but I am just grateful for the work that has been done so that we can understand more and therefore have more to offer to these patients and their families and their communities that are support. Dr Nevel: Yeah, absolutely. That's always the key, and just really exciting that we're starting to understand this better so that we can hopefully treat it better and inform our patients better---and ourselves. Can you talk to us a little bit about the multidisciplinary team approach and taking care of patients with nonepileptic seizures? Who's involved, what does best practice model look like? You have a clinic there, obviously; if you could share with us how your clinic runs in the multidisciplinary approach for care of these patients? Dr Bermeo-Ovalle: The usual experience of patients dealing with functional seizures, because this is a condition that has neurological symptoms and psychiatric symptoms, is that they go to the neurologist and the neurologist does not feel sufficiently able to manage all the psychiatric comorbidities of the condition. So, the patient is sent to psychiatry. The psychiatry really finds themselves very hopeless into handling seizures, which is definitely not their area of expertise, and these patients then being- “ping-ponging” from one to the other, or they are eventually sent to psychotherapy and the psychotherapist doesn't know what they're dealing with. So, we have found with- and we didn't come up with this. We had wonderful support from other institutions who have done- been doing this for a longer time. That bringing all of this specialty together and kind of situating ourselves around the patient so that we can communicate our questions and our discrepancies and our decision between who takes care of what without putting that burden on the patient is the best treatment not only for the patient, who finally feels welcome and not burden, but actually for the team. So that the psychiatrist and the neurologist support the psychotherapist who does the psychotherapy, rehabilitation, mind the program. And we also have the support and the involvement of neuropsychology. So, we have a psychiatrist, a neurologist, social worker, psychotherapist and neuropsychology colleagues. And together we look at the patient from everywhere and we support each other in the treatment of the patient, keeping the patient in the middle and the interest of the patient in the middle. And we have found that that approach has helped our patients the best, but more importantly, makes our job sustainable so that none of us is overburdened with one aspect of the care of the patient and we feel supported from the instances that is not our most comfortable area. So that is one model to do it. There's other models how to do it, but definitely the interdisciplinary care is the way to go so far for the care of patients with functional neurologic symptom disorders and with functional seizures or nonepileptic seizures in particular. Dr Nevel: Yeah, I can see that, that everybody brings their unique expertise and then doesn't feel like they're practicing outside their, like you said, comfort zone or scope of practice. In these clinics---or maybe this happens before the patient gets to this multidisciplinary team---when you've established a diagnosis of nonepileptic seizures, what's your personal approach or style in terms of how you communicate that with the patient and their loved ones? Dr Bermeo-Ovalle: It is important to bring this diagnosis in a positive term. You know, unfortunately the terminology question is still out and there's a lot of teams very invested into how to better characterize this condition and how to- being told that you don't have something is maybe not that satisfying for patients. So, we are still working on that, but we do deliver the diagnosis in positive terms. Like, this is what you have. It's a common condition. It's shared by this many other people in the world. It's a neuropsychiatric disorder and that's why we need the joint or collaborative care from neurology and psychiatry. We know the risk factors and these are the risk factors. You don't have to have all of them in order to have this condition. These are the reasons why we think this is the condition you have. There is coexisting epilepsy and functional seizures as well. We will explore that possibility and if we get to that conclusion, we will treat these two conditions independently and we- our team is able to treat both of them. And we give them the numbers of our own clinic and other similar clinics. And with that we hope that they will be able to get the seizures under better control and back to whatever is important to them. I tell my trainees and my patients that my goals of care for patients with functional seizures are the same as my patients with epileptic seizures, meaning less seizures, less disability, less medications, less side effects, less burden of the disease. And when we communicate it in that way, patients are very, very open and receptive. Dr Nevel: Right. What do you think is a mistake to avoid? I don't know if “mistake” is necessarily the right word, but what's something that we should avoid when evaluating or managing patients with nonepileptic seizures? What's something that you see sometimes, maybe, that you think, we should do that differently? Dr Bermeo-Ovalle: I think the opportunity of engaging with these patients is probably the hardest one. Because neurologists have the credibility, they have the relationship, they have- even if they don't have a multi-disciplinary team all sitting in one room, they probably have some of the pieces of this puzzle that they can bring together by collaborating. So, I think that missing the opportunity, telling the patient, this is not what I do or this is not something that belongs to me, you need to go to a mental health provider only, I think is the hardest one and the most disheartening for patients because our patients come to us just like all patients, with hopes and with some information to share with us so that we can help them make sense of it and have a better way forward. We as neurologists know very well that we don't have an answer to all our patients, and we don't offer zero seizures to any of our patients, right? We offer our collaborative work to understand what is going on and a commitment to walk in the right direction so that we are better every day. And I do think wholeheartedly that that is something that we can offer to patients with functional seizures almost in any environment. Dr Nevel: Yeah, absolutely. And using that multidisciplinary approach and being there with your patient, moving forward in a longitudinal fashion, I can see how that's so important. What do you find most challenging and what do you find most rewarding about caring for patients with nonepileptic seizures? Dr Bermeo-Ovalle: The thing that I find more challenging are the systemic barriers that the system still places. We discuss with the patients, what is the right time to go to the emergency room or not? Because the emergency room may be a triggering environment for patients with functional seizures and it may be a place where not everybody is necessarily attuned to have this conversation. Having said that, I never tell any of my patients not to go to the emergency room because I don't know what's happening with them. As a matter of fact, we're getting a lot of information on high mortality rates in patients with functional seizures, and it's not because of suicide and is probably not related to the seizure. Maybe this is---you know, this is speculation on my part---that is because they get to more severe conditions in other things that are not the functional seizures because they just experienced the healthcare system as very hostile because we are very in many instances. So, navigating that is a little bit difficult, and I try to tell them to have the doctors call me so that I can frame it in a different way and still be there for them. But I can tell you this clinic is the most rewarding clinic of all my clinical activities. And I love with all my heart being an epileptologist and seeing my patients with epilepsy. But the number of times my patients with functional seizures say, nobody had ever explained this to me, nobody had ever validated my experience in front of my family so that I'm not- like, feel guilty myself for having this episode, I can't tell you how many times. And obviously patients who come to the nonepileptic seizure clinic already know that they come to the nonepileptic seizure clinic, so that- you can say it's a selection of patients that are already educated in this condition to come to the clinic. But I would love everybody to know managing this population can be enormously, enormously satisfying and rewarding. Dr Nevel: Especially for, I imagine, patients who have been in and out of the ER, in and out of the hospital, or seen multiple providers and make their way to you. And you're able to explain it in a way that makes sense and hopefully reduces some of that stigma maybe that they have been feeling. Dr Bermeo-Ovalle: And along with that, iatrogenic interventions, unnecessary intubations, unnecessary ICUs; like, so much. And I think, I have no superpower to do that other than understanding this condition in a different way. And by I, I mean all the providers, because I'm not alone in this. There's many, many people doing excellent work in this state. And we just need to be more. Dr Nevel: Yeah, sure. Absolutely. So, on that note, what's next in research, or what do you think will be the next big thing? What's on the horizon in this area? Dr Bermeo-Ovalle: I think the community in the functional neurologic disorder community is really hopeful that more understanding into the neurobiology of this condition will bring more people over and more neurologists willing to take it on. There was an invitation from the NIH, I think, about four or five years ago to submit proposals for research in this area in particular. So, all of those studies must be ongoing. I'm much more a clinician than a researcher myself, but I am looking forward to what all of that is going to mean for our patients. And for- I think there's other opportunities in that further understanding of the clinical manifestations of many other conditions, and for our understanding of our relationship with our patients. I feel we are more attuned to align with a disease that, when the experience of the patient- and with a disease like this, a condition like this one, we have to engage with the personal experience of the patient. What I mean by that is that we are more likely to say,  I'm an epileptologist, I'm an MS doctor, you know, and we engage with that condition. This condition, like, just makes us engaging with the symptom and with the experience of the person. And I think that's a different frame that is real and rounded into the relationship with our patients. So, I think there's so much that we can learn that can change practice in the future. Dr Nevel: Yeah. And as your article, you know, outlines, and you've outlined today during our discussion, that- how important this is for the future, that we treat these patients and help them as much as we can, that comes with understanding the condition better, because wow, I was really surprised reading your article. The mortality associated with this, the healthcare costs, how many people it affects, was just very shocking to me. So, I mean, this is a really important topic, obviously, and something that we can continue to do better in. Wonderful. Well, thank you so much. It's been really great talking to you today. Dr Bermeo-Ovalle: Thank you, Katie, I appreciate it too. Dr Nevel: So again, today I've been interviewing Dr Adriana Bermeo about her article on a multidisciplinary approach to nonepileptic events, which she wrote with Dr Victor Petron. This article appears in the most recent issue of Continuum on epilepsy. 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 the 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.

We are kicking off the new year and a new season with a great guest! Dr. Kristen Steenerson, MD brings her expertise to the conversation with a deeper dive into Vestibular Migraine and Persistent Postural Perceptual Dizziness. Whether you're a patient or a clinician, you surely don't want to skip this episode! Kristen K. Steenerson, MD is a board-certified neurologist with fellowship training in vestibular neurology. She graduated cum laude from Claremont McKenna College, received her MD from the University of Utah, completed neurology residency at Mayo Clinic Arizona, and fellowship at Barrow Neurological Institute. She directs the Vestibular Balance Disorders Program of the Stanford Balance Center. She has joint appointments in the departments of Otolaryngology--Head and Neck Surgery and Neurology & Neurological Sciences at Stanford. Her clinical interests include vestibular migraine, persistent postural-perceptual dizziness, benign paroxysmal positional vertigo, Ménière's disease, and international neurology. Episode Resources - Central and peripheral vestibular disorders overview (and how much they overlap!): https://www.nature.com/articles/nrneurol.2017.58 - CGRP position paper: https://pubmed.ncbi.nlm.nih.gov/38466028/ - VMPATHI survey:https://redcap.ucsf.edu/surveys/?s=CY893NJHCM - VMPATHI paper: https://pubmed.ncbi.nlm.nih.gov/32176141/ - Comprehensive analysis of VM treatments: https://pubmed.ncbi.nlm.nih.gov/35859353/ - Migraine influences tinnitus and hearing loss: https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/ohn.201?casa_token=pfzZz62NjqcAAAAA:u0enZoqzF6n8D1_o_7G4HyTY5qpjFd0cDutwNpFtigKXd7xo4Zo65Cuzy4qZWjHDeuMICp0RYuKrGQ - Cognitive failures improve when migraine improves: https://pubmed.ncbi.nlm.nih.gov/37525385/ - Treat MdDS as migraine: https://pmc.ncbi.nlm.nih.gov/articles/PMC5823515/ - Magazine article: https://www.bustle.com/p/what-actually-happens-in-your-brain-when-you-have-a-migraine-according-to-experts-16823975 Hosted by Dr. Abbie Ross, PT, NCS, and Dr. Danielle Tolman, PT For Episode Recommendations or Requests, email us info@balancingactrehab.com Where to find us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://link.me/balancingactrehab⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.BalancingActRehab.com⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠Facebook: @BalancingActRehab Instagram: @BalancingActRehab Twitter: @DizzyDoctors TikTok: @BalancingActRehab

Você sabe o que é uma Taenia e como ela afeta a saúde? Separe trinta minutinhos do seu dia e descubra, com a Mila Massuda, como esses parasitas se disseminam, quais riscos eles oferecem, as doenças relacionadas (teníase e cisticercose) e a importância de práticas adequadas de higiene e alimentação para a prevenção de infecções.

In the past few years, Big Pharma has released not one, but three new treatments for Alzheimer's disease. Aducanemab (2021), Lecanemab (2023), and Donanemab (2024), are the first treatments to effectively clear the brain of amyloid plaques — the sticky protein clumps whose build-up in the brain has defined the disease for decades. The problem? They may not help patients at all.Today's guest, Stanford neurologist Mike Greicius, considers the new amyloid-clearing drugs a major disappointment — and worse, says they likely do more harm than good for patients.Despite this critique, Greicius, thinks that the next few years will be an exciting time for novel Alzheimer's therapies, as growing biological understanding of Alzheimer's risk and resilience bear fruit with promising new approaches to treatment.Learn More:Greicius is the Iqbal Farrukh and Asad Jamal Professor of Neurology and Neurological Sciences at Stanford Medicine, and a member of the Knight Initiative for Brain Resilience and Alzheimer's Disease Research Center at Stanford University.Amyloid Drug Skepticism:Substantial Doubt Remains about the Efficacy of Anti-Amyloid Antibodies(Commentary, Journal of Alzheimer's Disease, 2024)New Drug Approved for Early Alzheimer's (New York Times, 2024)Alzheimer's drug adoption in US slowed by doctors' skepticism (Reuters, 2024)One step back: Why the new Alzheimer's plaque-attack drugs don't work (Stanford Medicine Scope Blog, 2024)Alzheimer's Genetics Research:Knight-funded research uncovers gene mutations that may prevent Alzheimer's Disease (Knight Initiative for Brain Resilience, 2024)Why is a common gene variant bad for your brain? (Stanford Medicine Magazine, 2024)Scientists find genetic Alzheimer's risk factor tied to African ancestry (Stanford Medicine, 2023)Episode CreditsThis episode was produced by Michael Osborne, with production assistance by Morgan Honaker, and hosted by Nicholas Weiler. Art by Aimee Garza.Send us a text!Thanks for listening! If you're enjoying our show, please take a moment to give us a review on your podcast app of choice and share this episode with your friends. That's how we grow as a show and bring the stories of the frontiers of neuroscience to a wider audience. Learn more about the Wu Tsai Neurosciences Institute at Stanford and follow us on Twitter, Facebook, and LinkedIn.

In this week's PERSPECTIVES episode, Dr Nicholas Morris is joined by Dr Daryl Gress, Professor of Neurological Sciences at the University of Nebraska to discuss Dr Gress' lessons learned while building a new neurocritical care unit and training program at UCSF.

Most patients with migraine require acute treatment for at least some attacks. There is no one-size-fits-all acute treatment and multiple treatment trials are sometimes necessary to determine the optimal regimen for patients. In this episode, Teshamae Monteith, MD, FAAN, speaks with Rebecca Burch, MD, FAHS author of the article “Acute Treatment of Migraine,” in the Continuum April 2024 Headache issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Burch is an assistant professor in the Department of Neurological Sciences at Larner College of Medicine, University of Vermont, Burlington, Vermont.  Additional Resources Read the article: Acute Treatment of Migraine Subscribe to Continuum: continpub.com/Spring2024 Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Guest: @RebeccaCBurch Transcript 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, a companion podcast to the journal. Continuum Audio features conversations with the guest editors and authors of Continuum, 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 by visiting the link in the Show Notes. Subscribers also have access to exclusive audio content not featured on the podcast. As an ad-free journal entirely supported by subscriptions, if you're not already a subscriber, we encourage you to become one. For more information on subscribing, please visit the link in the Show Notes. AAN members, stay turned after the episode to get CME for listening. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. Today I'm interviewing Dr Rebecca Burch on acute treatment of migraine, which is part of the April 2024 Continuum issue on headache. Dr Burch is an Assistant Professor at Larner College of Medicine at the University of Vermont in Burlington, Vermont. Well, hi, Rebecca - thank you so much for being on our podcast. Dr Burch: Thank you so much for having me. It's always such a pleasure to talk with you. Dr Monteith: You wrote a really excellent article on acute management of migraine - really detailed. Dr Burch: Thanks so much. I'm glad you enjoyed it. I had a lot of fun writing it. Dr Monteith: Why don't you tell our listeners, what did you set out to do in writing this article? Dr Burch: Whenever I write a review article on a topic, I aim for two things, and these were the same things that I was aiming for here with this one. One is practicality and just for it to be really applicable to clinical practice and every day what we do - the ins and outs - and that was the case here as well. I really love a good table in a paper like this. I spend a lot of time on tables. I want people to be able to print them out, use them as reference, bookmark them. So, that was one thing that I aimed for - was just for this to be really useful. The other thing is, I really wanted to instill a sense of confidence in people after reading this article. I think the management of migraine can be very overwhelming for people taking care of people with migraine. And there are so many acute treatment options, so I wanted to give a framework for how to think about acute treatment (how to approach it), and then within that framework, to really go into the nuances of all the various options, and how to choose between them, and what to do in specific circumstances. And I also really wanted to cover what to do when the first couple of options don't work. Because I think most neurologists, PCPs, are comfortable prescribing sumatriptan, and then the question is, what happens when that doesn't work or the patient doesn't tolerate it? What do you do for rescue therapy? What do you do for your fifth-line treatment? And I think that was an area that I really wanted to cover as well. Dr Monteith: Yeah, you got a lot done, for sure. So, I agree - there's been so many options, new options, even over the past five or definitely ten years. One of the things that excited me about going into headache medicine were all the options, thinking of migraine and other headache disorders as a treatable disorder. What made you interested in headache medicine? Dr Burch: Like so many other people who ended up going into headache medicine, I had a fantastic mentor in residency who was really great at treating headache patients - as Brian McGeeney at Boston Medical Center (he's now at Brigham and Women's). He was really passionate about headache medicine, and seeing patients with him was always such a delight because he always had something to try. And many other situations, it would be, like, “Well, this person, we've tried something; we don't know what else to do.” But when you work with a headache specialist as a mentor or as a preceptor, they have so many things they can do, and people largely get better. And they're so grateful - it changes people's lives to be able to treat their migraine, their other headaches effectively. So that was really inspiring. And then when I started doing headache rotations and sort of thinking about whether this was the right subspecialty for me, I quickly realized two things about headache medicine that ended up being what I really love about it to this day. One is the longitudinal relationships that we have with patients - we take care of people for a long time. And it doesn't always have to be that we're seeing people every three months and making tweaks - sometimes it's once a year. But we do get to know people. You know, I have two children. Many of my patients saw me through both of those pregnancies and ask about my kids, and it's just lovely to have that sort of personal relationship over time. And then the other aspect that I really love is that we can't see patients in isolation just as their migraine disorder or headache disorder; we really have to think about who they are as a whole person. What's going on in your life? What are your stressors? How's your job, how's your family? How are you sleeping? How's your mood? Are you exercising? What's your diet like? All of these things impact how someone's migraine disorder is going. And I like to joke, “I'm half life coach, you know, and half pharmacologist,” and I love that. I love that I bring my whole self every time I see a patient and see their whole self, too. Dr Monteith: I can just imagine how well you do that. You mentioned the power of mentorship, and that seems to be a theme when interviewing authors (that mentors are super important). And I know you've been an incredible mentor. Why don't you tell us a little bit about your academic journey? I mean, I see you in the halls at these major conferences, but I've never pulled you aside and said, “Hey, what's your journey - your academic journey – like, other than your great editorial work for neurology, of course?” Dr Burch: I did my fellowship at Brigham and Women's and then stayed on there as an attending, and ultimately took over as fellowship director before I took a break, which I'll talk about in a minute. In that time, I was doing clinical care and I had a research program and I was doing education - doing a lot of teaching for CME work, and teaching primary care and subspecialists about migraine - and I really love that piece of things - and precepting fellows. And then, I also had my editorial work on top of that. I have been a medical journal editor as long as I have been a headache specialist. We were talking about mentors, and I want to talk, at some point, about my fantastic mentor, Elizabeth Loder, who is also a research editor, in addition to being an outstanding headache medicine clinician and researcher and educator. But she got me started as an Assistant Editor for Headache in my fellowship year - the journal Headache - and I continued as an Associate Editor there. I worked as a Research Editor for the British Medical Journal for a while and then joined the journal Neurology, where I am one of the eight Associate Editors. I cover the general neurology portfolio, which includes a lot of things - includes headache medicine, includes traumatic brain injury, pain, spine, neuro-oncology, neuro-otology - there's a whole bunch of different things that I have learned a lot about since starting as an editor. So, I have always had a lot of different parts to my job, which keeps me interested. It's also a lot, and I do always talk about the fact that I ended up taking a year off because I think it's important to be real about the lives that we lead and our jobs as academic neurologist. So I ended up having a bunch of family health issues that came up in 2021, and combined with all of the other things that we're doing, I just couldn't keep it all going. And I ended up getting sort of burned out a little bit and was having trouble balancing all of that and the family health issues that were going on. And I ended up taking about a year off from clinical work. I continued with my editorial work and kind of got everything sorted out with my family, and then just started my current position in January. I'd just like to bring that up to show that – you know, not everyone's going to be able to take a year off - I recognize that. But I think it's important to normalize that just being “pedal to the metal” all the time is not feasible for anyone. And we need to recognize that it's okay to take breaks periodically. So, I'm kind of an evangelist for the “taking-a-break model.” Dr Monteith: Yeah, you took a break but you kind of didn't, because you've been doing a lot for us in neurology, and I certainly appreciate that. Speaking about all of that and feeling burnt out - what inspires you; what does keep you going? Because I know you keep going. Dr Burch: I do. Well, it's really funny - when I took my time off, I used that as an opportunity to really think about, “Okay, is this really what I want to be doing? Is this the right path for me? Do I want to rethink things?” And I ended up in the same job that I left, just in a different place. I'm still doing clinical care, and I'm the fellowship director of my current institution, and I still do all this education, and I'm getting my research program going, and I'm still an editor. So, I think the bottom line is, I have always loved what I do; it's just a question of making it all fit. So, you know, when I get up in the morning, when it's a clinic day, I am so excited to just go and talk to my patients and see how they're doing and see if there's something I can do to make them feel better. And it's just delightful to be able to play that role in people's lives, even if they're not getting better. You know, I think sometimes just being there with them is of service and is worth doing, and that feels very meaningful to me. And I have a fellow now. I love working with my fellow and teaching, and I love just talking about headache medicine and, you know, “What can we do to help people?” So, that really inspires me. On an editorial day, I'm interested in what research people are doing and seeing how neurology can publish the best research possible. We're all moving the field forward and it's just delightful to see what people are doing. I don't know - I like all of it. Dr Monteith: Yeah - you spoke about talking to patients and having that interaction. I'm thinking about migraine and patients going into status, having severe attacks. Is there any case that really moved you, made you think differently? Dr Burch: What really sticks out in my mind when I think about acute treatment, in particular, is what doesn't necessarily fit neatly into the algorithms that we develop. The situations where creativity and persistence and working together really make a big difference for a patient. I am the first person to tell you we do not know everything yet, and maybe we will never know everything. And I think sometimes we need to think outside the box. We need to “listen between the lines” to what people are telling us, and really work together to figure out a very individualized, well-crafted plan. I'm thinking about times that - for example, someone came to me and said, “I'm having these intermittent episodes where I get all of the symptoms of migraine but I don't get headache pain. You know, I get the nausea and I get the photophobia and I'm irritable and, you know, what do I do about this?” And we ended up saying, “Okay, well, take your triptan and let's see what happens,” after trying some other things. And it worked, and it turned out to be the only thing that worked. And that's maybe something we wouldn't think about because we talk about pain all the time and that was really key to improving that person's quality of life. Or, you know, trying to figure out - if there's a situation that provokes an attack pretty reliably, how do we decide when this person is going to take their acute medication ahead of time to try and prevent that from happening? So, for example, somebody who always gets a migraine when they get on the airplane - can we maybe think about doing that? Is it part of the algorithm that we all think of? No, but it's what's right for that person. I feel like I am doing my best work when I really sit with the person and their individual story and listen to how they describe their experience, and then partner with them to come up with something that really works for their specific situation. Dr. Monteith: Give us a few tips. You mentioned the use of triptans, even thinking about most bothersome symptoms, associated symptoms. Let's say they tried the triptan, they have a severe migraine, and still with pain two hours later - what do we say? Dr Burch: Yeah, and I think this is - like I said at the beginning, this is where people often start to feel a little anxious sometimes; you've tried the triptan, it's not necessarily working - what do you do? I think there's a couple of things. First of all, triptans are still first line for migraine - in the absence of vascular risk factors, that's still what we start with. The guidelines ask us to try two different triptans before we try switching to a different class. So, the first thing - most people start with sumatriptan (it's the oldest one; it's usually covered well by insurance). So, first thing to ask is, what was the patient's experience with it? Was it not strong enough? Did it not work fast enough? Was it too strong? And then you think about - based on that response, are we going to go to eletriptan, which is kind of considered to be the strongest or most effective of the triptans? Are we going to go to rizatriptan, which is faster onset? Are we going to go to naratriptan or frovatriptan, which lasts longer? Then, if the second triptan doesn't work, we think about moving to a gepant - that's what the guidelines are currently recommending. The other thing to consider is whether someone needs an antinausea medication or an antiemetic, because if people are feeling queasy, they're worried about vomiting, then they may be reluctant to take medication. Or it could be that their GI system just isn't working as well, so we need to think about better absorption of the oral medications as well. There are lots of other tips and tricks also. I don't want to go through the whole list, but one of the things that I put in the article is a whole set of things to do if triptans are not effective or if your acute treatment is not effective. It's also things like making sure they're treating early, using combinations of medications - there's a whole list. Then that brings us to rescue therapy. And I think that's also essential; we don't talk enough about rescue therapy. We do think about it, but we think about it when we get the phone call to our clinic, where we get the message that says, “I took my treatment didn't work. And this is the second time this has happened. And I'm desperate, and what do I do?” That's not when you want to be managing this. You want to be managing this at the visit, before it happens. So, I think anybody who has an attack occasionally that doesn't respond to treatment needs a rescue plan. There's a bunch of different things you can do - I talk about this in the article as well - but some backup, like an injectable sumatriptan, might be helpful. Sometimes we use sedating medications to just try and help people go to sleep. I personally really like to give phenothiazine antiemetics because they have intrinsic antimigraine properties as well as being sedating and helping with nausea, so I sometimes use those. But there are a lot of different strategies and it's just worthwhile looking through them and getting comfortable with a few of them to give patients as a backup plan. Dr Monteith: I loved – I did love your tables. I love that you put the devices in the tables because usually when we think about neuromodulation, that's almost like usually a separate article. But you went ahead and combined it because all of the devices may have some acute benefits for patients. So, how do you think about devices? How do you talk to patients about devices? Dr Burch: Yeah, well, all of them were originally tested for acute treatment before their preventive indications. So, I think it's appropriate; if we're thinking about a plan, we want to have everything in one place, which is why I always include neuromodulation. The neuromodulation device that has the strongest evidence is remote electrical neuromodulation, which is the band that patient wears on their arm and uses as an acute strategy. The others may be helpful for individual patients, but I tend to lean towards the remote electrical neuromodulation as my acute treatment of choice just because of the strength of the evidence. I also haven't had as much trouble getting it for patients. The big barrier for all of these neuromodulation devices is cost because, relatively - I mean, they're not cheap and they're almost never covered by insurance (sometimes they are, but not always), and many of our patients are going to be able to access them and many of our patients are not. So, I'm always judicious in the way that I talk about them because I don't really want to put people in the situation of having to say, “I can't afford this thing that you think would be great for me.” Which, of course, comes up - not just with neuromodulation but with medication as well. But, you know, I think they're good for people who don't want to take medication or who are taking medications too often, and we need something to throw in there that is not a medication to prevent the development of medication overuse headache. Some people just prefer them. The evidence is not as strong for neuromodulation as it is for acute medications - and some of that just has to do with the challenges in blinding people to treatment arm in a clinical trial - but I think they have their place. Dr Monteith: When I'm just looking at the data, and then, as you mentioned, there are multiple options in terms of the latest developments. What are the things that you're most excited about in terms of either nonpharmacological, pharmacological interventions, or even patient populations like pregnant patients or patients with cardiovascular disease. Dr Burch: It is such an exciting time to be a headache specialist. I feel like things are coming out all the time, even in between writing this article and sending the final draft in, and now new things have come out. The zavegepant nasal spray is now FDA approved for acute treatment of migraine, and that was not the case when I wrote the final draft of this article. So, new formulations of medications are coming out and that's just really exciting. I think different patients prefer different things, and so I kind of like having different options to give them. I'm really interested in a couple of different things. There's been a lot of research coming out recently about the migraine prodrome - this sensation or symptom constellation that some patients get before what we think of as the more typical migraine – so, before the pain, maybe even before the more typical sensory hypersensitivity. Some patients know that an attack is coming, and there has been some research very recently coming out showing that, with gepants, taking the gepant before the attack actually happens in the prodromal phase can stave off an attack. I think that's cutting edge. I haven't really started talking to patients about it, but I'm interested to see what happens when that research is fully published and we kind of start test driving it. I'm also interested in the way that gepants don't seem to cause medication overuse headache in the same way that triptans or frequent use of NSAIDs do. I'm kind of thinking that the line between acute treatment and preventive treatment may start to get blurred a little bit with gepants. Dr Monteith: It's already blurred. Dr Burch: It's already blurred! It's pretty blurred, right? Dr Monteith: I agree. And it'd be cool to see an update on this article. It might need to be just a whole - imagine a whole kind of issue on its own, on just acute treatments. Dr Burch: Yes, for sure. Dr Monteith: Great. Thank you so much for being here. Dr Burch: Thanks. It's always a pleasure to talk to you, and I'm really excited for this article to make it out into the wild in the real world and for people to get a chance to take a look at it. Dr Monteith: Yeah, I know our listeners are going to love this article - they're going to get a lot out of it. And most importantly, their patients are going to get a lot out of it. Dr Burch: That's my goal. Dr Monteith: Again, today we've been interviewing Dr Rebecca Burch, whose article on acute treatment of migraine appears in the most recent issue of Continuum, on headache. Be sure to check out Continuum audio podcasts from this and other issues. And thank you to our listeners for joining me 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 practice. Right now, during our Spring Special, all subscriptions are 15% off. Go to Continpub.com/Spring2024, or use the link in the episode notes to learn more and take advantage of this great discount. This offer ends June 30, 2024. AAN members: go to the link in the episode notes and complete the evaluation to get CME. Thank you for listening to Continuum Audio.

Welcome to the Med Spa Success Strategies Podcast, presented by Ricky Shockley of Med Spa Magic Marketing. On this episode, we're joined by Dr. Brandon Kirsch of Kirsch Dermatology & Med Spa to discuss lessons learned, strategies, and tactics that allowed him to build a highly successful and reputable practice in Naples, FL. Kirsch Dermatology is known for excellence in patient care as evidenced by their incredible online reviews. Dr. Kirsch shares how he went from the "new-in-town" to a highly sought-after provider with the help of online marketing and an emphasis on providing top-tier patient experience. He also shares important lessons he learned along the way about financial planning, a profit-first mindset, and more. Per usual, I'm confident you'll get more than a few tidbits from this interview that, if put to use, will shape your practice for the better. If you're ready to implement more efficient & effective marketing strategies for your practice, book your FREE strategy session & marketing plan: https://go.medspamagicmarketing.com/schedule About Dr. Brandon Kirsch - Kirsch Dermatology & Med Spa Dr. Brandon Kirsch's work spans the worlds of dermatology, technology, business and law. He is a board-certified dermatologist who started his career as a lawyer and holds law degrees from the University of Western Ontario (LL.B.) and Georgetown University (LL.M. Securities and Financial Regulation). He completed medical school at Brown University, an internship at the Mayo Clinic and dermatology residency at the University of North Carolina. Dr. Kirsch serves as Chief of Dermatology for Naples Community Hospital. He has previously worked as Assistant Clinical Professor of Dermatology at the University of Colorado, Vice President and Therapeutic Area Head of Dermatology at the global biopharmaceutical company Arena Pharmaceuticals, and Vice President and Medical Director at Brickell Biotech, Inc. In his roles at Arena and Brickell, he was responsible for providing leadership and strategic direction to the clinical science team and overseeing research studies. Dr. Kirsch has also provided strategic medical consulting for the clinical-stage biopharmaceutical company Dermavant Sciences, Inc. Dr. Kirsch is a frequent contributor to the HuffPost and has been published in the Journal of the American Medical Association, Journal of the American Academy of Dermatology, Journal of Drugs in Dermatology, Journal of Clinical and Aesthetic Dermatology, Dermatology Times, The Journal of Investigative Dermatology, The Journal of Cancer Immunology Research, The Canadian Journal of Neurological Sciences, Reason, The Wall Street Journal, The Toronto Star, The Providence Journal, and The Jacksonville Times-Union. Read more about Dr. Kirsch's story here: https://www.kirschderm.com/dr-brandon-kirsch/ Read more about Kirsch Dermatology here: https://www.kirschderm.com/why-choose-us/

We like to believe that we are masters of our own fate, that we are the cause of our choices and actions. But what if that's not true? Imagine that all of our choices and actions are simply the product of history—whether that goes back one minute or 1000 years—and biological and environmental forces that we often don't even understand. In this episode we're exploring the question of whether free will exists and whether we should even want it to. Brian's guest is Robert Sapolsky: Professor of Biology, Neurology, Neurological Sciences, and Neurosurgery at Stanford University and author of Determined: A Science of Life without Free Will.

In this episode of Minding Memory, Matt & Donovan speak with Dr. Lisa Barnes, the Alla V. and Solomon Jesmer Professor of Gerontology and Geriatric Medicine, Department of Neurological Sciences and Associate-Director of the Rush Alzheimer's Disease Center at Rush University. Dr. Barnes talks with Matt & Donovan about racial disparities in Alzheimer's disease dementia and several obstacles that have impeded our understanding of race and dementia. Faculty Profile: https://www.rushu.rush.edu/faculty/lisa-barnes-phd RADC Resource Sharing Hub: https://www.radc.rush.edu/ Article Referenced in Podcast: Barnes LL. Alzheimer disease in African American individuals: increased incidence or not enough data? Nat Rev Neurol. 2022 Jan;18(1):56-62. doi: 10.1038/s41582-021-00589-3. Epub 2021 Dec 6. PMID: 34873310; PMCID: PMC8647782. The transcript for this episode can be found here.CAPRA Website: http://capra.med.umich.edu/ You can subscribe to Minding Memory on Apple Podcasts, Spotify, Google Podcasts or wherever you listen to podcasts. Hosted on Acast. See acast.com/privacy for more information.

We're baaaack with episode 2 of Turn-Based Besties, and today we are diving right into our top three games of 2023. Note, these will be our personal favorite games we played in 2023, not necessarily games that were released in 2023 (because we know DJ likes his retro and indie games). We will also be trying out a new segment called "Medical Moment" with Sam, as he discusses video games and certain illness or conditions that occur with a character. Disclaimer: we do not provide medical diagnoses, recommendations, treatment, etc. Here's a brief reference list for you nerds out there ;) References:  Loewenstein, Richard. (2023). Dissociative amnesia: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis. Retrieved 1/14/2024, from https://www.uptodate.com/contents/dissociative-amnesia-epidemiology-pathogenesis-clinical-manifestations-course-and-diagnosis?search=amnesia&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2# Lucas Alessandro, Mario Ricciardi, Hernán Chaves, Ricardo F. Allegri. Acute amnestic syndromes. Journal of the Neurological Sciences. Volume 413. 2020. https://doi.org/10.1016/j.jns.2020.116781. Angelica Staniloiu, Hans J Markowitsch. Dissociative amnesia. The Lancet Psychiatry. Volume 1, Issue 3. 2014. Pages 226-241. ISSN 2215-0366. https://doi.org/10.1016/S2215-0366(14)70279-2.

Welcome back to "From Our Neurons to Yours," a podcast where we criss-cross scientific disciplines to take you to the frontiers of brain science. This week, we explore the science of dizziness with Stanford Medicine neurologist Kristen Steenerson, MD, who treats patients experiencing vertigo and balance disorders.In our conversation, we'll see that dizziness is not a singular experience but rather a broad term encompassing a variety of different sensations of disorientation. We learn about the vestibular system, a set of biological "accelerometers" located deep within the inner ear that detect linear and angular acceleration, helping us perceive motion, orientation, and our connection to the world around us. We also discuss a wearable medical device Dr. Steenerson and colleagues at the Wu Tsai Neurosciences Institute are developing a wearable device to measure the activity of the vestibular system by tracking a patient's eye movements. With the ability to study  this mysterious system in unprecedented detail, we're on the verge of learning more than ever about this misunderstood "sixth sense."Learn MoreDr. Steenerson's Stanford academic profileDr. Steenerson's Stanford Healthcare profile (Neurology and Neurological Sciences, Otolaryngology)The wearable ENG, a dizzy attack event monitor (DizzyDx)ReferencesPopkirov, Stoyan, Jeffrey P. Staab, and Jon Stone. "Persistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizziness." Practical neurology 18.1 (2018): 5-13.Harun, Aisha, et al. "Vestibular impairment in dementia." Otology & Neurotology: Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 37.8 (2016): 1137.Brandt T, Dieterich M. The dizzy patient: don't forget disorders of the central vestibular system. Nat Rev Neurol. 2017 Jun;13(6):352-362. doi: 10.1038/nrneurol.2017.58. Epub 2017 Apr 21. PMID: 28429801.Allison S. Young, Corinna Lechner, Andrew P. Bradshaw, Hamish G. MacDougall, Deborah A. Black, G. Michael Halmagyi, Miriam S. Welgampola Neurology Jun 2019, 92 (24) e2743-e2753; DOI: 10.1212/WNL.0000000000007644Episode CreditsThis episode was produced by Michael Osborne, with production assistance by Morgan Honaker, and hosted by Nicholas Weiler. Cover art by Aimee Garza.Thanks for listening! Learn more about the Wu Tsai Neurosciences Institute at Stanford and follow us on Twitter, Facebook, and LinkedIn.

------------------Support the channel------------ Patreon: https://www.patreon.com/thedissenter PayPal: paypal.me/thedissenter PayPal Subscription 1 Dollar: https://tinyurl.com/yb3acuuy PayPal Subscription 3 Dollars: https://tinyurl.com/ybn6bg9l PayPal Subscription 5 Dollars: https://tinyurl.com/ycmr9gpz PayPal Subscription 10 Dollars: https://tinyurl.com/y9r3fc9m PayPal Subscription 20 Dollars: https://tinyurl.com/y95uvkao   ------------------Follow me on--------------------- Facebook: https://www.facebook.com/thedissenteryt/ Twitter: https://twitter.com/TheDissenterYT   This show is sponsored by Enlites, Learning & Development done differently. Check the website here: http://enlites.com/   Dr. Robert Sapolsky is the John A. and Cynthia Fry Gunn Professor and Professor of Biology, of Neurology and Neurological Sciences, and of Neurosurgery at Stanford University. Dr. Sapolsky is the author of several informative and comical books that present cutting-edge psychoneurobiological knowledge in an enjoyable, easy-to-read format. His latest book is Determined: A Science of Life without Free Will.   In this episode, we focus on Determined. We start by discussing the relationship between the science of human behavior and questions regarding free will, and why people believe in free will. We discuss whether it matters if we cannot fully predict behavior yet. We talk about intent and premeditation, biology and the environment, luck, and self-control. We discuss if people can choose the sort of people they will become. We talk about the idea of meritocracy, and the roles of blame, praise, and punishment. We discuss if hard determinists are bad people, and whether we should refrain from making absolute claims regarding free will. Finally, Dr. Sapolsky tells us what it would take for someone to convince him that free will exists. -- A HUGE THANK YOU TO MY PATRONS/SUPPORTERS: PER HELGE LARSEN, JERRY MULLER, HANS FREDRIK SUNDE, BERNARDO SEIXAS, OLAF ALEX, ADAM KESSEL, MATTHEW WHITINGBIRD, ARNAUD WOLFF, TIM HOLLOSY, HENRIK AHLENIUS, JOHN CONNORS, FILIP FORS CONNOLLY, DAN DEMETRIOU, ROBERT WINDHAGER, RUI INACIO, ZOOP, MARCO NEVES, COLIN HOLBROOK, PHIL KAVANAGH, MIKKEL STORMYR, SAMUEL ANDREEFF, FRANCIS FORDE, TIAGO NUNES, FERGAL CUSSEN, HAL HERZOG, NUNO MACHADO, JONATHAN LEIBRANT, JOÃO LINHARES, STANTON T, SAMUEL CORREA, ERIK HAINES, MARK SMITH, JOÃO EIRA, TOM HUMMEL, SARDUS FRANCE, DAVID SLOAN WILSON, YACILA DEZA-ARAUJO, ROMAIN ROCH, DIEGO LONDOÑO CORREA, YANICK PUNTER, ADANER USMANI, CHARLOTTE BLEASE, NICOLE BARBARO, ADAM HUNT, PAWEL OSTASZEWSKI, NELLEKE BAK, GUY MADISON, GARY G HELLMANN, SAIMA AFZAL, ADRIAN JAEGGI, PAULO TOLENTINO, JOÃO BARBOSA, JULIAN PRICE, EDWARD HALL, HEDIN BRØNNER, DOUGLAS FRY, FRANCA BORTOLOTTI, GABRIEL PONS CORTÈS, URSULA LITZCKE, SCOTT, ZACHARY FISH, TIM DUFFY, SUNNY SMITH, JON WISMAN, DANIEL FRIEDMAN, WILLIAM BUCKNER, PAUL-GEORGE ARNAUD, LUKE GLOWACKI, GEORGIOS THEOPHANOUS, CHRIS WILLIAMSON, PETER WOLOSZYN, DAVID WILLIAMS, DIOGO COSTA, ANTON ERIKSSON, CHARLES MOREY, ALEX CHAU, AMAURI MARTÍNEZ, CORALIE CHEVALLIER, BANGALORE ATHEISTS, LARRY D. LEE JR., OLD HERRINGBONE, STARRY, MICHAEL BAILEY, DAN SPERBER, ROBERT GRESSIS, IGOR N, JEFF MCMAHAN, JAKE ZUEHL, BARNABAS RADICS, MARK CAMPBELL, TOMAS DAUBNER, LUKE NISSEN, CHRIS STORY, KIMBERLY JOHNSON, BENJAMIN GELBART, JESSICA NOWICKI, LINDA BRANDIN, NIKLAS CARLSSON, ISMAËL BENSLIMANE, GEORGE CHORIATIS, VALENTIN STEINMANN, PER KRAULIS, KATE VON GOELER, ALEXANDER HUBBARD, LIAM DUNAWAY, BR, MASOUD ALIMOHAMMADI, PURPENDICULAR, JONAS HERTNER, URSULA GOODENOUGH, GREGORY HASTINGS, DAVID PINSOF, SEAN NELSON, AND MIKE LAVIGNE! A SPECIAL THANKS TO MY PRODUCERS, YZAR WEHBE, JIM FRANK, ŁUKASZ STAFINIAK, TOM VANEGDOM, BERNARD HUGUENEY, CURTIS DIXON, BENEDIKT MUELLER, THOMAS TRUMBLE, KATHRINE AND PATRICK TOBIN, JONCARLO MONTENEGRO, AL NICK ORTIZ, AND NICK GOLDEN! AND TO MY EXECUTIVE PRODUCERS, MATTHEW LAVENDER, SERGIU CODREANU, BOGDAN KANIVETS, AND ROSEY!

This week Dr Jonny Bardgett discusses Guillain–Barré syndrome (GBS) with Dr Gavin Langlands. Topics include; what GBS is, when to suspect GBS and diagnose, when to start treatment and escalate and the prognosis and rehabilitation of patients. Dr Gavin Langlands is in their penultimate year of neurology Registrar training at the Institute of Neurological Sciences, Glasgow in the West of Scotland, with a developing interest in neuromuscular disorders. Recording Date: 07 December 2022 -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: cme@rcpe.ac.uk

This week, Jonathan Sackier is joined by Robert Cowan, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, California, USA. The pair dive deep into the causes, manifestations, prevention, and treatment of headaches and migraine, discussing differences observed in brain anatomy. They discuss remote electrical neuromodulation for the prevention of migraine, stigmas associated with headaches and migraine, the differences between episodic and chronic migraine, and the manifestations and nature of auras.

Long COVID is a serious issue. And in July 2021, it was added as a recognized condition that could result in a disability under the Americans with Disabilities Act. But what is Long COVID? And why are only some people affected by it? Emerging research has found a relationship between Phrenic and Vagus nerve changes and chronic COVID symptoms, which may be one of the causes of lingering symptoms like fatigue, shortness of breath, difficulty concentrating, and digestive issues. So what's actually happening in the body when things don't feel "right" after the initial infection? You'll learn: The anatomy of Long COVID How it can impact your nervous system And how long-haul COVID can affect your diaphragm and breathing for months after the initial infection All the links: Nervous system consequences of COVID-19 (Science, 2022) Long COVID Symptoms Linked to Effects on Vagus Nerve (WebMD News) Phrenic Nerve Injury Diaphragmatic myoclonus due to SARS-CoV-2 infection (Neurological Sciences, 2020) Respiratory Distress in SARS-CoV-2 without Lung Damage: Phrenic Paralysis Should Be Considered in COVID-19 Infection (European Journal of Case Reports in Internal Medicine , 2020) A pilot randomized controlled trial of supervised, at-home, self-administered transcutaneous auricular vagus nerve stimulation (taVNS) to manage long COVID symptoms (Bioelectronic Medicine, 2022) Pilot study suggests long COVID could be linked to the effects of SARS-CoV-2 on the vagus nerve Join me for the 2023 Movement Mavens Retreat! www.aewellness.com/retreat/ 30 days to more strength + flexibility with the Mobility Mastery Toolkit Movement Mavens has the tools and strategy to support you on your path to enjoying life without pain - www.aewellness.com/mavens www.aewellness.com/podcast - Show notes, links and more. Come hang out with me on Instagram @hollaformala : https://instagram.com/hollaformala/ TikTok @ aewellness Bodywork Starter Guide - learn the 6 places you need to roll right now for quick relief, plus the reason why what you've tried so far has only given you a temporary fix. Download the guide for free now at www.aewellness.com/bodywork 818-396-6501 is the Body Nerd Hotline - how do you build consistency and/or where are you getting stuck? Drop me a line and let me know your body nerd hacks - you might just hear your voice on a future episode! Today's episode is brought to you by Mobility Mastery Toolkit. Forget icing and stretching - and get a simple program you can do on your own that actually works. The Toolkit includes 30-days of exercises so you know exactly what to do to improve the mobility of your hips, lower back, feet, neck and shoulders. With video demos and a full-body mobility workout calendar, you're just 15-mins a day from feeling stronger and more flexible. Get $20 off when you use the code MASTERY at www.mobilitytoolkit.co    

Today I talk with Dr. Sharon Sha! She is a behavioral neurologist at Stanford University. Dr. Sha's focus with her research is on preventing Alzheimer's and other neurodegenerative diseases. In this conversation we discuss the importance of brain health and things we can all do to help prevent or slow neurodegenerative diseases. I learned about Dr. Sha from the show ‘Limitless With Chris Hemsworth' on Disney+. In episode 5, Dr. Sha works with Chris on memory and the importance of challenging your brain! If you enjoyed the conversation, please give us a 5***** rating on your listening platform. Thank you! Start drinking smarter! Use code LIFE20 for 20% off your Rebel Rabbit orders! https://drinkrebelrabbit.com/discount/LLM20 For the best mattresses in the game, Engineered Sleep is your team! Use code LIVE15 to get 15% off your order. https://engineeredsleep.com Dr. Sha is a Clinical Associate Professor of Neurology and Neurological Sciences at Stanford University where she serves as Associate Vice Chair of Clinical Research, Director of the Huntington's Disease Center of Excellence and Ataxia Clinic, Co-Director of the Lewy Body Disease Association Research Center of Excellence, Clinical Core Co-Leader of the Stanford Alzheimer's Disease Research Center, and Director of the Behavioral Neurology Fellowship. Her clinical time is devoted to caring for patients with Alzheimer's disease and other neurodegenerative disorders and her research is devoted to finding treatments for these cognitive disorders. She also served on the California Governor's Alzheimer's Prevention and Preparedness Task Force Chaired by Maria Shriver in 2020. Dr. Sha received a Master's degree in Physiology and an MD from Georgetown University, followed by Neurology training at UCLA and Stanford University. She completed a clinical and research fellowship in Behavioral Neurology at UCSF, where she focused on identifying biomarkers for genetic forms of frontotemporal dementia and caring for patients with movement disorders with cognitive impairment. Dr. Sharon Sha's Stanford Profile: https://profiles.stanford.edu/sharon-sha

More than a million people in the United States have been killed by COVID-19 in the past 3 years. The numbers would be much higher, but the vaccines were developed with amazing speed. Time and again, the vaccines have been shown to be safe and effective. Yet some people persist in claiming the mRNA vaccines are causing an epidemic of stroke. The data is clear. They do not. If you want to reduce your chances of stroke, get the vaccine. The new thing that causes stroke over the past few years is COVID-19 itself. If you want to decrease your chances of having a stroke (or another stroke) don't get a severe COVID-19 infection. And the simplest thing you can do to reduce your chances of getting a severe COVID-19 infection is to get the COVID-19 vaccine. If you do catch COVID-19 despite the vaccine, the data shows it will be much less severe and much less likely to be fatal.  In addition to protecting yourself, you are also helping to protect others who may not be medically eligible to get the vaccine. The COVID-19 mRNA vaccines are saving lives every day. In this episode ... In this episode, I talk with data scientist and epidemiologist Dr. Remle Crowe about the research studies coming out now that show what we already knew from earlier research: the COVID-19 vaccine does not increase your risk stroke. We talk about several studies, and we talk about how you can do your own research on the credibility of these studies and evaluate how well they reflect the scientific reality of our world. In this post, you'll also find links to a bunch of these studies that you can read for yourself. Start by listening to this conversation. If you don't seed the audio player below visit http://Strokecast.com/MSN/vaccine to listen to the whole conversation.   Click here for a machine-generated transcript   I got my Bivalent COVID-19 booster and my 2022 Flu shot on the same day in October. Who is Dr. Remle Crowe? Dr. Remle Crowe is an expert in EMS research and quality improvement. From truck clutches to clinical care, she has shown how research and improvement science work to solve problems across fields. Prior to earning a PhD in Epidemiology, her EMS career began with the Red Cross in Mexico City as a volunteer EMT. She has authored numerous peer-reviewed publications related to prehospital care and the EMS workforce. Now, as a research scientist with ESO, Dr. Crowe routinely uses EMS data to improve community health and safety. Dr. Crowe previously appeared on the Strokecast in episode 132 to discuss the AHORA pneumonic to help Spanish speakers recognize and respond to a stroke. When it comes to stroke, Time is Brain regardless of which language you speak. A Sampling of the Studies When we claim the data indicates that the vaccine doesn't cause an increase in stroke, what data are we talking about? How did "they" analyze it? Who reviewed the studies to ensure they were accurate? Where can you read the details yourself? As Dr. Crowe explained, there are currently a whole bunch of studies that are coming out. That makes sense; it's roughly 18 months since the vaccines against COVID-19 became widely available. To conduct sound research, you need a large pool of people to look at. You need to take some time to see the results. You need to write up those results. Then you need to submit them for publication. Publications will then need to review before publishing them. That brings us to where we are today with all these studies now becoming available. Let's take a look at a few of them, and I encourage you to click through to the details and read them yourself. Click the study titles for more. Surveillance for Adverse Events After COVID-19 mRNA Vaccination This study published in JAMA (Journal of the American Medical Association) looked at nearly 12 million doses of the mRNA vaccine given to more than 6 million people. This is what they learned: "The incidence of events per 1 000 000 person-years during the risk vs comparison intervals for ischemic stroke was 1612 vs 1781 " In other words, the time period at greatest risk for stroke did not see an increased risk. They concluded: "In interim analyses of surveillance of mRNA COVID-19 vaccines, incidence of selected serious outcomes was not significantly higher 1 to 21 days postvaccination compared with 22 to 42 days postvaccination. While CIs were wide for many outcomes, surveillance is ongoing." COVID-19 Incidence and Death Rates Among Unvaccinated and Fully Vaccinated Adults with and Without Booster Doses During Periods of Delta and Omicron Variant Emergence — 25 U.S. Jurisdictions, April 4–December 25, 2021 We talked about this report from the CDC Morbidity and Mortality Weekly Report during the episode. This study looked at infections and deaths among vaccinated folks and unvaccinated folks. The rate of infection and death from COVID-19 was much higher among unvaccinated folks than among vaccinated or vaccinated and boosted folks. The report says: "Rates of COVID-19 cases were lowest among fully vaccinated persons with a booster dose, compared with fully vaccinated persons without a booster dose, and much lower than rates among unvaccinated persons during October–November (25.0, 87.7, and 347.8 per 100,000 population, respectively) and December 2021 (148.6, 254.8, and 725.6 per 100,000 population, respectively) (Table 2). Similar trends were noted for differences in the mortality rates among these three groups (0.1, 0.6, and 7.8 per 100,000 population, respectively) during October–November." Even though the vaccine does not guarantee a person will avoid COVID-19, it greatly increases their chances of avoiding infection. And if they do become infected, the vaccine greatly increases their chances of survival. Acute ischemic stroke and vaccine-induced immune thrombotic thrombocytopenia post COVID-19 vaccination; a systematic review This study in the Journal of Neurological Sciences looked throughout the published literature and found just 43 incidents of stroke following the vaccine administration. "AIS has been reported as a rare complication within 4 weeks post COVID-19 vaccination, particularly with viral vector vaccines. Health care providers should be familiar with this rare consequence of COVID-19 vaccination in particular in the context of VITT to make a timely diagnosis and appropriate treatment plan." The report specifically called out the risk of “viral vector vaccines” (and, again, it's a shockingly small risk). The most common viral vector COVID-19 vaccines are those from Johnson & Johnson and from Oxford-AstraZeneca. The mRNA vaccines from Moderna and Pfizer are not viral vector vaccines., indicating that those appear to be even safer. The recommendation is not to avoid vaccination. It's an extremely rare complication. The recommendation is to watch for signs of stroke, which is something we should be doing all the time anyway. Association Between Vaccination and Acute Myocardial Infarction and Ischemic Stroke After COVID-19 Infection This article, published in JAMA looked at what happens after a COVID-19 infection for both vaccinated and unvaccinated folks. If someone does get infected and, does their vaccination status reduce the impacts of infection? Yes, it does. In fact, folks who got the vaccine and the got COVID were LESS likely to have a stroke or heart attack after their COVID infection. "This study found that full vaccination against COVID-19 was associated with a reduced risk of AMI [heart attack] and ischemic stroke after COVID-19. The findings support vaccination, especially for those with risk factors for cardiovascular diseases." Risk of thrombocytopenia and thromboembolism after covid-19 vaccination and SARS-CoV-2 positive testing: self-controlled case series study This study in the UK looked at patients who had been infected with COVID-19 or who had received the vaccine. More than 30 million people were part of the study. The conclusions were clear: "Increased risks of haematological and vascular events that led to hospital admission or death were observed for short time intervals after first doses of the ChAdOx1 nCoV-19 and BNT162b2 mRNA vaccines. The risks of most of these events were substantially higher and more prolonged after SARS-CoV-2 infection than after vaccination in the same population." Even if there is a slight risk from vaccination, the risk from the actual disease is much higher. COVID-19 vaccine not linked to increased risk of stroke Not all research becomes available without a subscription. Researchers at Cedars-Sinai have found similar results to other studies though and have come to the same conclusion. "Newly compiled data evaluated by researchers in the Department of Neurology and the Smidt Heart Institute at Cedars-Sinai shows that COVID-19 vaccines do not raise stroke risk--but that severe COVID-19 infection does. Physician-scientists hope this growing body of evidence, highlighted today in an editorial in the peer-reviewed journal Neurology, will ease the minds of individuals still hesitant to be vaccinated." Risk of Myocarditis After Sequential Doses of COVID-19 Vaccine and SARS-CoV-2 Infection by Age and Sex We talked about this study in the conversation with Dr. Crowe. At first glance it is concerning. This is the conclusion: "Overall, the risk of myocarditis is greater after SARS-CoV-2 infection than after COVID-19 vaccination and remains modest after sequential doses including a booster dose of BNT162b2 mRNA vaccine. However, the risk of myocarditis after vaccination is higher in younger men, particularly after a second dose of the mRNA-1273 vaccine." That does seem scary for young men, and there are a couple things to keep in mind. First, the number of events was so small that it's tough to draw firm conclusions. When you get down to such low numbers, that stats can do weird things. Second, this was based on the adverse event reporting system. That does not prove causality. It just flags something to look at more closely if there are large numbers. Which there are not. The point of all this research, though, is to learn more and compile more and more evidence. And ultimately to let the body of evidence guide decision making and recommendations. What we know at this point is that the risk of stroke after a COVID-19 infection is much higher than the risk of stroke following a vaccination. And the risk of stroke after COVID-19 infection is much lower in folks that have been vaccinated than it is in those who have not been vaccinated. COVID-19 is not gone. It is still out there in the world infecting people, killing people, and giving people strokes. Billions of vaccinations later, this is what the data tells us. The simplest way to reduce your risk of stroke is to get the vaccine and stay boosted. Do Your Own Research We talked about a bunch of research in the podcast, and we looked at a bunch of reports above. You don't have to just accept my commentary or Dr. Crowe's. You can read the reports yourself and look at the data and see why the vast majority of medical professionals have concluded the vaccines are safe and effective. Dr. Crowe offered a number of tips to help you do your research. You'll find them and more in this list. Tip 1 Search research focused search engines and directories to find studies and resources. Google Scholar and PubMed are great places to start. Tip 2 Look at the Publication that publishes the research. Is it well known for scientific rigor? Does it have a strong requirement for peer review of articles? Or can someone publish in it by simply paying a fee? Tip 3 Search for the publication's Impact Factor. The more other publications that cite its work, the higher the number. A publication with a higher impact factor is likely more credible. Tip 4 When you get to the actual study, look at what type it is. If it was a case study, that's interesting. If it was a randomized, double-blind, placebo-controlled study on a large scale, that's even better. If it was a systemic review evaluating hundreds of other studies, that's stronger still. Tip 5 Look at how many people were part of the study. A few dozen is interesting. A few million is much more likely to yield credible results. Tip 6 Look at the results of the study, relative to the size of the study. A few results out of a dozen is one thing. A few results out of millions of subjects is another matter altogether. Tip 7 Look at the goal of the study. What were the authors hoping to demonstrate? Did they succeed? Why or why not? Tip 8 Consider confounding. Studies generally deal with a subset of the population -- a limited number of people -- and seek to extrapolate those results and draw conclusions about the broader population.  For those conclusions to be valid, though, the group studied needs to be similar to the group the study extrapolates to. The more different the groups are, the less reliable the results. Tip 9 Finally, does the study demonstrate causality or just coincidence? There's a reason folks will often say, “Correlation does not equal causation.” For example, the FDA Adverse Event Reporting System (FAERS) Public Dashboard is a collection of negative things that happen to a person after they get a vaccine. It's not a list of events caused by the vaccine. If a person gets hit by a bus after getting the vaccine, that can go in the database. It's an adverse event. That doesn't mean the vaccine caused the bus accident. Read the study carefully to see if the authors claim a causal relationship and if that relationship is supported by the evidence in the study. AHORA The last time Dr. Crowe was on the show was to talk about the AHORA messaging to help Spanish speakers recognize and respond to stroke. It's basically the equivalent of the BEFAST messaging we talk about a lot in English. Here is the stroke warning pneumonic device in Spanish. Download it and share it far and wide. Reconocer los signos de un accidente cerebrovascular y responder rápidamente. ¡Llame a una ambulancia si observa estas señales! Let's look at a translation. Letter Abbreviation for Spanish Description In English A Andar Tiene dificultad para andar? Tiene problemas con el equilibrio? Do they have difficulty walking? Do they have problems with balance? H Hablar Tiene dificultad para hablar o entender? Usa palabras que no tienen sentido? Do they have difficulty speaking or understanding language? Do they use words that don't make sense? O Ojos Tiene algün cambio de vista? Tiene visiön doble? Tiene dificultad para ver con ambos ojos? Do they have some change in vision? Do the have double vision? Do they have difficulty seeing with both eyes? R Rostro Tiene la mitad del rostro caido? Tiene un repentino dolor de cabeza como nunca se ha sentido? Do they have one-sided facial droop? Do they suddenly have the worst headache of their life? A Ambos Brazos Tiene dificultad para levantar un brazo o una pierna? Tiene debilidad en un brazo o una pierna? Do they have difficulty lifting an arm or a leg? Do they have weakness in an rm or a leg? And, of course, here is the BE FAST messaging for English speakers. Recognize the signs of a stroke and respond quickly. Call an ambulance if you observe these signs! Both sets of symptoms look for the same thing. The AHORA messaging includes legs and headaches. The BE FAST messaging specifically calls out calling an ambulance. Regardless, the more people that can recognize a stroke as it is happening, the better off we will all be. Pop Culture Moment During the conversation, Remle mentioned she is a big fan of the movie Sliding Doors. It's an examination of how simple moment can change the course of your life. What path lies ahead if we catch that train or miss it? https://www.youtube.com/watch?v=Da-Mizk86AE&ab_channel=Shout%21Factory Or what happens if we turn right instead of turning left? https://www.youtube.com/watch?v=YnzbuU5I7RI&ab_channel=DoctorWho In reflecting on the past, it's easy to get fixated on thing were so much better back then, but it's never that simple, is it? Billy Joel reminds us that: "The good old days weren't always good, and tomorrow ain't as bad as it seems." https://www.youtube.com/watch?v=ph7oZnBH05s&ab_channel=billyjoelVEVO Other Shows Journal Club Remle mentioned her show, PCRF Journal Club, which is a journal review webinar that meets each month. They go deep into looking at the latest research studies that are coming out. The focus is on research around EMS -- the ambulance and transport industry. If you'd like to learn more, check out its site here: https://www.cpc.mednet.ucla.edu/pcrf Successful and Disabled I was also recently featured on another podcast focused on being successful as a person with disabilities. I joined host Christ Mitchell on the Successful and Disabled podcast to share my story and discuss how I use mindset to drive my recovery and other goals in life. Listen to it here. If you don't see the audio player below, visit http://Strokecast.com/MSN/Vaccine to listen to the conversation: Hack of the Week Reading a paper book can be challenging with one functional hand. It's even harder if you try to do that while eating a meal. Why? Because books don't always want to stay open on their own. You have to hold them open, which makes it harder to pick up your cheeseburger. I use my phone to address this problem. I open the book and then lay my phone across the open pages. It's just heavy enough to keep the book from snapping shut so I can enjoy feeding my belly as I also enjoy feeding my mind. Give it a try. Links  Where do we go from here? Check out the links above to learn more about why getting the vaccine is safer than not getting the vaccine Share this episode with someone you know by giving them the link http://Strokecast.com/vaccine Do you have a recent win or victory in your recovery? Share it by calling 321-5 STROKE Get your vaccine and booster to protect against COVID if your doctor advises it Don't get best…get better

Following a motor vehicle accident, a client has dystonia—a neurological problem with muscle tone. She is using two powerful muscle relaxants: Botox injections and a baclofen intrathecal pump. Is there anything massage might do to help? Not only is the answer yes, but we even have some data to back it up!   Sponsors:     Books of Discovery: www.booksofdiscovery.com     Advanced-Trainings: www.advanced-trainings.com   Host Bio:                    Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology, now in its seventh edition, which is used in massage schools worldwide. Werner is also a long-time Massage & Bodywork columnist, most notably of the Pathology Perspectives column. Werner is also ABMP's partner on Pocket Pathology, a web-based app and quick reference program that puts key information for nearly 200 common pathologies at your fingertips. Werner's books are available at www.booksofdiscovery.com. And more information about her is available at www.ruthwerner.com.                    Recent Articles by Ruth:          “Unpacking the Long Haul,” Massage & Bodywork magazine, January/February 2022, page 35, www.massageandbodyworkdigital.com/i/1439667-january-february-2022/36.   “Chemotherapy-Induced Peripheral Neuropathy and Massage Therapy,” Massage & Bodywork magazine, September/October 2021, page 33, http://www.massageandbodyworkdigital.com/i/1402696-september-october-2021/34.           “Pharmacology Basics for Massage Therapists,” Massage & Bodywork magazine, July/August 2021, page 32, www.massageandbodyworkdigital.com/i/1384577-july-august-2021/34.       Resources:    Pocket Pathology: https://www.abmp.com/abmp-pocket-pathology-app   Botox for cervical dystonia: Effectiveness and more (2022). Available at: https://www.medicalnewstoday.com/articles/drugs-botox-for-cervical-dystonia (Accessed: 13 September 2022).   Frei, K. (2017) ‘Posttraumatic dystonia', Journal of the Neurological Sciences, 379, pp. 183–191. Available at: https://doi.org/10.1016/j.jns.2017.05.040.   Intrathecal Baclofen Pump For Muscle Spasticity Treatment (no date) Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/treatments/8997-intrathecal-baclofen-pump (Accessed: 13 September 2022).   Keenan, E. et al. (2020) ‘Intrathecal baclofen pump replacements under local anaesthetic: rapid pathway implementation under COVID-19', British Journal of Neuroscience Nursing, 16(4), pp. 174–178. Available at: https://doi.org/10.12968/bjnn.2020.16.4.174. (Picture of a baclofen pump in place)   Lipnicki, M. (2020) ‘Massage Therapy for Dystonia: a Case Report', International Journal of Therapeutic Massage & Bodywork, 13(2), pp. 33–44.   ‘Trauma-induced' (no date) Dystonia Ireland. Available at: https://www.dystonia.ie/forms-of-dystonia/secondary-dystonias/environmental-factors/ (Accessed: 13 September 2022).   Traumatic Injury (no date). Available at: https://dystonia-foundation.org/what-is-dystonia/types-dystonia/injury/ (Accessed: 13 September 2022).   About our Sponsor: About Til Luchau and Advanced-Trainings.com:   As a Certified Advanced Rolfer™, Til was on the faculty of the Dr. Ida Rolf Institute® for 20 years, where he served as Coordinator and Faculty Chair of the Foundations of Rolfing Structural Integration program. The author of the Advanced Myofascial Techniques textbook series (which has been translated into 6 languages), his regular Myofascial Techniques and Somatic Edge columns have been featured in Massage & Bodywork magazine since 2009, and (along with Whitney Lowe) he co-hosts the popular Thinking Practitioner Podcast. He is the Director of Advanced-Trainings.com which since 1985 has offered short, credit-approved professional trainings and certification for manual therapists of all types, in person and online.   Website: Advanced-Trainings.com   Email: info@advanced-trainings.com   Facebook:  facebook.com/Advanced.Trainings1/   Instagram: instagram.com/tilluchau   YouTube: youtube.com/user/AdvancedTrainings  

On the fifth episode of “No Shade, All Tea's” Season 2, host Dr. Nancy DiTunnariello talks with Maddie Bradford and Francisco Lopez about how people communicate with and through music. Show Info: Host: Dr. Nancy DiTunnariello, ditunnan@stjohns.edu Production: The Bolt Productions Intro/Outro Arrangement & Audio Editor: Courtney Lemkin Chief Audio Editor: Elizabeth Petrillo Chief Content Creator: Nicole Sutherland Show Linktree: https://linktr.ee/_NoShadeAllTea_ Photo Media: Cactus Girl Media Logo: Toni Sanchez Pop Art Guest Info: Name: Madeline Bradford Title: Social Media Coordinator, Mach 9 Digital LinkedIn: https://www.linkedin.com/in/madeline-bradford-2a96a9155 Name: Francisco Lopez Title: Documentarian Chief Editor LinkedIn: https://www.linkedin.com/in/francisco-lopez-78540b199 Research Sources: Bensimone, M. (2022). Integration of trauma in music therapy: A qualitative study. Psychological Trauma: Theory, Research, Practice, and Policy, 14(3), 367-376. Boster, J. B., Spitzley, A. M., Castle, T. W., Jewell, A. R., Corso, C. L., & McCarthy, J. W. (2021). Music improves social and participation outcomes for individuals with communication disorders: A systematic review. Journal of Music Therapy, 58(1), 12–42. Doi: 10.1093/jmt/thaa015 Fu, V. X., Oomens, P., Merkus, N., & Jeekel, J. (2021). The perception and attitude toward noise and music in the operating room: A systematic review. Journal of Surgical Research, 263, 193-206. Doi: 10.1016/j.jss.2021.01.038 Raglio, A., Bellandi, D., Manzoni, L., & Grossi, E. (2021). Communication improvement reduces BPSD: A music therapy study based on artificial neural networks. Neurological Sciences, 42, 2103-2106. Doi: 10.1007/s10072-020-04986-2

Early life adversities can have a lifelong impact. Tallie Z. Baram, distinguished professor in the Departments of Anatomy & Neurobiology, Pediatrics, Neurology, and Physiology & Biophysics at the University of California, Irvine, determines why. Prof. Tallie Z. Baram is the Danette Shepard Professor of Neurological Sciences, with appointments in several departments at UCI. Baram is […]

This Hot Topics Mini-Series episode includes a discussion with Dr. Lawrence Steinman, professor of Neurology and Neurological Sciences, Pediatrics, and Genetics at Stanford Medical School. Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system. In people with MS, the body's immune system attacks the insulating layer that surrounds nerve cells, often killing the cells. In this episode, Dr. Steinman unpacks the connection between the Epstein-Barr virus and MS and the implications for the development of new vaccines and anti-virals that have the potential to eradicate this disease. Read Transcript CME Information: https://stanford.cloud-cme.com/medcastepisode40 Claim CE: https://stanford.cloud-cme.com/Form.aspx?FormID=1164

For more details, visit the #DrGPCR Podcast Episode #71 page https://www.drgpcr.com/episode-71-with-dr-jean-martin-beaulieu ------------------------------------------- About Dr. Jean Martin Beaulieu Dr. Beaulieu received a Ph.D. in Neurological Sciences from McGill University and completed his post-doctoral training at Duke University. Prior to his recruitment Dr. Beaulieu was an associate professor and Canada Research Chair (Tier2) in the Department of Psychiatry and Neuroscience at Laval University. Dr. Beaulieu's research is aimed at understanding how cellular and molecular mechanisms regulated by psychoactive drugs intersect with genetic risk factors for mental illnesses such as schizophrenia, depression, and bipolar disorder. Dr. Beaulieu has pioneered work establishing a role for Beta-arrestin signaling in the brain in vivo and has established its importance in D2 dopamine receptors (D2R) functions. These receptors belong to the super-family of G-protein coupled receptors (GPCR), the major molecular target for drug development. In particular, D2R is the main pharmacological target of antipsychotic drugs prescribed for schizophrenia and bipolar disorders. Work by the Beaulieu Lab has demonstrated that mood stabilizer drugs (e.g. lithium) used for bipolar disorder therapy target signaling mechanisms regulated by dopamine receptors, thus providing a framework to understand how different drug classes can engage overlapping cellular mechanisms to exert their action. The Beaulieu group is presently investigating how cell surface express proteins can act as allosteric modulators of D2R signaling and explores the potential usefulness of beta-arrestins for the development of new pharmaceutical agents. Translational validation is important to validate findings obtained from experimental models research and bridge the gap between bench and bedside. Working in collaboration with geneticists, the Beaulieu-Lab has identified interactions between cellular mechanisms engaged by D2R and psychiatric drugs with genetic risk factors implicated in schizophrenia by large whole-genome association studies (GWAS) in humans. These investigations have led to the identification of an RNA binding protein (FXR1P) involved in the regulation of protein synthesis as a potential downstream effector of the action of mood stabilizers and other psychoactive drugs. In addition to basic research, the Beaulieu group is also actively implicated in translational research and industry collaboration to develop new drugs and drug development technology. Dr. Jean Martin Beaulieu on the web University of Toronto Google Scholar LinkedIn ResearchGate ------------------------------------------- We aspire to provide opportunities to connect, share, form trusting partnerships, grow, and thrive together. Fill out the Ecosystem waitlist form today to be the first to explore our brand new and improved space! For more details, visit our website http://www.DrGPCR.com/Ecosystem/.

CONTINUING EDUCATION If you are a psychologist and want CE credits for listening this episode, click on this link: https://learn.findempathy.com/courses/MS-Fatigue To find out more about our courses visit: FindEmpathy.com/learn. Learning Objectives: Identify at least three contributors to multiple sclerosis fatigue. Name two strategies for helping your patients manage or cope with MS-related fatigue. Identify two ways that CBT for Insomnia can be adapted for people living with multiple sclerosis, especially those with mobility challenges or increased disability. PODCAST SUMMARY Fatigue is one of the most disabling symptoms of multiple sclerosis and occurs in approximately 80% of people with this condition. In an article that was published in the Journal of Neurological Sciences in 2021, it was found that fatigue was the number one factor influencing self-reported ability to work. In this 2021 study, fatigue was significantly associated with an increased likelihood of missing work, low work productivity, and decreasing ability to work. When fatigue was combined with depression, there was a higher likelihood of people reducing their work hours or not working at all. And when fatigue and anxiety were present, fatigue was associated with many more work-related challenges. While fatigue can develop directly from multiple sclerosis. It can also be caused by or exacerbated by many other factors, including things like vitamin deficiencies, depression, and physical exertion. Another huge contributor to MS-related fatigue is poor sleep. Although fatigue and sleep can exacerbate one another. They can also be independent of one another. Sleep disorders are extremely common in people with multiple sclerosis. They can be caused by MS symptoms like bladder urgency at night, restless legs, chronic pain, or temperature dysregulation. But other conditions like sleep apnea are also more common and contribute to daytime sleepiness. In this podcast course, you will learn from two psychologists. The first is Dr. Anna Kratz. She's a research psychologist at the University of Michigan. She discusses new ways to assess fatigue, as well as ways to treat or mitigate its effects. Dr. Abbey Hughes from the Johns Hopkins University School of Medicine discusses different types of sleep disorders seen in individuals with multiple sclerosis, as well as a current study she's conducting to assist patients to improve their sleep. She offers advice for mental health professionals on how to work with their clients on sleep-related issues. Our patient voice and advocate is Kathy Chester. She's the host of the Move it or Lose it Podcast. And she's also the owner of Disrupt Fitness Gym. Kathy has lived with both multiple sclerosis and rheumatoid arthritis for over 20 years. She shares about living with both of those conditions, as well as some helpful tips for managing fatigue, especially for those who want to keep active and exercise regularly. Our Experts: Kathy Chester - MS Warrior, Certified MS Fitness Trainer and Certified Personal, Host of the Move It of Lose It Podcast Anna Kratz, PhD - Clinical Psychologists and Associate Professor in the Department of Physical Medicine and Rehabilitation at the University of Michigan Abbey Hughes, PhD - Clinical Psychologist, Assistant Profe

In this episode, moderated by Dr. Alissa Thomas (University of Vermont), patient caregiver Ms. Sandra Klima, hospice and palliative medicine physicians Dr. Gregg VandeKieft (Providence Institute for Human Caring) and Dr. Frank Ferris (Ohio Health), and medical oncologist Dr. Charles Blanke (Oregon Health and Science University) exchange perspectives on medical aid in dying, including legal, ethical and practical aspects. If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at education@asco.org.   TRANSCRIPT Dr. Thomas: Hello, and welcome to the ASCO Education podcast series. My name is Dr. Thomas, and I'm a Neuro-oncologist at the University of Vermont Medical Center, and  Associate Professor in the College of Medicine in the Department of Neurological Sciences in Burlington, Vermont. As today's host, I will be moderating a discussion on medical aid in dying with four guest speakers, Dr. Gregg VandeKieft, who is a Palliative Care Physician, Clinical Ethicist and Executive Medical Director at Providence Institute for Human Caring in Olympia, Washington. Dr. Charles Blanke, a Medical Oncologist and Professor of Medicine at Oregon and Health Sciences University in Portland, Oregon. Sandra Klima, who is the partner and caregiver of a patient who passed away using medical aid in dying in Vermont. And Dr. Frank Ferris, who is a hospice and palliative medicine physician, as well as executive director of Palliative Medicine Research and Education at Ohio Health in Columbus, Ohio.     For consistency during this talk, we'll be using the term medical aid in dying or MAID to refer to death with dignity and physician-assisted dying. So, to begin the discussion, I'd love to hear from Sandra about your perspective as a caregiver. Can you share with us what it was like caring for your partner and what your reaction was when you learned about his wishes?  Sandra Klima: Yes. Thank you. I'm glad to participate. My partner had died of glioblastoma in April of 2018. When we found out, it was pretty shocking. The very first thing he brought up was Act 39. And initially I was very surprised and uncomfortable with it because I didn't want to think about death, I wanted to think about living. And he was very quick, Rob was very quick. We made an appointment at the funeral parlor. He wanted to get everything taken care of quickly. So I was shocked that he wanted to use Act 39. I did not feel that it was, as I said, appropriate to talk about, but he explained he had a friend who had glioblastoma and she did not take that action.  And she kept a diary and he said it was very difficult to read. And he did not want to go through that process that she went through. He didn't want to lose who he was. He wanted to die as himself instead of a short time later as a lesser person. And wanted the choice, and Act 39 gave that to him. And I respected and supported his decision once we talked about it. Cancer is a progressive disease and there comes a time when you will not be in control. Facing that and knowing it only goes downhill is scary. So having the option that looked out before the end phase is a blessing, and it is death with dignity, and that's how it feels to me.  Dr. Thomas: Thank you so much for sharing that experience. This has been a hot topic and I'd love to hear from our panel, what are some of the common misconceptions around medical aid in dying, and how is this different from concepts like euthanasia or assisted suicide?  Dr. VandeKieft: Well, for starters in the United States, all the states that allow aid in dying require the person to self administer the agent. So it's not euthanasia where somebody else administers the lethal agent. Our neighbors to the north in Canada actually do allow voluntary euthanasia and about 90% of their aid in dying individuals do it by voluntary euthanasia as opposed to self-administration. Another misconception is that it is heavily targeting the most vulnerable and disenfranchised, when in fact data from Oregon and Washington really indicate that it's mostly the well-educated, economically privileged who tend to utilize the aid and dying acts. And so there's actually been some questions in recent years about equity in rural areas and for other people who have difficulty accessing aid in dying,  Dr. Blanke: I'd love to reinforce that point. So, the Oregon data suggests that 74% of participants have at least some college, and almost 99% actually have medical insurance, although getting the insurance company to actually pay for the drugs is a different issue. I'd like to also suggest that opponents of death with dignity say that it violates the Hippocratic Oath, which I do not believe it does. Death with dignity deaths make up a tiny minority of overall deaths in any of the states where it is legal, and a good chunk of patients, somewhere between 30% and 60%, get the prescription and never even take it. So, I like to say that the act fights out of its weight class. A lot of people get the power and control of having that medication, but never actually need it.  Dr. Thomas: I understand there are a number of safeguards within the law to try to protect patients and help access and protect physicians. Would you be able to touch on the safeguards?  Dr. Blanke: I'll start there if okay, and most of the other states have modeled their law after Oregon's. So first the patient has to make multiple requests over time. They have to demonstrate a continued interest in death with dignity, and the law has built in cooling off periods. The patients have to clearly understand what will happen if they actually take these drugs, and what happens in 99.5% of cases is they will die as a result. The patients have to put in a witnessed written request for medications, and one of the witnesses cannot be related by blood or marriage, cannot be the patient's doctor, and most importantly can't be in a patient's will. They cannot have a financial interest in the death. So I think those are very reasonable patient safeguards.  Dr. VandeKieft: One exception I would call out is the state of Montana, which did not actually pass the legislation or a voter initiative to legalize aid in dying. But it was a state Supreme Court decision that said it was unconstitutional to prohibit it. So they actually don't have a regulatory framework in place, but they do offer protections to physicians. If they participate, they cannot be prosecuted. But all the other states in the US that have laws have a regulatory framework, much like Dr. Blanke just described.  Dr. Thomas: That's really helpful for the legal ramifications. What are the main ethical considerations around medical aid in dying?  Dr. VandeKieft: If you think of the classic ethical framework, autonomy tends to drive a lot of the conversation, that is the patient's right to self-determination. If they choose to pursue aid in dying, even if we morally disagree with the appropriateness of it, is it our position to prohibit them from following through with it? But then many others will also look at the concepts of beneficence, that is the obligation to do good for our patients, and non-maleficence, that is the obligation to not do harm for our patients. And people on both sides of the arguments will invoke those terms. People who oppose it would say the good is to prolong life. People who support it would say the good is to give people the right to choose the best quality of life and self-determination. People who oppose would say that the death, if it's self administered is actually a harm. The supporters would say the harm is making a person suffer, when in fact they have the potential to cut that suffering short on their own terms.  And so those ethics discussions tend to get into it fairly significantly, particularly around the public policy and social aspects. And then finally, at least within the health system I work, we've really shifted our focus away from a lot of the high-level legal and ethical debates and into what do you do for the patients who request it, and how do we make sure that there's non abandonment, accompaniment through the end of life, and that we seek out the reasons that they asked about aid in dying in the first place, and figure out how we can best serve the concerns that raised the question?  Dr. Blanke: I would love to actually strengthen that last point that Dr. V just brought up. A lot of patients use up three months of their expected six months survival barely finding me. Because what happens is they went to their primary provider, asked for death with dignity. Their physician says, "I don't do it. I don't know anybody who does. Good luck with it." This is a legal option in the state of Oregon, as well as about 11 other states. And the question as to whether or not providers have the obligation to at least refer, is a strong ethical point. A lot of the state's statutes say they can't hinder referral. They have to supply records if the patient asks for it, but I'm not aware that any of them have mandatory referral. And I think the physician is ethically obliged to offer that possibility, even if they don't want to write a prescription, which of course is totally okay.  Dr. Ferris: And if I might comment, I think the other obligation here is to, for the patient, particularly with cancer, but with anybody with any diagnosis who might be choosing this pathway is to ensure that they've had very early referral for palliative care services. That all their symptoms, any issues that are causing suffering are actually being addressed. And that as you have suggested, that they are clearly accompanied by somebody without bias, who understands how to unwrap and provide counseling in all the different realms psychological, social, spiritual counseling, to make sure that they and their families or their partners are in a really good place. Everybody's comfortable with the choice. The family lives on after a situation like this, and they need to have been comfortable with that. That the choice was the appropriate one for the person, and that what we're doing is we're respecting that person's choices and they're comfortable with it.  Dr. Blanke: I totally support that. The flip side of the coin is none of the states really say what to do if you are unable to offer death with dignity. They don't certainly mandate palliative care. I see a number of patients who really don't have terminal illnesses, or they have terminal illnesses that they are not expected to die within the mandatory six months. And I think we should ask ourselves, why are they seeking death with dignity? We have to ask ourselves, "Should we be referring these patients for psychiatric care?"  Dr. Ferris: Well, and if I could come back and emphasize that, I think oncology broadly has frequently had late referral patterns to palliative care services. I've got story after story, I'm a radiation oncologist by background, having done palliative care for the last 35 years. Even in the last couple of weeks, students learning with me have said, "We tried to get referrals and the oncologist wouldn't refer. Is there anything wrong with having a partnership?" So, the oncologist continues to do their wonderful work, at the same time we're managing the patient's experience and that people understand all their options, of which this is one of them, and they have a legal right to that in 11 states, so that we do the best possible care for people.  Dr. VandeKieft: I want to amplify your point. Dr. Ferris, if people choose aid in dying as the culmination of excellent palliative or end-of-life care, that's a very different scenario than if they're choosing it in lieu of palliative care because they don't have access. And so anybody who has access to aid in dying certainly should have access to the highest quality palliative care and hospice care and behavioral health, as Dr. Blanke pointed out, to make sure that they aren't despairing for something that could be treated more readily.  Dr. Ferris: And if I could add one more point, I think there's also a palliative care evangelist who says, "Well, if you just do this a little longer, everything's going to be wonderful." Except that we haven't made a difference. We as a community need to recognize when that's the case as well. So none of us are perfect, but it's the making sure we're a really comprehensive team and able to walk with people and honor and respect their choices.  Dr. Thomas: Thank you. We've spoken a lot about some of the logistics and legal and ethical aspects. I'd love to hear about what the experience is actually like. What are the barriers that patients face when they're trying to seek out medical aid in dying? We have a caregiver here who directly experienced this. How was it trying to access this and are their barriers either individually or systemically?  Sandra Klima: When Rob made his choice, we obviously had to go to the physicians and do the two interviews and get the approvals and wait the days in between and sign all the forms. But eventually we got to go pick up this medicine. But there was one pharmacy that had the medicine. We went, made a drive there. It was far from where we were. So we went over there. We had to plan it to be when there was a physician there who would give us the medicine. So that kind of struck me as strange. So you had to schedule everything and then you get there, and I don't know if it was my paranoia or what, but you feel like everyone's looking at you from behind the counter like, "Oh, you are the people coming to get that medicine?" And it was really just a little uncomfortable.  And you feel like you were almost doing something illegal. So that is the pressure I felt during that process about that. The only other piece is once you start this process in motion, we had the hospice people and the palliative care people contact us. We had several meetings with them. We talked about it with our cancer counselor, so I was very comfortable. And most importantly, Rob was comfortable to get the medicine that he would have to take and have it with him. It gave him peace of mind. It gave him freedom to enjoy his life.  Dr. Blanke: I'll add a few practical matters. The states that have death with dignity mandate that the patient takes it through their GI tract. That usually involves swallowing. We have a number of patients who are unable to swallow, or they have GI obstruction. They're allowed to take the medication through their rectum, although that eliminates a lot of the dignity from death with dignity. But we are not allowed to use intravenous formulations. Even if the patient self-administers. We also have patients and patients with Lou Gehrig's disease or amyotrophic lateral sclerosis make up about 11% of death with dignity users. Many of those patients do not have the use of their limbs. I had one young lady who was nearly completely paralyzed. She could move her head and she could move the pinky of one hand. And I spent somewhere north of four hours simply figuring out how she could fulfill the law by self administering a drug.  Finally we put in an NG and she was able to press a syringe plunger while I held a syringe, legal in Oregon, with that single pinky. I think the law is incredibly discriminatory against people with disabilities in the interest allegedly of protecting them. Next issue is we talked about the written request, which I do think offers safeguards, but sometimes it's hard. If patients want confidentiality, which the law allegedly is interested in, they may not want their neighbor to know that they're going to do this and they may not have somebody who is able to sign the form. Finally, we have talked a little bit about finding a participating provider. That continues to be an absolutely huge barrier, particularly because it's not just one provider, it's a prescribing physician and a consulting physician. They have to find two doctors, and if they're in say a Catholic health system or they're at the VA, sometimes it's nearly impossible for them.  Dr. VandeKieft: Loop back to Miss Klima's comment about the peace of mind that her partner experienced, and note that sometimes even just the conversation provides that. I've had numerous patients who brought the topic up, and they weren't actually asking for requests. They were just seeking information or in one instance, trying to let her family know how badly she was suffering and bringing this up was a way of demonstrating that to them. But I had a patient with ALS who brought the question up. The fact that I accepted it, spoke back to her in a respectful and supportive manner, provided her some relief.  But then when the doctors from End of Life Washington, the advocacy group who can help provide support to people in the home, came out and visited her, she responded that it alleviated her anxiety and her depression, didn't resolve them, but eased them. And that also she learned that she didn't have to act as early as she thought she would have on her own. And so I kind of jokingly said, "So meeting with doctors may have actually prolonged your life." And she laughed and said, "You know, doctor, it did, because I would've done it earlier if I hadn't met with them."  Dr. Ferris: If I can speak to what you just said back in the era of HIV and AIDS, when we had very little, I cared for more than 1,000 people out in the community. And I would say more than 60% of them asked me that question of when they got to a spot of intractable suffering, when I hastened their death. And of course that was illegal in those days. But what I was clearly able to do, is talk about palliative sedation for them, to be clear I would look after them, clear I would look after their families. And just as you have suggested, I think one of the huge issues is, "I have an option. I have an alternative here. Somebody is going to look after me. And if I've decided, if I'm going to go to medical aid in dying, if I'm going to go the palliative route, I don't have to experience the horrible part that I don't want to experience."  We need to talk about both of these openly with people, and be clear that they and their families will be accompanied in whatever the process and as you've suggested, without judgment, maintaining confidentiality. These are super important issues for people. I think about my own personal future, these things loom. I think it is people with lots of thoughts about what might happen, maybe a bit too much knowledge, who worry about the intractable nature of suffering, whatever it is, whether it's psychological, physical, spiritual. It's being able to accompany people appropriately and respect their choices.  Dr. Thomas: Right.  Dr. Blanke: So I'd like to add one more practical detail. We talked a little bit about finding providers and how difficult that is. And if you think about the challenge of finding two providers in Portland, you have to multiply that by about 100 to find any providers in Klamath Falls or Eastern Oregon. The good news is telemedicine has made our lives and the lives of our patients quite a bit easier.  Dr. Thomas: As I listen to the conversation, I'd be curious about your thoughts about health equity issues around this. You've alluded to the fact that somebody who has physical or neurologic disability may have challenges depending on where you live. It may be challenging to access. Are there other populations of patients where you worry about health equity and access to medical aid in dying?  Dr. Blanke: Well, I can comment that most of the patients find me or my colleagues who provide this through web searches. So, they have to have access to computers, which is not necessarily all that easy for all the rural residents of Oregon. Even though I told you that 99% of patients have insurance, we also mentioned that getting the insurance company to pay for the drug is very, very difficult. Hospice almost never wants to pay for it for the usual hospice- related reasons, and the drugs are about $700 in Oregon. That is a hindrance to a lot of my patients.  Dr. VandeKieft: I think being mindful of historic disenfranchised communities, people of color, Native Americans, that the healthcare system has not always treated fairly historically, and they have reasons to be suspect at times. Now this is something that usually they will seek us out as opposed to the healthcare system promoting it, but just being sensitive to the fact that we're doing something that could be perceived as problematic by communities who have historically been mistreated by the health system as well as other systems.  Dr. Thomas: I'd like to just have a better understanding of residency and the law. I think that there is written into most of these laws, you have to be a resident of the state where medical aid in dying is available. But what does that mean to be a resident, and how do states define that?  Dr. Blanke: So for us in Oregon, it's not like the classic situation where you have to demonstrate that you have a driver's license or you have to produce a gas bill in your name. The statute basically allows the prescriber to define residency in their own mind.  Dr. Thomas: What advice would you give to oncologists and other physicians who might have patients approach with questions about this? How do you talk with patients about this matter?  Dr. VandeKieft: The very first thing I respond to is... This is a very important question. I appreciate that you brought it up and that you have the [inaudible 00:20:35] and trust in me to raise the topic. But before I get into the details, I'd like to learn more about what led you to ask me about it. Would that be okay? And even that last phrase, would that be okay as intentional and that by asking permission, I'm making sure that they have agency, and demonstrating respect to them. But that approach has made a huge difference in that I have learned on many occasions, people have no intent of actually proceeding with it. As I mentioned earlier, they may simply be asking for information.  One gentleman, his response was, "Well, my buddies told me about it, and I didn't even know that was a law. And when I started to explain it, he said, oh, that sounds too much like suicide. I would never do that. And then the other woman, I referenced, she went through it and then looked at me and said, “Doctor, I would never do it.”, and looked at her daughter and son-in-law, “I just want my family to know how badly I'm suffering.” And so starting with that open-ended question is really crucial because if we make assumptions and if we start projecting our own biases onto them, we may completely miss what they're looking for and the opportunity to provide them the best services that we could.  Dr. Blanke: If I merely mention that this is an option, the patient is going to think that I'm recommending it, and I certainly don't see it that way. It's just one of many options. If we offer chemotherapy, we are not mandating that particular drug or even suggesting they get chemotherapy at all. Certainly, with the exception of palliative care, I recommend they seek that out, that I really want them to seek it out. But I think it's incumbent on the providers if they see a patient with a terminal illness to list this among the many options that are possible for the patient living in Oregon or those other 10 states. I know that's controversial.  Dr. Ferris: Well, I really want to highlight what you just said, Gregg, about the process of inquiry. To me, everybody practicing oncology, everybody practicing medicine needs to be able to model exactly the way you opened when asking any significant question, including prognosis, "When am I going to die? What about this therapy?" Because what we know, many of the times, patients aren't asking what the words specifically say, they're calling out their suffering and how can we help them? Or they've got a plan, they've got something they want to do. So that was beautiful modeling, Gregg.  Dr. VandeKieft: Dr. Blanke, he used that example of people not hearing. And one of the cases that I still struggle with a little bit, I work in a Catholic health system, so I'm not a participating physician. And we're really counseled that we shouldn't be the one to bring it up. And I had an elderly woman. I was doing a hospice home visit and she asked me how long I thought she had. And unfortunately, Dr. Ferris, I didn't think to ask her what led her to ask me the question on that occasion. And I probably should have, because I told her my prognosis and she looked at me with a profound look of disappointment and said, "I don't think I can suffer that much longer." And a couple of days later, she died very unexpectedly. She took an intentional overdose and the fact that I didn't inform her of the option of aid in dying still haunts me that I may have failed her.  Dr. Thomas: Thank you so much for sharing that. Ms. Klima, we've heard a lot from the experts. Is there advice you'd give patient to patient or caregiver to caregiver about what to ask your physicians?  Sandra Klima: You need to ask as many questions as you want and have the doctor answer you truthfully. I think when a patient is asking a doctor a question, they're asking the doctor, "What are my options?" I'm going to assume you're going to give me all the options. I'm not going to assume you're not going to tell me the options you don't like, because I want to know what are my options. I'm the one who's suffering. I'm the one who will have to make a choice. And I can tell you the choice Rob made, to use Act 39 in Vermont, was a blessing for us. It was a peaceful death that I cannot overemphasize. It was the right decision to make. It was for his decision, but it was the right decision to make.  And I think if a physician would not have told us of that option, I would be in the same situation that you felt, Gregg, where the lady took it upon herself. Because you thought through it, you had a plan, it was planned. It was a nice wind up to an ending. And I think that physicians owe it to their patients to tell them all of the options available and let the patient make a choice. I also think physicians owe it to the patient to be clear what the end phase of their life will be. Because it's not roses. If they don't do this, they have to live through that end phase, which sometimes it's horrific. And I think they need to have a clear understanding of what's to come and a clean list of all the options. And I think that should just be required, and personal choice of a physician is not on the table.  Dr. Ferris: So it's important that we explain all the options, I completely agree, that are available within the context of the law. And certainly in the Americas, in Europe, and I've been in many other countries where palliative sedation is one of those therapeutic options. Where the patients can have amnesia, the family can be well looked after. We need to describe all the available options that are within the law, in the jurisdiction in which we live. I completely agree.  Dr. Blanke: And I'll add that that actually also applies to some of the patients who want death with dignity, are suffering horribly but don't actually qualify because they have a chronic illness expected to live too long. I just saw a patient last week and we actually talked about VCED, the voluntary cessation of eating and drinking, which is something that many, many people fear, including providers, but if done properly is fantastic. She used VCED. She passed away. She died two days later and her family could not have been more thankful.  Sandra Klima: I'll chime in on that because the comparison between my father dying and Rob dying, it really just has an impression on my mind. My father did not have a diagnosis of X amount of months to live, but my father had chronic problems and he was suffering. And the death that I watched him go through and was with him for, was nothing like Rob's death. It wasn't peaceful. It haunts me today. It haunts me. My father should have been a candidate, but he wasn't. What was the point of living four more months in this miserable state?  Dr. Thomas: You know, it dawns on me that this is a very different kind of death. It is not suicide legally or medically. It's a different process than natural death from a terminal illness. And it's not even possible in every state or every country. And I imagine it is very different for the people who are left behind, for family members and caregivers to process this kind of death and bereavement after their loved one passes. Can you comment, Sandra, on how medical aid in dying affects the caregivers and affects the family and how you can prepare for bereavement and support in bereavement?  Sandra Klima: I felt that this death was anticipated, and my bereavement, the part that bothered me about Rob's end of life, was that I was unprepared for how quickly the decision was made. The decision was made quickly because he started getting paralyzed again on the side of his body. And he decided, "Today's the day." And it was three or four hours later, and it took me by surprise at how quickly the decision was going to be made. That's the only part I regret was I didn't have a strong enough plan about what was going to happen when that decision was made. That probably needs to be emphasized because you can plan all you want when it's not going to happen. But at the moment it happens, it's like a fire drill. You got to go through and get all those things lined up. And I can tell you, I felt worse for my father's death than I did for Rob's death. So even though it's a different kind of death, it was a peaceful death with dignity.  Dr. Blanke: In terms of the bereavement, I have seen all sorts of responses from patients' families initially, from those who could not be more supportive. Sometimes they even seem to want it more than the patient does, to those who actively oppose it. But in my experience, which now numbers about 205, the families are almost always on board at the end when they see how much the patient has been suffering and how much peace the actual control over the patient's life and death gives them. I always offer after the patient is gone to the family to contact me whether it's a week later or a month later, or a year later, if they have questions about the process, if they need any help in referrals. It's never happened a single time.  Dr. VandeKieft: I think back to the landmark article that Tim Quill published in the early 1990s about his patient, Diane, and how he highlighted that she ended up committing suicide. And there's kind of a shame, it's done in the shadows, and that when you have aid in dying as an option that can be brought out into a planned open manner in the way that Ms Klima is describing with her partner. And then also with the bereavement and the partners, I think we need to listen once again. I just had a case yesterday that somebody was telling me of a gentleman who got the prescription for aid in dying, but ended up not taking it and died of "natural causes."  His wife told the bereavement counselor afterwards, “That was such a relief because I was struggling terribly with the spiritual aspects of this. And I would've really had a hard time had he gone through with it.” She had not shared that with her husband or anyone else because she wanted to be so supportive of him. And it was only by the bereavement counselor, listening and opening up that she could really understand, "What are the true struggles that this family is going through and how can I meet their needs?"  Dr. Ferris: If I can comment, it doesn't matter whether people have chosen medical aid in dying. When people die, there's a loss for anybody who's a survivor. People can be comfortable with the process that occurred or not. They can perceive suffering or not. The loss leads to changes. And what we know is the transitions through the loss period that we call bereavement for different people are profound in different ways. And what we need to make sure is that people are connected with services. It's why with every patient I care for, whatever therapy provided, I do participate in ventilator withdrawal. I participate in palliative sedation. I've done this all my career. I make sure they're in the hospice system, in the United States, which provides people with 13 months bereavement support or more, because if a death occurs in a hospital without hospice care, then the patient gets a decedent phone call from the chaplain, if they're lucky, or they're lucky enough to have a physician like Dr. Blanke who says call me.  Most people don't make themselves available and you're out at sea. And we know that the suffering of a bereavement can lead to incapacitance, people depressed, not functional, people even get illnesses in the process. So there's a huge cost to society for not addressing this issue carefully. It's about the preparation, and what I try to do is get the bereavement conversation going before the person dies, so that we're talking about it and integrating it.  Sandra Klima: Right, I agree.  Dr. Thomas: Thank you all so much for this conversation. Thank you, Sandra Klima and Dr. VandeKieft and Dr. Blanke and Dr. Ferris. I think this was such an important conversation. Talking about death can be very difficult and I just appreciate the openness and sensitivity and your willingness to share these experiences. Thank you to all of our listeners. We appreciate you tuning into this episode of ASCO Education podcast.    Thank you for listening to the ASCO Education podcast. To stay up to date with the latest episodes, please click subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive education center at education.asco.org.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care, and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization activity or therapy should not be construed as an ASCO endorsement. 

On "The Extra", we talk to Sarah Carlson, a News Anchor whose on-air epilepsy seizure went viral, on what it's like to be one of the 3 million Americans with epilepsy, as well as Dr. Michael C. Smith,* Dir., Dept of Neurological Sciences, Rush Medical College.  The guests joined KRDO News Radio to promote Wear Purple for Purple Day on March 26th to Support Epilepsy Awareness.  More info at Learn about Epilepsy. 

My biggest hero Robert Sapolsky returns to the show for an exceptionally important conversation about stress during a time where many of us have experienced the most in our life. This is an important conversation about how lack of predictability and control can lead to learned helplessness. This recipient of the MacArthur Foundation genius grant is a Professor at Stanford University holding joint appointments in several departments, including Biological Sciences, Neurology & Neurological Sciences, and Neurosurgery. In addition to everything else, he spent summers in Kenya study baboons which you can read about in his amazing book ‘A Primate's Memoir: A Neuroscientist's Unconventional Life Among the Baboons' As someone who has spent years interviewing scientists, taking classes, watching talks, and reading science books, I believe Robert Sapolsky is the greatest science communicator alive. I hope you enjoy this episode. His Human Behavioral Biology class changed my life and is probably the most useful and interesting 25 hours of my life. It's free online and I hope you have a chance to watch it. https://www.youtube.com/watch?v=NNnIGh9g6fA His books are amazing: Why Zebras Don't Get Ulcers  The Trouble with Testosterone: And Other Essays on the Biology of the Human Predicament Monkeyluv: And Other Essays on Our Lives as Animals Behave: The Biology of Humans at Our Best and Worst Here is a link to the first time I was on my show: https://www.herewearepodcast.com/episodes/578adw5viwkc1bdqqv1uz0iv40usxg?rq=sapolsky And here is a really fun episode of my comedy/philosophy podcast Mind Under Matter where we dug into some of his work: https://mindunderpod.com/blogs/episodes/episode-42-behaviors-past If you want to support this show and my mission to build appreciation for science and scientists in a fun and casual way, please consider joining my lovely little Patreon community https://www.patreon.com/shanemauss Thank you for watching and being an inquisitive being. Learn more about your ad choices. Visit megaphone.fm/adchoices

The movement disorders neurology group at RUSH University Medical Center is one of the largest and most experienced groups in the world, with clinicians who specialize in managing the symptoms of Parkinson's disease and other movement disorders. One of the treatment modalities they use to treat these patients is deep brain stimulation (DBS). DBS helps patients with movement disorders control their symptoms of tremor, rigidity, stiffness, slowed or abnormal movements and walking problems. RUSH treats the largest number of DBS patients in the Midwest. Dr. Neepa Patel is a neurologist in the RUSH University System for Health and the director for the Movement Disorder Interventional Program in the Department of Neurological Sciences. Her interests include improving the quality and delivery of care for patients receiving deep brain stimulation (DBS) and education to improve the utilization of new therapies in movement disorders. She is also part of the RUSH team caring for essential and Parkinsonian tremor patients with MR-guided focused ultrasound, an incisionless treatment designed to reduce hand tremor. “We work in a very comprehensive, multidisciplinary, team-based approach at RUSH to treat patients with movement disorders using DBS. We share our ideas and experiences because everyone comes from different training backgrounds, different expertise and years of experience in managing patients. This helps us take care of patients who are nontraditional, but who still could benefit from this therapy.” CME credit link: https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/484707/  

Last week, Medicare took an unprecedented step to restrict patients' access to the first new Alzheimer's disease treatment in nearly 20 years. We talk with a doctor, a patient and a former federal official about this unusual move and its wide-ranging implications.Guests:Jay Reinstein, Alzheimer's disease patient and advocateSharon Sha, MD, MS, Clinical Associate Professor of Neurology and Neurological Sciences, Stanford UniversitySean Tunis, MD, MSc, Senior Fellow, Tufts Center for Evaluation of Value and Risk in Health, former FDA advisor and former CMS officialRead a full transcript and dig deeper into the issues explored in today's episode on our website.Support this type of journalism today by making a donation.Sign up for our weekly newsletter to see what research health policy experts are reading right now, plus recommendations from our staff.Follow us on Twitter. See acast.com/privacy for privacy and opt-out information.

Kelly talks to Dr. Lawrence Steinman, a professor of Neurology and Neurological Sciences, Pediatrics, and Genetics at Stanford University.

A dirlo lo studio COVID Next dell’Università di Brescia e dell’Istituto Neurologico Besta di Milano pubblicato recentemente su Neurological Sciences. A Obiettivo Salute il commento del prof. Alessandro Padovani, Ordinario di Neurologia dell’Università di Brescia, presidente eletto Società Italiana di Neurologia e responsabile dello studio

Welcome to the NeurologyLive Mind Moments podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice. In this episode, we spoke with Gregory W. Albers, MD, director, Stanford Stroke Center, Coyote Foundation Professor of Neurology and Neurological Sciences, Stanford Medical Center; and founder, RapidAI. He shared his insight into the development and clinical use of RapidAI, a platform that leverages artificial intelligence to create enhanced, high-quality images from noncontrast CT, CT angiography, CT perfusion, and MRI diffusion and perfusion data, aiming to expedient diagnoses, treatment, and transfer decisions Episode Breakdown: 1:15 – Background on RapidAI and its development 3:30 – Findings from the pivotal DIFFUSE clinical program of the system 9:15 – Immediate future plans for RapidAI's capabilities and use 15:55 – Neurology News Minute 18:50 – RapidAI as a complement to the physician in diagnosis 22:00 – Integrating the RapidAI system across the United States 24:50 – The future use of AI in stroke and neuroimaging 28:00 – Closing thoughts The stories featured in this week's Neurology News Minute, which will give you quick updates on the following developments in neurology, are further detailed here: Lecanemab Rolling Submission for Alzheimer Disease Initiated by Eisai, Biogen Fenfluramine sNDA Submitted for Lennox-Gastaut Syndrome Atogepant Approved for Episodic Migraine Prevention Thanks for listening to the NeurologyLive Mind Moments podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com.

This week we had the pleasure of speaking with Dr. Mark Hamilton on the podcast. Dr. Hamilton is a neurosurgeon at the Foothills Medical Centre in Calgary. Dr. Hamilton helped us walk through a number of neurosurgical issues that are pertinent to general surgeons, such as hydrocephalus, the role of craniectomy in traumatic brain injuries, and DVT prophylaxis in patients with traumatic brain injuries. As always, send your comments and feedback to podcast.cjs@gmail.com. Links: 1. Treatment of hydrocephalus. https://pubmed.ncbi.nlm.nih.gov/19410156/ 2. RESCUE - ICP trial in NEJM. https://www.nejm.org/doi/full/10.1056/nejmoa1605215 3. ICP monitoring in TBI. https://www.nejm.org/doi/full/10.1056/nejmoa1207363 4. Reducing the risks of proximal and distal shunt failure in adult hydrocephalus (the shout-Qi initiative). https://fluidsbarrierscns.biomedcentral.com/articles/10.1186/s12987-019-0156-3 Bio (https://hbi.ucalgary.ca/profiles/dr-mark-hamilton): Dr. Hamilton graduated from McGill University Medical School in 1983. He did his Neurosurgery Residency at the University of Calgary and received his FRCSC in 1991. He did Fellowship training in cerebrovascular, skull base and Pediatric Neurosurgery at the Barrow Neurological Institute in Phoenix, Arizona and joined the University of Calgary Department of Clinical Neurosciences in 1994 where he is currently a Professor of Neurosurgery with additional appointments in the Department of Surgery and the Department of Pediatrics. He was the Chief of the Division of Pediatric Neurosurgery from 2002-2011 and is the current Director of the Adult Hydrocephalus Program. Dr. Hamilton established the University of Calgary Adult Hydrocephalus Program and started the University of Calgary Adult Hydrocephalus Clinic in 2008. Dr. Hamilton is the chair of the international Adult Hydrocephalus Clinical Research Network (AHCRN) which has eight clinical sites in three countries, President of the Hydrocephalus Society (International Society for Hydrocephalus and Cerebrospinal Fluid Disorders (ISHCSF)) and a member of the Board of Directors of the Hydrocephalus Association (HA) and the Medical Advisory Board (MAB) of HA and a member of the Board of Directors of Hydrocephalus Canada.. He was recently the Congress President for “Hydrocephalus 2015” the 7th annual meeting of the ISHCSF. Dr. Hamilton is a member of the Editorial Boards of The Journal of Neurosurgery, The Canadian Journal of Neurological Sciences, Fluids and Barriers of the CNS, and PLOS One. His main clinical and research interests are the diagnosis and management of hydrocephalus in adults.

Comprehensive transcriptome analysis of cerebral cavernous malformation (CCM) across multiple species and genotypes, Common transcriptome, plasma molecules, and imaging signatures in the aging brain and a Mendelian neurovascular disease, cerebral cavernous malformation, and A Roadmap for Developing Plasma Diagnostic and Prognostic Biomarkers of Cerebral Cavernous Angioma With Symptomatic Hemorrhage (CASH) Scientific Sense ® by Gill Eapen: Prof. Issam Awad is Professor of Neurological Sciences and Surgery, Neurology, Quantitative Biology and Human Behavior at the University of Chicago. One of his research interests is the natural history and biologic behavior of vascular malformations of the brain --- Send in a voice message: https://anchor.fm/scientificsense/message

Discipline matters.  More specifically self-regulation.  The more time that goes by in our lives, the greater the benefits exercising self-regulation.  Conversely, the greater the consequences in our lives if we don't.  What doesn't benefit us, however, are the generalized, overly simplified assumptions about why we do what we do.  Yet, we hear them so much, with such certainty, many people feel obliged to accept these assumptions as fact.  Maybe in some cases these assumptions are true.  The bigger question however is, are they helpful?  Imagine if a swim instructor rather than teaching his new beginner client the proper technique for staying afloat and the basic mechanics of swimming, simply admonished the client to work harder?  As that student started to sink, the teacher chastised him for his laziness, explaining that if he really wanted to stay afloat he would.  That client would probably find a new teacher, if he survived the session.  Consider this, the greater an individual's expertise, the greater distinctions that individual has.  Accordingly, the more that individual is aware of not only what she doesn't know, but how much there is to be known. Often, those with less expertise and the least ability, have the most certainty.  These people don't possess enough expertise to know what they don't know. As a result they have simple explanations for complex situations.     Neuro-endocrinologist and Professor of Neurology and Neurological Sciences at Stamford University, Robert Sapolsky says regarding human behavior is that “it's complicated”.   He goes on to say that “and you better be really careful, real cautious, before you conclude you know what causes a behavior.  Especially if it's a behavior you're judging harshly.” This episode I discuss why human behavior may not be as straightforward as we would like to think.  If you feel overwhelmed and frustrated by how self-help guru's judge your behaviors harshly, assuming to know your intentions, or if you have judged your own behaviors harshly and it has left you feeling stuck, this episode is for you.  There are many variables that play into human behavior.  When we struggle, what we might need most are strategies, not indictments.  Resources mentioned in this episode:1. The Mind, Body, Brain Project - Paul Taylor2. https://youtu.be/ORthzIOEf30 - Robert Sapolsky 3. The Marshmallow Test - Walter Mischel 

The challenge of living with MS often begins with the challenge of getting a timely and accurate diagnosis. There are no symptoms, physical findings, or laboratory tests that can, by themselves, determine if someone has MS, and the most common symptoms of MS can often resemble symptoms of other conditions. All of these variables can sometimes lead to patients getting the wrong diagnosis. Dr. Andrew Solomon, Associate Professor of Neurological Sciences and Division Chief of Multiple Sclerosis at the University of Vermont Larner College of Medicine, is joining me to discuss diagnosing and misdiagnosing MS. We'll also fill you in on the details of the upcoming European MS Platform Annual Conference (it's free to register!). We'll tell you about a cannabis-based treatment that's been shown to improve spasticity without causing weakness in people with MS. We'll share the results of a study that looked at how a COVID-19 infection affects MS. You'll hear about newly published research that may have isolated the gene that causes male immune cells to drive more severe MS. And we'll give you the rundown of this month's Can Do MS programs. We have a lot to talk about! Are you ready for RealTalk MS??! European MS Platform Annual Conference  1:38 Cannabis extract improves spasticity without causing weakness  2:44 How COVID-19 may affect MS  4:43 A word about our show notes  6:49 Study shows male immune cells drive more severe MS  8:18 This month's Can Do MS programs  11:38 Dr. Andrew Solomon discusses diagnosing MS and misdiagnosing MS  13:13 Share this episode  25:54 Have a minute? Leave a rating & review for the podcast  26:14 SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/196 ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.comPhone: (310) 526-2283 And don't forget to join us in the RealTalk MS Facebook group! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes in the RealTalk MS app or at www.RealTalkMS.com National MS Society COVID-19 Vaccine Guidance for People Living with MS European MS Platform Annual Conference STUDY: COVID-19 is Associated with New Symptoms of Multiple Sclerosis That are Prevented by Disease-Modifying Therapies STUDY: Male Sex Chromosomal Complement Exacerbates the Pathogenicity of Th17 Cells in a Chronic Model of Central Nervous System Autoimmunity Can Do MS Program Information and Registration Join the RealTalk MS Facebook Group Download the RealTalk MS App for iOS Download the RealTalk MS App for Android Give RealTalk MS a Rating and Review Follow RealTalk MS on Twitter, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 196 Guests: Dr. Andrew Solomon Tags: MS, MultipleSclerosis, MSResearch, MSSociety, RealTalkMS Privacy Policy

Dr Evan  Lewis is a Pediatric Neurologist and Clinical Neurophysiologist with expertise in epilepsy, epilepsy surgery, and medical cannabis for the treatment of neurologic disorders. He is the director of the Neurology Centre of Toronto (NCT) which he established in January 2017. At NCT, Evan treats children with a variety of neurological disorders as well as seeing adult patients for concussion, headaches and epilepsy.He is an Assistant Professor with the Department of Pediatrics at the Hospital for Sick Children and the University of Toronto.Evan's interest in medical cannabis began in 2013 while training at Miami Children’s Hospital – one of the major sites for the Epidiolex trials. He has significant clinical experience with medical cannabis in adults and children and is a member of the Canadian Consortium for the Investigation of Cannabinoids (CCIC), Canadian Childhood Cannabinoid Clinical Trials (C4T), and the Cannabinoid Research Initiative of Saskatchewan (CRIS).He is is the Chief Medical Adviser for the Jamaican Medical Cannabis Corporation,  member of the Expert Committee of the Medical Cannabis Clinicians Society (MCCS) in the United Kingdom and sits on the Advisory Councils for Cannabis Patient Advocacy & Support Services (CPASS) and MedCan. With a strong commitment to research, Evan is a Fellow of the Royal College of Physicians of Canada and was the Tariff Chair of the Neurology Section for the Ontario Medical Association from 2017 - 2019. He sits on the Editorial Board for the Journal of Child Neurology’s Resident/Fellow Section and is an ad-hoc reviewer for the Canadian Journal of Neurological Sciences and Paediatrics & Child Health.  His research and special interests include cannabinoids in the treatment of epilepsy and other neurological conditions and the delivery of novel virtual care models in neurology. Evan has spoken extensively on cannabis in neurologic disorders nationally and internationally.Resources:https://www.dr-lewis.ca/ https://neurologycentretoronto.com/Support the show (https://www.paypal.com/paypalme/marybiles71)

On today’s episode of Jimmy Makes Science Simple on the LLVLC Show, Jimmy brings you a look at the latest research on Thyroid function, epilepsy, and more. “It is commonly assumed that eating keto lowers thyroid function even without any scientific evidence showing that.”  - Jimmy Moore We kick off today’s episode with an April 7, 2021 study published in the European Journal of Preventative Cardiology entitled “Prevalence of diabetes and impact on cardiovascular events and mortality in patients with chronic coronary syndromes, across multiple geographic regions and ethnicities”: https://academic.oup.com/eurjpc/advan… Does heart disease lead to a greater risk of Type 2 diabetes? In today’s second segment, Jimmy shares from an April 12, 2021 study published in the journal Neurological Sciences entitled “The effect of ketogenic diet on thyroid functions in children with drug-resistant epilepsy”: https://link.springer.com/article/10…. Does a ketogenic diet lower thyroid function? In the third and final segment of today’s show Jimmy explores the idea of gut flora and its impact on using the keto diet to treat epilepsy. Jimmy shares from a June 2021 study (yes, that’s the right date) published in the journal Microbial Pathogenesis entitled “Gut flora and metabolism are altered in epilepsy and partially restored after ketogenic diets”: https://pubmed.ncbi.nlm.nih.gov/33894…

Michel Bouvier is a professor of Biochemistry and Molecular Medicine and the CEO of the Institute for Research in Immunology and Cancer (IRIC) at the Université de Montréal. Following his Ph.D. in Neurological Sciences at the same university in 1985, he completed a post-doctoral fellow at Duke University in the laboratory of R.R. Lefkowitz. In 1989, he returned to Montréal as a professor of biochemistry and a scholar of the Medical Research Council of Canada at the Faculty of Medicine of the Université de Montréal. Since 2001, he holds the Canada Research Chair in Signal Transduction and Molecular Pharmacology. Dr. Bouvier is the author of 300 scientific papers and 15 patents and delivered close to 500 invited conferences. He is a world-renowned expert in the field of cell signaling and GPCRs and made seminal contributions to our understanding of this major class of drug targets. In addition to paradigm shifts including inverse agonism, biased signaling, and pharmacological chaperones, his work on bioluminescence resonance energy transfer (BRET) resulted in the development of screening assays that are now widely used for drug discovery. His work received more than 30,000 citations yielding an h-index of 95. He has supervised the research work of 75 graduate students and 40 post-doctoral fellows. Michel's scientific contributions were recognized by the attribution of many awards and distinctions including his election as a fellow of the Royal Society of Canada (2014), the Julie Axelrod award from the American Society of Pharmacology and Exerimental Therapeutics (2017), the Wilder Penfield award from the Quebec Government (2017), the innovation award of ADRIQ (2019) and the 2021 Killam prize form the Canada Council for the Arts. ------------------------------------------- Imagine a world in which the vast majority of us are healthy. The #DrGPCR Ecosystem is all about dynamic interactions between us who are working towards exploiting the druggability of #GPCR's. We aspire to provide opportunities to connect, share, form trusting partnerships, grow, and thrive together. To build our #GPCR Ecosystem, we created various enabling outlets. For more details, visit our website http://www.DrGPCR.com/Ecosystem/. Are you a #GPCR professional? - Register to become a Virtual Cafe speaker http://www.drgpcr.com/virtual-cafe/ - Subscribe to our Monthly Newsletter http://www.drgpcr.com/newsletter/ - Listen and subscribe to #DrGPCR Podcasts http://www.drgpcr.com/podcast/ - Support #DrGPCR Ecosystem with your Donation. http://www.drgpcr.com/sponsors/ - Reserve your spots for the next #DrGPCR Virtual Cafe http://www.drgpcr.com/virtual-cafe/ - Watch recorded #DRGPCR Virtual Cafe presentations: https://www.youtube.com/channel/UCJvKL3smMEEXBulKdgT_yCw - Bring in a #GPCR Consultant http://www.drgpcr.com/consulting/ - Share your feedback with us: http://www.drgpcr.com/audience-survey/ - Become a #DrGPCR Ecosystem Member http://www.drgpcr.com/membership/

This edition of Airing Pain has been funded by educational grants from The R. S. Macdonald Charitable Trust and The Stafford Trust.Do you, someone you care for or perhaps your patients, suffer from persistent burning or gnawing pain? Many don’t know that often, neuropathic pain presents as a burning sensation. Persistent pain can impact all areas of our lives. It can stop us from sleeping, working and pursuing the hobbies we enjoy. Unfortunately, sometimes the healthcare professionals we see about our pain are unaware of the multitude of pain management techniques we can adopt to try and minimise the impact pain has on our lives. Different types of pain are widely misunderstood and many of us don't know much about the conditions that can cause them. What do you think of when you think of Parkinson's Disease? Many would say a tremor or shaking limbs, but persistent pain can be one of the most debilitating symptoms of Parkinson's Disease. The fastest growing neurological condition in the world is poorly understood and pain is a major unmet need in those who live with it. Ground-breaking studies funded by the charity Parkinson's UK are shedding new light on the relationship between Parkinson's pain and neuropathic pain. Persistent pain that affects people who have Parkinson's Disease is widely misunderstood and something that many of us are entirely in the dark about. If you suffer with Parkinson's, the chances are you will be all too familiar with the burning, gnawing pain associated with the disease.  In this programme Paul Evans speaks to Kirsty Bannister, a doctor of neuroscience at Kings College London, who discusses the role that 'pain-blocking nerve pathways' and psychological status play for those who experience chronic pain. We also hear from former primary school teacher Janet Kerr, who shares with us her own experience of dealing with Parkinson's Pain and how she manages it with things like yoga and distraction techniques such as massage. Contributors: Carol Vennard, Clinical Nurse Specialist in Parkinson's Disease Nurse Specialist, NHS Greater Glasgow and Clyde Janet Kerr, ex-primary school teacher who lives with Parkinson’s Disease Kirsty Bannister, Senior Lecturer and Principal Investigator at the Institute of Psychiatry, Psychology & Neuroscience, Kings College London. More information: Parkinson’s UK  Airing Pain 115: Neuropathic Pain 1 Airing Pain 116: Neuropathic Pain 2   Pain Concern’s leaflet on Neuropathic Pain  Institute of Neurological Sciences, Neurology in NHS Greater Glasgow and Clyde  Senior Lecturer and Principal Investigator Kirsty Bannister’s key publications  Finding a Parkinson’s Nurse - https://www.parkinsons.org.uk/information-and-support/parkinsons-nurses IASP Global Year Against Neuropathic Pain 2014-15  Stress Management Society, Stress Awareness Month April 2021. With thanks to: IASP, International Association for the Study of Pain – https://www.iasp-pain.org/ The British Pain Society, An alliance of professionals advancing the understanding and management of pain for the benefit of patients – https://www.britishpainsociety.org/.

This week on RN Huddle we have a new guest with us! Dr. Kathleen Healey is an Assistant Professor in the Department of Neurological Sciences. She’s joined by BOTH of our co-hosts Renee Paulin and Heidi Keeler as they talk about an important topic related to caring for patients with MS and other debilitating disorders, creating challenges to home care access. Our guests discuss community resources that are important to be aware of and incorporate into the comprehensive care plan to help improve the quality of care for those with complex comorbidities. Her research has been very impactful in terms of specialized comprehensive care when caring for those with MS. Join us on RN Huddle to hear more on this unique topic with a very passionate and knowledgeable guest!

Shane talks with Multiple Sclerosis Specialist, May Han, about the new research being done on MS, the diagnosis process, and things patients can do to help treat their symptoms. They are joined by special guest and personal friend of Shane's, Megan, who shares her personal journey through being diagnosed with Multiple Sclerosis.  Dr. Han is a Board-certified neurologist and a clinician-scientist who specializes in multiple sclerosis and central nervous system demyelinating diseases as well as the Associate Professor of Neurology & Neurological Sciences at Stanford School of Medicine.  Her research focuses on utilizing Systems Biology approach (genomics, transcriptomics and proteomics) to identify targets for therapy in MS and NMO. Dr. Han is also an attending physician at the Neuroimmunology clinic and at the Stanford Hospital. Thank you for watching and being an inquisitive being. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Lewis is a Pediatric Neurologist and Clinical Neurophysiologist with expertise in epilepsy. He completed Medical School and Pediatric Neurology Residency at the University of Ottawa, and Clinical Neurophysiology and Epilepsy fellowships at Nicklaus Children's Hospital in Miami and the Hospital for Sick Children in Toronto. Dr. Lewis is the Founder & Director of the Neurology Centre of Toronto, and is an Assistant Professor with the Department of Pediatrics at the Hospital for Sick Children at the University of Toronto. He sits on the Editorial Board for the Journal of Child Neurology's Resident/Fellow Section and is an ad-hoc reviewer for the Canadian Journal of Neurological Sciences and Paediatrics & Child Health. His research and special interests include cannabinoids in the treatment of epilepsy and other neurological conditions, concussion, epilepsy, headache and teleneurology. Dr. Lewis is an advocate for the use of teleneurology to reach the underserved areas of Ontario. Show notes available at northernexposurepodcast.ca

Dr Whitaker is a pediatric anesthesiologist at the University of Vermont Children’s Hospital and an Assistant Professor of Anesthesiology, Neurological Sciences, & Pediatrics at The University of Vermont College of Medicine. His clinical interests lie in the anesthetic care of neonates and in spinal anesthesia for neonates, infants, and children. His research is focused on developing optimal anesthesia care for neonates and infants and his current research interests include developing novel ways to monitor pediatric regional anesthesia.  Today he shares how he got started with this practice, the groundwork established by his mentors, and the recent findings and developments in this field. We also talk about the general reception of spinal analgesia from parents, doctors, and other stakeholders.  This episode is very practical and eye opening. If you're being asked about it or are thinking of how to start incorporating spinal analgesia in your clinical practice or you’re still on the fence, this episode is definitely for you!  Takeaways In This Episode: How Dr. Emmett Whitaker got interested and started the practice of spinal anesthetics The importance of having a surgeon champion and the stakeholders being really engaged partners  for a successful implementation of a new initiative/program When is it appropriate to do spinal anesthesia analgesia for children The benefits of pediatric spinal anesthesia Parents' reception of pediatric spinal anesthesia Anesthesiologists’  and surgeons reception of pediatric spinal anesthesia How can an institution get started with pediatric spinal anesthesia program Skill set required to perform this procedure The typical workflow for pediatric spinal anesthesia Dr. Emmett Whitaker’s final thoughts on pediatric spinal anesthesia Links Emmett Whitaker, MD Contact Dr. Whitaker Ensuring Opioid Safety for Children and Teens Opioid Stewardship: Responsible Pediatric Pain Care! Proactive Pain Solutions Physicians Academy

Evaluation and Credit: https://www.surveymonkey.com/r/MedChat18   Target Audience            This activity is targeted toward Primary care specialties and psychiatrists. Statement of Need Promising research is being conducted on psychedelics for the treatment of psychiatric disorders.  Providers should be aware of emerging treatments. This podcast will address the research base and clinical use of psychedelics in the United States. Providers will be informed on the potential for use in practice in the future. Objectives At the conclusion of this offering, the participant will be able to: Review the history of psychedelics. Discuss the chemical and pharmacological properties of psychedelics. Describe the clinical use of psychedelics in the United States, including clinical trials.   Moderator John J. Wernert, M.D., MHA, DLFAPA Executive Medical Norton Behavioral Medicine   Speaker Christopher D. Bojrab, M.D., DFAPA President Indiana Health Group Carmel, Indiana   Speaker Disclosure The speaker has the following conflicts of interest to disclose:  Consultant and Speakers Bureau – Allergan, Assures/Myriad, Neurocrine, Otsuka, Sunovion, Takeda and Teva. Moderator and Planner Disclosures  The moderator and planners for this activity have no potential or actual conflicts of interest to disclose. Commercial Support  This activity has not received commercial support.   Continuing Education Credits American Medical Association   Accreditation Norton Healthcare is accredited by the Kentucky Medical Association to provide continuing medical education for physicians.   Designation Norton Healthcare designates this enduring material for a maximum of .50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.   Kentucky Board of Nursing Kentucky Board of Nursing (KBN) Approved Provider: Norton Healthcare, provider number 4-0002-12-20-245. The program has been approved by Norton Healthcare for 0.6 contact hours which expires 12/31/2020. KBN approval of a continuing education provider does not constitute endorsement of program content. Nursing participants must attest to the number of hours of attendance and complete the evaluation to receive contact hours. For more information related to nursing credits, contact Sally Sturgeon DNP, RN, SANE-A, AFN-BC at (502) 446-5889 or sally.sturgeon@nortonhealthcare.org   Date of Original Release | September 2020 Course Termination Date | December 2021  Contact Information | Center for Continuing Medical Education; (502) 446-5955 or cme@nortonhealthcare.org     Resources for Additional Study    Chi, Tingying and Gold Jessica A., A review of emerging therapeutic potential of psychedelic drugs in the treatment of psychiatric illnesses, Journal of the Neurological Sciences, Volume 411, 15, April 2020. https://www.sciencedirect.com/science/article/pii/S0022510X20300514?via%3Dihub  Krediet, Erwin, et.al., Reviewing the Potential of Psychedelics for the Treatment of PTSD, International Journal of Neuropsychopharmacology, March 20, 2020. https://academic.oup.com/ijnp/article/23/6/385/5805249 Romeo, Bruno, et. al, Efficacy of psychedelic treatments on depressive syndromes: A meta-analysis, Journal of Psychopharmacology, May 25, 2020.  https://journals.sagepub.com/doi/10.1177/0269881120919957   

John P. Sanchez, MD, MPH, and Reena Thomas, MD speak on today's episode of "Success Stories In The Appointment and Promotion Process." Dr. Thomas is a Clinical Associate Professor of Neurology and Neurological Sciences and the Director of Adult Neuro-Oncology Fellowship at Stanford Medicine. This episode of the podcast feature's Dr. Thomas' journey in academia and celebrates her recent faculty appointment.Purchase Book our book "Succeeding in Academic Medicine": https://www.amazon.com/Succeeding-Academic-Medicine-Students-Residents/dp/3030332667Register for Webinar Series: https://forms.gle/gu2FstR6MgRYkWkRA Music Credit-NIDRED - Cinematic InspirationRoyalty-Free Music Portfolio: http://goo.gl/uGD6rr

For the week's Futureproof Podcast we cast our attention back to a very special episode in which Jonathan seeks to better understand some of the bigger questions when it comes to what drives human behaviour, our relationship with time and consciousness, how we construct the world around us, and the very nature of truth itself. Donald Hoffman, cognitive scientist and author of 'Visual Intelligence: How We Create What We See' joins Jonathan to discuss the idea that, evolutionarily speaking, it may be more beneficial for us to see things as they are not, and not as they truly are & asks if so much of our understanding of the world is a construct in our own minds, how much of what we see can we truly believe? Robert Sapolsky, Professor of Biology, Neurology and Neurological Sciences at Stanford University and author of 'Behave: The Biology of Humans at Our Best and Worst' unpacks the concept of free will, and looks at whether anything we ever do, think, or say can ever be attributed to it. Finally, Marc Wittman, Research Fellow at the Institute for Frontier Areas in Psychology and Mental Health in Freiburg and author of 'Altered States of Consciousness: Experiences Out of Time and Self' delves into questions of how we experience time, why our experience of it can be altered depending on the circumstances and asks - what can these altered states tell us about consciousness itself? Listen and subscribe to Futureproof with Jonathan McCrea on Apple Podcasts and Spotify.    Download, listen and subscribe on the Newstalk App.    You can also listen to Newstalk live on newstalk.com or on Alexa, by adding the Newstalk skill and asking: 'Alexa, play Newstalk'.

In this panel, Mary Rinella MD and Lisa VanWagner MD, MSc, FAST, FAHA discuss Nonalcoholic Fatty Liver Disease. They share information on their study in Journal of the Neurological Sciences on the association between NAFLD and stroke and how the association with cardiovascular disease is becoming more appreciated. They talk about the role and limitations of current diagnostics and how important early diagnosis is as being crucial to improve outcome prediction. They also tell us about Northwestern Medicine’s approach to the management of patients with nonalcoholic fatty liver disease and some of the new and exciting research happening in the Northwestern Medicine Non-Alcoholic Fatty Liver Disease Program.

In this episode, Stanford Movement Disorder's Specialist, Dr. Kathleen Poston, discusses the cognitive changes in Parkinson's Disease. Guest: Kathleen Poston MD, Associate Professor of Neurology and Neurological Sciences, Stanford University School of Medicine.  Host: Pardis Zarifkar For more information on Dr. Kathleen Poston's work: https://med.stanford.edu/poston-lab.html

 In this episode, Dr. Kathleen Poston, talks about her unique path to neurology, how she manages her time (and gets things done), and shares her thoughts on leadership.  Guest: Kathleen Poston MD, Associate Professor of Neurology and Neurological Sciences, Stanford University School of Medicine.  Host: Pardis Zarifkar For more information on Dr. Kathleen Poston's work: https://med.stanford.edu/poston-lab.html

Intracerebral hemorrhage (ICH) affects more than one million people annually, worldwide, and is the deadliest and most disabling type of stroke. In this episode of Critical Matters we will discuss the critical care management of ICH. Our guest is Dr. Sayona John, Associate Professor in the Department of Neurological Sciences at Rush Medical College. She is a practicing neurointensivist and also serves as the Head of the Section of Critical Care Neurology and Medical Director of the Neuroscience Intensive Care Unit & Neuroemergency Transfer programs at Rush University Medical Center in Chicago. Additional Resources: AHA 2015 Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: http://bit.ly/33ovvZo The ICH score: a simple, reliable grading scale for intracerebral hemorrhage: http://bit.ly/2rsRh0G ICH Score Calculator: http://bit.ly/2OotfNx Music Mentioned in this Episode: Brother in Arms by Dire Straits: https://amzn.to/34pMxYj Money for Nothing by Dire Straits: http://bit.ly/34pAWZ9

Acute ischemic stroke is a leading cause of morbidity and mortality worldwide. Intensive care management of strokes is focused on reducing complications related to reperfusion treatment and decreasing secondary neurological injury. In this episode of Critical Matters, we will discuss the critical care management of acute ischemic strokes. Our guest is Dr. Sayona John, Associate Professor in the Department of Neurological Sciences at Rush Medical College. She is a practicing neurointensivist and also serves as the Head of the Section of Critical Care Neurology and Medical Director of the Neuroscience Intensive Care Unit & Neuroemergency Transfer programs at Rush University Medical Center in Chicago. Additional Resources: AHA 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: http://bit.ly/30TJkxL Educational video on performing the NIH Stroke Scale: http://bit.ly/2opldcZ Link to a pdf document with the NIH Stroke Scale: http://bit.ly/2LVtWMV How to do a four-minute neurological examination: http://bit.ly/328IXRr Books Mentioned in this Episode: Lincoln's Hundred Days: The Emancipation Proclamation and the War for the Union by Louis P. Masur: https://amzn.to/2VlTTse

Welcome. My name is Danish Bhatti. I’m an assistant professor in the Department of Neurological Sciences at University of Nebraska Medical Center, and I have the pleasure of having Professor John Bertoni MD PHD, the Director for Parkinson’s Disease Program, with us today to discuss an important topic about nutrition and Parkinson’s disease. John Bertoni: Well, yes, we are co directors of the Parkinson’s Disease Clinic now. So it’s a pleasure working with you. And as you know, we’re into some important research about nutrition and Parkinson’s disease. Danish Bhatti: That’s right. So I have trained with you as a movement disorder fellow and I’ve been working with you for the last five years and I know that you’ve always paid attention to nutritional status and vitamins of your patient with Parkinson’s disease. And I’ve seen your patients do very well with their Parkinson’s disease for 20-30 years and still walking to clinic and coming regularly. And I’ve always tried to figure out what are those things that I can replicate and have my patients have similar outcome. So, you know, I am now working with you and we’re working together on this nutritional study of Parkinson’s disease. What would […] The post MD Podcast: Nutrition and Parkinson Disease appeared first on Danish Bhatti.

Mesmerism has had an outsize influence on medicine, despite the rapid rise and fall of its inventor Dr. Franz Mesmer and hostility from the medical establishment. This curious story covers the healing powers of magnets, secret societies in pre-Revolutionary France, fundamental questions about what makes someone alive, and one of the most fascinating medical investigations in history led by a dream team of Benjamin Franklin, Lavoisier, and Guillotine on behalf of King Louis XVI. Plus, a #AdamAnswers about the origin of the phrase “Code Blue.”   Sources: Damton R. Mesmerism and the End of the Enlightenment in France. Cambridge, MA: Harvard University Press, 1968.   Dyer R, Mesmerism, Ancient and Modern. Victorian Web. Franklin B et al, The Reports of the Royal Commission on Mesmer’s System of Animal Magnetism and other contemporary documents, James Lind Library, translated by Iml Donaldson. Retrieved online at https://www.rcpe.ac.uk/sites/default/files/files/the_royal_commission_on_animal_-_translated_by_iml_donaldson_1.pdf Lanska JT and Lanska DJ, Mesmer, Franz. Encyclopedia of the Neurological Sciences, 2014, pp 1106-1107. Lanska DJ and Lanksa JT, Franz Anton Mesmer and the Rise and Fall of Animal Magnetism: Dramatic Cures, Controversy, and Ultimately a Triumph for the Scientific Method. Brain, Mind and Medicine: Essays in Eighteenth-Century Neuroscience pp 301-320 “Mesmerism,” Boston Med Surg J 1837; 17:185-187 Normandin S, Visions of Vitalism: Medicine, Philosophy and the Soul in NineteenthCentury France, October 2005 Shermer, M, Testing the Claims of Mesmerism: The First Scientific Investigation of the Paranormal Ever Conducted. Skeptic, retrieved online at https://www.skeptic.com/eskeptic/10-09-22/ Sollberg, G. Vitalism and Vital Force in Life Sciences – The Demise and Life of a Scientific Conception Weckowicz TE and Liebel-Weckowicz HP, 7 Nineteenth Century: Vitalist-Mechanist and Psychic-Somatic Controversies. Advances in Psychology, Volume 66, 1990, Pages 109-152   Youtube videos of the Armonica: Adagio for Glass Armonica, Mozart: https://www.youtube.com/watch?v=QkTUL7DjTow Rutgers video on history of Armonica: https://www.youtube.com/watch?v=BdtLK9pAh5k

Emma tells Emlyn about the Italian neurobiologist and nobel laureate, Rita Levi-Montalcini, and Emlyn tells Emma about the mathematical rules of living cells and about males that choose very, very bad mates.    Sources Main Story - Rita Levi Montalcini   Biography in Treccani http://www.treccani.it/enciclopedia/rita-levi-montalcini_(Dizionario-Biografico)/ Biography in Neurological Sciences https://link.springer.com/article/10.1007/s10072-013-1303-2 Obituary: https://source.wustl.edu/2013/01/obituary-nobel-laureate-rita-levimontalcini/ Biography in Trends in Cell Biology  https://www.cell.com/trends/cell-biology/fulltext/S0962-8924(04)00143-6?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0962892404001436%3Fshowall%3Dtrue Biography in Nature https://www.nature.com/news/2009/090401/full/458564a.html Women who werk Shoutout #1 Robyn P. Araujo, Lance A. Liotta. The topological requirements for robust perfect adaptation in networks of any size. Nature Communications, 2018; 9 (1) DOI: 10.1038/s41467-018-04151-6 Queensland University of Technology. "Math sheds light on how living cells 'think'." ScienceDaily. ScienceDaily, 2 May 2018. www.sciencedaily.com/releases/2018/05/180502094636.htm   Shoutout #2 Shevy Waner, Uzi Motro, Yael Lubin, Ally R. Harari. Male mate choice in a sexually cannibalistic widow spider. Animal Behaviour, 2018; 137: 189 DOI: 10.1016/j.anbehav.2018.01.016 American Associates, Ben-Gurion University of the Negev. "Brown widow male spiders prefer sex with older females likely to eat them afterwards." ScienceDaily. ScienceDaily, 30 April 2018. .

“I would also dart and anesthetize my baboons using blow gun systems, and there's a bunch of people in DC where I would love to put a big hefty dart in their rears, and maybe put in some ear tags and find out what's going on with their hormone levels.” | Professor Robert Sapolsky, biologist and neuroscientist, on the natural processes behind today’s decision-makers. Sapolsky sat down with Shiv and Wes to discuss his path to neuroscience, human compassion, and effective strategies for talking about science in political and social terms. Biography: One of the preeminent neurobiologists in the world, Robert Sapolsky is a professor at Stanford University where he holds joint appointments in the Biological Sciences, Neurology & Neurological Sciences, and Neurosurgery departments. After being raised in Brooklyn, he graduated summa cum laude from Harvard University with a Bachelors in Biological Anthropology and later went on to get his PhD from Rockefeller University in Neuroendocrinology. He is the recipient of numerous awards, including the prestigious MacArthur Fellowship genius grant in 1987 and the National Science Foundation Presidential Young Investigator Award. For decades he has been traveling to Africa every year to observe a group of baboons as part of his work on stress and gene degeneration. Quote Preview: “A large percentage of social mammals can be divided into what’s called pair-bonded species: they mate for life, males do a lot of child-care, females choose males who are good partners, there’s not a whole lot of aggression. Or tournament species: males are much bigger than females, and big sharp canines, ornamentation, they fight tons…. So what about humans? By every measure you could come up with from cultural anthropology to literally what sort of genetic diseases we have, we are halfway in between… and this explains like 90% of poetry and divorces... We are incredibly confused species in that regard.” (9:30) “People have a lot of trouble imagining that whatever it is right now is going to change as much in the next ten years as whatever it was ten years ago.” (12:59) “We have to not only not despair, but do everything possible to hasten the end of the political regime that was about to come in.” (13:50) “If Donald Trump does not destroy the planet with some of his plans, he certainly is going to destroy research and science and a lot of medical work. I think that the cuts that he is proposing, the hostility he has to things like global warming, the hostility that he has to fact, to cause and effect, basically I think puts us all in great danger. But if you happen to be somebody that happens to traffic in truth and facts for a living, particularly so.” (14:02) “We do weird things like invent sheepishness about status, or being embarrassed about the wealth we come from, or things like that.” (16:00) “At a place like this, with really smart and really privileged people, who are gonna have all sort of options down the line, I guess the clearest thing I wish I had had hammered into me more is: get a really good sense if you can of what you’re gonna have to give up for your ambition, and is it worth it?” (18:39)

Tony Wyss-Coray is a professor of Neurology and Neurological Sciences at Stanford University, the Co-Director of the Stanford Alzheimer’s Disease Research Center, and the Associate Director of the Center for Tissue Regeneration, Repair and Restoration at the Palo Alto VA. In this talk he talks about blood borne factors from young mice or humans are sufficient to slow aspects of brain aging and improve cognitive function in old mice, and vice versa, factors from old mice are detrimental for young mice and impair cognition.

Dr. Helen Bronte-Stewart is the John E Cahill Family Professor in the department of Neurology and Neurological Sciences at Stanford give a talk about recent advances in wearable physiosensors and sensing neurostimulators which are enabling us to study the brain’s effect on Parkinson’s disease motor signs, such as tremor, bradykinesia and rigidity, in real time in freely moving human subjects.

Josep O. Dalmau, Editor of Neurology: Neuroimmunology & Neuroinfammation introduces the podcast inverview. Dr. Laura Benjamin interviews Dr. Don Gilden about his paper Widespread arterial infection by varicella zoster virus explains refractory giant cell arteritis.J. Damlau is the editor of Neurology: Neuroimmunology & Neuroinflammation, is on the editorial board for Neurology UpToDate, holds patents for and receives royalties from Ma2 autoantibody test, NMDA receptor autoantibody test, GABA(B) receptor autoantibody test, GABA(A) receptor autoantibody test, DPPX autoantibody test, IgLON5 autoantibody test, received research support from Euroimmun, NIH, Fondo de Investigaciones Sanitarias de la Seguridad Social (Spanish Government); L. Benjamin reports no disclosures; D. Gilden is a senior Associate editor for Journal of NeuroVirology, is on the editorial board for In Vivio, Journal of Virology, Scientific American Medicine, Virus Genes, Neurology, Journal of the Neurological Sciences, received research support from NIH;

[intro music]   Hello, and welcome to Episode Forty-Three of Multiple Sclerosis Discovery, the podcast of the MS Discovery Forum. I’m your host, Dan Keller.   This week’s podcast features an interview with Dr. May Han, who discusses issues related to following patients with clinically isolated syndrome. But first, here are some new items on the MS Discovery Forum.   We recently posted an article on a surprisingly strong association between a certain gene variant and non-response to interferon beta in people with RRMS. The study is a meta-analysis of three independent cohorts in Italy, France, and the U.S., and it comes from the labs of Philip De Jager and Filippo Boneschi. You’ll find this article by clicking first on News & Future Directions and then on New Findings.   This past week we published the latest in our series of data visualizations. This month’s visualization is a series of word clouds illustrating how key terms in the MS clinical-trial literature have changed between 1993 and 2014. To find this visualization, first click on Research Resources, then on Data Visualizations, and then on Word Cloud.   According to our curated list of the latest scientific articles related to MS, 30 such articles were published last week. To see last week’s list, go to msdiscovery.org and click on Papers. We selected one of those papers as an Editors’ Pick. It’s study of the association between depressive symptoms and walking ability in people with RRMS.   Are you attending the annual meeting of the Consortium of Multiple Sclerosis Centers in Indianapolis this week? If so, please come visit us at the Accelerated Cure Project’s booth. We’ll be demonstrating some of our latest data visualizations along with other features of the MS Discovery Forum. You’ll find the booth in the hallway close to the main entrance to the exhibit hall, and we look forward to meeting you.   [transition music]   Now to the interview. Dr. May Han is an assistant professor in Neurology and Neurological Sciences at Stanford University. I spoke with her about following patients with clinically isolated syndrome, as well as her approach to patients with MS across the course of their disease. But first, she addressed some unmet needs in MS.   Interviewer – Dan Keller Dr. Han, you told me that we’re good at the diagnosis of MS in general, but still there’s a vast area that we don’t know about. What are some of those unmet needs?   Interviewee – May Han So it’s been over 150 years since Charcot first described multiple sclerosis, and I have to say that we have come a long way in understanding and treating this disease. But as you have mentioned, there are still areas where we have no idea, there are gaps in our understanding of this disease. One of these areas that is clinically very relevant and is very challenging is in the day and age where we have a dozen disease-modifying therapies for MS patients, and yet we don’t have a good way, a scientific way of selecting the most effective therapy for a particular patient is what I find quite challenging in the clinics.   MSDF What gives you clues or how do you approach this essentially algorithm of deciding where to begin and how to move on to other medications if the first one’s not working well?   Dr. Han Currently, of course, we follow the guidelines. So for any relapsing-remitting patients, our logic is to go for the safest medication that we think are going to be most effective, which means we go with the first-line therapies. So we have the convention ABC drugs such as beta-interferon family of therapies and glatiramer acetate, plus the newer oral medications such as Tecfidera and fingolimod or Gilenya that we use for the first-line therapy; not a whole lot of science in choosing these medications for a particular patient, but what we would do is initially we would educate the patient about these disease-modifying therapies and then select the medication together with the patient to see what would be most appropriate and the patient could be most compliant for a particular medication.   To give you an example, certain patients have aversion to needles, in which case we go with the oral medications. We also have in mind what the preference of the patient, such as whether they could be able to follow it through for years on end with a particular medication. Ideally, we would like to have zero relapses or MRI activity when a patient is on a disease-modifying therapy, but as we all know none of these medications are 100% foolproof, and they can still have some degree of MRI activity or infrequent relapses on this medication. However, if a patient is clearly not responding to a therapy either in terms of not being compliant, being intolerant to the mode of administration, or if they’re having worsening disease activity, we would decide to go on to stronger medications or second-line of therapy.   MSDF Do you initially discuss a plan of action, a stepwise pattern of medication prescribing, or do you wait until something needs to be changed to bring it up with patients?   Dr. Han That is a very good question. I’m sure it varies among clinicians, but, however, I would like to paint the picture to the patient the best that I can. So, let’s say for example, if a patient who is a newly-diagnosed MS patient who has very few MRI lesions, I would discuss with them what the most appropriate medication could be. We would decide a medication and we would also give them an outline of what the followup plan would be and when we would be deciding to switch to a different therapy, and if so, which medications would be most likely appropriate for them, and also how we would monitor them. So by doing this, it gives the patient a better picture of their path and what to watch out for, and in my experience we have a better outcome with these patients.   MSDF Do you find that once you achieve success in limiting relapses and lesions that the medication is fairly stable for a long time, or do you have to have an armamentarium that you keep moving through?   Dr. Han So my model if a patient is responding to a medication, unless they have other side effects or reasons to switch, I would like to get the most mileage out of the medication as much as I can for a particular patient. However, if a patient, for example, has JC virus positivity, in which case even if they’re responding to Tysabri really well, there is a cutoff time point where we have to sit down and consider whether this patient should be switched onto a different medication to prevent the development of opportunistic brain inflammation such as PML, in which case what the next medication would be. And so we would sit down and talk the pros and cons; this conversation was started even before the patient was started on medication, but that would be the checkpoint.   MSDF I suppose another aspect is do medications start to fail patients even after a long period of stability, or do they usually continue to be stable if the medication is working for some period of time?   Dr. Han This is also a very pertinent question. MS patients, as we know, is very heterogeneous. Some of the patients, if they are stable on a medication, they would continue to do well on a medication for several years up to decades. However, some patients would have an initial improvement or stabilization of their disease, however in the later stages they would have worsening disease. And it is really unclear whether because their disease per se is getting worse or whether their body is rejecting the medication secondary to the immune response. And that is also one area that we should do research on to better understand this condition.   MSDF When you say reject the medication, are you actually referring to an immune rejection such as with, say, interferon; I would think it would be less likely they would actually mount an immune response to a small molecule. Am I clear on that or not?   Dr. Han I think we have quite a lot of information in terms of beta interferon therapies, because we clearly know that patients do tend to develop antibodies against beta interferon, especially the therapy. However, even that we don’t really know if all those antibodies are attacking the drug or whether they are just there. So just by finding the antibody alone is not enough to say that the patient is not responding to it; I think we need to use it hand-in-hand with the clinical response as well as the MRI activity.   Getting to the second part of your question whether there’ll be less intolerance or rejection to the therapy if it were small molecules, but I don’t think we understand at the cellular or molecular level. For small molecules there could be receptor down-regulation, there could be availability or cellular sequestration, or even the prodrug being converted to an active drug, or how the breakdown process occurs. So when a patient does not respond anymore to a medication, we just know that the clinical response is worse, and we don’t really know whether it is because the disease activity has worsened or other aspects, pharmacodynamic or kinetic aspects of the system has changed in such a way that they no longer respond. So, again, we do need to do more research to have a better understanding.   MSDF You have called it MS comes in many different flavors. Have you found that any medications are particularly good for different constellations of symptoms, or is everything about equal no matter how they present?   Dr. Han Very good question as well. I think in the experimental models people know that MS, or central system autoimmunity, can have a bias towards one type of inflammation as opposed to the other. For example, some would say that certain medications are better to treat Th1 as opposed to the Th17 type of inflammation, however in human beings there’s no clear-cut Th1 MS or Th17 MS. I don’t think people have done enough studies to clearly decipher the immune profiles of patients. So the answer is we don’t know.   MSDF Finally, let’s talk about the need for biomarkers especially very early in the disease when someone’s presenting with CIS which may or may not become MS. Where does that stand and how acute is the need?   Dr. Han The need is there, especially if you look at it from a patient who just had an initial attack. If you tell them that we don’t really know whether this is a one-time thing or whether you’re going to develop MS, and we’ll have to wait and see for three-plus years. So for these three years, the patient’s life is very much consumed by the “is it going to be MS” kind of question. And it does affect their physical-mental wellbeing as well as their quality of life.   I think we’ve come a long way with the advancement of the MRI studies in such a way that if a patient has MRI lesions together with the first-time attack, we could almost clearly say that this is going to blossom into MS. However, for patients who are radiographically clean and who just had one episode, it would be very, very helpful to have some kind of blood biomarkers to predict whether this could be a single event or whether it could be a central nervous system inflammatory disorder.   MSDF You picked three years as a period of waiting, watching. Are they out of the woods after that, or how late can it blossom into full MS?   Dr. Han It’s always a bell-shaped curve. There are patients who would declare themselves sooner than three years, there are also patients who would take several years before they have the second attack. I have one patient who had an initial attack of optic neuritis and nine years later she had the second attack. During that period, she had had MRI scans for three years which were clean. So, I guess, one is never completely out of the woods, but at the same time it is also not prudent to perform unnecessary tests on a patient.   So I think we have to focus on what is the safety net and pick a period of time, but at the same time it is very important to educate a patient to symptoms to watch out for, how to get help, and to work very closely with the primary care physician or a neurologist so in case the symptoms show up they will not be ignored or delayed to receiving treatment.   MSDF Is there anything we’ve missed or is important to add? I’m sure it’s a gigantic field, but is there anything glaring that should be added?   Dr. Han I would like to encourage people in the field to also focus on the secondary-progressive stage of MS. We know that relapsing-remitting MS patients with or without therapy eventually would end up having secondary-progressive MS, so it’ll be really important to decipher whether during the secondary-progressive stage there is no inflammation but only the early neurodegeneration, or how the immune system and the central nervous system interact and how we can change it, or at least modulate it, to either delay or to prevent neurodegeneration. The third area that I think is very important is to try to understand the regenerative aspects of the central nervous system.   As I have given you the example, if we have two patients who have had similar lesion burden or even lesions that are approximately the same in similar areas, a patient can be severely devastated, neurologically devastated, whereas the other may have minimal neurologic deficits. And we would always say that it depends on the brain reserve, or neural reserve, but we don’t quite know what it is. Is it the stem cells, is it the nervous system being more resistant to insult and how the immune system interacts with it? And I think this is also a big area that we should focus on, of course, to prevent further damage, but also once the damage is done to limit the damage and perhaps to regenerate it. And I think that people always have within themselves the ability to heal.   MSDF Good, thank you.   Dr. Han Thank you.   [transition music]   Thank you for listening to Episode Forty-Three of Multiple Sclerosis Discovery. This podcast was produced by the MS Discovery Forum, MSDF, the premier source of independent news and information on MS research. MSDF’s executive editor is Robert Finn. Msdiscovery.org is part of the non-profit Accelerated Cure Project for Multiple Sclerosis. Robert McBurney is our President and CEO, and Hollie Schmidt is vice president of scientific operations.   Msdiscovery.org aims to focus attention on what is known and not yet known about the causes of MS and related conditions, their pathological mechanisms, and potential ways to intervene. By communicating this information in a way that builds bridges among different disciplines, we hope to open new routes toward significant clinical advances.   We’re interested in your opinions. Please join the discussion on one of our online forums or send comments, criticisms, and suggestions to editor@msdiscovery.org.    [outro music]

1) Prevalence and distribution of VZV in temporal arteries of patients with giant cell arteritis and 2) Topic of the month: Immune-mediated necrotizing myopathy. 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. Jennifer Bickel interviews Dr. Don Gilden about his paper on the prevalence and distribution of VZV in temporal arteries of patients with giant cell arteritis. Dr. Adam Numis is reading our e-Pearl of the week about unresponsive CIDP: Is it POEMS? In the next part of the podcast Dr. Ted Burns interviews Dr. Andy Mammen about the topic of dermatomyositis. The participants had nothing to disclose except Drs. Gilden, Numis, Burns and Mammen.Dr. Gilden serves as an Senior Associate Editor for Journal of NeuroVirology; serves as an editorial board member of In Vivo, Journal of Virology, Scientific American Medicine, Virus Genes, Neurology and Journal of the Neurological Sciences; and receives research support from the NIH.Dr. Numis serves on the editorial team for the Neurology® Resident and Fellow Section. Dr. Ted Burns serves as Podcast Editor for Neurology®; and has received research support for consulting activities with CSL Behring and Alexion Pharmaceuticals, Inc.Dr. Mammen serves on the scientific advisory boards of aTYR Pharmaceuticals Inc. and Biogen Idec; serves as an editorial board member of Experimental Neurology and Arthritis and Rheumatism; receives license fee payments, royalties and revenue for a patent from INOVA Diagnostics Inc. for licensed test for anti-HMGCR antibodies; and research support from the NIH.

1) Optimal combination of secondary prevention drug treatment and stroke outcomes and 2) Topic of the month: Myelopathy due to 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. Andy Southerland interviews Dr. Bruce Ovbiagele about his paper on the optimal combination of secondary prevention drug treatment and stroke outcomes. Dr. Sarah Wesley is reading our e-Pearl of the week about persistent cryptococcal meningitis. In the next part of the podcast Dr. Ted Burns interviews Dr. Steven L. Lewis about the topic of myelopathy due to systemic disease: autoimmune disorders. The participants had nothing to disclose except Drs. Southerland, Ovbiagele, Wesley, Burns and Lewis.Dr. Southerland serves as Podcast Deputy Editor for Neurology®; serves as Clinical Research Advisor for Totier Technologies, Inc.Dr. Ovbiagele serves as an Assistant Editor of Stroke; serves as an Associate Editor of the Journal of Neurological Sciences; serves on the editorial board of the Journal of Stroke and Cerebrovascular Diseases and receives research support from the NIH.Dr. Wesley serves on the editorial team for the Neurology® Resident and Fellow Section. Dr. Ted Burns serves as Podcast Editor for Neurology®; and has received research support for consulting activities with CSL Behring and Alexion Pharmaceuticals, Inc.Dr. Lewis serves as CME Section Co-Editor for Neurology® and as Editor in Chief for Continuum: Lifelong Learning in Neurology®; received royalties for book authorship and editorship from the publishers Wolters Kluwer and Wiley- Blackwell.

Jeffrey D. Bernstein is a Researcher in the Stanford Center for Memory Disorders Stanford School of Medicine, Department of Neurology and Neurological Sciences. Jeffrey discusses his work with volunteers and patients in current studies. For more info, go to www.neurology.stanford.edu/labs/kerchnerlab

Jeffrey D. Bernstein is a Researcher in the Stanford Center for Memory Disorders Stanford School of Medicine, Department of Neurology and Neurological Sciences. Jeffrey discusses his work with volunteers and patients in current studies. For more info, go to www.neurology.stanford.edu/labs/kerchnerlab

[intro music]   Host – Dan Keller Hello, and welcome to Episode Six of Multiple Sclerosis Discovery, the Podcast of the MS Discovery Forum. I’m your host, Dan Keller.   This week’s Podcast features an interview with Dr. Jeffrey Dunn, who explores the prospect of personalized medicine in MS. But to begin, here’s a brief summary of some of the topics we’ve been covering on the MS Discovery Forum at msdiscovery.org.   Recently, blogger Emily Willingham shared a person experience with MRI interpretation in our blog, MS Patient, Ph.D. She wrote, “I’ve come to realize in my various dealings with MRI reports that neuroradiologists are like economists; everyone has an opinion and no two readers will agree on what they see in exactly the same data.” Willingham, a developmental biologist, provides a unique view into the life of an MS patient. Her experiences bring a first-person perspective of MS, while her scientific background informs her insights in a way that many researchers and clinicians may find valuable.   We’d also like to bring your attention to the data visualization section of the MSDF website. Under the research resources tab, you can find a series of interactive data visualizations useful for MS researchers. One visualization aggregates 106 clinical trials. You can organize the data by the compound, phase, population, or even the funding. Our latest visualization is of the natural history of MS symptoms. The interactive bar chart allows you to see the change of various symptom severity in MS over a 30-year period.   Also in research resources, check out the drug development pipeline. This is where we keep detailed information on, at last count, 40 drugs currently in development or on the market for MS. This database, which is updated daily as new information becomes available, contains a wealth of data on each agent. This includes the agent’s class, its intended target and routes of administration, its regulatory status and commercial history, its chemical properties, mechanism of action and adverse effects, and all its clinical trials.   Now for the interview. Dr. Jeffrey Dunn is a Professor of Neurology and Neurological Sciences at Stanford University. He met with MSDF editor Bob Finn to discuss the use of biomarkers and personalized medicine. But first he shared a little history.   Interviewee – Jeffrey Dunn So, in the history of multiple sclerosis, when cases of CNS demyelinating disease were first discovered, they were discovered as isolated case instances at a number of different and variable institutions throughout Europe and in the United States. The doctors knew of the patients’ symptoms, of course, because they had cared for them. Many of these patients went on to pathology examination, and multiple cases of areas of inflammation or even scar formation were seen within the central nervous system. These cases from the mid-1800s and into the late-1800s were described as isolated instances. And the physician who is given credit for the discovery of what we now know to be multiple sclerosis was Dr. John-Martin Charcot in Paris, because he had had the experience of a very close relationship with a patient he named Mademoiselle V. He had known that she had had a tremor and ataxia and eye movement abnormalities, so Charcot knew his patient’s phenotype, her clinical manifestations, very well, and specifically had seen evidence of eye movement abnormalities, tremor, and ataxia. She had consented to have her nervous system evaluated pathologically, and so Charcot was able to make a connection between what she had looked like in life, and then what her brain and spinal cord had looked like after she had passed away.   It’s that clinicopathologic correlation that really was a paradigm-buster at the time. And Charcot found palpably hard spots – areas of gliosis or scar formation – that occurred in plaques and patches throughout the spinal cord and brain (and cerebellum in this case). He called the disease almost an adjective really; he called it “la sclérose en plaques”, which is French for sclerosis – meaning hard spots essentially – in plaques. So hard spots was the disease. Multiple sclerosis is really an adjective more than a diagnosis. But in the early 20th Century leading up to the mid-20th century, there was increasing recognition on the basis of these isolated case reports that this disease that was now increasingly being called multiple sclerosis might be far more common than people had realized, and great credit needs to be given to Sylvia Lawry, who as you know was the founder of the National Multiple Sclerosis Society. The National MS Society was put together to try to bring physicians together to create a forum by which they could crosstalk, share the anecdotal information each of them had compiled, and come up with a more systematic review so that the disease could be better described and so that treatments could be more likely discovered. This was a huge step forward in terms of our discovery and ability to diagnosis and ultimately later to treat MS, but it created a framework that said that MS was, in some respects, one disease.   Now all of us even today, I would say, as physicians are trained that MS is a distinct disease; that it’s one type of disease with many variations according to individuals, but I think we’re actually at the very beginning of a very important paradigm shift in this consideration. There’s a difference, of course, between a disease and a syndrome. A disease is a quantifiable isolated entity – a classic example might be a genetic disorder caused by a single mutation in a coding sequence of DNA – whereas a syndrome is probably a collection of different but closely related diseases. I think there’s increasing evidence now, an increasing recognition that MS may be very heterogeneous and variable across individuals; I don’t think there would be any argument among my colleagues that MS is a heterogeneous process. My suggestion to you is that now, I think, we’re at the threshold of a paradigm that says that MS should not be regarded as a monolith or a single pathologic entity, but maybe more as a Stonehenge; a collection of closely related conditions that share some common pathology, but that need to be considered on an individual basis.   At the clinical, radiologic, immunologic, and pathologic levels we have evidence that MS is very heterogeneous among individuals. I think the theory that we now need to proceed according to is that multiple sclerosis is not one disease entity, but a number of different conditions. This idea and paradigm of personalized medicine is gaining traction. Our oncology colleagues who treat cancer have used this with some great and promising success in terms of applying optimum regimens and chemotherapeutic protocols to their patients, but I think there’s tremendous opportunity in multiple sclerosis to practice personalized medicine, because I think that the process of MS is a personalized one in which there are unique and eminently measurable proteins or protein profiles one day we’ll be able to identify, and hopefully that day is soon, and we can use that as the rationale for our prescription for the patients.   Interviewer – Bob Finn So when some people think about biomarkers, they think about an individual protein or some other biological signal that will be prognostic or in some other way tell you about what the patient is experiencing or might experience. It sounds to me like you’re talking about not an individual biomarker, but a constellation of biomarkers that would provide a fingerprint. Am I right about that?   Dr. Dunn I think so. Just as the disease pathogenesis itself is heterogeneous, I don’t think that one single protein would be able to help us. What I would foresee as an individual approaches us, that we might do a panel. There’s a series of questions that has to be asked. The immune process itself is sequential and acts, I think, as a cascade, and we have some biomarkers today that are available. I think you could argue them as biomarkers that help us in decision-making, that help the clinician decide what might be the best therapy, at least in terms of risk-benefit balance, but we just don’t have enough of them to be able to make the kinds of personalized decisions that I think we all hope we’ll be able to make one day.   MSDF Would you mention a couple of the ones that are – or some of the ones – that are available now?   Dr. Dunn So one example that I think would be well agreed on is the presence or absence of JC virus infection that can now be measured by a two-step ELISA assay, with a false-positive rate of an estimated 2.5%. One of the great challenges we face in treating MS is that we have to, in some respects, down-regulate the immune system to protect the brain and central nervous system, but we can’t overshoot the mark to cause a systemic immunosuppression. Immunosuppression can manifest in a number of different ways, including opportunistic infections and even malignancy. One of the most lethal and daunting of the opportunistic infections is a condition called progressive multifocal leukoencephalopathy – that’s precisely why we tend to call that PML instead, three syllables is far preferable – and that condition is caused by an infection of an otherwise relatively benign virus called JC virus, that if it gets into the central nervous system and begins to affect oligodendrocytes and cells of the central nervous system, can cause rapid intracellular proliferation and damage to the brain; that can spread geometrically throughout the brain and can cause very profound brain damage, and sometimes cases of death as well.   We’ve known of PML previously in patients with lymphoma and also in patients with untreated HIV infection who had severe and advancing immunosuppression. But we’ve seen this same PML condition in immunocompetent patients who have been treated with some of the agents that we might use for multiple sclerosis. This concern is not unique to MS, but it’s a concern with any immunotherapy that you use. The ability to measure whether a patient has previously been infected with a JC virus or not helps us in the risk-benefit balance considerations we have to make on behalf of our patients. It’s known that the absence of evidence of a JC virus infection is associated with a markedly decreased risk of PML, whereas its presence means that’s an active consideration in our prescribing.    Now that, I think, functions as a biomarker. Any time you might see an elevation of a measurable protein or another biomarker in general that normalizes with remission that gives you the opportunity to suggest that that either might be a therapeutic target – so let’s just call it protein X, for example, just for simplification and clarification. If a patient having an MS attack has a measurable increase in protein X in their blood which then now returns to normal or what had been their previous baseline in remission, that tells the clinician investigator that protein X might either be part of the immunologic cascade that causes the MS attack, and therefore suggests that the ability to intervene, down-regulate, or modify the expression of protein X may help with disease pathogenesis, OR it could also mean, or it could emerge as a candidate as a tool of assessment for disease status, so that one question we always have to ask as clinicians when we start patient on any given therapy or just in following them is how are they doing. Of course, that’s a primary mandate for the clinician taking care of patients.   Today, we do that by asking how they’re feeling, we strive to get into quality of life metrics with them, we also turn to their examination findings to look for interval change, and we look at MRI to see if there’s been a change there, with the hope that we’re seeing no evidence of disease activity. But the field of multiple sclerosis does not have its own version of a hemoglobin A1c, such as our endocrinologists have. In that scenario for those that aren’t familiar with it, A1c can be a value obtained literally with a single drop of blood that tells the practicing clinician caring for the patient what the average blood sugar of that patient has been over a substantial period of time prior to the time of their clinical encounter. So it helps the clinician make wise judgments and counsel to the patient regarding the optimum way to treat their diabetes, whether adjustments have to be made in their diet or in their prescription medications.   We don’t have such a thing in multiple sclerosis today. If we could find such a thing, it would make our care, I think, far superior in its quality. I think it would make physicians’ advice to our patients far more wise, and it would make the entire medical enterprise of caring for the MS patient less expensive, because we wouldn’t have to resort to important but still somewhat stodgy and expensive technologies like serial MRIs done with what could be high-frequency for the patient. Serial MRIs are safe for the patient, but you can see that if we could identify such a biomarker as that, if that were possible, I think that would have revolutionary implications for our care of the MS patient, not just in reducing medical costs – that’s an important goal – but the more important goal and what physicians need to focus on is superior advice, improved advice and counsel to the patients that are in our care.     MSDF So you and I are both old enough to remember when the Human Genome Project was proposed, and one of the values of the Human Genome Project that was articulated was that it would usher in an era of personalized medicine. Now it’s 13 years or so after the Human Genome Project has been completed, and, arguably, that promise has never been realized. How much longer will it take in multiple sclerosis to realize an era of personalized medicine?   Dr. Dunn The short answer is I don’t know, but there’s some important considerations to be made along the way. One fact is there are approximately 25,000 genes in the human body, but there are an estimated 500,000 proteins. The reason for the difference is that after an original protein is manufactured on the basis of the blueprint of DNA, it can be modified in transcription and translation. For those of you in your field, this would be post-production modifications. The same thing happens with proteins, and what that means is that the field of proteomics, you could argue, is 20 times more sensitive than the field of genomics if the ratio is 25,000 to 500,000 genes to proteins in the human body, respectively.   MS does have a genetic component, and that’s been proven by research in this past two decades by our country’s leading researchers, but the genetic input of MS is not the only answer; MS is only partially a genetic disease. It seems to be, in my own opinion and I think it’s shared by my colleagues – many of them, most of them perhaps – is that MS is primarily an environmental condition. The greatest risk of obtaining MS is not so much that family members are affected, though cases of that have happened and happen regularly, it seems to be more related to environment, where one lives. Now you may know that epidemiologically, MS is almost absent, or very sparse, at the equator, but in moving north and south on Earth, the greater that one moves away from the equator, the greater the prevalence of MS. And right about the 35th parallel or so both north and south of the equator, there appears to be a relatively large increase in how much MS there is. And that’s true, to the best of our knowledge, all the way around the world.   And so if MS is more of an environmental condition than a genetic one – although it’s both – then I think a genetic assay may be part, but not likely to be all of the answer, and the promise of going to a more sensitive assay to get into the post-transcription and post-translational modification that takes place in human molecules, which ultimately are the language of how the immune system affects our nervous system, is going to be and prove to be a more enriched and more promising field of inquiry.   MSDF I wonder if you can mention some of the labs that are doing the most promising work in this area.   Dr. Dunn I’m pleased to say that there are labs throughout the world that I think are doing research in this. Within the United States – I don’t want to leave anybody out – but I think that special kudos need to be given to the Mayo Clinic. I think on the east coast the Partners Program of the Harvard Medical Schools are very interested in this field; Johns Hopkins is doing work that I think is exemplary. Out west, our colleagues at UCSF. And, of course, I have to give special kudos to my colleagues at Stanford University. These are places that are publishing in translational medicine the bench-to-bedside framework in which discoveries that are being made at the level of the bench, there’s an active effort being made to try to translate that to human care. I’m very sensitive to the idea of excluding anybody, because I think that this is really an international search, and it’s going to require multilevel of collaboration. So I hope that as we go forward, we’ll be able to really work together.   I mentioned just a moment ago, I think practice of personalized medicine in this field is going to require not one discovery, it’s going to require a panel, perhaps, of different measurable biomarkers. I don’t anticipate one single lab is going to be able to discover all of those biomarkers, I think we’ll get one discovery from one place, one from another, one from another. And it’s going to require a transcendent collaboration between institutions and individuals and researchers and investigators to bring it all together for the collective good.   MSDF Dr. Dunn, thank you very much.   Dr. Dunn Okay, alright, thank you very much, Bob.   [transition music]   Thank you for listening to Episode Six of Multiple Sclerosis Discovery. This Podcast was produced by the MS Discovery Forum, MSDF, the premier source of independent news and information on MS research. MSDF’s executive editor is Robert Finn. Msdiscovery.org is part of the nonprofit Accelerated Cure Project for Multiple Sclerosis. Robert McBurney is our President and CEO, and Hollie Schmidt is Vice President of Scientific Operations.   Msdiscovery.org aims to focus attention on what is known and not yet known about the causes of MS and related conditions, their pathological mechanisms, and potential ways to intervene. By communicating this information in a way that builds bridges among different disciplines, we hope to open new routes toward significant clinical advances.   We’re interested in your opinions. Please join the discussion on one of our online forums or send comments, criticisms, and suggestions to editor@msdiscovery.org.   [outro music]

1) Clinical characteristics and outcome of brain abscess and 2) Topic of the month: Mitochondrial disorders. 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. Bryan Cupka interviews Dr. Matthijs Brouwer about his paper on clinical characteristics and outcome of brain abscess. Dr. Roy Strowd is reading our e-Pearl of the week about angioedema after tPA. In the next part of the podcast Dr. Maria Farrugia interviews Dr. Grainne Gorman about the fundamental principles of mitochondrial disorders. The participants had nothing to disclose except Drs. Brouwer, Strowd and Gorman.Dr. Brouwer receives research support from the Dutch Scientific Organization; received research support from the European Federation of Neurological Sciences and European Society of Clinical Microbiology and Infectious Diseases.Dr. Strowd serves on the editorial team for the Neurology® Resident and Fellow Section. Dr. Gorman receives research support from the UK NIHR Biomedical Research Centre for Aging and Age-related disease, Research Fellow, awarded to the Newcastle upon Tyne Trust Foundation Hospitals NHS Trust.

Ralph Gregory, secretary for the Association of British Neurologists and consultant neurologist in Dorset, gets an update on peripheral nerve disease research and practice from James Overell, consultant neurologist, Institute of Neurological Sciences, Glasgow.They discuss treatment for CIDP, differences in neuropathy prevention and management in type 1 and type 2 diabetes, chronic inflammatory neuropathies, and hereditary motor sensory neuropathies.This podcast is one of a series produced in collaboration with the Association of British Neurologists, of which there will be more to come over the next few months. You can find all the podcasts in the series here https://soundcloud.com/tags/abn%202013.

Regenerative Medicine Today welcomes Thomas Rando, PhD. Dr. Rando is the deputy director of the Stanford Center on Longevity at Stanford University and a professor with the Department of Neurology and Neurological Sciences, Stanford University School of Medicine.  Dr. Rando discusses his research in muscle stem cell biology as well as his role in [...]

Frank Longo, MD, PhD, professor and chair of the Department of Neurology and Neurological Sciences, discusses his research and the development of new treatments to prevent the onset or delay the progression of Alzheimer's. (February 2, 2011)

1) Depression in Parkinson disease and 2) Topic of the month: Aphasia. 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. Russ Swerdlow interviews Dr. Massimo Filippi about his paper on depression in Parkinson disease. In the next segment, Dr. Ryan Overman is reading our e-Pearl of the week about five clues to the diagnosis of inclusion body myositis...and...amphiphysin antibody-associated stiff-person syndrome. In the next part of the podcast Dr. Alberto Espay interviews Dr. Keith Josephs about post-stroke aphasias for our Lesson of the Week. Over the next subsequent three weeks, we will highlight primary progressive aphasias. The participants had nothing to disclose except Drs. Filippi, Overman, Espay and Josephs. Dr. Filippi serves on scientific advisory boards for Teva Pharmaceutical Industries Ltd. and Genmab A/S; has received funding for travel from Bayer Schering Pharma, Biogen-Dompe AG, Genmab A/S, Merck-Serono, and Teva Pharmaceutical Industries Ltd.; serves on editorial boards of the American Journal of Neuroradiology, BMC Musculoskeletal Disorders, Clinical Neurology and Neurosurgery, Erciyes Medical Journal, Journal of Neuroimaging, Journal of Neurology Neurosurgery and Psychiatry, Journal of Neurovirology, Magnetic Resonance Imaging, Multiple Sclerosis, and Neurological Sciences; serves as a consultant to Bayer Schering Pharma, Biogen-Dompe AG, Genmab A/S, Merck-Serono, Pepgen Corporation, and Teva Pharmaceutical Industries Ltd.; serves on speakers' bureaus for Bayer Schering Pharma, Biogen-Dompe AG, Genmab A/S, Merck-Serono, and Teva Pharmaceutical Industries Ltd.; and receives research support from Bayer Schering Pharma, Biogen-Dompe AG, Genmab A/S, Merck-Serono, Teva Pharmaceutical Industries Ltd., Fondazione Italiana Sclerosi Multipla, and Fondazione Mariani. Dr. Overman serves as Deputy Editor on the Neurology® Resident and Fellow Section editorial team and the Neurology® Podcast Committee. Dr. Espay received has personal compensation as a consultant for Boehringer Ingelheim; grant support from Codman; Medtronic, Inc; Allergan, Inc.; and CleveMed, and honoraria from UCB-SCHWARZ PHARMA AG; Medtronic, Inc. and Novartis. Dr. Josephs is funded by R01- DC010367 (PI), the Dana Foundation (PI), and the Morris K. Udall PD Research Center of Excellence NIH/NINDS P50 NS40256 (Co-I).

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. Mark Keegan interview Dr. Massimo Filippi about his paper on oral vs. intravenous methyprednisolone in MS. In the next segment, Dr. Ryan Overman is reading our e-Pearl of the week about pseudo-myasthenic ptosis. The next part of the podcast is Dr. Alberto Espay interviews Dr. Josep Dalmau for our Lesson of the week toolbox about NMDAR encephalitis. The participants had nothing to disclosure except Drs. Keegan, Filippi, Espay and Dalmau. Dr. Keegan serves as Section Co-Editor for Neurology and the Neurology Podcast Panel.Dr. Filippi serves on scientific advisory boards for Teva Pharmaceutical Industries Ltd. and Genmab A/S; has received funding for travel from Bayer Schering Pharma, Biogen-Dompè AG, Genmab A/S, Merck Serono, and Teva Pharmaceutical Industries Ltd.; serves on editorial boards of the American Journal of Neuroradiology, BMC Musculoskeletal Disorders, Clinical Neurology and Neurosurgery, Erciyes Medical Journal, Journal of Neuroimaging, Journal of Neurology Neurosurgery and Psychiatry, Journal of Neurovirology, Magnetic Resonance Imaging, Multiple Sclerosis, and Neurological Sciences ; serves as a consultant to Bayer Schering Pharma, Biogen-Dompè AG, Genmab A/S, Merck Serono, Pepgen Corporation, and Teva Pharmaceutical Industries Ltd.; serves on speakers' bureaus for Bayer Schering Pharma, Biogen-Dompè AG, Genmab A/S, Merck Serono, and Teva Pharmaceutical Industries Ltd.; and receives research support from Bayer Schering Pharma, Biogen-Dompè AG, Genmab A/S, Merck Serono, Teva Pharmaceutical Industries Ltd., Fondazione Italiana Sclerosi Multipla, and Fondazione Mariani. Dr. Espay has received personal compensation as a consultant for Boehringer Ingelheim; grant support from Codman; Medtronic, Inc; Allergan, Inc.; and CleveMed, and honoraria from UCB-SCHWARZ PHARMA AG; Medtronic, Inc. and Novartis.Dr. Dalmau has received honoraria for lectures not funded by industry; receives research support from EUROIMMUN and the NIH/NCI [RO1CA107192 (PI) and RO1CA89054-06A2 (PI)]; has received license fee payments from EUROIMMUN for an NMDA receptor autoantibody test (patent pending PCT/US07/18092, filed: August 15, 2007); and has received royalty payments and may accrue revenue for US Patent 6,387,639;, issued: May 14th, 2002: Patent for Ma2 autoantibody test.