Podcasts about Neurology

Dr. Alex Menze and Dr. Christopher J. Klein discuss whether GLP-1RA usage is linked to radiculoplexus neuropathy and common fibular neuropathy.  Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000213916   

Dr. Alex Menze talks with Dr. Christopher J. Klein about the clinical presentation, diagnosis, and management of diabetic lumbosacral radiculoplexus neuropathy and common fibular neuropathy in the context of GLP-1RA. Read the related article in Neurology®. Disclosures can be found at Neurology.org. 

In the final episode of this foundational neurology series, Casey Kozak discusses serotonin syndrome. 

Progressive supranuclear palsy and corticobasal syndrome are closely related neurodegenerative disorders that present with progressive parkinsonism and multiple other features that overlap clinically and neuropathologically. Early recognition is critical to provide appropriate treatment and supportive care. In this episode, Teshamae Monteith, MD, FAAN speaks with Nikolaus R. McFarland, MD, PhD, FAAN, author of the article “Progressive Supranuclear Palsy and Corticobasal Syndrome” in the Continuum® August 2025 Movement Disorders 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. McFarland is an associate professor of neurology at the University of Florida College of Medicine at the Norman Fixel Institute for Neurological Diseases in Gainesville, Florida. Additional Resources  Read the article: Progressive Supranuclear Palsy and Corticobasal Syndrome Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Monteith: Hi, this is Dr Teshamae Monteith. Today I'm interviewing Dr Nikolaus McFarland about his article on progressive supranuclear palsy and cortical basilar syndrome, which appears in the August 2025 Continuum issue on movement disorders. Welcome, how are you? Dr Farland: I'm great. Thank you for inviting me to do this. This is a great opportunity. I had fun putting this article together, and it's part of my passion. Dr Monteith: Yes, I know that. You sit on the board with me in the Florida Society of Neurology and I've seen your lectures. You're very passionate about this. And so why don't you first start off with introducing yourself, and then tell us just a little bit about what got you interested in this field. Dr Farland: I'm Dr Nicholas McFarlane. I'm an associate professor at the University of Florida, and I work at the Norman Fixel Institute for Neurological Diseases. I am a director of a number of different centers. So, I actually direct the cure PSP Center of Care and the MSA Center of Excellence at the University of Florida; I also direct the Huntington's clinic there as well. But for many years my focus has been on atypical parkinsonisms. And, you know, I've treated these patients for years, and one of my focuses is actually these patients who suffer from progressive supranuclear palsy and corticobasal syndrome. So that's kind of what this review is all about. Dr Monteith: You probably were born excited, but I want to know what got you interested in this in particular? Dr Farland: So, what got me interested in this in particular was really the disease and the challenges that's involved in it. So, Parkinson's disease is pretty common, and we see a lot of that in our clinic. Yet many times, roughly about 10 to 15% of my patients present with these atypical disorders. And they're quite fascinating. They present in different ways. They're fairly uncommon. They're complex disorders that progress fairly rapidly, and they have multiple different features. They're sort of exciting to see clinically as a neurologist. I think they're really interesting from an academic standpoint, but also in the standpoint of really trying to bring together sort of a team. We have built a multidisciplinary team here at the University of Florida to take care of these patients. They require a number of folks on that team to take care of them. And so, what's exciting, really, is the challenge of treating these patients. There are very limited numbers of therapies that are available, and the current therapies that we have often really aren't great and over time they fail. And so, part of the challenge is actually doing research. And so, there's actually a lot of new research that's been going on in this field. Recently, there's been some revisions to the clinical criteria to help diagnose these disorders. So, that's really what's exciting. The field is really moving forward fairly rapidly with a number of new diagnostics, therapeutics coming out. And hopefully we can make a real difference for these patients. And so that's what really got me into this field, the challenge of trying to treat these patients, help them, advocate for them and make them better. Dr Monteith: And so, tell me what the essential points of this article. Dr Farland: So, the essential points, really, of this article is: number one, you know, just to recognize the new clinical criteria for both PSP and corticobasal syndrome, the diagnosis for these disorders or the phenotypic spectrum has really expanded over the years. So, we now recognize many different phenotypes of these disorders, and the diagnosis has gotten fairly complicated. And so, one of the goals of this article was to review those new diagnostic criteria and the different phenotypic ways these diseases present. I wanted to discuss, also, some of the neuropathology and clinicopathological overlap that's occurred in these diseases as well as some of the new diagnostic tests that are available. That's definitely growing. Some of the new studies that are out, in terms of research and clinical trials. And then wanted to review some of the approaches for treatment for neurologists. Particularly, we're hoping that, you know, this article educates folks. If you're a general neurologist, we're hoping that recognizing these diseases early on will prompt you to refer these patients to specialty clinics or movement disorder specialists early on so they can get appropriate care, confirm your diagnosis, as well as get them involved in trials if they are available. Dr Monteith: And how has the clinical criteria for PSP and cortical basilar syndrome changed? Dr Farland: I think I already mentioned there's been an evolution of the clinical criteria for PSP. There's new diagnostic criteria that were recently published, and it recognizes the multiple clinical phenotypes and the spectrum of the disease that's out there, which is much broader than we thought about. Corticobasal clinical criteria are the Dr Armstrong criteria from 2013. They have not been updated, but they are in the works of being updated. But it does recognize the classic presentation of corticobasal syndrome, plus a frontal executive predominant and then a variant that actually overlaps with PSP. So, there's a lot more overlap in these two diseases than we originally recognized. Dr Monteith: And so, you spoke a bit about FTD spectrum. So why don't you tell us a little bit about what that is? I know you mentioned multiple phenotypes. Dr Farland: What I really want to say is that both PSP and corticobasal syndrome, they're relatively rare, and what- sort of as to common features, they both are progressive Parkinson disorders, but they have variable features. While they're commonly associated with Parkinson's, they also fit within this frontotemporal lobar spectrum, having features that overlap both clinically and neuropathologically. I just want folks to understand that overlap. One of this pathological overlap here is the predominant Tau pathology in the brain, an increasing recognology- recognition of sort of the pathological heterogeneity within these disorders. So, there's an initial description, a classic of PSP, as Richardson syndrome. But now we recognize there are lots of different features to it and there are different ways it presents, and there's definitely a lot of clinical pathological overlap. Dr Monteith: Why don't we just talk about some red flags for PSP? Dr Farland: Yeah, sure. So, some of the red flags for PSP and even corticobasal syndrome are: number one is rapid progression with early onset of falls, gait difficulty, falling typically backwards, early speech and swallow problems that are more prominent than you see in Parkinson's disease, as well as eye gaze issues. So, ocular motor features, particularly vertical gaze palsy. In particular what we talk about is the supranuclear gaze palsy, and one of the most sensitive features that we've seen with these is downgaze limitation or slowed downgaze, and eventually a full vertical gaze palsy and followed supranuclear gaze palsy. So, there's some of the red flags that we see. So, while we think about the lack of response to levodopa frequently as something that's a red flag for Parkinson's, there are many times that we see Parkinson's patients, and about a quarter of them don't really respond. There's some features that don't respond to levodopa that may not be so specific, but also can be helpful in this disease. Dr Monteith: And what about the red flags for cortical basilar syndrome? Dr Farland: So, for cortical basilar syndrome, some of the red flags again are this rapidly depressive syndrome tends to be, at least in its classical present presentation, more asymmetric in its presentation of parkinsonism, with features including things like dystonic features, okay? For limb dystonia and apraxias---so, inability to do a learned behavior. One of those red flags is a patient who comes in and says, my hand doesn't work anymore, which is something extremely uncommon that you hear in Parkinson's disease. Most of those patients will present, say, I might have a tremor, but they very rarely will tell you that I can't use my hand. So look out for that sign. Dr Monteith: And let's talk a little bit about some of the advances in the fields you mentioned, evolving biomarker and imaging capacities. So, how are these advances useful in helping us understand these conditions, especially when there's so much heterogeneity? Dr Farland: I might start by talking a little bit about some of the clinical criteria that have advanced. Why don't we start there and just discuss some of the advances? I think in PSP, I think, originally we had both probable and possible diagnoses of PSP, and the diagnostic criteria were basically focused on what was what's called “classical PSP” or “Richardson syndrome”. But now we recognize that there are multiple phenotypes. There's an overlap with Parkinsonism that's slower in progression and morphs into PSP, the classical form. There's a frontal behavioral variant where patients present with that frontal behavioral kind of thing. There's a speech-language variant that can overlap with PSP. So they have prominent speech language, potentially even apraxia speech. So, recognition of these different phenotypes is sort of a new thing in this field. There's even overlap with cortical basal syndrome and PSP, and we note that the pathology can overlap as well. So, I think that's one of the things that have changed over time. And these were- recently came out in 2017 in a new publication in the Movement Disorders Society. So, in terms of diagnostic tests as well---and there's been quite a bit of evolution---really still to date, our best diagnostic test is imaging. MRI is really one of our best tests currently. Currently blood tests, spinal fluid, there's new biomarkers in terms of skin… they're still in the research phase and not necessarily very specific yet. So, we rely heavily on imaging still; and for PSP, what we're looking for largely are changes in the brain stem, and particularly focused on the midbrain. So disproportionate midbrain atrophy compared to the pons and the rest of the midbrain is a fairly specific intensive sign for PSP. Whereas in MSA we see more of a pontine atrophy compared to the midbrain. So that can be really helpful, and there are lots of different new measurements that can be done. PET scans are also being used as well. And there are new PET markers, but they still remain kind of research-based, but are becoming more and more prevalent and may be available soon for potential use. Although there's some overlap with PET tracers with Alzheimer's disease and different Tau isoforms. So, something to be wary about, but we will be seeing some of these soon coming out as well. More kind of up-to-date things include things like the spinal fluid as well as even some of the skin biopsies. And I think we've heard some word of recent studies that have come out that potentially in the very near future we might actually have some Tau protein tests that we can look at Tau either in spinal fluid or even in a skin biopsy. But again, still remains research-based and, we still need more information as to whether these tests can be reproducible and how sensitive or specific they are. Dr Monteith: It sounds like, when really approaching these patients, still, it's a lot of back to the history, back to the clinical and some basic imaging that we should be able to identify to distinguish these types of patients, and we're not quite where we need to be yet for biomarker. Dr Farland: I totally agree with you. I think it starts, really, with the clinical exam and that's our main focus here; and understanding some of the new clinical criteria which are more sensitive, but also specific, too. And they're really useful to look at. So, I think reviewing those; patients do progress, following them over time can be really useful. And then for diagnosis, getting imaging if you suspect a patient has an atypical presentation of parkinsonism, to look for signs or features that might be specific for these different disorders. Dr Monteith: Why don't we take a typical case, a typical patient that you would see in clinic, and walk us through the thought process---especially, maybe they presented somewhat early---and the different treatment approaches to helping the patient, and of course their family. Dr Farland: Yeah, sure. So, a typical patient might be someone who comes in with, like, a three year history of progressive gait problems and falling. And let's say the patient says, I'm falling backwards frequently. They may have had, like, a rib fracture, or they hit their head once, and they're describing some speech issues as well. Now they're relying on a walker and family members saying they rarely let them be by themselves. And there may be some slowing of their cognitive function and maybe a bit of withdrawal. So that's a typical patient. So, the approach here is really, what are some of the red flags? I think already you hear a red flag of a rapidly progressive disease. So, Parkinson's disease patients rarely have frequent falls within the first five years. So, this is within three years or less. You're already hearing early onset of gait problems and falling, and particularly falling backwards rather than forwards as often Parkinson's disease patients do. You're hearing early speech problems and maybe a subtle hint of cognitive slowing and some withdrawal. So, a lot of things that sort of are red flags. So, our approach really would be examining this patient really closely. Okay? We'd be listening to the history, looking at the patient. One thing is that some of these patients come in, they may be in a wheelchair already. That's a red flag for us. If they're wearing sunglasses---sometimes we see that patients, they have photosensitivity and they're in a chair and they're wearing sunglasses---you take the glasses off and you look at their face and they have that sort of a facial stare to them---not just the masked face, but the stare---and their eyes really aren't moving. So, another kind of clue, maybe this is probably something atypical, particularly PSP is what I'm thinking about. So, the approach is really, do a thorough exam. I always recommend looking at eye movements and starting with volitional saccades, not giving them a target necessarily, but asking them to look up and then look down. And then particularly look at the speed of downgaze and whether they actually have full versions down, are able to do that. That's probably your most sensitive test for a patient who has PSP. Not the upgaze, which can be- upgaze impairment in older patients can be nonspecific. So, look for that down gaze. So, if I can get out one message, that's one thing that can be easily done and examined fairly quickly for diagnosis of these patients. And then just look for signs of rigidity, bradykinesia, maybe even some myelopraxia, and then look at their gait carefully so that there's a high suspicion. Again, if there's some atypical features, imaging is really important. So, my next step would be probably getting an MRI to evaluate whether- do they have brain somatrophy or other widespread atrophy or other signs? You need to think about your differential diagnosis for some of these patients as well. So, common things are common; vascular disease, you can't have vascular parkinsonism or even signs of NPH. Both of those can present with progressive gait difficulty and falls. So, the gait may look more like Parkinson's rather than ataxic gait that we see in classic PSP, but still they have early gait issues, and that can be a mimicker of PSP, So looking for both of those things in your imaging. Think about sort of autoimmune potentially causes. So, if they have a really rapid progressive cause, there are some rare autoimmune things. There have been recent reports of things like IgLON5, although there's limited cases, but we're doing more screening for some of those autoimmune causes. And then even some infectious causes like Whipples, that are rarely present like this. Okay? And have other signs and features. Dr Monteith: So, let's say you diagnose this patient with PSP and you're assessing the patients to see how you can improve their quality of life. So, what are some potential symptomatic managements that will help our patient? Dr Farland: I recommend for most all of these patients… while the literature indicates that many patients with PSP, and especially corticobasal syndrome, don't respond well to levodopa. So, the classic treatment for parkinsonism. However, we all recommend a trial of levodopa. These patients may respond partially to doses of levodopa, and we try to push the doses a bit higher. So, the recommended trial is usually a dose up to roughly 1000 milligrams of levodopa per day. And give it some time, at least two, if not actually three months of a trial. If not well-tolerated, you can back off. If there's no response at all or no improvement, then slowly back off and taper patients off and ask them to tell you whether they feel like they're actually worsening. So, many patients, sometimes, don't recognize the improvements, or family members don't recognize it until we actually taper them back off. And they may end up saying there are some other things that even recognize. Even some nonmotor benefits can be seen with levodopa. In some cases, we do keep them on levodopa, but levodopa's our best therapy for this. Dopamine agonists, MAO inhibitors, have all been sort of tried and they've been studied, but often don't really help or fail to help benefit these patients and could be fraught with some other side effects. I think many people do also turn to Amantadine as a treatment for Parkinson's, gait problems, freezing, if you see it in these disorders. Yet Amantadine is fraught with issues of side effects, including cognitive issues, and I think is not well-tolerated. But there are the rare patient who actually does respond to this or claims they respond to this. By and large, these patients relentlessly progress, unfortunately. So, beside treatment of other symptoms, I think it's really important to recognize that they require supportive cares and therapy. So, starting those early on and getting your allied healthcares kind of involved. So that includes people like physical, occupational therapy for the gait issues, the falls, occupational therapy for doing daily activities. Speech language pathology can be really a critical player for these because of the early speech and language issues, as well as swallow difficulties. Swallow is compared quickly in these patients. And so, we do recommend the screening evaluation, then often following patients either every six- or even annually, at least, with a swallow evaluation. And we recommend the fluoroscopic-guided kind of modified barium swallow for these patients.  Dr Monteith: And how does that differ if, let's say, the patient had cortical basilar syndrome? What are some of the symptomatic treatments that would be high on your consideration? Dr Farland: So actually, these patients also have a very similar approach, and they often have some overlapping features. Maybe a little bit of difference in terms of the level of apraxia and some dystonic features that you see in corticobasal syndrome. So, as I mentioned earlier that these patients have a more typ- when they present, typically have a more asymmetric presentation. And one of the biggest issues is this limb apraxia. They may have abnormal movements as well as, like, the alien limb-type phenomena as well. So, the focus of therapy, while similar in the sense we focus on the parkinsonism, I do always try levodopa and try to ramp up the doses to see if it benefits. It does often fail, but it's definitely worth trying. The other focus of these patients is trying to treat symptoms. Dystonia, those features… in some cases, we can help; if it's painful or uncomfortable, muscle relaxants can be used. If it's vocal, things like Botox can be really helpful. Often times it is more palliative than actually restorative in terms of function, but still can be really helpful for patients who ask about pain and discomfort and trying to treat. And then of course, again, the focus on our supportive care. We need to build that network and build that team of folks, the therapists, the physical, occupational, and the speech therapist to help them. If they have language problems---like either in PSP or corticobasal---I'll also include my request to a speech language pathologist to work on cognitive function. That's a special, additional thing you have to ask for and then specifically request when you make a referral to a speech language pathologist. Dr Monteith: That is so important. I think keeping the simulation, keeping the social support, and I would probably guess that you would also include screening for sleep and mood disorder. Dr Farland: Absolutely. Mood disorders are really big in these diseases. Patients are suffering terribly. You do hear about labile mood in both of these diseases, particularly PSP; and even what's called pseudobulbar palsy, where the mood is not always congruent with the affect. So they may laugh or cry inappropriately, and particularly the crying can be very disturbing to family and caregivers to see that. And so, treating those things can be really important. So always asking about the mood issues. Depression in particular is something that we're very sensitive about, and there is a higher incidence of suicidal ideations. Asking about that and feeling and making sure that they are in a safe environment can be really important. Dr Monteith: Thank you so much. Dr Farland: Thank you. Dr Monteith: Today I've been interviewing Dr Nikolaus McFarland about his article on progressive supranuclear palsy and cortical basilar syndrome, which appears in the August 2025 Continuum issue on movement disorders. 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.

In part four of this foundational neurology series, Casey Kozak explores neuroleptic malignant syndrome and highlights key similarities and differences with malignant hyperthermia. 

16 months ago, yoga/meditation/sound teacher Reggie Hubbard had a near-death experience, a major stroke. He visits the podcast to describe the experience of his "neurological storm" and the path of collapse and healing that he's been on ever since, and how it has profoundly affected his views as a practitioner, teacher, and his views of the neurological storm that the United States and the world is currently experiencing. If there's such a thing as a "must-listen" episode of this podcast, this it it.  Reggie Hubbard is a senior political strategist, certified yoga and meditation teacher, and founder of Active Peace Yoga. He bridges the worlds of activism and wellness, helping changemakers cultivate inner peace as a foundation for meaningful civic engagement. His mission is to support activists in finding balance while encouraging the wellness community to become more socially conscious. With a background in global marketing, government relations, and activism, Reggie holds a B.A. in philosophy from Yale and an M.B.A. in international strategy from Vlerick Business School. He turned to yoga in 2014 during a period of deepprofessional adversity, and has since studied with renowned teachers including Faith Hunter, Rod Stryker, Dharma Mittra, and Jack Kornfield. Through Active Peace Yoga, Reggie offers accessible yoga rooted in inclusion and healing, drawing inspiration fromartists like Prince and Jimi Hendrix. His teaching blends movement, meditation, and breathwork with honest conversation and compassion. Following a major stroke, his recovery journey further deepened his commitment to contemplative practice. A passionate advocate for equity in wellness, Reggie advises studios and organizations on diversity and inclusion. He has been featured by Yoga Journal, Kripalu, the Omega Institute, Be Here Now Network, and more. He also supports community programs including Black Boys Om and The Food Group. Reggie currently resides in Maryland. Please support the podcast via Substack and subscribe for free or with small monthly contributions. Additional links and show notes are available there. Paid subscribers will receive occasional extras like guided meditations, extra podcast episodes and more! The Thursday Meditation Group happens each week at 8am ET on Thursdays, and a special guided meditation on Open Awareness in Everyday Life was released this week. Another bonus podcast discussed a mindful take on the Revolutionary Astrology of Summer 2025 with Juliana McCarthy and Ethan Nichtern. These are all available to paid subscribers. You can also subscribe to The Road Home podcast wherever you get your pods (Apple, Spotify,Ethan's Website, etc). Ethan's most recent book, Confidence: Holding Your Seat Through Life's Eight Worldly Winds was just awarded a gold medal in the 2025 Nautilus Book Awards. You can visit Ethan's website to order a signed copy. Please allow two weeks from the time of your order for your copy to arrive. Don't forget to sign up for thee upcoming 5 day retreat at the lovely Garrison Institute Sep 29 - Oct 4, 2025 at this link ! Check out all the cool offerings at our podcast sponsor Dharma Moon, including a free webinar with David Nichtern on why become a meditation teacheron Sep 2th, 2025. Free video courses co-taught by Ethan and others, such as The Three Marks of Existence, are also available for download at Dharma Moon.

Tune into the latest podcast from the American Neurological Association (ANA), ANA Investigates: 75 Years of NINDS. This year marks the 75th anniversary of the National Institute of Neurological Disorders and Stroke (NINDS)—an opportunity to reflect on the institute's past achievements and look ahead to the future of neurological research.  This month, ANA Investigates welcomes Dr. Walter Koroshetz, Director of NINDS, in conversation with Dr. Adeline Goss, Neurohospitalist at Highland Hospital. Dr. Koroshetz joined the institute in 2007 as Deputy Director and became Director in 2015. Before joining the NINDS, he served as Vice Chair of Neurology, Director of Stroke and Neurointensive Care Services at Massachusetts General Hospital, and neurologist in the MGH Huntington's Disease Clinic.   Tune in as they discuss highlights from the NINDS's 75-year history and explore what lies ahead for neurological research and innovation. Guest: Walter J. Koroshetz, MD, FANA Director National Institute of Neurological Disorders and Stroke Interviewer: Adeline Goss, MD Neurohospitalist Highland Hospital Disclosures: None

In this episode of Talk Nerdy, Cara is joined by professor in the Departments of Neurology and Psychiatry and Behavioral Sciences at the UC San Francisco, Dr. Virginia Sturm. They discuss her book: Mysteries of the Social Brain: Understanding Human Behavior Through Science. Follow Virginia: @brainsturming

Dr. Jeff Ratliff talks with Dr. Valtteri Kaasinen about the clinical challenges of diagnosing Parkinson disease and how that diagnosis can evolve over time.  Read the related article in Neurology®.  Disclosures can be found at Neurology.org. 

In part three of this foundational neurology series, Casey Kozak discusses malignant hyperthermia caused by inhaled anesthetics and depolarizing neuromuscular blockers.   

In this episode of the SRNA "Ask the Expert" podcast moderated by Dr. GG deFiebre, Dr. Kyle Blackburn and Dr. Benjamin Greenberg discussed the need for updated diagnostic criteria for myelitis. Dr. Blackburn explained the term myelitis and the importance of precise terminologies for accurate diagnoses and research [00:05:10]. Dr. Greenberg elaborated on the advancements in testing and understanding of associated disorders like NMOSD and MOGAD since 2002 [00:11:10]. Both experts stated that the shift from "transverse myelitis" to "myelitis" will aid future research, treatments, and patient care [00:17:27]. They reassured patients that these changes would essentially refine their care but not alter it dramatically [00:23:40]. They encouraged patients to stay informed and communicate with their healthcare providers about these updates [00:28:58].Kyle Blackburn, MD is an Assistant Professor in the Department of Neurology at UT Southwestern Medical Center in Dallas, Texas. He specializes in neuroimmunology and has clinical interests in antibody-mediated neurologic disorders, including autoimmune encephalitis, epilepsy, and ataxias; neurologic complications of cancers, including paraneoplastic disorders and checkpoint inhibitor/CAR T-cell toxicity; and demyelinating disorders, including sarcoidosis, neuromyelitis optica, myelin oligodendrocyte glycoprotein (MOG)-associated disease, and multiple sclerosis. Dr. Blackburn earned his medical degree at the University of Kentucky College of Medicine. He performed his residency in adult neurology at UT Southwestern, serving his final year as Chief Resident, and stayed to complete a fellowship in neuroimmunology, during which he earned the James T. Lubin Clinician Scientist Award from the Siegel Rare Neuroimmune Association (SRNA). He joined the UT Southwestern faculty in 2020.Benjamin M. Greenberg, M.D., M.H.S. is a Professor and the Cain Denius Scholar in Mobility Disorders in the Department of Neurology at UT Southwestern Medical Center in Dallas, Texas. He currently serves as the Vice Chair of Translational Research and Strategic Initiatives for the Department of Neurology. He is also the interim Director of the Multiple Sclerosis Center and the Director of the Neurosciences Clinical Research Center. In addition, he serves as Director of the Transverse Myelitis and Neuromyelitis Optica Program and the Pediatric Demyelinating Disease Program at Children's Medical Center.Dr. Greenberg earned his medical degree at Baylor College of Medicine before completing an internal medicine internship at Chicago's Rush Presbyterian-St. Luke's Medical Center. He performed his neurology residency at the Johns Hopkins School of Medicine. He also holds an M.H.S. in molecular microbiology and immunology from the Bloomberg School of Public Health, as well as a bachelor's degree in the history of medicine – both from Johns Hopkins. Prior to his recruitment to UT Southwestern in 2009, Dr. Greenberg was on the faculty of the Johns Hopkins Division of Neuroimmunology, serving as the Director of the Encephalitis Center and Co-Director of the nation's first dedicated Transverse Myelitis Center.Dr. Greenberg splits his clinical time between adult and pediatric patients at William P. Clements Jr. and Zale Lipshy University Hospitals, Parkland, and Children's Medical Center. His research focuses on better diagnosing, prognosticating, and treating demyelinating diseases and nervous system infections. He also coordinates clinical trials to evaluate new treatments to prevent neurologic damage and restore function to affected patients. 00:00 Introduction00:58 Overview of Myelitis and Diagnostic Criteria02:57 Historical Context and Importance of Updated Criteria05:10 Challenges with Current Terminology11:10 Changes in Understanding and Diagnostic Approaches17:27 Implications for Patients and Clinical Practice23:40 Impact on Research and Future Directions28:58 Patient Advocacy31:17 Conclusion

Kathryn Moore discusses going into neurology as a second career with neurologists Dr. Jodi Hawes and Dr. Shruti Agashe, former physical therapist and biomedical engineer, respectively. They discuss the reasons for switching, what was easy and what was hard about making the switch, and the things they learned along the way.

Dr. Trey Bateman and Dr. David T. Jones discuss how the StateViewer system leverages FDG-PET imaging and machine learning to improve diagnostic accuracy and clinical decision-making for Alzheimer disease and related disorders. Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000213831 

Dr. Trey Bateman talks with Dr. David T. Jones about how the StateViewer system leverages FDG-PET imaging and machine learning to improve diagnostic accuracy and clinical decision-making for Alzheimer disease and related disorders. Read the related article in Neurology®.  Disclosures can be found at Neurology.org. 

Dr. Dan Ackerman talks with Dr. Urs Fischer about the optimal timing of anticoagulation after ischemic stroke in patients with atrial fibrillation.  show reference: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00439-8/fulltext  

In this episode of the Brain and Life podcast, Dr. Daniel Correa is joined by guest co-host Dr. Proleta Datta, assistant professor and epileptologist at Oregon Health & Science University who specializes in hard‑to‑treat seizures and improving access to epilepsy care. They delve into the complex relationship between epilepsy and driving safety, discussing the latest guidelines and recommendations while highlighting the importance of personalized care for all people living with epilepsy. Tune in to learn about the legal and practical aspects of driving with epilepsy, and discover resources available to support independence and mobility for all.   Additional Resources New Position Statement: When People with Epilepsy Can Safely Drive Again Navigating Life with Epilepsy When Is It Time to Stop Driving Because of a Neurologic Condition?   Other Brain & Life Podcast Episodes on Similar Topics JenVon Cherry on Educating Communities of Color About Epilepsy Actor Cameron Boyce's Legacy and Raising Awareness About SUDEP Tiffany Kairos on Finding Her Voice in Epilepsy Advocacy   We want to hear from you! Have a question or want to hear a topic featured on the Brain & Life Podcast? Record a voicemail at 612-928-6206 Email us at BLpodcast@brainandlife.org Social Media Guests: Dr. Proleta Datta @oshunews  Hosts: Dr. Daniel Correa @neurodrcorrea; Dr. Katy Peters @KatyPetersMDPhD

In this episode, editor in chief Joseph E. Safdieh, MD, FAAN, highlights articles about whether small fiber neuropathy is an autoimmune disorder; Merit Cudkowicz, MD, MSc, FAAN, recipient of this year's AAN Lifetime Achievement Award for Clinically Relevant Research; and how neurologist couples pursue work-life balance.

In this episode, I sit down with preventative neurologist, Dr. Kellyann Niotis to talk about the importance of brain health. We discuss how to protect our cognitive function and prevent neurodegenerative diseases like Alzheimer's, Dementia, and Parkinson's. Dr. Niotis shares her insights on risk factors, early detection testing, and lifestyle choices that can significantly impact our brain health. I was fortunate enough to do my own preventative testing with her before this episode, so we touch on my experience with concussions, my family history, and how they both impact my own brain health.Key Takeaway / Points:What is preventive neurology and why is it crucial for our long-term health?Innovative testing methods and the importance of early detectionWhy brain health matters starting in your 30s and 40sThe connection between mental health and neurodegenerative diseasesThe role of genetics in brain healthThe link between lifestyle choices and neurodegenerative diseases, plus the effects of alcohol, cannabis, and social media on the brainWhy women are at higher risk for Alzheimer'sHow sleep quality impacts cognitive function and memory consolidationThe importance of diverse experiences and social engagement for brain healthSimple daily habits to boost cognitive functionSponsors:Thrive Market: Go to [ThriveMarket.com/cameron] and start saving today. Sale ends 8/31Crown Maple: Visit CrownMaple.com and use code CAMERON20 at checkout for 20% off your orderArya: Go to Arya.Fyi/Cameron to get 15% off your first orderCotton: Learn more at TheFabricOfOurLives.comLMNT: Right now LMNT is offering a free 8-count Sample Pack of their most popular drink flavors with any purchase. Get yours at DrinkLMNT.com/cameronFollow Dr. Kellyann Niotis:Instagram: @drkellyanniotisWebsite: drkellyanniotis.comFollow me:Instagram: @cameronoaksrogers and @conversationswithcamSubstack: Fill Your CupWebsite: cameronoaksrogers.comTikTok: @cameronoaksrogers and @conversations_with_camYoutube: Cameron RogersSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In today's VETgirl online veterinary continuing education podcast, we interview Dr. Nick Jeffery, BVSc, PhD, MSc, DECVS, DECVN, Professor in Neurology and Neurosurgery from Texas A&M on a recent study by Freeman et al entitled “Percutaneous enzymatic chemonucleolysis of intervertebral disks appears safe and effective in treatment of acute-onset paraparesis and paraplegia in small dogs,” published in JAVMA in March 2025. Can the use of intradiscal chondroitinase ABC (often called "CHASE") injections under fluoroscopic-guidance work as a safe, minimally invasive option for small dogs with acute nonambulatory paraparesis or paraplegia, especially when deep pain perception is intact? If you're a general practitioner who sees a lot of down dogs—and especially if you practice in a Dachshund-heavy region—you'll definitely want to tune in.

Schizophrenia may develop in people of all ages, and the early signs of the disorder vary greatly from person to person. While the symptoms are the same, the presentation of them can change due to age of onset, gender, and severity. Host Rachel Star Withers, a diagnosed schizophrenic, and co-host Gabe Howard explore how the early signs of schizophrenia can present differently and specific behaviors to watch for. Joining them is Dr. Gus Alva, a distinguished fellow of the American Psychiatric Association and board certified by the American Board of Psychiatry and Neurology and the American Board of Geriatrics. As an author and coauthor, Dr. Alva's work has been published in peer-reviewed medical journals, including the International Journal of Geriatric Psychiatry and the Journal of the American Psychiatric Association. He has been featured on numerous media outlets and has served as an expert guest in various television programs, such as CNN News. About Our Guest & Hosts Our guest, Dr. Gus Alva, is a Distinguished Fellow of the American Psychiatric Association. He is also Board Certified by the American Board of Psychiatry and Neurology and the American Board of Geriatrics. He completed his residency training at the University of California, Irvine Medical Center in the Department of Psychiatry and Human Behavior, where he served as chief resident during his final year of residency. He also served as an associate professor and deputy director in the department of psychiatry at U.C. Irvine Medical Center, and he is currently serving as an assistant professor at U.C. Riverside Medical School, Department of Neuroscience. As author or co-author, his work has been published in peer-reviewed medical journals, including the International Journal of Geriatric Psychiatry, The Journal of the American Psychiatric Association, and Clinics in Geriatric Medicine. He has published numerous articles and presented at national and international meetings and conferences. He was the recipient of the First Annual Senior Care Humanitarian Award as Outstanding Physician in Dementia Care and the Physician's Recognition Award by the American Medical Association. He has been featured in numerous media outlets and has served as an expert guest in various television programs, such as CNN News, Inside OC, Salud Es Vida, Despierta America, The Morning Blend, Healthy Body, Healthy Mind. Our host, Rachel Star Withers, (Link: www.rachelstarlive.com) is an entertainer, international speaker, video producer, and schizophrenic. She has appeared on MTV's Ridiculousness, TruTV, NBC's America's Got Talent, Marvel's Black Panther, TUBI's #shockfight, Goliath: Playing with Reality, and is the host of the Healthline podcast “Inside Schizophrenia”. She grew up seeing monsters, hearing people in the walls, and having intense urges to hurt herself. Rachel creates videos documenting her schizophrenia, ways to manage, and letting others like her know they are not alone and can still live an amazing life. She has created a kid's mental health comic line, The Adventures of ____.  (Learn more at this link: https://www.amazon.com/Adventures-Fearless-Unstoppable-Light-Ambitious/dp/B0FHWK4ZHS ) Fun Fact: She has wrestled alligators.  Our cohost, Gabe Howard, is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, "Mental Illness is an Asshole and other Observations," available from Amazon; signed copies are also available directly from the author. He also hosts the twice Webby honored podcast, Inside Bipolar, with Dr. Nicole Washington. To learn more about Gabe, please visit his website, gabehoward.com. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Bradley Ong shares early insights from the EMERGE trial, presented at the American Headache Society's 67th Annual Scientific Meeting in June 2025.  Show reference:  https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/head.14957

Multiple system atrophy is a rare, sporadic, adult-onset, progressive, and fatal neurodegenerative disease. Accurate and early diagnosis remains challenging because it presents with a variable combination of symptoms across the autonomic, extrapyramidal, cerebellar, and pyramidal systems. Advances in brain imaging, molecular biomarker research, and efforts to develop disease-modifying agents have shown promise to improve diagnosis and treatment. In this episode, Casey Albin, MD speaks with Tao Xie, MD, PhD, author of the article “Multiple System Atrophy” in the Continuum® August 2025 Movement Disorders issue. Dr. Albin is a Continuum® Audio interviewer, associate editor of media engagement, and an assistant professor of neurology and neurosurgery at Emory University School of Medicine in Atlanta, Georgia. Dr. Xie is director of the Movement Disorder Program, chief of the Neurodegenerative Disease Section in the department of neurology at the University of Chicago Medicine in Chicago, Illinois. Additional Resources Read the article: Multiple System Atrophy 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: @caseyalbin Full episode transcript available here Dr. Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Albin: Hello everyone, this is Dr Casey Albin. Today I'm interviewing Dr Tao Xie about his article on diagnosis and management of multiple system atrophy, which appears in the August 2025 Continuum issue on movement disorders. Welcome to the podcast, and please introduce yourself to our audience. Dr Xie: Thank you so much, Dr Albin. My name is Tao Xie, and sometimes people also call me Tao Z. I'm a mood disorder neurologist, professor of neurology at the University of Chicago. I'm also in charge of the mood disorder program here, and I'm the section chief in the neurodegenerative disease in the Department of Neurology at the University of Chicago Medicine. Thank you for having me, Dr Albin and Dr Okun and the American Academy of Neurology. This is a great honor and pleasure to be involved in this education session. Dr Albin: We are delighted to have you, and thank you so much for the thoughtful approach to the diagnosis and management. I really want to encourage our listeners to check out this article. You know, one of the things that you emphasize is multiple system atrophy is a fairly rare condition. And I suspect that clinicians and trainees who even have a fair amount of exposure to movement disorders may not have encountered that many cases. And so, I was hoping that you could just start us off and walk us through what defines multiple system atrophy, and then maybe a little bit about how it's different from some of the more commonly encountered movement disorders. Dr Xie: This is a really good question, Dr Albin. Indeed, MSA---multisystem atrophy----is a rare disease. It is sporadic, adult-onset, progressive, fatal neurodegenerative disease. By the name MSA, multisystem atrophy. Clinically, it will present with multiple symptoms and signs involving multiple systems, including symptoms of autonomic dysfunction and symptoms of parkinsonism, which is polyresponsive to the levodopa treatment; and the symptom of cerebellar ataxia, and symptom of spasticity and other motor and nonmotor symptoms. And you may be wondering, what is the cause- underlying cause of these symptoms? Anatomically, we can find the area in the basal ganglia striatonigral system, particularly in the putamen and also in the cerebellar pontine inferior, all of the nuclear area and the specific area involved in the autonomic system in the brain stem and spinal cord: all become smaller. We call it atrophy. Because of the atrophy in this area, they are responsible for the symptom of parkinsonism if it is involved in the putamen and the cerebral ataxia, if it's involved in the pons and cerebral peduncle and the cerebellum. And all other area, if it's involved in the autonomic system can cause autonomic symptoms as well. So that's why we call it multisystem atrophy. And then what's the underlying cellular and subcellular pathological, a hallmark that is in fact caused by misfolded alpha-synuclein aggregate in the oligodontia site known as GCI---glial cytoplasmic increasing bodies---in the cells, and sometimes it can also be found in the neuronal cell as well in those areas, as mentioned, which causes the symptom. But clinically, the patient may not present all the symptoms at the same time. So, based on the predominant clinical symptom, if it's mainly levodopa, polyresponsive parkinsonism, then we call it MSAP. If it's mainly cerebellar ataxia, then we call it MSAC. But whether we call it MSP or MSC, they all got to have autonomic dysfunction. And also as the disease progresses, they can also present both phenotypes together. We call that mixed cerebellar ataxia and parkinsonism in the advanced stage of the disease. So, it is really a complicated disease. The complexity and the similarity to other mood disorders, including parkinsonism and the cerebellar ataxia, make it really difficult sometimes, particularly at the early stages of disease, to differentiate one from the other. So, that was challenging not only for other professionals, general neurologists and even for some movement disorder specialists, that could be difficult particularly if you aim to make an accurate and early diagnosis. Dr Albin: Absolutely. That is such a wealth of knowledge here. And I'm going to distill it just a little bit just to make sure that I understand this right. There is alpha-synuclein depositions, and it's really more widespread than one would see maybe in just Parkinson's disease. And with this, you are having patients present with maybe one of two subtypes of their clinical manifestations, either with a Parkinson's-predominant movement disorder pattern or a cerebellar ataxia type movement disorder pattern. Or maybe even mixed, which really, you know, we have to make things quite complicated, but they are all unified and having this shared importance of autonomic features to the diagnosis. Have I got that all sort of correct? Dr Xie: Correct. You really summarize well. Dr Albin: Fantastic. I mean, this is quite a complicated disease. I would pose to you sort of a case, and I imagine this is quite common to what you see in your clinic. And let's say, you know, a seventy-year-old woman comes to your clinic because she has had rigidity and poor balance. And she's had several falls already, almost always from ground level. And her family tells you she's quite woozy whenever she gets up from the chair and she tends to kind of fall over. But they noticed that she's been stiff,and they've actually brought her to their primary care doctor and he thought that she had Parkinson's disease. So, she started levodopa, but they're coming to you because they think that she probably needs a higher dose. It's just not working out very well for her. So how would you sort of take that history and sort of comb through some of the features that might make you more concerned that the patient actually has undiagnosed multiple systems atrophy? Dr Xie: This is a great case, because we oftentimes can encounter similar cases like this in the clinic. First of all, based on the history you described, it sounds like an atypical parkinsonism based on the slowness, rigidity, stiffness; and particularly the early onset of falls, which is very unusual for typical Parkinson disease. It occurs too early. If its loss of balance, postural instability, and fall occurred within three years of disease onset---usually the motor symptom onset---then it raises a red flag to suspect this must be some atypical Parkinson disorders, including multiple system atrophy. Particularly, pou also mentioned that the patient is poorly responsive to their levodopa therapy, which is very unusual because for Parkinson disease, idiopathic Parkinson disease, we typically expect patients would have a great response to the levodopa, particularly in the first 5 to 7 years. So to put it all together, this could be atypical parkinsonism, and I could not rule out the possibility of MSA. Then I need to check more about other symptoms including autonomic dysfunction, such as orthostatic hypertension, which is a blood pressure drop when the patient stands up from a lying-down position, or other autonomic dysfunctions such as urinary incontinence or severe urinary retention. So, in the meantime, I also have to put the other atypical Parkinson disorder on the differential diagnosis, such as PSP---progressive supranuclear palsy---and the DLBD---dementia with Lewy body disease.---Bear this in mind. So, I want to get more history and more thorough bedside assessment to rule in or rule out my diagnosis and differential diagnosis. Dr Albin: That's super helpful. So, looking for early falls, the prominence of autonomic dysfunction, and then that poor levodopa responsiveness while continuing to sort of keep a very broad differential diagnosis? Dr Xie: Correct. Dr Albin: One of the things that I just have to ask, because I so taken by this, is that you say in the article that some of these patients actually have preservation of smell. In medical school, we always learn that our Parkinson's disease patients kind of had that early loss of smell. Do you find that to be clinically relevant? Is that- does that anecdotally help? Dr Xie: This is a very interesting point because we know that the loss of smelling function is a risk effect, a prodromal effect, for the future development of Parkinson disease. But it is not the case for MSA. Strange enough, based on the literature and the studies, it is not common for the patient with MSA to present with anosmia. Some of the patients may have mild to moderate hyposmia, but not to the degree of anosmia. So, this is why even in the more recent diagnosis criteria, the MDS criteria published 2022, it even put the presence of anosmia in the exclusion criteria. So, highlight the importance of the smell function, which is well-preserved for the majority in MSA, into that category. So, this is a really interesting point and very important for us, particularly clinicians, to know the difference in the hyposmia, anosmia between the- we call it the PD, and the dementia Lewy bodies versus MSA. Dr Albin: Fascinating. And just such a cool little tidbit to take with us. So, the family, you know, you're talking to them and they say, oh yes, she has had several fainting episodes and we keep taking her to the primary care doctor because she's had urinary incontinence, and they thought maybe she had urinary tract infections. We've been dealing with that. And you're sort of thinking, hm, this is all kind of coming together, but I imagine it is still quite difficult to make this diagnosis based on history and physical alone. Walk our listeners through sort of how you're using MRI and DAT scan and maybe even some other biomarkers to help sort of solidify that diagnosis. Dr Xie: Yeah, that's a wonderful question. Yeah. First of all, UTI is very common for patients with MSA because of urinary retention, which puts them into a high risk of developing frequent UTI. That, for some patients, could be the very initial presentation of symptoms. In this case, if we check, we say UTI is not present or UTI is present but we treat it, then we check the blood pressure and we do find also hypertension---according to new diagnosis criteria, starting drop is 20mm mercury, but that's- the blood pressure drop is ten within three minutes. And also, in the meantime the patients present persistent urinary incontinence even after UTI was treated. And then the suspicion for MS is really high right at this point. But if you want increased certainty and a comfortable level on your diagnosis, then we also need to look at the brain MRI mark. This is a required according to the most recent MDS diagnosis criteria. The presence of the MRI marker typical for MSA is needed for the diagnosis of clinically established MSA, which holds the highest specificity in the clinical diagnosis. So then, we have- we're back to your question. We do need to look at the brain MRI to see whether evidence suggestive of atrophy around the putamen area, around the cerebellar pontine inferior olive area, is present or not. Dr Albin: Absolutely. That's super helpful. And I think clinicians will really take that to sort of helping to build a case and maybe recognizing some of this atypical Parkinson's disease as a different disease entity. Are there any other biomarkers in the pipeline that you're excited about that may give us even more clarity on this diagnosis? Dr Xie: Oh, yeah. This is a very exciting area. In terms of biomarker for the brain imaging, particularly brain MRI, in fact, today there's a landmark paper just published in the Java Neurology using AI, artificial intelligence or machine learning aid, diagnoses a patient with parkinsonism including Parkinson's disease, MSA, and PSP, with very high diagnostic accuracy ranging from 96% to 98%. And some of the cases even were standard for autopsy, with pathological verification at a very high accurate rate of 93.9%. This is quite amazing and can really open new diagnosis tools for us to diagnose this difficult disease; not only in an area with a bunch of mood disorder experts, but also in the rural area, in the area really in need of mood disorder experts. They can provide tremendous help to provide accurate, early diagnosis. Dr Albin: That's fantastic and I love that, increasing the access to this accurate diagnosis. What can't artificial intelligence do for us? That's just incredible. Dr Xie: And also, you know, this is just one example of how the brain biomarker can help us. Theres other---a fluid biomarker, molecular diagnostic tools, is also available. Just to give you an example, one thing we know over the past couple years is skin biopsy. Through the immunofluorescent reaction, we can detect whether the hallmark of abnormally folded, misfolded, and the phosphorate, the alpha-synuclein aggregate can be found just by this little pinch of skin biopsy. Even more advanced, there's another diagnosis tool we call the SAA, we call the seizure amplification assay, that can even help us to differentiate MSA from other alpha-synucleinopathy, including Parkinson disease and dementia with Lewy bodies. If we get a little sample from CSF, spinal cerebral fluids, even though this is probably still at the early stage, a lot of developments still ongoing, but this, this really shows you how exciting this area is now. We're really in a fast forward-moving path now. Dr Albin: It's really incredible. So, lots coming down the track in, sort of, MRI, but also with CSF diagnosis and skin biopsies. Really hoping that we can hone in some of those tools as they become more and more validated to make this diagnosis. Is that right? Dr Xie: Correct. Dr Albin: Amazing. We can talk all day about how you manage these in the clinic, and I really am going to direct our listeners to go and read your fantastic article, because you do such an elegant job talking about how this takes place in a multidisciplinary setting, if at all possible. But as a neurointensivist, I was telling you, we have so much trouble in the hospital. We have A-lines, and we have the ability to get rapid KUBs to look at Ilias, and we can have many people as lots of diagnosis, and we still have a lot of trouble treating autonomiclike symptoms. Really, really difficult. And so, I just wanted to kind of pick your brain, and I'll start with just the one of orthostatic hypotension. What are some of the tips that you have for, you know, clinicians that are dealing with this? Because I imagine that this is quite difficult to do without patients. Dr Xie: Exactly. This is indeed a very difficult symptom to deal with, particularly at an outpatient setting. But nowadays with the availability of more medication---to give an example, to treat patients with orthostatic hypertension, we have not only midodrine for the cortisol, we also have droxidopa and several others as well. And so, we have more tools at hand to treat the patient with orthostatic hypertension. But I think the key thing here, particularly for us to the patient at the outpatient setting: we need to educate the patient's family well about the natural history of the disease course. And we also need to tell them what's the indication and the potential side effect profile of any medication we prescribe to them so that they can understand what to expect and what to watch for. And in the meantime, we also need to keep really effective and timely communication channels, make sure that the treating physician and our team can be reached at any time when the patient and family need us so that we can be closely monitoring, their response, and also monitoring potential side effects as well to keep up the quality of care in that way. Dr Albin: Yeah, I imagine that that open communication plays a huge role in just making sure that patients are adapting to their symptoms, understanding that they can reach out if they have refractory symptoms, and that- I imagine this takes a lot of fine tuning over time. Dr Xie: Correct. Dr Albin: Well, this has just been such a delight to get to talk to you. I really feel like we could dive even deeper, but I know for the sake of time we have to kind of close out. Are there any final points that you wanted to share with our listeners before we end the interview? Dr Xie: I think for the patients, I want them to know that nowadays with advances in science and technology, particularly given a sample of rapid development in the diagnostic tools and the multidisciplinary and multisystemic approach to treatment, nowadays we can make an early and accurate diagnosis of the MSA, and also, we can provide better treatment. Even though so far it is still symptomatically, mainly, but in the near future we hope we can also discover disease-modifying treatment which can slow down, even pause or prevent the disease from happening. And for the treating physician and care team professionals, I just want them to know that you can make a difference and greatly help the patient and the family through your dedicated care and also through your active learning and innovative research. You can make a difference. Dr Albin: That's amazing and lots of hope for these patients. Right now, you can provide really great care to take care of them, make an early and accurate diagnosis; but on the horizon, there are really several things that are going to move the field forward, which is just so exciting. Again today, I've been really greatly honored and privileged to be able to talk to Dr Tao Xie about his article on diagnosis and management of multiple system atrophy, which appears in the August 2025 Continuum issue on movement disorders. Be sure to check out Continuum Audio episodes for this and other issues. And thank you again to our listeners for joining us today. Dr Xie: Thank you so much for having me. 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.

In part two of this foundational neurology series, Casey Kozak discusses key differences and clinical implications of subdural hematomas.

Dr. Dan Ackerman talks with Dr. Urs Fischer about the optimal timing of anticoagulation after ischemic stroke in patients with atrial fibrillation.  Read the related article in The Lancet.  Disclosures can be found at Neurology.org.   

In part one of this foundational neurology series, Casey Kozak discusses how to interpret a head CT as well as the clinical presentation of epidural hematomas.   

In part one of this foundational neurology series, Casey Kozak discusses epidural and subdural hematomas.  

Dr. Wilner would love your feedback! Click here to send a text! Thanks!Many thanks to Rashie Jain for joining me on this episode of The Art of Medicine with Dr. Andrew Wilner!  Rashie is an engineer and Co-Founder of Marvix.AI, her second start-up. Rashie observed that many physicians struggle with high administrative burdens, especially medical specialists who spend more time with patients and deal with complex cases. With the advent of large language models, she created an "ambient scribe" that takes notes during a patient encounter, organizes them, and presents them for review as a finished product. With just a little tweaking, doctors can embed these notes into the electronic medical record (EMR). I tried out Rashie's software at the recent American Academy of Neurology meeting in San Diego, CA. Her Co-Founder played the role of a migraine patient, and we chatted for about 10 minutes. Truth be told, the ambient scribe did a great job capturing the essential details. I could have edited it in just a couple of minutes, which would save time compared to typing it into the EMR myself! To learn more about Marvix.AI, or to try it in your own office, please contact Rashie Jain at https://www.marvixapp.ai#AI #ambientscribe #largelanguagemodel #womenentrepreneurPlease click "Fanmail" and share your feedback!If you enjoy an episode, please share with friends and colleagues. "The Art of Medicine with Dr. Andrew Wilner" is now available on Alexa! Just say, "Play podcast The Art of Medicine with Dr. Andrew Wilner!" To never miss a program, subscribe at www.andrewwilner.com. You'll learn about new episodes and other interesting programs I host on Medscape.com, ReachMD.com, and RadioMD.com. Please rate and review each episode. To contact Dr. Wilner or to join the mailing list: www.andrewwilner.com Finally, this production has been made possible in part by support from “The Art of Medicine's” wonderful sponsor, Locumstory.com, a resource where providers can get real, unbiased answers about locum tenens. If you are interested in locum tenens, or considering a new full-time position, please go to Locumstory.com. Or paste this link into your browser: https://locumstory.com/?source=DSP_directbuy_drwilnerpodcast_ph...

Drs. Jeff Ratliff, Michael A. Van Es, and Eva de Boer discuss what this study taught us about the value and application of the 2020 consensus criteria for diagnosing primary lateral sclerosis.  Show reference:  https://www.neurology.org/doi/10.1212/WNL.0000000000213461 

  Interviewees: Tom Pisano, MD PhD and Laura Ashley Stein, MD, MS, Ed. Interviewer: Lisa Meeks, PhD, MA Description: In Episode 111, Dr. Lisa Meeks talks with Dr. Tom Pisano (former Penn neurology resident; now neuro-hospital medicine and neuro-immunology fellow) and Dr. Laura Stein (Adult Neurology Program Director at Penn) about building an accessible neurology residency for a physician who uses a wheelchair—and how trust, planning, and culture made it work. Together, they trace Tom's match-day disclosure strategy and “find-your-people” approach, an accessibility walk-through with tape measures and ADA checks, and the practical creativity of equivalent rotations when sites differ in accessibility. They also unpack a real barrier—a security policy that blocked ED entry during stroke alerts—and how reframing access as patient safety moved the system. Listeners will hear candid advice for residents (hold onto your “why,” communicate early, invite teaching adaptations) and for program directors (start with goals, not habits; assume success; apply the same creativity you offer patients to your trainees). This episode accompanies a written case study and a Mini Grand Rounds conversation in Learn at ACGME. Part of the ACGME/DWDI Disability Resource Hub, supported by the Josiah Macy Jr. Foundation Catalyst Award, it's a practical guide for PDs, residents, and anyone committed to equitable clinical training.   Transcript: https://docs.google.com/document/d/1xB_Cp8EiekJ9ExUZLP61EvE-0y4HUv22LuRp0D6uNB0/edit?usp=sharing Key words: Medical education, physical disability, disability research, residency, accommodations, wheelchair, SCI, medical technology, residency, neurology, program director, GME, GME Policy Bio: Laura Stein I have been involved in the Neurology Residency Program since 2018, and Director of the program since 2024. I teach residents on multiple inpatient services as well as in outpatient continuity clinic and stroke clinics. I also lead didactic sessions and workshops for resident onboarding and in our resident lecture series. I am particularly interested in expanding resident exposure to structured experiences in medical education and quality improvement and currently mentor multiple residents per year in medical education and quality improvement projects. In 2020, I was honored to receive the University of Pennsylvania Neurology Residents teaching award. I received my masters in medical education from the University of Pennsylvania in 2018. I have been a member of the American Academy of Neurology (AAN) Residency-In-Training Examination Committee since 2019. I have also been a member of the American Heart Association (AHA) Stroke Professional Education Committee since 2016 and currently serve as the Vice Chair of this committee. Clinically, I function predominantly as a neurohospitalist and attend on the stroke inpatient and consult services, the neurology ward service, and the PPMC consult service. I am dedicated to ensuring delivery of high-quality neurologic care across our system and currently am the physician co-lead for our neurovascular disease team, which spans our six-hospital network, as well as our HUP inpatient neurology unit-based quality improvement team. Tom Pisano I enjoy weekend bike rides with my wife, followed by trying out a new restaurant. When traveling, if possible, I always try to get in some monoskiing or scuba diving. I would also consider myself a (very) mildly competitive board gamer. I will be pursuing a combined neurohospitalist/neuroimmunology fellowship to develop expertise in myelopathies. My research includes brain-computer interfaces, especially of the spinal cord. Producer:  Lisa Meeks Follow Us: X: @DocsWith Instagram: @DocsWithDisabilities Linked In: https://www.linkedin.com/company/docs-with-disabilities-initiative Resources:  Disability Resource Hub: https://dl.acgme.org/pages/disability-resource-hub Case Studies in Disability Resource Hub: https://dl.acgme.org/pages/disability-resource-hub#case_studies UME to GME Toolkit:  https://dl.acgme.org/pages/disability-resource-hub-transitions-toolkit-introduction Policy Toolkit: https://dl.acgme.org/pages/disability-resource-hub-policy-toolkit Disability in Graduate Medical Education Program:  https://www.docswithdisabilities.org/digme   Link to Case Study: Coming Soon!              

Dr. Neil Toupin, a child neurologist at UK HealthCare, shares insight for patients and community members about Duchenne muscular dystrophy, a rare disease, and how treatment is evolving.  Learn more about David Toupin, MD 

Dr. Jeff Ratliff talks with Drs. Michael A. Van Es and Eva de Boer about the current diagnostic criteria for PLS, the role of genetic testing, and the clinical implications for patient management.  Read the related article in Neurology®.  Read the additional related article mentioned in this episode. Disclosures can be found at Neurology.org. 

Drs. BJ Hicks, Birgitte Hede Ebbesen, and Boris Modrau discuss fatigue following transient ischemic attack and examine the characteristics of patients who experience pathologic fatigue.  Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000213605   

In part two of this two-part episode of the Brain & Life Podcast, co-host Dr. Daniel Correa speaks with internationally bestselling author Liz Nugent, who shares her journey as a writer and her experiences living with dystonia. Liz discusses her experience with Deep Brain Stimulation and the relationship between her writing and her dystonia diagnosis. Dr. Correa is then joined by world-renowned neurologist and movement disorders specialist Dr. Alfonso Fasano, Chair in Neuromodulation at the University of Toronto and a neurologist at Toronto Western Hospital. Dr. Fasano explains Deep Brain Stimulation and upcoming research for dystonia.   Additional Resources Liz Nugent Dystonia Overview Speaking Up About Dystonia   Other Brain & Life Podcast Episodes on Similar Topics Billy McLaughlin on Life as a Musician with Focal Dystonia Rogers Hartmann on Beating Dystonia Self-Discovery and The Lost Voice with Songwriter Greta Morgan   We want to hear from you! Have a question or want to hear a topic featured on the Brain & Life Podcast? Record a voicemail at 612-928-6206 Email us at BLpodcast@brainandlife.org   Social Media: Liz Nugent @liznugentwriter; Dr. Alfonso Fasano @al_fasao Guests: Hosts: Dr. Daniel Correa @neurodrcorrea; Dr. Katy Peters @KatyPetersMDPhD  

About the Guest(s): Dr. Kristin Hieshetter is a passionate host of the Functional Health Radio and a health expert focusing on functional and neurological health. With ongoing education through the Carrick Institute of Neurology, Dr. Kristin is onboard to become a board-certified neurologist. She is committed to exploring scientific literature and practical health strategies to promote longevity and improve quality of life across various contexts. Dr. Kristin's passion for brain health and energy, structured restoration for youngsters, and continuous learning positions her as an engaging and knowledgeable voice in functional health. Episode Summary: In this intriguing episode of Functional Health Radio, host Dr. Kristin Hieshetter takes listeners on a deep dive into the NRF2 pathway and its remarkable role within the human body. With her characteristic blend of scientific rigor and practicality, Dr. Kristin dissects the complex function of NRF2—nuclear factor erythroid 2-related factor 2—as a cornerstone in antioxidant defense and inflammation control. She explains how NRF2 signaling might revolutionize treatments for inflammatory and neurodegenerative diseases, making this episode a must-listen for health enthusiasts seeking insights into cutting-edge health science. Dr. Kristin's exploration covers NRF2's involvement in cellular protection, detoxification, and its response to environmental and metabolic stressors. With citation to pivotal studies in molecular science, she illuminates NRF2's potential impact on disease processes such as Alzheimer's, cancer, and autoimmune conditions. Her passion for brain health is evident as she links NRF2 activation to improved mitochondrial function and autophagy, underlying its significance in maintaining cognitive function. Through detailed exploration, she emphasizes how compounds like curcumin enhance NRF2 activity, heralding a new frontier in functional health strategies. Key Takeaways: NRF2 Pathway Significance: NRF2 is crucial in regulating the body's response to oxidative stress and inflammation, with promising applications in cancer, neurodegenerative disorders, and metabolic health. Inflammation and Immunity: Inflammation is a key player in various diseases; NRF2 can moderate inflammatory responses by influencing and downregulating harmful gene expressions. Neuroprotective Functions: NRF2 supports brain health by promoting DNA repair, mitochondrial health, and autophagy, suggesting substantial benefits for conditions like Alzheimer's and Parkinson's. Curcumin as NRF2 Activator: The compound curcumin, found in turmeric, activates NRF2 signaling, providing a naturally derived method to enhance cellular defense systems. Lifestyle Recommendations: Strategies such as intermittent fasting and targeted supplementation can support NRF2 activity, promoting better health outcomes and longevity. Notable Quotes: "NRF2 can flip your genes on and off to help you deal with inflammation. Amazing, right?" "This NRF2 can flip itself on or off when you need it. That is incredible." "Autophagy protects you from free radical damage; it helps cells repair themselves." "Learning and memory are enhanced when you are undergoing autophagy." "The NRF2 pathway—inflammation moderation, mitochondrial protection, DNA repair—could become the next therapeutic target in all neurodegenerative diseases." Resources: Molecules Journal: November 2020 publication on the "Overview of NRF2 Signaling Pathway and its Role in Inflammation." International Journal of Molecular Science: September 4, 2021, article by Grzynska et al. on NRF2's role in neurodegenerative diseases. Curcumin Studies: Information on the activation of NRF2 through curcumin, as studied in prostate cancer research. Further Information and Updates: Dr. Kristin's Health Podcast Series (Link to be searched/added separately). Tune in to this enlightening episode today to further your understanding of NRF2's transformative potential in health science. Stay connected with Functional Health Radio for more groundbreaking insights into functional health and wellbeing.

In the final episode of this ten-part series, Dr. Paul Crane and Dr. Prashanth Ramachandran discuss when and where to use clinical metagenomic next-generation sequencing tests, as well as the limitations of these tests.  Show reference:  https://www.nature.com/articles/s41591-024-03275-1 

Frontotemporal lobar degeneration (FTLD) is one of the most common causes of dementia in individuals under the age of 60, yet it remains lesser known and often misunderstood. From the early symptoms to the challenges of diagnosis and treatment, FTLD presents unique hurdles for clinicians, researchers and families alike. Joining the podcast to discuss this complex disease is Dr. Brad Boeve, principal investigator of the ALLFTD study, a major national research effort aimed at identifying biomarkers and clinical tools to improve early detection of FTLD and prepare for future treatment trials.  Guest: Brad Boeve, MD, neurologist, Department of Neurology and Center for Sleep Medicine, professor of neurology, Division of Behavioral Neurology, Mayo Clinic, co-director, Mayo Clinic Alzheimer's Disease Research Center, principal investigator, ARTFL-LEFFTDS Longitudinal Frontotemporal Lobar Degeneration (ALLFTD) research study Show Notes Are you a clinician interested in receiving continuing education (CE) credits for listening to this episode? Find credit designation information, disclosures and evaluation information on our website and on the UW–Madison Interprofessional Continuing Education Partnership (ICEP) website. The accreditation for this course expires 8/12/2026. After this date, you will no longer be able to access the course or claim credit. Learn more about Dr. Boeve and his research at his profile on the Mayo Clinic website.  Listen to our episode with Dr. Wolk, “LATE, Explained,” mentioned by Dr. Chin at 10:12 on our website. Visit the Association for Frontotemporal Degeneration (AFTD) website, mentioned by Dr. Boeve at 21:59. Visit the CurePSP website mentioned by Dr. Boeve at 22:21. Connect with us Find transcripts and more at our website. Email Dementia Matters: dementiamatters@medicine.wisc.edu Follow us on Facebook and Twitter. Subscribe to the Wisconsin Alzheimer's Disease Research Center's e-newsletter. Enjoy Dementia Matters? Consider making a gift to the Dementia Matters fund through the UW Initiative to End Alzheimer's. All donations go toward outreach and production.

Tom Frieden is the president and chief executive officer of Resolve to Save Lives and former director of the Centers for Disease Control and Prevention. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. T.R. Frieden. Dismantling Public Health Infrastructure, Endangering American Lives. N Engl J Med 2025;393:625-627.

Essential tremor is the most common movement disorder, although it is often misdiagnosed. A careful history and clinical examination for other neurologic findings, such as bradykinesia, dystonia, or evidence of peripheral neuropathy, can reveal potential alternative etiologies. Knowledge about epidemiology and associated health outcomes is important for counseling and monitoring for physical impairment and disability. In this episode, Lyell Jones, MD, FAAN, speaks with Ludy C. Shih, MD, MMSc, FAAN, author of the article “Essential Tremor” in the Continuum® August 2025 Movement Disorders issue. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Shih is clinical director of the Parkinson's Disease and Movement Disorders Center at Beth Israel Deaconess Medical Center in Boston, Massachusetts. Additional Resources Read the article: Essential Tremor 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: @LyellJ Guest: @ludyshihmd Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today, I'm interviewing Dr Ludy Shih, who recently authored an article on essential tremor for our latest issue of Continuum on movement disorders. Dr Shih is an associate professor of neurology at Harvard Medical School and the clinical director of the Parkinson's Disease and Movement Disorder Center at Beth Israel Deaconess Medical Center in Boston. Dr Shih, welcome, and thank you for joining us today. Why don't you introduce yourself to our listeners? Dr Shih: Thank you, Dr Jones, for having me. It's a real pleasure to be here on the podcast with you. I'm a neurologist, I trained in movement disorders fellowship, and I currently see patients and conduct clinical research. We offer a variety of treatments and diagnostic tests for our patients with movement disorders. And I have developed this interest, a clinical research interest in essential tremor. Dr Jones: And so, as an expert in essential tremor, the perfect person to write such a really spectacular article. And I can't wait for our listeners to hear more about it and our subscribers to read it. And let's get right to it. If you had, Dr Shih, a single most important message for our listeners about caring for patients with essential tremor, what would that message be? Dr Shih: Yeah, I think the takeaway that I've learned over the years is that people with essential tremor do develop quite a few other symptoms. And although we propose that essential tremor is this pure tremor disorder, they can experience a lot of different comorbidities. Now, there is some debate as to whether that is expected for essential tremor or is this some part of another syndrome, which we may talk about later in the interview. But the fact of the matter is, it's not a benign condition and people do experience some disability from it. Dr Jones: And I think that speaks to how the name of this disorder has evolved over time. right? You point out in your article, it used to be called benign essential tremor or benign familial tremor. But it's really not so straightforward as it. And fairly frequently these symptoms, the patient's tremor, can be functionally limiting, correct? Dr Shih: That is correct. In fact, the reason I probably started getting interested in essential tremor was because our center had been doing a lot of deep brain stimulation for essential tremor, which is remarkably effective, especially for tremor that reaches an amplitude that really no oral medication is going to satisfyingly treat. And if you have enough upper limb disability from this very large-amplitude tremor, a surgical option may make a lot of sense for a lot of patients. And yet, how did they get to that point? Do they continue to progress? These were the sort of interesting questions that got raised in my mind as I started to treat these folks. Dr Jones: We'll come back to treatment in just a minute here, because there are many options, and it sounds like the options are expanding. To start with the diagnosis- I mean, this is an extraordinarily common disorder. As you point out, it is the most common movement disorder in the US and maybe the world, and yet it seems to be underrecognized and frequently misdiagnosed. Why do you think that is? Dr Shih: Great question. It's been pretty consistent, with several case series over the decades showing a fairly high rate of quote/unquote “misdiagnosis.” And I think it speaks to two things, probably. One is that once someone sees a postural and kinetic tremor of the arms, immediately they think of essential tremor because it is quite common. But there's a whole host of things that it could actually be. And the biggest one that we also have to factor in is also the heterogeneity of the presentation of Parkinson's disease. Many people, and I think increasingly now these days, can present with not a whole lot of the other symptoms, but may present with an atypical tremor. And it becomes actually a little hard to sort out, well, do they have enough of these other symptoms for me to suspect Parkinson's, or is the nature of their tremor suspicious enough that it would just be so unusual that this stays essential tremor and doesn't eventually develop into Parkinson's disease? And I think those are the questions that we all still grapple with from time to time in some of our clinics. Dr Jones: Probably some other things related to it with, you know, our understanding of the pathophysiology and the availability of tests. And I do want to come back to those questions here in just a minute, but, you know, just the nomenclature of this disorder… I think our clinical listeners are familiar with our tendency in medicine to use words like essential or idiopathic to describe disorders or phenomena where we don't understand the precise underlying mechanism. When I'm working with our trainees, I call these “job-security terms” because it sounds less humbling than “you have a tremor and we don't know what causes it,” right? So, your article does a really nice job outlining the absence of a clear monogenic or Mendelian mechanism for essential tremor. Do you think we'll ever have a eureka moment in neurology for this disorder and maybe give it a different name? Dr Shih: It's a great question. I think as we're learning with a lot of our neurologic diseases---and including, I would even say, Parkinson's disease, to which ET gets compared to a lot---there's already now so much more known complexity to something that has a very specific idea and concept in people's minds. So, I tend to think we'll still be in an area where we'll have a lot of different causes of tremor, but I'm hopeful that we'll uncover some new mechanisms for which treating or addressing that mechanism would take care of the tremor in a way that we haven't been able to make as much progress on in the last few decades as maybe we would have thought given all the advances in in technology. Dr Jones: That's very helpful, and we'll be hopeful for that series of discoveries that lead us to that point. I think many of our listeners will be familiar with the utility---and, I think, even for most insurance companies, approval---for DAT scans to discriminate between essential tremor and Parkinsonian disorders. What about lab work? Are there any other disorders that you commonly screen for in patients who you suspect may have essential tremor? Dr Shih: Yeah, it's a great question. And I think, you know, I'm always mindful that what I'm seeing in my clinic may not always be representative of what's seen in the community or out in practice. I'll give an example. You know, most of the time when people come to the academic Medical Center, they're thinking, gosh, I've tried this or that. I've been on these medicines for the last ten years. But I've had essential tremor for twenty years. We get to benefit a little bit from all that history that's been laid down. And so, it's not as likely you're going to misdiagnose it. But once in a while, you'll get someone with tremor that just started a month ago or just started, you know, 2 or 3 months ago. And you have to still be thinking, well, I've got to get out of the specialist clinic mindset, and think, well, what else really could this be? And so, while it's true for everybody, moreso in those cases, in those recent onset cases, you really got to be looking for things like medications, electrolyte abnormalities, and new-onset thyroid disorder, for example, thyroid toxicosis. Dr Jones: Very helpful. And your article has a wonderful list of the conditions to consider, including the medications that might be used for those conditions that might result or unmask a tremor of a different cause. And I think being open-minded and not anchoring on essential tremor just because it's common, I think is a is a key point here. And another feature in your article that I really enjoyed was your step-by-step approach to tremor. What are those steps? Dr Shih: Well, I think you know first of all, tremor is such common terminology that even lay people, patients, nonclinicians will use the word “tremor.” And so, it can be tempting when the notes on your schedule says referred for tremor to sort of immediately jump to that. I think the first step is, is it tremor? And that's really something that the clinician first has to decide. And I think that's a really important step. A lot of things can look superficially like tremor, and you shouldn't even assume that another clinician knows what tremor looks like as opposed to, say, myoclonus. Or for example a tremor of the mouth; well, it actually could be orolingual or orobuccal dyskinesia, as in tardive dyskinesia. And another one that tremor can look like is ataxia. And so, I think- while they sound obvious to most neurologists, perhaps, I think that---especially in the area of myoclonus, where it can be quite repetitive, quite small amplitude in some conditions---it can really resemble a tremor. And so, there are examples of these where making that first decision of whether it's a tremor or not can really be a good sort of time-out to make sure you're going down the right path to begin with. And I think what's helpful is to think about some of the clinical definitions of a tremor. And tremor is really rhythmic, it's oscillatory. You should see an agonist and antagonist muscle group moving back and forth, to and fro. And then it's involuntary. And so, I think these descriptors can really help; and to help isolate, if you can describe it in your note, you can probably be more convinced that you're dealing with the tremor. The second step that I would encourage people to really consider: you've established it's a tremor. The most important part exam now becomes, really, the nontremor part of the exam. And it should be really comprehensive to think of what else could be accompanying this, because that's really how we make diagnosis of other things besides essential tremor. There really should be a minimum of evidence of parkinsonism, dystonia, neuropathy, ataxia- and the ataxia could be either from a peripheral or central nervous system etiology. Those are the big four or five things that, you know, I'm very keen to look for and will look pretty much in the head, neck, the axial sort of musculature, as well as the limbs. And I think this is very helpful in terms of identifying cases which turn out to have either, say, well, Parkinson's or even a typical Parkinson disorder; or even a genetic disorder, maybe even something like a fragile X tremor ataxia syndrome; or even a spinal cerebellar ataxia. These cases are rare, but I think if you uncover just enough ataxia, for example, that really shouldn't be there in a person, let's say, who's younger and also doesn't have a long history of tremor; you should be more suspicious that this is not essential tremor that you're dealing with. And then the last thing is, once you've identified the tremor and you're trying to establish, well, what should be done about the tremor, you really have to say what kind of tremor it is so that you can follow it, so you can convey to other people really what the disability is coming from the tremor and how severe the tremor is. So, I think an example of this is, often in the clinic, people will have their patients extend their arms and hands and kind of say, oh, it's an essential tremor, and that's kind of the end of the exam. But it doesn't give you the flavor. Sometimes you'll have a patient come in and have a fairly minimal postural tremor, but then you go out, take those extra few seconds to go grab a cup of water or two cups of water and have them pour or drink. And now all of a sudden you see this tremor is quite large-amplitude and very disabling. Now you have a better appreciation of what you really need to do for this patient, and it might not be present with just these very simple maneuvers that you have at bedside without props and items. And then the severity of it; you know, we're so used to saying mild, moderate, severe. I think what we've done in the Tremor Research Group to use and develop the Essential Tremor Rating Assessment Scale is to get people used to trying to estimate what size the tremor is. And you can do that by taking a ruler or developing a sense of what 1 centimeter, 2 centimeters, 3 centimeters looks like. I think it'd be tremendously helpful too, it's very easy and quick to convey severity in a given patient. Dr Jones: I appreciate you, you know, having a patient-centered approach to the- how this is affecting them and being quantitative in the assessment of the tremor. And that's a great segue to a key question that I run into and I think others run into, which is when to initiate therapy? You know, if you see a patient who, let's say they have a mild tremor or, you know, something that quantitatively is on the mild end of the spectrum, and you have, you know, a series of options… from a medication perspective, you have to say, well, when does this across that threshold of being more likely to benefit the patient than to harm the patient? How do you approach that question? What's your threshold for starting medication? Dr Shih: Yeah. You know, sometimes I will ask, because---and I know this sounds like a strange question---because I feel like my patients will come for a couple of different reasons. Sometimes it's usually one over the other. I think people can get concerned about a symptom of a tremor. So, I actually will ask them, was your goal to just get a sense for what this tremor is caused by? I understand that many people who develop tremor might be concerned it might be something like Parkinson's disease. Or is this also a tremor that is bothering you in day-to-day life? And often you will hear the former. No, I just wanted to get checked out and make sure you don't think it's Parkinson's. It doesn't bother me enough that I want to take medication. They're quite happy with that. And then the second scenario is more the, yeah, no, it bothers me and it's embarrassing. And that's a very common answer you may hear, may be embarrassing, people are noticing. It's funny in that many people with essential tremor don't come to see a doctor or even the neurologist for many years. And they will put up with it for a very long time. And they've adopted all sorts of compensatory strategies, and they've just been able to handle themselves very admirably with this, in some cases, very severe tremor. So, for some of them, it'll take a lot to come to the doctor, and then it becomes clear. They said, I think I'm at the point where I need to do something about this tremor. And so, I think those three buckets are often sort of where my patients fall into. And I think asking them directly will give you a sense of that. But you know, it can be a nice time to try some as-needed doses of something like Propranolol, or if it's something that you know that they're going to need something on day-to-day to get control of the tremor over time, there are other options for that as well. Dr Jones: Seems like a perfect scenario for shared decision-making. Is it bothersome enough to the patient to try the therapy? And I like that suggestion. That's a nice pearl that you could start with an a- needed beta blocker, right, with Propranolol. And this is a question that I think many of us struggle with as well. If you've followed a patient with essential tremor for some time and you've tried different medications and they've either lost effectiveness or have intolerable adverse effects, what is your threshold for referring a patient for at least considering a surgical neurostimulator therapy for their essential tremor? Dr Shih: Yeah, so surgical therapies for tremor have been around for a long time now, since 1997, which was when it was approved by the FDA for essential tremor and Parkinson tremor. And then obviously since then, we have a couple more options in the focus ultrasound thalamotomy, which is a lesioning technique. When you have been on several tremor medications, the list gets smaller and smaller. It- and then chance of likely satisfying benefit from some of these medications can be small and small as you pass through the first and second line agents and these would be the Propranolol and the primidone. And as you say, quite a few patients- it's estimated between 30 to 50% of these patients end up not tolerating these first two medications and end up discontinuing them. Some portion of that might also be due to the fact that some of our patients who have been living with essential tremor for decades now, to the point that their tremor is getting worse, are also getting older. And so, polypharmacy and/or some of the potential side effects of beta blockers and anticonvulsants like primidone may be harder to bear in an older adult. And then as you talk about in the article, there's some level of evidence for topiramate, and then from there a number of anticonvulsants or benzos, which have even weaker evidence for them. It's a personal decision. As I tell folks, look, this is not going to likely extend your life or save your life, but it's a quality of life issue. And of course, if there are other things going on in life that need to be taken care of and they need that kind of care and attention, then, you know, you don't need to be adding this to your plate. But if you are in the position where those other things are actually okay, but quality of life is really affected by your being unable to use your upper limbs in the way that you would like to… A lot of people's hobbies and applications are upper limb-based, and enjoying those things is really important. Then I think that this is something- a conversation that we begin and we begin by talking about yes, there are some risks involved, but fortunately this is the data we have on it, which is a fairly extensive experience in terms of this is the risk of, you know, surgery-related side effects. This is the risk of if you're having stimulation from DBS stimulation-related side effects, which can be adjustable. It's interesting, I was talking with colleagues, you know, after focused ultrasound thalamotomy was approved. That really led more people to come to the clinic and start having these discussions, because that seemed like a very the different sort of approach where hardware wasn't needed, but it was still a surgery. And so, it began that conversation again for a bunch of people to say, you know, what could I do? What could I tolerate? What would I accept in terms of risk and potential benefit? Dr Jones: Well, I think that's a great overview of a disorder where, you know, I think the neurologist's role is really indispensable. Right? I mean, you have to have this conversation not just once, this is a conversation that you have over time. And again, I really want to refer our listeners to this article. It's just a fantastic overview of a common disorder, but one where I think there are probably gaps where we can improve care. And Dr Shih, I want to thank you for joining us, and thank you for such a great discussion on essential tremor. I learned a lot from your article, and I learned even more from the interview today. I suspect our readers and listeners will too. Dr Shih: Well, thank you again for the invitation and the opportunity to kind of spread the word on this really common condition. Dr Jones: Again, we've been speaking with Dr Ludy Shih, author of a fantastic article on essential tremor in Continuum's latest issue on movement disorders. Please check it out, 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.

In part nine of this ten-part series, Dr. Paul Crane and Dr. Prashanth Ramachandran discuss the findings from this study and the implications for global vaccine strategy.  Show reference:  https://pubmed.ncbi.nlm.nih.gov/40086461/     

Dr. BJ Hicks talks with Drs. Birgitte Hede Ebbesen and Boris Modrau about the study's methodology, findings, and implications for clinical practice, emphasizing the need for better awareness and support for TIA patients. Read the related article in Neurology®.  Disclosures can be found at Neurology.org. 

In part two of this two-part series, Dr. Stacey Clardy and Casey R. Vanderlip discuss the changes that neurologists should implement in their clinics based on the findings from this study regarding APOE genotype.  Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000213853  

What if science and spirituality are not in conflict, but are two sides of the same coin? In this episode, Sandra is joined by Dr. Rafael Rezende, an Assistant Professor of Neurology at Harvard Medical School who is also a dedicated lecturer and teacher in the Spiritist community. Dr. Rezende shares his powerful personal journey, from having visions as a child in a Catholic family in Brazil to finding answers in Spiritism. He explains the science behind mediumship, the evidence for reincarnation, and how diseases like autism can be understood from a physical, psychological, and spiritual perspective. Listen to his "goosebump" story of dreaming of his future children and how a pre-birth message gave him a new perspective on a challenging health diagnosis. This is a profound conversation that builds a bridge between the rigorous world of academic science and the expansive truths of the soul. *Find out more about Spiritism at https://spiritist.us/ - the YouTube channel he mentions is https://www.youtube.com/@usspiritistfederation - His talk can be found at: https://www.youtube.com/live/UKX5Yyl0WBc?si=o7GJvIODhGc9WvzF and the film, Nosso Lar (Astral City) can be viewed with English subtitles at https://youtu.be/0uWe-3JYc-Q?si=BNKCMEQcJpKMrztZ Thanks for listening! Connect with Sandra:  * Website (Free book by joining the 'Insiders Club, Free empowering Sunday Gatherings with medium demonstration, Mediumship Classes & more): http://wedontdie.com *Patreon (Early access, PDF of over 750 episodes & more): Visit https://www.patreon.com/wedontdieradio  *Don't miss Sandra's #1 "Best of all things afterlife related" Podcast 'Shades of the Afterlife' at https://bit.ly/ShadesoftheAfterlife

In part one of this two part series, Dr. Stacey Clardy and Casey R. Vanderlip discuss what neurologists need to know about how APOE4 and amyloid interact to impact cognitive function.  Show reference:  https://www.neurology.org/doi/10.1212/WNL.0000000000213853 

Dr. Stacey Clardy talks with Casey R. Vanderlip about whether the accelerated decline in episodic memory among APOE4 carriers is due to increased Aβ deposition or heightened susceptibility to Aβ-related effects.  Read the related article in Neurology®.  Disclosures can be found at Neurology.org. 

A neurologist visits the podcast this week! Fred Wininger, VMD, MS, DACVIM (Neurology) has recently opened a state-of-the-art neurology focused specialty center called The Animal Neurology Center in St. Louis, MO! He joins the podcast to discuss the clinical signs that can overlap between neurology and dermatology. Whether a head tilt, nystagmus or circling, how do you know where to start with your patient? Dr. Wininger has the unique ability to take a complicated subject (he's literally a brain surgeon) and break it down to digestible, practical information.Check out this week's episode of The Derm Vet podcast where we explore the canine brain, ear and beyond!0:00 Intro00:25 Dr. Fred Wininger02:34 Differentiating cases07:57 What other things are considered with peripheral vestibular?10:55 Idiopathic vestibular disease in young dogs13:17 Primary Secretory Otitis Media (PSOM)18:35 Flea Prevention22:45 Skin disease associated with neurologic pain25:11 Dermatomyositis26:55 Outro

Dr. Halley Alexander and Dr. Juan Luis Alcala-Zermeno discuss the outcomes of epilepsy surgery, specifically for patients with tonic-clonic seizures.  Show references:  https://onlinelibrary.wiley.com/doi/10.1111/epi.18243  https://onlinelibrary.wiley.com/doi/full/10.1111/epi.17452  https://directory.libsyn.com/episode/index/id/26286819 

In this episode of the Neurology Minute, Dr. Alison Christy delves into another women's history minute to discuss Tilly Edinger. 

In the August episode of the President's Spotlight, Dr. Jason Crowell and Dr. Natalia Rost discuss the mid-year assessment of AAN's five-year strategic plan.  Show reference:  https://www.aan.com/about-the-aan/presidents-spotlight   

Dr. Halley Alexander talks with Dr. Juan Luis Alcala-Zermeno about the outcomes of epilepsy surgery, specifically for patients with tonic-clonic seizures.  Read the related article in Epilepsia.  Read the additional related article in Epilepsia.  Listen to the previous podcast episode mentioned in this episode.  Disclosures can be found at Neurology.org.   

The invention Eadweard Muybridge is known for is his zoopraxiscope, an early movie technology. But he also innovated in photography, had some other inventions, and was the defendant in a murder trial. Research: Ball, Edward. “The Inventor and the Tycoon: A Gilded Age Murder and the Birth of Moving Pictures.” Doubleday. 2013. Cohen, Paula Marantz. “Flickering Like Photography.” Times Literary Supplement. https://www.the-tls.com/lives/biography/scoundrel-harry-larkyns-pitiless-killing-photographer-eadweard-muybridge-rebecca-gowers-review “A Fast Trotter Caught by a Skillful Artist on the Fly.” The Lamar Republican. May 29, 1873. https://www.newspapers.com/image/666936878/?match=1&terms=occident%20Muybridge%20 “Madness and Murder.” Whidbey Island Center for the Arts. https://www.wicaonline.org/blog/2020/2/2/1rmzzg46joal5ajvy4tesnui7v314p “A Startling Tragedy.” Los Angeles Herald. October 22, 1874. https://cdnc.ucr.edu/?a=d&d=LAH18741022.2.15&e=-------en--20--1--txt-txIN-------- The Editors of Encyclopaedia Britannica. "Eadweard Muybridge". Encyclopedia Britannica, 23 Jun. 2025, https://www.britannica.com/biography/Eadweard-Muybridge The Editors of Encyclopaedia Britannica. "Leland Stanford". Encyclopedia Britannica, 17 Jun. 2025, https://www.britannica.com/biography/Leland-Stanford Higgins, Charlotte. “Eadweard Muybridge's motion towards Tate Britain.” The Guardian. April 27, 2010. https://www.theguardian.com/artanddesign/2010/apr/27/eadweard-muybridge-tate-britain-motion-studies “The Last Call.” San Francisco Examiner. Jul 19, 1875. https://www.newspapers.com/image/457599375/?match=1&terms=Harry%20Larkyns Shimamura, Arthur P. “Muybridge in Motion: Travels in Art, Psychology and Neurology.” History of Photography. 2002. https://doi.org/10.1080/03087298.2002.10443307 Muybridge, Eadweard. “Animal Locomotion. An Electro-Photographic Investigation of Consecutive Phases of Animal Movements. Commenced 1872 - Completed 1885. Volume XI, Wild Animals and Birds.” Met Museum. https://www.metmuseum.org/art/collection/search/266431 Manjila, S., Singh, G., Alkhachroum, A. M., & Ramos-Estebanez, C. (2015). Understanding Edward Muybridge: historical review of behavioral alterations after a 19th-century head injury and their multifactorial influence on human life and culture. Neurosurgical Focus FOC, 39(1), E4. https://doi.org/10.3171/2015.4.FOCUS15121 Prodger, Phillip and Tom Gunning. “Time Stands Still: Muybridge and the Instantaneous Photography Movement.” Iris & B. Gerald Cantor Center for Visual Arts at Stanford University, 2003 Solnit, Rebecca. “River of Shadows: Eadweard Muybridge and the Technological Wild West.” Viking, 2003. Wolf, Byron. “Eadweard Muybridge’s Secret Cloud Collection.” Places Journal. September 2017. https://placesjournal.org/article/eadweard-muybridges-secret-cloud-collection/?cn-reloaded=1 See omnystudio.com/listener for privacy information.