Podcasts about Neurology

In this moment, the world-renowned expert in Neurology and Sleep Medicine, Professor Guy Leschziner outline why sleep is crucial to every aspect of your life, and the biggest mistake people make when it comes to get a good night's sleep. Humans spend a third of their lives sleeping, however science still understands very little about it. Guy says that sleep is of fundamental importance to humans otherwise evolution would have removed it. Despite its importance, Guy thinks that people underestimate the power of sleep. He's says that too often people make lifestyle choices that ensure they will have the worst possible sleep, which can then impact everything from their immune system, cardiovascular system, and mental health. Listen to the full episode here - Spotify- https://g2ul0.app.link//HrQyIkjaIOb Apple -  https://g2ul0.app.link//QMALvueaIOb Watch the Episodes On Youtube - https://www.youtube.com/c/%20TheDiaryOfACEO/videos Guy Leschziner: https://www.guyleschziner.com/ Learn more about your ad choices. Visit megaphone.fm/adchoices

Episode description: We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Bayan presents a case of headache and seizure to Aye. Neurology DDx Schema Aye Chan Moe Thant ( @AyeThant94 ) Aye is a physician from Myanmar and now working as a clinical research team member at the Department… Read More »Episode 366: Neurology VMR – Headache and Seizure

In part one of this two-part series, Dr. Justin Abbatemarco and Dr. Maarten Titulaer discuss long-term cognitive and functional outcomes in patients with anti-NMDAR encephalitis and their implications for rehabilitation. Show reference: https://www.neurology.org/doi/pdf/10.1212/WNL.0000000000210109

Dr. Justin Abbatemarco talks with Dr. Maarten Titulaer about long-term cognitive and functional outcomes in patients with anti-NMDAR encephalitis and their implications for rehabilitation. 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 Dr. Elias Sotirchos discuss abandoning the term lupus myelitis and emphasize the importance of accurately naming and identifying each autoimmune condition. Show reference: https://www.neurology.org/doi/10.1212/NXI.0000000000200329  

Get ready for a new perspective on the secrets of better sleep with Dr. W Chris Winter, an international expert on sleep who has helped more than 10,000 patients rest better at night. A dynamic speaker and researcher on the science of sleep, he is author of two acclaimed books, The Sleep Solution and The Rested Child. In a wellness world where prioritizing sleep has rapidly become as crucial as diet and exercise, Dr. Winter sets out to dispel the many myths about sleep optimization, offering straightforward, effective strategies to help you improve your sleep habits. Join us as we explore the fascinating role sleep stages play in rejuvenating our bodies and minds, discussing the function of REM versus deep sleep and attempting to answer the question, why do we dream? Dr. Winter examines the impact of sleep deprivation, particularly for shift workers, and explains how sleep orchestrates our bodily functions like a skilled conductor. We also navigate the complex world of sleep disorders, differentiating between insomnia and sleep deprivation and advocating for a comprehensive, lifestyle-aware approach to diagnosis - highlighting how quality and quantity of sleep is relevant, but most crucially how important consistency is. Our conversation extends to the benefits and misunderstandings surrounding sleep supplementation such as melatonin, why most of his client's don't need sleep studies and the importance of chrononutrition - the study of how the timing of meals, nutrition and circadian rhythms interact with health. Dr. Winter offers insights into historical sleep patterns and the advantages of biphasic sleep, napping and structured rest. We highlight the synergistic connection between meditation and sleep, encouraging you to embrace meditative rest as a tool for enhanced wellbeing. Join us as we cut through the noise of sleep information overload, focusing on timeless principles that ensure quality rest, and transform your understanding of sleep's pivotal role in health and performance.As founder of Charlottesville Neurology and Sleep Medicine, CNSM Consulting and the Medical Director of the Martha Jefferson Hospital Sleep Medicine Center, Dr. Winter has been involved with sleep medicine and sleep research for over thirty years. He is board certified in sleep medicine by both the American Board of Sleep Medicine and by the American Board of Internal Medicine. He is also board certified in Neurology by the American Board of Psychiatry and Neurology. Dr. Winter's current research focuses on sleep and athletic performance, and he has served as a consultant across professional sports for the MLB, NBA, NHL and NFL.wchriswinter.comLiked what you heard? Help us reach more people! Please rate and review us on Apple Podcasts Start Energy Healing Today!Unlock your healing potential with our informative and fun introductory 10 hour LIVE online class in energy healing Our Flagship Training is Setting the Standard in Energy HealingThe 100 hour EHT-100 Energy Healing Training Contact Field Dynamics Email us at info@fielddynamicshealing.com energyfielddynamics.com Thanks for listening!

In part one of this two-part series, Dr. Stacey Clardy and Dr. Elias Sotirchos discuss key features of inflammatory myelopathy in rheumatologic disease, helping to better characterize the underlying causes of lupus myelitis. Show reference: https://www.neurology.org/doi/10.1212/NXI.0000000000200329 

For certain diagnoses and patients who meet clinical criteria, neuromodulation can provide profound, long-lasting relief that significantly improves quality of life. In this episode, Aaron Berkowitz, MD, PhD, FAAN speaks with Prasad Shirvalkar, MD, PhD, author of the article “Neuromodulation for Neuropathic Pain Syndromes,” in the Continuum® October 2024 Pain Management in Neurology issue. Dr. Berkowitz is a Continuum® Audio interviewer and a professor of neurology at the University of California San Francisco in the Department of Neurology and a neurohospitalist, general neurologist, and clinician educator at the San Francisco VA Medical Center at the San Francisco General Hospital in San Francisco, California. Dr. Shirvalkar is an associate professor in the Departments of Anesthesia and Perioperative Care, Neurological Surgery, and Neurology at Weill Institute for Neurosciences at the University of California, San Francisco in San Francisco, California. Additional Resources Read the article: Neuromodulation for Neuropathic Pain Syndromes 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: @AaronLBerkowitz Guest: @PrasadShirvalka Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor in Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors, who are the leading experts in their fields. Subscribers to the Continuum Journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Berkowitz: This is Dr Aaron Berkowitz, and today I'm interviewing Dr Prasad Shirvalkar about his article on neuromodulation for painful neuropathic diseases, which appears in the October 2024 Continuum issue on pain management in neurology. Welcome to the podcast, and if you wouldn't mind, please introducing yourself to our listeners.  Dr Shirvalkar: Thanks, Aaron. Yes, of course. So, my name is Prasad Shirvalkar. I'm an associate professor in anesthesiology, neurology and neurological surgery at UCSF. I am one of those rare neurologists that's actually a pain physician.  Dr Berkowitz: Fantastic. And we're excited to have you here and talk to you more about being a neurologist in in the field of pain. So, you wrote a fascinating article here about current and emerging neuromodulation devices and techniques being used to treat chronic pain. And in our interview today, I'm hoping to learn and for our listeners to learn about these devices and techniques and how to determine which patients may benefit from them. But before we get into some of the clinical aspects here, can you first just give our listeners an overview of the basic principles of how neuromodulation of various regions of the nervous system is thought to reduce pain? Dr Shirvalkar: Yeah, I would love to try. But I will promise you that I will not succeed because I think to a large extent, we don't understand how neuromodulation works to treat pain, to describe or to define neuromodulation. Neuromodulation is often described as using electrical stimuli or a chemical stimuli to alter nervous system activity to really influence local activity, but also kind of distant network activity that might be producing pain. On one level, we don't fully understand how pain arises, specifically how chronic pain arises in the nervous system. It's a huge focus of study from the NIH Heal Initiative and many labs around the world. But acute pain, which is kind of when you stub your toe or you burn your finger, is thought to be quite different from the changes over time and the kind of plasticity that produces emotional, cognitive and sensory dimensions. Really what I think is its own disease, chronic pain, of which there are multiple syndromes when we use neuromodulation, either peripheral nerve stimulation or electrical spinal cord stimulation. One common or predominant theory actually comes from a paper in science from 1967 and people still use it, foundational theory and it's called the gate control theory. Two authors, Melzack and Wall, postulated that at the spinal level, there are, there's a local inhibitory circuit or, you know, there's a local circuit where if you provide input to either peripheral nerves or either spinal cord ascending fibers that to kind of summarize it, there's only so much bandwidth, you know, that nerves can carry. And so that if you literally pass through artificial signals electrically, that you will help gate out or block natural pathological but natural pain signals that might be arising from the periphery or spinal cord. So, you know, one idea is that you are kind of interfering with activity that's arising for chemical neuromodulation. The most common is something known as intrathecal drug infusion drug delivery ITTD for that we quite literally put a catheter in the spinal fluid, you know, at the level of the dorsal horn neurons that we think are responsible for perpetuating or creating the pain. Where's the pain generator? And you really, you can infuse local anesthetic, you can infuse opioids. And what's nice is you avoid a lot of systemic side effects and toxicity because it goes right to the spinal cord, you know, by infusing in the fluid. So there's a couple of modalities, but I will say just, like maybe all of our living experience, pain is in the brain. And so, we don't really understand, I would say, what neuromodulation is doing to the higher spinal or brain levels. Dr Berkowitz: Fascinating topic. And yeah, very interesting to hear both what our current understanding is that some of our current understanding is based on data that's 60 years old and that we're actually probably learning about pain by using these modulation techniques, even though we don't really understand how they might be working. So interesting feedback loop there as well as in as in the as in this land. So, your article very nicely organizes the neuromodulation techniques from peripheral to central. So, encourage our listeners to check out your article. And first before we get into some of the clinical applications, just to give the listeners the lay of the land, can you sort of lay out the devices and techniques available for treating pain at each level of the neuroaxis? We'll get into some of the indications in patient selection in a moment, but just sort of to lay out the landscape. What's available that you and your colleagues can use or implant at different levels when we're thinking of referring patients too? Dr Shirvalkar: Absolutely. So, starting from the least invasive or you know, over the counter patients can purchase themselves a TENS machine. Many folks listening to this have probably tried a TENS machine in the past. And the idea is that you put a couple of pads, at least two. So you have like a dipole or you have a positive and a negative lead and you basically inject some current. So, the pads are attached to a battery and you can put these pads over muscle. If you have areas where myofascial pain or sore muscles, you can put them, frankly, over nerves as well and stimulate nerves that are deeper. Most TENS machines kind of use electrical pulses that occur at different rates. You change the rates, you can change the amplitude and patient can kind of have control for what works best. Then getting slightly more invasive, we can often stimulate electrically peripheral nerves. To do this we implant through a needle, a small wire that consists of anywhere from one electrical contact to four or even eight electrical contact. What I think is particularly cool, like TENS, which is transcutaneous electrical nerve stimulation that goes through the skin. Peripheral nerve stimulation aims to stimulate nerves, but you don't have to be right up against the nerve. So, yeah. We typically do this under an ultrasound and you can visualize a nerve like the sciatic nerve, peroneal nerve, or you know, even if someone has an ulnar or a neuropathy, you know, that's the compression. There's a role obviously for surgery and release, but if they have predominantly pain, it's not related to a mechanical problem per se, you could prevent a wire from a peripheral nerve stimulator as far as one centimeter from a nerve and it'll actually stimulate that that modulated and then, you know, kind of progressing even more deeply. The spinal cord stimulation, SCS, it's probably the most ubiquitous or popular form of neuromodulation for pain. People use it for all kinds of diseases. But what it roughly involves is a trial period, which is a placement of either two cylindrical wires, not directly over the spinal cord, but actually in the epidural space, right? So, it's kind of like when you get an epidural injection or doing labor and delivery, when women get epidural catheters, placing spinal cord stimulator leads in that same potential space outside the dura, and you're stimulating through the dura to actually target the ascending dorsal column fibers. And so, you do a trial period or a test drive where the patients get these wires put in. They're coming out of the skin, they're connected to a battery, and they walk around at home for about a week, take careful notes, check in with them, and they keep a diary or a log about how much it helps. Separately. I will say it's hard to distinguish this, the placebo effect often, but you know, sometimes we want to use the placebo effect in clinical practice, but it is a concern, you know, with such invasive things. But you know, if the trial works well, right, you basically can either keep the leads where they are and place a battery internally. And it's for neurologists. You're familiar with deep brain stimulation. These devices are very similar to DVS devices, but they're specifically made for spinal cord stimulation. And there's now like seven companies that offer manufacturers that offer it, each with their own proprietary algorithm or workflow. But going yet more invasive, there is intrathecal drug delivery, which I mentioned, which involves placement of the spinal catheter and infusion of drug into spinal fluid. You could do a trial for that as well. Keep a patient in the hospital for a few days. You've all probably had experience with lumbar drains. It's something real similar. It just goes the other way. You know, you're infusing drugs, and it could also target peripheral nerves or nerve roots with catheters, and that's often done. And last but not least, there's brain stimulation. Right now, it's all experimental except for some forms of TMS or transcranial magnetic stimulation, which is FDA approved for migraine with aura. There are tens machine type devices, cutaneous like stimulators where you can wear on your head like a crown or with stickers for various sorts of migraines. I don't really talk about them too much in in the article, but if there's a fast field out there for adjunctive therapy as well,  Dr Berkowitz: Fantastic. That's a phenomenal overview. Just so we have the lay on the land of these devices. So, from peripheral essentially have peripheral nerve stimulators, spinal cord stimulators, intrathecal drug delivery devices and then techniques we use in other areas of neurology emerging for pain DBS deep brain stimulation and TMS transcranial magnetic stimulation. OK let's get into some clinical applications now. Let's start with spinal cord stimulators, which - correct me if I'm wrong - seem to be probably the most commonly seen in practice. Which patients can benefit from spinal cord stimulators? When should we think about referring a patient to you and your colleagues for consideration of implantation of one of these spinal cord stimulator devices?  Dr Shirvalkar: So, you know, it's a great question. I would say it's interesting how to define which patients or diagnosis might be appropriate. Technically, spinal cord stimulators are approved for the treatment of most recently diabetic peripheral neuropathy. And so, I think that's a really great category if you have patients who have been failed by more conservative treatments, physical therapy, etcetera, but more commonly even going back, neuropathic low back pain and neuropathic leg pain. And so, you think about it and it's like, how do you define neuropathic pain. Neuropathic pain is kind of broadly defined as any pain that's caused by injury or some kind of lesion in the somatosensory nervous system. We now broaden that to be more than just somatosensory nervous system, but still, what if you can't find a lesion, but the pain still feels or seems neuropathic. Clinically, if something is neuropathic, we often use certain qualitative descriptors to describe that type of pain burning, stabbing, electric light, shooting radiates. There's often hyperpathia, like it lingers and spreads in space and time as opposed to, you know, arthritis, throbbing dull pain or as opposed to muscle pain might be myofascial pain, but sometimes it's hard to tell. So, there aren't great decision tools, I would say to help decide. One of the most common syndromes that we use spinal cord stimulation for is what used to be called failed back surgery syndrome. We never like to, we now try to shy away from explicitly saying something is someone has failed in their clinical treatment. So, the euphemism is now, you know, post-laminectomy syndrome. But in any case, if someone has had back surgery and they still have a nervy or neuropathic type pain, either shooting down their legs and often there's no evidence on MRI or even EMG that that something is wrong, they might be a good candidate, especially if they're relying on long term medications that have side effects or things like full agonist opioids, you know that that might have side effects or contraindication. So, I would say one, it's not a first line treatment. It's usually after you've gone through physical therapy for sure. So, you've gone through tried some medications. Basically, if chronic pain is still impacting your life and your function in a meaningful way that's restricting the things you want to do, then it it's totally appropriate, I think, to think about spinal cord stimulation. And importantly, I will add a huge predictor of final court stimulation success is psychological composition, you know, making sure the person doesn't have any untreated psychological illness and, and actually making sure their expectations going in are realistic. You're not going to cure anyone's pain. You may and that's, you know, a win, but it's very unlikely. And so, give folks the expectation that we hope to reduce your pain by 50% or we want you to list personally, I like functional goals where you say what is your pain preventing you from doing? We want to see if you can do X,Y, and Z during the trial period. Pharmacostimulation right now. Yeah. Biggest indication low back leg pain, Diabetic peripheral neuropathy. There is also an indication for CRPS, complex regional pain syndrome, a lesser, I'd say less common but also very debilitating pain condition. For better or worse. Tertiary quaternary care centers. You often will see spinal cord stem used off label for neuropathic type pain syndromes that are not explicitly better. That may be for example, like a nerve injury that's peripheral, you know, it's not responding. A lot of this off label use is highly variable and, you know, on the whole at a population level not very successful. And so, I think there's been a lot of mixed evidence. So, it's something to be aware about.  Dr Berkowitz: That's a very helpful framework. So, thinking about referring patients to who have most commonly probably the patients with chronic low back pain have undergone surgery, have undergone physical therapy, are on medications, have undergone treatment for any potential psychological psychiatric comorbidities, and yet remain disabled by this pain and have a reasonable expectation and goals that you think would make them a good candidate for the procedure. Are those similar principles to peripheral nerve stimulation I wasn't familiar with that technique, I'm reading your article, so are the principles similar and if so, which particular conditions would potentially benefit from referral for a trial peripheral nerve stimulation as opposed to spinal cord stimulation?  Dr Shirvalkar: Yeah, the principles are similar overall. The peripheral nerve stimulation, you know, neuropathic pain with all the characteristics you listed. Interestingly enough, just like spinal cord stim, most insurances require a psychological evaluation for peripheral nerve stim as well. And we want to make sure again that their expectations are reside, they have good social support and they understand the kind of risks of an invasive device. But also, for peripheral nerve stem, specifically, if someone has a traumatic injury of an individual peripheral nerve, often we will consider it seeing kind of super scapular stimulation. Often with folks who've had shoulder injuries or even sciatic nerve stimulation. I have done a few peroneal nerve stimulations as well as occipital nerve stimulation from migraine, so oxygen nerve stimulation has been studied a lot. So, it's still somewhat controversial, but in the right patient it can actually be really helpful. Dr Berkowitz: Very helpful. So, these are patients who have neuropathic pain, but limited to one peripheral nerve distribution as opposed to the more widespread back associated pains, spine associated pains. Dr Shirvalkar: Yeah, Yeah, that's right. And maybe there's one exception actually to this, which is brachial plexopathy. So, you know, folks who've had something like a brachial plexus avulsion or some kind of traumatic injury to their plexus, there is I think good Class 2 evidence that peripheral nerve stem can work. It falls under the indication. No one is as far as to my knowledge, No one's done an explicit trial, you know PNS randomized controlled trial. Yeah, that's, you know, another area one area where PNS or peripheral nerve stems emerging is actually, believe it or not in myofascial low back pain to actually provide muscle stimulation. There are some, there's a company or two out there that seeks to alter the physiology of the multifidus muscle, one of your spinal stabilizer muscles to really see if that can help low back pain. And they've had some interesting results.  Dr Berkowitz: Very interesting. You mentioned TENS units earlier, transcutaneous electrical nerve stimulation as something a patient could get over the counter. When would you encourage a patient to try TENS and when would you consider TENS inadequate and really be thinking about a peripheral nerve stimulator?  Dr Shirvalkar: Yeah, you know TENS we think of as really appropriate for myofascial pain. Folks who have muscular pain, have clear trigger points or taught muscle bands can often get relief from TENS If you turn a TENS machine up too high, you'll actually see muscle infection. So, there's an optimal level where you actually can turn it up to induce, like, a gentle vibration. And so folks will feel paresthesia and vibrations, and that's kind of the sweet spot. However, I would say if folks have pain that's limited or temporary in time or after a particular activity, TENS can be really helpful. The unfortunate reality is TENS often has very time-limited benefits - just while you're wearing it, you know? So, it's often not enduring. And so that's one of the limitations. Dr Berkowitz: That's helpful to understand. We've talked about the present landscape in your article, also talk a little bit about the future and you alluded to this earlier. Tell us a little bit about some off label emerging techniques that we may see in future use. Who, which types of patients, which conditions might we be referring to you and your colleagues for deep brain stimulation or transcranial magnetic stimulation or motor cortex stimulation? What's coming down the pipeline here?  Dr Shirvalkar: That's a great question. You know, one of my favorite topics is deep brain stimulation. I run the laboratory that studies intracranial signals trying to understand how pain is processed in the brain. But, believe it or not, chronic pain is probably the oldest indication for which DBS has been studied. the first paper came out in 1960, I believe, in France. And you know, the, the original pivotal trials occurred even before the Parkinson's trial and so fell out of favor because in my opinion, I think it was just too hard or too difficult or a problem or too heterogeneous. You know, many things, but there are many central pain syndromes, you know, poststroke pains, there's often pains associated with Parkinson's disease, epilepsy, or other brain disorders for which we just don't have good circuit understanding or good targets. So, I think what's coming down the pipeline is a better personalized target identification, understanding where can we stimulate to actually alleviate pain. The other big trend I think in neuromodulation is using closed loop stimulation which means in contrast to traditional electrical stimulation which is on all the time, you know it's 24/7, set it and forget it. Actually, having stimulation respond or adapt to ongoing physiological signals. So that's something that we're seeing in spinal cord stem, but also trying to develop in deep brain stimulation and noninvasive stimulation. TMS is interestingly approved for neuropathic pain in Europe, but not approved by the FDA in the US. And so I think we may see that coming out of pipeline broader indication. And finally, MR guided focused ultrasound is, is a kind of a brand new technique now. You know, focused ultrasound lesions are being used for essential tremor without even making an incision in the skull or drilling in skull. But there are ways to modulate the brain without lesioning. And, you know, I think a lot of research will be emerging on that in the next five years for, for pain and many other neuronal disorders. Dr Berkowitz: That's fascinating. I didn't know that history that DBS was first studied for pain and now we think of it mostly for Parkinson's and other movement disorders. And now the cycle is coming back around to look at it for pain again. What are some of the targets that are being studied that are thought to have benefit or are being shown by your work and that of others to have benefit as far as DBS targets for, for chronic pain? Dr Shirvalkar: You know, that's a great question. And so, the hard part is finding one target that works for all patients. So, it may actually require personalization and actually understanding what brain circuit phenotypes do you have with regards to your chronic pain and then based on that, what target might we use? But I will say the older targets. Classical targets were periaqueductal gray, which is kind of the opioid center in your brain. You know, it's thought to just release large amounts of endogenous opioids when you stimulate there and then the ventral pusher thalamus, right. So, the sensory ascending system may be through gait control theory interferes with pain, but newer targets the answer singlet there's some interest in in stimulating there again, it doesn't work for everybody. We found some interesting findings with the medial thalamus as well as aspects of the caudate and other basal ganglion nuclei that we hopefully will be publishing soon in a data science paper.  Dr Berkowitz: Fantastic. That's exciting to hear and encourage all of our listeners to check out your article. That goes into a lot more depth than we had time to do in this short interview, both about the science and about the clinical indications, pros and cons, risks and benefits of some of these techniques. So again, today I've been interviewing Dr Prasad Shirvalkar, whose article on neuromodulation for painful neuropathic diseases appears in the most recent issue of Continuum on pain management in neurology. Be sure to check out Continuum Audio episodes from this and other issues. And thank you again to our listeners for joining today.  Dr Shirvalkar: Thank you for having me. It was an honor. Dr Monteith: This is Dr Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/AudioCME. Thank you for listening to Continuum Audio.

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

  This week we discuss the field of Functional Neurology with Dr. Alexander Zubkov.  Stroke care is complex and does not stop when a patient is discharged from the hospital.  As a Functional Neurologist, Dr. Zubkov offers comprehensive follow-up for Stroke care, and focus on prevention through health and wellness.  According to his online presence, these are the benefits of such tailored medical care: Benefits of Integrative Neurology and Functional Medicine Identify the root cause of your illness Decrease excessive inflammation Balance your brain Reversal of cognitive decline Improve your overall health State of the art laboratory testing Nutritionist evaluation Short and long-term health planning Physician-grade supplement   Dr. Zubkov believes that we are facing an epidemic of unhealthy lifestyles and environments, but there is hope for change. You have the power to make positive changes in your life, and it doesn't have to be a sacrifice of joy and fun. With one voice and one mind, we can learn to eat real food, exercise, and rest to achieve radiant health. While crisis care is excellent in acute cases, the current model of healthcare fails in preventing and treating chronic diseases. However, since the early 90s, there has been a wealth of rock-solid studies proving that many chronic illnesses are preventable. The problem is that the abundance of information can lead to confusion, without the specific context for each individual. Core Beliefs: Dr. Zubkov knows that each person is unique, and it's not enough to simply tell them what not to eat. By understanding their personal story and history, teaching them, and backing up strategies with proper laboratory assessments, we can make meaningful changes towards a healthier life. So don't lose hope - you have the power to improve your health and wellbeing. Dr. Zubkov founded Mind Body Neurology, PLLC to help patients to recover from neurological diseases through holistic approach.

Alpha-synuclein plays a key role in the pathophysiology of Parkinson's disease, and researchers have been investigating this protein as a therapeutic target and also as a potential biomarker for the disease. The alpha-synuclein seed amplification assay, developed by Dr. Claudio Soto and colleagues, leverages the self-replicating nature of the misfolded alpha-synuclein proteins that form aggregates in Parkinson's disease. Amplifying misfolded alpha-synuclein can allow researchers and clinicians to detect the presence of the pathological form of the protein in biospecimens, even when the amount of misfolded alpha-synuclein in a sample is very low. In this episode, Claudio discusses his work in this area and how it has opened the doors for a variety of potential uses of the alpha-synuclein seed amplification assay, including applications in diagnosis, clinical trials, and drug development for Parkinson's disease.This year, Claudio received the 2024 Robert A. Pritzker Prize for Leadership in Parkinson's Research for his substantial contributions to research and his commitment to mentoring the next generation of scientists in the field. Claudio is the Huffington's Distinguished University Chair, Professor of Neurology, and Director of the George and Cynthia Mitchell Center for Alzheimer's Disease and Related Brain Disorders at The University of Texas Medical School in Houston. He is also the Founder, Vice-President, and Chief Scientific Officer at AMPRION Inc.This podcast is geared toward researchers and clinicians. If you live with Parkinson's or have a friend or family member with PD, listen to The Michael J. Fox Foundation Parkinson's Podcast. Hear from scientists, doctors and people with Parkinson's on different aspects of life with the disease as well as research toward treatment breakthroughs at https://www.michaeljfox.org/podcasts.

In this episode, I am joined by Nicholas Silvestri, Professor of Neurology at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences, where he is also Associate Dean for Student and Academic Affairs. He is board-certified in neurology, neuromuscular medicine, and electrodiagnostic medicine.Over the past several years, Nicholas Silvestri's research interests have included myasthenia gravis and inflammatory neuropathies, and he has authored over 60 peer-reviewed articles, book chapters, and textbooks.Our conversation covers the full spectrum of myasthenia gravis – from its pathology and pathogenesis to its clinical features, investigations and treatments. He explains such tricky areas of myasthenia gravis, such as why the antibody levels do not correlate with clinical severity of the disease, and why the disease frequently starts in the ocular muscles.We also explored such themes as why anti MUSK myasthenia gravis favours Black people and those living around the equator, and why steroid treatment may worsen myasthenic symptoms.Nicholas Silvestri also discussed the newer and more effective treatments of refractory myasthenia gravis, and how he manages the different facets of the disease.

How do the dividing cells of an embryo know where there need to go to create a baby? Psychiatrist Rick Leskowitz knows that an energetic template guides those cells to their proper places. Templates also seem to guide the creation of synchronicities, partly influenced by your intentions and partly influenced by current mysteries. Being able to feel the energy field of a man's amputated leg convinced Rick that we are more than flesh. More than bones. We have biofields that shape our minds and bodies, that help us get into the flow, into the zone and that participate in coincidence creations through resonance and entrainment with other people and our surroundings. Dr. Eric (Rick) Leskowitz was a consultant psychiatrist for over 25 years with the Pain Management Program at Spaulding Rehabilitation Hospital in Boston, where he founded the Integrative Medicine Task Force. He holds an appointment at Harvard Medical School, has studied energy healing, meditation and hypnosis for over 40 years, and has had 50+ articles published in leading scientific journals. He has also edited three textbooks, and his documentary film about group energies and sports, The Joy of Sox: Weird Science and the Power of Intention, was broadcast on PBS. The Mystery of Life Energy is his latest book. https://www.TheMysteryOfLifeEnergy.com The Joy of Sox film (PBS): https://www.youtube.com/channel/UCgh11r8xB7ltgm7P6Qujblw Sports, Energy and Consciousness (book): https://www.amazon.com/Eric-Leskowitz-Sports-Energy-Consciousness/dp/B00SB2DBUK The Mystery of Life Energy (book): https://www.amazon.com/Mystery-Life-Energy-Energetics-Consciousness-ebook/dp/B0CFM722W8 Coast to Coast AM Podcast with George Noory: https://www.coasttocoastam.com/show/2024-04-15-show/ Bernard D. Beitman, MD has broken out of the restrictive bounds of conservative academic research to produce a blueprint for the practically-oriented new discipline of Coincidence Studies. He has served as chair of the Department of Psychiatry and Neurology and then as chair of the Department of Psychiatry at the University of Missouri-Columbia. He has reached more than one million people through his Psychology Today blog, radio show, website, and two coincidence books, Connecting with Coincidence and Meaningful Coincidences. Yale and Stanford educated, He is the founder and president of The Coincidence Project. https://www.innertraditions.com/books/meaningful-coincidences to purchase Dr. Beitman's new book "Meaningful Coincidences". Visit https://www.coincider.com/ to learn more about Dr. Beitman's research. #coincidence #serendipity #synchronicity

Dr. Stacey Clardy talks with Dr. Elias Sotirchos about the underlying etiologies of myelitis in patients with rheumatologic disease. Read the related article in Neurology: Neuroimmunology & Neuroinflammation. Disclosures can be found at Neurology.org.

In the final part of this three-part series, Dr. Justin Abbatemarco and Dr. Ahmad Nehme discuss how to differentiate between CAA-RI and PACNS. Show reference: https://www.neurology.org/doi/abs/10.1212/WNL.0000000000209548 

Nous commencerons notre émission en discutant de l'actualité. Tout d'abord, nous commenterons la victoire de Donald Trump aux élections présidentielles américaines. Ensuite, nous parlerons du 35ème anniversaire de la chute du mur de Berlin. La discussion scientifique portera sur une étude publiée dans la revue Neurology. Ses résultats indiquent qu'une somnolence excessive durant la journée pourrait mener à la démence chez les personnes âgées. Enfin, nous aborderons un nouveau phénomène montant inspiré d'un mouvement féministe sud-coréen qui prône le refus des relations sexuelles.    Le dialogue de grammaire contiendra de nombreux exemples illustrant la leçon d'aujourd'hui : Les articles : le, la, les, l', un, une, des. Le dialogue d'expression montrera, quant à lui, comment utiliser l'expression de la semaine : Avoir quelqu'un dans le collimateur. - Il faut se préparer à des changements spectaculaires dans l'ordre mondial après la victoire de Donald Trump - Des dizaines de milliers de personnes célèbrent le 35ème anniversaire de la chute du mur de Berlin - La somnolence diurne serait un signe avant-coureur de démence - Suite à la victoire de Trump, un mouvement encourage les femmes à priver les hommes de sexe - En cas de catastrophe, Paris ne pourrait tenir que quelques jours - En raison de la crise du logement, la pression s'accroît sur Airbnb

Dr. Gregg Day and Dr. Kathryn T. Hall discuss the complexities of the placebo effect, its variability among patients, and the genetic factors that influence responses to placebo treatments. 

Inizieremo la nostra puntata discutendo di attualità. Per prima cosa, commenteremo la vittoria decisiva di Donald Trump alle elezioni presidenziali negli Stati Uniti. Poi, parleremo del 35° anniversario della caduta del Muro di Berlino. L'argomento scientifico della puntata riguarda uno studio pubblicato sulla rivista Neurology. In base ai risultati di questo studio l'eccessiva sonnolenza diurna negli anziani porta alla demenza. Infine, parleremo di un fenomeno sociale in crescita, proveniente dal movimento femminista sudcoreano, che nega il sesso agli uomini.   Il dialogo di grammatica avrà molti esempi sul tema di oggi, ovvero il Present indicative. Regular verbs ending in -are, -ere, -ire. Il dialogo sulle espressioni illustrerà l'uso dell'espressione Calzare a pennello. - La vittoria di Donald Trump segna cambiamenti drammatici nell'ordine mondiale esistente - Decine di migliaia di persone celebrano il 35° anniversario della caduta del Muro di Berlino - La sonnolenza diurna potrebbe essere un campanello d'allarme dello sviluppo della demenza - La vittoria di Trump ispira un movimento femminista per negare il sesso agli uomini - Venezia raddoppia il costo del biglietto d'ingresso per i turisti - Un piano per il Castello di Sammezzano

For more information regarding this CME/CE activity and to complete the CME/CE requirements and claim credit for this activity, visit:https://www.mycme.com/courses/management-of-amyloid-cardiomyopathy-and-polyneuropathy-9813SummaryIn this CME/CE podcast episode, Cardiologist Dr. Michelle Kittleson and Neurologist Dr. Chafic Karam discuss the multidisciplinary management of transthyretin amyloidosis (ATTR). They explore how ATTR affects both the heart and the nervous system, focusing on recognizing symptoms, diagnosing the disease, and managing treatment. Dr. Karam shares insights on peripheral neuropathy caused by amyloidosis, including clues that suggest amyloidosis over more common neuropathies. Dr. Kittleson highlights how cardiologists assess and manage TTR cardiomyopathy, emphasizing the importance of early diagnosis and the evolving therapeutic landscape. Together, they discuss the collaborative nature of care, the impact of new therapies on clinical outcomes, and the importance of raising awareness for ATTR.Learning ObjectivesDescribe the correct diagnostic algorithm for suspected ATTR, including interpretation of the monoclonal protein screen and indications for biopsy and genetic testingInitiate appropriate management, including disease-directed therapy and appropriate cardiac care, or referral when indicatedThis activity is accredited for CME/CE CreditAssociation of Black Cardiologists, Inc. (ABC) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.Association of Black Cardiologists, Inc. designates this enduring material for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.This activity has been planned and implemented in accordance with the Accreditation Standards of the American Association of Nurse Practitioners® (AANP) through the joint providership of the National Association for Continuing Education (NACE) and ABC. NACE is accredited by the AANP as an approved provider of nurse practitioner continuing education. Provider number 121222. This activity is approved for 0.25 contact hours (which does not include hours of pharmacology).For additional information about the accreditation of this program, please contact NACE at info@naceonline.com.Summary of Individual DisclosuresPlease review faculty and planner disclosures here.Disclosure of Commercial SupportThis educational activity is supported by an educational grant from Alnylam Pharmaceuticals Inc., and an educational grant from AstraZeneca Pharmaceuticals.Please visit http://naceonline.com to engage in more live and on demand CME/CE content.

Today, November 8, 2024, marks Science Friday's 33rd broadcast anniversary. One of the most beloved interviewees on Science Friday over the years was the late neurologist and author Dr. Oliver Sacks, who shared his insights into neuroscience, art, and what it means to be human. Recently, Sacks' long-time collaborator Kate Edgar published a book of Dr. Sacks' letters. And earlier this fall, the New York Public Library announced its acquisition of Sacks' entire archive.In this segment, Ira revisits a 2007 conversation with Oliver Sacks about his book Musicophilia. They talk about the way music and the brain interact, why music can sometimes remain in the brain long after other memories fade, and why a person with limited language abilities might still be able to sing unimpaired.Transcripts for each segment will be available after the show airs on sciencefriday.com. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

Dr. Gregg Day talks with Dr. Kathryn T. Hall about the complexities of the placebo effect, its variability among patients, and the genetic factors that influence responses to placebo treatments.  Disclosures can be found at Neurology.org.

Comenzaremos el programa discutiendo la actualidad. Primero hablaremos de la decisiva victoria de Donald Trump en las elecciones presidenciales estadounidenses. Después, hablaremos del 35º aniversario de la caída del muro de Berlín. La noticia de ciencia del programa la dedicaremos a un estudio publicado en la revista Neurology. El estudio sugiere que una excesiva somnolencia diurna en las personas mayores conduce a la demencia senil. Y, para acabar, hablaremos de un creciente fenómeno social que viene del movimiento feminista surcoreano, y que consiste en denegarles el sexo a los hombres. La segunda parte incluirá una sección gramática y otra de expresiones. El diálogo de gramática incluirá multitud de ejemplos del tema de hoy: The Present Indicative - Irregular verbs. El diálogo de expresiones ilustrará el uso de la expresión de esta semana: Buscarle (los) tres pies al gato. La victoria de Donald Trump es preludio de enormes cambios en el orden mundial Decenas de miles de personas celebran el 35º aniversario de la caída del muro de Berlín La somnolencia diurna podría ayudar con la detección precoz de la demencia senil La victoria de Trump inspira un movimiento feminista para negarles el sexo a los hombres Efectos adversos del cambio climático en el Levante español Censurado el cartel de la nueva película de la directora Mar Coll

In part two of this three-part series, Dr. Justin Abbatemarco and Dr. Ahmad Nehme discuss the underlying pathophysiology and how to diagnose primary angiitis of the CNS in clinical practice. Show reference: https://www.neurology.org/doi/abs/10.1212/WNL.0000000000209548 

In this episode of the Brain & Life podcast, co-host Dr. Daniel Correa is joined by Deborah Vauclare, loving mother of Leo, who is living with a rare genetic neurodegenerative condition called Infantile Neuroaxonal Dystrophy (INAD.) Deborah shares about Leo's diagnosis and symptoms and how she and her family started an organization called Bisous for Léo with the goal to eradicate INAD and other related neurodegenerative diseases. Dr. Correa is then joined by Dr. Darius Adams, clinical geneticist who works as the Medical Director of the Goryeb Children's Hospital Genetics and Metabolism Division. Dr. Adams explains what INAD is and what types of research are being conducted to better the lives of patients and their families.   We invite you to participate in our listener survey! By participating in the brief survey, you will have the opportunity to enter your name and email address for a chance to win one of five $100 Amazon gift cards.   Additional Resources Bisous for Léo INADCure Foundation How Parents Advocate for Their Children with Rare Diseases Advice for Caregivers of People with Rare Diseases   Other Brain & Life Episodes on this Topic Rare Thoughts on a Rarer Neurologic Condition Advocacy and Athleticism with the Pittsburgh Steeler's Cam Heyward Neurofibromatosis Advocacy and Community Building with the Gilbert Family Foundation   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: Deborah Vauclare @bisousforleo; Dr. Darius Adams @AtlanticHealth Hosts: Dr. Daniel Correa @neurodrcorrea; Dr. Katy Peters @KatyPetersMDPhD

01:00Personal Reflections and Sporting MemoriesMichael Wright and Stephen Peters discuss their childhood experiences with sports, highlighting the importance of unstructured play. Stephen reminisces about playing Wembley doubles and cricket with his brothers, which fostered their love for sports. He cites Gary Lineker as his sporting idol and recalls the memorable moment of watching England win the Rugby World Cup, sharing the experience with his family.7:26Sportsmanship and Values in RugbyStephen Peters discusses the values embodied by the All Blacks, noting their dedication to sportsmanship, ethics, and leaving the environment better than they found it. He contrasts the brutal nature of rugby with the humility displayed by teams like Japan, who also prioritize cleanliness and respect. Michael Wright agrees, emphasizing the importance of maintaining good standards both during and after the game.10:18Stephen Peters' Football Journey and Coaching ExperienceStephen Peters recounted his football journey, beginning at Southampton's academy and transitioning through various clubs, including Torquay and Tiverton, where he played alongside notable players. After enduring six knee operations, he shifted to coaching, spending significant time at Bristol Rovers and developing his own coaching business, which included holiday camps and elite training sessions. He later worked with Southampton's academy in London before returning to coaching youth football at Forest Green.17:32Exploring Functional Neurology and Primitive ReflexesStephen Peters recounted his introduction to developmental neurology through Seb Cain, whose daughter with Down syndrome surpassed medical predictions. Peters emphasized the importance of understanding primitive reflexes in helping children with various developmental challenges. 24:11Understanding Primitive Reflexes in Child DevelopmentStephen Peters emphasized the role of primitive reflexes in early childhood development, noting that they are crucial for survival and must integrate as children grow. He highlighted that these reflexes should typically disappear by age three, with most vanishing by age one. If they remain active, they can hinder neurological development and lead to issues such as speech delays.28:15Understanding Primitive Reflexes and Their Impact on Child DevelopmentStephen Peters explains that primitive reflexes are crucial for neurological development and can create barriers to higher functions if they remain active. He notes that the current environment, characterized by excessive screen time and reduced physical activity, is preventing children from moving enough to deactivate these reflexes. This lack of movement can lead to various developmental issues, including emotional regulation problems and speech delays.35:24Understanding Optimal Brain Development and DyslexiaMichael Wright raised questions about the sequence of reflexes in child development and whether it matters if milestones are missed. Stephen Peters confirmed that there is an optimal developmental route, highlighting that missing the crawling phase can lead to challenges such as dyslexia. He emphasized the significance of movement patterns in brain development and the potential for improvement at any age.38:06Reflex Assessment and Movement Integration in ChildrenStephen Peters highlighted the significance of assessing retained reflexes, such as the palmar reflex, in children and how these reflexes can lead to involuntary movements that hinder fine motor skills. He described a case involving an 11-year-old girl whose active palmar reflex caused her hand to close involuntarily while holding objects. Peters emphasized the need for targeted movement exercises to help integrate these reflexes, ultimately improving skills like handwriting and emotional regulation. Hosted on Acast. See acast.com/privacy for more information.

Joy Kong, M.D. is a UCLA-trained, triple board-certified physician (American Board of Psychiatry & Neurology, American Board of Addiction Medicine, American Board of AntiAging & Regenerative Medicine). She specializes in stem cell therapy, and is widely known and respected in the regenerative medicine field as a leader, innovator, and educator. Dr. Kong founded American Academy of Integrative Cell Therapy, where she provides training to physicians throughout the U.S. and globally on stem cell therapy. Dr. Kong also conducts clinical research on stem cell therapy, and is a published author in scientific journals. In an effort to provide her patients with the best regenerative medicine products, Dr. Kong founded Chara Biologics, and developed the most potent and comprehensive stem cell product in the country with a patent-pending formula, as well as a 100% natural stem cell skin cream CharaOmni. Dr. Kong was recognized for her contribution to the field of regenerative medicine and awarded the “Top Doctor of the Year in Stem Cell Therapy” in 2019 as well as “Stem Cell Doctor of the Decade” in 2021 by the prestigious IAOTP (International Association of Top Professionals). Dr. Kong is also passionate about mental health, and provide ketamine therapy and other innovative therapeutic modalities to address depression, anxiety, Post-Traumatic Stress Disorder (PTSD), Obsessive Compulsive Disorder (OCD), addiction, as well as other brain conditions such as ADHD, Traumatic Brain Injury (TBI), cognitive decline and dementia, etc. Dr. Kong's memoir Tiger of Beijing has garnered tremendous interest, and was named “2020 Book of the Year” and showcased at Times Square. Dr. Kong was also featured in the 2021 book HEROES, LEADERS, LEGENDS: the Power of the Human Spirit, along with movers and shakers such as Oprah Winfrey, Deepak Chopra and Maya Angelo.See omnystudio.com/listener for privacy information.

In part one of this three-part series, Dr. Justin Abbatemarco and Dr. Ahmad Nehme discuss how cerebral amyloid angiopathy and CAA-RI present in clinical practice and how to make a diagnosis. Show reference: https://www.neurology.org/doi/abs/10.1212/WNL.0000000000209548 

Send us a textAbout the guest: Joshua Siegel, MD, PhD is a psychiatrist & systems neuroscience at New York University. He uses functional imaging to study the effects of psychedelics and other drugs on the human brain.Episode summary: Nick and Dr. Siegel discuss: fMRI and how it works; relationship between neural activity and blood flow; functional connectivity & the default mode network of the human brain; the functional effects of psilocybin on the brain; the role that subjective & expectancy effects in psychedelics medicine; and more.Related episodes:M&M #173: Psychedelics, Consciousness, Psychiatry, Psychology, Mental Health & the Entropic Brain HypothesisM&M #163: Anesthesia, Placebo Effects, Consciousness, Subjectivity, MDMA, Ketamine, Opioids, Psychedelics*This content is never meant to serve as medical adviceSupport the showAll episodes (audio & video), show notes, transcripts, and more at the M&M Substack Affiliates: MASA Chips—delicious tortilla chips made from organic corn and grass-fed beef tallow. No seed oils, artificial ingredients, etc. Use code MIND for 20% off. SiPhox Health—Affordable, at-home bloodwork w/ a comprehensive set of key health marker. Use code TRIKOMES for a 10% discount. Lumen device to optimize your metabolism for weight loss or athletic performance. Use code MIND for 10% off. Athletic Greens: Comprehensive & convenient daily nutrition. Free 1-year supply of vitamin D with purchase. Consensus: AI-powered academic research tool. Find & understand the best science, faster. Free 1-year premium sub with code MINDMATTERSPECIAL Learn all the ways you can support my efforts

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

Opioids may be considered for temporary use in patients with severe pain related to selected neuropathic pain conditions and only as part of a multimodal treatment regimen. Close follow-up when initiating or adjusting opioid therapy and frequent reevaluation during long-term opioid therapy is required. In this episode, Allison Weathers, MD, FAAN speaks with Friedhelm Sandbrink, MD, FAAN, an author of the article “Opioids and Cannabinoids in Neurology Practice,” in the Continuum® October 2024 Pain Management in Neurology issue. Dr. Weathers is a Continuum Audio interviewer and the associate chief medical information officer at the Cleveland Clinic in Cleveland, Ohio. Dr. Sandbrink is the national program director of Pain Management, Opioid Safety and Prescription Drug Monitoring Programs at the Veterans Health Administration, Uniformed Services University in Bethesda, Maryland. Additional Resources Read the article: Opioids and Cannabinoids in Neurology Practice 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 @ContinuumAAN facebook.com/continuumcme Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum Journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal and how to get CME. Dr Weathers: I'm Dr Allison Weathers. Today I'm interviewing Dr Friedhelm Sandbrink, who is one of the authors of the article Opioids and Cannabinoids for the Practicing Neurologist from the October 2024 Continuum issue on pain management Neurology. Welcome to the podcast and please introduce yourself to our audience.  Dr Sandbrink: Yeah, hi. So, I'm Friedhelm Sandbrink. I'm a neurologist and pain physician. I work at the Washington DC VA Medical Center, where I lead our intercessory pain management team, and I have a role also in the VA central office for pain management. I'm also associate professor, clinical associate professor at George Washington University and at the Uniformed Services University in Bethesda.  Dr Weathers: A lot of expertise, which you obviously brought to this article. And I do want to emphasize before we get started, although the article discusses both opioids and cannabinoids, as I said in the introduction, you worked in specifically on opioids. And so that's the part of the article where we'll focus our conversation today. Of course, I think all of our Continuum Audio topics are really fascinating. I know that some may not resonate as much, especially with our non-neurology listeners as others. Clearly not the case with your articles. I was reading it and preparing for a conversation today. I was really struck by how broadly applicable this topic is, not only to all neurologists but, really, all physicians, and even it should be to all of our listeners. Especially with what happened been going on over the last several years, what's been in the news about the opioid epidemic. And while usually like to start with this question, it feels even more pertinent in your case, what is the most important clinical message of your article? Dr Sandbrink: So, the role of the opioid, the role of opioid therapy, really, for pain care has changed dramatically over the last many years right? I mean, it's we, we still consider opioids like the most potent analgesic medication for treatment of acute pain. The benefit for chronic pain really has changed right I mean, you know, we- the understanding in that regard and they're controversial. So, they're generally not recommended for chronic treatment for neuropathic pain conditions or for headache, but there are probably situations when opioids are still indicated and may be considered especially for temporary use. So, one example is probably the patient who has severe acute post hepatic neuralgia and we know that we use other medications for that, you know, the gabapentinoids and duloxetine and but they may take several days or weeks to work, right? And we have to titrate them up. And when more acute pain relief is needed, the opioid medication may be may be an option for temporary use. But I think what we need to keep in mind is that when we use it, we need to be informed about how to mitigate the risks, right? What, what are our best ways to reduce harms? And we need to also know the regulatory, you know, situation right I mean, what is that that we have to do nowadays to stay within the frameworks, right? And so, one of the main emphasis on this article is really go through what the clinical that the CDC has now established as the standards for opiate therapy when we use opioids I think we all need to know the rules right I mean, we know what to do to mitigate risks. What is expected from us in regard to use it as safely as possible, right? And that's important for the patient. That's also important for us in our practice.  Dr Weathers: I think very important advice. And this seems so obvious, but at the same time, I think it's worth very clearly stating why is it so important for neurology clinicians and again, really all clinicians, to read this article? Dr Sandbrink: Yeah. We need to know the words regarding opiate prescribing right in the clinic. You know, the CDC has now issued their opiate practice guide, the Opiate Therapy Guideline. Really, it's a guideline for pain care in 2022. It's an update from 2016 that made some major changes in that regard. And I think we need to know really where we are nowadays in regard to expectations. I think we need to place the opiate therapy appropriately in our armamentarium regarding the many options that we have for pain care. But then when we use them, we need to know what we need to do to make it safe. Right? So, I'm thinking about the prescription drug monitoring programs and the patient education that's expected. We use in our practice an informed consent process even for patients on chronic pain, When and how to interpret urine drug screens, right? And how to issue, and maybe when to issue a naloxone comedication in order to have a rescue medication in case the patient is in a terrible situation. So, these are just things that have become nowadays standards of care and part of our practice. And we need to be familiar with it and use them as we take care of the patients. And for instance, in regard to opiate medication, we need to know about the specific rules regarding telehealth, prescribing of controlled substances, controlled Substances Act and the Ryan Hate Act that mandates in person evaluations for patients when we prescribe controlled substances. That obviously has been somewhat amended or changed or temporarily put on hold during the COVID crisis. And many states now have started developing their own guidance in regard to what's available and what's possible during telehealth. And we need to be familiar about that also.  Dr Weathers: I think those are such important and thoughtful points. I, I've mentioned it several times on this podcast before. I am a clinical informaticist and this is a topic that really lends itself to the EHR being able to help support. So, a lot of the things that you just mentioned, the consents for patients, the prescribing of naloxone, some of the support, clinical decision support can really be done in the electronic health record to help support providers. However, it's also one of those things where if people don't understand what's behind it, it can become a little bit of a crutch. And so, as I was reading the article, I was really struck by how helpful it is to really have that background. I think people can become very dependent and it becomes almost just doing it all for them and, and they lose the- then you can make this argument about probably a lot of the other clinical decision supports in there, but really understanding the why behind a lot of the support that's there around all of the, the tools that are in there to, to support safe opioid prescribing. I think it's so important for that people have that background that the article provides.  Dr Sandbrink: I think often it feels like you're going through a checklist of things to do right and, and, and you do right. But at the same time, as you said, you need to know why you're doing it right And, and I think it's very important for us to know what the rules are and the expectations in regard to standards of care. So, we also know what is the framework that we have to follow, but where can we make modifications? Where can we individualize based on the patient's need? What is really that that is still within our ability to do and how to modify that? Because in the very end, it really is about good care of the patient. We need to know what we are allowed to do, but we also need to know where the limits are right And I hope that that article provides really some information about that, especially as it outlines what the CDC expects. But then also, I think it gives - hopefully, and this is a message that the CDC also has – it really emphasizes that it's about good communication with the patient, truly informing them and about what are the range of options and the limits that we have, but also at the same time never to abandon the patient. You know, I think this is something that we need to understand. It's not really about us. The rules are there to make the care of the patients safer. The rules are not the primary goal itself. It is still patient care. So, in that regard, we need to make sure to never abandon the patient, even if the patient for instance, may come to us and maybe they took more opiates and prescribed or you know, and they ran out early and figure out what exactly was that drove the patient for that, right? I mean, you know, so that we know maybe it is actually worse than pain. Maybe there was something that happened that caused the patient to have a significant increase of it. You know, I think one of the biggest misconceptions is really also that patients who make sure some misuse of medication, that everybody has opioid abuse disorder, addiction. Common, far too common, right? And I think we've learned over the years how common it is. Clearly pain itself, intractable pain is a very strong driver of behavior. If you're in pain, if a patient is in pain, they are desperate often to seek some kind of relief. And taking extra medication in itself, while it's not at all something that we can endorse and tolerate, obviously in many ways, right, we have to still take it as a possible sign of pain control rather than opiate use disorder in itself. So, we need to be very careful of how to assess such a patient and that we guide them into the right direction in regard to the next.  Dr Weathers: That, again, is very important advice, and thinking about how chronic pain on a very different level than acute pain, right? Understanding how these patients are processing pain in a very different way than patients with acute pain. And again, also, I think a very important point that the pendulum has swung kind of back and forth over the years. You know, that they were in pain was another vital sign and it was make sure you're asking your patient about pain. And then all of a sudden it was, oh, we have to be really careful and people should not, nobody should be on these medications, which you- to your point, led to sudden abandonment. And that's not the point. That's not what we should be doing as providers. I know, though, there's very sensitive and challenging situations when you find out a patient though, perhaps taking more than expected because of chronic pain, but perhaps diversion. How have you handled those challenging cases? Dr Sandbrink: I think diversion needs to be taken obviously very, very seriously. And you know, if a patient is truly diverting medication and there are obviously multiple variations of that, right? I mean, it's like giving it to a family member, for instance. That's one thing. It's on the other hand actually selling it. I think a patient who diverts is such a situation where opioid prescribing has to stop immediately, right? I mean, this is not a patient that we would take off at this point. I mean, so I think it's one of the very, very few occasions where you'd say that you have to just stop it immediately. I think there are other situations really in general, I think the patients who have been on opioids long term, especially in higher doses, I mean the majority of patients are not different. We have to be aware of it. We have to always look out for it. That's part of our risk mitigation. But we also have to make sure that patients on long term opioid therapy, right, that we guide them appropriately. I think the guidance probably in many ways is that we want to make sure whether opioids, the opioid medications still have helps them to achieve their functional goal. Are they truly helpful for the patients in achieving what they aspire to do in regard to their work life, in regard to the family situation. I think a lot of times for patients who have been on opioids long term, it's probably not that it really helps them that much for pain anymore, but they've often made that experience and they try to stop it. Pain gets worse, which is the effect obviously, that that happens with opiates right I mean, the moment you stop them, the opposite of the effect happens right I mean, they become irritable, right? The sleep gets worse, the pain gets worse, right? And it's a temporary phenomenon. And so, when we try to talk to a patient about possibly reducing the medication, I think this is one of the most challenging aspects that we have, that we really look at the patient and try to motivate them to be part of that plan. It's not something that we want to impose on the patient, but rather that we motivate the patient to look towards in the long term, probably more efficient pain care, which is really much more comprehensive pain care using all modalities. And I think one of the things that we learned over the last years is that when we make opiate medication reductions, we have to go very slowly. I think in the past we've talked about a matter of weeks and now the guidance including from the CDC guideline is probably more- closer to 10% per month to reducing it. So, you make reductions that may take many months to a year even, right. And the patient is allowed to help us, guide us how fast we can go. And you're allowed to make pauses if needed for the patient to adjust physiologically to reduction. And we want to go slowly enough that we don't run into an acute withdrawal situation right If you do it very gradually, it's much more manageable for the patient to do that. Then they'll be much more motivated to work with you. But still, it's a challenge right I think that we do. And I think at the very end, it's really providing good patient care that allows us to build that rapport with the patient that they trust us and that they say, Hey, you know, yes, I'm, I'm willing to work with you, doc, to maybe reduce my reliance on the medication, right? So that that I don't end up on this. You know, one of the things that I sometimes do is asking patients when they come to us this first time and there are a lot of opiate medication maybe is like, what's your goal in this regard? Where do you see yourself in, in five or ten years? Are you thinking you will still be on this medication or would you want to come off? And how can we help you then if that's your goal? So, I think this is all part of our important conversation that we have to have in order to motivate the patient.  Dr Weathers: What I heard you say repeatedly through that. And what I really want to emphasize for our listeners is that the therapeutic relationship with that patient that no matter what that scenario, really keeping them and their goals at the focus and really making it a partnership, not a paternalistic relationship, not dictating to them what the plan will be, but really emphasizing shared decision-making. And I think again, that's such a key take home point for our listeners. And also, even going back to my original question about diversion, what really struck me in your response is even though you said yes, then that was one of the few cases or perhaps even the only case where you said, all right, this is where we have to cut it off immediately. It still wasn't abandoning them as a patient, although you said we have to stop the medication. It wasn't about ending that relationship with that patient necessarily, but ending that therapy option. So really critical in how we think about opioids therapy and our relationship overall with patients.  Dr Sandbrink: So, Allison, maybe I can add on, you know, I think the patient with diversion is the one aspect where we have to look at the population as a whole and the opioid that makes it to somebody else, potentially a vulnerable child, right, even you know, who could die from it, right? Another aspect of probably the patients we mentioned them earlier who have opioid use disorder, who maybe take more than prescribed and where we as a neurologist feel often quite uncomfortable dealing with that. And I think that's so important that at that point we don't abandoned the patient, right. I mean, you know, maybe we want to continue, we don't want to continue the opiate medication for the treatment of the pain. But as we diagnose and initially suspect opiate use disorder and have a conversation about it with a patient, we need to guide them to therapy. It's a treatable condition, right? It's an untreated, it's, it's actually rather lethal in many situations, right? So, we have to make sure that we provide an integrated access to the treatment or we have a warm hand off to somebody who will continue that and not abandon the patient in regard to that pain care, as we said earlier also, right? I mean, because that second condition really doesn't obviously I mean in any way that the pain is any better. No, I mean it's a common concurrent situation and we need to make sure that they still have the better pain care possible. Dr Weathers: Again, it's a really key point for our listeners as and as I emphasized at the beginning, regardless of their subspecialty or specialty or even if they're physicians, I hope for everybody listening they can take away something from this. How did you become interested in pain management? I know that this was something that that you became interested in even when still in training. What struck you about this? Dr Sandbrink: So, yeah, so my initial fellowship actually after residence was clinical neurophysiology. So, you know, a lot of the spine and different nerve conditions really was, was, but then when I began practice, clearly longitudinal care, chronic disease management, I think many of us in neurology do that right That, that became an emphasis. And I think building that accord with the patients right and, and, and that having that ability to provide pain care is something that really worked out very well. I think I love teamwork and part of teamwork pain care in in our setting is a collaborative approach right You have other disciplines, physical therapist, psychologist, right? You know, you have intervention and nonintervention provider. I think nowadays we even have integrative modalities available to us. So, I'm working together on a team, trying to optimize it here with many team members that we have with everybody bringing that personal expertise is something that I really cherish. Dr Weathers: I feel like that's such a great example and I feel like a lot of people don't necessarily think about this specialty as one that is, that is collaborative in that way. And it really is. So, I, I think that's a wonderful way to highlight it. I always like to end on a hopeful note. And I know that there hasn't been necessarily a lot of hope or positive news in regards to, to opioid use, opioid therapy in the last several years. But are there developments that give you hope that you're excited about?  Dr Sandbrink: So, you know, I think there are probably two things I would mention. On one hand, I think patients are so much more aware now about the risk of opioids. So that is actually much easier to look and get them motivated about comprehensive pain care. There's much more interest in integrative modalities. Patients nowadays would be much more willing to maybe try acupuncture or mindfulness or yoga or Tai chi. So, I think that's actually a really nice development in that regard. But if I think about opioids specifically, I think the availability of buprenorphine as a medication, it's certainly something we should mention in this interview here, right? I mean, buprenorphine is now increasingly used for pain as well, not just in the higher dosage for opiate use disorder. It really is a good choice for patients who have. pain conditions, chronic pain conditions, severe pain and to require a daily opioid, especially in regard to safety aspect when the patient has medical conditions or mental health conditions that may put them at higher risk and they have to be on an opiate anyway. This is really something that I think has changed our practice. As you know, we don't have to rely on the X waiver anymore. Anybody with a DA license can prescribe buprenorphine. Even for opiate disuse disorder, it really has become something that I think many of us integrate much more into our practice and I want to encourage the listener to really look into that direction.  Dr Weathers: Excellent advice and I'll actually refer our listeners who are subscribers of Continuum to reference, specifically, Table 4 where you dive into the buprenorphine. It's just a fantastic table, as are all the tables. It really goes into detail of the commonly prescribed opioids for pain with the special characteristics and the conversion of morphine equivalent, but especially for this one about how to prescribe the details of us. Again, when I was preparing for this, I said wow. Like for me as a neurohospitalist and thinking about when I'm on service, how to use it, when to use it, I thought it was incredibly useful for that management of patients, especially as a powerful point of care tool. Well, thank you so much for being here with me today for this great conversation.  Dr Sandbrink: Yeah, thank you. That was my pleasure. Dr Weathers: Again, today I've been interviewing Dr Friedhelm Sandbrink, whose article on opioids and cannabinoids for the practicing neurologist, written with Dr Nathaniel Schuster, appears in the most recent issue of Continuum on Pain Management and Neurology. To learn more about the topics of opioids and cannabinoids, be sure to read the full article. And don't forget to listen to Continuum audio episodes from this and other issues. Thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/AudioCME. Thank you for listening to Continuum Audio.

In this fourth episode of the series, we are joined by José del R. Millán. Dr. Millán is a professor at the University of Texas at Austin, where he runs the Clinical Neuroprosthetics and Brain Interaction Lab and holds the Linda Steen Norris & Lee Norris Endowed Chair in Neuroengineering in the Chandra Family Department of Electrical and Computer Engineering. He is also a professor in the Department of Neurology at Dell Medical School, co-director of the UT CARE Initiative and associate director of Texas Robotics. Dr. Millán has made several seminal contributions to the field of brain-machine interfaces (BMI), especially non invasive EEG-based BCIs. Many of his achievements revolve around the design of brain-controlled robots. While his work prioritizes the translation of BMI to people who live with motor and cognitive disabilities, he is also designing BMI technology to offer new interaction modalities for able-bodied people that augment their abilities. In this episode, we discuss various elements of Dr. Millán's work, including neuroplasticity and brain signaling as a skill, noninvasive EEG-based mobile robots, VR-based neurorehabilitation, BCI-controlled wheelchairs and exoskeletons, telerobotic surgery, enhancing human driving capabilities with BCI technology, the importance of 'shared control' between human and machine, integrating AI and machine learning with brain-computer interfaces, and the evolution of non-invasive BCIs towards sleeker, more user-friendly designs.

Dr. Stacey Clardy discusses vitamin D in this lab minute.

Episode hosted by Dr. Julie Foucher of the Pursuing Health Podcast, on Sep 17, 2024: #PursuingHealth Tony Nader, MD, PhD is a medical doctor trained at Harvard University and Massachusetts Institute of Technology (Ph.D. in neuroscience) and a globally recognized expert in the science of Consciousness and human development. Dr. Nader, whose training includes internal medicine, psychiatry, and neurology, is a bestselling author (One Unbounded Ocean of Consciousness), with his book Consciousness is All There Is recently released on August 6 (Penguin/Hay House). He is the successor to Maharishi Mahesh Yogi and the head of the Transcendental Meditation organizations globally. Dr Nader conducted research on neurochemistry, neuroendocrinology, and the relationship between diet, age, behavior, mood, seasonal influences, and neurotransmitter and hormonal activity, and on the role of neurotransmitter precursors in medicine. Dr. Nader's interest to explore the full potential of the human physiology, and the human mind led him to also study and conduct research on ancient and modern techniques of self-development. For many years, Dr. Nader worked closely with Maharishi Mahesh Yogi, who first introduced Transcendental Meditation or TM® to the world in 1958, and who emphasized the scientific understanding and validation of Transcendental Meditation. Dr. Nader has discussed his expertise at academic institutions such as Harvard Business School on The Neuroscience of Transcendence, Stanford University, where he gave talks in a series entitled "Hacking Consciousness" as well as the keynote speaker for a number of conferences at the House of Commons, British Parliament. His research has been published in Neurology, Journal of Clinical Endocrinology and Metabolism, Journal of Gerontology, Progress in Brain Research, and many other journals. Dr. Nader has been awarded many time for his outstanding contribution in human development, environment, education, and health. You can connect with Dr. Nader via Instagram @drtonynader https://www.instagram.com/drtonynader If you like this episode, please subscribe to Pursuing Health on iTunes and give it a rating or share your feedback on social media using the hashtag #PursuingHealth. I look forward to bringing you future episodes with inspiring individuals and ideas about health. Disclaimer: This podcast is for general information only, and does not provide medical advice. I recommend that you seek assistance from your personal physician for any health conditions or concerns. iTunes: https://goo.gl/UFjY0q | Stitcher: http://goo.gl/xKMmiR | Spotify: https://spoti.fi/3aiTnBg | Google Play: http://bit.ly/2vrlTSD To order Dr Tony Nader's book Consciousness Is All There Is: https://www.drnaderbooks.com or use your favorite bookseller. Website https://www.drtonynader.com Instagram https://instagram.com/drtonynader Facebook https://facebook.com/DrTonyNader YouTube https://youtube.com/@DrTonyNader X https://x.com/DrTonyNader TikTok https://tiktok.com/@drtonynader Original podcast episode link https://youtu.be/V4QecGh3lNQ?si=wP7VzRkYHSlqz0wm To learn Transcendental Meditation https://www.tm.org To view the Meditate America event https://live.meditateamerica.org Maharishi International University https://www.miu.edu

As we continue to recognize November as National Epilepsy Awareness Month, Joyce welcomes Dr. James Valeriano, Director of the Comprehensive Epilepsy Program at Allegheny Health Network (AHN) in Pittsburgh, Pennsylvania. Dr. Valeriano is a sought-after speaker and expert on neurological issues and epilepsy. During the show he will discuss his career and the latest advances in the treatment of epilepsy.

Up next for our curriculum series is an episode on Neurology! Take a listen so that you're prepared for our pre-test! Author and host: Dr. Ritika Kompella, Chief Medical Resident, UCONN  Guest speakers:  Stroke mimics and chameleons: Dr. Karan Tarasaria, Stroke Neurology, Hartford Hospital  Additional readings: https://pubmed.ncbi.nlm.nih.gov/38568487/ https://pubmed.ncbi.nlm.nih.gov/38568485/ https://pubmed.ncbi.nlm.nih.gov/36222768/ https://pubmed.ncbi.nlm.nih.gov/36222765/ https://pubmed.ncbi.nlm.nih.gov/35393959/ https://pubmed.ncbi.nlm.nih.gov/38568491/ https://pubmed.ncbi.nlm.nih.gov/38830069/ https://pubmed.ncbi.nlm.nih.gov/35393968/

Dr. Justin Abbatemarco talks with Dr. Ahmad Nehme about the complexities of diagnosing and differentiating between Cerebral amyloid angiopathy-related inflammation and biopsy-positive primary angiitis of the central nervous system. Read the related article in Neurology. Disclosures can be found at Neurology.org.

Dr. Halley Alexander discusses the Neurology Today article, "Could Reducing Environmental Toxins Help Mitigate the Risk for Parkinson's Disease? Where the Evidence Is Leading" by Gina Shaw, available in the November 7th issue of Neurology Today or at neurologytoday.com. Show reference: https://journals.lww.com/neurotodayonline/pages/articleviewer.aspx?year=2024&issue=11070&article=00001&type=Fulltext

Send us a textAbout the guest: Richard Cytowic is a neurologist, poplar science writer and professor at the George Washington University. Episode summary: Nick and Dr. Cytowic discuss: the effects of smart phones and social media on the developing and adult brain; artificial blue light vs. broad spectrum natural light; attention & addiction to technology; sensory overstimulation & “virtual autism”; synesthesia and multimodal sensory perception; and more.Related episodes:M&M 78: Nature vs. Nurture, Neurogenetics, Personality, Autism, Schizophrenia, Synesthesia, Perception, Agency & Free Will | Kevin Mitchell*This content is never meant to serve as medical adviceSupport the showAll episodes (audio & video), show notes, transcripts, and more at the M&M Substack Affiliates: MASA Chips—delicious tortilla chips made from organic corn and grass-fed beef tallow. No seed oils, artificial ingredients, etc. Use code MIND for 20% off. SiPhox Health—Affordable, at-home bloodwork w/ a comprehensive set of key health marker. Use code TRIKOMES for a 10% discount. Lumen device to optimize your metabolism for weight loss or athletic performance. Use code MIND for 10% off. Athletic Greens: Comprehensive & convenient daily nutrition. Free 1-year supply of vitamin D with purchase. Learn all the ways you can support my efforts

As we grow up, there are little windows of time when we can learn very, very fast, and very, very deeply. Scientists call these moments, critical periods. Real, neurological, biological states when our brain can soak up information like a sponge. Then, these windows of learning close. Locking us in to certain behaviors and skills for the rest of our lives. But … what if we could reopen them? Today, we consider a series of discoveries that are reshaping our understanding of when and how we can learn. And what that could mean for things like PTSD, brain disease, or strokes. And cuddle puddles. It's a mind-bending discussion. Literally and figuratively.This is the second episode in an ongoing series hosted by Molly Webster, in conversation with scientists and science-y people, doing work at the furthest edges of what we know. You can find the first episode here. More to come! Special thanks to Gül Dölen, at the University of California, Berkeley, along with researcher Romain Nardou. Plus, Charles Philipp and David Herman.We have some exciting news! In the “Zoozve” episode, Radiolab named its first-ever quasi-moon, and now it's your turn! Radiolab has teamed up with The International Astronomical Union to launch a global naming contest for one of Earth's quasi-moons. This is your chance to make your mark on the heavens. Vote on your favorites starting in November: https://radiolab.org/moonEPISODE CREDITS: Hosted by - Molly WebsterReported by - Molly WebsterProduced by -Sindhu Gnanasambandan with help from - Timmy Broderick and Molly WebsterOriginal music and sound design contributed by - Dylan Keefewith mixing help from - Jeremy BloomFact-checking by - Emily Kriegerand Edited by  - Soren WheelerEPISODE CITATIONS:Science Articles -Gul's 2019 paper: Oxytocin-dependent reopening of a social reward learning critical period with MDMA  (https://zpr.io/wfQjeA6PGCBv) on the feel-good brain chemical oxytocin, and how it reopens social reward learning when combined with MDMA.Gul's 2023 paper: Psychedelics reopen the social reward learning critical period (https://zpr.io/TKDKEwiLwGRN) on the role of psychedelics in social reward learning. Sign-up for our newsletter. It includes short essays, recommendations, and details about other ways to interact with the show. Sign up (https://radiolab.org/newsletter)!Radiolab is supported by listeners like you. Support Radiolab by becoming a member of The Lab (https://members.radiolab.org/) today.Follow our show on Instagram, Twitter and Facebook @radiolab, and share your thoughts with us by emailing radiolab@wnyc.org.Leadership support for Radiolab's science programming is provided by the Gordon and Betty Moore Foundation, Science Sandbox, a Simons Foundation Initiative, and the John Templeton Foundation. Foundational support for Radiolab was provided by the Alfred P. Sloan Foundation.

      Can a career in military medicine offer unexpected opportunities to innovate and shape the future of healthcare? Join us as we explore this intriguing question with Air Force Neurologist Lieutenant Colonel Adam Willis, MD. From his initial fascination with physics to his pivotal role in supporting operational medicine, Adam recounts his unique journey and the moment that brain-computer interface technology ignited his passion for neurology. Discover how neurologists make crucial contributions in managing traumatic brain injuries and seizures in combat zones while addressing the longer-term challenges of headaches, sleep disruptions, and cognitive performance.     In this episode, we unravel the complexities of trauma patient evacuation and the innovative strides being made to enhance survival rates. Adam sheds light on the "golden hour" concept and the development of groundbreaking technologies that ensure rapid access to care. As an insider at DARPA through the Service Chiefs Fellowship Program, Adam shares how his experiences have spurred projects to revolutionize field intensive care medicine. Learn about his work on a game-changing intravascular cannula project, which promises to transform medical care from the injury site through evacuation.     Finally, dive into the world of DARPA with insights into projects like SNAP, which seeks to assess warfighters' readiness using non-invasive biomarkers. Adam's story serves as a reminder of the power of commitment and proactivity in military medicine careers. Individuals can unlock doors to additional training and career advancement by aligning personal goals with the organization's mission. Hear how seizing unexpected opportunities and embracing new challenges can lead to meaningful contributions to the future of military medicine.   Chapters: (00:04) Neurology in Military Medicine (15:39) Advances in Trauma Patient Evacuation (23:16) Revolutionizing Field Intensive Care Medicine (28:01) Innovating Military Technology With DARPA (40:48) Commitment and Innovation in Military Medicine   Chapter Summaries: (00:04) Neurology in Military Medicine    Air Force neurologist discusses role in military medicine, managing TBI and seizures, and innovative intravascular cannula for polytrauma patients. (15:39) Advances in Trauma Patient Evacuation   Maximizing survival from traumatic injuries through rapid patient movement and exploring innovative projects at DARPA. (23:16) Revolutionizing Field Intensive Care Medicine    Collaboration between DARPA and industry to develop a miniaturized, non-anticoagulated ECMO-like system for extending the golden hour in emergency medical situations. (28:01) Innovating Military Technology With DARPA     DARPA program manager crafts questions to harness innovation, funded by DoD, SNAP project for non-invasive warfighter readiness assessment. (40:48) Commitment and Innovation in Military Medicine     Commitment and proactivity in military medicine careers can lead to opportunities for training and advancement.   Take Home Messages: Career Flexibility and Innovation: The journey from a physics background to a career in military neurology demonstrates the importance of being open to unexpected career paths. Embracing new technologies, such as brain-computer interfaces, can lead to groundbreaking roles in fields like military medicine. Neurology's Critical Role in Combat Medicine: Neurologists play a vital role in managing traumatic brain injuries and seizures in combat situations. Their expertise extends beyond acute care, addressing post-TBI issues like headaches and cognitive disruptions, which are essential for maintaining operational readiness. Advancements in Trauma Evacuation: Innovations in trauma care, such as extending the "golden hour," are crucial for improving survival rates from traumatic injuries. Technologies that facilitate rapid and scalable patient movement to definitive care can significantly impact outcomes. Integration of Technology and Medicine: The collaboration between military medicine and advanced research agencies, like DARPA, showcases the potential of integrating artificial intelligence and biotechnology to revolutionize trauma care. Projects like SNAP, which use non-invasive biomarkers, highlight the future of assessing warfighter readiness. Importance of Commitment and Networking: Aligning personal ambitions with organizational missions, seizing opportunities, and proactive networking are key strategies for career advancement in military medicine. Taking initiative and being open to new challenges can lead to significant contributions in the field.   Episode Keywords: Military Medicine, Combat Neurology, Brain-Computer Interface, Traumatic Brain Injury, Battlefield Innovation, DARPA, Adam Willis, Trauma Care, Intravascular Cannula, SNAP Initiative, Artificial Intelligence, Biotechnology, Military Healthcare, Neurocritical Care, Trauma Patient Evacuation, Field Intensive Care, Military Technology, Warfighter Readiness Hashtags: #MilitaryMedicine #CombatNeurology #BattlefieldInnovation #BrainInjuryCare #DARPA #TraumaCareTech #NeuroInnovation #OperationalMedicine #MilitaryHealthcare #WarfighterReadiness   Honoring the Legacy and Preserving the History of Military Medicine The WarDocs Mission is to honor the legacy, preserve the oral history, and showcase career opportunities, unique expeditionary experiences, and achievements of Military Medicine. We foster patriotism and pride in Who we are, What we do, and, most importantly, How we serve Our Patients, the DoD, and Our Nation.   Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/our-guests Subscribe and Like our Videos on our YouTube Channel: https://www.youtube.com/@wardocspodcast Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield,demonstrating dedication to the medical care of fellow comrades in arms.     Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast YouTube Channel: https://www.youtube.com/@wardocspodcast

In the final part of this three-part series, Dr. Justin Abbatemarco and Dr. Jennifer L. Orthmann Murphy highlight important indicators for when to suspect hereditary spastic paraplegia, as well as guidelines for testing and interpreting results.  Show references: https://www.neurology.org/doi/10.1212/NXG.0000000000200192  https://cshperspectives.cshlp.org/content/early/2024/08/10/cshperspect.a041457

In this comprehensive discussion, four prominent neuromuscular experts—Drs. Bhaskar Roy, Jeff Allen, Diana Castro, and Luis Querol—explore recent developments in Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). The conversation centers on the new European Academy of Neurology and Peripheral Nerve Society guidelines, highlighting significant changes in diagnostic criteria and disease classification. The experts discuss the challenges of diagnosing CIDP, particularly in pediatric cases and variant forms, while emphasizing the importance of proper electrodiagnostic testing and the role of supportive criteria like CSF studies and MRI. They delve into the emerging field of autoimmune neuropathies and the significance of specific antibody testing. The podcast concludes with a discussion of treatment options, including traditional approaches (IVIG, corticosteroids, plasmapheresis) and newer therapies such as FcRn inhibitors and complement-targeting drugs, while also addressing the controversial role of rituximab in CIDP treatment. Throughout the discussion, the experts stress the importance of regular diagnostic reassessment and the need for more personalized treatment approaches based on patient profiles.

In the concluding segment of this two-part series, Dr. Justin Abbatemarco talks with Dr. Jennifer L. Orthmann-Murphy about genetic leukodystrophies and the increasing recognition of these disorders in adult neurology, the importance of genetic testing, and the evolving treatment landscape.  Read the related articles in Neurology and CHS Perspectives.  Disclosures can be found at Neurology.org.