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In this episode, we review the high-yield topic of Tuberous Sclerosis from the Neurology section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode, we review the high-yield topic of Von Hippel-Lindau Disease from the Neurology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
In this episode, we review the high-yield topic of Brain Abscess from the Neurology section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode, we review the high-yield topic of Neuromuscular Blockade from the Neurology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
In this episode, we review the high-yield topic of Transverse Myelitis from the Neurology section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode, we review the high-yield topic of Bell Palsy from the Neurology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
Dr. Tesha Monteith talks with Dr. Jennifer Robblee about the latest consensus on refractory migraine, its definition, and management strategies, including new guidelines for emergency treatment. Read the related article in Cephalalgia. Read the related article in Headache. Disclosures can be found at Neurology.org.
In this episode, we review the high-yield topic of Brain Death Diagnosis from the Neurology section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode, we review the high-yield topic of Myasthenia Gravis from the Neurology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
In this episode, we review the high-yield topic of Germinal Matrix and Intraventricular Hemorrhage from the Neurology Disease section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode, we review the high-yield topic of Visual Pathway from the Neurology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
In this episode, we review the high-yield topic of Cerebellum from the Neurology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
Yo-El Ju is the Barbara Burton and Reuben Morris Professor of Neurology at Washington University, St. Louis. She got her AB from Harvard and MD from Columbia and actively practices sleep medicine and is a prolific researcher, one of the top sleep scientists in the country. Here are some of the topics we discussed and a few related hyperlinked citations:—Importance of Deep Sleep (and her paper on what happens when deep sleep is purposely disrupted, how it is modulated, effect of alcohol —The Orexin Antagonist drugs that promote sleep (and a study that shows they can reduce p-tau217 and other neuroinflammation markers—Link of sleep regularity with less all-cause, cardiovascular, and cancer related mortalityFigure 3.9 from SUPER AGERS (SRI-sleep regularity index) More things we discussed:—A sleep foundation model that predicts 130 diseases—Impact of menopause on sleep—Getting to sleep vs staying asleep—Role of naps—Impact of interruptions of sleep—Sleep apnea and new interventions—Vagal nerve stimulation and sleep—Cerebrospinal fluid wave that occurs during attention lapse after poor sleep—cognitive behavioral therapy for improved sleep —Wearables, sleep scores, and effect on sleep—Any supplements that help sleep?—The rare genetically endowed short sleepersThank you Jeoffry Gordon, MD, MPH, Dr. Sara Wolfson, Lynn L, Vau Geha, Bernie Newman, and more than 600 others for tuning into my live video with Yo-El Ju! Join me for my next live video in the app.**************************************************Thanks to Ground Truths subscribers (> 200,000) from every US state and 210 countries. Your subscription to these free essays and podcasts makes my work in putting them together worthwhile. Please join!If you found this interesting PLEASE share it!Paid subscriptions are voluntary and all proceeds from them go to support Scripps Research. They do allow for posting comments and questions, which I do my best to respond to. Please don't hesitate to post comments and give me feedback. Let me know topics that you would like to see covered.Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past two years. It enabled us to accept and support 47 summer interns in 2025! We aim to accept even more of the several thousand who will apply for summer 2026.+++++++++++++++++++++++++++++I also want to thank the National Academies of Science, Medicine and Engineering for their recent recognition. Get full access to Ground Truths at erictopol.substack.com/subscribe
The word “trauma” is used so widely at present, arguably too widely. But it bespeaks a tenor of our shared reality. This episode is a journey inside what I've come to see as a parallel universe unfolding, where our species is unlocking knowledge about ourselves and capacities for radical healing of the most extreme trauma and distress. These findings are even giving rise to dramatic healing alliances across political and social lines that are inflamed in the culture at large. At universities and research laboratories around the U.S. and world, there are countless clinical studies, yielding results it's hard not at times to call miraculous — for complex PTSD, long-term addiction, treatment-resistant depression. What I'm talking about are therapeutically-administered treatments with plant medicines and chemical compounds we call psychedelic or empathogenic. Use those words, and many of us — including me until not that long ago — might become wary. Like all forces of great power, these can cut in every direction — the dark and the light of the human condition. But the conversation you are about to hear, with one of the leading neuroscientists in this field, revolves around serious, important research in settings designed for careful, beneficial human effect. Gül Dölen's groundbreaking contribution to all of us is in her fascinating insight into what psychedelically-assisted therapies are revealing about the workings of the human brain and the brain's capacity to change and the human capacity for major transformation altogether. The potential consequences of this science are intimate and civilizational at once. I see them as a stunning ray of hope in a struggling world. I interviewed Gül Dölen at the 2025 Aspen Ideas Festival. Find an excellent transcript of this show, edited by humans, on our show page. Sign yourself and others up for The Pause to be on our mailing list for all things On Being and to receive Krista's monthly Saturday newsletter, including a heads up on new episodes, special offerings, recommendations, and event invitations. Gül Dölen leads the Dölen Lab at U.C. Berkeley, where she is a Professor and the Bob & Renee Parsons Endowed Chair in the Department of Neuroscience and the Department of Psychology at the Berkeley Center for the Science of Psychedelics and the Helen Wills Neuroscience Institute. She also maintains an Adjunct Professorship in Neuroscience and Neurology at the Johns Hopkins University, School of Medicine. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
Dr. Tesha Monteith talks with Dr. Patricia Pozo-Rosich about the latest advancements in headache medicine, focusing on key research findings from 2025. Disclosures can be found at Neurology.org.
In part two of the series, Dr. Andy Southerland and Dr. Seemant Chaturvedi break down key takeaways from the OCEANIC‑STROKE trial. Show citation: Read more about the OCEANIC-STROKE trial. Show transcript: Dr. Andy Southerland: Hello everyone. This is Andy Southerland from the University of Virginia. For today's Neurology Minute, I've just been speaking with my colleague, Seemant Chaturvedi from the University of Maryland, about exciting trials presented at this year's 2026 International Stroke Conference from the American Heart Association, American Stroke Association. And the one we want to discuss for today's Neurology Minute in brief was the OCEANIC-STROKE trial. This was a very large international trial looking at the use of a novel antithrombotic agent, a Factor XI inhibitor, compared to placebo as an adjunct to our traditional antiplatelet therapies for secondary stroke prevention. And it was received with quite a bit of excitement. So Seemant, tell us in brief, what did we learn from OCEANIC-STROKE? Dr. Seemant Chaturvedi: One new class of agents, which is being tested are the Factor XIa inhibitors. And this has a unique mechanism of action, and it's believed that it can reduce thrombotic events without causing an increase in bleeding, which would be truly a major breakthrough. And so in OCEANIC-STROKE, over 12,000 patients were enrolled with either stroke or high-risk TIA within 72 hours of the last event. And the trial found that patients who had fairly mild strokes with a median NIH score of two, that when you add the asundexian 50 milligrams per day on top of either dual antiplatelet or single antiplatelet therapy, that there was an improved outcome and reduction in stroke with asundexian. There was a 2.2% absolute reduction in ischemic stroke, 26% in relative terms. Stroke, MI, and vascular death was also reduced with asundexian, as was disabling stroke. An exciting finding was that major bleeding was not increased with asundexian. And so this confirmed the preclinical hypothesis. And so I think this was a significant result in terms of reducing recurrent ischemic stroke without increasing bleeding. And so I think we eagerly await the full publication, and I think it could be applicable to many of the patients that we see in our clinical practice. Dr. Andy Southerland: So asundexian, folks, you'll hear more about this as the drug hopefully comes on the market and we see the full primary publication of this OCEANIC-STROKE trial, but exciting nonetheless to have a possible new treatment to help us reduce the risk of recurrent stroke for our patients. So Seemant, thanks so much again for joining us for today's Neurology Minute. And I encourage all of our listeners, as always, to listen to the full podcast interview ain The Neurology Podcast. Seemant, thanks for joining us. Dr. Seemant Chaturvedi: My pleasure.
Mike Ochsner joins Denise Allen to share how repeated concussions led him into applied neurology—and why simple vision and balance drills can create big shifts in recovery and performance. They discuss why so many people are told “this is as good as it gets,” how the brainstem and vestibular system affect reading, driving, pain, and coordination, and a few listener-friendly drills you can safely experiment with to explore what your brain can do.Resources mentioned: Peak Brain Reboot (free experiential workshop): https://peakbrainreboot.com Book – Unleash ADHD As Your Six Million Dollar Superpower: https://adhdadvantage.com Also available on Amazon.If you liked this episode, click here to send me a message. I also appreciate guest and topic suggestions.Click the link above to message me directly. It comes to me as FAN MAIL! How great is that? Just click on the place that says, "If you liked this episode CLICK HERE:"
Dr. Israr Ul Haq, Neurologist and Clinical Neurophysiologist at the Riverside Brain and Spine Institute, joins us to discuss signs and symptoms of Multiple Sclerosis and how neurologists diagnose and treat the condition. Learn more about Israr Ul Haq, MD
In part four of this series, Dr. Tesha Monteith explores the true potential of AI integration in medical education. Show transcript: Dr. Tesha Monteith: Hi. This is Tesha Monteith with the Neurology Minute. I've been speaking with Roy Strowd, Jeff Ratliff, and Justin Abbatemarco about the use of AI in neurology education for the neurology podcast. My take is that we're just getting started with this stuff, including the true potential of AI integration in medical education. In my regular work, I used AI to generate clinical case vignettes that help trainees practice diagnostic reasoning, and also to create patient images that better reflect the cultural diversity of our neurology population. Beyond content creation, AI has helped me evaluate my curriculum by identifying gaps and strengths to better train fellows and residents. I've even used it as a tool to help me frame feedback, highlighting strengths, identifying areas for growth, and to provide a more forward-looking feedback approach. AI still needs work. It should be monitored and scrutinized, and it certainly can't replace us, but it can provide meaningful augmentation of how we teach and how our learners develop. This is Tesha Monteith. Thank you for listening to the Neurology Minute.
What unsuspecting dangers lie within a garden compost bin? The Case Reports team are back to uncover a new pair of neurological mysteries. The first case this episode (1:24) comes from Edinburgh, centred on an 88-yo woman who presents with headache and eye-pain on her right side. She receives an early diagnosis of migraine, but returns a few weeks later with intermittent vomiting and subsequent progressive visual loss. https://pn.bmj.com/content/26/1/83 The second case (19:51) from Wessex features a common presentation of tingling feet, with a 62-yo man who develops gait instability. More curious are a significant drop in his weight, as well as a scaly patch on his chest. https://pn.bmj.com/content/26/1/63 The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Babak Soleimani³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the October 2025 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Clinical Lecturer in Neurology at the Institute of Cognitive Neuroscience, University College London, and an Honorary Neurology SpR at the National Hospital for Neurology and Neurosurgery. (3) Clinical Research Fellow, Oxford Laboratory for Neuroimmunology and Immunopsychiatry, Nuffield Department of Medicine, University of Oxford Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://bit.ly/4aXF46i). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Brian O'Toole. Thank you for listening.
If you've been feeling foggy or forgetful—you might be low on Vitamin B-12. Dr. Jeanine Cook-Garard and Pandora Groth talk with Dr. Majid Fotuhi, a neurologist, and adjunct professor at the Mind Brain Institute at Johns Hopkins and at the department of Psychology and Brain Sciences at George Washington University. He is also the author of The Invincible Brain.
The new semi-autobiographical play “The Reservoir” spins a comedic narrative around cognitive reserve, the idea that doing brain-stimulating activities can prevent or delay the onset of dementia symptoms. It's currently running at the Atlantic Theater Company and co-produced by The Ensemble Studio Theater in New York.* Host Ira Flatow talks with playwright Jake Brasch about his inspiration for the play and how to mesh science into the theater. Then, neurologist Marilyn Albert discusses some of the latest science of mental stimulation and dementia. After following a diverse group of older adults for 20 years, her research found that a modest amount of specialized cognitive training reduced dementia risk by 25%. You can try a very similar brain training exercise at home. *“The Reservoir” received funding from the Sloan Foundation, which also helps support Science Friday. Guests: Jake Brasch is a writer, performer, composer, clown, and writer of the new play “The Reservoir.” Dr. Marilyn Albert is a professor of neurology and director of the Alzheimer's Disease Research Center at Johns Hopkins Medicine.Transcripts for each episode are available within 1-3 days at sciencefriday.com. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.
Dr. Andy Southerland talks with Dr. Seemant Chaturvedi about the latest findings from the 2026 International Stroke Conference. Read more about the CHOICE-2 trial. Read more about the OCEANIC-STROKE trial. Read more about the FASTEST trial. Disclosures can be found at Neurology.org.
In part two of this series, Dr. Justin Abbatemarco, Dr. Marjo S. van der Knaap, and Romy J. van Voorst discuss the patient management card and how patients should use it. Show citation: and Clinical Management of Vanishing White Matter. Neurology. 2025;105(11):e214320. doi:10.1212/WNL.0000000000214320 Show transcript: Dr. Justin Abbatemarco: Hello and welcome back. This is Justin Abbatemarco here with Romy J. van Voorst and Dr. Marjo S. van der Knaap. After discussing her article, Published Neurology Consensus Base Expert Recommendation for Diagnosis and Clinical Management of Vanishing White Matter Disease. Romy, I really want to talk with you about the patient management card. What inspired you to create that in this publication, and how should patients use that? Romy J. van Voorst: So what the main motivation was of the study was actually a previous study that we did before. And in this study, we looked at the impact of any short matter on unaffected family members. And we found out that actually many family members encountered clinicians that were unfamiliar with its disease or disease-specific management. And during interviews, we saw that there was an urgent need for moral harmonization of care and also symptom management because families felt like they are left alone with just their child and no guidance on how to go further. And we wrote these recommendations to help families better understand the diagnostic and care process so they can also participate in informed decision-making. So they can understand what kind of preventive measures they can take and whether or not this interferes, for example, with quality of life goals. So there are a lot of different recommendations families can take home with. Dr. Justin Abbatemarco: Marjo, anything else you want to add there? Dr. Marjo S. van der Knaap: Yeah, I think the management card also helps because they have a physical card when they go to consultation or to emergency room that they can hand over. It's an official publication. It's developed by the Finishing WebMetter Expert Consortium in combination with other experts in combination with patient advocates and representatives. And so it's really a sort of a guidance that cannot be denied. So it has some authority to it. Dr. Justin Abbatemarco: But I think it's a theme that applies to many neurological diseases, and addressing that. You do it really practically. And I agree, giving something more tangible for patients to present, especially to non-neurologists to help them give some guidance. It's an idea that we need to think about in clinic all the time on how we're interacting and supporting caregivers and when they're interfacing with the medical community at large. So I love what you guys have done here and to make us think about this more broadly. Thanks again for all your time and your work on this topic. Dr. Marjo S. van der Knaap: Thank you for having us.
In this episode of PEM Currents: The Pediatric Emergency Medicine Podcast, we take a structured, evidence-based approach to the acute treatment of migraine in children and adolescents. From confirming the diagnosis and screening for concerning features to optimizing outpatient therapy and executing a protocolized emergency department strategy, this episode walks through what works. We review the role of NSAIDs and triptans, clarify how IV fluids and ketorolac fit into care, and provide a stepwise framework for dopamine antagonists, valproate bridge therapy, DHE protocols, steroids, discharge planning, and admission decisions. Practical dosing, reassessment timing, and family-centered communication strategies are emphasized throughout. Learning Objectives Recognize the clinical features of pediatric migraine and distinguish it from secondary causes of headache. Implement a stepwise, evidence-based emergency department approach to acute pediatric migraine, including appropriate medication selection and timing of reassessment. Develop safe discharge and follow-up plans by defining treatment endpoints, minimizing medication overuse, and identifying patients who require referral or inpatient management. References 1. Oskoui M, Pringsheim T, Holler-Managan Y, et al. Practice Guideline Update Summary: Acute Treatment of Migraine in Children and Adolescents: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2019;93(11):487-499. doi:10.1212/WNL.0000000000008095. 2. Patterson-Gentile C, Szperka CL. The Changing Landscape of Pediatric Migraine Therapy: A Review. JAMA Neurology. 2018;75(7):881-887. doi:10.1001/jamaneurol.2018.0046. 3. Bachur RG, Monuteaux MC, Neuman MI. A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department. Pediatrics. 2015;135(2):232-238. doi:10.1542/peds.2014-2432. 4. Ashina M. Migraine. The New England Journal of Medicine. 2020;383(19):1866-1876. doi:10.1056/NEJMra1915327. 5. Richer L, Billinghurst L, Linsdell MA, et al. Drugs for the Acute Treatment of Migraine in Children and Adolescents. The Cochrane Database of Systematic Reviews. 2016;4:CD005220. doi:10.1002/14651858.CD005220.pub2. Transcript This transcript was generated using Descript automated transcription software and has been reviewed and edited for accuracy by the episode's author. Edits were limited to correcting names, titles, medical terminology, and transcription errors. The content reflects the original spoken audio and was not substantively altered. And today we're gonna talk about the acute treatment of migraine headache in children and adolescents. This is bread and butter for the PED, requires precise diagnosis and evidence-based treatment. We're gonna talk about making that diagnosis, red flags, outpatient and ED treatment, as well as some second-line agents, admission decisions, and a whole lot more. So migraine in children is defined by three criteria, and at least five attacks lasting two to 72 hours. So you gotta have at least two of the following: pulsating or throbbing quality, moderate to severe intensity, aggravation by routine activity, and a unilateral location. Although in children, it's often bilateral, plus at least one of nausea or vomiting and photophobia and/or phonophobia. In children headaches are frequently bilateral, bifrontal, bitemporal. The duration might be shorter than adults, especially in kids under second or third grade. And you may have to infer whether or not they have photophobia from their behavior. Like does the child close their eyes or wanna go into a dark room? In the emergency department, we're often diagnosing based on pattern recognition plus exclusion of dangerous secondary causes. Or even more often than that, the patient comes in and says, I've got a migraine. Before I move on to treatments, let's talk about some red flags where you might wanna pause and not just jump to migraine therapy. And the mnemonic SNOOP can be helpful here. And it stands for S for systemic symptoms such as fevers, myalgia, weight loss, or another S, secondary risk factors such as an immune deficiency, cancer, pregnancy, N for neurologic signs, papilledema, focal deficit, confusion, seizures. O onset sudden, or thunderclap. Migraines are often a little more gradual than that. The other O is older age, or technically younger age too, younger than five years or older than 50. Hopefully those patients are not coming into the pediatric emergency department. And then pattern changes, these new symptoms in a previously stable pattern. Don't ignore that. And precipitants, you know, is it worse with Valsalva, position change, or under significant exertion? If these signs are present, you'll probably wanna take a pause and just not throw migraine treatment at the patient. If they're stable, MRI is the preferred imaging modality, but a very sick patient, it'd be okay to get a head CT. If you've got a normal neurologic exam, there's no red flags. Again, you don't need routine imaging for migraine headaches. So let's talk about treatment. So hopefully patients have actually started to treat their headache before they arrive in the emergency department. If they haven't, it's a good idea to have some triage protocols in place. So ibuprofen, 7.5 to 10 milligrams per kilogram, 10 milligrams per kilogram is superior to placebo and it's superior to acetaminophen at two hours. So that's what we would use. Early treatment's critical. So ideally within the first hour of onset. So that's why triage protocols help. We'll give kids 10 mg per kg of ibuprofen and like 30 ounces of Gatorade. Blue is often the first Gatorade choice, though that's not an evidence-based statement. You can also use naproxen, but most of the studies are on ibuprofen. If NSAIDs fail, many adolescents and some older children will be prescribed triptans. The best evidence currently supports sumatriptan plus naproxen or zolmitriptan nasal spray. Rizatriptan is FDA approved down to age six. Adolescents respond to these agents better than younger children, and the route matters. The nasal formulations help when nausea is prominent. Families should be counseled to treat early, use weight-appropriate dosing, and avoid using acute medications more than 10 days per month. Often patients will have already taken an NSAID and a triptan before they get to the ED, and that's where we get into the treatment of refractory migraine. Now this is most of the patients that I will see, and before we push medications, let's briefly review ED treatment goals. You either want the patient headache free. Back to their baseline or mild descending pain. So a pain score of one to three. If you don't reach one of those endpoints and it's not agreed upon with the patient and their family, you've not completed treatments. You should do a reassessment within one hour after each intervention. And let's face it, if you're not reassessing within an hour and defining treatment goals, you're not practicing protocolized migraine care. So in the emergency department, many of you may be familiar with the migraine cocktail. So what is that? In general, it's a dopaminergic agent such as prochlorperazine or metoclopramide plus ketorolac, plus IV fluids. Let's take a look at all three of those components and see if you can guess which one is actually the one that can abort the migraine. So fluids are commonly given in pediatric migraine, but they alone do not treat it. They're helpful. Many patients have been throwing up or a bit dehydrated, but there are small randomized trials that show essentially no meaningful pain reduction in patients that get IV fluids alone. Well, what about ketorolac? Toradol, like that's the first thing you give to a kid with a kidney stone, right? It does help, but it's really adjunctive. So the main first-line agents for refractory or status migrainosus in the emergency department are the dopamine antagonists, and the first-line treatment for most patients is prochlorperazine or Compazine. The dose is 0.15 milligram per kilogram IV. The max is 10 milligrams. This is the backbone of ED migraine care. And why do they work? Well, migraines aren't just some random vascular headache. This is an inherited disorder with central pain pathways gone awry. Dopamine plays a large role in that pain, nausea, hypersensitivity, amplification of symptoms and more that, frankly, I won't get into this podcast because molecules hurt my head. The dopamine antagonists treat the headache, they reduce the nausea, and they just tamp down this process. Overall, the response rates approach 85%. Some studies have suggested that the response rate is about 77% at an hour and 90% at three hours. If you add the ketorolac and IV fluids, you get your response rate up to about 93 to 94%. These agents really do work well together. There have been randomized trials comparing IV prochlorperazine versus ketorolac. 85% of prochlorperazine patients achieved headache relief versus only 55% of ketorolac patients. So ketorolac helps, but really it's the prochlorperazine. Metoclopramide, or Reglan, is used in a lot of centers as well. There are some smaller studies in children and adolescents that show that prochlorperazine is more effective, but if kids have an adverse reaction, more on that in a moment, or they prefer metoclopramide because they've responded to it in the past, it's okay to go with it as well. Right. So what does it actually look like when you give the migraine cocktail to a patient? I think it's important to explain to patients and families what to expect, and if this is a teenager, I'm talking to them directly. I mean, they're getting the medication first and foremost. I tell them that the most effective way to treat their headache is with an IV. This often causes lots of angst, even in older teenagers. The medication just does not get to the brain as effectively and fast enough if you take it by mouth. Many patients who get the dopaminergic agents, so prochlorperazine, will invariably feel jittery or anxious or like they gotta move or like they got ants in their pants. I tell them to expect this so they're not surprised and worried when it happens. I tell them that once they start feeling that way, it means the medicine is probably working. They need to hit the nurse button and we're gonna get them up and have them take a walk. This fixes it for the majority of patients just getting up and moving. In adult centers, even with the initial administration of the prochlorperazine or as sort of a reflexive response to any of those symptoms, they just give a slug of IV Benadryl. There's some studies in adolescents especially that this may decrease the effectiveness of the IV agents you're giving in the first place, and it may also increase return rates to the ED. So I will use IV diphenhydramine if getting up and moving around isn't working, or if the distress is significant, or if the patient clearly indicates they've needed it in the past. So if after the migraine cocktail, the patient has met their pain goals and the reassessment is favorable, they can go home to outpatient follow-up. How about if the headache got better, but not all the way? It's usually when the initial migraine cocktail didn't achieve the pain endpoints fully, like it helped partially. If the dopamine blockade didn't do anything, valproate is unlikely to rescue the case. And so valproate works on GABA and it stabilizes some of these pain processes, but the dopaminergic agent needs to have done something first for valproate to work. Per the most common protocol, you give an initial dose of IV valproate, then you discharge the patient home on Depakote ER. So oral valproic acid under 10 years old or under 50 kilograms, 250 milligrams PO twice a day for two weeks, or older than 10 or greater than 50 kilos, 500 milligrams twice a day for two weeks. This is the extended release and it's most helpful if you give the first oral dose in the emergency department. So that's why it's very important to build this protocol in advance. If you don't have IV valproate, then don't just give the patient oral valproate, and definitely don't prescribe an oral course for discharge. All right, well, what about DHE? Dihydroergotamine for refractory or status migrainosus? Generally, this is only given at pediatric centers where you have neurology coverage. It's contraindicated if you've had another dose of DHE within 14 days, or you've had any triptan of any sort within 24 hours, and you must obtain a pregnancy test in adolescent females before giving it. The dosing for less than 30 kilograms is 0.5 milligram. At least 30 kilograms is one milligram. You give 50% of the dose over three minutes, then the remaining 50% over 30 minutes. If this is gonna work, the patients are gonna start feeling wretched at first. They're gonna get very nauseous and they're gonna vomit. They're gonna have flushing, and you'll see transient hypertension. Most of that resolves within the hour in most centers. If you're committing to DHE, you're kind of bringing the patient into the hospital anyway, though some facilities will have DHE done in the emergency department with close outpatient follow-up. Either way, it's really best practice to involve child neurology if you're giving DHE. Alright, well what about steroids? They give those in grownups too, right? Steroids really only have a role for recurrence prevention in children. So for kids that have a history of returning within 72 hours for rebound headache, you can give dexamethasone 0.6 milligram per kilogram IV dose, the max of 10 milligrams. You do not discharge them home on a steroid prescription or a Medrol dose pack or something else, and this can cut the recurrence risk down a bit. There's other therapies out there like magnesium and ketamine. There's just not enough evidence there. And the purpose of this episode is to discuss the therapies that have good evidence behind them and should be part of protocols across the country. Some patients are unfortunately not responsive to emergency department therapy and need admission. The main inpatient therapy is the DHE protocol. If they're not DHE eligible, they haven't tolerated it well or it's unavailable, admission's unlikely to help them unless they just need some IV fluids to help them get back up on their feet. You should consult neurology if the headache goals are not met after maximizing ED therapy for advice. And we should definitely avoid opioids. They don't treat patients with migraines. They increase recurrence risk. They increase revisit rates. Again, the dopamine antagonist prochlorperazine, it's superior for sustained relief when families ask about them, and fortunately they're asking about opioids far less. We use medications that treat the migraine pain pathways and signaling. We don't just wanna mask the pain. All right, so that's all I've got on the acute management of migraine headaches, especially in the emergency department. Remember that migraine care in the ED should be protocolized and evidence-based. IV fluids are supportive. Prochlorperazine is the first line, or you can use metoclopramide as well. Ketorolac is an adjunctive therapy. Valproate is next line. If you've gotta escalate, and DHE is specialized therapy, you can start in the ED, but most of these patients are getting admitted. Dexamethasone or steroids in children can reduce recurrence risk, but they're not really part of the acute management. You should definitely define the endpoints and structurally and systematically reassess patients at an hour. The goal is to get them feeling better to a defined endpoint and to restore function. There is evidence-based pediatric emergency migraine care. You should understand that, plus how to explain why these agents are being given and some of the side effects to patients and families. I find that that approach increases your likelihood of buy-in and success. Alright, so that's it for this episode on the Acute Management of Migraine Headaches in Children and Adolescents. I hope you found it helpful and I can pretty much guarantee that you're gonna see a patient with a migraine on your next shift. If you've got any feedback or comments, send them my way. If you like this episode, leave a review on your favorite podcast site. It helps more people find the show. Or recommend it to a colleague. If there's other topics that you'd like to hear, send them my way for the Pediatric Emergency Medicine podcast. This has been Brad Sobolewski. See you next time.
On February 26, 2026 we were joined by Dr. Peter Fox to talk about quantitative brain imaging methods and how they can reveal localized changes in brain structure in brain disorders that traditionally have not been associated with specific neuropathology. Guest:Peter Fox, Director, Brain Imaging Institute and Professor of Radiology, Neurology, and Physiology at UT Health San Antonio.Participating:George Perry, Department of Neuroscience, Developmental and Regenerative Biology, UTSA.Host:Charles Wilson, Department of Neuroscience, Developmental and Regenerative Biology, UTSA.
The March 2026 recall showcases four previously posted episodes focused on clinical issues relevant to hospital-based neurologists. The episode opens with Dr. Jennifer E. Fugate discussing PRES, focusing on clinical presentation, diagnostic criteria, neuroimaging findings, and management strategies. The episode continues with Dr. Ava Easton discussing the World Health Organization's technical brief on encephalitis. In the third episode, Dr. Matthew Ryan Woodward discusses the complexities of status epilepticus, from definition through refractory and super-refractory stages. The episode concludes with Dr. Adrian Budhram discussing common challenges neurologists face when interpreting CSF results. Podcast links: Evolving Insights into the Diagnosis, Management, and Outcomes of PRES WHO Launches Technical Brief for Encephalitis Super Refractory Status Epilepticus Diagnosis, Management, and Prognostication CSF Correction Factors for Traumatic Lumbar Puncture in Adults Article links: Posterior Reversible Encephalopathy Syndrome: Evolving Insights in Diagnosis, Management, and Outcomes WHO Launches Technical Brief for Encephalitis Super Refractory Status Epilepticus Diagnosis, Management, and Prognostication Clinical Utility of CSF Correction Factors for Traumatic Lumbar Puncture in Adults Disclosures can be found at Neurology.org.
Welcome to the NeurologyLive® Mind Moments® podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice.In this special Mind Moments episode, Lauren Sansing, MD, MS, FAHA, FANA, Professor of Neurology at Yale School of Medicine, joins the podcast to provide a clinical breakdown of the 2026 International Stroke Conference and its implications for real-world stroke care. Sansing reflects on how this year's meeting built on prior advances, highlighting expanded global collaboration, greater patient engagement, and a record number of clinical trials presented. The discussion explores which late-breaking studies may influence practice in the coming year, including data on secondary stroke prevention, adjunctive thrombolysis strategies, and evolving patient selection for thrombectomy in extended windows and large core infarcts. Sansing also reviews renewed momentum in neuroprotection research, key updates from the newly released acute ischemic stroke guidelines, emerging pediatric stroke data, and how the conference continues to shape the roadmap for 2027 and beyond.Looking for more Stroke discussion? Check out the NeurologyLive® Stroke clinical focus page.Episode Breakdown: 1:00 – Biggest moments and structural evolution of ISC 2026 3:15 – Presented practice-changing trial data impacting stroke care 7:05 – Thrombectomy strategy and extended window patient selection 10:40 – Renewed momentum in neuroprotection research 15:20 – Neurology News Network 17:40 – Key updates from the new acute ischemic stroke guidelines 25:00 – A brief look-ahead to ISC 2027 The stories featured in this week's Neurology News Minute, which will give you quick updates on the following developments in neurology, are further detailed here: PTC Withdraws Ataluren Submission as Treatment for Nonsense Mutation Duchenne Muscular Dystrophy Microbiome-Targeted Agent PLL001 Passes Safety Check in Phase 1/2 Trial of ALS Rimegepant Displays Safety and Efficacy in Study of Adolescents With Migraine Thanks for listening to the NeurologyLive® Mind Moments® podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com.
We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Zakariyya presents a case of acute psychiatric disturbance and tremors to Sebastian. Neurology DDx Schema Zakariyya Ellemdin Zakariyya is a medical doctor from South Africa with a strong passion for internal medicine, neurology, and clinical reasoning. He thrives on… Read More »Episode 441: Neurology VMR – acute psychiatric disturbance and tremors
Dr. Andy Southerland talks with Dr. Shyam Prabhakaran about the 2026 AHA/ASA guidelines for the early management of acute ischemic stroke, highlighting key recommendations, the role of advanced imaging, and the importance of thrombolysis and thrombectomy. Read the related article in the journal Stroke. Disclosures can be found at Neurology.org.
In part one of this two-part series, Dr. Justin Abbatemarco, Dr. Marjo S. van der Knaap, and Romy J. van Voorst discuss vanishing white matter disease, focusing on the clinical and MRI findings that would prompt the consideration of genetic testing. Show citation: van Voorst RJ, Schoenmakers DH, Bonkowsky JL, et al. Consensus-Based Expert Recommendations for Diagnosis and Clinical Management of Vanishing White Matter. Neurology. 2025;105(11):e214320. doi:10.1212/WNL.0000000000214320 Show transcript: Justin Abbatemarco: Hello and welcome. This is Justin Abbatemarco here with Romy J. van Voorst and Marjo S. van der Knaap. After discussing their article published in Neurology, Consensus-Based Expert Recommendation for Diagnosis and Clinical Management of Vanishing White Matter. They both work for Amsterdam University Medical Center in the Netherlands. And we're going to have a two-part episode dissecting maybe two elements of this paper. Marjo, maybe we could start here and just talking about what vanishing white matter disease is and what in the clinic and MRI findings would make us go towards a genetic testing. Dr. Marjo S. van der Knaap: There are two things about vanishing white matter that matter most to families, and one is the stress sensitivity. So any type of physical stress, like fever, viral infection, anything may cause a rapid decline and you never know when it comes. And that brings me to the second item that's very difficult and painful for families. And that's the unpredictability. You never know when a disease is going to hit and then your child is going to go down. So you really need the support of neurologists who know about this disease and help you go through this situation. Dr. Justin Abbatemarco: Right. And this paper serves as a great resource for folks that if they have a patient in clinic like this, medications to avoid, how to manage those stress responses. And so it's a really helpful publication to have there. And then I think another message we talked a lot about on the podcast was the importance of genetic testing when patients aren't fitting a typical bucket and this specific disease has unique characteristics. I think the cystic appearance of the MRI, which you do a great job highlighting, would really lead us down that road. So I think it's all really helpful and it gives us some ways to start in clinic with patients and our caregivers. So thank you. Come back and join us for the second part of The Neurology Minute episode where we're going to talk about the patient management.
In the final episode of this three-part series, Dr. Stacey Clardy and Max Goldman talk about telehealth. Stay updated with everything related to Neurology on the Hill. Show transcript: Dr. Stacey Clardy: Hi, this is Stacey Clardy, and today we're wrapping up our three-part series covering the Top Advocacy Issues for Neurology on the Hill 2026 in Washington, DC. This is the event where many neurologists fly in from all over the country to meet with our elected representatives to discuss the issues of the most importance to our patients, and to allow us to continue to take good quality care of our neurology patients. We have again back with us, Max Goldman. He's the Director of Congressional Affairs from the AAN Legislative Team. Max, we covered Medicare, we covered neuroscience research in the Brain Initiative. The third and final issue is telehealth. What do we need to accomplish on telehealth in Washington, DC this year? Max Goldman: The telehealth flexibilities provided with the COVID-19 public health emergency have been so important to providing neurological care to patients across the country. However, what we saw during the government shutdown at the end of 2025 was a lapse in those flexibilities, which caused a huge amount of panic, of uncertainty for both our members, the AAN, who are providing care, and patients who relied on care through telehealth from their neurologist. That can't happen again. These flexibilities have been extended short-term basis for one year, two year, a couple of months, and what we need now is a permanent extension of these flexibilities so they can't lapse again, and our patients know they can access the care they need. What we're doing at Neurology on the Hill is going to ask our members of Congress to co-sponsor the Connect for Health Act. This bill would permanently extend telehealth flexibilities, including a full extension of protection of audio-only visits, which is important for folks in areas without great broadband or access to internet. This would just be a really good bill. It's got a lot of momentum this year, and we're hopeful that this will finally make telehealth a permanent part of neurological care going forward. Dr. Stacey Clardy: So important. I certainly know out here in Utah where we cover several rural states, this has really been a lifeline to our patients. To learn more about this issue and the other issues being discussed at Neurology on the Hill, you can go to AAN.com and click on advocacy. Thanks for listening, and thank you Max, for representing us in DC.
In this episode, Douglas A. Ross, MD, CPE, FACS, Chief Medical Officer at AdventHealth Carrollwood, discusses rising pressures from age related neurological conditions, the shift toward team based and community anchored care models, and how biomarkers, functional imaging, and AI supported screening are reshaping early detection and treatment across the AdventHealth network.
Bruce Chabner is a professor of medicine at Harvard Medical School and clinical director emeritus of the Massachusetts General Hospital Cancer Center. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. I.D. Goldman and B.A. Chabner. Cerebral Folate Deficiency, Autism, and the Role of Leucovorin. N Engl J Med 2026;394:833-835.
Neurologic complications of hematologic disorders are frequently encountered in clinical practice and can involve both the central and peripheral nervous systems. Early recognition and appropriate management in collaboration with a hematologist are essential to reduce morbidity and mortality. In this episode, Kait Nevel, MD, speaks with Lauren Patrick, MD, and Mark Terrelonge, MD, MPH, authors of the article "Neurologic Complications of Hematologic Disorders" in the Continuum® February 2026 Neurology of Systemic Disease issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Patrick is an assistant professor of neurology at the University of California, San Francisco, in San Francisco, California. Dr. Terrelonge is an associate professor of neurology at the University of California, San Francisco, in San Francisco, California. Additional Resources Read the article: Neurologic Complications of Hematologic Disorders Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @IUneurodocmom Full episode transcript available here Dr Nevel: Thick blood, thin blood. These are terms often used by patients and caregivers to describe some of the hematologic disorders that can lead to neurological diseases such as stroke. So, when should we consider a hematologic disorder as a potential cause for neurological conditions, such as stroke or neuropathy. Today I have the opportunity to interview Drs Lauren Patrick and Mark Terrelonge to learn more about neurologic complications of hematologic disorders in their recent article in Continuum. Dr Jones: This is Dr Lyell Jones, editor-in-chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Nevel: Hello, this is Dr Kate Nevel. Today I'm interviewing Drs Lauren Patrick and Mark Terrelonge about their article on neurologic complications of hematologic disorders. This article appears in the February 2026 Continuum issue on neurology of systemic disease. Welcome to the podcast, and please introduce yourself to the audience. Dr Patrick: Thank you for having us. We're both thrilled to be here. I'm Lauren Patrick, a vascular neurologist and assistant professor at the University of California, San Francisco, and program director for the Vascular Neurology Fellowship here. Dr Terrelonge: And I'm Mark Terrelonge, I'm an associate professor of neurology and neuromuscular medicine here at UCSF and one of the associate program directors for the adult neurology residency. Nice to meet you. Dr Nevel: Nice to meet you both. Really looking forward to getting into your article and learning more. So, to kind of kick us off, I always like to ask what do you think is the most important takeaway from your article for the practicing neurologist? And maybe since there are two of you and I suspect you covered slightly different aspects of this article, maybe you could give us two most important takeaways. Dr Patrick: Sure. I think the biggest takeaway is to keep hematologic disorders on the differential when evaluating patients with neurologic symptoms. Conditions like sickle cell disease, myeloproliferative neoplasms, or plasma cell dyscrasias and paraproteinemia can cause strokes or peripheral neuropathies, and many have specific and targetable treatments. The early recognition and collaboration with our hematology colleagues can truly change patient outcomes, whether that's by initiating cytoreductive therapy, managing thrombocytopenia, or optimizing antithrombotic therapy. Dr Nevel: Great. So, this is a really big and diverse topic. As always, I'm going to urge our listeners to read the article because there is a lot of really good stuff in your article that we just don't have time to get into during this interview today. But you cover a lot of different hematological disorders and how they can cause neurological complications. One of the major neurological complications of hematological disorders is cerebral vascular events. So, I'm hoping, Warren, that you can walk us through a little bit. When should we consider workup of potential hematologic disorder as a cause when we see a patient with ischemic stroke, because certainly not all patients with ischemic stroke should be getting a broad hematological disorder work up. So how can we kind of identify early on that there might be something else at play? Dr Patrick: Absolutely, great question. So, in many cases, the underlying hematologic disorder is already known, such as sickle cell disease or polycythemia vera. But sometimes stroke is the initial presentation or manifestation of the disease. So red flags can include young age, recurrent cryptogenic strokes or thrombosis, and unusual locations like the cerebral venous system. Laboratory clues such as unexplained erythrocytosis, thrombocytosis, thrombocytopenia, or hemolytic anemia should raise suspicion for an occult hematologic disorder. In the setting of acute illness, immune-mediated or heparin-induced thrombocytopenia or thrombotic microangiopathies should be suspected in patients that have hemorrhagic and or thrombotic complications, particularly when relevant lab disturbances are present. Acquired thrombophilia such as anti-phospholipid antibody syndrome should be considered in young patients with autoimmune disease, prior venous or arterial thrombotic complications, or pregnancy morbidity. Now, these are rare causes overall, but they're important to catch because the management can differ dramatically from our typical stroke care. Dr Nevel: Great. And what are some of the most common inherited or acquired thrombophilias and when should we be sending these labs? Dr Patrick: The hematologic causes really account for small minority of arterial strokes approximately one to two percent, but among those, sickle cell disease, anti-phospholipid antibody syndrome and the myeloproliferative neoplasms are the most common. Timing of testing is key. So, the genetic thrombophilia panels can be drawn at presentation, but lab values such as protein C, protein S, and antithrombin levels may be falsely low during acute thrombosis, so they're often repeated weeks later. Similarly, for anti-phospholipid antibody testing that should be done at presentation and when positive, confirmed at twelve weeks, since transient positivity can occur with affections or acute events. So, in patients that are already anticoagulated for anti-phospholipid antibody syndrome, testing becomes particularly tricky, especially with lupus anticoagulant assays. Some results need to be interpreted carefully or repeated when feasible. The main message is to collaborate early with our hematology colleagues to guide the timing and interpretation of these studies. Dr Nevel: Yeah, wonderful. Thank you. I'll ask some similar questions about neuropathy. So when should we consider an underlying hematologic disorder as being the cause for someone's neuropathy? Dr Terrelonge: So, luckily for a neurologist, then serum protein electrophoresis or an SPEP is already a part of the first pass evaluation for even the most common neuropathies we see, technically already considered every time we do an evaluation. However, we do know that most neuropathies progress very slowly and don't really lead to significant limitations in patient activities of daily living. And for those, the initial workup step, you may not need to do any additional search for any hematologic diseases after that first step. Within patients who start to have more unusual features with their neuropathy, including a rapid progression, early proximal weakness, significant and extremely painful neuropathies, significant ataxia, or new tremor or anything that's kind of outside of the garden variety neuropathy, then you should start to think about a hematologic cause. Additionally, if a patient already has a known hematologic malignancy or process before their neuropathy, there should be some form of assessment to see through exam or electrodiagnostically if the two are correlated. I do have to add one caveat, though, and that's just because someone has a hematologic malignancy or a paraprotein seen in their blood, their neuropathy and the neurologic syndrome don't necessarily have to be causally related. So, we have to do some additional testing to determine if the patient's presentation of the paraprotein are actually linked. Dr Nevel: Can you walk us through a little bit how we determine if they're associated or just coincidental? Dr Terrelonge: Yeah. So, for some of the proteins, there's a specific phenotype that will come with the specific protein. For example, an anti MAG proteinopathies or MAG standing for a myelin associated glycoprotein, it usually leads to a distal sensor and motor polyneuropathy where the most distal portions of nerves are affected. So, in that case, people might notice that they have numbness and weakness in their toes and their fingers, and it doesn't follow that typical length dependent pattern. So, in that case, if you have the anti mag neuropathy and the electrodiagnostic signature of an anti mag neuropathy along with the symptoms, you're more likely to think that the two are related then if not. Dr Nevel: Great. Thank you. And I was hoping you could speak a little bit more about amyloidosis just because I think that that's one that can be really tricky to diagnose. And I see patients, you know, have sometimes more drawn out evaluations or see multiple providers before a diagnosis is reached. So, can you speak a little bit more to how we diagnose amyloidosis in relationship to neuropathy or other neurological conditions and when we should push for more invasive testing like a nerve biopsy? Dr Terrelonge: So, amyloidosis certainly is a tricky diagnosis. I've been tricked by it and I think most of my neuromuscular colleagues have probably been tricked by it at least once. It's a hard diagnosis to make is it usually requires a pretty high index of suspicion, and also requires a tissue diagnosis to cinch. There're some patients who will come in with a prior history of amyloidosis and they're a little bit easier to figure out if the neuropathy is related. Maybe it's started in their heart or their kidney first and then you can just see if the type of amyloid they have usually deposits in nerve, and that may be enough. But if there's any diagnostic uncertainty, you could go forward with tissue biopsy. But it's patients in which the neuropathy is the first symptom that amyloidosis can be especially tricky to diagnose. It's a primarily light chain disease. So, if you do only an SPEP as a part of your initial neuropathy evaluation, you could miss it. But usually, the patients will have either a severely painful neuropathy, early autonomic dysfunction, or really prominent bilateral carpal tunnel syndrome. So, if they have any of those, usually we'll add in an amyloid workup as a part of that of the rest of the workup, which would include both light chain evaluations to see if there's any increase in Lambda or Kappa light chains and then also biopsy. Biopsy can be of the skin or fat pad first, which have reasonable sensitivity for picking up disease, but they're not necessarily a hundred percent. So if the suspicion remains high in those cases, a nerve biopsy should be considered. And the reason why this is important is that the chemotherapeutic agents that we have now can actually help arrest a lot of these diseases and stop further organ involvement. So, if you think about it, it is important to keep pushing and looking until you find it. Dr Nevel: Thank you so much for that. And a follow up question to that, once patients are started on appropriate therapy, the diagnosis is made, chemotherapy is started, what's the typical clinical course that you see in terms of their neuropathy? Do you ever see improvement or is it arrest of worsening? Dr Terrelonge: Usually for amyloid, there is an arrest of disease, but in some patients, they could have some improvement, not necessarily a dramatic improvement, but some patients could see some reversal of symptoms. That may not necessarily be because nerves injured nerves are regrowing, but because of reorganization of nerves to muscle, they could have some strength increases or at least less pain. Dr Nevel: Yeah, thank you. So, when should we involve a hematologist in aiding in the evaluation of patients we suspect may have an underlying hematological disorder? You guys really outlined very nicely in your article some of the laboratory workup or other workup like you just talked about with amyloidosis. But at what point in that workup should we reach out to our hematology colleagues? Dr Patrick: I would say almost always. So, these disorders are inherently multi-system and benefit from early co-management. In acute sickle cell stroke, for example, hematology helps direct emergent exchange transfusion. For myeloproliferative disorders they guide cyto reduction and long term antithrombotic strategy. And for antibody mediated or plasma cell disorders, hematology determines disease specific therapies. So, neurology may help with identifying the presentation, but the definitive management is almost always shared with our hematology colleagues. Dr Nevel: And as you both have mentioned that a lot of times in these cases, their hematologic disorder may be already known before they present with their neurological symptoms. So, I imagine obviously in those cases that a hematologist hopefully is already heavily involved in their care. What do you think is the most difficult aspect of identifying and diagnosing patients with neurologic illness as having an underlying hematological disorder? Dr Patrick: The hardest part is maintaining a high index of suspicion, especially since hematologic causes account for a very small minority of arterial strokes. Most strokes are from traditional vascular risk factors like you mentioned, or cardio embolism, so it's easy to stop diagnostic evaluation after standard studies have been performed. An example of a challenging case is a patient that's young, they've had recurrent cryptogenic stroke, and they could have antiphospholipid antibody syndrome, but it can be easy to miss if their antibody titers are borderline or if they're already anticoagulated, which would complicate retesting. So, it's about balancing the urge to over-test with recognizing the few cases where identifying A hematologic cause truly changes that management. Dr Terrelonge: And then on the neuropathy side, probably the hardest part is deciding what's causal and what's coincidence. Monoclonal gammopathy of unknown significance, or MGUS, is really common in older adults, so not every M-spike on an SPEP explains a neuropathy. And even sometimes there's times when the neurologic picture will develop a little bit faster than the hematologic one. So, it's hard to put the two together. Dr Nevel: Yeah. What's the most rewarding aspect of taking care of patients with complications from their hematologic disorders? Dr Patrick: It's deeply rewarding when a targeted diagnosis leads to a tangible improvement in that patient's care. For example, identifying A cryptogenic stroke is being due to myeloproliferative neoplasm or an inherited thrombophilia allows us to move from empiric treatment to possible disease specific strategy. It's really gratifying to give patients that clarity, to give them a diagnosis and in some cases prevent future events. Dr Terrelonge: Agreed. And even on the neuropathy side, almost all of the neuropathies that are hematologically related are treatable. So, it's so satisfying whenever you have a patient with say an anti-MAG neuropathy or Waldenström can start the patient on therapy, and you can see someone who's been having a progressive decline to stability and in those cases sometimes even significant recovery. Dr Nevel: Yeah, absolutely. Very rewarding when you can identify the problem and make it better. That's what it's all about. So, what are the future areas of research in this area? What do we still need to learn? Dr Patrick: There's still a lot to learn. I think we need better data on the safety of acute reperfusion therapy and antithrombotic agents, particularly in patients that are at dual risk for bleeding and thrombosis. Other examples, secondary prevention strategies and anti-phospholipid antibody syndrome. What's the best target INR? Do you add aspirin to warfarin or not? All of that is often left up to expert opinion. What's the best management for adults with sickle cell stroke? There are many open questions there. A lot of the protocols that we have in place for sickle cell patients that are adults as derived from pediatric literature and there's vast potential in terms of disease modifying therapies, especially in the fields of sickle cell disease and amyloidosis. And we'll need to reassess how those treatments may change neurologic outcomes. Dr Terrelonge: I think on the neuropathy side that having some form of new biomarkers to help us clearly know of the neuropathy and that hematologic illness are associated would be very helpful. On the treatment side, a lot of this is really being driven by the hematology space, but new therapies that treat hematologic plasma cell disorders, including some of the new BTK inhibitor, may be incorporated relatively soon into the algorithm for how we treat many of our patients. I'm excited to see what's to come from this. Dr Nevel: Wonderful. Thank you so much for sharing your knowledge with us today. I know I've certainly learned a lot by reading your article and through our discussion today. Highly encourage our listeners to read your wonderful article, which is a very thorough review of hematologic disorders and neurological complications. Again, today I've been interviewing Dr Lauren Patrick and Dr Mark Terrelonge on their article Neurologic Complications of Hematologic Disorders, which appears in the February 2026 Continuum issue on Neurology of Systemic Disease. Please be sure to check out Continuum Audio episodes from this and other issues. And as always, thank you so much to our listeners for joining today, and thank you so much to Lauren and Mark. Dr Terrelonge: Yeah, thank you so much for having us. Dr Patrick: Thank you so much for having us and for highlighting this topic. We hope the issue encourages clinicians to think broadly about hematologic causes of neurologic disease and to continue collaborating closely with our hematology colleagues. It's a complex but very fascinating intersection for both of our fields. 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.
This important Dementia 101 episode breaks down some of the “basics” of dementia, and guides us through the touching experiences of someone supporting a loved one. Guest Alexandra Aguzzi, who cares for her mom Anna, shares candid insights into her life as the caregiver of someone living with dementia, and reflects on moments along her and her mom's journey. Then neuroscientist, clinical neurologist and associate Professor in the Division of Neurology at the University of Alberta, Dr. Valerie Sim, helps us make sense of several major dementia diseases, including those affecting lex's mother. Visit us at defydementia.org. Our Guests: Alexandra Aguzzi, a retired civil servant, is the main caregiver to her mom, Anna Aguzzi. Early in life, Anna picked up a paintbrush and transformed a hobby into a life's passion, becoming a successful painter. Alexandra and Anna now enjoy spending time together at Baycrest, where Anna has been a resident for six years, following a diagnosis of Alzheimer's with Lewy body dementia. Dr. Valerie Sim is a neuroscientist, clinical neurologist, and Associate Professor in the Division of Neurology at the University of Alberta, as well as a scientist at the University's Centre for Prions and Protein Folding Diseases. Her research has explored dementia at many levels: from the misfolding of proteins in a tube, to growing slices of brain in a dish, to human diagnosis and treatment trials. She cares for people living with a variety of neurological disorders, including dementia, and teaches medical students and residents how to diagnose and help people living with complex neurological problems.
In the second installment of this three-part series, Dr. Stacey Clardy and Max Goldman discuss neuroscience research and the BRAIN Initiative. Stay updated with everything related to Neurology on the Hill. Show transcript: Dr. Stacey Clardy: Hi, this is Stacey Clardy. We are going to continue with our three-part series today about the top advocacy issues covered at Neurology on the Hill 2026 in Washington, DC. Again, as many of you know, this is the AAN's annual advocacy fly-in event. Neurologists come from all over the US to Washington and meet with elected representatives to discuss issues of high importance to allow us to continue providing high-quality care to patients in the US with neurological diseases. In the first minute, we discuss the topic of Medicare, and I have with me again, Max Goldman, director of Congressional Affairs from the AAN legislative team, to talk to us about issue number two, which is neuroscience research, and specifically the BRAIN Initiative. Max, what are we going to discuss about neuroscience research? What do we need to happen in order to continue doing high-quality research? Max Goldman: So, this one is so important, and there's this wonderful program at the NIH called The BRAIN Initiative. This was founded in 2013, really reinforced in 2016 with the 21st Century Cures Act. It's just funding for basic research into how the brain works, right? And the idea behind this is that if we can understand how the brain works, we can find the next generation of treatment or cures for neurological conditions, psychiatric conditions, and issues that go through the brain. This year, we are in a precarious position. Mandatory funding for this program is expiring, and so we're going to lose a lot of money and a lot of opportunities to provide more grants to people to figure out how the brain works. So, what we are doing on Neurology on the Hill is we're asking members of Congress to support $468 million in funding in fiscal year 2027 for the BRAIN Initiative, so we can keep up the good work and keep working towards the next generation of treatments and cures for neurological conditions. Dr. Stacey Clardy: So important. Thank you, Max. To learn more about this issue and the other two issues, you can go to AAN.com. Click on advocacy. And stick with us for the third Neurology Minute, where we will get to the final issue to be discussed, telehealth.
Neurology is amazing in a crisis. Stroke at 3 a.m.? Seizure in the ER? Modern medicine delivers. But chronic brain issues are different. Migraine. Brain fog. Parkinson's. Alzheimer's risk. These often turn into symptom management with a fancy label and a longer medication list. In this episode of Medical Disruptors, I sit down with neurologist Dr. Ken Sharlin to talk about what comes before the diagnosis gets permanent. Why decline isn't inevitable. And why the real leverage points aren't “more meds” or “more supplements”—it's the inputs that shape inflammation, metabolism, and nervous system stability. Dr. Sharlin breaks down his 5-part clinical roadmap for brain health, explains why getting the diagnosis right actually matters, and walks through the early drivers that can show up years before symptoms become irreversible. We also go deep on migraines—what they really are, why your brain can get stuck on high alert, and how you bring the system back under control. If you want brain health guidance that's grounded, practical, and not fear-based, hit play. Want more practical health tips? Join my newsletter! https://freechapter.lpages.co/newsletter-opt-in/ Check us out on social media: drefratlamandre.com/instagram drefratlamandre.com/facebook drefratlamandre.com/tiktok #functionalmedicine #drefratlamandre #medicaldisruptor #NPwithaPHD #nursepractitioner #medicalgaslighting Chapters: [00:00:00] Sharlin's path [00:06:10] Acute vs chronic [00:10:20] Five pillars roadmap [00:22:40] Alzheimer's early drivers [00:34:20] Migraine threat circuitry Guest Links: FB: https://www.facebook.com/SharlinHealthandNeurology IG: https://www.instagram.com/sharlinhealthandneurology/ YT: https://www.youtube.com/@dr.kensharlin1548 Website:https://functionalmedicine.doctor Learn more about your ad choices. Visit megaphone.fm/adchoices
In this episode, Douglas A. Ross, MD, CPE, FACS, Chief Medical Officer at AdventHealth Carrollwood, discusses rising pressures from age related neurological conditions, the shift toward team based and community anchored care models, and how biomarkers, functional imaging, and AI supported screening are reshaping early detection and treatment across the AdventHealth network.
Last year, the FDA approved adaptive deep brain stimulation for the treatment of people with Parkinson's disease. This is a major step forward in neurology. It allows personalized therapy by adjusting deep brain stimulation settings in real-time based on an individual's brain signals. Our guest on this episode is Dr. Helen Bronte-Stewart, the John E. Cahill Family Professor of Neurology and Director of the Human Motor Control and Neuromodulation Lab at Stanford University. Dr. Bronte-Stewart was interviewed by Dr. Karlo Lizarraga, Associate Professor of Neurology and Director of the Motor Physiology and Neuromodulation program at the University of Rochester. Disclosures: Dr. Bronte-Stewart disclosed equity in QDG Health. Dr. Lizarraga disclosed FHC: Consulting (Course Instructor), BlueRock: Research support.
In the first part of this three-part series, Dr. Stacey Clardy and Max Goldman discuss the state of Medicare in 2026. Stay updated with everything related to Neurology on the Hill. Show transcript: Dr. Stacey Clardy: Hi, this is Stacey Clardy. Today, we're going to start the first of a three-part series about the top advocacy issues at Neurology on the Hill 2026 in Washington, DC. As many of you know, this is the AAN's Annual Advocacy fly-in event in the US, where neurologists come to Washington and meet with our elected representatives to discuss the issues that are important for all of us in the US to continue providing high-quality care to patients with neurological diseases. Every year in preparation for this event, the AAN selects a few issues to focus on with our lawmakers, and we're going to cover those in a three-minute series. We have Max Goldman, the Director of Congressional Affairs from the AAN Legislative Team, to give us the details. Max, the first topic that will be covered at Neurology on the Hill this year is Medicare. What do we need to know about the state of Medicare in 2026? Max Goldman: Thank you so much for having me. As many of you know, the way the Medicare physician fee schedule works and the way that you all are reimbursed for the care you provide patients across the country has been broken for several years. We have this cycle of indiscriminate cuts that keeps happening, where the CMS will present a fee schedule, it'll have a cut for you all, then we have to go to Congress to beg for them to fix the cut. This year, we are talking to Congress about a structural reform that they can make, so we don't have to do that anymore, and the reimbursement that you all receive is commensurate with cost of actually providing care. This year we're going to ask for two things. We're going to ask for them to adjust the triggers to the budget neutrality requirement in the fee schedule, meaning that CMS can make some more changes to the fee schedule without requiring cuts to everyone's reimbursement, and we're going to request that they provide a permanent inflationary adjustment to physician reimbursement so that the reimbursement you get is in track with the cost of providing care in any given year. Dr. Stacey Clardy: Thanks for that summary. Here's hoping to get some traction on that. To learn more about this issue, you can go to aan.com and click on advocacy. And in the upcoming two minutes, we are going to discuss the other issues being brought to Congress at Neurology on the Hill. Thank you for listening to today's Neurology Minute.
In this Practitioner Spotlight, Dr. Dave Boyton—a Cincinnati-based functional medicine specialist—shares how he transformed his practice by integrating neurological assessment with functional medicine. After his wife was misdiagnosed with multiple autoimmune conditions, Dr. Boynton dove deep into functional medicine and discovered what most practitioners miss: the neurological component.Dr. Boyton reveals why hypoglycemia isn't just "getting hangry"—it's frontal lobe dysfunction that sabotages healing. He explains why most functional medicine exams are inadequate, how he turned his intake into a "show and tell" experience that builds patient confidence, and why cookie-cutter protocols fail chronically ill patients.To become a Certified Functional Medicine practitioner, visit https://kharrazianinstitute.com/. Try our 7-day free trial, no credit card required. 00:00 Functional Medicine Journey05:46 "Chiropractic, Neurology, and Individualized Care"10:00 Ambassadors of Hope in Healthcare11:59 Tinnitus Neurology Exercises Explained17:13 "Prioritizing Health and Wellness"21:20 Passion Key for Functional Medicine22:58 Evolving Functional Medicine Insights26:36 "Functional Medicine Training Resources"Support this show http://supporter.acast.com/solving-the-puzzle-with-dr-datis-kharrazian. Hosted on Acast. See acast.com/privacy for more information.
Autism, Parenting, And The Art Of Ignoring Unsolicited Advice Julie Green had a very limited understanding of autism before her son was born. Navigating his diagnosis was difficult, especially when differing opinions were being thrown at them from all sides. Green reveals the realities of motherhood, autism, and self-discovery in her new book, Motherness. Guests: Julie M. Green, author, Motherness Host: Elizabeth Westfield Producer: Kristen Farrah Kitchen Chemistry: The Cooking Oil That May Be Driving Obesity Though there are various cooking oils to choose from, soybean oil remains the most commercially popular choice in America. But is this cheap option making us obese? Our experts reveal how the high concentration of a particular fatty acid in this common oil may be influencing how our bodies store fat and contribute to rising health concerns. Guests: Sonia P. Deol, assistant professional researcher in the department of microbiology and plant pathology, University of California, Riverside Frances M. Sladek, professor of cell biology & toxicologist, University of California, Riverside Host: Greg Johnson Producer: Kristen Farrah Medical Notes: How Energy Drinks May Worsen Your Cancer, A Non-Invasive Treatment For Seizures, And How To Fight Against Procrastination Are energy drinks making you sick? A new treatment for seizures may soon be possible without the need for invasive brain surgery. Good news for sugar addicts! Scientists have created a healthier sweetener using tagatose. How to fight against procrastination. Host: Maayan Voss de Bettancourt Producer: Kristen Farrah Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
Dr. Alex Menze and Dr. Divyanshu Dubey discuss the clinical insights into autoimmune nodopathies, particularly focusing on CASPR1 and CASPR1/CNTN1-complex-IgG. Show citation: Paramasivan NK, Basal E, LaFrance-Corey RG, et al. Clinical Insights Into CASPR1 and CASPR1/Contactin-1 Complex Autoimmune Nodopathies. Neurology. 2026;106(5):e214403. doi:10.1212/WNL.0000000000214403 Show transcript: Dr. Alexander Menze: Hi, this is Alexander Menze. I just finished interviewing Divyanshu Dubey for the Neurology podcast. For today's Neurology Minute, I'm hoping you can tell us the main points of your paper. Dr. Divyanshu Dubey: Our paper talks about a rare form of autoimmune neuropathy associated with antibodies, CASPR1, as well as CASPR1/Contactin-1 complex IgG. These patients present with similar to CIDP, IDP, but tend to have more rapid progression, often a lot of sensory features preceding motor deficits including sensory ataxia in the contact and CASPR complex cases and presence of neuropathic pain in some of the CASPR1 cases. These patients, similar to other neuropathies are refractory to IVIg, but respond relatively well to rituximab. Dr. Alexander Menze: Thank you. Be sure to download this week's podcast to hear our full interview.
Your brain isn't breaking. It's rewiring in ways no one explained, and for many women, menopause is the moment everything suddenly feels unfamiliar.Brain fog, sleep disruption, anxiety, memory lapses, and feeling unlike yourself can be deeply unsettling, especially when no one has given you a framework for what's happening. In this conversation, we explore the science behind midlife brain changes and why menopause is a neurological transition, not a personal failure.Dr. Lisa Mosconi is an associate professor of Neuroscience in Neurology and Radiology at Weill Cornell Medicine and director of the Alzheimer's Prevention Program and the Women's Brain Initiative. She is a world-renowned neuroscientist and the New York Times bestselling author of The Menopause Brain.In this episode, you'll discover • Why Alzheimer's risk begins in midlife, not old age • What estrogen actually does in the brain and why its shift matters • The hidden reason brain fog and mood changes show up during menopause • How the brain adapts and rebuilds after hormonal change • What science currently says about hormone therapy and brain healthMenopause can feel confusing and isolating, but understanding what your brain is doing can replace fear with clarity. Listen to learn how to navigate this transition with more confidence, compassion, and agency.You can find Lisa at: Website | Instagram | Episode TranscriptNext week, we're sharing a really meaningful conversation with psychiatrist and mental health educator Dr. Tracey Marks about what anxiety really is, why it feels so physical, and how understanding your brain can help you feel steadier and more at ease.Check out our offerings & partners: Join My New Writing Project: Awake at the WheelVisit Our Sponsor Page For Great Resources & Discount Codes Hosted on Acast. See acast.com/privacy for more information.
Dr. Alex Menze talks with Dr. Divyanshu Dubey about the clinical insights into autoimmune nodopathies, particularly focusing on CASPR1 and CASPR1/CNTN1-complex-IgG. Read the related article in Neurology®. Disclosures can be found at Neurology.org.
Dr. Halley Alexander and Dr. Alissa M. D'Gama discuss genetic testing for infantile epilepsies. Show citation: Nguyen JNH, Lachgar-Ruiz M, Higginbotham EJ, et al. Diagnostic Yield of Comprehensive Reanalysis After Nondiagnostic Short-Read Genome Sequencing in Infants With Unexplained Epilepsy. Neurology. 2026;106(6):e214645. doi:10.1212/WNL.0000000000214645 Show transcript: Dr. Halley Alexander: Hi, this is Halley Alexander with today's Neurology Minute, and I'm here with Dr. Alissa D'Gama from Boston Children's Hospital and Harvard Medical School, and we just finished recording a full-length podcast about some exciting new work in genetic testing for infantile onset epilepsies. Alissa, can you tell us what you found briefly and why it's important for neurology care? Dr. Alissa D'Gama: Infantile epilepsies are relatively common, and they're associated with substantial burden of disease, and we know that identifying underlying genetic causes can impact clinical care. It's important for emerging precision therapies. But even after genome sequencing, which is the most comprehensive clinical genetic testing currently available, most infants remain genetically unsolved. And so what we did was take that genome sequencing data and reanalyze it for a cohort of infants who had unexplained non-acquired epilepsy and non-diagnostic genome sequencing, and in about 5% of cases, our reanalysis was able to identify a genetic diagnosis, and all of these diagnoses had impact on clinical care for their infants and their families. In some cases, we could incorporate new information, either new clinical information about the patient or new scientific methods or information about disease associations, and in other cases, we were able to incorporate new analysis methods to identify variants. And so our findings suggest that implementing reanalysis for infants or any individual with epilepsy within a year or two of non-diagnostic testing may be useful. Dr. Halley Alexander: Thank you so much, and you can find a lot more details by listening to the full-length podcast, which is available now on the Neurology podcast, and you can find the full article in the March 10th issue of Neurology or online at neurology.org. As always, thanks for tuning in for today's Neurology Minute.
In part three of this series, Dr. Jeff Ratliff discusses how access to information is not the same as clinical confidence. Show transcript: Dr. Jeff Ratliff: Hi, this is Jeff Ratliff from Thomas Jefferson University, and this is your Neurology Minute. I'm back again with a Neurology Minute episode to complement the podcast discussion I had with Roy Strowd, Justin Abbatemarco, and Tesha Monteith on the topic of technology-driven shifts in neurology education. In the episode, we touched on podcasting, AI-based learning, and social media on neurology education as a panel discussion. While there is still tremendous utility and promise and excitement around these tools, I think it's still helpful for us all to remember that access to information is not the same as clinical confidence. With tools like podcasts, learners can hear expert discussions on their commute or review topics in new interactive formats. With AI tools, learners can simulate talking to patients with a multitude of neurologic conditions. These digital tools can provide answers at hours, and our learners fingertips much more readily than even recent years. But as we watch the explosion of these tools impact, we must keep in mind the value of bedside clinical teaching. As teachers, as educators, there's still a great impact we can have by watching a resident examine a patient with ataxia, or coaching them through a difficult conversation with a patient. We can still help them teach the skill of reasoning through their clinical encounters in real time so that they can remember to ask that key history question, or to add in that critical exam maneuver. So, as impressive and impactful the latest and greatest teaching tool may be, I encourage you all not to shy away from going back to the bedside with the student, the resident, or fellow working with you today. Thanks for listening to the Neurology Minute. We'll see you next time.
The Illusion of Optimization: Balancing Physiology and Neurology in Coaching In this episode of the Coaching Coaching Podcast, hosts Steve Magness and John Marcus dive into a deep discussion about the complexities of coaching that lie beyond the modern obsession with optimization. They argue that true coaching success comes from a balance between understanding physiology…
A mini-review published in Frontiers in Neurology suggests that acupuncture may assist ICU patients in recovering more quickly by relieving pain, lowering sedative use, shortening ventilator dependency, enhancing strength, and increasing days free from delirium Acupuncture may help calm inflammation, boost immunity, and improve blood flow in sepsis patients, offering supportive benefits alongside standard ICU treatment It's not just for managing one symptom: Acupuncture could act as a whole-body support tool in the ICU, easing pain, stress, and sleep issues while reducing drug side effects and helping the body recover Emotional Freedom Techniques (EFT) is a needle-free method using fingertip tapping on acupuncture points that offers a gentler alternative for patients wary of traditional acupuncture Other nondrug therapies such as massage, music therapy, and mindfulness contribute to ICU recovery by alleviating anxiety, decreasing pain, and enhancing sleep quality
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