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In the hospital setting, neurologists may be responsible for managing common end-of-life symptoms. Comprehensive end-of-life care integrates knowledge of the biomedical aspects of disease with patients' values and preferences for care; psychosocial, cultural, and spiritual needs; and support for patients and their families. In this episode, Teshamae Monteith, MD, FAAN, speaks with Claudia Z. Chou, MD, author of the article "End-of-Life Care and Hospice" in the Continuum® December 2025 Neuropalliative Care issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Knox is an assistant professor of neurology and a consultant in the Division of Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester, Minnesota. Additional Resources Read the article: End-of-Life Care and Hospice Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Monteith: This is Dr Teshamae Monteith. Today I'm interviewing Dr Claudia Chou about her article on end-of-life care and hospice, which is found in the December 2025 Continuum issue on neuropalliative care. Welcome to our podcast. How are you? Dr Chou: I'm doing well. Thank you for having me. This is really exciting to be here. Dr Monteith: Absolutely. So, why don't you introduce yourself to our audience? Dr Chou: Sure. My name is Claudia Chou. I am a full time hospice and palliative medicine physician at Mayo Clinic in Rochester. I'm trained in neurology, movement disorders, and hospice and palliative medicine. I'm also passionate about education, and I'm the program director for the Hospice and Palliative Medicine fellowship here. Dr Monteith: Cool. So just learning about your training, I kind of have an idea of how you got into this work, but why don't you tell me what inspired you to get into this area? Dr Chou: It was chance, actually. And really just good luck, being in the right place at the right time. I was in my residency and felt like I was missing something in my training. I was seeing these patients who were suffering strokes and had acute decline in functional status. We were seeing patients with new diagnosis of glioblastoma and knowing what that future looked like for them. And while I went into neurology because of a love of neuroscience, localizing the lesion, all of those things that we all love about neurology, I still felt like I didn't have the skill set to serve patients where they perhaps needed me the most in those difficult times where they were dealing with serious illness and functional decline. And so, the serendipitous thing was that I saw a grand rounds presentation by someone who works in neurology and palliative care for people with Parkinson's disease. And truly, it's not an exaggeration to say that by the end of that lecture, I said, I need to do palliative care, I need to rotate in this, I need to learn more. I think this is what I've been missing. And I had plans to practice both movement disorders neurology and palliative care, but I finished training in 2020… and that was not a long time ago. We can think of all the things that were going on, all the different global forces that were influencing our day-to-day decisions. And the way things worked out, staying in palliative care was really what my family and I needed. Dr Monteith: Wow, so that's really interesting. Must have been a great lecturer. Dr Chou: Yes, like one of the best. Dr Monteith: So why don't you tell me about the objectives of your article? Dr Chou: The objectives may be to fill in some of the gaps in knowledge that may be present for the general neurologist. We learn so much in neurology training, so much about how to diagnose and treat diseases, and I think I would argue that this really is part and parcel of all we should be doing. We are the experts in these diseases, and just because we're shifting to end-of-life or transitioning to a different type of care doesn't mean that we back out of someone's care entirely or transition over to a hospice or palliative care expert. It is part of our job to be there and guide patients and their care partners through this next phase. You know, I'm not saying we all need to be hospice and palliative care experts, but we need to be able to take those first steps with patients and their care partners. And so, I think objectives are really to focus in on, what are those core pieces of knowledge for end-of-life care and understanding hospice so we can take those first steps with patients and their care partners? Dr Monteith: So, why don't you give us some of those essential points in your article? Dr Chou: Yeah. In one section of the article, I talk about common symptoms that someone might experience at the end of life and how we might manage those. These days, a lot of hospitals have order sets that talk us through those symptoms. We can check things off of a drop-down menu. And yet I think there's a little bit more nuance to that. There may be situations in which we would choose one medication over another. There may be medications that we've never really thought of in terms of symptom management before. Something that I learned in my hospice and palliative medicine fellowship was that haloperidol can be helpful for nausea. I know that's usually not one of our go-tos in neurology for any number of reasons. So, I think that extra knowledge can take us pretty far when we're managing end of life symptoms, particularly in the hospital setting. And then I think the other component is the hospice component. A lot of us may have not had experience talking about hospice, talking about what hospice can provide, and again, knowing how to take those first steps with patients. We may be referring to social work or palliative medicine to start those conversations. But again, I think this is something that's definitely learnable and something that should be part of our skill set in neurology. Dr Monteith: Great. And so, when you speak about symptom management and being more comfortable with the tools that we have, how can we be more efficient and more effective at that? Dr Chou: Think about what the common symptoms are at end of life. We may know this kind of intuitively, but what we commonly see are things like pain, nausea, dyspnea, anxiety, delirium or agitation. And so, I think having a little bit of a checklist in mind can be helpful. You know, how can I systematically think through a differential, almost, for why my patient might be uncomfortable? Why they might be restless? Have I thought through these different symptoms? Can I try a medication from my tool kit? See if that works, and if it does, we can continue on. If not, what's the next thing that I can pivot to? So, I think these are common skills for a little bit of a differential diagnosis, if you will, and how to work through these problems just with the end-of-life lens on it. Dr Monteith: So, are there any, like, validated tools or checklists that are freely available? Dr Chou: I don't think there's been anything particularly validated for end-of-life care in neurologic disease. And so, a lot of our treatments and our approaches are empiric, but I don't think there's been anything validated, per se. Dr Monteith: Great. So, why don't we talk a little bit about the approach to discussions on hospice? We all, as you kind of alluded to, want to be effective neurologists, care for our patients, but we sometimes deal with very debilitating diseases. And so, when we think that or suspect that our patient is kind of terminally ill, how do we approach that to our patients? Of course, our patients come from different backgrounds, different experiences. So, what is your approach? Dr Chou: So, when we talk about hospice and when a patient may be appropriate for hospice, we have to acknowledge that we think that they may be in the last six months of their disease. We as the neurologist are the experts in their disease and the best ones to weigh in on that prognosis. The patient and their care partners then have to accept that the type of care that hospice provides is what makes sense for them. Hospice focuses on comfort and treating a patient's comfort as the primary goal. Hospice is not as interested in treating cancer, say, to prolong life. Hospice is not as interested in life-prolonging measures and treatments that are not focused at comfort and quality of life. And so, when we have that alignment between our understanding of a patient's disease and their prognosis and the patient care partner's goal is to focus on comfort and quality of life above all else, that's when we have a patient who might be appropriate for hospice and ready to hear more about what that actually entails. Dr Monteith: And what are some, maybe, myths that neurologist healthcare professionals may have about hospice that you really want us to kind of have some clarity on? Dr Chou: That's a great question. What we often tell patients is that hospice's goal is to help patients live as well as possible in the time that they have left. Again, our primary objective is not life prolongation, but quality of life. Hospice's goal is also not to speed up or slow down the natural dying process. Sometimes we do get questions about that: can't you make this go faster or we're ready for the end. But really, we are there to help patients along the natural journey that their body is taking them on. And I think hospice care can actually be complex. In the inpatient setting, in particular in neurology, we may be seeing patients who have suffered large strokes and have perhaps only days to a few weeks of life left. But in the outpatient setting and in the home hospice setting, patients can be on hospice for many months, and so they will have new care needs, new urinary tract infections, sometimes new rashes, the need to change their insulin regimens around to avoid extremes of hyperglycemia or hypoglycemia. So, there is a lot of complexity in that care and a lot that can be wrapped up under that quality-of-life and comfort umbrella. Dr Monteith: And to get someone to hospice requires a bit of prognostication, right? Six months of prediction in terms of a terminal illness. I know there's some nuances to that. So how can you make us feel more comfortable about making the recommendations for hospice? Dr Chou: I think this is a big challenge in the field. We're normally guided by Medicare guidelines that say when a patient might be hospice-appropriate. And so, for a neurologic disease, this really only encompasses four conditions: ALS, stroke, coma, and Alzheimer's dementia. And we can think of all the other diseases that are not encompassed in those four. And so, I think we say that we paint the picture of what it means to have a prognosis of six months or less. So, from the neurologic side, that can be, what do you know about this disease and what end-stage might look like? What is the pattern of the patient's functional decline? What are they needing more help with? Are there other factors at play such as heart failure or COPD that may in and of themselves not be a qualifying diagnosis for hospice, but when it's taken together in the whole clinical picture, you have a patient who's very ill and one that you're worried may die in the next six months or less? Dr Monteith: Then you also had some nice charts on kind of disease-specific guidelines. Can you take us a little bit through that? Dr Chou: The article does contain tables about specific criteria that may qualify someone for hospice with these neurologic conditions. And they are pretty dense. I know they're a checklist of a lot of different things. And so, how we practice is by trying to refer patients to hospice based on those guidelines as much as possible and then using our own clinical judgment as well, what we have seen through taking care of patients through the years. So, again, really going back to that decline. What is making you feel uncomfortable about this patient's prognosis? What is making you feel like, gosh, this patient could be well supported by hospice, and they could have six months or less? So, all of that should go into your decision as well. And all of that should go into your discussion with the patient and their care partners. Dr Monteith: Yeah. And reading your article, what stood out was all the services that patients can receive under hospice. So, I think sometimes people think, okay, this is terminal illness, let's get to hospice for whatever reasons, but not necessarily all the lists and lists and lists of benefits of hospice. So, I don't know that everyone's aware of all those benefits. So, can you talk to us a little bit about that? Dr Chou: Yeah, I like that you brought that up because that's also something that I often say to patients and their care partners when we're talking about hospice. When the time is right for a patient to enroll in hospice, they should not feel like they're giving anything up. There should be no more clinical trial that they're hoping to chase down, and so they should just feel like they're gaining all of those good supports: care that comes to their home, a team that knows them well, someone that's available twenty-four hours a day by phone and can actually even come into the home setting if needed to help with symptom management. Hospice comes as well with the psychosocial supports for just coping with what dying looks like. We know that's not easy to be thinking about dying for oneself, or for a family member or care partner to be losing their loved one. So, all of those supports are built into hospice. I did want to make a distinction, too, that hospice does not provide custodial care, which I explain to patients as care of the body, those daily needs for bathing, dressing, eating, etc. Sometimes patients are interested in hospice because they're needing more help at home, and I have to tell them that unfortunately, our healthcare system is not built for that. And if that's the sole reason that someone is interested in hospice, we have to think about a different approach, because that is not part of the hospice benefit. Dr Monteith: Thank you for that. And then I learned about concurrent care. So why don't you tell us a little bit about that? That's a little bit of a nuance, right? Dr Chou: Yeah, that is a little bit of a nuance. And so, typically when patients are enrolling in hospice, they are transitioning from care the way that it's normally conducted in our healthcare system. So, outpatient visits to all of the specialists and to their primary care providers, the chance to go to the ER or the ICU for higher levels of care. And yet there are a subset of patients who can still have all of those cares alongside hospice care. That really applies to two specific populations: veterans who are receiving care through the Veterans Administration, and then younger patients, so twenty six years old and less, can receive that care through, essentially, a pediatric carve out. Dr Monteith: Great. Well, I mean, you gave so much information in your article, so our listeners are going to have to read it. I don't want you to spill everything, but if you can just kind of give me a sense what you want a neurologist to take away from your article, I think that would be helpful. Dr Chou: I think what I want neurologist to take away is that, again, this is something that is part of what we do as neurologists. This is part of our skill set, and this is part of what it means to take good care of patients. I think what we do in this transition period from kind of usual cares, diagnosis, full treatment to end of life, really can have impact on patients and their care partners. It's not uncommon for me to hear from family members who have had another loved one go through hospice about how that experience was positive or negative. And so, we can think about the influence for years to come, even, because of how well we can handle these transitions. That really can be more than the patient in front of us in their journey. That is really important, but it can also have wide-reaching implications beyond that. Dr Monteith: Excellent. And I know we were talking earlier a little bit about your excitement with the field and where it's going. So why don't you share some of that excitement? Dr Chou: Yeah. And so, I think there is a lot still to come in the field of neuropalliative care, particularly from an evidence base. I know we talked a lot about the soft skills, about presence and communication, but we are clinicians at heart, and we need to practice from an evidence base. I know that's been harder in palliative care, but we have some international work groups that really are trying to come together, see what our approaches look like, see where standardization may need to happen or where our differences are actually our strength. I think there can be a lot of variability in what palliative care looks like. So, my hope is that evidence base is coming through these collaborations. I know it's hard to have a conversation these days without talking about artificial intelligence, but that is certainly a hope. When you look at morbidity, when you look at patients with these complicated disease courses, what is pointing you in the direction of, again, a prognosis of six months or less or a patient who may do better with this disease versus not? And so, I think there's a lot to come from the artificial intelligence and big data realm. For the trainees listening out there, there is no better time to be excited about neuropalliative care and to be thinking about neuropalliative care. I said that I stumbled upon this field, and hopefully someone is inspired as well by listening to these podcasts and reading Continuum to know what this field is really about. And so, it's been exponential growth since I joined this field. We have medical students now who want to come into neuropalliative care as a profession. We have clinicians who are directors of neuropalliative care at their institutions. We have an international neuropalliative care society and neuropalliative care at AAN. And I think we are moving closer to that dream for all of us, which is that patients living with serious neurologic illness can be supported throughout that journey. High-quality, evidence-based palliative care. We're not there yet, but I think it is a possibility that we reach that in my lifetime. Dr Monteith: Well, excellent. I look forward to maybe another revision of this article with some of that work incorporated. And it's been wonderful to talk to you and to reflect on how better to approach patients that are towards the end of life and to help them with that decision-making process. Thank you so much. Dr Chou: Yeah, thank you for having me. And we're very excited about this issue. Dr Monteith: Today. I've been interviewing Dr Claudia Chou about her article on end-of-life care and hospice, which is found in the December 2025 Continuum issue on neuropalliative care. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.
Episode description: We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Sarah presents a case to Sebastian and Vijay. Sarah Blaine (@sarahkblaine) Sarah Blaine is an MD/MSc student at Emory University School of Medicine applying into neurology residency. She isfrom SouthernCalifornia and went to UC Berkeley for her undergraduate… Read More »Episode 435: Neurology VMR – Weakness and numbness
Overview This special episode of the [Tick Boot Camp Podcast](https://tickbootcamp.com/podcast/) was recorded live at the 2nd Annual Alzheimer's Pathobiome Initiative (AlzPI) and PCOM Symposium in collaboration with Pathobiome Perspectives. Hosted by Ali Moresco in partnership with Nikki Schultek, Executive Director of AlzPI, the conversation continues the Tick Boot Camp mission of exploring infection-associated chronic illness (IACI)—including Lyme disease and other tick-borne infections—within the global Alzheimer's and neuroimmunology research community. Tick Boot Camp co-founders Matt Sabatello and Rich Johannesen partnered with Ali and Nikki to highlight leading scientists connecting microbes, immune dysregulation, and neurodegenerative disease. This episode features Dr. Elizabeth “Betsy” Bradshaw, Assistant Professor of Neurology at Columbia University Irving Medical Center, whose research investigates how past infections leave lasting imprints on the brain's immune system and influence the development of Alzheimer's disease. Guest Elizabeth M. Bradshaw, PhD Assistant Professor of Neurology, Columbia University Irving Medical Center Principal Investigator, Bradshaw Laboratory – Neuroimmunology and Genetics of Alzheimer's Dr. Bradshaw's laboratory focuses on the immune system's role in neurodegeneration, particularly how infection and inflammation alter brain immunity and predispose individuals to conditions like Alzheimer's disease. Her work builds on large-scale genome-wide association studies (GWAS) that identified immune-related genetic variants linked to Alzheimer's susceptibility, suggesting that subtle changes in immune function—not just neuronal factors—may underlie disease onset. Her team is exploring how pathogens such as HSV-1 (Herpes Simplex Virus Type 1) interact with the brain's immune cells, known as microglia, and how these infections can “reprogram” immune responses long after the pathogen is cleared. Key Discussion Points Dr. Bradshaw explains how her research bridges genetics, immunology, and infectious disease to better understand Alzheimer's. Through GWAS data, her team found that many of the genes linked to Alzheimer's risk involve immune pathways rather than neuronal signaling. This discovery redirected the field's attention toward how immune cells respond to pathogens and environmental stressors across a lifetime. Using human-derived microglia-like cells created from blood monocytes, her team observes how infections reshape immune cell metabolism and memory. By infecting these microglia-like cells with Alzheimer's-associated pathogens like HSV-1, they study how genetic background and infection history determine immune cell behavior. The findings suggest that past infections may epigenetically and metabolically train microglia—changing how they respond to aging, stress, and amyloid buildup. Even when the infection has resolved, these “reprogrammed” immune cells can remain altered for decades, silently increasing the brain's vulnerability to neurodegeneration. Dr. Bradshaw emphasizes that understanding how infections rewire the brain's immune landscape could transform early intervention strategies. Identifying combinations of genetic risk factors and pathogen exposures may enable targeted prevention or immune-modulating treatments long before symptoms appear. “Microglia remember. Even after the pathogen is gone, they carry its imprint—responding differently decades later when the brain faces new challenges.” — Dr. Elizabeth Bradshaw Why It Matters Dr. Bradshaw's work reframes Alzheimer's disease as a neuroimmune condition shaped by infection and host genetics. Her research highlights how microbial exposures, immune history, and inflammation converge to influence cognitive decline. By integrating infection biology with genetics and immunology, her team is redefining how scientists and clinicians view the root causes of Alzheimer's and other neurodegenerative diseases. This work strengthens the growing case that the immune system's “memory” of infection may be one of the most important and overlooked factors in brain health and aging. About the Event This interview was recorded at the 2nd Annual Alzheimer's Pathobiome Initiative (AlzPI) and Philadelphia College of Osteopathic Medicine (PCOM) Symposium, held October 3, 2025, at Ohio University in Dublin, Ohio. The event brought together more than 20 leading researchers exploring how microbes, the microbiome, and immune dysregulation contribute to Alzheimer's, dementia, and infection-associated chronic illness (IACI). Tick Boot Camp partnered with Ali Moresco and Nikki Schultek to share these conversations and connect chronic Lyme, infection, and neurodegenerative research communities. Learn More Learn more about the Alzheimer's Pathobiome Initiative (AlzPI) Listen to Tick Boot Camp Podcast episodes, including Episode 406: Pathobiome – An Interview with Nikki Schultek and Episode 101: The Young Gun – An Interview with Alex (Ali) Moresco discussed in this interview.
Click here to send me a quick message :) So many of us live with some form of chronic or acute pain. We get used to it, we look for ways to relieve it, we may find some things that work - temporarily or long term. Sometimes that's movement practices, sometimes it's bodywork, sometimes it's structural adjustments, etc. But more often than not, we're not actually looking to the root of the pain. And unfortunately if it's connective tissue or bone-based, it can often be exacerbated in transitional times like postpartum or perimenopause / post-menopause.After many years of offering Structural Integration style bodywork, Mia Esquivel found that for both her own post-menopausal body and for her clients, she wasn't seeing the relief she knew could be possible.So she started seeking solutions outside of her bodywork box and came upon something called "Applied Neurology" and it has been a GAME CHANGER for herself and her clients.Listen in to hear all about it (and a little on her perimenopause and post-menopause story - hint: you might never guess that foot pain could be related to hormonal shifts!).Resources:Today's shownotes: Get links to Mia's offerings Free guide: 10 Key Herbs for Your Hormonal HealthEpisode 110: Healing chronic pelvic pain w Julia DyerEpisode 169: From a year of debilitating endo pain to feeling well w Mary Lauren FraserIf you loved this episode, share it with a friend, or take a screenshot and share on social media and tag me @herbalwombwisdomAnd if you love this podcast, leave a rating & write a review! It's really helpful to get the show to more amazing humans like you. ❤️DISCLAIMER: This podcast is for educational purposes only, I am not providing any medical advice, I am not a medical practitioner, I'm an herbalist and in the US, there is no path to licensure for herbalists, so my role is as an herbal educator. Please do your own research and consult your healthcare provider for any personal concerns.Support the show
Many people will be familiar with Parkinson's disease: the progressive brain disorder that causes symptoms including tremors and slower movement, leading on to serious cognitive problems. You might not know that it's the fastest-growing neurological condition in the world. Today it affects around 11.8 million people and that's forecast to double by 2030. Dr Sonia Gandhi is one of the scientists working to change that trend. As Professor of Neurology at University College London and Assistant Research Director at the Francis Crick Institute, her work involves using stem cells to build models of the human brain, helping to drive the development of drugs and other therapies for Parkinson's patients. Talking to Professor Jim Al-Khalili, Sonia explains why this destructive condition is on the rise - and the promising routes they're studying to find new ways to tackle it.
In the second part of this two-part series, Dr. Dan Ackerman talks with Drs. Valérie Biousse and Nancy J. Newman about recent clinical trials, the need for collaboration between stroke neurologists and eye care providers, and the role of technology in improving patient outcomes. Read the article referenced in this interview in the Journal of Stroke & Cerebrovascular Diseases. Disclosures can be found at Neurology.org.
Send us a textWhat if artificial intelligence could change how neurological diseases are diagnosed, treated, and even prevented? And how far are we from that future?This week's episode is with returning guest Dr. Aniket Natekar to explore how AI is actively reshaping neurology and modern healthcare. We break down what AI integration could look like in clinical settings, from neurosurgery and diagnostic support to reducing administrative burden, and how physicians are currently utilizing these tools in practice. We also look ahead to what is coming next, including AI-powered wearables, personalized brain-health profiles, earlier detection of epilepsy and neurodegenerative disorders, and tools that could significantly reduce misdiagnosis.Of course, we cannot talk about AI without addressing the ethical concerns and risks. Dr. Natekar tackles the big questions: How will patient data be protected? Could clinicians become too reliant on AI? Who carries responsibility if AI makes a mistake — the doctor, the hospital, or the developer? And what does the rise of AI mean for the already uneven access to neurological care between urban and rural communities?This is a particularly important conversation because AI isn't just a buzzword — it's becoming deeply embedded in healthcare. So understanding the benefits, limitations, and ethical landscape is more crucial than ever, and Dr. Natekar provides such thoughtful, nuanced perspectives to this topic.Don't forget to rate and subscribe to The Neurological Disorder Podcast on Spotify, Apple Podcasts, or wherever you listen to your podcasts. Fill out this form ( https://forms.gle/V8ZrX8iwQZnk3xVF9) if you have questions, guest suggestions, or topics you would love to hear about! **everything discussed today reflects our personal opinions and should not be taken as medical advice. Feel free to contact me via:Email: neurologicaldisorderpodcast@gmail.comInstagram: @neurologicaldisorderpodcastContact Dr. Natekar via: Instagram: @anik_skywalker
Join Phillip Kuo, MD, PhD, and Jacob Dubroff, MD, PhD as they delve into discussions about the latest tracers, brain imaging techniques, and advances in patient care. To learn more about advancements in neurology in nuclear medicine, register for the upcoming SNMMI Mid-Winter Meeting with a dedicated neurology track. Register Here: https://snmmi.org/MWM/MWM/Attend/Register.aspx
Why do your migraines always strike right before your period? What if your body is actually trying to tell you something—something that could help you prevent the next one?In this episode of Migraine Heroes Podcast, host Diane Ducarme explores the intricate connection between your menstrual cycle and migraine attacks. Together, we decode what your body is signaling in those fragile days before your period—and how to work with it, not against it.You'll discover:
In part one of this two-part series, Dr. Dan Ackerman talks with Drs. Valérie Biousse and Nancy J. Newman about the clinical presentations, diagnostic challenges, and the importance of accurate diagnosis in managing CRAO and BRAO. Read the article referenced in this interview in the Journal of Stroke & Cerebrovascular Diseases. Disclosures can be found at Neurology.org.
In this episode of One Voice for Neurology, we explore how personalised and precision approaches in neurology can improve care for everyone by recognising individual differences in brain health, including gender, sleep, and hormonal factors. Our guests — Dr Antonella Santuccione Chadha, medical doctor, neuroscientist, and founder of the Women's Brain Foundation, and Dr Thomas Penzel, President of the World Sleep Society — discuss the latest research on gender differences in neurological conditions, the role of sleep and hormonal influences in prevention, and how holistic, individualised care can enhance outcomes for patients, clinicians, and health systems worldwide. We also hear from Chéri Ballinger, a Women's Brain Foundation ambassador and traumatic brain injury survivor, who shares a personal account of how a gender-informed, individualised approach transformed her care. Topics covered include: How sex and gender impact neurological disease prevalence, symptoms, and treatment responseThe role of sleep and hormonal factors in supporting brain health and preventing diseaseAdvances in technology and AI supporting personalised approaches to neurologyThe importance of investing in research, sharing data, and promoting female leadership to drive equitable, patient-centred neurological careReal-world implications of holistic and precision neurology for patients and healthcare systemsWhether you're a clinician, researcher, patient, or advocate, this episode highlights how understanding differences in brain health can lead to better, more equitable care for everyone.
Neurologists are privileged to act as guides for patients as they navigate the complex course of serious neurologic illnesses. Because of the impact on quality of life, personhood, and prognosis, neurologists must be able to conduct serious-illness conversations to improve rapport, reduce patient anxiety and depression, and increase the likelihood that treatment choices agree with patient goals and values. In this episode, Teshamae Monteith, MD, FAAN speaks with Jessica M. Besbris, MD, author of the article "The Approach to Serious-Illness Conversations" in the Continuum® December 2025 Neuropalliative Care issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Besbris is an assistant professor of neurology and internal medicine, and the director of the neuropalliative care, at Cedars-Sinai Medical Center in Los Angeles, California. Additional Resources Read the article: The Approach to Serious-Illness Conversations Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Guest: @JessBesbris Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Monteith: Hi, this is Dr Teshamae Monteith. Today I'm interviewing Dr Jessica Besbris about her article on the approach to serious illness conversation, which is found in the December 2025 Continuum issue on neuropalliative care. How are you? Dr Besbris: I'm doing great. Thank you so much for having me here today. Dr Monteith: Well, thank you for being on our podcast. Dr Besbris: My pleasure. Dr Monteith: Why don't we start off with you introducing yourself? Dr Besbris: Sure. So, my name is Jessica Besbris. I am a neurologist with fellowship training in palliative care, and I am currently at Cedars Sinai Medical Center in Los Angeles, where I am the director of our neuropalliative care program. Dr Monteith: Excellent. So, how did you get involved in that? Dr Besbris: Like, I think, many neurologists, I always knew I wanted to be a neurologist---or, I should say, from the moment I decided to be a doctor I knew that that was the type of doctor I wanted to be, a neurologist. So, I went into medical school with the aim of becoming a neurologist. And very quickly, when I started my clinical years, I was exposed to patients who were living with very serious illnesses. And I found myself really drawn to opportunities to help, opportunities to make people feel better, opportunities to improve quality of life in situations that on the face of it seemed really challenging, where maybe it seemed like our usual treatments were not necessarily the answer or were not the only answer. And so, I pretty quickly recognized that taking care of patients with serious illness was going to be a big part of my life as a neurologist and that palliative care was the way I wanted to help these patients and families. Dr Monteith: And you mentioned you're leading the group. So, how many colleagues do you have in the program? Dr Besbris: We have a very large palliative care group, but within neuropalliative care, it's myself and one other physician, a nurse practitioner, and a social worker. Dr Monteith: Okay, well, I know you guys are busy. Dr Besbris: Yes, we are very happy to be busy. Dr Monteith: Yes. So, let's talk about the objectives of your article. Dr Besbris: Sure. So, the goal of this article is to impress upon neurologists that it really is all of our jobs as neurologists to be having these conversations with our patients who are affected with serious illness. And then, in most areas of neurology, these conversations will come up. Whether it's giving a life changing diagnosis, or talking about treatment choices, or treatment not going the way that we had hoped, or even sometimes progression of disease or end-of-life care. These topics will come up for most of us in neurology, and really, we're hoping that this article not only makes the case that neurologists can and should be having these conversations, but that there are skills that we can teach in this article and with other resources to improve the skill level and sense of confidence that neurologists have when they enter into these conversations. Dr Monteith: Great. I read that there are some developments in the field, on organizational levels, about really making these skills part of standard of care in terms of education. So, can you speak to that? Dr Besbris: Yes. So, there have been a couple of really landmark papers and changes in the educational landscape that I think have really brought neuropalliative care in general, and serious illness conversation in particular, to the forefront. So, there were the position statements released by the American Academy of Neurology in 1996 and 2022, both of which really said, hey, all neurologists should be doing this and receive training on how to have these conversations and provide this care. And the ACGME, the Accreditation Council for Graduate Medical Education, also requires neurology residency programs to learn how to communicate with patients and families, assess goals, and talk about end-of-life care. So, there's a real structural imperative now for neurologists to learn early on how to have serious illness conversations with their patients. Dr Monteith: Great. If there's anything for our listeners to get out of this conversation, what are the essential points? Dr Besbris: If you only take away one or two things from this conversation, I hope that they're that this is an awesome responsibility to be in a moment with a patient going through something challenging, to meet them in that moment with thoughtful, honest, empathic conversations about who they are and what's important to them. And that, just like any other procedure, these are skills that can be taught so that you can feel really confident and comfortable being in these moments. Dr Monteith: Excellent. Wow. Okay, I feel your energy and your empathy already. And so, why don't we just talk about skills? What is the best way to deliver tough news? I read this wonderful chart on SPIKES protocol. Dr Besbris: Yeah, the SPIKES protocol is one really well-known way to deliver serious news. And what's nice about SPIKES is it gives a mnemonic. And as neurology learners, we all love a good mnemonic to help you really center yourself when you're entering into these conversations so that you have a structured format to follow, just like with any procedure. So, the SPIKES protocol stands for Setting: so, making sure you have the right environment; Perception, or assessing what your patient or surrogate decision maker knows already so that you know where to begin; receiving an Invitation to deliver serious news. And then K stands for Knowledge, delivering in a clear and concise way the information that you want to make sure the family or patient walk away with. E for exploring Emotion; and S for really Summarizing what's been discussed and Strategizing on next steps. I think that having these kinds of conversations, it's just like being expert in anything. When you first start learning, it's helpful to have a set of very concrete steps you can follow. And you might even think through the mnemonic as you get ready to walk into that room. And as you become more expert, the flow becomes more natural. And maybe what you do before walking in to prepare is just honing what is that headline? What is that concise statement that I'm really going to give? And the rest may start to feel more natural and less protocolized. Dr Monteith: And there are a few other mnemonics. There's the NURSE mnemonic, which I like. You know, there's a balance between saying things and sounding kind of… you know, sometimes they're like, well, how could you understand what I'm going through? Have you been through something like this? And people shy away, and they're afraid to kind of be a part of these conversations. So how do we approach that with this, a NURSE mnemonic in a way that's kind of sincere? Dr Besbris: Absolutely. So, the NURSE mnemonic, unlike SPIKES, is not a step-by-step protocol. So, NURSE is a mnemonic, but you don't go through each letter and sort of give a naming statement and then an understanding statement and then a respecting statement and so on. Nurse is really a toolkit of different types of statements that we can give in response to emotions so that when you find yourself in a situation where a patient or family member is tearful, is scared, is angry, is expressing feelings, you have some phrases ready that feel authentic to you and that you feel are going to meet the moment and allow you to empathically respond to those emotions. Because until we do that, we really can't move further in this conversation with our patients and families feeling heard and respected. So, that NURSE mnemonic, those Naming, Understanding, Respecting, Supporting and Exploring statements, are really examples of statements that we can use to meet that moment with empathy and understanding and without implying that we have walked in their shoes. We want to avoid being presumptuous and really focus on just being present and empathic. Dr Monteith: So, let's just kind of run through, I think it's really important. Let's run through some of these examples. Maybe if someone's crying hysterically, how would we respond to that? Dr Besbris: So, this is an opportunity for Naming. And I made this one, I think, in the chart, a little bit obvious, meaning that we recognize when someone is crying that they are feeling probably very sad. This is an opportunity for us to name and thus normalize that emotion. I just think something as simple as, I think anyone would be really sad hearing this. These responses are not intended to fix this emotion. I'm not trying to get someone to stop crying or to, you know, necessarily not feel sad. It's really just to say, yeah, it's normal that you're feeling sad. It's okay. I'm here with you while you're feeling sad. And I'm going to be with you no matter what you're bringing to the table. Dr Monteith: Yeah. Let's go through just a couple of others. I mean, these are really good. Dr Besbris: Sure. Maybe Respecting. Dr Monteith: Yeah. So, my Dad is a fighter. Only God, not doctors, can know the future. Dr Besbris: Yeah. So, I love giving these examples with our learners because these statements, things like my Dad is a fighter or God will bring me a miracle or you don't know the answer. Only God knows what's going to happen, I think that they give a lot of doctors a feeling of confrontation, a feeling of anxiety. And I think there are a few reasons for that. And I think one of the main ones is that they're statements that imply that we as doctors are not all-powerful and it's our patients or families sort of looking for a different locus of control, whether it's internal fortitude or a higher power. They're looking to something other than us, and maybe that makes us feel a little bit uncomfortable. And I think that sometimes physicians think that these statements imply that someone doesn't even understand what's going on. But maybe they're coming to this from a place of denial. And I would argue that when someone comes to you with a statement like my dad is a fighter or, you know, I'm looking to God to bring me a miracle or to show me the future. I think that what they're really saying is, wow, I'm really hearing that things are serious, so much so that I'm reaching for these other resources to give me strength and hope. I don't think anyone asks for a miracle if they think that a miracle is not needed, if the problem is easy to fix. And so, rather than come to these types of statements from a confrontational place of I'm the doctor and I know best, I think this is a great opportunity to show some respect and give some respecting statements. Your dad is a fighter. I don't think he could have come this far without being a fighter. Or, you know, I am so grateful that you have your faith to lean on during times like these to give you strength. These are also nice opportunities for exploring statements. For example, I'm so grateful to learn more about your dad. Can you tell me what it is that he has been fighting for all of this time? Dr Monteith: I love that. It's like a follow-up, and also validating. Dr Besbris: Yeah, it's validating. And it allows us to learn a little bit more about this person and to learn, well, is he fighting for a life that we can still achieve with our interventions to lead into the next part of a conversation? Or, is God is going to bring me a miracle? Well, tell me what a miracle looks like for you. I can't tell you how many times I thought someone was going to tell me that a miracle would be cure. And sometimes that is what comes up. But other times I hear, a miracle would be, you know, my loved one surviving long enough for the rest of the family to gather. And, you know, that is certainly something we can work towards together. Dr Monteith: So, why don't we talk a little bit about approach to goals of care discussions? They are tough, and let's just put it into perspective to the critical care team. It's time, the person's been in the ICU, the family wants everything thrown at medically. And it's to the point that the assessment is that would be medical futility. Dr Besbris: Lots to unpack there. Dr Monteith: I wanted to make it hard for you. Dr Besbris: No, no, this is good! I mean, this is something- I work in a, you know, almost one thousand-bed hospital with a massive critical care building. And so, these are not unusual circumstances at all. First of all, I would just say that goals of care conversations are not only about end-of-life care. And I make that point a few different times in the article because I think when people imagine goals of care, and one of the reasons that I think clinicians may sometimes shy away from goals of care discussions, is that they think they have to be sad, they have to be scary, they have to be about death and dying. And I would argue that, really, goals of care discussions are about understanding who a person is, how they live their life, what's most important to them. Most of these conversations should be about living. How are we going to together achieve a quality of life that is meaningful for you and treatments that are going to fit your needs and your preferences? But there is a little slice of that pie in the pie chart of goals of care discussions that is in the arena of end-of-life care. For example, ICU care with, really, the highest levels of intensity of care, and having to talk about whether that still is meeting the moment from the perspective of goals as well as the perspective of efficacy. So, from the goals standpoint, I approach these conversations just like any other goals of care conversation. Usually at this point, we're speaking to family members and not our patients because in a neurocritical care unit, if someone is that sick, they probably are incapacitated. And so, it's a moment to really sit down with family and say, please tell me about the human being lying in that bed. They can't introduce themselves. What would they tell me about themselves if they could speak right now? What kinds of things were important to them in the course of their treatment? What kind of a life did they want to live or do they want to live? So that then we can reflect on, well, can our treatment achieve that? And this process is called shared decision making. This is really where we take in data from the family, who are experts in the patient, and then our own expertise in the illness and what our treatments can achieve, and then bring all of that information together to make a recommendation that aligns with what we believe is right for a particular patient. So, in the example that you gave, the extreme circumstance where someone is receiving maximal intensive care and we're starting to reach the point of futility, I think that we need to first really understand, well, what does futility mean for this particular patient? Is it that we as healthcare providers would not value living in the state this person is in? Or is it that the treatments truly cannot physiologically keep them alive or meet their stated goals? If it's the first one, that I wouldn't want to be on machines unconscious, you know, at the end of my life, well, I have to set that aside. It's really about what this patient wants. and if the family is telling you they valued every breath, every moment, and if we have care that can achieve that, we should continue to offer and recommend that care. And as healthcare providers, it is so important that we do explain when treatments are not going to be able to physiologically meet a patient's needs or achieve their goals. And that's where we can say, I'm going to continue to do everything I can, for example, to, you know, keep your loved one here for these meaningful moments. And we are at a point where performing CPR would no longer be able to restart his heart. And I just wanted to let you know that that's not something that we're going to do because I have an obligation not to provide painful medical treatments that will not work. So, my approach to futility is really different than my approach to shared decision-making because in the context of objective futility, it's not about necessarily- it's not about decision-making, it's not about shared decision-making as much as it is explaining why something is simply not going to work. Does that make sense? Dr Monteith: Absolutely. And what I love in your article is that, you know, you go beyond the skills, but also potential communication challenges---for example, patients' neurologic status, their ability to understand complex communication, or even cultural differences. So, can you speak about that briefly? Dr Besbris: Absolutely. In the world of neurological serious illness, it is incredibly common for our patients to face challenges in communication. That might be because they are aphasic, because they have a motor speech deficit, it might be because they're intubated, it might be because their capacity is diminished or absent. And so, there are a lot of challenges to keeping patients in these conversations. And in the article, I summarize what those challenges can look like and some strategies that we can use to continue to engage our patients in these conversations to the greatest extent possible and also turn to their surrogate decision makers where the patients themselves are no longer able to participate or participate fully. In terms of cultural considerations, I mean, there could be an entire article or an entire Continuum just on cultural considerations in neurology and in serious illness communication. And so, the key points that I really tried to focus on were exploring from a place of cultural humility what the beliefs and practices of a particular patient and family are in their cultural context, to ask questions to help you understand how those cultural differences may impact the way you approach these conversations. And being sensitive to folks with limited English proficiency, to ensure that we are using medical interpreters whenever possible. Dr Monteith: Excellent. Well, there's so much in the article. There's already so much that we just discussed, but our listeners are going to have to go to the article to get the rest of this. I do want to ask you to just kind of reflect on, you know, all the different cases and experiences that you have, and just, if you can give us a final remark? Dr Besbris: I can think of a number of cases that I've seen in my work as both an inpatient and outpatient neuropalliative provider where I've seen patients after strokes in the hospital with uncertain prognosis, whose families were struggling with a decision around feeding tubes. And where we have made a determination based on goals; for example, to pursue what's called a time-limited trial, to say let's place a feeding tube, let's meet again in the clinic in a few months after some rehab and let's just see, is this meeting this patient 's goals and expectations? I have been pleasantly surprised by the number of patients who have walked into my office after a period of rehabilitation who have regained the ability to eat, who are living an acceptable quality of life, and who have expressed gratitude for the work that I did in eliciting their goals, helping support their families. And some of whom have even come in and said, now that I'm doing better, I'd really like to do an advance directive to better guide my family in the future. People asking for more goals of care discussions, having seen how successful and helpful these conversations have been. Dr Monteith: Great. That's really life-altering for that patient, the family, so many people. Thank you so much for the work you do and for writing this great article and sharing all of this that we really need to learn more about. Dr Besbris: It's been a privilege. Thank you so much for talking with me today. Dr Monteith: Today I've been interviewing Dr Jessica Besbris about her article on the approach to serious illness conversation, which is found in the December 2025 Continuum issue on neuropalliative care. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.
The Wahls Protocol is a diet that may reduce inflammation, oxidative stress, and mitochondrial dysfunction. Although these are plausible mechanisms for slowing ALS progression, we discuss the fact that there are no actual data to support this hypothesis, and there are risks which are especially important to consider in people living with ALS.
Guest: Victoria Coleman-Cowger, PhD Gene therapy offers transformative potential for individuals with sickle cell disease, but the psychosocial challenges that accompany such a major decision are often underestimated. Hear from Dr. Victoria Coleman-Cowger as she highlights recommendations for supporting emotional wellbeing during and after gene therapy and explains the importance of recognizing both the psychological and social impacts of curative treatment. Dr. Coleman-Cowger is a licensed clinical psychologist and the Associate Vice President of Neurology and Cell and Gene Therapy at Emmes, a full-service clinical research foundation.
Dr. Andy Southerland talks with Dr. Seemant Chaturvedi about the highlights from the 17th World Stroke Congress. Learn more on the World Stroke Congress website. Disclosures can be found at Neurology.org.
In the final episode of our five-part series on primary progressive aphasia (PPA), Dr. Rogan Magee discusses bedside testing for PPA. Show citations: Show citations: Grossman M, Seeley WW, Boxer AL, et al. Frontotemporal lobar degeneration. Nat Rev Dis Primers. 2023;9(1):40. Published 2023 Aug 10. doi:10.1038/s41572-023-00447-0 Gorno-Tempini ML, Hillis AE, Weintraub S, et al. Classification of primary progressive aphasia and its variants. Neurology. 2011;76(11):1006-1014. doi:10.1212/WNL.0b013e31821103e6 Santos-Santos MA, Rabinovici GD, Iaccarino L, et al. Rates of Amyloid Imaging Positivity in Patients With Primary Progressive Aphasia. JAMA Neurol. 2018;75(3):342-352. doi:10.1001/jamaneurol.2017.4309 Mandelli ML, Lorca-Puls DL, Lukic S, et al. Network anatomy in logopenic variant of primary progressive aphasia. Hum Brain Mapp. 2023;44(11):4390-4406. doi:10.1002/hbm.26388 Putcha D, Erkkinen M, Daffner KR. Functional Neurocircuitry of Cognition and Cognitive Syndromes. In: Silbersweig DA, Safar LT, Daffner KR. eds. Neuropsychiatry and behavioral neurology: principles and practice. McGraw Hill; 2021. Accessed November 6, 2025. https://neurology.mhmedical.com/content.aspx?bookid=3007§ionid=253215676 Montembeault M, Brambati SM, Gorno-Tempini ML, Migliaccio R. Clinical, Anatomical, and Pathological Features in the Three Variants of Primary Progressive Aphasia: A Review. Front Neurol. 2018;9:692. Published 2018 Aug 21. doi:10.3389/fneur.2018.00692 Clark DG. Frontotemporal Dementia. Continuum (Minneap Minn). 2024;30(6):1642-1672. doi:10.1212/CON.0000000000001506
Dr. Alex Menze and Dr. Kristen Dams-O'Connor discuss traumatic encephalopathy syndrome and its relationship with traumatic brain injury. Show Citation: Dams-O'Connor K, Selmanovic E, Pruyser A, et al. Traumatic Encephalopathy Syndrome in the Late Effects of Traumatic Brain Injury (LETBI) Study Cohort. Neurology. 2025;1(2):e000015. doi:10.1212/WN9.0000000000000015
Today's guest is Dr. Jarod Burton. Jarod is a chiropractor and sports performance coach focused on neurology-driven movement. He blends manual therapy, strength modailities, and nervous system training to unlock better mechanics and athletic output. His work centers on identifying and clearing the neural limits that hold athletes back. In training, there are many layers to human performance and athletic outputs. One critical layer is the power transmission of the nervous system, and how to unlock this ability in all athletes. Many athletes naturally have a more adept system, while others may need more bridges to reach their highest levels of performance. In this episode, Jarod speaks on how his approach has evolved since entering clinical practice. He shares how he uses flywheel training to teach rhythm, “the dance” of force, and powerful catches rather than just concentric effort. He and Joel dig into spinal mobility, ribcage expansion, and even breakdance-style spinal waves as underrated keys to athletic freedom. Jarod then simplifies neurology for coaches, explaining how posture reveals brain-side imbalances and how targeted “fast stretch” work, loud/sticky altitude drops, and intelligently high training volumes can rebalance the system and unlock performance. Today's episode is brought to you by Hammer Strength. Use the code “justfly20” for 20% off any Lila Exogen wearable resistance training, including the popular Exogen Calf Sleeves. For this offer, head to Lilateam.com Use code “justfly10” for 10% off the Vert Trainer View more podcast episodes at the podcast homepage. (https://www.just-fly-sports.com/podcast-home/) Timestamps 0:00 - Jarod's background and early coaching lens6:55 - Internal vs external focus and simple cues13:40 - What good movement feels like20:10 - Speed shapes and improving posture29:18 - Blending strength with elastic qualities41:02 - Breathing mechanics and better movement options52:37 - Pelvis function and creating better positions1:00:15 - Skill acquisition and training that sticks1:11:48 - Programming principles and individual needs1:19:40 - Coaching philosophy and athlete communication Actionable Takeaways 0:00 – Jarod's background, influences, and early coaching lens Jarod draws heavily on mentors in track and field, particularly their ability to teach posture, projection, and simple shapes. He notes that he used to overcoach mechanics and learned that athletes need experiences, not micromanagement. Emphasize principles over preferences. As Jarod says, “If I can teach the principles, the application can change.” 6:55 – Internal versus external focus and simple cues that work Jarod prefers cues that help athletes feel positions instead of thinking about them. He explains that internal cues can work when used to create awareness, but they cannot dominate the session. Use cues that point the athlete toward an outcome. For example, he prefers “push the ground away” instead of detailed joint instructions. 13:40 – What good movement feels like and the problem with forcing technique Jarod warns that coaches often chase “pretty” movement at the cost of effective movement. Technique should emerge from intention, not the other way around. He encourages coaches to give athletes tasks that naturally produce the shapes they want. If an athlete is struggling, simplify the environment rather than stack more verbal instructions. 20:10 – Speed development, posture, and improving shapes without overcoaching Jarod explains that acceleration improves when athletes learn to project rather than lift. Upright running quality comes from rhythm and relaxation, not from forcing tall mechanics. He recommends using contrast tasks to improve posture, such as wall drills combined with short accelerations. Let the environment teach the athlete and save verbal coaching for key errors only. 29:18 – Blending strength training with elastic qualities Jarod sees weight room work as support, not the driver, of speed and skill. He focuses on the elastic properties of tendons and connective tissue for speed athletes. He notes that heavy lifting can coexist with stiffness and elasticity if programmed strategically rather than constantly chased. Use low amplitude hops, bounds, and rhythm-based plyos to balance the traditional strength program. 41:02 – Breathing, ribcage mechanics, and natural movement options Jarod uses breathing work to help athletes find positions that allow better rotation and force transfer. He explains that tight ribcages limit athletic expression, not just breathing capacity. Many athletes struggle with rotation due to rigid breathing patterns, not lack of strength. Use breathing resets before high-speed work to create better movement “access.” 52:37 – Understanding the athletic pelvis and creating better positions Jarod emphasizes that pelvic orientation shapes nearly every aspect of movement. He encourages developing a pelvis that can both yield and create force, instead of being locked in extension or tucked under. Simple low-level movements like hip shifts, step-ups, and gait-primer patterns can transform sprint positions. Train the pelvis in motion, not just through isolated exercises. 1:00:15 – Skill acquisition, variability, and choosing training that sticks Jarod believes athletes need movement options and adaptability, not one perfect model. Variability builds resilience and skill transfer. Too much rigidity in training creates athletes who cannot adapt to chaotic sport environments. Coaches should create tasks that allow athletes to explore rather than follow rigid repetitions. 1:11:48 – Programming principles and adjusting training to the individual Jarod adjusts cycles based on athlete readiness rather than fixed rules. He focuses on how athletes respond to stress rather than the stress itself. Training should follow the athlete's progression of competence and confidence, not arbitrary timelines. He prefers a flexible structure where principles guide but the athlete determines the pace. 1:19:40 – Coaching philosophy, communication, and what athletes need Jarod highlights that coaching is not about showing off knowledge but helping someone move better. He builds trust through communication and clarity rather than overwhelming athletes with science. He believes athletes need environments that reward curiosity and creativity. The coach creates the environment, but the athlete creates the movement. Jarod Burton Quotes “If I can teach the principle, the application can change, and the athlete can adapt.” “Good movement should feel rhythmic and natural, not forced.” “The environment will teach the athlete faster than a paragraph of cues.” “When an athlete stops trying to make the movement pretty, it usually starts to become pretty.” “The weight room supports speed. It should not compete with speed.” “Breathing gives athletes access to positions they did not know they had.” “Adaptable athletes win. Rigid athletes break.” “Coaching is about creating options for the athlete, not limiting them.” “I want athletes who can solve problems, not just follow instructions.” “Trust comes from communication, not complexity.” About Jarod Burton Dr. Jarod Burton is a chiropractor and sports performance coach who lives in the intersection of clinical practice, neuroscience, and high-performance human movement. A student of neurology and motor learning, Jarod works to uncover the hidden nervous system constraints that influence posture, coordination, elasticity, and power expression in sport. His methods combine manual therapy, joint mapping, sensory integration, and movement-based diagnostics to create individualized solutions that free up range, recalibrate neural rhythm, and unlock athletic speed, strength, and resilience. Jarod is passionate about a holistic philosophy of performance; one where the brain, body, and environment work in concert to reveal the best version of the athlete.
Dr. Alex Menze talks with Dr. Kristen Dams-O'Connor about traumatic encephalopathy syndrome and its relationship with traumatic brain injury. Read the related article in Neurology® Open Access. Disclosures can be found at Neurology.org.
In this episode of the Brain and Life podcast, Dr. Daniel Correa is joined Emmy award-winning broadcaster Mark McEwen. Mark shares his inspiring journey of recovery after suffering a stroke at the age of 52, which led to aphasia. He discusses his broadcasting career, the challenges he faced during recovery, and the importance of hope and resilience. Dr. Correa is then joined by Dr. Rachel Forman, a stroke neurologist and Assistant Professor of Neurology at Yale School of Medicine. Dr. Forman explains stroke risk factors, the importance of awareness, community health initiatives, and access to healthcare to prevent these life-altering events. Articles Mentioned Stamp Out Stroke Get Smart about Stroke Navigating the Complexities of Stroke Other Brain & Life Podcast Episodes on These Topics Understanding Stroke with Dr. Laurel Cherian Solving the Stroke with Will Shortz Matt and Kanlaya Cauli on Rebuilding Life After Stroke 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: Guest: Dr. Rachel Forman @yaleneurology Hosts: Dr. Daniel Correa @neurodrcorrea; Dr. Katy Peters @KatyPetersMDPhD
This week, Ash sits down with Dan Cohen, a diplomat of the American Board of Psychiatry and Neurology who revolutionized sleep medicine and launched Breathe Right nasal strips, selling for $566 million. Dan shares his journey from developing automated sleep diagnostic equipment to rewriting the playbook for consumer product launches through creative marketing and NFL partnerships. The conversation explores Dan's philosophy on innovation - trusting intuition over overthinking and accessing the "higher mind" through meditation and receptivity. He dives deep into sleep science, explaining why we lose crucial deep sleep starting at age 25 and its connection to chronic disease, while offering practical optimization strategies. From sleep tips to patent strategy, Dan demonstrates how balancing inner wisdom with smart execution can lead to extraordinary outcomes, even when it means going against conventional wisdom. In This Episode, You'll Learn: Why deep sleep is critical for health and how we lose 60-70% of it by our mid-40s Simple meditation techniques focusing on body awareness and feeling states How Dan launched Breathe Right with radio interviews and creative distribution tactics Why intellectual property strategy is crucial for entrepreneurs How to identify leverage points when launching products without massive capital The importance of planning your exit strategy from the beginning Connect with Dan Cohen LinkedIn: https://www.linkedin.com/in/dan-cohen-md-55b33287/ Connect with Ash: https://www.instagram.com/ashleystahl/ Want to become a professional speaker and skyrocket your personal brand? Ashley's team at Wise Whisper Agency offers a done-with-you method to get your signature talk written and booked and it's helped more than 100 clients onto the TEDx stage! Head over to https://wisewhisperagency.com/speak/
In the final episode of our five-part series on primary progressive aphasia (PPA), Dr. Rogan Magee discusses bedside testing for PPA. Show citations: Grossman M, Seeley WW, Boxer AL, et al. Frontotemporal lobar degeneration. Nat Rev Dis Primers. 2023;9(1):40. Published 2023 Aug 10. doi:10.1038/s41572-023-00447-0 Gorno-Tempini ML, Hillis AE, Weintraub S, et al. Classification of primary progressive aphasia and its variants. Neurology. 2011;76(11):1006-1014. doi:10.1212/WNL.0b013e31821103e6 Santos-Santos MA, Rabinovici GD, Iaccarino L, et al. Rates of Amyloid Imaging Positivity in Patients With Primary Progressive Aphasia. JAMA Neurol. 2018;75(3):342-352. doi:10.1001/jamaneurol.2017.4309 Mandelli ML, Lorca-Puls DL, Lukic S, et al. Network anatomy in logopenic variant of primary progressive aphasia. Hum Brain Mapp. 2023;44(11):4390-4406. doi:10.1002/hbm.26388 Putcha D, Erkkinen M, Daffner KR. Functional Neurocircuitry of Cognition and Cognitive Syndromes. In: Silbersweig DA, Safar LT, Daffner KR. eds. Neuropsychiatry and behavioral neurology: principles and practice. McGraw Hill; 2021. Accessed November 6, 2025. https://neurology.mhmedical.com/content.aspx?bookid=3007§ionid=253215676 Montembeault M, Brambati SM, Gorno-Tempini ML, Migliaccio R. Clinical, Anatomical, and Pathological Features in the Three Variants of Primary Progressive Aphasia: A Review. Front Neurol. 2018;9:692. Published 2018 Aug 21. doi:10.3389/fneur.2018.00692 Clark DG. Frontotemporal Dementia. Continuum (Minneap Minn). 2024;30(6):1642-1672. doi:10.1212/CON.0000000000001506
In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Maisha T. Robinson, MD, MSHPM, FAAN, FAAHPM, who served as the guest editor of the December 2025 Neuropalliative Care issue. They provide a preview of the issue, which publishes on December 2, 2025. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Robinson is the Chair of the Division of Palliative Medicine and an assistant professor of neurology at Mayo Clinic in Jacksonville, Florida. Additional Resources Read the issue: continuum.aan.com Subscribe to Continuum®: shop.lww.com/Continuum Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Guest: @neuropalldoc Full episode transcript available here Dr Jones: Most of us who see patients with chronic progressive neurologic disease are aware of the value of palliative care. The focus on symptom management and quality of life is a key aspect of helping these patients. But how many of us are comfortable starting the conversation about palliative care or care at the end of life? Today we have the opportunity to speak with a leading expert on neuropalliative care, Dr Maisha Robinson, about how we can better integrate neuropalliative care into our practices. 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 subscribing to the journal, listening to verbatim recordings of the articles, and exclusive access to interviews not featured on the podcast. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today I'm interviewing Dr Maisha Robinson, who is Continuum's Guest Editor for our latest issue of Continuum on neuropalliative care, and our first-ever issue fully dedicated to this topic. Dr Robinson is an assistant professor of neurology at Mayo Clinic in Florida, where she is Chair of the Division of Palliative Medicine, and she also serves on the AAN Board of Directors as Chair of the Member Engagement Committee. Dr Robinson, welcome. Thank you for joining us today. Why don't you introduce yourself to our listeners? Dr Robinson: Well, Dr Jones, thank you for having me. Really a pleasure to be here. I'm Maisha Robinson at the Mayo Clinic in Jacksonville, Florida. I spent my time as a neurohospitalist, a general palliative care physician, and a neuropalliative care physician. Dr Jones: So, this is a topic that at Continuum, we have heard about from subscribers for a long time requesting a fully dedicated issue to palliative care. And we've titled this neuropalliative Care. So, we want to respond to our subscribers and bring them content that they're interested in. I also think that palliative medicine is a big education gap in our specialty of neurology and something that we have room to improve on. So, let's start with the basics, Dr Robinson. Palliative medicine has been around for a long time, but this concept of "neuropalliative care" feels relatively new. What is neuropalliative care? Dr Robinson: That's a great question. Generally, what I would say is palliative care, first of all, is really just a specialty that focuses on trying to improve quality of life for people that have a serious or advanced medical condition. And neuropalliative care is really palliative care for people with neurologic conditions. And you'll see a number of neurologists doing neuropalliative care, but also there are internists as well, and people from other specialties, who focus on patients with neurologic disease and really trying to improve their quality of life. Dr Jones: Got it. And so, it's really the principles of palliative medicine in a specialty-specific context, which I think is important for us given the prevalence of chronic disease in our specialty. And I was obviously reading through these articles in this issue, and in the really wonderful articles, there are some themes that came up multiple times in various different articles. And one of them was obviously the importance of communication with patients and families. I think, and I'm speaking a little bit from personal experience here, many physicians feel uncomfortable bringing up the discussion of palliative care. And I'm sure that is something that reflects on your practice, too. How often do you have a patient who shows up to clinic and they ask you, why am I here? Dr Robinson: It happens all the time, because colleagues who are referring patients are nervous to tell them that they're sending them to palliative care. But we try to tell people it's really just to normalize it, to say that the palliative care team is going to see you, they're going to help with some symptoms, they're going to help you think about big picture, and they're going to be sort of an added layer of support to your team. And I think if people approach it from that standpoint, then patients and family members will say, that sounds great, I need a little extra support. Dr Jones: So, I think most neurologists have a threshold at which they would feel more comfortable having specialty support, having a palliative medicine specialist to help them in symptom management with the patient. For the palliative care that they provide themselves---and we want our subscribers to read this issue and feel more comfortable with delivering some palliative care on their own---how would you encourage them to begin that conversation? How should they initiate that conversation with a patient about working more toward palliative management of symptoms? Dr Robinson: So, one of the things we recommend is really introducing an approach to palliative care very early in the disease process. So, discussions about big picture and goals of care, discussions about who might help make medical decisions if the person can't make them for themselves. Those kinds of things can be discussed very early on. And in fact, that's palliative care. And then they can talk to patients more about the fact that as the disease progresses, there may be an additional team that can help walk along alongside the neurologist in helping you prepare for what's to come. You know, I think it's very important for patients and family members who feel like you're not abandoning them, but you're adding additional resources. And so, I like the way that we often will suggest to people to say partner or collaborate or bring in extra resources with the palliative care team. I think patients and family members will respond to that. Dr Jones: Yeah. So, by talking about it early, you kind of, at least, help to avoid that problem of the patient perceiving the introduction of palliative care as the quote-unquote "giving-up problem." Is that right? Dr Robinson: Correct. Because we also don't want to see people who are just being referred to us for end-of-life care. Palliative care is about much more than that. But if patients will Google palliative care, they may see hospice come up. And so, introducing the concept early and discussing some palliative topics early will allow the patient and family members to think that, okay, this isn't because I'm at the end of life. This is just because my clinician wants to make sure that I have all the bases covered. Dr Jones: This was also mentioned in several of the articles, the studies that have shown how frequently palliative care is initiated very near the end of life, which is usually, I think, perceived as a missed opportunity, right? To not wait so long to take advantage of what palliative care has to offer. Dr Robinson: That's correct. And the benefit of palliative care is that oftentimes we work alongside an interdisciplinary team, a team that could be quite helpful to patients and their support systems throughout the course of the disease. So, we have chaplains, we have nurses, we often have other clinicians, advanced practice providers as well, who work with us. We have spiritual advisors as well. And the patients and family members could benefit from some of those resources throughout the course of the disease. Who they might need to meet with may vary depending on what the disease is and how they're doing. But there's definitely some benefit to having a longitudinal relationship with the palliative care team and not just seeking them out at the end of life. Dr Jones: So- that's very helpful. So, it'll obviously vary according to an individual provider's level of comfort, right, where they're comfortable providing certain palliative management care versus when they need to have some assistance from a specialist. Are there types of care or are there certain thresholds that you say, wow, this patient really should go see a specialist in palliative medicine or neuropalliative care? Dr Robinson: So, I think that if there are, for instance, refractory symptoms, where the neurologist has been working with a patient for a while trying to manage certain symptoms and they're having some challenges, that person may benefit from being referred to palliative care. If patients are being hospitalized multiple times and frequently, that may suggest that a good serious-illness conversation may be necessary. If there are concerns about long-term artificial nutrition, hydration, or functional and cognitive decline, then some of those patients have benefited from palliative care. Not only the patient, but also the caregiver, because our team really focuses on trying to make sure that we're walking through the course of disease with these patients to ensure that all of the needs are managed both for the patient and the family member. Dr Jones: Got it. And that's very helpful. And I know that we talk about a lot of these decisions happening in an ideal environment when there's good access to the neurologist and good access to a palliative medicine specialist or even a neuropalliative medicine expert. In your general sense, I- and maybe we'll talk a little bit here in a minute or two about the growing interest in neuropalliative care. But in terms of access, in terms of availability of really, truly neuropalliative expertise, what is your sense of how widely available that is in the US? Dr Robinson: There's a shortfall of palliative care clinicians in the United States. Everybody who needs a palliative care clinician won't have access to one. And I think your point about the primary palliative care is so important. That's really what we encourage all clinicians, neurologists, neurosurgeons, even, physiatrists, the neurology care team members need to be comfortable with at least initiating some of these conversations. Because, to your point, not everyone's going to have access to a palliative care physician. But by reading issues such as this one, attending some courses---for instance at the American Academy of Neurology meetings---, doing some online trainings, those types of things can be helpful to bring any neurology clinician up to speed who certainly may not have access to a palliative care physician. Dr Jones: So, I know---and this is in part from my own conversations with patients in my own practice---there are a number of fears that patients have when they have a chronic disease, something that's progressive or something that we don't have a curative treatment for. But I think one of, if not the most common fear among patients is pain, and pain that can't be managed adequately during the course of chronic illness or at the end of life. One of the interesting concepts that I saw mentioned in a few of the articles in this issue is this concept of total pain. So, not just the somatic pain that I think we tend to think of as clinicians and patients tend to think of as patients, but a more holistic definition of pain. Walk us through that and how that relates to palliative medicine. Dr Robinson: So, Dame Cicely Saunders, the modern-day founder of palliative medicine, really described this biopsychosocial model for pain. And so, you're right, it's not just physical pain, but it's psychological pain, it's spiritual pain. And oftentimes when we are taking care of patients with neurologic disease, they may have some physical pain, but a lot of them are thinking about, for instance, the things that they will miss, which may cause some internal discomfort. Things that they're grieving, the life they thought they were going to have, the person that they used to be, the life they used to have, and what they anticipated their life as being. And some of that can cause people to have not only the spiritual discomfort, but also some psychological discomfort as well. And so, when we're thinking about how to provide rehensive care to these patients, we have to be thinking about all of these aspects. Dr Jones: It's really helpful. And I guess the more you can identify those, the more you can either help yourself or find the right expert to help the patient. I thought that was an interesting expansion of, of my view of how to think about pain. And another observation that came up in several of the articles was a lack of high-quality clinical trial evidence to inform a lot of the interventions in neuropalliative care. Some of them are common-sense, some of them are based on clinical experience or expert advice. In your own practice, if there was one key knowledge gap to close---in other words, if there was one pivotal trial that we could do to answer one question in helping patients with chronic neurologic disease---what would you say is the main gap? Dr Robinson: I think the real gap is, who needs palliative care and when? That seems very simple. We have tried things such as automatic triggers for palliative care, for instance, in patients with ALS, or we've said that maybe all glioblastoma patients should see palliative care. But is that true? Are we utilizing the resources in the best possible way that we can? We're not sure. And so, you'll see these practices doing things all a little bit different because we don't have a best practice and it's not really standardized about when people should see palliative care, or why, for instance, they should see palliative care, or who should see palliative care. And I think if we could help drill that down, we can provide some better guidance to our colleagues about when and why and who should see palliative care. Dr Jones: It's a really kind of a fundamental, foundational, who needs the service to begin with or who needs to care. Okay, that's- that is a big gap. So, one of the interesting concepts that I read- and it was in Benzi Kluger's article on neuropalliative care for patients who have movement disorders. I think it's a concept that is interesting, really, maybe in the management of patients with a lot of different chronic, progressive neurologic diseases. And it's this idea of stealing victories or bringing joy to patients. In other words, not just managing or trying to minimize some of the negative aspects or symptoms of disease, but looking for opportunities to bring something positive to their experience or improving their quality of life. Tell us a little more about that, because I think that's something patients would appreciate, but I think neurologists would appreciate that, too. Dr Robinson: Dr Kluger loves to talk about sustaining and finding joy in patients who have really serious or advanced neurologic conditions. He likes to talk about stealing victories, which can relate to the fact that patients and their loved ones can find even some benefit despite having a serious or advanced neurologic condition. Neurologists and neurology clinicians also can steal victories in their patients when they notice, for instance, that they've gained a new skill, and they've lost a skill that they used to love because of the advancing disease. And this is just an opportunity for not only the patients and family members, but also the care providers to recognize that in the midst of decline, there are positive things to be found. Dr Jones: I think it gives patients a sense of maybe reclaimed autonomy when they can say, well, there's maybe nothing I can do to cure this disease in the conventional sense, but I can maybe go on this trip with my family, which has been something I've always wanted to do. Or, I can do these things, so I can attend certain events that I want to. And I think that autonomy and independence aspect of that, I think that I think that was really meaningful and something that I'm going to bring back to my own practice in my care of patients who have ALS, for example. When you think about neuropalliative care---and you've been a leader in this area, Dr Robinson---what do you think the biggest change in neuropalliative care has been over the last few years? Dr Robinson: I think there's a growing cohort of people who are recognizing that there is some benefit in having dedicated specialists who focus on palliative care for patients with neurologic disease. When I said I was going to do neuropalliative care, somebody asked me, why would a neurologist be interested in palliative care? Over the last decade and a half, we've seen that shift. And not only are our colleagues recognizing the benefit, but also patients and caregivers are. Some are even asking for palliative care. I think people are recognizing that not only having their primary neurologist or neurology clinician taking care of them, they have this extra layer of support, and this extra team really focused on quality-of-life issues can be beneficial. Dr Jones: So, one of the things that I think you and I have both seen, Dr Robinson, is a growing interest among neurology trainees in palliative medicine. And maybe that's anecdotal, but in my own practice, I've seen more and more trainees express an interest in this. For neurology residents who are interested in this as a component of or maybe a focus of their career, what would you recommend to them? How should they go about this? Dr Robinson: Yes, it used to be that every neurology resident interested in palliative care would call me or email me or send me a message, but now there are so many that I can't keep up. We're excited about the growing number of people interested in neuropalliative care. What I would say to those people is that you can really try to hone your skills by, for instance, doing a rotation with the palliative care team at your hospital, if there is one. If there isn't one, you might even ask to spend some time with the local hospice agency, which may be helpful to you. If you're attending some of the national meetings---for instance, the American Academy of Neurology meeting---you may want to go to a course and learn a little bit about palliative care. There are a couple that are offered every year. There is an education opportunity for education in palliative and end-of-life care as well. And so, there are a number of resources that you can find in addition to this issue of Continuum as well. Dr Jones: I find it gratifying that trainees ask about this. And I'm sorry, I think I've probably sent a bunch of trainees your way for advice about this, and you've been incredibly generous with your time and expertise. So, I find it very gratifying that our neurology trainees are interested in this area, because it's an important area of medicine. It's also probably a challenging practice just from the cognitive load and the emotional load of caring for patients who are moving through a progressive illness. What is your thinking about how to have a sustainable career in palliative medicine? What is your approach to that? Is it for everyone? Dr Robinson: Yeah, the issue with palliative care is that we do see some very challenging situations, and frankly some very sad situations. But I actually love what I do because I think that we're helping patients and their family members during very, very difficult times. I feel like this is why I went to medical school, to try to be there for people when they need me the most. The way that I think about it is, the patients and family members will be going through this anyway. We're trying to help improve their quality of life as they're going through it. And what you might find interesting is that these patients are so grateful. And their loved ones, they're so grateful. Even if they're nearing the end of life, just to have someone who's helping them see that, for instance, the pain could be better, or that they have more resources for the loved ones to be able to take care of them. And so, I think that helps sustain us, realizing that we are really having a positive benefit on the patients and also their family members. Dr Jones: Well, I think that's a great point to end on. And these are patients who need help. Even if we don't have a curative therapy, they do need support. And that's an important service and a function and an important facet of our profession. So, Dr Robinson, I want to thank you for joining us, and I want to thank you for such a great discussion of neuropalliative care. I learned a lot from our conversation today. I've learned a lot reading the articles and the experts that you put together. This is an important topic. I'm really grateful to you to having assembled this team of expert authors and put together an issue that I think will be really important for not only our junior readers, but also our more experienced subscribers as well. Dr Robinson: Thank you, Dr Jones, for the opportunity. Dr Jones: Again, we've been speaking with Dr Maisha Robinson, Guest Editor of Continuum's most recent issue and first issue fully dedicated to neuropalliative care. Please check it out, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. Thank you for listening to Continuum Audio.
What if the fear of your next migraine is the very thing keeping it alive?In this episode of Migraine Heroes Podcast, host Diane Ducarme dives deep into the fear–migraine feedback loop, how the mere anticipation of pain can activate the same pathways as pain itself.We explore how chronic fear trains your brain to stay on high alert and how that hypervigilance quietly keeps your nervous system in “migraine mode.”You'll discover:
In the fourth installment of our series on primary progressive aphasia (PPA), Dr. Rogan Magee discusses semantic variant PPA. Show citations: Grossman M, Seeley WW, Boxer AL, et al. Frontotemporal lobar degeneration. Nat Rev Dis Primers. 2023;9(1):40. Published 2023 Aug 10. doi:10.1038/s41572-023-00447-0 Gorno-Tempini ML, Hillis AE, Weintraub S, et al. Classification of primary progressive aphasia and its variants. Neurology. 2011;76(11):1006-1014. doi:10.1212/WNL.0b013e31821103e6 Santos-Santos MA, Rabinovici GD, Iaccarino L, et al. Rates of Amyloid Imaging Positivity in Patients With Primary Progressive Aphasia. JAMA Neurol. 2018;75(3):342-352. doi:10.1001/jamaneurol.2017.4309 Mandelli ML, Lorca-Puls DL, Lukic S, et al. Network anatomy in logopenic variant of primary progressive aphasia. Hum Brain Mapp. 2023;44(11):4390-4406. doi:10.1002/hbm.26388 Putcha D, Erkkinen M, Daffner KR. Functional Neurocircuitry of Cognition and Cognitive Syndromes. In: Silbersweig DA, Safar LT, Daffner KR. eds. Neuropsychiatry and behavioral neurology: principles and practice. McGraw Hill; 2021. Accessed November 6, 2025. https://neurology.mhmedical.com/content.aspx?bookid=3007§ionid=253215676 Montembeault M, Brambati SM, Gorno-Tempini ML, Migliaccio R. Clinical, Anatomical, and Pathological Features in the Three Variants of Primary Progressive Aphasia: A Review. Front Neurol. 2018;9:692. Published 2018 Aug 21. doi:10.3389/fneur.2018.00692 Clark DG. Frontotemporal Dementia. Continuum (Minneap Minn). 2024;30(6):1642-1672. doi:10.1212/CON.0000000000001506
Guest: Dr. Anderson is currently the Albert H. Coons Professor of Neurology at Harvard Medical School, Senior Scientist at the Brigham and Women's Hospital, Institute Member of the Broad Institute of MIT and Harvard, and Core Faculty Member of the Gene Lay Institute of Immunology and Inflammation. She talks about her research on immune regulation in cancer and enhancing anti-tumor immunity. (38:33) Featured Products and Resources: Submit your abstract now for IMMUNOLOGY2026! Download a free wallchart on the production of CAR T cells. The Immunology Round Up CAR Tregs for Atherosclerosis: Anti-oxidized low-density lipoprotein CAR Tregs reduce atherosclerotic plaque formation in mouse models. (2:20) Tumor-Reactive T Cells: Tumor-reactive CD8+ T cells can be isolated and expanded from clinical samples. (14:24) Harnessing Myeloid and Lymphoid Synergy for Immunotherapy: Myeloid-targeted immunocytokines and natural killer/T cell enhancers show potential for treating solid cancers. (18:50) Subcutaneous Fat Affects Intestinal Aging: Subcutaneous white adipose tissue dysfunction triggers aging-like intestinal dysfunctions in mouse models. (32:40) Subscribe to our newsletter! Never miss updates about new episodes. Subscribe
Dr. Jeff Ratliff talks with Dr. Dara Albert about the misconceptions surrounding FND, the importance of compassionate communication with patients, and the need for improved educational strategies to address knowledge gaps. Read the related article in Neurology® Education. Disclosures can be found at Neurology.org.
The December 2025 recall features four previously released episodes focused on neuropalliative care. The episode begins with Dr. Stacey Clardy speaking with Dr. Janis Miyasaki about her path into neurology, the integration of palliative care into neurologic practice, and the essential role of patient-centered care. The conversation continues with Dr. Miranda Wan addressing strategies to enhance training and public awareness to optimize palliative care for patients with neurologic conditions. The recall concludes with Dr. Carolyn Rennels discussing the characteristics and motivations of patients with ALS who sought medical aid in dying in a two-part series. Podcast links: 2025 AAN President's Award Recipient - Dr. Janis Miyasaki Attitudes and Perceptions on Palliative Care Characteristics and Motivations of People With ALS Who Pursue Medical Aid in Dying - Part 1 Characteristics and Motivations of People With ALS Who Pursue Medical Aid in Dying - Part 2 Article links: 2025 AAN President's Award Neurologists' Attitudes and Perceptions on Palliative Care: A Qualitative Study Characteristics and Motivations of People With Amyotrophic Lateral Sclerosis Who Pursue Medical Aid in Dying in California Disclosures can be found at Neurology.org.
In the third installment of our series on primary progressive aphasia (PPA), Dr. Rogan Magee discusses nonfluent/agrammatic PPA. Show citations: Grossman M, Seeley WW, Boxer AL, et al. Frontotemporal lobar degeneration. Nat Rev Dis Primers. 2023;9(1):40. Published 2023 Aug 10. doi:10.1038/s41572-023-00447-0 Gorno-Tempini ML, Hillis AE, Weintraub S, et al. Classification of primary progressive aphasia and its variants. Neurology. 2011;76(11):1006-1014. doi:10.1212/WNL.0b013e31821103e6 Santos-Santos MA, Rabinovici GD, Iaccarino L, et al. Rates of Amyloid Imaging Positivity in Patients With Primary Progressive Aphasia. JAMA Neurol. 2018;75(3):342-352. doi:10.1001/jamaneurol.2017.4309 Mandelli ML, Lorca-Puls DL, Lukic S, et al. Network anatomy in logopenic variant of primary progressive aphasia. Hum Brain Mapp. 2023;44(11):4390-4406. doi:10.1002/hbm.26388 Putcha D, Erkkinen M, Daffner KR. Functional Neurocircuitry of Cognition and Cognitive Syndromes. In: Silbersweig DA, Safar LT, Daffner KR. eds. Neuropsychiatry and behavioral neurology: principles and practice. McGraw Hill; 2021. Accessed November 6, 2025. https://neurology.mhmedical.com/content.aspx?bookid=3007§ionid=253215676 Montembeault M, Brambati SM, Gorno-Tempini ML, Migliaccio R. Clinical, Anatomical, and Pathological Features in the Three Variants of Primary Progressive Aphasia: A Review. Front Neurol. 2018;9:692. Published 2018 Aug 21. doi:10.3389/fneur.2018.00692 Clark DG. Frontotemporal Dementia. Continuum (Minneap Minn). 2024;30(6):1642-1672. doi:10.1212/CON.0000000000001506
Send us a textMost people think memory loss is a downhill slide you can't stop. We don't. In this conversation with neurologist and neuroscientist Dr. Majid Fotuhi, we map out a twelve‑week blueprint that measurably improves memory, focus, and even grows hippocampal volume by targeting the real drivers of decline: poor sleep, chronic stress, insulin resistance, hearing loss, inactivity, and hidden medical issues.Dr. Majid Fotuhi is a pioneering neurologist, neuroscientist, and professor with more than thirty-five years of experience in brain health, memory, neuroplasticity, and the prevention of Alzheimer's disease. His work bridges research, clinical innovation, and public education.He earned his PhD in neuroscience from Johns Hopkins University, completed medical training at Harvard Medical School, and returned to Johns Hopkins for his neurology residency. He currently serves as an adjunct professor at Johns Hopkins University.An author and communicator, Dr. Fotuhi has written several books and is known for making complex science accessible. His excellence in teaching earned him the American Academy of Neurology's prestigious award. His research has appeared in peer-reviewed journals, been presented at major conferences, and cited widely by scientists worldwide.Dr. Fotuhi has created a twelve-week program that has helped thousands of patients with memory loss, brain fog, concussion, mild cognitive impairment, and early Alzheimer's disease. His expertise has been featured by CNN, NBC News, the Today Show, ABC News, The New York Times, The Washington Post, and The Times (London).We start by clarifying what mild cognitive impairment is, how it differs from dementia, and why so many cases are preventable. Dr. Fotuhi explains the “type 3 diabetes” model—how decades of sugar spikes and inflammation erode the blood‑brain barrier and starve neurons of a stable environment. Then we get practical. You'll hear how a personalized “brain portfolio” guides treatment: VO2 max testing to shape exercise, sleep studies and CPAP when needed, targeted brain training that matches deficits, and labs for vitamin D, B12, and omega‑3 status. The results? Early wins in two to three weeks, statistically significant gains at six and twelve, and habits that stick.We don't stop at diet and steps. Oral health impacts cognition by limiting whole foods and increasing inflammation; chewing itself engages neural circuits. Hearing loss quietly accelerates decline—hearing aids can move people from mild impairment back to normal. Add a simple, sustainable food approach—ditch ultra‑processed foods, eat vegetables, legumes, fruits, quality proteins, and healthy fats—and consider targeted supplementation with DHA/EPA omega‑3s and corrected D and B12 levels. Along the way, we address why amyloid hogged the spotlight, and point to powerful data: the Lancet's estimate that 45% of dementia cases are preventable and the American Heart Association's claim that 80% of strokes can be avoided.If you want a sharper brain by summer, this is your starting line. Subscribe, share this with someone you love, and leave a review telling us the one habit you'll change this week. Your future brain will thank you.Links:Majid Fotuhi, MD, PhD: https://drfotuhi.com/https://krieger.jhu.edu/mbi/directory/majid-fotuhi/https://neurogrow.com/about-us/dr-majid-fotuhi-md-phd/https://psychology.columbian.gwu.edu/majid-fotuhiTweet me @realdrhamrahIG @drhamrah
Ever feel like your migraines strike right when your hormones swing? That's no coincidence. In this episode of Migraine Heroes Podcast, hosted by Diane Ducarme dives how hormonal shifts, especially sudden estrogen drops, can spark migraine attacks and emotional turbulence.With a blend of neuroscience and Eastern medicine, we uncover:
Today we are exploring the diagnosis of Alzheimer's disease, treating dementia and how nutrition can help with cognitive decline.This podcast is sponsored by Macquarie University Hospital, part of Macquarie University Health – a trailblazer in healthcare, education and research.Dr Heather Francis is an endorsed Clinical Neuropsychologist. She is experienced in the diagnosis and management of neurological and neurosurgical conditions. She provides evidence based cognitive and lifestyle recommendations and interventions to improve brain health and mental wellbeing, as well as reduce risk of cognitive decline in aging. She has a research interest in the effects of diet on the brain.Professor James Burrell graduated with a combined Arts/Medicine degree from the University of New South Wales in 2000. He completed basic physicians training at Prince of Wales Hospital, before progressing through advanced training in neurology at Concord and Royal Prince Alfred hospitals. He completed a fellowship in neuromuscular disease and neurophysiology in 2008. Professor Burrell completed a PhD, based at Neuroscience Research Australia, then took up a position as Senior Research Officer at the same institution from 2012-2016, before moving to the University of Sydney in 2017. His PhD and subsequent research contributions focus on the clinical, neuropsychological, neurophysiological, and neuroimaging characteristics of dementias, with a specific aim of improving diagnostic and prognostic markers. He was appointed Clinical Associate Professor in 2019.Professor Burrell held a position as Staff Specialist in neurology at Concord Hospital from 2011 to 2025. He was appointed Senior Staff Specialist and Head of Neurology in August 2020. He is a Consultant Neurologist and Professor of Cognitive Neurology at Macquarie University. Professor Burrell is also a dedicated educator and mentor, with extensive publications in leading neurology journals.
Welcome to the Psychedelic Conversations Podcast!In this episode, we discuss the emerging frontier of psychedelic-assisted neurorehabilitation with clinical neurologist Burton Tabaac. We explore his path into psychedelic science, his work with Johns Hopkins University, and the groundbreaking Fathom Trial—a study investigating whether psilocybin, paired with enriched, non-task-based play, can reopen critical periods of neuroplasticity to support stroke recovery far beyond the traditional healing window. We also dive into the legal and regulatory challenges of Schedule I substances, the evolving balance between clinical and ceremonial approaches, and the importance of honoring indigenous lineages while expanding patient access. Together, we reflect on the art of medicine, the role of set and setting, and the hopeful future of psychedelics in neurological healing.About Burton:Dr. Burton J. Tabaac, MD, FAHA, brings a wealth of expertise in neurology and stroke rehabilitation to Rose Hill. As an Associate Professor and Section Chief of Neurology at The University of Nevada's Reno School of Medicine, and Medical Director of Stroke at Carson Tahoe Health, Dr. Tabaac has been at the forefront of innovative neurological treatments. A graduate of the prestigious cerebrovascular neurology fellowship program at The Johns Hopkins University Hospital, Dr. Tabaac's accolades include being a three-time recipient of The Arnold P. Gold Foundation's Humanism and Excellence in Teaching Award and induction into the Alpha Omega Alpha Honor Medical Society. He recently published an eight-part paper in the American Journal of Therapeutics reviewing psychedelics as therapeutics for primary care clinicians. Dr. Tabaac's groundbreaking research focuses on the application of psychedelics in brain injury and stroke rehabilitation. Dr. Tabaac was recently appointed by the Governor of Nevada to serve as a member of the state's Psychedelic Medicines Working Group, which provides expertise and testimony relating to the therapeutic use of entheogens. As the host of The Zero Hour Podcast, he engages with leading experts in psychedelic research. His commitment to advancing the field was further highlighted in his 2022 TEDx talk at UCLA, “Mental Health Meets Psychedelics.”Connect with Burton:- Website: https://rosehill.life/- Twitter: https://x.com/burtontabaac?lang=en- LinkedIn: https://www.linkedin.com/in/burtontabaacThank you so much for joining us! Psychedelic Conversations Podcast is designed to educate, inform, and expand awareness.For more information, please head over to https://www.psychedelicconversations.comPlease share with your friends or leave a review so that we can reach more people and feel free to join us in our private Facebook group to keep the conversation going. https://www.facebook.com/groups/psychedelicconversationsThis show is for information purposes only, and is not intended to provide mental health or medical advice.About Susan Guner:Susan Guner is a holistic psychotherapist with a mindfulness-based approach grounded in Transpersonal Psychology, focusing on trauma-informed, community-centric processes that offer a broader understanding of human potential and well-being.Connect with Susan:Website: https://www.psychedelicconversations.com/Facebook: http://www.facebook.com/susan.gunerLinkedIn: https://www.linkedin.com/in/susan-guner/Instagram: http://www.instagram.com/susangunerTwitter: http://www.twitter.com/susangunerBlog: https://susanguner.medium.com/Podcast: https://anchor.fm/susan-guner#PsychedelicConversations #SusanGuner #BurtonTabaac #PsychedelicPodcast #Microdosing #PsychedelicScience
Dr. Alex Menze and Professor Hakan Cetin discuss the need to reevaluate the approach to diagnosing and treating seronegative myasthenia gravis. Show citations: Krenn M, Wagner M, Schuller H, et al. Screening for Congenital Myasthenic Syndromes in Adults With Seronegative Myasthenia Gravis Using Next-Generation Sequencing. Neurology. 2025;105(8):e214177. doi:10.1212/WNL.0000000000214177
Neurologist Dr. Carolyn Larkin Taylor, MD joins Frank Schaeffer to talk about her powerful new memoir Whispers of the Mind — a life in neurology, grief, intuition, near-death stories, medical gaslighting, and one extraordinary golden retriever named Prancer who became a four-legged healer in the clinic._____LINKShttps://www.carolynlarkintaylorauthor.com/Whispers of the Mind: A Neurologist's Memoirhttps://bookshop.org/a/99692/9781647429362_____Across three decades of practice, Dr. Taylor has walked families through ALS, Parkinson's, dementia, addiction, traumatic brain injury, concussions, and devastating strokes — including the massive stroke that took her own brother. She and Frank go deep on:How women are routinely dismissed and “gaslit” in medical settingsHer own almost-missed endometrial cancer, brushed off as “just stress”The emotional cost of telling families the worst news a human can hearWhy she nearly quit medicine after her mother died in an ICUThe hidden danger of youth sports concussions and second-impact syndromeNear-death experiences, souls, and why she believes something comes after this lifePrancer the therapy dog: intuitive diagnoses, comforting the paralyzed, and angels in furI have had the pleasure of talking to some of the leading authors, artists, activists, and change-makers of our time on this podcast, and I want to personally thank you for subscribing, listening, and sharing 100-plus episodes over 100,000 times.Please subscribe to this Podcast, In Conversation… with Frank Schaeffer, on your favorite platform, and to my Substack, It Has to Be Said. Thanks! Every subscription helps create, build, sustain and put voice to this movement for truth. Subscribe to It Has to Be Said. The Gospel of Zip will be released in print and on Amazon Kindle, and as a full video on YouTube and Substack that you can watch or listen to for free.Support the show_____In Conversation… with Frank Schaeffer is a production of the George Bailey Morality in Public Life Fellowship. It is hosted by Frank Schaeffer, author of The Gospel of Zip. Learn more at https://www.thegospelofzip.com/Follow Frank on Substack, Facebook, Twitter, Instagram, Threads, TikTok, and YouTube. https://frankschaeffer.substack.comhttps://www.facebook.com/frank.schaeffer.16https://twitter.com/Frank_Schaefferhttps://www.instagram.com/frank_schaeffer_arthttps://www.threads.net/@frank_schaeffer_arthttps://www.tiktok.com/@frank_schaefferhttps://www.youtube.com/c/FrankSchaefferYouTube In Conversation… with Frank Schaeffer Podcast
Neurology requires some detective work at times, and identifying the patterns of symptoms associated with drug misuse can be a tricky mystery indeed. For this episode, we're receiving a masterclass from Dr. Robin Howard¹ on the wide variety of drugs that bring patients into hospital, as well as the mechanisms they act on. His paper "Neurological aspects of drug misuse" is the Editors' Choice for the October 2025 issue, and he joins PN podcast editor Dr. Amy Ross Russell in the studio. From the new dangers of synthetic psychoactives to the profound consequences of chronic use, the discussion unveils critical clinical presentations every neurologist should recognize. We delve into fascinating phenomena including "punding," compulsive repetitive behaviors seen with stimulant abuse, and the rare but striking CHANTER syndrome, with its signs of disturbed consciousness and extensive cerebellar involvement. Hear too about the distinctive spongiform leukoencephalopathy associated with "chasing the dragon," a dangerous method of heroin inhalation, but which can also be caused by cocaine usage. Read the paper: https://pn.bmj.com/content/25/5/411 (1) Guy's and St. Thomas' NHS Foundation Trust, London, UK 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://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production by Amy Ross Russell and Brian O'Toole and editing by Brian O'Toole. Thank you for listening.
Dr. Alex Menze talks with Professor Hakan Cetin about the need to reevaluate the approach to diagnosing and treating seronegative myasthenia gravis. Read the related article in Neurology®. Disclosures can be found at Neurology.org.
From 18th century London to the promise of a global cure: the 200-year history of Parkinson's disease. To mark the release of our 'Ask the MD' conversation with The Michael J. Fox Foundation for Parkinson's Research, and to welcome a new influx of listeners, we're sharing one of our very first episodes, first aired in August 2024. Watch our full 'Ask the MD' interview, focused on lifestyle strategies for boosting brain health, on the foundation's website: https://www.michaeljfox.org/news/lifestyle-strategies-boost-brain-health-ask-md-video Parkinson's, a neurodegenerative disorder most commonly characterized by tremors and other motor symptoms, is so complex, many medical professionals are starting to classify it as a group of diseases, rather than a single disease. In this episode, we explain those complexities, including: • The motor symptoms (e.g. cogwheel rigidity, bradykinesia) and non-motor symptoms (e.g. depression, sleep disorders) • How the industrial revolution may have brought about environmental factors which contribute to Parkinson's • The differences and similarities between Parkinson's and other neurodegenerative diseases, like Alzheimer's • How Parkinson's manifests in our brains • Why one nurse was able to detect Parkinson's through smell • The neurogenetics of Parkinson's, and the ethical quandaries of evolving genetic technology • Why lifestyle — nutrition, exercise, etc. — is so key to preventing and managing Parkinson's Joining us for this extensive conversation are three incredible guests: • Dr. Rachel Dolhun, Senior Vice President of Medical Communications at The Michael J. Fox Foundation for Parkinson's Research • Dr. Michael Okun, evolutionary biologist, movement disorders specialist, and Director of the Norman Fixel Institute for Neurological Diseases • Dr. Matthew Farrer, neurogenetics expert and Professor Of Neurology at the University of Florida 'Your Brain On' is hosted by neurologists, scientists, and public health advocates Ayesha and Dean Sherzai. SUPPORTED BY: the 2026 NEURO World Retreat. A 5-day journey through science, nature, and community, on the California coastline: https://www.neuroworldretreat.com/ 'Your Brain On... Parkinson's' • SEASON 6 • EPISODE 4 (SEASON 3 REUPLOAD) ————— LINKS Dr. Rachel Dolhun: At the Michael J. Fox Foundation: https://www.michaeljfox.org/bio/rachel-dolhun-md-dipablm 'Ask the MD' series: https://www.michaeljfox.org/ask-md The Michael J. Fox Foundation on YouTube: https://www.youtube.com/@michaeljfoxfoundation/videos Dr. Michael Okun: At the University of Florida: https://neurology.ufl.edu/profile/okun-michael/ The book 'Ending Parkinson's Disease': https://endingpd.org/ The Norman Fixel Institute: https://fixel.ufhealth.org/ Dr. Matthew Farrer: At the University of Florida: https://neurology.ufl.edu/profile/farrer-matthew/ ————— References: Bloem, B. R., Okun, M. S., & Klein, C. (2021). Parkinson's disease. The Lancet, 397(10291), 2284-2303. Morris, H. R., Spillantini, M. G., Sue, C. M., & Williams-Gray, C. H. (2024). The pathogenesis of Parkinson's disease. The Lancet, 403(10423), 293-304. Dorsey, E., Sherer, T., Okun, M. S., & Bloem, B. R. (2018). The emerging evidence of the Parkinson pandemic. Journal of Parkinson's disease, 8(s1), S3-S8. Dorsey, E. R., Okun, M. S., & Tanner, C. M. (2021). Bad Air and Parkinson Disease—The Fog May Be Lifting. JAMA neurology, 78(7), 793-795. Tsalenchuk, M., Gentleman, S. M., & Marzi, S. J. (2023). Linking environmental risk factors with epigenetic mechanisms in Parkinson's disease. npj Parkinson's Disease, 9(1), 123. Reynoso, A., Torricelli, R., Jacobs, B. M., Shi, J., Aslibekyan, S., Norcliffe‐Kaufmann, L., ... & Heilbron, K. (2024). Gene–Environment Interactions for Parkinson's Disease. Annals of Neurology, 95(4), 677-687. Golsorkhi, M., Sherzai, A., & Dashtipour, K. The Influence of Lifestyle on Parkinson's Disease Management. In Lifestyle Medicine, Fourth Edition (pp. 919-924). CRC Press. Sherzai, A. Z., Tagliati, M., Park, K., Pezeshkian, S., & Sherzai, D. (2016). Micronutrients and risk of Parkinson's disease: a systematic review. Gerontology and geriatric medicine, 2, 2333721416644286. ————— FOLLOW US Join NEURO Instagram: @thebraindocs Website: TheBrainDocs.com More info and episodes: TheBrainDocs.com/Podcast
In the second installment of our series on primary progressive aphasia (PPA), Dr. Rogan Magee discusses logopenic PPA. Show citations: Grossman M, Seeley WW, Boxer AL, et al. Frontotemporal lobar degeneration. Nat Rev Dis Primers. 2023;9(1):40. Published 2023 Aug 10. doi:10.1038/s41572-023-00447-0 Gorno-Tempini ML, Hillis AE, Weintraub S, et al. Classification of primary progressive aphasia and its variants. Neurology. 2011;76(11):1006-1014. doi:10.1212/WNL.0b013e31821103e6 Santos-Santos MA, Rabinovici GD, Iaccarino L, et al. Rates of Amyloid Imaging Positivity in Patients With Primary Progressive Aphasia. JAMA Neurol. 2018;75(3):342-352. doi:10.1001/jamaneurol.2017.4309 Mandelli ML, Lorca-Puls DL, Lukic S, et al. Network anatomy in logopenic variant of primary progressive aphasia. Hum Brain Mapp. 2023;44(11):4390-4406. doi:10.1002/hbm.26388 Putcha D, Erkkinen M, Daffner KR. Functional Neurocircuitry of Cognition and Cognitive Syndromes. In: Silbersweig DA, Safar LT, Daffner KR. eds. Neuropsychiatry and behavioral neurology: principles and practice. McGraw Hill; 2021. Accessed November 6, 2025. https://neurology.mhmedical.com/content.aspx?bookid=3007§ionid=253215676 Montembeault M, Brambati SM, Gorno-Tempini ML, Migliaccio R. Clinical, Anatomical, and Pathological Features in the Three Variants of Primary Progressive Aphasia: A Review. Front Neurol. 2018;9:692. Published 2018 Aug 21. doi:10.3389/fneur.2018.00692 Clark DG. Frontotemporal Dementia. Continuum (Minneap Minn). 2024;30(6):1642-1672. doi:10.1212/CON.0000000000001506
Dystrophinopathies are heritable muscle disorders caused by pathogenic variants in the DMD gene, leading to progressive muscle breakdown, proximal weakness, cardiomyopathy, and respiratory failure. Diagnosis and management are evolving areas of neuromuscular neurology. In this episode, Kait Nevel, MD, speaks with Divya Jayaraman, MD, PhD, an author of the article "Dystrophinopathies" in the Continuum® October 2025 Muscle and Neuromuscular Junction Disorders issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Jayaraman is an assistant professor of neurology and pediatrics in the division of child neurology at the Columbia University Irving Medical Center in New York, New York. Additional Resources Read the article: Dystrophinopathies Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @IUneurodocmom Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. 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 Dr Divya Jayaraman about her article on dystrophinopathies, which she wrote with Dr Partha Ghosh. This article appears in the October 2025 Continuum issue on muscle and neuromuscular junction disorders. Divya, welcome to the podcast, and please introduce yourself to the audience. Dr Jayaraman: Thank you so much, Dr Nevel. My name is Divya, and I am an assistant professor of Neurology and Pediatrics at Columbia University Irving Medical Center, and also an attending physician in the Pediatric Neuromuscular program there. In that capacity, I see patients with pediatric neuromuscular disorders and also some general pediatric neurology patients and also do research, primarily clinical research and clinical trials on pediatric neuromuscular disorders. Dr Nevel: Wonderful. Thank you for sharing that background with us. To set us on the same page for our discussion, before we get into some more details of the article, perhaps, could you start with some definitions? What comprises the dystrophinopathies? What are some of the core features? Dr Jayaraman: So, the dystrophinopathies, I like that term because it is a smaller subset from the muscular dystrophies. The dystrophinopathies are a spectrum of clinical phenotypes that are all associated with mutations in the DMD gene on chromosome X. So, that includes DMD---or, Duchenne muscular dystrophy---, Becker muscular dystrophy, intermediate muscular dystrophy (which falls in between the two), dilated cardiomyopathy, asymptomatic hyperCKemia, and manifesting female carriers. In terms of the core features of these conditions, so, there's some variability, weakness being prominent in Duchenne and also Becker. The asymptomatic hyperCKemia, on the other hand, may have minimal symptoms and might be found incidentally by just having a high CK on their labs. They all will have some degree of elevated CK. The dilated cardiomyopathy patients, and also the Becker patients to a lesser degree, will have cardiac involvement out of proportion to skeletal muscle involvement, and then the manifesting carriers likewise can have elevated CK and prominent cardiac involvement as well as some milder weakness. Dr Nevel: Now that we have some definitions, for the practicing neurologists out there, what do you think is the most important takeaway from your article about the dystrophinopathies? Dr Jayaraman: I like this question because it suggests that there's something that, really, any neurologist could do to help us pick up these patients sooner. And the big takeaway I want everyone to get from this is to check the CK, or creatine kinase, level. It's a simple, cheap, easy test that anyone can order, and it really helps us a lot in terms of setting the patient on the diagnostic odyssey. And in terms of whom you should be thinking about checking a CK in, obviously patients who present with some of the classic clinical features of Duchenne muscular dystrophy. This would include young boys who have toe walking, as they're presenting, sign; or motor delayed, delayed walking. They may have calf hypertrophy, which is what we say nowadays. You might have seen calf pseudohypertrophy in your neurology textbooks, but we just say calf hypertrophy now. Or patients can often have a Gowers sign or Gowers maneuver, which is named after a person called Gowers who described this phenomenon where the child will basically turn over and use their hands on the floor to stand up, usually with a wide-based gait, and then they'll sort of march their hands up their legs. That's the sort of classic Gowers maneuver. There are modified versions of that as well. So, if anyone presents with this classic presentation, for sure the best first step is to check a CK. But I would also think about checking a CK for some atypical cases. For example, any boy with any kind of motor or speech delay for whom you might not necessarily be thinking about a muscle disorder, it's always good practice to check a CK. Even a boy with autism for whom you may not get a good clinical exam. This patient might present to a general pediatric neurology clinic. I always check a CK in those patients, and you'll pick up a lot of cases that way. For the adult folks in particular, the adult neurologist, a female patient could show up in your clinic with asymptomatic hyperCKemia. And I think it's an important differential to think about for them because this could have implications not just for their own cardiac risks, but also for their family planning. Dr Nevel: So, tell us a little bit more about the timing of diagnosis. Biggest takeaway: check a CK if this is anywhere on your radar, even if somewhat of an atypical case. Why is it so important to get kiddos started on that diagnostic odyssey, as you called it, early? Dr Jayaraman: This is especially important for kids because if they especially get a Duchenne muscular dystrophy diagnosis, you might be making them eligible for treatments that we've had for some time, and also treatments that were not available earlier that hinge on making that diagnosis. So, for example, people may be skeptical about steroids, but there's population data to suggest that initiation and implementation of steroids could delay the onset of loss of ambulation as much as three years. So, you don't want to deprive patients of the chance to get that. And then all the newer emerging therapies---which we'll be talking about later, I'm sure---require a Duchenne muscular dystrophy diagnosis. So, that's why it's so important to check a CK, have this on your radar, and then get them to a good specialist. Dr Nevel: I know that you alluded already, or shared a few of the kind of exam paroles or findings among patients with dystrophinopathy. But could you share with us a little bit more how you approach these patients in the clinic who are presenting with muscle weakness, perhaps? And how do you approach this or think about this in terms of ways to potentially differentiate between a dystrophinopathy versus another cause of motor weakness or delay? Dr Jayaraman: It's helpful to think through the neuraxis and what kinds of disorders can present along that neuraxis. A major differential that I'm always thinking about when I'm seeing a child with proximal weakness is spinal muscular atrophy, which is a genetic anterior horn cell disorder that can also present in this age group. And some of the key differences there would be things like reflexes. So, you should have dropped reflexes in spinal muscular atrophy. In DMD, surprisingly, they might have preserved Achilles reflexes even if their patellar reflexes are lost. It may only be much later that they go on to lose their Achilles reflex. So, if you can get an Achilles reflex, that's quite reassuring, and if you cannot, then you need to be thinking about spinal muscular atrophy. They can both have low muscle tone and can present quite similarly, including with proximal weakness, and can even have neck flexion weakness. So, this is an important distinction to make. The reason for that is, obviously there are treatments for both conditions, but for spinal muscular atrophy, timing is very, very important. Time is motor neurons, so the sooner you make that diagnosis the better. Other considerations would be the congenital muscular dystrophies. So, for those that they tend to present a lot younger, like in infancy or very early on, and they can have much, much higher CKS in that age range than a comparable Duchenne or Becker muscular dystrophy patient. They can also have other involvement of the central nervous system that you wouldn't see in the dystrophinopathies, for example. My mnemonic for the congenital muscular dystrophies is muscle-eye-brain disease, which is one of the subtypes. So, you think about muscle involvement, eye involvement, and brain involvement. So, they need an ophthalmology valve. They can have brain malformations, which you typically don't see in the dystrophinopathies. I think those are some of the major considerations that I have. Obviously, it's always good to think about the rest of the neuraxis as well. Like, could this be a central nervous system process? Do they have upper motor neuron signs? But that's just using all of your exam tools as a neurologist. Dr Nevel: Yeah, absolutely. So, let's say you have a patient in clinic and you suspect they may have a dystrophinopathy. What is your next diagnostic step after your exam? Maybe you have an elevated CK and you've met with the patient. What comes next? Dr Jayaraman: Great question. So, after the CK, my next step is to go to genetics. And this is a bit of a change in practice over time. In the past we would go from the CK to the muscle biopsy before genetic testing was standard. And I think now, especially in kids, we want to try and spare them invasive procedures where possible. So, genetic testing would be the next step. There are a few no-charge, sponsored testing programs for the dystrophinopathies and also for some of the differential diagnosis that I mentioned. And I think we'll be including links to websites for all of these in the final version of the published article. So, those are a good starting point for a genetic workup. It's really important to know that, you know, deletions and duplications are a very common type of mutation in the DMD gene. And so, if you just do a very broad testing, like whole exome, you might miss some of those duplications and deletions. And it's important to include both checking for duplications and deletions, and also making sure that the DMD gene is sequenced. So always look at whatever genetic test you're ordering and making sure that it's actually going to do what you want it to do. After genetics, I think that the sort of natural question is, what if things are not clear after the genetics for some reason? We still use biopsy in this day and age, but we save it for those cases where it's not entirely clear or maybe the phenotype is a little bit discordant from the genotype. So, for mutations that disrupt the reading frame, those tend to cause Duchenne muscular dystrophy, whereas mutations that preserve the reading frame tend to cause Becker muscular dystrophy. There are some important exceptions to this, which is where muscle biopsy can be especially helpful in sorting it out. So, for example, there are some early mutations early in the DMD gene where, basically, they find an alternate start codon or an initiation codon to continue with transcription and translation. So, you end up forming a largely functional, somewhat truncated protein that gives you more of a milder Becker phenotype. On the other hand, you can have some non-frameshift or inframe mutations that preserve the reading frame, but because they disrupt a very key domain in the protein that's really crucial for its function, you can actually end up with a much more severe Duchennelike phenotype. So, for these sorts of cases, you might know a priori you're dealing with them, but might just be a child who is who you think has DMD has a mutation that's showed up on testing. There isn't enough in the literature to point you one way or another, but they look maybe a little milder than you would expect. That would be a good kid to do a biopsy in because there are treatment decisions that hinge on this. There are treatments that are only for Duchenne that someone with a milder phenotype would not be eligible for. Dr Nevel: So, that kind of stepwise approach, but maybe not all kids need a muscle biopsy is what I'm hearing from you. If it's a mutation that's been well-described in the literature to be fitting with Duchenne, for example. Dr Jayaraman: Absolutely. Dr Nevel: So, after you confirm the diagnosis through genetic testing---and let's say, you know, whether or not you do a muscle biopsy or not, after you know the diagnosis is a dystrophinopathy---how do you counsel the families and your patients? What are the most important points to relay to families, especially in that initial phase where the diagnosis is being made? Dr Jayaraman: This is a lot of what we do in pediatric neurology in general, right? So, I actually picked up this approach from the pediatric hematology oncology specialists at Boston Children's. They had this concept of a day-zero conversation, which is the day that you disclose the life-changing diagnosis or potentially, at some point, terminal diagnosis to a family. And some of the key components of that are a not beating around the bush, telling them what the diagnosis is, and then letting them have whatever emotional response they're going to have in the moment. And you may not get much further than that, but honestly, you want them to take away, this is what my child has. I did not do anything to cause this, nor could I have done anything to prevent this. Because often for these genetic conditions, there's a lot of guilt, a lot of parental guilt. So, you want to try and assuage that as much as possible. And then to know that they're not going to be alone on this journey; that, you know, they don't have to have it all figured out right then, but we can always come back and answer any questions they have. There's going to be a whole team of specialists. We're going to help the family and the kid manage this condition. Those are sort of my big takeaways that I want them to get. Dr Nevel: Right. And that segues into my next question, which is, who is part of that team? I know that these teams that help take care of people with dystrophinopathies and other muscle disorders can be very large teams that span multiple specialists. Can you talk a little bit more about that for this group of patients? Dr Jayaraman: Of course. So, the neuromuscular neurologist, really, our role is in coordinating the diagnosis, the initiation of any disease-specific treatments, and coordinating care with a whole group of specialists. So, we're sort of at the center of that, but everyone else is equally important. So, the other specialists include physical therapists; occupational therapists; rehab doctors or physiatrists; orthotists who help with all of the many braces and other devices that they might need, wheelchairs; pulmonology, of course, for managing the respiratory manifestations of this. It becomes increasingly important over time, and they are involved early on to help monitor for impending respiratory problems. Cardiac manifestations, this is huge and something that you should be thinking about even for your female carriers, the mother of the patient you're seeing in the clinic, or your patient who comes to adult clinic with asymptomatic hyperCKemia. if you end up making a diagnosis of DMD carrier for those patients, or if you make a Becker diagnosis, the cardiac surveillance is even more important because the cardiac involvement can be out of proportion to the skeletal muscle weakness. And of course, extremely important for the Duchenne patients as well. Endocrinologists are hugely important because in the course of treating patients with steroids, we end up giving them a lot of iatrogenic endocrinologic complications. Like they might have delayed puberty, they might have loss of growth, of height; and of course metabolic syndrome. So, endocrinology is hugely important. They're also important in managing things like fracture prevention, osteoporosis, prescribing bisphosphonates if necessary. Nutrition and GI are also important, not just later on when they might need assistance to take in nutrition, whether that's through tube feeds, but also earlier on when we're trying to manage the weight. Orthopedics, of course, for the various orthopedic complications that patients develop. And then finally, a word must be said for social work and behavioral and mental health specialists, because a lot of this patient population has a lot of mental health challenges as well. Dr Nevel: After you give the diagnosis, you've counseled the patient and families and you've had those kind of initial phase discussions, the day-zero discussion, when you start getting into discussions or thoughts about management, disease-specific medication. But what are the main categories of the treatment options, and maybe how do you kind of approach deciding between treatment options for your patients? Dr Jayaraman: So, there are two broad categories that I like to think about. So, one is the oral corticosteroids and oral histone deacetylase, or HDAC inhibitors, which share the common characteristic that they are non-mutation specific. And within corticosteroids, patients now have a choice between just Prednisone or Prednisolone, or Deflazacort or Vermilion. The oral HDAC inhibitors are newly FDA-approved as a nonsteroidal therapy in addition to corticosteroids in DMD patients above six years of age. I would say we're in the early phase of adoption of this in clinical practice. And then the other big category of treatment options would be the genetic therapies as a broad bucket, and this would include gene therapy or gene replacement therapy, of which the most famous is the microdystrophin gene therapy that was FDA-approved first on an accelerated approval basis for ages four to eight, and then a full approval in that age group as well as an accelerated approval for all comers, essentially, with DMD. This is obviously controversial. Different centers approach this a bit differently. I think our practice at our site has been to focus on the ambulatory population, just thinking about risk versus benefit, because the risks are not insignificant. So really this is something that should be done by experienced sites that have the bandwidth and the wherewithal to counsel patients through all of this and to manage complications as they arise with regular monitoring. And then another class that falls within this broader category would be the Exon-skipping therapies. So as the name suggests, they are oligonucleotides that cause an Exon to be skipped. The idea is, if there is a mutation in a particular Exon that causes a frame shift, and there's an adjacent Exon that you can force skipping of, then the resulting protein, when you splice the two ends together, will actually allow restoration of the reading frame. I think the picture I want to paint is that there's a wide range of options that we present to families, not all of which everyone will be eligible for. And they all have different risk profiles. And I really think the choice of a particular therapy has to be a risk-benefit decision and a shared decision-making process between the physician and the family. Dr Nevel: What is going on in research in this area? And what do you think will be the next big breakthrough? I know before we started the recording you had mentioned that there's a lot of things going on that are exciting. And so, I'm looking forward to hearing more. Dr Jayaraman: Of course. So, I'll be as quick as I can with this. But I mentioned that next-generation Exon skipping therapies, I think the hope is that they will be better at delivering the Exon skipping to the target tissue and cells and that they might be more efficacious. I'm also excited about next-generation gene therapies that might target muscle more specifically and hopefully reduce the off-target effects, or combination use of gene therapies with other immunosuppressive regimens to improve the safety profile and maybe someday allow redosing, which we cannot do currently. Or potentially targeting the satellite cells, which are the muscle stem cells, again, to improve the long term durability of these genetic therapies. Dr Nevel: That's great, thank you for sharing. Thank you so much for talking to me today about your article. I really enjoyed learning more about the dystrophinopathies. Today I've been interviewing Dr Divya Jayaraman about her article on the dystrophinopathies, which she wrote with Dr Partha Ghosh. This article appears in the October 2025 Continuum issue on muscle and neuromuscular junction disorders. Please be sure to check out the Continuum Audio episodes from this and other issues. Also, please read the Continuum articles for more details than what we were able to get to today during our discussion. Thank you, as always, so much to the listeners for joining us today, and thank you, Divya, for sharing all of your knowledge with us today. Dr Jayaraman: Thank you so much for having me on the podcast. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.
In the first part of this series, Dr. Rogan Magee provides an introduction to primary progressive aphasia (PPA) and explains its three subtypes. Show citations: Grossman M, Seeley WW, Boxer AL, et al. Frontotemporal lobar degeneration. Nat Rev Dis Primers. 2023;9(1):40. Published 2023 Aug 10. doi:10.1038/s41572-023-00447-0 Gorno-Tempini ML, Hillis AE, Weintraub S, et al. Classification of primary progressive aphasia and its variants. Neurology. 2011;76(11):1006-1014. doi:10.1212/WNL.0b013e31821103e6 Santos-Santos MA, Rabinovici GD, Iaccarino L, et al. Rates of Amyloid Imaging Positivity in Patients With Primary Progressive Aphasia. JAMA Neurol. 2018;75(3):342-352. doi:10.1001/jamaneurol.2017.4309 Mandelli ML, Lorca-Puls DL, Lukic S, et al. Network anatomy in logopenic variant of primary progressive aphasia. Hum Brain Mapp. 2023;44(11):4390-4406. doi:10.1002/hbm.26388 Putcha D, Erkkinen M, Daffner KR. Functional Neurocircuitry of Cognition and Cognitive Syndromes. In: Silbersweig DA, Safar LT, Daffner KR. eds. Neuropsychiatry and behavioral neurology: principles and practice. McGraw Hill; 2021. Accessed November 6, 2025. https://neurology.mhmedical.com/content.aspx?bookid=3007§ionid=253215676 Montembeault M, Brambati SM, Gorno-Tempini ML, Migliaccio R. Clinical, Anatomical, and Pathological Features in the Three Variants of Primary Progressive Aphasia: A Review. Front Neurol. 2018;9:692. Published 2018 Aug 21. doi:10.3389/fneur.2018.00692 Clark DG. Frontotemporal Dementia. Continuum (Minneap Minn). 2024;30(6):1642-1672. doi:10.1212/CON.0000000000001506
Dr. Gregg Day talks with Professor Jonathan Rohrer about the significance of studying individuals at risk of developing genetic frontotemporal dementia, focusing on how early cognitive changes before symptoms appear can inform research and future therapeutic trials. Read the related article in Neurology®Genetics. Disclosures can be found at Neurology.org.
In this episode, we review the high-yield topic of Cavernous Sinuses 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 Lambert-Eaton Syndrome 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 Parkinson's Disease Drugs from the Neurology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
Dr. Jason Crowell talks with Dr. YuHong Fu about the importance of differentiating between dementia with Lewy bodies and Parkinson disease dementia. Read the related article in Nature. Disclosures can be found at Neurology.org.
Dr. Dan Ackerman and Dr. Isabel Hostettler discuss the diagnosis, risk factors, and prognosis of RCVS, highlighting the need to recognize symptoms and distinguish it from other causes of subarachnoid hemorrhage. Show reference: Hostettler IC, Ponciano A, Wilson D, et al. Outcomes After Reversible Cerebral Vasoconstriction Syndrome With Convexity Subarachnoid Hemorrhage: Individual Patient Data Analysis. Neurology. 2025;105(5):e213984. doi:10.1212/WNL.0000000000213984
Not every episode that looks like a seizure is one, and for pediatricians, distinguishing the difference can be challenging. Few moments in the clinic can feel as urgent, or as uncertain, as evaluating spells. In this episode, we unravel the mysteries of seizures and their mimics to prevent misdiagnosis and avoid unnecessary intervention. This episode was recorded on the exhibit floor at the 2025 American Academy of Pediatrics Conference in Denver, Colorado. Joining us is Shavonne Massey, MD. She is a neurologist at Children's Hospital of Philadelphia and an Assistant Professor of Neurology at the University of Pennsylvania School of Medicine. Some highlights from this episode include: Differentiators between seizures and mimics What pediatricians can do when a child is experiencing a seizure Key factors they can look for during an exam Most common seizure mimics that present in children depending on age For more information on Children's Colorado, visit: childrenscolorado.org.
Dr. Dan Ackerman talks with Dr. Isabel Hostettler about the diagnosis, risk factors, and prognosis of RCVS, highlighting the need to recognize symptoms and distinguish it from other causes of subarachnoid hemorrhage. Read the related article in Neurology®. Disclosures can be found at Neurology.org.
In the news show, flu season starts early in the Northern hemisphere due to pesky new strains, so will vaccines be effective? Also, the baby 'swim cap' which promises less invasive brain monitoring, and the European Space Agency's GPS powered satellites which are surveying the water cycle. Then, we find out the best way to shout at seagulls to stop them stealing our snacks... Like this podcast? Please help us by supporting the Naked Scientists