Podcasts about Neurology

Why do we crave some foods the more often we eat them? Are we addicted?Dr. Dana Small's research suggests that food craving reaches far beyond taste or willpower, and that “addiction” isn't a helpful descriptor. Every time we eat, unconscious signals from the body teach the brain which foods deliver useful nutrients, and train us to want more of those. In other words, we don't eat crave foods because they taste good; foods taste good because our body craves them.Understanding that means we can rethink overeating. It's not a matter of addiction or self-control; it's our body behaving the way nature intended it to, but in the setting of foods not found in the wild, like those high in both fat and carbohydrates. But we may also be able to train our brain away from these cravings.Free course: Improve your metabolic healthGet our free email course on how glucose, nutrition, exercise, sleep, and measurement can help you build habits that support better energy and long-term health: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://levels.link/wnl⁠What We CoverTaste vs. flavor, pleasure, motivation, and food rewardHow gut nutrient signals teach the brain which foods to seekWhy fat + carbs produce an unusually strong reward responseWhat eight weeks of high-fat, high-sugar snacks did to the brainHow GLP-1s may cut food wanting while preserving pleasure

In part two of this series on the 2026 Alzheimer Association International Conference, Dr. Greg Cooper talks with Drs. Trey Bateman and Gregg Day about recent clinical trials, evolving treatment strategies, and prevention efforts.    Disclosures can be found at Neurology.org. 

Dr. Justin Abbatemarco recaps a presentation on Hashimoto encephalopathy from the AAN Autoimmune Neurology Conference.   Show citation:    Valencia-Sanchez C, Pittock SJ, Mead-Harvey C, et al. Brain dysfunction and thyroid antibodies: autoimmune diagnosis and misdiagnosis. Brain Commun. 2021;3(2):fcaa233. Published 2021 Jan 5. doi:10.1093/braincomms/fcaa233    Brain, Jellinek E, Ball K HASHIMOTO'S DISEASE AND ENCEPHALOPATHY The Lancet, 288, 512-514    Mattozzi S, Sabater L, Escudero D, et al. Hashimoto encephalopathy in the 21st century. Neurology. 2020;94(2):e217-e224. doi:10.1212/WNL.0000000000008785

Dr. Masud Husain is a Professor of Neurology & Cognitive Neuroscience at the University of Oxford and a leading expert on the science of motivation, apathy, and neurological diseases. We discuss how dopamine and specific brain circuits shape motivation, including how the brain weighs the trade-off between effort vs reward when deciding what goals to pursue. Dr. Husain also explains practical tools to increase motivation, reduce distractions, and make it easier to start and maintain goal pursuit. We also discuss dementia, Parkinson's and Alzheimer's disease, including new insights into cognitive resilience and factors that help protect against age-related cognitive decline. Show notes: https://go.hubermanlab.com/masud-husain-295 Thank you to our sponsors AG1: https://drinkag1.com/huberman David: https://davidprotein.com/huberman BetterHelp: https://betterhelp.com/huberman Eight Sleep: https://eightsleep.com/huberman Function: https://functionhealth.com/huberman Timestamps (00:00:00) Masud Husain (00:02:24) Apathy, Motivation (00:08:07) Rewards, Apathy & Motivation; Dopamine (00:13:20) Sponsors: David & BetterHelp (00:15:44) Types of Apathy; Goal Prioritization: Effort vs Rewards (00:23:26) Motivation, Apathy, Tool: Activation Energy & Overthinking (00:29:24) Tools to Increase Motivation: Incentives, Subdivide Tasks, Planning (00:35:13) Subjective Effort, Mental Framing; Learning & Motivation (00:42:24) Sponsors: AG1 & Eight Sleep (00:44:54) Perseverance, Failure; Finding Your Passion, Depression vs Apathy (00:50:58) Self-Concept, Ambition; Life Satisfaction (00:58:25) Psychedelics, Anhedonia & Changing Self (01:03:09) Personal & Social Identity, Tools: Curiosity, Purpose & Dementia Risk (01:11:58) Addiction, Dopamine; Social Media & Dopamine "Hits"? (01:18:36) Sponsor: Function (01:20:13) Dopamine, Parkinson's Disease; Other Roles of Dopamine (01:26:59) Life Purpose, Culture; Reflection, Weighing Decisions (01:34:21) Internal & External Attention (01:39:59) Internal Chatter, Distraction; Working Memory, Stimulants, Nicotine (01:48:54) ADHD, Diagnosis; Attention & Motivation (01:54:34) Goal Planning & Perseverance (01:59:44) Alzheimer's Disease, Dementia, Apathy, Tools: Dementia Risk Factors (02:06:55) Neurodegenerative Disease & Emerging Treatments (02:10:59) Can You Train Attention?, Tool: Reduce Distraction (02:15:14) Enrichment, Art (02:17:45) Zero-Cost Support, YouTube, Spotify & Apple Follow, Reviews & Feedback, Sponsors, Protocols Book, Social Media, Neural Network Newsletter Disclaimer & Disclosures Learn more about your ad choices. Visit megaphone.fm/adchoices

In part one of this series, Dr. Greg Cooper talks with Drs. Trey Bateman and Gregg Day about blood-based biomarkers, anti-amyloid therapies, and other highlights from the 2026 Alzheimer Association International Conference.  Disclosures can be found at Neurology.org. 

Why would a neurologist recommend an infusion instead of a pill, and what should patients expect when they arrive for treatment? Neuro infusion therapy can be used for conditions including multiple sclerosis, myasthenia gravis and Alzheimer's disease, but the process can feel unfamiliar or intimidating at first.In this episode of Baptist Health Talk, host Dr. Anthony Gonzalez speaks with Janisse Marin and Leah Marcelin about how neurological infusion therapy works, why it may be recommended, and how care teams help patients through treatment. What neuro infusion therapy is and how it differs from chemotherapy  Why an infusion may be chosen instead of an oral medication  What happens before, during and after an infusion appointment  Common side effects and how patients are monitored for reactions  How infusion therapy is used for multiple sclerosis, myasthenia gravis and Alzheimer's disease  Why some treatments are designed to slow disease progression rather than immediately relieve symptoms  How education and a coordinated care team can make treatment less overwhelmingHost:Anthony Gonzalez, M.D.Chief of Surgery, Baptist Health Baptist HospitalMedical Director of Bariatric Surgery, Baptist HealthGuests:Janisse P. Marin RN, MSNChief Nursing Officer/Assistant Vice President Baptist Outpatient ServicesHalena Leah Marcelin, PharmDAssistant Vice President, Pharmacy Business Affairs & DevelopmentBaptist HealthIf you found this episode helpful, we recommend the following for additional information:Infusion Care for Osteoporosis: What Patients Should KnowThe Power of Infusion Therapy: What You Need to Know

Send us Fan MailToday we're releasing a new episode from a brand new series called the Boundless Body Radio Heritage Series! I wanted to do something extra special to celebrate 1,000 podcast episodes recorded here at Boundless Body Radio, a milestone that we hit on June 24, 2026!These episodes are actually not new, although they might be new to you! When we first got started back in October, 2020, I was so fortunate that so many incredible people said "YES" to being hosted on the show, however, we didn't have very many listeners at the time!Today, we get thousands of downloads every single month, and are usually included in the top 150 Fitness and Nutrition Podcasts on the Apple Podcast charts!To honor our amazing guests, I will be selecting one of those original episodes and posting them here on for this special series!As I was going through these episodes again, I remembered how valuable these conversations actually were. it was really striking how much the information these experts have shared has born out to be even more accurate several years later.The audio quality of a show was not as good back then as it is now, but I still really hope you enjoy these episodes, and find them relevant and helpful to you today!Cheers, thanks as always for listening, and I really hope you enjoy this episode of the Boundless Body Radio Heritage Series!Dr. Thomas Seyfried is a returning guest on our show! Be sure to check out his first appearance on Boundless Body Radio on episode 60, which one of the most fascinating discussions we've ever had, all about cancer as a metabolic disease! He was also hosted on episode 363 of our podcast.Thomas N. Seyfried received his Ph.D. in Genetics and Biochemistry from the University of Illinois, Urbana, in 1976. He was a Postdoctoral Fellow in the Department of Neurology at the Yale University School of Medicine and then served on the faculty as an Assistant Professor in Neurology. Other awards and honors have come from such diverse organizations as the American Oil Chemists Society, the National Institutes of Health, The American Society for Neurochemistry, the Ketogenic Diet Special Interest Group of the American Epilepsy Society, the Academy of Comprehensive and Complementary Medicine, and the American College of Nutrition.Dr. Seyfried has over 150 peer-reviewed publications and is the author of the book, Cancer as a Metabolic Disease: On the Origin, Management, and Prevention of Cancer (Wiley, 1st ed., 2012).Find Dr. Seyfried at-https://foundationformetaboliccancertherapies.com/Movie, coming soon- CANCERREVOLUTION: A Cancer Science Documentary with Dr. Seyfried and former podcast guest Travis Christofferson.Find Boundless Body at-myboundlessbody.comFind Boundless Body at-myboundlessbody.comBook a session with us here! 

Dr. Shuvro Roy and Prof. Catherine Jutzeler discussed how age influences neurologic and functional recovery after spinal cord injury and how these findings could inform treatment and future clinical trials.  Show citation:  Pavese C, Scivoletto G, Puci M, et al. The Relationship Between Age and Recovery After Spinal Cord Injury: A Longitudinal Cohort Study. Neurology. 2026;106(2):e214516. doi:10.1212/WNL.0000000000214516    

Dr. Shuvro Roy talks with Prof. Catherine Jutzeler about how age influences neurologic and functional recovery after spinal cord injury and how these findings could inform treatment and future clinical trials. Read the related article in Neurology®. Disclosures can be found at Neurology.org. 

Dr. Greg Cooper and Dr. Chloe Hill discuss comparing virtual and in-person neurology outpatient visits for new patients. Show citation:  Hill CE, Lin CC, Harris A, et al. Virtual vs In-Person Neurologic Ambulatory Care: A Case-Control Study of Subsequent Health Care Utilization. Neurology. 2026;106(10):e214989. doi:10.1212/WNL.0000000000214989 

Dr. Margarita Fedorova talks with Dr. Sunanjay Bajaj about the Consortium of Neurology Residents and Fellows (CNRF).  Visit the AAN website to learn more about the CNRF.  Connect with the AAN's Consortium of Neurology Residents and Fellows on Synapse. 

Dr. Greg Cooper talks with Dr. Chloe Hill about comparing virtual and in-person neurology outpatient visits for new patients.  Read the related article in Neurology®. Disclosures can be found at Neurology.org. 

Dr. Aaron Zelikovich discusses the efficacy and anthropometric effect of vamorolone with prednisone and deflazacort. Show citation:  Clemens PR, Berglund A, Schiava M, et al. Vamorolone for Duchenne Muscular Dystrophy: A Cross-Trial Efficacy Comparison With Classic Corticosteroids From the FOR-DMD Trial. Neurology. 2026;107(1):e214756. doi:10.1212/WNL.0000000000214756 

Dr Rachel Forman is an Assistant Professor of Neurology at Yale School of Medicine and a stroke neurologist at Yale New Haven Hospital. She tells us signs to watch out for and how to make sure you are preventing having a stroke.

We continue our campaign to #EndNeurophobia, with the help of Dr. Helen Shi. This time, Gillian presents a case of a 56 year old man found wondering naked in grocery store. The discussants are Aye and Vale. Gillian is a second-year medical student at the Icahn School of Medicine at Mount Sinai in New York.… Read More »Episode 471: Neurology VMR – Found wondering naked in grocery store

Dr. Dara Albert talks with Dr. Daniel Freedman about the new practice guideline from the American Epilepsy Society on infantile epilepsy, highlighting key findings on medication, dietary therapy, and the importance of early surgical intervention for infants with epilepsy.  Read the related guideline here.   Disclosures can be found at Neurology.org.   

Transcranial magnetic stimulation (TMS) is one of the most promising new technologies in psychiatry. Essentially, it allows us to reach inside the brain, stimulate it, and alter the brain circuits that go awry in disorders like depression. As the late Nolan Williams once explained, we've known for a long time that mental health disorders are caused by changes in electrical circuits in our brains, until TMS came along, we didn't had a good way of nudging those circuits back toward healthier function.But for all its promise, there is still much we don't understand about what exactly TMS is doing. We know it sends electromagnetic waves into the brain and changes the flow of electricity within. What we don't know is how it changes brain circuits and networks or why that helps treat depression, obsessive-compulsive disorder, or any of the other conditions where it's being used.Today's guest, Corey Keller, is dedicated to addressing that gap. He's been developing methods for recording inside the brain to help us understand how treatments like TMS change our brain circuits and address psychiatric disease.Learn moreStanford Precision Neurotherapeutics LabKoret Human Neurosciences Community LabClosed-loop Optimized rTMS for Depression (Stanford Medicine Clinical Trials)Probing the Dorsolateral Prefrontal Cortex and Central Executive Network for Improving Neuromodulation in Depression (Stanford Medicine Clinical Trials)Non-invasive brain stimulation opens new ways to study and treat the brain (Wu Tsai Neurosciences Institute, 2025)Music supercharges brain stimulation (Wu Tsai Neurosciences Institute, 2025)How brain imaging is transforming mental health (From Our Neurons to Yours 2025)Psychiatry 3.0 (From Our Neurons to Yours, 2023)Stanford Psychiatry's Corey Keller Awarded Grant to Research Biomarkers to Improve Efficacy of rTMS for Treatment-Resistant Depression (Stanford Medicine Psychiatry and Behavioral Sciences, 2026)Personalizing Brain Stimulation for Psychiatric Disorders: From Circuits to Closed-Loop Control (American Journal of Psychiatry, 2026)Transcranial magnetic stimulation with intracranial recording in humans and primates: a review (Brain: A Journal of Neurology, 2025)Neural effects of TMS trains on the human prefrontal cortex (Scientific Reports, 2023)Send us a text!Thanks for listening! If you're enjoying our show, please take a moment to give us a review on your podcast app of choice and share this episode with your friends. That's how we grow as a show and bring the stories of the frontiers of neuroscience to a wider audience.We want to hear from your neurons! Email us at at neuronspodcast@stanford.eduLearn more about the Wu Tsai Neurosciences Institute at Stanford and follow us on Twitter, Facebook, and LinkedIn. 

In this episode of the Brain & Life Podcast, co-host Dr. Daniel Correa is joined by actress, comedian, playwright, and storyteller Lauren Weedman. Lauren discusses her diagnosis of Bell's palsy after developing a sudden facial paralysis while filming in 2024 and how it changed her outlooks on work, motherhood, and mental health. Dr. Correa is then joined by Dr. Gary Gronseth, Professor and Chair of Neurology at the University of Kansas School of Medicine. Dr. Gronseth explains what Bell's palsy is, why it happens, what recovery typically looks like, and why some people—like Lauren Weedman—continue to experience lasting symptoms long after the initial diagnosis.   Additional Resources "This Is a Good Face": Lauren Weedman on Life After Bell's Palsy Bouncing Back from Bell's Palsy What Doctors Know About Bell's Palsy   Brain & Life Podcast Episodes on Similar Topics Playwright Sarah Ruhl Finds Inspiration in her Bell's Palsy Journey   We want to hear from you! Have a question or want to hear a topic featured on the Brain & Life Podcast? ·       Record a voicemail at 612-928-6206 ·       Email us at BLpodcast@brainandlife.org   Social Media Guests: Lauren Weedman @lauren_weedman Hosts: Dr. Daniel Correa @neurodrcorrea; Dr. Katy Peters @KatyPetersMDPhD

Obstructive sleep apnea affects approximately one in four adults and is especially common among patients with neurologic disorders, including stroke, Parkinson disease, dementia, epilepsy, and neuromuscular conditions. In this episode, Dr. Stephanie Stahl discusses why neurologists should routinely screen for OSA, highlights key symptoms and risk factors, reviews important considerations when interpreting sleep studies, and outlines current treatment options beyond CPAP. Learn how recognizing and treating sleep apnea can improve quality of life, optimize management of neurologic disease, and reduce long-term health risks. In this episode, Aaron L. Berkowitz, MD, PhD, FAAN, speaks with Stephanie M. Stahl, MD, FAASM, author of the article "Obstructive Sleep Apnea" in the Continuum® August 2026 Sleep Neurology issue. Dr. Berkowitz is a Continuum® Audio interviewer and a professor of neurology in the Department of Neurology at the University of California, San Francisco, in San Francisco, California. Dr. Stahl is an Associate Professor of Clinical Medicine and Sleep Medicine Fellowship Program Director at Indiana University School of Medicine in Indianapolis, Indiana, where she also serves as Sleep Laboratory Medical Director in the Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine. Additional Resources Read the article: Obstructive Sleep Apnea Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @AaronLBerkowitz  Full episode transcript available here Dr Berkowitz: Obstructive sleep apnea is very common. It can cause or contribute to common neurologic symptoms, such as headache and impaired cognition, and it's a risk factor for stroke. And yet, if you're like me, you may not know too much more about sleep apnea than that. Today, I have the pleasure of talking to sleep expert Dr. Stephanie Stahl to learn what every neurologist should know about OSA.  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 Berkowitz: This is Dr. Aaron Berkowitz. Today I'm interviewing Dr. Stephanie Stahl about her article on obstructive sleep apnea. This article appears in the 2026 Continuum issue on Neurology of Sleep. Welcome to the podcast, Dr. Stahl, and could you please introduce yourself to our audience?  Dr Stahl: Yeah. Thank you for having me. I'm a sleep medicine physician and neurologist and medical director of the Indianapolis Sleep Lab at Indiana University Health. I serve as the director of the Sleep Medicine Fellowship program. I'm faculty advisor for our very first student interest group in sleep medicine at Indiana University School of Medicine. I'm also actively involved in some national leadership roles, including the incoming chair of the American Academy of Sleep Medicine's Education Committee and co-chair of the Academy's Inter-Scorer Reliability Gold Standard Panel. So, I really appreciate this opportunity. I look forward to our discussion.  Dr Berkowitz: Me too, and we appreciate the opportunity too to get to talk to you. You have so much expertise in this area, and I certainly encourage our listeners to look at your article, which is very comprehensive and up to date, and I learned a ton from it. I didn't get much exposure to sleep neurology as a trainee, and I've always worked in academic centers where we have a sleep group and we can refer patients there. So, I have to admit, sleep may probably be the area of neurology I know the least about, and felt like I was learning something new from pretty much every line of your article, and I know our readers will too. So, your article has a lot of excellent detail for our readers on the diagnosis and treatment of this very common condition. But I'd like to keep our interview relatively high level today and focus on the essentials for the practicing general neurologist. So, to start, can you just give us a sense of what obstructive sleep apnea is, and what every neurologist should know about it?  Dr Stahl: Yeah. So obstructive sleep apnea is characterized by either partial or full obstructions in the upper airway. That may sound pretty simple, but this leads to a whole bunch of issues. It leads to oxygen desaturations, arousals from sleep, leading to sleep fragmentation. This can then lead to sympathetic nervous system activation, cerebral hypoperfusion, leading to a whole bunch of symptoms or neurologic conditions.  Dr Berkowitz: Great. And you mentioned this in your article, but just to emphasize, how common is obstructive sleep apnea in the general population?  Dr Stahl: Yeah. So, about a quarter of the general population have obstructive sleep apnea. Much more common in many neurologic conditions.  Dr Berkowitz: Yeah, so very common disorder. We are seeing patients with it quite frequently, whether that's the reason they are seeing us in neurology or not. And this leads to my next question, which is what neurologic symptoms or presenting concerns of a patient should make us think about OSA and the differential diagnosis, and what factors based on the history or the exam or the context would make you suspicious for OSA as the cause of a neurologic symptom? In other words, the patient's presenting with classic symptoms of OSA, and that's why they're seeing a neurologist or seeing a primary care doctor, but is coming for evaluation of, say, headache or other symptoms. And what symptoms would make you think of wanting to consider OSA, and then what aspects of the history or otherwise would make you want to evaluate the patient for OSA?  Dr Stahl: I think a really important takeaway is for neurologists to know that obstructive sleep apnea is very common in neurologic conditions and has that potential to worsen a lot of these conditions or their associated symptoms. And so, it should be on our radar. There are certainly some basic questions and signs and symptoms that we can ask patients about or, or take a look at on exam. And so particular symptoms include snoring. Anybody that snores loudly or frequently, that's a strong risk factor for obstructive sleep apnea. If someone's seeing them stop breathing in their sleep, if they are waking up a lot throughout the night. There are some other symptoms that we may not necessarily attribute upfront to obstructive sleep apnea, such as nocturia, nocturnal reflux, night sweats. There are some daytime symptoms, of course, too, like unrefreshing sleep, daytime sleepiness, morning headaches, an important one in neurology. And then we take a look at the patient's exam. And so, some things that neurologists might want to be thinking about are people with obesity are certainly at a risk for obstructive sleep apnea. But it's also very important to know that someone does not need to have obesity in order to have obstructive sleep apnea. We look at neck size, other morphologic characteristics, such as how much that we can see in the back of their mouth. Can we see their uvula? Does their tongue size appear large in their mouth? And then some other risk factors too, such as male gender, older age, family history, post-menopausal state in women. All that being said, though, sometimes in neurologic conditions, we don't have all of those symptoms or risk factors to be thinking about. And so, in certain neurologic conditions such as stroke where obstructive sleep apnea is very common and has the potential to increase the risk of another stroke, we may need to be thinking about testing these patients even with minimal symptoms or other risk factors.  Dr Berkowitz: That's very helpful. So, you mentioned their headache might be the presenting symptom, right, to a neurologist, and we should certainly be thinking about obstructive sleep apnea as a potential diagnosis, even the cause of the patient's headache, particularly you said patients with morning headache. I often try to think about in patients presenting with, for memory loss, or other cognitive concerns, and that may be due more to inattention from poor sleep, so asking about sleep and symptoms of sleep apnea in those contexts. Are there any other presenting neurologic symptoms not particularly related to sleep? I'm thinking of headache, memory loss, other symptoms that would make you think, "Oh, I should actually screen this patient for sleep apnea also."  Dr Stahl: Yeah, other symptoms to think about in pediatrics, hyperactivity, people that have impaired vigilance, as you alluded to, that poor attention. Sometimes people get misdiagnosed with ADHD, and it's actually just a manifestation of obstructive sleep apnea.  Dr Berkowitz: You alluded to this, Dr. Stahl, that stroke, for example, patients are at higher risk of developing sleep apnea as a result of stroke, and it's also a risk factor for stroke. What other neurologic conditions, primary neurologic diseases, put patients at a higher risk of OSA? And again, similar to the last question I asked you, what are some clues that we should evaluate for? We might be following a patient for their post-stroke care over time and not necessarily thinking about diagnosing a separate condition in them since we're following them for their stroke or their degenerative disease. What are the conditions that put patients at a higher risk of OSA as a result of the condition, and then when would you think about screening them for it?  Dr Stahl: Some particular neurologic conditions where obstructive sleep apnea are very common, in addition to stroke and, and TIA, include Parkinson disease. It can worsen a lot of the motor, cognitive symptoms, sleep disruption that we can see in Parkinson disease. Very common in all causes of dementia, but in particular Alzheimer disease and Lewy body dementia. Very common in neuromuscular conditions. We should definitely have obstructive sleep apnea and all forms of sleep-disordered breathing high on our radar. In conditions like myotonic dystrophy. Charcot-Marie-Tooth is another one where obstructive sleep apnea is very common. Myasthenia gravis, it can worsen the symptoms of that. In particular, a pearl is if somebody has morning weakness in myasthenia gravis, obstructive sleep apnea should be high on your radar. And also, as you mentioned, any forms of headaches. There are some other things too. If somebody has poor seizure control, especially nocturnal seizures, you might have obstructive sleep apnea on your radar as well.  Dr Berkowitz: So, I think you've covered essentially every category of neurologic disease, right? We have cerebrovascular, movement, neurodegenerative, neuromuscular, epilepsy, all conditions where either the disorder itself, such as stroke or the, correct me if I'm wrong, the neurodegenerative disease puts the patient at risk. Or the patient may be at risk for exacerbations of their disease, as you mentioned in myasthenia. I love that pearl. Not fatiguable at the end of the day, but if the patient with myasthenia is telling you they're feeling weaker at the beginning of the day, then think about obstructive sleep apnea and that obstructive sleep apnea worsening control of epilepsy due to poor sleep. So really a lot of bidirectional interactions with this common condition. Okay, so if we're concerned about obstructive sleep apnea, again, myself, a general neurologist speaking perhaps on behalf of other general neurologists, we see a patient with headache or reporting memory loss that we find to be impaired attention, or we see exacerbation of their underlying primary neurologic disease. As you mentioned, we think, "Oh, I've listened to this podcast. I've read Dr. Stahl's article. I should probably be thinking about OSA in this patient, and I should order a sleep study." Now, I admit when I get the sleep study back, I scroll to the bottom, I see they do have obstructive sleep apnea, I'm going to send them over to a sleep specialist. But for the general neurologist, what are some high-yield pearls and some pitfalls to be aware of when we get sleep studies for obstructive sleep apnea, and we are looking at the results? Dr Stahl: The first thing is to understand that there are two main types of sleep studies: in-lab polysomnography and home sleep apnea test. In-lab studies are typically what we consider the more accurate type of study. Main reason for that is that we have EEG, so we can see if someone is awake versus asleep. Most home sleep apnea tests do not utilize EEG, and so when we're looking at respiratory events, apneas or hypopneas, we're looking at over the total recording time rather than the total sleep time. So, we know we're going to capture some time where a person is awake, where we don't have sleep apnea events, and that can be a big amount of time in people with insomnia, poor sleep efficiency. And as a result of that, it can lead to an underestimation of the apnea-hypopnea index. That's really important for people to understand that that means we can end up with a false negative home sleep apnea test, or it can put them in a category of lower severity than what they actually have. And so, if you get a home sleep study report back that's negative for sleep apnea and you remain concerned, you need to go on to do an in-lab study, where about twenty to fifty percent of people will go on to have a positive in-lab study. You can also get false positives with home sleep apnea tests too, and so ideally, we should only be doing home sleep apnea tests in people that are at high risk of having obstructive sleep apnea to decrease our chance of false positive study. When we get that sleep study report, what's important to take a look at? So the main number that we look at currently is the apnea-hypopnea index. The number of apneas, which are full obstructions in that upper airway, or hypopneas, partial obstructions in the upper airway where either there's an oxygen desaturation or an arousal associated with that. Less than five is considered to be normal. Anything five or more gives them a diagnosis of obstructive sleep apnea, and then we stratify them based on the AHI. But it's important to take a look at more than just the apnea-hypopnea index. And while my eyes too on various reports like echocardiograms want to jump to the impression, it is important to take a look at that full report, see what their oxygen levels averaged and what they dipped down to. The arousal index, which is how many times a patient may have woken up briefly throughout the night. Take a look at the histogram, usually an image at the bottom of their report that shows what sleep fragmentation may have been like so that you can take that all in and make that decision. How important are these study findings, and is this a person that would benefit from treatment?  Dr Berkowitz: That's a fantastic overview of sleep studies and some of the highlights to look out for, even if we won't be understanding every detail as you would to know most importantly the caveats about home sleep testing having a fairly high percentage of false negative and false positive results. So being wary if our suspicion is high, and that test is normal or inconclusive to get an in-lab sleep study. And if our suspicion is low or maybe we haven't ordered the test and the patient has had it done elsewhere, and the history doesn't really match up to know that there are false positives on the home studies as well, and again, an in-lab study to settle the diagnosis. Is that right?  Dr Stahl: Yes.  Dr Berkowitz: Okay. Now, for most neurologists, probably if we diagnose OSA, we will be referring the patient to a sleep specialist like yourself for treatment. I think we're all familiar with CPAP and patients being on CPAP. Your article mentions a number of treatment modalities I admit I have not heard of before or maybe heard of in passing, acknowledging most general neurologists are not going to be prescribing or knowing with the nuance that you do as an expert how to decide which treatment a patient would most benefit from or most qualify for. So, can you just give us a broad overview, again, for the general neurologist acknowledging we might see a patient whose past medical history says OSA being treated with fill in the blank. What are the different treatment modalities, and how do you think, just so we can learn from you in broad brush strokes, about particular treatments for particular patients?  Dr Stahl: As you mentioned, most people are familiar with positive airway pressure or PAP therapy, and that does remain our most efficacious treatment. The way I explain it to patients is why PAP therapy is the most effective treatment is it's the only treatment that can take all of the tissues of that upper airway and open them up. Whereas all of our other treatments, we're going to target smaller spaces of that upper airway. So, our first option is if we can get somebody on PAP therapy, we know that that's going to be the best option for the majority. PAP therapy works by basically acting as an air splint to open up the air tissues. Know that masks are not interchangeable. There are masks that cover the nose and go over the nose and mouth and under the nose. Full face masks that cover the nose and mouth, they do typically require higher pressures, also tend to be less comfortable for a lot of patients as well. In addition to different PAP masks, there's different modalities of positive airway pressure therapy too. There are machines that auto-adjust, some that provide fixed pressure, bi-level PAP that provides a higher inspiratory pressure, lower expiratory pressure. Then outside of PAP therapy, there are, as you alluded to, a lot of options and more, continuing to come down the pipeline as well. Mandibular advancement devices or a form of oral appliances has been around for a while. This is device that somebody wears in their mouth. It's preferably customized for their teeth and titratable, meaning that they can make adjustments that pulls their mandible forward in relation to the maxilla in order to pull those tongue tissues further away from the back of the upper airway. That's ideally managed by a qualified sleep dentist or someone that specializes in oral appliance management. Other treatments include surgical options, including hypoglossal nerve stimulation, which is an implanted device that causes the tongue to protrude repetitively throughout their sleep period to hopefully open up the airspace. There's some other surgical options too that open up various places of the upper airway. There's a daytime treatment of obstructive sleep apnea, transoral neuromuscular electrical stimulation that changes the muscle fiber type of the tongue. And then there's some adjunctive treatments that can be helpful too, such as positional therapy, oral facial myofunctional therapy that helps a person breathe better through their nose and may help train the upper airway muscles.  Dr Berkowitz: Great. Well, that's a very helpful overview, and again, I refer our listeners to your article, which talks about all of those modalities in very comprehensive detail. So, Dr. Stahl, as we wrap up our conversation, you have a captive audience of neurologists and neurology trainees here. What would you like to leave us with that every neurologist should know about obstructive sleep apnea?  Dr Stahl: The most important, again, is for neurologists to know that obstructive sleep apnea is so common in your patient population, and it can have a significant negative impact on quality of life and health, including many neurologic conditions. And at the same time, obstructive sleep apnea is very treatable. We have so many options nowadays that we can usually get someone onto adequate treatment. And treatment has that potential to improve several neurologic symptoms and disorders, even at times when you don't think that there's an opportunity to improve symptoms such as say in, headache. So, neurologists really should be screening for signs and symptoms of obstructive sleep apnea, as well as considering testing in high-risk, potentially asymptomatic or minimally symptomatic patients.  Dr Berkowitz: That's a fantastic overview of some of the many pearls that you shared with us today, as well as in your article. So, thank you so much again. Today, I've been interviewing Dr. Stephanie Stahl about her article on obstructive sleep apnea. This article appears in the August 2026 Continuum issue on neurology of sleep. Be sure to check out Continuum Audio episodes from this and other issues. And thank you so much to our listeners for joining today, and thank you again, Dr. Stahl.  Dr Stahl: Thank you again for having me.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.  

Dr. Jessica Ailani talks with Dr. Serena Orr about the genetic risk of migraine and post-traumatic headache in children.  Read the related article in Neurology®Genetics.  Disclosures can be found at Neurology.org. 

What if the biggest missing piece in chiropractic care isn't the spine... but is in the feet?In this episode of TechTalk Healthcare, Dr. Jay Greenstein and Brad Cost sit down with Dr. Andrew Powell, founder of Better Balance Orthotics, to explore how proprioceptive orthotics are helping chiropractors improve patient outcomes by stimulating the nervous system instead of simply supporting the foot.Dr. Powell explains the science behind the foot-brain connection, why traditional orthotics often fail to create lasting change, and how neurological input from the feet influences posture, balance, movement, scoliosis, chronic pain, and overall function.You'll learn:Why supportive orthotics may not solve the root cause of dysfunctionThe difference between support-based and proprioceptive orthoticsHow sensory input from the feet impacts the brain and nervous systemThe role of foot mechanics in posture, balance, scoliosis, and spinal healthHow chiropractors can incorporate neurological orthotics into their practicesThe business model behind offering Better Balance Orthotics to patientsWhether you're a chiropractor, healthcare provider, or someone interested in improving movement and balance, this episode offers a fresh perspective on how optimizing foot function can transform whole-body health.Topics Covered: Chiropractic, Orthotics, Proprioception, Foot Health, Balance, Posture, Neurology, Functional Movement, Scoliosis, Chiropractic Technology, Practice Growth, Better Balance Orthotics

Alpha-lipoic acid (ALA) is a naturally occurring fatty acid. It has several plausible mechanisms for slowing ALS progression. Preclinical studies showed ALA slowed motor function decline. Some patients reported improvement when taking ALA together with other supplements. Here we discuss the mechanism, clinical studies, and potential risks. 

Dr. Paul Crane talks with Drs. Fiifi Duodu and Malya Sahu about neuroimmunology and multiple sclerosis diagnosis in Africa, including challenges and efforts to improve care.  Read the related article here.  Disclosures can be found at Neurology.org.   

Dr. Elizabeth Coon and Dr. Lucy Norcliffe-Kaufmann discuss the mechanism-based therapy with ampreloxetine for neurogenic orthostatic hypotension in multiple system atrophy, highlighting recent clinical trial results and future directions.  Show citation:  Freeman R, Kaufmann H, Biaggioni I, et al. Mechanism-Based Therapy With Ampreloxetine for Neurogenic Orthostatic Hypotension in Multiple System Atrophy: A Randomized Withdrawal Trial. Neurology. 2026;107(3):e218284. doi:10.1212/WNL.0000000000218284 

In this episode, editor-in-chief Joseph E. Safdieh, MD, FAAN, highlights articles about a pilot American Board of Psychiatry and Neurology Academic Pathway, a study of the EpiWatch app, and a new approach to magnetic resonance scanning.

In this episode, I sit down with pediatric chiropractor Dr. Tracey Norman to explore how chiropractic care supports children's brain and nervous system development beyond back pain. We discuss the connection between movement, the vagus nerve, stress regulation, and early childhood development, along with simple strategies parents can use to help their children build healthier, more resilient nervous systems. - - - - - About the Guest: Dr. Tracey Norman is a prenatal, pediatric, and family chiropractor dedicated to helping children and families thrive through nervous system-focused chiropractic care. Drawing from her own childhood experience with chiropractic and years of clinical practice, she helps parents understand how movement, nervous system regulation, and early intervention can support healthier development and improved well-being for children. - - - - - Social Handles: Instagram: https://www.instagram.com/drtraceynorman/ TikTok: https://www.tiktok.com/@dr.traceynorman Facebook: https://www.facebook.com/tracey.wright.7165/ - - - - - Connect with Dr. Laura Hanson Website: https://www.connectmybrain.com/ Instagram: https://www.instagram.com/connect.my.brain/ Facebook: https://www.facebook.com/connectmybrain YouTube: https://www.youtube.com/@dr.laurahanson4765 - - - - - PODCAST Thank you for listening. Please subscribe and share. This podcast is produced by DrTalks.com https://drtalks.com/podcast-service/

In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Karin G. Johnson, MD, FAAN, who served as the guest editor of the August 2026 Sleep Neurology issue. They provide a preview of the issue, which publishes on August 3, 2026. 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. Johnson is a Professor in the Department of Neurology at the University of Massachusetts Chan School of Medicine–Baystate and the Sleep Medicine Division Chief at Baystate Medical Center in Springfield, Massachusetts 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: @drsleepykarin  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 subscribing to the journal, listening to verbatim recordings of the articles, and exclusive access to interviews not featured on the podcast.  Dr Albin: All right, welcome all. For the first time ever in the history of Continuum Audio, we are coming to you live from Chicago here at the AAN annual meeting. And now over to your host, the one and only editor-in-chief, Dr. Lyell Jones.  Dr Jones: Welcome, everybody. My name is Lyell Jones, editor-in-chief of Continuum, and I'm here today with Dr. Karin Johnson, and we're interviewing Dr. Johnson for the upcoming and recently published issue of Continuum on Sleep Neurology. We have been doing Continuum Audio for a while, but we're doing something different this time. As our listeners online can tell, we are recording this for the first time ever with a live studio audience at the American Academy of Neurology annual meeting in Chicago, Illinois. So, this is a fun experience for us. I hope it's been fun so far for you, Dr. Johnson.  Dr Johnson: Great to be here.  Dr Jones: It's great to have you. So, before we get into the interview, I do wanna introduce our team here for the live recording of the podcast. You've already heard Dr. Casey Albin's voice. Dr. Casey Albin is an associate professor of neurology at Emory University. Also serves as one of our associate editors at the journal and one of our Continuum Audio interviewers. So, she's going to be working the crowd today. Let's have a round of applause for Dr. Albin. And our guest of honor today is Dr. Karin Johnson. Dr. Johnson is a professor of neurology at UMass Chan Medical School and, Baystate Medical Center in Massachusetts. She is a world-renowned expert in sleep neurology and is the guest editor for the most recent issue of Continuum on Sleep Neurology. Dr. Johnson, welcome. Why don't you introduce yourself to our audience?  Dr Johnson: You did a great introduction, but I'm a clinical sleep medicine specialist. Spend my days seeing patients, taking care of people with narcolepsy, sleep apnea, restless legs, everything that comes my way. And then I have a side interest in doing sleep medicine advocacy, especially for permanent standard time.  Dr Jones: And we may get to that. I mean, that might be part of our conversation today. So, you've now read all of the articles in this issue, and it's a really great issue. There's a lot of new developments in sleep neurology. There are some updates for clinicians, people who see patients with sleep disorders that I think are, are timely and important updates. You have this unique view because you have just read all of these articles, really good articles by expert authors. When you read through these, Dr. Johnson, what was the biggest, what was the biggest thing that surprised you?  Dr Johnson: I think the biggest surprise for me is just so many changes in, in all of these articles. I realized how easy it was for us to make a journal that is so different from a few years ago. Whether it's Dr. Stahl's obstructive sleep apnea and new ways to think about endotyping sleep apnea that is gonna have treatment implications or the new treatments that are out there like tirzepatide, the changes that we're having with restless leg treatment. I particularly wanted to have a chapter on circadian neurology that Dr. Abbott did a great job really highlighting how if we think about the timing of when we give meds, the timing of when we eat, how that really can help neurological health, brain health, overall health, as well as mental health and cognition, especially as the AAN thinks about brain health as a whole, not just treating our patients, but how we can treat the population of people by improving sleep. I like how we hit on all these different areas in this issue.  Dr Jones: And I don't know how you managed to do it. They're just a small number of articles. We cover a lot of existing territory with well-characterized diseases, with new advances. But there's a lot of new stuff in sleep, and so somehow, it's all packed in there. It's really impressive. One of the things I was gonna ask you about was an evolution, and this has been a number of years now in how we manage restless leg syndrome. When I was training, it was all about dopamine agonists, and that was your first line. And over time, the evidence has supported moving away from that, and now we have more recent guidelines that have come out, and it's really the alpha-two delta-one calcium channel antagonists. How is that transition going? Do you still see people in practice who come in on dopamine agonists? How is that going? How's the field responding to that?  Dr Johnson: That's one of my most frequent restless leg consults. So even though it's been years since I have really initiated dopamine agonists in my patient, every day we get in people often on very high doses of dopamine agonists, and their doctors have just been escalating and escalating these meds over the years, and they come in with horrible augmentation. Their symptoms are much worse than they used to be, happening earlier in the day. And so, trying to get these patients off of these meds that are addictive, the way I like to teach about it is these dopamine agonists are the Fioricets of the sleep world. We know they work great, but in the long run, the patients are gonna be worse overall. And so, it's so hard to get people off these dopamine agonists, just like it's so hard to convince a headache patient that they don't need their Fioricet and that they're gonna be better off if we can get them off of it. What I think has really changed is we have more options to use. So, the alpha-delta-like agonists like gabapentin are now considered first line, but there's a lot of patients who they just don't work well enough with or they don't tolerate. And so, what do you do in that case? It's easy when that works, but and, when that doesn't work, we are being much more aggressive these days with iron replacement, potentially even trying to push ferritin levels in refractory patients up to three hundred, and using IV iron rather than just oral iron to get over the absorption issues to get the brain levels high enough. Motor stimulators, little cuffs that kind of go around the leg and stimulate the peroneal nerve in a certain way that not only can give people immediate relief, but also some data that suggests that over time it actually lessens their restless legs. We have agents like dipyridamole that work on the adenosine system in a sort of new novel pathway at addressing restless legs. And then the opiates, often meds like methadone or Suboxone can be used in some patients. But as we're getting more of these other options, often we don't need to go to those levels because we do have more to work with.  Dr Jones: So, the key point is lots of options. We're not starting with dopamine agonists anymore. And I think the fact that you're still seeing a lot of patients who have been initiated on that probably tells us there's an education gap field that we need to work on. So, another thing that I noticed reading through the issue was, and this feels like a change over the last few years, is the availability and the tendency to use in-home sleep apnea testing as opposed to formal, traditional in-lab. And that feels like a great new option, and maybe that increases and improves availability for patients who need access to the test. But how do you work through that?  Dr Johnson: So, I love in-home testing. We've been using it for over a decade. Other parts of the country where insurances didn't sort of mandate it are now being more mandated. I think the real change happened for a lot of places over the pandemic when labs closed down. But I think it's good because it brings a lot more patients to us. They get tested, they get tested quicker. People who would say, "I would never go into a lab. Oh, I'll do a home study." So, it just does bring more people in, and it gets them to treatment that they need that can really be life-changing. But it's not for everybody. The biggest people are people that have other bad pulmonary issues. If you're on oxygen therapy, you should not be getting a home study. That really should be a group of people that come in the lab. Similarly, if you have bad COPD, you probably should be getting a full in-lab study, so we can get more monitoring. Central sleep apnea is an interesting one. It can be very hard in some cases to differentiate the centrals and obstructive nature as well on a home study. Doesn't mean you can't do a home. So, if it's a person that just can't get an in-lab study easily, maybe you start with the home. If it looks purely obstructive, and you're all set, then you got an answer, and you can move on. But if you get back a home study that looks questionably central, they're gonna need to come into that lab. So, if you already know they're high risk because they're on narcotics, cause they have congestive heart failure, it's usually worth going straight to the lab. But again, you may consider a home study based on the patient. Patients that really cannot use the equipment can also be an issue. So, if they've had a debilitating stroke and have no one to help them put on that device, or cognitively they just can't handle the device, they're gonna be someone who's gonna benefit from coming into the lab and getting the help from the techs. So, those are the big populations that you might go starting for a home. And then the other thing that confuses a lot of people, the home is only for diagnostics. It really isn't for treatment. So, I have patients that say, "Oh, like, you can just titrate my CPAP with a home study." No. So if it's a treatment decision where they're not doing well on treatment, or I need to figure out do they need CPAP or BiPAP or IVAPS or one of these more complicated treatments, those are people that are gonna need to come into the lab to get that treatment portion of the evaluation.  Dr Jones: What a great summary. That's like everything I needed to know about who do I need to bring into the lab and who do I think maybe could do an at-home study. Really great. And speaking of devices, I think all of us who see patients in the room here and our listeners out there online have experienced patients, and this feels like a very recent phenomenon to me, are coming in with their commercial at-home wearable device. And they have printouts sometimes, and they show me their phone, and they give me some numbers that I don't really know how to interpret. Reading through this issue, I learned a couple of great new words. I learned about orthosomnia, right? So, people who become so preoccupied with their sleep, it keeps them awake at night, literally, right? I mean, it's a complete paradox. I learned about nearables, so things that aren't necessarily wearables that are just in the room while the patient is sleeping that monitor proxies for sleep quality, sleep stage, and other things. And I frankly, I'm not really sure what to tell patients. So, what do you tell patients who come in with all the data? Like, or how do you tell patients to use these?  Dr Johnson: I think these devices can go both ways. So, I do kind of say the pros and cons of these devices. I think for a lot of patients, they're empowering. It's getting them to think about sleep, to wanna know how good their sleep is. Are they getting enough sleep? So, if it's used in those ways, it's gonna be very helpful. I actually had a patient last week, and they noted that they're having big desats all night and could show me essentially an overnight oximetry data rather than me having to order it, and I had days of data, which sometimes can be too much. But in this case, it's like, oh, when he was on his side that night, he looked a lot better, so I can use that to give advice to the patient about particular treatments. He actually went down to Mexico, and a doctor friend gave him oxygen therapy while he was there randomly. And we could see on the nights that he had the oxygen therapy, it did really help his central sleep apnea pattern. And so that pushed us towards saying, "Let's qualify you for that up here in the States." So, I think in some cases it can give really important data. Now, I saw a posting on social media the other day of someone saying, "Can I get advice on how to improve my REM sleep? My tracker says I have no REM sleep, and I need to do something about it." There's really not data to support needing to do something about it. And so, I do think it can get some people on these wild goose chases, trying to get to a certain percentage of sleep. And these trackers, they're good in a lot of ways, but they're not perfect. He could be getting REM sleep that the tracker on him does not show. You want to relate it to what symptoms are they having. I think they can be very good for trying something out. So, let's say someone, has their tracker telling them they get five hours of sleep, and they try this intervention, and that helps them show that they got the seven hours of sleep, or they went from no REM to REM and it goes in the right direction. It can help give them that positive feedback that something they're trying, is working. But the absolutes for any given patient, it's hard to over-- What does it mean if it says you've got a 50% score versus a 70% score? That may or may not be meaningful in any given person, but again, they can compare themselves to themselves. If they were a lower score and now they're a higher sleep score because they did something that was meaningful, and that goes along with them feeling better, that can help give them that positive feedback to do something good.  Dr Jones: So, a little bit of a mixed picture.  Dr Johnson: Yeah.  Dr Jones: Sometimes they help. Sometimes they distract. Hopefully- Dr Johnson: And as a provider, sometimes it can be overwhelming because they're like, "Come look at my year's worth of data." And you're like, "No."  Dr Jones: Yeah.  Dr Johnson: You know, let me see one page or two pages of data and be like, "Yep, okay, I get it." Dr Jones: Just show of hands in the audience, who in the room wears a sleep device at night, like a ring or a, some kind of sleep monitoring app? That's about half the audience.  Dr Johnson: This is why they're here.  Dr Jones: So that's really helpful, and I think it is. You want to be supported by the data. You want to be supported by evidence and high-quality biometric evidence. Another big trend, and this has been a number of years in the making, is the understanding, Dr. Johnson, of the relationship between sleep physiology and neurodegenerative disease. One of the things I love about neurology is there's still so much left to learn about the normal physiologic functioning of the brain. So glymphatics and other aspects of sleep physiology that we didn't know about a decade or two ago. When you think about how that relationship has developed, sleep physiology, maybe sleep disorders and neurodegenerative disease, how has that changed your approach to talking to patients? Do you counsel patients differently now because of what we understand better about that?  Dr Johnson: Yeah, I mean, we are still limited with our data. We have so many studies that show the associations between whether it's not enough sleep, too much sleep, or having a sleep disorder like obstructive sleep apnea, and that being a risk factor for stroke or Alzheimer's or Parkinson's. But we still sort of lack the treatment trials that necessarily say, "If you treat obstructive sleep apnea, you're gonna have less dementia," or, "You're gonna be less likely to have that stroke." So, we have a lot of physiological studies, a lot of reasons why it makes sense, but we don't have that final, nail in the coffin to say, "If you do this, you'll definitely be better." So, we know certain groups are more at risk. If you have obstructive sleep apnea and you are symptomatic, you seem to have higher cardiovascular risk. If you have a person who's had a stroke and we find a milder case of sleep apnea, and they're someone that's totally asymptomatic. They say, "I sleep fine. I feel fine." There's not great data to say, "If you treat your sleep apnea, you're gonna be less likely to have a stroke." Now, if they come in and they're sleepy and their sleep apnea is really severe, and they have more hypoxic burden, which is also more connected with a lot of these risks, I'm going to say, "I think you are in the higher risk group of sleep apnea people who it's probably gonna be more likely to help your cardiovascular risk, your dementia risk." We can counsel them, and then it's really a personal decision. Some people are like, "No way. I'm never gonna use a CPAP machine, ever." And other people are like, "You know, my mom had a stroke. My dad had Alzheimer's. I want to do every possible thing I can to make it less likely that I have this outcome that I want to avoid." And so, you're going to take that in to, you know, do you want to try this treatment or not? It's a lot easier when you have outcomes that you can follow, like, "If I try CPAP, does my blood pressure get better? Do I stop having AFib attacks?" It's a lot harder when, will I or not get Alzheimer's ten years down the road or have that stroke?  Dr Jones: It's hard to get people to do things for kind of an abstract prevention down the road, but could be important. Are there trials going on that are going to assess this data?  Dr Johnson: Yeah. We currently have a big trial getting people right away, right after their stroke, on CPAP, and not only looking at prevention, but also looking at recovery outcome. It's been running for several years. Hopefully, we'll get enough data to close out the study coming up.  Dr Jones: We'll look forward to that.  Dr Johnson: Yeah.  Dr Jones: So, I'm really excited to get to our audience here, but before we do that, I do want to ask Dr. Johnson one more question. Dr. Johnson is famous for her advocacy for sleep in general, but specifically related to Standard Time. So, let's do a little experiment here. I didn't warn Dr. Johnson about this, so we'll see how she does. She does a ton of advocacy. She's a pro. So, pretend like we're in DC, and I'm a senator, and we just got in an elevator. You're going to give me your elevator pitch on what we should do.  Dr Johnson: So, you know, sleep is one of the few essential things in life. We need to eat, we need to drink, we need to have clean air, and we need to sleep and when we improve sleep, we can improve basically every outcome, whether it's academics, whether it's productivity, whether it's our physical health, our mental health. And the problem is we structure our lives in a way that really keep people, and especially our teenagers, from getting the sleep they need. And one of these structural things we do is permanent daylight savings time. Essentially, what you're doing is you're putting the sun out later, makes it harder to go to bed. I was just talking to someone, the sun's going down at 9:00, and you need to get your kid to sleep at 7:30, 8:00 so they can get the amount of sleep they need. That is almost an impossible task because their circadian rhythms are being pushed later, they can't fall asleep on time. Then you're setting their clocks an hour earlier, so when that alarm clock is going off at 6:00 AM in the morning, it's actually 5:00 AM in the morning. You're squeezing sleep from both sides, and it's basically impossible to get enough sleep. A lot of people think the only problem with daylight savings time is twice a year with the changes, and there are certainly harms related to that. So, a lot of people think if we went to permanent daylight savings time it would be better, and we got rid of those changes. What they don't realize is that permanent circadian misalignment by setting the sun more ahead, at 1:00 to 2:00 instead of at noon causes the sleep and circadian disruption all year round that leads to increased incidents of strokes, of heart attacks, of obesity, of cancer, of suicides, of depression, of worse academic grades. Again, pretty much every outcome you have there that relates to brain health, we have now data that shows that it's worse. And so, we can improve our lives if we can go to permanent Standard Time.  Dr Jones: You convinced me. How about that? If there were any skeptics in the room, I doubt there are any left. We only went to like the fifth floor there, and she... I'm like, "I'm voting for this. Whatever, whatever this bill is, I'm gonna vote for it." So, I'm excited to get to the audience here. Before we get to questions and answers, and we want you to get your questions ready for Dr. Johnson. I do have a couple of trivia questions. And we've been doing this for a little while now on the podcast. The first trivia question actually relates to arts and culture.  Dr Jones: What famous artist used transitions between sleep and wake states to inspire his art? Anybody know?  Guest Speaker 1: Is it Van Gogh?  Dr Jones: Not Van Gogh that I know of. There in the back.  Guest Speaker 2: Picasso.  Dr Jones: Picasso, not that I know of. Right here.  Guest Speaker 3: Salvador Dali.  Dr Jones: Salvador Dali. We have a winner. Thank you for your answer. So apparently, I read this. Salvador Dali would sit in a chair holding onto a metal key and wait until he fell asleep, and it would fall out of his hands and drop into a bowl, and it would wake him up. So, then he would pick it back up, and he would go in and out of sleep trying to generate hypnagogic hallucinations, basically, and he would use that to inspire his art. And you think about his art, maybe that kind of makes sense. All right, now I've got a neurology trivia question. Okay, so maybe we're a little more comfortable with the neurology trivia in here. What is the center in the brain that is responsible for REM sleep atonia?  Guest Speaker 4: The receptor is for erection in the lateral hypothalamus.  Dr Jones: That is not correct. REM sleep atonia. Right here.  Guest Speaker 4: Emilio Malgona, Hyannis, Massachusetts. Dorsal raphe nucleus.  Dr Jones: We'll give you credit for that. Very good. Excellent. So, the-  Dr Johnson: Well, no. That's actually the serotonin. He's talking about another one.  Dr Jones: Oh, I thought I heard, I thought I heard-  Dr Johnson: You heard dorsal  Dr Jones: ... I heard dorsolateral tegmental nucleus of the pod.  Dr Johnson: Not quite.  Dr Jones: You get a prize anyway, sir, just for, just for answering. Thank you very much. All right. So, we're all warmed up here. So, Dr. Albin, what do you think? Should we get some questions from the audience?  Dr Johnson: All right, we've got some questions.  Guest Speaker 5: I have a statement and a question.  Dr Jones: Please tell the podcast your name again, sir.  Guest Speaker 5: Steve Spar, New York City. The tyranny of the morning people. You don't want people, you don't want the sun to go down too late because it'll keep people up longer. I spent my whole life fighting people like you. I am a nighttime person. Why do I have to go to sleep earlier? I want to go to sleep later. I want to wake up later. I don't want to wake up at 7:00 in the morning. I want to wake up at 10:00. There's a certain tyranny that we must use circadian rhythms of the majority, and it persecutes people like me who are night people.  Dr Johnson: So that is a great question.  Guest Speaker 5: What say you?  Dr Johnson: What say me is actually the harms of daylight savings time are actually to the night owls, and don't really affect the morning people. I can still go to sleep on time and get up on time without that pressure of needing to go to work. The night owl people, they can't fall asleep until later. They want to sleep in earlier, but we're forcing them to get up an hour earlier for work and school. And because we're doing daylight savings time, you're not getting the morning light you need, you're getting too much light at night, and you are more sensitive to a delay in your circadian rhythm, which makes you even more of a night owl and increase the degree of social jet lag. So, we actually see that the harms and risks of things like depression, cardiovascular risks are much greater in night owls than they are in normal people or morning larks. And this is again why the risks are the highest for our teenagers, who are essentially all night owls. You're making it harder for them to fall asleep on time. You're making them more and more of a night owl that it becomes more out of line with our standard social schedule. So, what we can do for a night owl is say to our schools, say to life that we want to change our society norms of getting up early. But that has nothing to do with daylight savings time. That has to do with how we make our schedule Dr Jones: All right, next question. And introduce yourself to the audience.  Guest Speaker 6: Sure. I'm Sanjay Rathi from New Haven area, Neurology. Movement disorders, Parkinson's disease, sleep disruptions, sleep-regulating REM, RBD issues, what are your recommendations? And as things get worse, what additional intervention should we do?  Dr Johnson: Yeah, I think it's hard with a lot of our neurodegenerative disorders, it's a two-way sleep. The disorders themselves often worsen sleep quality, have decrease in their sort of circadian amplitudes, and so that can affect sleep ability. And so, trying to do the things that promote sleep, like getting lights down in the evening, keeping things dark and quiet, doing cognitive behavioral sort of therapies if that's needed can all be helpful. Very high incidence of obstructive sleep apnea or other sleep-disordered breathing, whether it's Parkinson's or other neurodegenerative disorders, so evaluating and treating that if need be. And some of these people, especially as they get later on, you may end up considering medication for insomnia because their underlying disorders was causing it and there's, and you're not going to CBTI your way out of it. We do have the new orexin antagonist sleep agents, which are more recommended for older people and probably safer agents than your Z drugs and some of the other sleep meds out there. So, some people should be on some of those meds if their sleep is so disrupted. I've seen some sleep studies where it's basically like wake, sleep, wake, sleep, wake, sleep all night long. And it's like, wow, you really cannot sustain sleep, and we think it's not just a behavioral thing. I think it is part of their underlying Parkinson's and underlying disorders that can really cause major sleep disruption.  Dr Jones: It's a great question. Before we get more from the audience here, Dr. Albin, I'm just curious, you know, you got some questions from online. Don't know if any of those stood out to you. And the other thing is, I think about your practice, Dr. Albin, as a neurointensivist, there's some great content in this issue on how to maintain an adequate sleep environment in the hospital and the importance of that for the acute episode, maybe for some long-term outcomes. When I was reading the article, I didn't really didn't think about the ICU setting. That must be-- what do you do in the ICU?  Dr Albin: Well, we happen to have a question about just that. Dr Jones: Well, there you go  Dr Albin: From Dr. Manners of Baltimore, Maryland. "What meds should I be giving patients in the ICU or the inpatient setting to preserve or recalibrate their sleep-wake cycles? Is there anything that we can do besides just getting them out of bed during the day?"  Dr Johnson: Meds are always hard cause as sleep doctors, we're usually the last one to recommend meds. But there are situations and scenarios where meds may be appropriate. I can't say what's one better than the other, and some of the meds we have probably aren't even available as options in the hospital. So, the, you know, again, the orexin antagonist may be a good class to try to use, but they may not be an option. There was a good study that looked at empowering the patient and whether or not the ICU patients are empowerable. But they give a card to the patients in the hospital and say, "Tell your nurse to turn off my TV and my lights. Do I need all the blood draws all throughout the night, or can it be put off to the morning?" And trying to empower the patient to ask for these things and do some of the behavioral things. And they found that doing that did improve the duration of sleep, did reduce some of the number of awakenings that people ended up having at night. So, I think the ICU is a very particular population where there's a lot of things you can't get rid of. But certainly, turning on the lights, turning off the lights, and trying to limit noises as much as you can, in those night hours, trying to give some sense of a 24-hour day. The other thing is feeding is really important to circadian rhythms. I had a patient that had a brain bleed and, after it, she just her circadian rhythms were just off, and part of it was she was getting tube feeds through the night. So, one of the very first interventions we did was to move her timing of her feeding so that it wasn't in sleep, and that really did help make a difference in getting her back on a pattern, along with light therapy and other behavioral techniques as well.  Dr Jones: It's a great question.  Dr Albin: Absolutely. I mean, I think that validates just that we spend a lot of time actually asking like, "Can we feed people during the day?" Or, "Can we, can we limit the amount of baths that are happening at 3:00 in the morning?" We also had another one from the audience that came from Dr. Lavina Singla of Mississippi, and I think a lot of our patients are asking this question. Is melatonin addictive?  Dr Johnson: Is melatonin safe? Is melatonin addictive? I think with any sleeping aid, people become addictive to what they perceive is the outcome. So, if they said, "This got me to sleep, and now I'm sleeping great, I don't want to come off of it." And so, you get this to meds that are truly addictive, but even meds that aren't felt to have that addiction, there is certainly a behavioral change. And that's a lot of what cognitive behavioral therapy is working with these patients on, is challenging that belief of maybe it isn't the med, maybe it's your internal belief and your worry about doing this. One thing about sleep is sleep happens when you are relaxed and calm and not worried. When you're worried about thinking that thing you're worried about is whether or not you're getting sleep, then you don't sleep. In terms of melatonin, if you don't need to use it, I wouldn't use it. If you are gonna use it, I'd try to use as low doses as possible. Do we know all the risks? We don't know. And especially I think there are potentially more risks in a growing child than, maybe someone who isn't having the same sort of hormonal, needs and growth needs. But then again, if you have, let's say, a kid with autism and melatonin helps him sleep, I'd much rather use melatonin than a lot of other agents, and if that really changes their functionality, that probably is very good for them and better than having them not get sleep. So, I think you have to weigh each individual situation and combine it, especially with the behavioral approaches so that hopefully this is not a long-term addictive thing you're on.  Dr Jones: So, it's complicated. Sounds like it.  Dr Albin: Not a straightforward answer.   Dr Jones: I thought that was gonna be just this hard no, but I guess it is something you have to think about. So, I want to really take a minute here to thank Dr. Karin Johnson, who has been our interviewee for this episode of the Continuum Audio Podcast sleep issue just came out. Really want to encourage our subscribers, our listeners, and our studio audience here to enjoy it. Thank you, Dr. Johnson, for joining us today. I want to give a big round of applause to Dr. Casey Albin for managing this crowd. Thank you to our listeners. Thank you to our subscribers. Thank you to you all for coming 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.   

In part two of this series, Dr. Halley Alexander and Dr. Heidi Munger Clary discuss the steps to take if you are screening for a psychiatric comorbidity and the results indicate that someone may be positive for depression, anxiety, or another condition.  Show citations:  Mula M, Brodie MJ, de Toffol B, et al. ILAE clinical practice recommendations for the medical treatment of depression in adults with epilepsy. Epilepsia. 2022;63(2):316-334. doi:10.1111/epi.17140  Patel AD, Baca C, Franklin G, et al. Quality improvement in neurology: Epilepsy Quality Measurement Set 2017 update. Neurology. 2018;91(18):829-836. doi:10.1212/WNL.0000000000006425  

Send us Fan MailDescription: An immersive reading of Morning Tea by Michael L. Wynn with reflection on atrial fibrillation, strokes, space and time.Website:https://anauscultation.wordpress.comWork: https://www.neurology.org/doi/10.1212/WNL.0000000000214487 References:Wynn ML. Morning Tea. Neurology. 2025 Dec 23;105(12):e214487. doi: 10.1212/WNL.0000000000214487. Epub 2025 Nov 20. PMID: 41264895.

Dr. Elizabeth Coon talks with Dr. Lucy Norcliffe-Kaufmann about the mechanism-based therapy with ampreloxetine for neurogenic orthostatic hypotension in multiple system atrophy, highlighting recent clinical trial results and future directions.  Read the related article in Neurology®. Disclosures can be found at Neurology.org. 

If you enjoy this episode, we're sure you will enjoy more content like this on The Occult Rejects.  In fact, we have curated playlists on occult topics like grimoires, esoteric concepts and phenomena, occult history, analyzing true crime and cults with an occult lens, Para politics, and occultism in music. Whether you enjoy consuming your content visually or via audio, we've got you covered - and it will always be provided free of charge.  So, if you enjoy what we do and want to support our work of providing accessible, free content on various platforms, please consider making a donation to the links provided below.  Thank you and enjoy the episode!Links For The Occult Rejectshttps://linktr.ee/theoccultrejectsOccult Research Institutehttps://www.occultresearchinstitute.org/Substackhttps://substack.com/@theoccultrejects?r=7auau0&utm_campaign=profile&utm_medium=profile-pageCash Apphttps://cash.app/$theoccultrejectsVenmo@TheOccultRejectsBuy Me A Coffeebuymeacoffee.com/TheOccultRejectsPatreonhttps://www.patreon.com/TheOccultRejectsBibliographyCore Eye Anatomy, Retina, Optic Nerve, and Visual PathwaysBelliveau, A. P., & Somani, A. N. “Pupillary Light Reflex.” StatPearls. Treasure Island, FL: StatPearls Publishing, updated 2023.Cleveland Clinic. “Optic Nerve: What It Is, Function, Anatomy & Conditions.” Cleveland Clinic, updated 2024.Gupta, M., & Ireland, A. C. “Neuroanatomy, Visual Pathway.” StatPearls. Treasure Island, FL: StatPearls Publishing, updated 2022.Kolb, H. “Simple Anatomy of the Retina.” Webvision: The Organization of the Retina and Visual System. University of Utah / NCBI Bookshelf.Purves, D., Augustine, G. J., Fitzpatrick, D., et al., eds. Neuroscience. 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Englewood Cliffs, NJ: Prentice-Hall, 1973.Laeng, Bruno, Sylvain Sirois, and Gustaf Gredebäck. “Pupillometry: A Window to the Preconscious?” Perspectives on Psychological Science 7, no. 1, 2012: 18–27.Mathôt, Sebastiaan. “Pupillometry: Psychology, Physiology, and Function.” Journal of Cognition 1, no. 1, 2018.Piquado, Tepring, David Isaacowitz, and Arthur Wingfield. “Pupillometry as a Measure of Cognitive Effort in Younger and Older Adults.” Psychophysiology 47, no. 3, 2010: 560–569.Zekveld, Adriana A., Sophia E. Kramer, and Tammo Houtgast. “The Pupil Dilation Response to Auditory Stimuli: Current State of Knowledge.” Trends in Hearing 22, 2018.Emotion, Attraction, Arousal, and the PupilBradley, Margaret M., Laura Miccoli, Miguel A. Escrig, and Peter J. Lang. “The Pupil as a Measure of Emotional Arousal and Autonomic Activation.” Psychophysiology 45, no. 4, 2008: 602–607.de Winter, Joost C. 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Kalwani, and Joshua I. Gold. “Relationships Between Pupil Diameter and Neuronal Activity in the Locus Coeruleus, Colliculi, and Cingulate Cortex.” Neuron 89, no. 1, 2016: 221–234.Murphy, Peter R., Ian H. Robertson, James H. Balsters, and Redmond G. O'Connell. “Pupillometry and P3 Index the Locus Coeruleus–Noradrenergic Arousal Function in Humans.” Psychophysiology 48, no. 11, 2011: 1532–1543.Sara, Susan J. “The Locus Coeruleus and Noradrenergic Modulation of Cognition.” Nature Reviews Neuroscience 10, 2009: 211–223.Uddin, Lucina Q. “Salience Processing and Insular Cortical Function and Dysfunction.” Nature Reviews Neuroscience 16, 2015: 55–61.Memory, Emotion, Initiation, and Ritual EncodingCahill, Larry, and James L. McGaugh. “Mechanisms of Emotional Arousal and Lasting Declarative Memory.” Trends in Neurosciences 21, no. 7, 1998: 294–299.McGaugh, James L. “Memory—A Century of Consolidation.” Science 287, no. 5451, 2000: 248–251.McGaugh, James L. “The Amygdala Modulates the Consolidation of Memories of Emotionally Arousing Experiences.” Annual Review of Neuroscience 27, 2004: 1–28.Seligman, Rebecca, and Laurence J. Kirmayer. “Dissociative Experience and Cultural Neuroscience: Narrative, Metaphor and Mechanism.” Culture, Medicine, and Psychiatry 32, 2008: 31–64.Seligman, Rebecca, Ryan A. Brown, and Laurence J. Kirmayer. “Theory and Method at the Intersection of Anthropology and Cultural Neuroscience.” Social Cognitive and Affective Neuroscience 5, no. 2–3, 2010: 130–139.Whitehouse, Harvey. Arguments and Icons: Divergent Modes of Religiosity. Oxford: Oxford University Press, 2000.Whitehouse, Harvey. Modes of Religiosity: A Cognitive Theory of Religious Transmission. Walnut Creek, CA: AltaMira Press, 2004.Ritual, Synchrony, Social Bonding, and Embodied MeaningHobson, Nicholas M., Juliana Schroeder, Jane L. Risen, Dimitris Xygalatas, and Michael I. Norton. “The Psychology of Rituals: An Integrative Review and Process-Based Framework.” Personality and Social Psychology Review 22, no. 3, 2018: 260–284.Jackson, Joshua Conrad, Brock Bastian, and others. “Synchrony and Physiological Arousal Increase Cohesion and Cooperation in Large Naturalistic Groups.” Scientific Reports 8, 2018.McCauley, Robert N., and E. Thomas Lawson. Bringing Ritual to Mind: Psychological Foundations of Cultural Forms. Cambridge: Cambridge University Press, 2002.Rappaport, Roy A. Ritual and Religion in the Making of Humanity. Cambridge: Cambridge University Press, 1999.Turner, Victor. The Ritual Process: Structure and Anti-Structure. Chicago: Aldine, 1969.Xygalatas, Dimitris. Ritual: How Seemingly Senseless Acts Make Life Worth Living. New York: Little, Brown Spark, 2022.Xygalatas, Dimitris, et al. “Extreme Rituals Promote Prosociality.” Psychological Science 24, no. 8, 2013: 1602–1605.Meditation, Prayer, Trance, and AbsorptionFox, Kieran C. R., Matthew L. Dixon, Savannah Nijeboer, et al. “Functional Neuroanatomy of Meditation: A Review and Meta-Analysis of 78 Functional Neuroimaging Investigations.” Neuroscience & Biobehavioral Reviews 65, 2016: 208–228.Jerath, Ravinder, John W. Crawford, Vernon A. Barnes, and Kyler Harden. “Self-Regulation of Breathing as a Primary Treatment for Anxiety.” Applied Psychophysiology and Biofeedback 40, 2015: 107–115.Lutz, Antoine, John D. Dunne, and Richard J. Davidson. “Meditation and the Neuroscience of Consciousness.” In The Cambridge Handbook of Consciousness, edited by Philip David Zelazo, Morris Moscovitch, and Evan Thompson. Cambridge: Cambridge University Press, 2007.Tellegen, Auke, and Gilbert Atkinson. “Openness to Absorbing and Self-Altering Experiences (‘Absorption'), a Trait Related to Hypnotic Susceptibility.” Journal of Abnormal Psychology 83, no. 3, 1974: 268–277.Vago, David R., and David A. Silbersweig. “Self-Awareness, Self-Regulation, and Self-Transcendence: A Framework for Understanding the Neurobiological Mechanisms of Mindfulness.” Frontiers in Human Neuroscience 6, 2012.Darkness, Sensory Deprivation, Ganzfeld, and Visual InstabilityCaputo, Giovanni B. “Strange-Face-in-the-Mirror Illusion.” Perception 39, no. 7, 2010: 1007–1008.Caputo, Giovanni B. “Visual Perception During Mirror-Gazing at One's Own Face in Patients with Depression.” The Scientific World Journal, 2014.Caputo, Giovanni B. “Strange-Face Illusions During Eye-to-Eye Gazing in Dyads.” Imagination, Cognition and Personality 38, no. 1, 2018: 51–77.Metzger, Wolfgang. “Optische Untersuchungen am Ganzfeld.” Psychologische Forschung 13, 1930: 6–29.Shenyan, O., et al. “Visual Hallucinations Induced by Ganzflicker and Ganzfeld Differ in Frequency, Complexity, and Content.” Scientific Reports 14, 2024.Wackermann, Jiří, Peter Pütz, and Carsten Allefeld. “Ganzfeld-Induced Hallucinatory Experience, Its Phenomenology and Cerebral Electrophysiology.” Cortex 44, no. 10, 2008: 1364–1378.Zuckerman, Marvin, and Nathan Cohen. “Sources of Reports of Visual and Auditory Sensations in Perceptual-Isolation Experiments.” Psychological Bulletin 61, no. 1, 19Also want to remind people about the website, if you're into reading we have tons of information by multiple contributors, and we got t-shirts up on the site if you're interested. Fun fact, the art is all based on the eyeball. 

We get more listener emails about diet and MS than almost any other topic. If you're curious about how some of the well-known diets for MS actually stack up, or you're interested in understanding the connection between diet and MS-related fatigue, or you want to know what the biggest obstacle to staying on a new diet is (and this may surprise you), then this is the episode for you. We're devoting this week's entire episode to my conversation with Dr. Tyler Titcomb, an assistant professor in the Department of Dietetics and Nutrition, and a registered dietitian with a PhD in Nutritional Sciences in the Department of Neurology at the University of Kansas Medical Center. We have a lot to talk about! Are you ready for RealTalk MS??! This Week: We're taking a deep dive into diet and MS  :22 Dr. Tyler Titcomb breaks down what you need to know about how diet influences multiple sclerosis and why it plays such a key role.  :54 Share this episode  25:22 Next week  25:41 SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/466 ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.com Phone: (310) 526-2283 And don't forget to join us in the RealTalk MS Facebook group! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes at www.RealTalkMS.com JOIN: The RealTalk MS Facebook Group https://facebook.com/groups/realtalkms REVIEW: Give RealTalk MS a rating and review http://www.realtalkms.com/review Follow RealTalk MS on X, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 466 Guest: Dr. Tyler Titcomb Privacy Policy

We discuss headache and migraine treatment with Dr. Susan Broner of St. Peter's MS and Headache Center. Ray Graf hosts.

The August 2026 recall showcases five incredible interviews highlighting recent advances in headache medicine. The episode begins with Dr. Patricia Pozo-Rosich discussing the latest advancements in headache medicine, focusing on key research findings from 2025. The episode continues with Dr. Jennifer Robblee discussing the latest consensus on refractory migraine. In the third episode of this series, Dr. Michael Eller discusses the implications of CGRP therapies in migraine treatment.  The recall concludes with a two-part discussion featuring Drs. Tesha Monteith and Peter Goadsby, who highlight major developments in headache medicine presented at the 2026 AAN Annual Meeting.   Podcast links:    The Best of Headache Medicine from 2025: A Year in Review   Refractory Headache Disorders, New Consensus, and Emergency Department Migraine Guidelines   CGRP-Targeted Migraine Therapies in Patients With Vascular Risk Factors or Stroke   Headache Medicine Highlights from the 2026 AAN Annual Meeting - Part 1  Headache Medicine Highlights from the 2026 AAN Annual Meeting - Part 2  Article links:  Reaching International Consensus on the Definition of Refractory Migraine Using the Delphi Method 2025 Guideline Update to Acute Treatment of Migraine for Adults in the Emergency Department CGRP-Targeted Migraine Therapies in Patients With Vascular Risk Factors or Stroke   Disclosures can be found at Neurology.org. 

The Daily Quiz - Science and Nature Today's Questions: Question 1: What medical term is often caused by abnormally high fluid pressure in the eye? Question 2: What is the name of the soil that is always frozen and helps to define the boundary of the Arctic? Question 3: What would you call a baby eagle? Question 4: What is the name of a shape with three sides? Question 5: What is Somatology the study of? Question 6: What is the word for a young bird? Question 7: What is Neurology the study of? Question 8: How Many Bits In A Byte Question 9: What kind of animal is a kookaburra? This podcast is produced by Klassic Studios Learn more about your ad choices. Visit megaphone.fm/adchoices

While the Spanish flu was tearing across the globe,another epidemic began stealing people's bodies from them.Encephalitis lethargica aka “sleepy sickness” - could make victimssleep almost continuously. It could also cause insomnia,hallucinations, involuntary movements, dramatic personality changes,paralysis, and death. Those who survived sometimes became livingstatues, unable to initiate even the smallest movement as lifecontinued around them.Chris and Ed trace this forgotten plague from World War I Europe tothe institutions where survivors remained trapped for decades.SHOW NOTESOriginally aired on Patreon: 09/25/25https://satt.short.gy/nfu16 Originally aired on Patreon: 09/18/25 Want even more out of SATT? Now you can SUPPORT THE SHOW and get NEW SATT content EVERY WEEK for as little as 5 BONES — which includes our bonus video show New Fear Unlocked — by joining CLUB SATT: www.patreon.com/scaredallthetimeBecome a supporter of this podcast: https://www.spreaker.com/podcast/scared-all-the-time--7084296/support.Get the latest episodes of our bonus show NEW FEAR UNLOCKED -- and a whole lot more! -- by supporting the show on Patreon: https://www.patreon.com/ScaredAllTheTime

In part two of this series, Dr. Shuvro Roy talks with Drs. Jiwon Oh and Amit Bar-Or about the latest developments in BTK inhibitors for MS, including safety signals, trial results, and future directions.  For more information, please read about the abstract that was presented at the 2026 AAN Annual Meeting.  Read more about the Fenebrutinib Trial.  Disclosures can be found at Neurology.org. 

In part one of this series, Dr. Halley Alexander and Dr. Heidi Munger Clary discuss the best methods for screening patients with epilepsy in a clinical setting. Show citations:  Mula M, Brodie MJ, de Toffol B, et al. ILAE clinical practice recommendations for the medical treatment of depression in adults with epilepsy. Epilepsia. 2022;63(2):316-334. doi:10.1111/epi.17140  Patel AD, Baca C, Franklin G, et al. Quality improvement in neurology: Epilepsy Quality Measurement Set 2017 update. Neurology. 2018;91(18):829-836. doi:10.1212/WNL.0000000000006425  

Unruptured intracranial aneurysms and arteriovenous malformations are frequently discovered incidentally on neuroimaging, presenting complex decisions around monitoring, referral, and treatment. This episode highlights key risk factors for rupture, the role of imaging in evaluation, and practical approaches to triage and management, including when specialist intervention is warranted. In this episode, Gordon Smith, MD, FAAN, speaks with Edgar Samaniego, MD, FAAN, authors of the article "Unruptured Intracranial Aneurysms and Arteriovenous Malformations" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Smith is a Continuum® Audio interviewer and a professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. Samaniego is a professor of neurology, neurosurgery, and radiology and the director of the vascular neurology fellowship at the University of Iowa in Iowa City, Iowa. Additional Resources Read the article: Unruptured Intracranial Aneurysms and Arteriovenous Malformations 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: @GordonSmithMD Guest: @esamaniego Full episode transcript available here Dr Smith: Have you ever ordered an MRI of the brain and found a coincidental unruptured aneurysm or perhaps an arteriovenous malformation? If so, are you up to speed on how to manage this common situation, how to monitor, when to refer, and how to counsel your patients? If your answers to these two questions are yes and or no, then please keep listening.  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 Smith: This is Dr. Gordon Smith. Today, I'm interviewing Dr. Edgar Samaniego about his article on unruptured intracranial aneurysms and arteriovenous malformations. This article appears in the June two thousand twenty-six Continuum issue on cerebrovascular disease. Edgar, welcome to the podcast, and maybe you can briefly introduce yourself to our listeners.  Dr Samaniego: Yeah. Thank you, Gordon. So, I'm an interventional neurologist. I'm practicing at the University of Iowa. I've been in Iowa for the last ten years. I'm originally from Ecuador. Did my residency in Wisconsin, and then I went to Stanford for neuro critical care and stroke. And then I did my neurointerventional fellowship at the Baptist Cardiac and Vascular Institute in Miami.  Dr Smith: You're a triple threat in the world of vascular and critical care, which I want to get to later. But your article's really great. I'll admit one of the first things I do when I read an article for Continuum Audio is I see how long it is. I saw yours was as long as the rest, and I was a little surprised because this sounded like a simple topic. But having read it, it's anything but simple. This is really important and complex stuff. I wonder if maybe you can orient our listeners to the importance of this. We frequently find unruptured aneurysms or vascular malformations on brain imaging that we order for something else. I mean, how common is that, and why do you think our listeners need to be particularly attentive to our conversation today?  Dr Samaniego: It's pretty frequent that we see patients with unruptured brain aneurysms. A lot of times, you know, we do imaging like CT angiograms, or magnetic, resonance angiography. Patients come to the ER with headaches, and we find an unruptured aneurysm. And you know, the question always comes, "What should we do with this aneurysm that we found?" We know that a lot of these aneurysms will not rupture, but the caveat is that when they rupture, like fifty percent of these patients may die or have bad outcomes. So, it's always a puzzling question, you know. What should we do with the aneurysm?  Dr Smith: Well, thanks, Edgar. I mean, this is certainly something that I come across. I'm glad to hear that other people struggle with this as well. What actually is the prevalence of aneurysms in the general population? How common is this?  Dr Samaniego: It's more common than what we think, you know. The, the estimates talk about like one in every fifty people have a brain aneurysm, and about every eighteen minutes an aneurysm will rupture. In the United States, there's approximately thirty thousand ruptures per year. So, there's a significant number of, of patients affected by brain aneurysms. And, and the key thing is that affects usually younger patients who are in the most productive years of their lives. So that's why it shouldn't be ignored, and once we find an aneurysm, we have to have all the information for triaging and deciding on treatment of these aneurysms.  Dr Smith: Well, it's a great way to begin our conversation. I mean, this is not a rare problem. It's a common problem, and there's actually a really great section of the article I'll refer people to about medical malpractice and the importance of recognizing and dealing with this thoughtfully. It's an empowering section, not a scary one, but this is important for our listeners to know about. Pretty high-stakes stuff. Maybe you can orient listeners like me or maybe simple neuromuscular people. What different types of aneurysms are there?  Dr Samaniego: That's the interesting question because there's multiple types of aneurysms, and there is a whole spectrum of aneurysm. When we say aneurysm, you can be talking about a fusiform versus a saccular aneurysm. We tend to classify them based on shape, also location. But the two main classifications for brain aneurysms will be saccular, which, you know, has a sac kind of morphology shape, and then you have the fusiform aneurysms. Those are the main morphological classifications. Then on top of that, you have two other subtypes that you see quite often. The one that we see is mycotic aneurysms that is like a misnomer because it's not a fungal aneurysm. It's just an infectious aneurysm that most of the time we see on the setting of endocarditis. These behave a little bit different than the typical saccular or fusiform aneurysms. And then also you have other more rare types of aneurysms like blister aneurysms that are sometimes located in the anterior wall of the carotid artery. So, you know, within this spectrum, we have those main aneurysms. The typical aneurysms, which can be fusiform or saccular, and also the more atypical, which can be mycotic and also blister-like aneurysms.  Dr Smith: I wonder if you might comment a little bit on the relevance of the type of aneurysm, fusiform, saccular, blister, and then location on rupture risk or prognosis.You have a really great figure about anatomic classification in the article actually that I encourage everyone to check out when they hopefully read it. But what do these characteristics imply for risk?  Dr Samaniego: Yeah. This is very complex question because, you know, entails different characteristics of aneurysms such as shape, the location, morphology. So, we know that some locations, for example, the anterior communicating artery has a high risk of rupturing as opposed to patients such as the part of ophthalmic aneurysm, which are usually located at the origin of the ophthalmic artery in the internal carotid artery. So, by risk of rupturing, the highest risk is usually the anterior communicating. Then you have posterior communicating artery aneurysms, which are usually located in the internal carotid artery, but because of their proximity to the origin of the posterior communicating artery, they're called posterior communicating artery aneurysms. Then you have the posterior circulation aneurysms on top of risk of rupturing is the top of the basilar artery location. Those three are the highest risk for rupturing: ACOM, PCOM, and top of the basilar. In terms of morphology, I always tell my patients, you know, if it's like a nice-looking aneurysm that has this rounded shape is a benign morphology. If you have the aneurysm that's having these Mickey Mouse ears that has these blebs or daughter sacs, those are aneurysms that usually scare us because those are the ones that usually rupture. So that's another criteria, morphology. And then the other criteria would be size. There is this magnificent study called ISUIA, which was published several years ago, and basically what it demonstrated was that aneurysms that are seven millimeters or larger are more likely to rupture versus smaller aneurysms. So those are the three criteria that I'm looking into when talking to patients about morphology, location, size, and the, the shape or morphology of the aneurysm.  Dr Smith: So, let's say a general neurologist or comprehensive neurologist practicing in a community setting in a rural area orders a, let's just say a CT or CTA for a patient with a TIA and finds what looks like an aneurysm. What's the next step in terms of imaging? What's the best next step? I mean, there are a bunch of different imaging modalities. Do you get an MRA? Is it time-of-flight, contrasted? You know, when do you get a DSA and so forth?  Dr Samaniego: Yeah. The first thing to do is to better characterize the aneurysm. Order of more accurate imaging that we can obtain without being invasive with a diagnostic cerebral angiogram. The rest will be a magnetic resonance angiography with contrast that, you know, gives you really good detailed information about the aneurysm. Similar in terms of quality and precision will be a CT angiography. The caveat there is with CT angiography is that, you know, you use radiation, and the patient has to get iodine. And then under those two, you will have a time-of-flight magnetic resonance angiography, which doesn't use any contrast, but then you lose a little bit of quality in terms of the imaging and some morphological features you might miss. So usually what we do in my practice, I don't wanna do a diagnostic cerebral angiogram, and somebody has to refer an unruptured aneurysm. I try to do CT angiogram as a baseline, see how the aneurysm looks, and then for follow-up, I usually do magnetic resonance an- angiograms with with contrast. If there is a concern that the aneurysm has some dangerous features like it's irregular in shape, it's, it's larger, it's in one of these high-risk locations, might be better just to refer the, the patient to a specialist for a diagnostic cerebral angiography.  Dr Smith: So, you know, there are these scales that you talk about in the article. There's phases in the UIATS that are used to predict rupture risk and guide decision-making. Are these scales that general neurologists or non-vascular neurologists can use to guide care? I'm thinking of like Chad-Baskin, ASBAD, which, you know, all our residents know about. Should we all be familiar with these scores?  Dr Samaniego: I think they're very helpful in the sense that it will give us some guidance. Some of the characteristics of the scale might be up- outdated. For example, like ancestry. Although it's been described more in Japanese and Finnish populations, and North American, not as much as these two other populations. We do see a lot of aneurysms in people from North America and other backgrounds. For example, one of the biggest critiques for the phases is that doesn't take into account smoking history. Smoking that we know is a risk factor. And the other critiques for phases is that, for example, if you are older than seventy years old, you will score one point, which will increase your risk of aneurysm rupturing. Having said that, we do see like tons of aneurysms on younger patients, actually the most productive years of their lives that they rupture. So, it gives you some parameters like the presence of hypertension, the size, as I said, seven or larger, previous history of subarachnoid hemorrhage, and the location of the aneurysm. But it doesn't take into account other factors like smoking or morphological features of the aneurysm. Dr Smith: Now, you mentioned size. I'd like to maybe go back and talk about a case from your article, which I found really impactful. For our listeners, this is a sixty-four-year-old woman who had a five-millimeter ACOM aneurysm. She was imaged serially, didn't change over the time period, and then two years later ruptured with devastating consequence, right? And so that's a small aneurysm. Most aneurysms, I guess, are small aneurysms. I just wonder, when you see a patient like that, how do you handle the discussion regarding risk? And how do you decide when to refer them for an intervention?  Dr Samaniego: Yeah. It's always puzzling when we see these smaller aneurysms. And this example is a typical example of a patient that doesn't follow the rule of seven or larger aneurysm size for rupturing. We see that quite often on aneurysms located in the anterior communicating artery. Just this last week, I treated two patients with similar characteristics, with smaller aneurysms, like average size between four and five, that rupture, and both were located in the anterior communicating artery. So, we know that there is definitely a linear relationship between size and risk and rupture, but we do see a lot of patients that have smaller aneurysms, like three, four, five millimeters that rupture, and we don't really understand very well the, biology of these aneurysms. So, when we see these aneurysms, we try to maximize the characterization of the aneurysm with better imaging, try to see the morphology. And usually when an aneurysm is discovered, what we do for follow-up is a six-month follow-up with some type of imaging, CTA, MRA with contrast, and see if there's has been any change in, on the aneurysm.  Dr Smith: So, is it fair to say that a knowledgeable non-vascular neurologist can safely manage these patients, follow them over time using what they learned from reviewing your article, identify patients who have higher risk aneurysms based on the characteristics you summarize, and refer them to a tertiary center? When I get these, it's easy for me to have our vascular neurosurgeon see them or a vascular neurologist, right? But in a community where you may not have ready access to that subspecialist, is it still important to get all of these patients to a tertiary center? Are there select instances where a community-based general neurologist can follow them and then refer if there's change in size, for instance?  Dr Samaniego: Yeah. I think that everything else that we do in neurology, it's important to do some type of triage in referring some of these patients for further studying and  expert opinion. I think age and size of the aneurysm, age of the patient and size of the aneurysm are huge factors. For example, if we have an older patient in their nineties and has incidentally found two-millimeter aneurysm in a low-risk location like the parathalmic, that patient probably needs to be seen locally. I don't think merits a full workup. As opposed to a younger patient with a three-millimeter aneurysm located in the ACOM. I think that type of patient probably needs to be referred to a tertiary s-stroke center for workup. I mean, most of the time what's gonna happen is that if it's a small aneurysm with benign characteristics, you know, it's gonna be seen by the specialist and they're gonna determine some type of follow-up, which can be done locally.  Dr Smith: So maybe we can pivot a little bit and talk about AVMs, if that's okay. What's your approach to a coincidentally discovered AVM, right? I mean, presumably, we need to think about symptomatic AVMs a little differently, I would think. So maybe we can start with the same scenario we've been talking about. You get an imaging study for something else, and, well, we find an AVM. What's the approach to that situation?  Dr Samaniego: Yeah. AVMs are fascinating vascular lesions because they're very complex, they're very heterogeneous. If we're talking about the morphological features with aneurysms, this, in the case of AVMs, is way more complex in terms of location size. The complexity added to AVMs is that you have a feeding artery, you have a nidus, and then you have draining veins. So, all of these can be very heterogeneous. In case of AVMs, I think those definitely need to be referred to a tertiary center because the management of AVMs is multidisciplinary, even in the tertiary centers. You know, we don't have a magic wand that will say, you know, all these AVMs need to be treated this way. Sometimes they don't even need to be treated because we know from some studies that just watching them will be good enough.  Dr Smith: You raised management of AVMs. Maybe we can go back and talk a little bit about what's the latest in management of aneurysms. You manage aneurysms from soup to nuts and as an endovascular interventional neurologist. What's the latest in management of aneurysms?  Dr Samaniego: The latest is that, which falls within management, is that we have tools that they have not really been validated a hundred percent because we're still understanding the biology of some of these aneurysms. But high-resolution MRI will help us to define if there is some enhancement of the aneurysm. There is the thought that if there is enhancement after the administration of contrast, might be more of an inflammatory process. So that can be used for management, triage, and follow-up of some of these aneurysms. In terms of endovascular treatment, it has been really a revolution of how we treat these lesions. You know, we have a lot of new devices, better catheters to access the aneurysms.There is devices that you can place inside the aneurysm sac and it'll completely shut down flow into the aneurysm. There is other special stents called flow diverters that can take the flow away from the aneurysm and bypassing the aneurysm. So, all of these things have really revolutionized how we treat them. Having said that, you know, there's always a risk with any of these procedures, and that's why we gotta be mindful when we decide to treat these patients with unruptured incidentally found aneurysm.  Dr Smith: I've got just one more question, Edgar, which I kind of led with. You've got training as a vascular neurologist, a neurointensivist, and an interventional neurologist. And you know, Ralph Sacco, as you probably know, used to like to talk about the neurologist, and part of the neurologist was interventional. I wonder what wisdom you have to trainees that are listening to us right now who might be interested in pursuing a career as a neuroendovascular neurologist. What wisdom do you have for them about how to go about doing that?  Dr Samaniego: It has been really rewarding to be part of this process and evolution of treating a stroke and aneurysms and AVMs because I remember when I was a resident at the University of Wisconsin, we only had, like, thrombolysis and only one device for, retrieving some of these clots. But now we have, like, 10 different devices. We have two different indications or two, two different thrombolytics. So, my best advice for trainees that want to pursue neuroendovascular is to get engaged early on, understand very well the biology and the thought process because it's not only a technical field. You have to have really good judgment on when to do and when not to do the procedure, and try to find mentorship. You know, there is a lot of neurointerventional neurologists out there right now. Having a good mentor will really facilitate your career choices and getting into training.  Dr Smith: Well, Edgar, thanks so much. What an exciting conversation. It's just another great example of how exciting neurology is these days. Many exciting advances and innovations, and we just scratched the surface. I encourage all of our listeners to read the article. It's actually really, really informative. So, thank you very much.  Dr Samaniego: Thank you so much, Gordon.  Dr Smith: Again, today I've been interviewing Dr. Edgar Samaniego about his article on unruptured intracranial aneurysms and AVMs. This article appears in the June 2026 issue of Continuum on Cerebrovascular Disease. Be sure to check out other Continuum Audio episodes from this and other issues, and thanks to you, our listeners, for joining us today.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

In today's episode, we highlighted an OncLive Peer Exchange discussion about cancer-associated Lambert-Eaton myasthenic syndrome (LEMS) moderated by Misty D. Shields, MD, PhD. Dr Shields is an assistant professor of clinical medicine in the Department of Medicine in the Division of Hematology/Oncology at the Indiana University (IU) School of Medicine, as well as an adjunct assistant professor of medical & molecular genetics and an associate member of Experimental and Developmental Therapeutics at the IU Melvin and Bren Simon Comprehensive Cancer Center in Indianapolis. She was joined by Triparna Sen, MD, PhD, MS, a professor at The Ohio State University in Columbus, and Ditte Primdahl, MD, an assistant professor of neurology (neuro-oncology) and neurological surgery at the Northwestern University Feinberg School of Medicine in Chicago, Illinois.In this exclusive conversation, the experts discussed the ties between cancer-associated LEMS and small cell lung cancer. They noted that LEMS is characterized by proximal muscle weakness, hyperreflexia, and autonomic dysfunction, and that diagnostic challenges include late referral to neurology and misattribution of symptoms to cancer-related fatigue. They also highlighted key symptoms, which include proximal leg weakness, dry mouth, and blurred vision. Furthermore, they dove into treatment options for symptom control and emphasized that a multidisciplinary approach to care, including oncology, neurology, and laboratory medicine, is crucial for early LEMS diagnosis and effective management.

In part one of this series, Dr. Shuvro Roy talks with Drs. Jiwon Oh and Amit Bar-Or about recent multiple sclerosis clinical trial data.  For more information, please read about the abstract that was presented at the 2026 AAN Annual Meeting.  Read more about the Fenebrutinib Trial.  Disclosures can be found at Neurology.org.   

Send us Fan MailIn this systematic review and meta-analysis, Nim and Adrianne dig into just how common brain injury really is in neonates with critical congenital heart disease. Pooling 31 studies spanning two decades, the authors found that nearly 70% of these babies show some form of ischemic brain injury, split roughly between pre-operative and post-operative timing. Counter to what most clinicians would predict, kids who went to surgery earlier (days 4-6) had higher rates of white matter injury than those who waited longer. MRI remained the most sensitive tool for picking up these lesions, well ahead of ultrasound or CT. But the data stops well short of proving these findings predict long-term outcomes, and Nim pushes back on the idea that an abnormal scan alone should steer decisions about whether to operate.----Prevalence of Ischemic Brain Injury in Neonates With Congenital Heart Disease: A Systematic Review and Meta-Analysis.Kim C, Chetan D, Kazazian V, Alzamil J, Chau V, Seed M, Miller SP, Selvanathan T.Neurology. 2026 Feb 10;106(3):e214569. doi: 10.1212/WNL.0000000000214569. Epub 2026 Jan 9.PMID: 41512205Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

In this SRNA “Ask the Expert” episode, GG deFiebre spoke with Dr. Michael Levy and Dr. Benjamin Greenberg about optic neuritis and how it is most often linked to multiple sclerosis but can also be idiopathic or associated with MOGAD and NMOSD. They compared differences across these conditions (including age patterns, bilateral involvement, severity, exam findings, and typical recovery), outlined diagnostic workups such as MRI, antibody testing, and spinal fluid studies, and reviewed acute treatments [03:14]. The discussion also covered emerging therapies like Pivikto for neuroprotection and efgartigimod alfa to lower IgG as a potential alternative to plasma exchange, and examined challenges in remyelination and stem-cell delivery approaches like Q-Cells while cautioning against unproven stem cell clinics [11:57].Benjamin M. Greenberg, MD, MHS is a Professor and the Cain Denius Scholar in Mobility Disorders in the Department of Neurology [https://utswmed.org/why-utsw/departments/neurology/] at UT Southwestern Medical Center in Dallas, Texas. He currently serves as the Vice Chair of Translational Research and Strategic Initiatives for the Department of Neurology. He is also the interim Director of the Multiple Sclerosis Center [https://utswmed.org/locations/aston/multiple-sclerosis-and-neuroimmunology-clinic/] and the Director of the Neurosciences Clinical Research Center. In addition, he serves as Director of the Transverse Myelitis and Neuromyelitis Optica Program and the Pediatric Demyelinating Disease Program [https://www.childrens.com/specialties-services/specialty-centers-and-programs/neurology/demyelinating-disease-program] at Children's Medical Center. Prior to his recruitment to UT Southwestern in 2009, Dr. Greenberg was on the faculty of the Johns Hopkins Division of Neuroimmunology, serving as the Director of the Encephalitis Center and Co-Director of the nation's first dedicated Transverse Myelitis Center. Dr. Greenberg splits his clinical time between adult and pediatric patients at William P. Clements Jr. and Zale Lipshy University Hospitals, Parkland, and Children's Medical Center. His research focuses on better diagnosing, prognosticating, and treating demyelinating diseases and nervous system infections. He also coordinates clinical trials to evaluate new treatments to prevent neurologic damage and restore function to affected patients. Michael Levy, MD, PhD is a recognized neurologist with over 15 years of clinical and research expertise in rare neuroimmunological disorders. He established the Neuroimmunology Clinic and Research Laboratory at Massachusetts General Hospital and is the Research Director in the Division of Neuroimmunology and Neuroinfectious Disease. Previously, Dr. Levy was on the faculty at Johns Hopkins University and was the founding Director of their Neuromyelitis Optica Clinic. Clinically, Dr. Levy cares for patients with MOG antibody disease (MOGAD), neuromyelitis optica spectrum disorder (NMOSD), and idiopathic transverse myelitis (TM). Dr. Levy is also the principal investigator (PI) on numerous patient studies and drug trials for new and improved treatments for these disorders. In 2022, Dr. Levy became the lead principal investigator for the two worldwide clinical trials in MOG antibody disease. In the lab, Dr. Levy's research focuses on the development of animal models of NMO and MOG with the goal of tolerization as a sustainable long-term treatment. Dr. Levy has more than 200 peer-reviewed research articles, reviews and editorials, and 3 patents covering NMO tolerization therapy, TM diagnostics, and stem cell regeneration approaches.00:00 Welcome01:02 Optic Neuritis Basics02:27 Causes and Percentages03:14 MS vs NMO vs MOG06:07 Workup and Testing07:51 Acute Attack Treatment09:30 Recovery and Vision Measures11:57 Pivikto Neuroprotection15:30 Efgartigimod vs Plasma Exchange17:59 Repair vs Remyelination20:15 Q-Cells and Stem Cell Delivery22:22 Closing

Dr. Davoudian is a board-certified Health psychologist with expertise in reproductive mental health. She provides psychotherapy to patients who are pregnant, postpartum or seeking fertility treatment. Dr. Davoudian also offers psychological consultations for individuals utilizing third-party reproduction as well as assessments of gamete donors and gestational surrogates. Her research interests include psychological aspects of third party reproduction and has served as a principal investigator on a study examining posttraumatic stress among fertility patients. Glorisel González Viera, MD, is double board-certified in Psychiatry and Sleep Medicine by the American Board of Psychiatry and Neurology. She is an Assistant Professor at Baylor College of Medicine in the Departments of Obstetrics & Gynecology and Psychiatry & Behavioral Sciences, where she practices as a Reproductive Psychiatrist at The Women's Place at Texas Children's Hospital Pavilion for Women. Originally from Puerto Rico, she completed her Psychiatry residency at Ponce Health Sciences University, serving as Chief Resident, followed by fellowships in Sleep Medicine at the VA Caribbean Healthcare System and Women's Mental Health at Baylor College of Medicine. Her clinical and research interests center on the intersection of sleep and women's mental health across the reproductive lifespan, with a particular focus on perimenopause and menopause. She also conducts research in reproductive loss and atypical forms of grief. Dr. González Viera is passionate about advancing evidence-based care, educating healthcare professionals, and improving access to specialized mental health care for women.   CONNECT WITH DVORA ENTIN: Website: https://www.dvoraentin.com/ Instagram: https://www.instagram.com/dvoraentin YouTube: https://www.youtube.com/@misconceptionspodcast  

If you enjoy this episode, we're sure you will enjoy more content like this on The Occult Rejects.  In fact, we have curated playlists on occult topics like grimoires, esoteric concepts and phenomena, occult history, analyzing true crime and cults with an occult lens, Para politics, and occultism in music. Whether you enjoy consuming your content visually or via audio, we've got you covered - and it will always be provided free of charge.  So, if you enjoy what we do and want to support our work of providing accessible, free content on various platforms, please consider making a donation to the links provided below.  Thank you and enjoy the episode!Links For The Occult Rejectshttps://linktr.ee/theoccultrejectsOccult Research Institutehttps://www.occultresearchinstitute.org/Substackhttps://substack.com/@theoccultrejects?r=7auau0&utm_campaign=profile&utm_medium=profile-pageCash Apphttps://cash.app/$theoccultrejectsVenmo@TheOccultRejectsBuy Me A Coffeebuymeacoffee.com/TheOccultRejectsPatreonhttps://www.patreon.com/TheOccultRejectsCore Sleep Paralysis ScienceSharpless, Brian A., and Jacques P. Barber. “Lifetime Prevalence Rates of Sleep Paralysis: A Systematic Review.” Sleep Medicine Reviews 15, no. 5 (2011): 311–315.Sharpless, Brian A. “A Clinician's Guide to Recurrent Isolated Sleep Paralysis.” Neuropsychiatric Disease and Treatment 12 (2016): 1761–1767.Cheyne, J. Allan, Steve D. Rueffer, and Ian R. Newby-Clark. “Hypnagogic and Hypnopompic Hallucinations during Sleep Paralysis: Neurological and Cultural Construction of the Night-Mare.” Consciousness and Cognition 8, no. 3 (1999): 319–337.Cheyne, J. Allan. “Sleep Paralysis and the Structure of Waking-Nightmare Hallucinations.” Dreaming 13, no. 3 (2003): 163–179.Cheyne, J. Allan. “Situational Factors Affecting Sleep Paralysis and Associated Hallucinations: Position and Timing Effects.” Journal of Sleep Research 11, no. 2 (2002): 169–177.Solomonova, Elizaveta. “Sleep Paralysis: Phenomenology, Neurophysiology and Treatment.” In The Oxford Handbook of Spontaneous Thought: Mind-Wandering, Creativity, and Dreaming, edited by Kieran C. R. Fox and Kalina Christoff. Oxford University Press, 2018.Baland Jalal / Panic-Hallucination / TreatmentJalal, Baland. “How to Make the Ghosts in My Bedroom Disappear? Focused-Attention Meditation Combined with Muscle Relaxation (MR Therapy): A Direct Treatment Intervention for Sleep Paralysis.” Frontiers in Psychology 7 (2016): 28. doi:10.3389/fpsyg.2016.00028.Jalal, Baland, and V. S. Ramachandran. “Sleep Paralysis and ‘The Bedroom Intruder': The Role of the Right Superior Parietal, Phantom Pain and Body Image Projection.” Medical Hypotheses 83, no. 6 (2014): 755–757.Jalal, Baland. “The Neuropharmacology of Sleep Paralysis Hallucinations: Serotonin 2A Activation and a Novel Therapeutic Drug.” Psychopharmacology 235, no. 11 (2018): 3083–3091.Jalal, Baland, Lucia Moruzzi, Andrea Zangrandi, Matteo Filardi, Claudio Franceschini, Fabio Pizza, et al. “Meditation-Relaxation (MR Therapy) for Sleep Paralysis: A Pilot Study in Patients with Narcolepsy.” Frontiers in Neurology 11 (2020): 922. doi:10.3389/fneur.2020.00922.Folklore, Myth, and the Old HagHufford, David J. The Terror That Comes in the Night: An Experience-Centered Study of Supernatural Assault Traditions. Philadelphia: University of Pennsylvania Press, 1982.Hufford, David J. “Sleep Paralysis as Spiritual Experience.” Transcultural Psychiatry 42, no. 1 (2005): 11–45.Adler, Shelley R. Sleep Paralysis: Night-mares, Nocebos, and the Mind-Body Connection. New Brunswick: Rutgers University Press, 2011.Davies, Owen. “The Nightmare Experience, Sleep Paralysis, and Witchcraft Accusations.” Folklore 114, no. 2 (2003): 181–203.Bond, John. An Essay on the Incubus, or Nightmare. London: Printed for D. Wilson and T. Durham, 1753.Golzari, Samad E. J., et al. “Sleep Paralysis in Medieval Persia — The Hidayat of Akhawayni (?–983 AD).” Neuropsychiatric Disease and Treatment 8 (2012): 229–234.Cross-Cultural Sleep ParalysisHinton, Devon E., Vuth Pich, Dara Chhean, and Mark H. Pollack. “‘The Ghost Pushes You Down': Sleep Paralysis-Type Panic Attacks in a Khmer Refugee Population.” Transcultural Psychiatry 42, no. 1 (2005): 46–77.Hinton, Devon E., Vuth Pich, Dara Chhean, Mark H. Pollack, and Richard J. McNally. “Sleep Paralysis among Cambodian Refugees: Association with PTSD Diagnosis and Severity.” Depression and Anxiety 22, no. 2 (2005): 47–51.Jalal, Baland, and Devon E. Hinton. “Rates and Characteristics of Sleep Paralysis in the General Population of Denmark and Egypt.” Culture, Medicine, and Psychiatry 37, no. 3 (2013): 534–548.Jalal, Baland, Joseph Simons-Rudolph, Bamo Jalal, and Devon E. Hinton. “Explanations of Sleep Paralysis among Egyptian College Students and the General Population in Egypt and Denmark.” Transcultural Psychiatry 51, no. 2 (2014): 158–175.Jalal, Baland, Andrea Romanelli, and Devon E. Hinton. “Cultural Explanations of Sleep Paralysis in Italy: The Pandafeche Attack and Associated Supernatural Beliefs.” Culture, Medicine, and Psychiatry 39, no. 4 (2015): 651–664.Olunu, Esther, Ruth Kimo, Esther Olufunmbi Onigbinde, Mary-Amadeus Uduak Akpanobong, and Inyene Ezekiel Enang. “Sleep Paralysis, a Medical Condition with a Diverse Cultural Interpretation.” International Journal of Applied and Basic Medical Research 8, no. 3 (2018): 137–142.Sensed Presence / Body Map / Shadow Person NeuroscienceArzy, Shahar, Margitta Seeck, Stephanie Ortigue, Laurent Spinelli, and Olaf Blanke. “Induction of an Illusory Shadow Person.” Nature 443 (2006): 287.Blanke, Olaf, Stephanie Ortigue, Theodor Landis, and Margitta Seeck. “Stimulating Illusory Own-Body Perceptions.” Nature 419 (2002): 269–270.Blanke, Olaf, Theodor Landis, Laurent Spinelli, and Margitta Seeck. “Out-of-Body Experience and Autoscopy of Neurological Origin.” Brain 127, no. 2 (2004): 243–258.Ionta, Silvio, Lukas Heydrich, Bigna Lenggenhager, Michael Mouthon, Eleonora Fornari, Dominique Chapuis, Roger Gassert, and Olaf Blanke. “Multisensory Mechanisms in Temporo-Parietal Cortex Support Self-Location and First-Person Perspective.” Neuron 70, no. 2 (2011): 363–374.Blanke, Olaf, Polona Pozeg, Masayuki Hara, Lukas Heydrich, Andrea Serino, Akio Yamamoto, Toshiro Higuchi, et al. “Neurological and Robot-Controlled Induction of an Apparition.” Current Biology 24, no. 22 (2014): 2681–2686.Alien Abduction / Modern Mythic MaskMcNally, Richard J., and Susan A. Clancy. “Sleep Paralysis, Sexual Abuse, and Space Alien Abduction.” Transcultural Psychiatry 42, no. 1 (2005): 113–122.Clancy, Susan A. Abducted: How People Come to Believe They Were Kidnapped by Aliens. Cambridge, MA: Harvard University Press, 2005.Blackmore, Susan. “Abduction by Aliens or Sleep Paralysis?” Skeptical Inquirer 22, no. 3 (1998): 23–28.Clinical Sleep / Narcolepsy / REM BackgroundAmerican Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed., text revision. Darien, IL: American Academy of Sleep Medicine, 2023.Scammell, Thomas E. “Narcolepsy.” New England Journal of Medicine 373, no. 27 (2015): 2654–2662.Saper, Clifford B., Patrick M. Fuller, Nigel P. Pedersen, Jun Lu, and Thomas E. Scammell. “Sleep State Switching.” Neuron 68, no. 6 (2010): 1023–1042.Brooks, Patricia L., and John H. Peever. “Identification of the Transmitter and Receptor Mechanisms Responsible for REM Sleep Paralysis.” Journal of Neuroscience 32, no. 29 (2012): 9785–9795.Avidan, Alon Y., and Phyllis C. Zee, eds. Handbook of Sleep Medicine. Philadelphia: Lippincott Williams & Wilkins, 2011.Visual / Art HistoryFuseli, Henry. The Nightmare. 1781. Oil on canvas. Detroit Institute of Arts.Myrone, Martin. Gothic Nightmares: Fuseli, Blake and the Romantic Imagination. London: Tate Publishing, 2006.Powell, Nicolas. Fuseli: The Nightmare. London: Allen Lane, 1973.Also want to remind people about the website, if you're into reading we have tons of information by multiple contributors, and we got t-shirts up on the site if you're interested. Fun fact, the art is all based on the eyeball. 

Dr. Dara Albert talks with Dr. Jon Stone about the latest advancements in FND from the recent International Conference on Functional Neurological Disorder. Dr. Jon Stone shares insights on the field's growth, multidisciplinary care, cultural perspectives, and future directions. Check out the FNDS website for more information about FND.  Disclosures can be found at Neurology.org. 

Tonight on America At Night with McGraw Milhaven, retired U.S. Marine Corps Intelligence Officer and former Deputy Director for Intelligence Mark Chandler breaks down the latest developments between Iran and the United States, along with Defense Secretary Pete Hegseth's appearance on Capitol Hill and what it could mean for U.S. national security. Dr. Beth Malow, Professor of Neurology and Pediatrics at Vanderbilt University Medical Center, explains why standard time may be better for your health than daylight saving time, including the impact of clock changes on sleep and the body's natural rhythms. Plus, author Alex Wright joins McGraw Milhaven to discuss his book, Empire of Ink. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Dr. Stacey Clardy talks with Dr. John Ney about the link between military sexual trauma and migraine among US veterans.  Read the related article in Neurology® Clinical Practice.  Disclosures can be found at Neurology.org. 

Dr. Derek Stitt talks with Dr. Jennifer Morganroth about the evolving landscape of genetic testing in ALS, the importance of longitudinal care for at-risk individuals, and the capacity challenges faced by clinics.  Read the related article in Neurology® Genetics.  Disclosures can be found at Neurology.org. 

*Content Warning:  neglect, rejection, friendship betrayal, betrayal, and infidelity.Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources   SWW Sticker Shop!: https://brokencyclemedia.com/sticker-shop SWW S26 Theme Song & Artwork: The S26 cover art is by the Amazing Sara Stewart instagram.com/okaynotgreat/  Follow Something Was Wrong: Website: somethingwaswrong.com  IG: instagram.com/somethingwaswrongpodcast TikTok: tiktok.com/@somethingwaswrongpodcast  Follow Tiffany Reese: Website: tiffanyreese.me  IG: instagram.com/lookieboo Follow Dr. Marisa G. Franco: Website - https://www.drmarisagfranco.com/ Instagram - https://www.instagram.com/drmarisagfranco Platonic, How The Science of Attachment Can Help You Make - and Keep - Friends - https://drmarisagfranco.com/platonic-the-book/ Worth, The New Science of Self-Esteem and Secure Attachment: https://drmarisagfranco.com/worth-the-book/ *Sources:  Almaatouq, Abdullah, et al. "Are You Your Friends' Friend? Poor Perception of Friendship Ties Limits the Ability to Promote Behavioral Change." PLOS ONE, vol. 11, no. 3, 2016, article e0151588, https://doi.org/10.1371/journal.pone.0151588 Center for the Study of Traumatic Stress. When Losses of Loved Ones Are Not Acknowledged: Understanding Disenfranchised Grief. Department of Psychiatry, Uniformed Services University, n.d., https://www.cstsonline.org/assets/media/documents/CSTS_FS_When_Losses_of_Loved_Ones_Are_Not_Acknowledged_Understanding_Disenfranchised_Grief.pdf Dodson, William W., et al. "Rejection sensitivity dysphoria in attention-deficit/hyperactivity disorder: A case series." Neurology 7 (2024): 23-30.  Franco, Marisa G. Platonic: How the Science of Attachment Can Help You Make—and Keep—Friends. Penguin Random House, 6 Sept. 2022 https://www.penguinrandomhouse.com/books/676695/platonic-by-marisa-g-franco-phd/ Franco, Marisa G. Worth: The New Science of Self-Esteem and Secure Attachment. G.P. Putnam's Sons, 15 Sept. 2026, Penguin Random House,https://www.penguinrandomhouse.com/books/784327/worth-by-marisa-g-franco-phd/ Gobin, Robyn L., and Jennifer J. Freyd. "The impact of betrayal trauma on the tendency to trust." Psychological Trauma: Theory, Research, Practice, and Policy 6.5 (2014): 505. https://psycnet.apa.org/record/2013-24397-001 Guy-Evans, Olivia. “Self-Verification Theory.” Simply Psychology, 11 May 2026, https://www.simplypsychology.org/self-verification-theory.html Here & Now Newsroom. “Research Shows We Replace Half Our Friends Every 7 Years. Here's How to Make New Ones.” NPR Illinois, 23 June 2025, https://www.nprillinois.org/2025-06-23/research-shows-we-replace-half-our-friends-every-7-years-heres-how-to-make-new-ones Hillman, James. "Betrayal." Loose Ends: Primary Papers in Archetypal Psychology, Spring Publications, 1975, pp. 63–79. Jarrett, Christian. "The Liking Gap: We Usually Think People Like Us Less Than They Actually Do." Research Digest, British Psychological Society, 13 Sept. 2018, https://www.bps.org.uk/research-digest/liking-gap Kenny, Serafina. "Having Friends Is as Important as Diet and Exercise for Living Longer, a Longevity Expert Says." Business Insider, 22 Sept. 2023, https://www.businessinsider.com/longevity-antiaging-friendship-social-interaction-relationships-2023-9 Nader, Karim. “Reconsolidation and the Dynamic Nature of Memory.” Cold Spring Harbor perspectives in biology vol. 7,10 a021782. 9 Sep. 2015, doi:10.1101/cshperspect.a021782, https://pubmed.ncbi.nlm.nih.gov/26354895/ Nussbaum, Ben. "FRIENDSHIP FLATTENS HILLS: It's time to put connections at the center of wellbeing, says relationship expert Marisa Franco." Spirituality & Health Magazine, vol. 25, no. 5, Sept.-Oct. 2022, pp. 46+. Gale Academic OneFile link.gale.com/apps/doc/A763799199/AONE?u=anon~858b38f4&sid=googleScholar&xid=6b08179d One Another. Directed by Amber Love, produced by Andrea Raby, Joycie Films, 2026. World premiere, SXSW Film & TV Festival, Austin, TX, 12 Mar. 2026. https://schedule.sxsw.com/2026/films/2249924 Romm, Cari. "Half of Your Friends Probably Don't Think of You as a Friend." The Cut, 9 May 2016, https://www.thecut.com/2016/05/half-of-your-friends-probably-dont-think-of-you-as-a-friend.html Thompson, Sophia, Kaitlyn Deaner, and Marisa G. Franco. "How to Help Clients Make Friends." Journal of Health Service Psychology 49.2 (2023): 77-85 https://link.springer.com/article/10.1007/s42843-023-00085-w Wallace, Anna Kodé. "Why Friendship Betrayal Feels Impossible to Get Over." The Cut, 22 Apr. 2026, https://www.thecut.com/article/friendship-betrayal-explained-psychology-summer-house.html