Podcasts about Neurology

In part one of this series, Dr. Andy Southerland talks with Dr. Dan Ackerman about the latest guidelines for managing acute ischemic stroke, emphasizing thrombolytic therapy, imaging techniques, and decision-making regarding treatment in extended time windows. Disclosures can be found at Neurology.org. 

The June 2026 Recall highlights four previously posted episodes on parkinsonian disorders. The episode begins with Dr. Valtteri Kaasinen discussing the clinical challenges of diagnosing Parkinson disease and how that diagnosis can evolve over time. The discussion continues with Dr. YuHong Fu, who addresses the importance of differentiating between dementia with Lewy bodies and Parkinson disease dementia. The third episode features Dr. Daniel Weintraub discussing clinical considerations and strategies for effective communication when addressing cognitive concerns in patients with Parkinson disease. The episode concludes with Prof. Franziska Hopfner discussing the frequency and disease trajectory of MSA patients who do not experience dysautonomia, compared with those who have autonomic involvement. Podcast links:  Stability and Accuracy of a Diagnosis of Parkinson Disease Over 10 Years  Dementia with Lewy Bodies and Parkinson Disease Dementia Clinical Approach to Dementia Risk in Patients with Parkinson Disease  Multiple System Atrophy Without Dysautonomia  Article links:  Stability and Accuracy of a Diagnosis of Parkinson Disease Over 10 Years  Dementia with Lewy bodies and Parkinson Disease Dementia — The Same or Different and is it Important?  Long-Term Dementia Risk in Parkinson Disease  Multiple System Atrophy Without Dysautonomia: An Autopsy-Confirmed Study Disclosures can be found at Neurology.org. 

Dr. Gregg Day talks with Drs. Sonia Vallabh and Eric Minikel about scientific insights and the future of prion disease treatment, highlighting the importance of early diagnosis, personalized medicine, and hope for affected families.  Learn about the clinical trial.   Learn more about the Prion Alliance.  Disclosures can be found at Neurology.org.  

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Balancing disease control with pregnancy and neonatal considerations in people with neuroinflammatory disease throughout the family planning, pregnancy, and postpartum periods is crucial. Modern treatment paradigms enable women to safely become pregnant and breastfeed alongside effective disease management. Shared decision making is an important part of this process. In this episode, Kait Nevel, MD, speaks with Ruth Dobson, MD and Kerstin Hellwig, MD, authors of the article "Family Planning in Neuroinflammatory Disease" in the Continuum® April 2026 Multiple Sclerosis and Related Disorders issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Dobson is a professor in the Centre for Preventive Neurology at the Wolfson Institute of Population Health, Queen Mary University of London, and a consultant neurologist in the Department of Neurology at the Royal London Hospital, Barts Health NHS Trust, in London, United Kingdom. Dr. Hellwig is a professor in the Department of Neurology at Katholisches Klinikum, Ruhr‑Universität Bochum, in Bochum, Germany. Additional Resources Read the article: Family Planning in Neuroinflammatory Disease Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @IUneurodocmom Guest: @drruthdobson Full episode transcript available here

In part two of this episode, In this episode, Thom Van De Meer shares his journey from academic background to applying StrongFirst principles in training athletes, including the women's rowing team he trained to prepare for the 2020 Olympics— Project2020. We explore the principles of strength training, the science of energy systems, and how targeted, sustainable training can enhance performance and health. Check out Thom's breathwork tracks on Spotify and his website to check out from him. Chapters (00:00) - Introduction to Knowledge vs. Wisdom (01:52) - The Impact of Mental Work on Physical Performance (05:29) - Strength Training Methodologies and Their Applications (06:42) - Transforming Athletes from Novices to Competitors (11:16) - Training Protocols and Recovery Strategies (17:53) - The Role of Energy Systems in Training (30:36) - Integrating Strength and Rowing Training (40:26) - Practical Strength Training Insights (43:18) - The Role of Neurology in Strength (44:45) - Understanding Strength Beyond Muscle Size (49:36) - Neurological Drive and Strength Training (57:28) - Complex Adaptive Systems in Training (01:03:54) - The Importance of Slow Changes in Training (01:12:14) - Vitality and Lifelong Strength Training

Contributor: Travis Barlock, MD Educational Pearls:   Caffeine Geography and Types: Caffeine is found throughout the world and has evolved independently in various plants that are not evolutionarily related through direct lineage, but rather demonstrate convergent evolution (i.e. different species evolve the same traits).  These plants use caffeine as an insecticide.  Examples of caffeine sources include coffee, tea, yerba-mate, guaraná, cacao, and yaupon holly. Roughly 85% of Americans are estimated to consume caffeine daily.   Caffeine Pharmacology in Humans:  In humans, caffeine is a nonselective competitive antagonist (blocker) of adenosine receptors (A1 and A2A).  During waking hours, neuronal metabolic activity consumes ATP, and a byproduct of ATP hydrolysis is created: adenosine.  Adenosine proceeds to build a "sleep pressure".  Acting on A1 and A2A adenosine receptors to induce sleep (on A1, it suppresses neuronal "wakefulness" and on A2A it is believed to be an inducer of sleep).  Caffeine, by blocking those receptors, blunts sleep induction and feelings of being tired.  Caffeine has a half-life of around 6 hours, and a quarter life of approximately 12 hours, which is when the caffeine will off-load and adenosine can once again occupy those receptors, potentially causing a "crash".  Thus, for shift-workers, it is important to time caffeine intake roughly 10 hours before target bed time.  Caffeine exerts other effects on the body.  It is methylxanthine similar to theophylline, which works as a bronchodilator (via phosphodiesterase and adenosine pathways). Caffeine has clinical use to promote bronchodilation in pre-term infants.  Caffeine exerts diuretic effects as well (blocking proximal renal tubule reabsorption).  Recent ingestion of caffeine may blunt therapeutic use of adenosine in patients with SVT.  Key Takeaway? Caffeine exerts a wide variety of effects beyond making us feel more awake. It has cardiovascular, pulmonary, and renal implications in its pharmacodynamics.   References    Benarroch EE. Adenosine and its receptors: multiple modulatory functions and potential therapeutic targets for neurologic disease. Neurology. 2008;70(3):231-236. doi:10.1212/01.wnl.0000297939.18236.ec Mitchell DC, Knight CA, Hockenberry J, Teplansky R, Hartman TJ. Beverage caffeine intakes in the U.S. Food Chem Toxicol. 2014;63:136-142. doi:10.1016/j.fct.2013.10.042 Bruschettini M, Brattström P, Russo C, Onland W, Davis PG, Soll R. Caffeine dosing regimens in preterm infants with or at risk for apnea of prematurity - Bruschettini, M - 2023 | Cochrane Library. Accessed May 23, 2026. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013873.pub2/full?cookiesEnabled Huang R, O'Donnell AJ, Barboline JJ, Barkman TJ. Convergent evolution of caffeine in plants by co-option of exapted ancestral enzymes. Proc Natl Acad Sci U S A. 2016;113(38):10613-10618. doi:10.1073/pnas.1602575113 Cabalag MS, Taylor DM, Knott JC, Buntine P, Smit D, Meyer A. Recent caffeine ingestion reduces adenosine efficacy in the treatment of paroxysmal supraventricular tachycardia. Acad Emerg Med. 2010;17(1):44-49. doi:10.1111/j.1553-2712.2009.00616.x  Summarized by Dan Orbidan, OMS2 | Edited by Dan Orbidan & Ahmed Abdel-Hafiz, NREMT-P   Donate: https://emergencymedicalminute.org/donate/   Join our mailing list: http://eepurl.com/c9ouHf  

In the second episode of this series, Dr. Tesha Monteith and Dr. Peter Goadsby continue their conversation on advances in headache medicine, including brain health, migraine as a risk factor for dementia, and future directions in neurology.  Disclosures can be found at Neurology.org. 

May 30th is World MS Day! This year, the theme for World MS Day is "My MS Diagnosis," and I've been thinking about what happens right after that diagnosis. After an individual hears, "You have MS." This week, Dr. Nancy Sicotte joins me to discuss the things you should know, the things you should be thinking about, and the things you should be doing in the first 100 days following an MS diagnosis.  Dr. Sicotte is the Chair of Neurology and Director of Multiple Sclerosis and Neuroimmunology at Cedars-Sinai in Los Angeles, and she's the past Chair of the National MS Society's National Medical Advisory Committee.  We're also sharing results of a study that showed an exercise hormone protected neurons from inflammatory attack in a mouse model of MS. And we're sharing encouraging news about an experimental nasal spray that's been shown to delay disability progression and improve fatigue among people with non-active secondary progressive MS. We have a lot to talk about! Are you ready for RealTalk MS??! This Week: World MS Day!  :22 Study reveals an exercise hormone has neuroprotective effects on a mouse model of MS    2:40 Tiziana shares evidence that Foralumab delays progression and improves fatigue in people with non-active secondary progressive MS  4:34 Dr. Nancy Sicotte looks at the first 100 days following an MS diagnosis  8:40 Share this episode  28:51 Next week  29:12 SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/456 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 World MS Day Poster Maker https://worldmsday.org/poster-maker STUDY: The Exercise Hormone Irisin Has Neuroprotective Effects in a Mouse Model of Multiple Sclerosis https://www.nature.com/articles/s42255-026-01527-7 CLINICAL TRIAL: A Study of Nasal Foralumab in Non-Active Secondary Progressive Multiple Sclerosis Patients https://clinicaltrials.gov/study/NCT06292923 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 456 Guest: Dr. Nancy Sicotte Privacy Policy

The "Community Meets Clinic" podcast series introduces clinicians and healthcare personnel specializing in rare neuroimmune disorders. In this episode hosted by Krissy Dilger of SRNA, we met Dr. Benjamin Greenberg of the UT Southwestern Medical Center. He outlined his translational research, including the Q Study, a Phase 1 trial assessing the safety and feasibility of transplanting human glial restricted progenitor cells into the spinal cord of people who have been diagnosed with transverse myelitis (TM) [05:49]. He also described research on immune-remodeling therapies for NMO aimed at reducing long-term immunosuppression. Dr. Greenberg illustrated multidisciplinary care at UT Southwestern and Children's Medical Center, emphasized options for second opinions and clinician-to-clinician remote consultation, and shared hopes for nervous system repair trials and curative immune therapies [07:18]. You can view Dr. Benjamin Greenberg's medical profile here:https://utswmed.org/doctors/benjamin-greenberg/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 at Children's Medical Center [https://www.childrens.com/specialties-services/specialty-centers-and-programs/neurology/demyelinating-disease-program].Dr. Greenberg earned his medical degree at Baylor College of Medicine before completing an internal medicine internship at Chicago's Rush Presbyterian-St. Luke's Medical Center. He performed his neurology residency at the Johns Hopkins School of Medicine. He also holds an M.H.S. in molecular microbiology and immunology from the Bloomberg School of Public Health, as well as a bachelor's degree in the history of medicine – both from Johns Hopkins. Prior to his recruitment to UT Southwestern in 2009, Dr. Greenberg was on the faculty of the Johns Hopkins Division of Neuroimmunology, serving as the Director of the Encephalitis Center and Co-Director of the nation's first dedicated Transverse Myelitis Center.Dr. Greenberg splits his clinical time between adult and pediatric patients at William P. Clements Jr. and Zale Lipshy University Hospitals, Parkland, and Children's Medical Center. His research focuses on better diagnosing, prognosticating, and treating demyelinating diseases and nervous system infections. He also coordinates clinical trials to evaluate new treatments to prevent neurologic damage and restore function to affected patients.00:00 Welcome and Guest Intro01:41 Path to Neurology03:50 Why Neuroimmunology05:49 Research Focus and Trials07:18 Clinic Team and Referrals10:31 Self Care and Hobbies12:17 How the Clinic Can Help14:16 Hope for Future Therapies15:56 Wrap Up

In the first part of this series, Dr. Tesha Monteith talks with Dr. Peter Goadsby about some major themes that emerged from the AAN Annual Meeting regarding headache medicine.   Disclosures can be found at Neurology.org. 

Dr. Alex Menze and Dr. Breton Asken discuss the long-term impacts of repetitive head impacts in football players, focusing on inflammation, brain microstructure, and cognitive decline. Show citation:  Emanuel OM, Miner AE, Lee SY, et al. Inflammation, Limbic White Matter Microstructure, and Clinical Symptoms in Retired American Football Players With Repetitive Head Impacts. Neurology. 2026;106(6):e214646. doi:10.1212/WNL.0000000000214646 

In this episode, Bernadette Boden-Albala, MD, MPH, DrPH, Founding Dean, Joe C. Wen School of Population & Public Health; Professor, Health, Society & Behavior and Neurology, University of California, Irvine, discusses building a next-generation public health school, advancing prevention and community health, and preparing future leaders to tackle today's biggest healthcare challenges.

In this episode of Fit, Fun, and Frazzled, host Nikki Lanigan sits down with pelvic health physical therapist Val Brown to explore one of the most overlooked parts of women's wellness: the pelvic floor. Val shares her Vital Axis Method — a groundbreaking approach that integrates pelvic health, neurology, yoga, and functional medicine to help women reconnect with their bodies, reduce injuries, and step into their pleasure, power, and purpose. Whether you're a postpartum mom, a busy professional dealing with burnout, or an athlete who keeps getting hurt, this conversation will change how you think about your body.Find Val:Website: http://vitalaxispt.com/Instagram: @Vital.axis.methodYouTube: VitalaxisWorkshops: link in Val's Instagram BioTimestamped Show Notes:0:00 — Intro & Meet Val Brown~1:00 — What Is the Vital Axis Method?~2:30 — Pelvic Floor Beyond Pregnancy & Kegels~5:00 — The Neurology & Shame Behind the Pelvic Floor~8:00 — Chronic Stress, Burnout & Pelvic Health~10:00 — Exercise, Movement & Whole-Body Connection~12:30 — Why Women's Health Is Dismissed~16:00 — One Thing Everyone Should Know~17:00 — Rapid Fire: Books, TV, Matcha vs. Coffee~22:00 — Where to Find Val

Palliative care in multiple sclerosis spans the disease course, from early screening and support after diagnosis to symptom management and quality‑of‑life optimization in midstage disease, and end‑of‑life care in advanced MS. This episode outlines a staged approach to palliative care, highlights the roles of neurology and primary care teams, and discusses tools such as patient‑reported outcomes and symptom scales to support ongoing assessment of patients and care partners. In this episode, Katie Grouse, MD, FAAN, speaks with Penelope Smyth, MD, FRCPC and Janis M. Miyasaki, MD, MEd, FRCPC, coauthors of the article "Palliative Care in Multiple Sclerosis" in the Continuum® April 2026 Multiple Sclerosis and Related Disorders issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California, San Francisco in San Francisco, California. Dr. Smyth is the director of the Division of Neurology in the Department of Medicine at the University of Alberta in Edmonton, Alberta, Canada. Dr. Miyasaki is a professor in the Division of Neurology in the Department of Medicine at the University of Alberta and the zone clinical department head for Clinical Neurosciences at Alberta Health Services in Edmonton, Alberta, Canada. Additional Resources Read the article: Palliative Care in Multiple Sclerosis 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 Full episode transcript available here Dr Grouse: With the new treatments for MS, people might be saying palliative care is not relevant at all. It's about giving up hope and hopelessness. But this article covers why palliative care is important for your patients and families throughout their illness trajectory. 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 Grouse: This is Dr. Katie Grouse. Today, I'm interviewing Drs Penelope Smyth and Janis Miyasaki about their article on palliative care in multiple sclerosis, which appears in the April 2026 Continuum issue on multiple sclerosis. Welcome to the podcast, and please introduce yourselves to our audience.  Dr Smyth: Thank you, Katie. I'm Penny Smyth. I am a neurologist at the University of Alberta, a professor in neurology, and a clinical multiple sclerosis specialist.  Dr Miyasaki: Hi, Katie. Thanks for having us. I'm Janis Miyasaki. I am a movement disorder neurologist primarily who also provides neuropalliative care at the University of Alberta in Edmonton, Canada.  Dr Grouse: It's so great having you today to talk with us about your article. I thought this article was really a wonderful take on the topic. I learned a lot, and I'm really hoping all of our listeners will take advantage of this article and take advantage of all the learning they can get from reading about this topic. So, I wanted to start with a more general question, which is, what is the key message from this article that you're hoping your readers will take away?  Dr Smyth: In terms of key takeaways, I think it's our hope that neurologists will come away from reading this article with, really, an expanded understanding of what palliative care is and how that might be applicable to them in their care for their patients with MS along a continuum of treating people with MS, that there can be components of palliative care and strategies that can be integrated early after diagnosis in, really, anywhere along the continuum of caring for people with MS. We've called that kind of mid-stage. And then there are particular needs for people with MS and their care partners in late-stage or severe MS and end of life that might require different palliative care strategies. I think we kind of have maybe a bit of a bias sometimes in thinking of palliative care as more directed towards those that are near end-of-life. But in fact, it's a much expanded concept.  Dr Miyasaki: And I'll just add that we also discuss a palliative approach, that palliative care skills and philosophies can be used by generalists---in this case, neurologists who are providing care to people with MS---and that adopting certain skills and communication techniques can help us better address our patients' and their families' symptoms. And also to keep in mind that for most people with neurologic illness, the unit of care is not only the patient, but it's the patient and the family, however that family looks.  Dr Grouse: Now, Penny, I'm curious, how are early-stage and mid-stage multiple sclerosis palliative care strategies different from, say, a typical evaluation and counseling that a neurologist would give, say, an MS specialist or even a general neurologist?  Dr Smyth: Thank you, Katie. That's a great question, and something that actually I learned in writing this piece with Janice and from her as a neuropalliative care expert. I think in terms of early strategies around palliative care that can be helpful to the general neurologist in their office, palliative care is about holistic support for patients and their care providers spiritually, emotionally, physically. There are components of palliative care and symptom management and making sure that the patient is at the center of the care, as well as support for their care partners with their holistic approach of relief of suffering as well as offering hope. When I started this piece, I was thinking that many of us neurologists, I think, often informally utilize many of these components already when we're dealing with patients early on after diagnosis in terms of communication, counseling, and education; going through their fear of an uncertain future; spiritual well-being; and then connecting them with supports for adaptive coping strategies. And then as well in mid-stage, which is really around what we can do in symptom management and improving quality of life, with screening tools and patient-reported outcome measures. However, I have to say that there are many unmet needs for people with MS and their care partners that they identify that are clearly not being met by us neurologists in this day and age. So even though we may be incorporating some of these strategies, I don't think we're meeting the mark all the time and hitting the target, especially in our busy office practices, in various ways. Dr Grouse: Given that, at a high level, what are some important early-stage MS palliative care concepts that we should be keeping in mind when we are counseling patients in these stages of the disease? Dr Miyasaki: An important concept to keep in mind for neurologists dealing with early-stage MS patients is that for us, we feel successful that we have made a diagnosis. And yet for the patient, it is taking away that hope. Maybe it's not MS. Maybe I just have a numb hand and it's gonna go away. And for us to appreciate that while we make this diagnosis multiple times a week---or, for MS specialists multiple times a day---for this person, it is the first time, the first experience, and it shakes their entire foundation of who they are as a person, how they will perform all the tasks and roles that they have in society, in their professional lives, in their family structures, and in their close, intimate relationships. As physicians, we may be overwhelmed by acknowledging that. I feel that it's important for us to understand the needs that our patients have and to allow them to have their feelings. You know, feelings can feel messy and time-consuming, and yet when we fully see our patients, I feel that this is the best of medicine. And it certainly is, in terms of palliative care, the principle that we seek. We accept all of the patient, the joy and the sorrow, the anger and the frustration. We accept it all, and we try to determine what will serve this person who is suffering in front of us now.  Dr Smyth: There's another piece to this, which came up as Janice and I were writing together. We were talking about offering a prognosis to a patient as to how they would do, and this was something that I thought deeply about, because I said, we always communicate how uncertain the prognosis is and how we can't predict the future. And then she said to me, well, what about offering a roadmap to a person with MS soon after diagnosis as to how you're gonna determine how they do over the next couple of years? Which are really important years in terms of determining how patients are doing on their disease-modifying therapies, whether they're having progression or not, and things. It's a pivotal time. So, if you can offer a roadmap to a person with MS and say, look, this is when we will be following you up. This is how we will be following you with MRI and biomarkers if you have that available, and this is how we will determine how responsive you are and then how we move forward from there. Dr Grouse: Really important concepts. And the roadmap certainly makes a lot of sense to me and something that, apart from just being useful to the patient for so many reasons to help set expectations, you know, is useful for us to better partner with the patient so they understand this is sort of how we do things and everyone's sort of expectations are met. So, I think those sound like really great goals and things to keep in mind. Now, we talked about early-stage MS palliative care concepts. How does that change as you get into the mid-stage of the disease?  Dr Smyth: Yeah. So, this is reflecting the fact that the course of MS is so different and the experience of MS is so different person to person. And so, what do we do as neurologists when we follow these people long-term over years and decades of living with their MS as their needs evolve, as their symptoms evolve, and as their disability evolves? Well, really, this is about the time of getting into, what are the symptoms that they're struggling with, what are the causes of their suffering at various points? And then how do we identify that, maybe with use of patient-reported outcome measures, screening scales, things like that. And then how do we direct symptomatic management to the specific symptoms that are causing distress to the patient? As well as trying to improve their quality of life in various ways, treating their comorbidities, making sure to check on exercise, healthy living, and that kind of thing.  Dr Grouse: Now getting into, I think, topics that we're more used to thinking about when we think about palliative care: a lot of us, I think, are really unsure of the right time to discuss advanced care directives in the course of multiple sclerosis, and I think that's not helped by the fact that many of us are just, in general, not terribly comfortable talking about those types of things in general. What is your advice to questions like this?  Dr Smyth: And this is something that, again, Janice and I had to come together on, because there is no universal accepted time for when is the right time in multiple sclerosis to discuss advanced care directives and goals of care. And in fact, when they have looked at it in the literature, different things have come out. It has come out that neurologists can be uncomfortable discussing this. There's unique challenges to people with MS in that they have a diagnosis at a young age with an uncertain trajectory of how their course of disease is going to go. And many of these things lead care providers to be somewhat hesitant as to when is the right time, as well as, there were identified barriers within patients themselves as to when the right time might be to discuss. In that, you know, some of the coping strategies might be, as identified by some of the qualitative studies that have been done on this, around the fact that they would prefer to focus on the present rather than the future. In some studies expressed an ambivalence as to when they thought the right time might be, as well as some negative experiences that they might have had from providers trying to discuss these things in their previous experience. So, I went back to looking at the European guidelines for palliative care in MS, who suggested when a person might have severe MS---which they define as walking with bilateral aids for at least twenty meters or an EDSS of six or higher---or trigger-based, when there has been a change in the patient's status, when there's been a decline in some way or progression. Now, this is a little different, actually, than what we offer other people with neurologic diseases, and I don't know if that's the right answer. And this is where I'm going to turn it over to Janice, because I think we could learn something, as neurologists who treat people with MS, from our palliative care specialists.  Dr Miyasaki: I think of advanced care planning in a very different way. I think what a lot of the patients were expressing in the studies was that being asked about advanced care planning signaled to them in some way that they have reached this point in their illness where things aren't going so great and I anticipate that you may run into complications. Whereas in our movement disorder clinic, one of our fellows did a study looking at capacity for decision-making. And even in people who scored normally on the Montreal Cognitive Assessment, they had impairments in some of the domains of decision-making. And so, our philosophy in movement disorders at least---and some of our patients are quite young who have multiple system atrophy, they could be in their forties---we take the philosophy that everyone over the age of decision-making capacity, which is generally eighteen, should have some goals of care established. And how I introduce it in my clinic is, you know, for the young resident, you want the full-meal deal, because the likelihood of the resident surviving the ICU admission is very high. And then when we look at me, who… I am older, the likelihood of surviving an ICU admission is considerably lower. And so, the appropriate goals of care might be that I am willing to go to the ICU, and if things go well, then they can continue. But if things are not going well, they can have a discussion with my personal directive or power of attorney to talk about what the goals of care should be. And then the other aspect is sometimes having the conversation with family is really important because most of our families in hospital express an uncertainty. Am I doing the right thing? And they want to do the right thing for their loved ones. And most people actually say, if you ask them, I don't want to burden my family with making decisions that are going to tear at their hearts. So, then we can't actually make good informed decisions for our loved ones unless we have clear conversations. I think it does speak to our superstitious beliefs that if we talk about death, it's going to happen. But I hope the listeners will take my word for it, it really doesn't. And someone had a really good saying about the advanced directive. They're kind of like evening clothes. You should take them out every once in a while and make sure they still fit. And so, when you normalize it in this way, it helps people to just say, oh, yeah, it's once a year. Dr. Miyasaki is gonna ask me about how do I feel about those goals of care. And then it doesn't have this portent of, oh, I'm not doing well. Instead, it's just, this is what we should all be doing for our sake and for our family's sake.  Dr Smyth: Now, one thing that I have to add on to this is that it is important to try to establish advanced care directives before patients experience cognitive decline, because then that can make it a much more challenging conversation and brings nuances of challenge into the interactions, which, you know, are hard.  Dr Grouse: And Penny, I'm glad you brought that up, because I was really struck by that point too when reading this article, how easy it is to miss the subtle signs that cognitive changes are happening. I think it's just- it's a good kind of segue into that topic in general, but it is such an important link to, you know, making sure that you get those advanced directives at a time when the patient's really able to express and understand what they're talking to you about. Now, on the topic of the cognitive screenings, what's a good way to do this type of screening, and why is this type of screening so particularly important in the case of multiple sclerosis?  Dr Smyth: Yeah. Thank you, Katie. I think that it's important for our listeners to think about and recognize when we see our patients with MS because it is one of the invisible symptoms that people with MS can live with and may not be apparent on regular conversation in the office. So, it's important to deliberately ask about subjective challenges in cognition. Ask the partner about how they're doing in terms of their cognition in various ways. As well as asking them and exploring then, how are they doing in their professional roles if they're working or in their surroundings? How are they coping on a daily basis on a cognitive level in addition to a physical level? We know that cognitive issues are actually the biggest contributor for not working and are a huge driver of disability in MS in terms of functioning, even more than physical decline in many ways. So, it is important for us neurologists to keep top of mind and to think about and deliberately attend to. There are screening tests that we can do in the office. The easiest for us, which measures the verbal processing speed, is the SDMT test, which is a ninety-second test matching symbols and numbers. It's easy to do. You can train a MOA to do it before you see the patient and things like that, and it just gives you an idea as to where the patient is at. And usually they're having difficulties if they're greater than two standard deviations below the norm for their age, or if there's a significant drop of four or eight points, and that might signal to you that there might be more going on. You can explore it, and then if you do have this available, the ability to refer for neuropsychological testing if there's questions. But often we can't get it with the MoCA score, unfortunately.  Dr Grouse: Talking about all these concepts, I think they all sound great. I think a lot of us hearing this will naturally say, "Yes, these are absolutely things we should be incorporating in the care of these patients." What I wondered about was, certainly we're all very busy, it is really hard to find time for a lot of these things. We don't always have access to specialists who can help us with some of these conversations. How can we find time, and how can we work this into the care of our patients effectively and still make time for all the other things we have to talk about, and make sure that we're seeing all of our other patients and staying on time and all of those things?  Dr Miyasaki: Yes. I think that's the challenges of dealing with people who actually, over time, their care needs increase, is huge in neurology. I can't think of a single subspecialty where care actually gets easier. It's constantly getting harder. You know, having come from private practice, I completely understand my colleagues' challenges in the community. Some of the ways that other groups have managed this when they don't have government or university support in their center is actually to look at not-for-profits. There are a lot of not-for-profits that can help in terms of wayfinding for social services, explaining to the patients and the family what is available to them. And in fact, some of them can also provide some cognitive supports, as well as point them in the way of day programs. And many of them have very established caregiver support groups, as well as patient support groups for various stages of their illness. So, I think it requires for the individual or small or even a large group practice to be inventive, to look in your community and see what resources are available and free for your patients in order to establish that loose team without boundaries to help your patients. Of course, for those in academic centers, I know that times are tight for all of us, and if you haven't established a team, it is a challenge; and then learning how to write a business plan or a briefing note for your institution and to learn how to speak the love language of administrators, is really key to putting forward the needs of our patients. Which, compared to heart attack patients or hips and knees, they are very rare, and yet our patients can result in significant cost to the healthcare system. So, we do have an opportunity to make the case that putting a little bit of investment in the ambulatory setting can result in significant cost savings to the system when it comes to acute care hospitalization.  Dr Smyth: So, I was thinking, Janis, as you were talking about that, when you were talking about not-for-profit groups, it's really the MS societies in various countries that are very active in this and have a lot of resources available, especially for care partners.  Dr Grouse: Those are really great tips. Thank you for bringing those up as potential other resources we can take advantage of. I wanted to ask specifically about physician-assisted death and assisted suicide, which certainly does come up, especially in later-stage parts of the disease. How can palliative care specialists be helpful when patients do express interest in these types of interventions?  Dr Miyasaki: As you know, Katie, in Canada, we've had a legislative right to access to what we call medical assistance in dying. When the legislation passed, one of my other colleagues and I felt that these were the only conversations we were having with our patients. In all this experience, I have sort of developed in my mind a framework of people who are what we call MAID-curious. They want to know what their rights are and how it would look, when they feel the time is close, for them to exercise that right. And then there are those who are fearful of future suffering. And some of them may have a very unrealistic view of what the future will look like. And this may be in particular for multiple sclerosis because many of the public's view is based on what treatment was like thirty years ago. It may not be informed by more recent treatment where patients actually do quite well, and the majority never get to progressive MS. And so, to explore and be open to that request is the first thing that is important. And then if the person has unresolved symptoms that, traditionally, we can't care for, the palliative care specialist can be very helpful because they just have inventive ways of looking at things. They look at it outside the box, and they have a different toolkit available to them. I would not want all neurologists to just send all these patients requesting physician-assisted death to their palliative care colleagues. But I think for those who are having unaddressed symptoms, it can be very helpful. Certainly, if there is an acute event in the hospital, then this is a time of crisis. And often hospitals will have an in-hospital palliative care team who can come and speak to the patient about what is going on and address some of their needs. And I would also like to emphasize the importance of spiritual care, because for many of our patients, they are not just having the physical suffering, they are also having the spiritual suffering of hopelessness or of feeling that they are a burden or that they just are not seen because a lot of the symptoms in MS are invisible. To have that understanding by a spiritual care counselor is really helpful for the people to feel understood and to reduce some of that suffering.  Dr Grouse: That's a really great point, I think, to end on, and I think it really ties in a lot of the themes that we've been talking about today. Thank you so much for coming to talk with us today. It's been such a pleasure having you both here. Dr Smyth: Thank you. Dr Miyasaki: Thank you, Katie. Dr Grouse: Again, today I've been interviewing Drs Penelope Smyth and Janis Miyasaki about their article on palliative care in multiple sclerosis, which appears in the April 2026 Continuum issue on multiple sclerosis. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

May is mental health awareness month, so I've gone back and pulled the top tips and advice from neuroscientists, psychologists and biohacking experts on how to improve your happiness, anxiety, and depression through specific supplement protocols, brain health hacks, and healing your gut. Because we can't ignore the physical side to mental health, and taking care of our bodies is a key piece in taking care of our minds.  Tune in to hear about: Our mood has EVERYTHING to do with our brain health. So what do top neuroscientists recommend for psychiatric issues? Dr. Kristen Willeumier offers her EXACT protocol for improving anxiety without a medical prescription. This is game-changing advice on the power of supplements for managing anxiety and psychiatric disorders, from an award-winning neuroscientist with a PHD and Masters in neurobiology, Masters in Physiological science, and postdoctoral scientist in the Department of Neurology at Cedars-Sinai Medical Center in LA. Your gut can play a huge role in your mental health (95% of the serotonin in our body is housed in the gut!). Clinical psychologist, author, and founder of Heartship Psychological Services, Dr. Lauren Cook, breaks down what tests and bloodwork to get, the supplements that changed her brain, and how gut health is intrinsically linked to mental health.  If you're struggling with persistent low mood and energy, this surprising supplement recommendation from chemical engineer and biohacking pro Chloe Deutscher could be the answer. Learn why certain supplements and vitamins can help with depression, calm anxiety, and boost your serotonin.   For advertising and sponsorship inquiries, please contact Frequency Podcast Network. Subscribe to my Substack:teachmehowtoadult.substack.comFollow us on the ‘gram:@teachmehowtoadultmedia@gillian.bernerFollow on TikTok: @teachmehowtoadultSubscribe on YouTube

Women make up about two-thirds of people diagnosed with Alzheimer's disease, but experts say longer life expectancy alone does not explain the gap. Dr. Jessica Caldwell's research focuses on how sex and gender influence Alzheimer's disease risk, resilience, and progression, including the roles of genetics, menopause, lifestyle factors, and life stressors. Caldwell is a neuropsychologist and investigator of the Wisconsin Registry for Alzheimer's Prevention, or WRAP, at the Wisconsin Alzheimer's Institute, as well as a visiting associate professor in the Department of Neurology at UW–Madison. She previously directed the Women's Alzheimer's Movement Prevention Center at Cleveland Clinic, the first Alzheimer's prevention center designed exclusively for women.In this conversation with Being Patient's Mark Niu, Caldwell explained how the disparity is influenced by multiple factors, including genetics, menopause, estrogen loss, medical conditions, lifestyle, and caregiving-related stress. She discussed why midlife may be an important window for prevention, especially for women. Caldwell also described how hormonal changes during menopause, symptoms such as hot flashes and depression, and chronic stress may affect brain health, while lifestyle factors such as exercise, nutrition, medical care and social connection may help support resilience.---If you loved listening to this Live Talk, visit our website to find more of our Alzheimer's coverage and subscribe to our newsletter: https://www.beingpatient.com/Follow Being Patient: Twitter: https://twitter.com/Being_Patient_Instagram: https://www.instagram.com/beingpatientvoices/Facebook: https://www.facebook.com/beingpatientalzheimersLinkedIn: https://www.linkedin.com/company/being-patientBeing Patient is an editorially independent journalism outlet for news and reporting about brain health, cognitive science, and neurodegenerative diseases. In our Live Talk series on Facebook, former Wall Street Journal Editor and founder of Being Patient, Deborah Kan, interviews brain health experts and people living with dementia. Check out our latest Live Talks: https://beingpatient.com/live-talks/

Often what brings someone into our office looks straightforward at first—a concussion, dizziness, headache, or a sense that something is not quite right. But what begins as the search to fix a symptom often reveals something deeper—a nervous system that has lost its bearings, sensory maps that no longer line up, and a body quietly adapting around signals it can no longer fully trust.Ayla Wolf and Clayton Shiu both work at the intersection of functional neurology and East Asian medicine. Through clinical observation, modern diagnostic tools, and hands-on palpation, they've developed ways of seeing patterns that often sit beneath symptoms most people wouldn't connect to the brain.Listen into this conversation as we explore how concussion can masquerade as digestive issues, tinnitus, anxiety, or vestibular dysfunction. And why the neck, eyes, inner ear, and autonomic nervous system all can be part of the problem. We'll explore how acupuncture can help restore orientation, balance, and sensory accuracy. And what becomes possible when ancient medicine intersects with a modern understanding of neuroplasticity.

Photobiomodulation Stroke Recovery: How Laser Therapy Is Restarting Damaged Brains After Stroke For seven years, a woman lived unable to remember faces. She had developed prosopagnosia, a condition that turned every person she met into a stranger, no matter how many times they had been introduced. She kept notes. She took photographs. She built systems to compensate for what her brain could no longer do on its own. Then she sat down for a single laser therapy session with Dr. Robert Hedaya. One session later, the problem was gone. “I can remember the face of the person I worked with this morning and his wife and the dimple on his face,” she told him, describing something she hadn’t been able to do in nearly a decade. What Dr. Hedaya witnessed that day and what he now works to replicate for stroke survivors, people living with aphasia, early dementia, and Parkinson’s, is the result of a therapy called photobiomodulation. And the principle behind it may fundamentally change how you understand your own recovery ceiling. Your Neurons May Not Be Dead. They May Just Be Stuck When a stroke occurs, conventional medicine draws a clear line. Tissue that is destroyed is gone. Deficits that persist beyond the early recovery window are considered permanent. Survivors are told, sometimes gently, sometimes bluntly, that they have plateaued. Dr. Hedaya challenges that directly. In his clinical experience, there is often a population of neurons that survived the stroke intact but are no longer functioning. They are alive. Their cellular architecture is preserved. But they have lost their energy supply, specifically, the ability to produce ATP, the molecule that powers every cellular process in the body. Without energy, these neurons go quiet. They stop firing. From the outside, this looks like permanent damage. But it isn’t. It is dormancy. This mirrors the concept of the chronic penumbra explored in hyperbaric oxygen therapy research, where viable tissue sits in a suspended state, waiting for conditions to change. Dr. Hedaya’s approach is different in method but identical in premise: the brain has not finished recovering. It is waiting for the right signal. Photobiomodulation provides that signal. What Photobiomodulation Actually Does “After the first laser treatment, the problem was gone. Gone. She told me — I can remember the face of the person I worked with this morning.” — Dr. Robert Hedaya Photobiomodulation, also called transcranial laser therapy, delivers precise wavelengths of near-infrared light to targeted areas of the scalp. The photons penetrate through the skull, meninges, and tissue to reach dormant neurons, where they act on the fourth complex of the mitochondrial electron transport chain, the site where nitric oxide accumulates and blocks ATP production. The photons dislodge that nitric oxide. The mitochondria resume normal energy output. The neuron now has what it needs to resume its function. The downstream effects are significant: new synapses form through a process called synaptogenesis, brain-derived neurotrophic factor (BDNF) is produced, inflammation decreases, and misfolded proteins associated with cognitive decline begin to clear. Given energy, the brain begins repairing itself, not because the laser forces it to, but because the cells already know what to do. They were just waiting for the fuel. How QEEG Makes It Precise Not every stroke survivor responds to the same laser parameters or needs treatment in the same regions. This is where Dr. Hedaya’s approach clearly separates from consumer LED helmets or generic light therapy devices. Before any laser is applied, he conducts a quantitative EEG, a brain mapping process that measures electrical activity at 19 points across the scalp. Unlike a standard EEG, which relies on a clinician reading scrolling waveforms visually, QEEG uses AI to analyse thousands of data points and reverse-engineer the source. The result is a functional map: which networks are underperforming, which are overactive, and where pathways between regions have broken down. This is paired with a neuroquant MRI that measures 30 to 40 distinct brain structures volumetrically. Together, they function as a GPS triangulating exactly where the laser should be directed, at what wavelength, power, pulse frequency, and joule delivery for each individual patient. These parameters are adjusted as the patient responds, session by session. This level of precision is what distinguishes clinical photobiomodulation from anything available over the counter. A half-watt LED helmet delivering diffuse light through hair and scalp is not the same intervention. Depression After Stroke – And the Whole-Body Connection Roughly 30% of stroke survivors experience depression in the aftermath. This is not simply an emotional response to a difficult event – it is a physiological outcome with identifiable drivers that conventional psychiatry often does not investigate. Dr. Hedaya’s model, which he calls whole psychiatry, treats post-stroke depression as a downstream expression of broader disruption: hypothyroidism, hormonal imbalance, B12 deficiency, elevated mercury from dietary sources, gut dysbiosis, chronic inflammation, and unresolved neurological stress all play measurable roles. In one of his current stroke cases, treating low thyroid function triggered seizure sensitivity because post-stroke tissue is more vulnerable to excitatory input. That kind of complexity is precisely why a comprehensive functional evaluation must precede treatment. For survivors too depleted to engage with lifestyle changes, Dr. Hedaya will now often begin with laser therapy directly. Once cellular energy is restored, the motivation and capacity to make further changes typically follow. The jump-start, he has found, enables everything else. Is Recovery Still Possible After a Plateau? If you have been told you have reached your ceiling, the core message of this episode is worth sitting with: the plateau is often not a biological fact. It is frequently the consequence of underlying conditions that haven’t been identified, and dormant tissue that hasn’t been activated. “The brain is incredibly plastic,” Dr. Hedaya says. “When you challenge it and give it everything it needs, nutrients, light, hormones, and remove the toxins, great things can happen. There is hope. There is so much hope.” His practice, the Whole Psychiatry and Brain Recovery Center, offers initial consultations via Zoom for those who cannot travel to New Jersey. For survivors with a local physician willing to collaborate, educational consultation is also available. Reach Dr. Hedaya at wholepsychiatry.com. If this episode opened something up for you, Bill’s book – The Unexpected Way That A Stroke Became The Best Thing That Happened follows the full arc of what recovery can become when you stop accepting the ceiling and start questioning it. Find it at recoveryafterstroke.com/book. If the Recovery After Stroke podcast has supported your journey, you can support the show at patreon.com/recoveryafterstroke. This blog is for informational purposes only and does not constitute medical advice. Please consult your doctor before making any changes to your health or recovery plan. The Laser That Restarts Brains – Dr. Robert Hedaya on Photobiomodulation, QEEG, and Whole Psychiatry After Stroke A laser pointed at the right spot in your brain can restart neurons that stopped working. Dr. Robert Hedaya explains how and who it can help. Hyperbaric Oxygen Therapy – Dr. Amir Hadanny Highlights: 00:00 Introduction – Photobiomodulation Stroke Recovery 01:09 Dr. Hedaya’s Medical Journey 07:55 Transition to Functional Medicine 10:31 Photobiomodulation Stroke Recovery Applications 19:21 Understanding Laser Mechanisms 24:36 Jumpstarting Healing with Laser Therapy 29:48 Understanding EEG vs. QEEG 34:10 Addressing Depression Post-Stroke 39:38 Holistic Approaches to Recovery 46:20 Patient-Centered Care and Follow-Up 51:38 The Role of Spirituality in Healing Transcript: Introduction – Photobiomodulation Stroke Recovery Dr Bob Hedaya (00:00) After the first laser treatment, the problem was gone. Gone. She told me, she said, my God, I can remember the face of the person I worked with this morning and his wife and the dimple on the face. And I said, what are you talking about? She says, have prosopagnosia. I said, says, can’t remember faces. I have to write down everything that I do and take pictures of everything and every person. I said, my God, it’s gone, gone. that’s when I went home that night and I was like, this doesn’t make any sense. How could this be? There’s nothing about a neurological condition being turned around in one minute. It makes no sense. Dr. Hedaya’s Medical Journey Bill Gasiamis (00:41) Welcome everyone to the Recovery After Stroke podcast. I’m Bill Gasiamis and my guest today is Dr. Robert Hedaya, a board-certified psychiatrist, functional medicine practitioner, and the founder of the Hull Psychiatry and Brain Recovery Center in New Jersey. Dr. Hedaya trained at Georgetown and the National Institute of Mental Health. And over the course of his career, he moved from conventional psychopharmacology into functional medicine after discovering of what was driving his patient’s symptoms had nothing to do with their medications and everything to do with their biology. In more recent years, Dr. Hedaya has added a tool that very few practitioners anywhere in the world are using, QEEG, guided transcranial photobiomodulation. That’s laser therapy, precisely using a functional brain map to reactivate neurons that survived the stroke but stopped working. In this conversation, we get into the science behind photobiomodulation and what it actually does inside the cell. How QEEG brain mapping removes the guesswork from treatment, why post-stroke depression is so often mismanaged, the role of nutrition, hormones, and toxin load in recovery. and why Dr. Hedaya believes the plateau most survivors are told about is not the biological sealing they’ve been led to believe it is. Now, before we get into this episode, if you found this podcast helpful in your recovery, my book, The Unexpected Way That a Stroke Became the Best Thing That Happened goes deeper into the tools and mindset shifts that support long-term recovery and personal transformation. You can find it at recoveryafterstroke.com/book. And if this show has supported you, you can support it at patreon.com/recoveryafterstroke. Now let’s get into it. Bill Gasiamis (02:38) Dr. Hedaya. Welcome to the podcast. Dr Bob Hedaya (02:41) Thank you. Pleasure to be here. Bill Gasiamis (02:43) It is a very good pleasure to have you here as well. The reason being is because I, what we’re going to discuss, but B the way that you came to be on my podcast was through somebody who listens to my podcast, reaching out and saying, need to have this gentleman on your podcast. And I get that a lot. And sometimes it’s like, thank you for the referral, but maybe that’s not for me, but this is definitely for me. Can you give me a little bit of. Dr Bob Hedaya (03:01) Mm-hmm. Mm-hmm. Bill Gasiamis (03:13) background for people who are listening to understand how it is that you and I came to be on the podcast today, but more importantly, like your medical journey to today. Dr Bob Hedaya (03:26) Well, so first of all, I ⁓ was treating a woman who was, let’s say, about 50 years old. She had several strokes. And her husband looked me up, and they came here for treatment. in New Jersey. And ⁓ she had significant improvement in her ability to speak over a short period of time. That’s a little. kind of summary of the situation, but it was ⁓ profound. She still has work to do, a lot of work to do, but she’s doing it and she’s progressing nicely. So that’s, he basically, I guess, decided this needs to get out. And so he contacted you, et cetera, et cetera. In terms of my journey, ⁓ that could take a few hours. So let me try and summarize it. I will say I basically went to medical school, took off six months to study medicine on my own after two years because I really, lot of reasons, but one of them was I just was memorizing things and I didn’t really understand what I was doing. And so I took off six months and I really learned about the human body. I studied, I had a schedule, a very fixed schedule, about 10 hours a day of studying and exercise and eat. was very, you know, I was young and regimented. And I had six books, six subjects that I wanted to get through and I did. And I learned all about the body and different parts of the body, how they interact with each other. And also I was able to understand and predict even certain kinds of processes and problems in the body. So that was an integrative experience, which ⁓ later really served as the foundation for what I do. Fast forward, I was going to be a surgeon, decided to be a psychiatrist instead, because I was fascinated by by the human mind. And what happened was I was trained at Georgetown National Institute of Mental Health in Washington, DC. And then I was in practice for about a year. And I was treating a woman who had panic attacks. And they weren’t getting better after a year. And panic attacks are pretty easy to treat. And so I was like, what’s going on here? She paged me one night after a year, Saturday night. And I remember I had a little beeper, you know, and I went to find a phone booth and, hey, Joanne, what’s going on? It’s midnight, right? She’s talking to me, I’m having a panic attack. And I mean, I still remember the anguish in her voice. You know, it was really, really, really rough to listen to. So Monday morning, I went into the office very early and I’m like, I’m missing something. What am I missing? So I found I had one piece of blood work. had a blood count and the size of her red blood cells was large. and I had seen that and didn’t know what it meant and ignored it. Very little. It wasn’t very large. It was just a little bit out of the norm. And I was trained in hospitals. know, in hospitals, you don’t worry about the little things. You worry about the train wrecks, right? So you never really learn what the little things mean. So here was a so-called little thing and it was ruining her life. Meanwhile, I did some research. It was a B12 deficiency. I gave her B12 injection. And with the first injection, her panic was gone. Transition to Functional Medicine I mean, gone, gone, gone. And I was like, whoa, what else am I missing? Because psychiatry, neuropsychiatry, it’s a revolving door. You go to this doctor, you take these meds, you do this therapy. That works for a while, then you go somewhere else. I figured I’m missing a lot of stuff. And basically, ended up learning. I didn’t know it was called functional medicine, but I ended up learning functional medicine on my own. Wrote a book, got introduced. to Jeff Bland at IFM. contacted me and took formal training and then, you know, that was what I was doing. And I did that, ⁓ put out a second book ⁓ and that was a best seller. And ⁓ the book was called the Anti-Depressant Survival Program. But really it was functional medicine psychiatry or whole psychiatry, which I like to call it. But it’s functional medicine psychiatry, but the publisher wanted… you know, a nice fancy title that would, know, so they decided to call it the Anti-Depressant Program, you know, survival program. Anyway, the best seller and we had thousands of phone calls, we had a lot of publicity and I couldn’t obviously see everybody. So I picked people who had treatment resistant depression and people who had the resources and the motivation or the support to be able to do what they needed to do. And I just treated them with functional medicine. And at this time, you’ve got to realize I was a psychopharmacologist. I was also trained as a psychopharmacologist. So I was doing a lot of psychopharmacology. I mean, a lot. And now I’m doing functional medicine on everybody. And after about three years, I’m noticing that I’m not actually doing that much psychopharmacology anymore. And everybody’s getting better. And the diabetes is going away. and osteoporosis is going away and one woman’s MS lesion in her brain went away and I’m like, what’s going on here? You know what? I might be lying to myself. So maybe I’m paying attention to the positive cases and I’m ignoring the negative. So I hired a statistician to go over all my cases over the course of this period of time, it two or three years. Ended up in 23 cases of treatment resistant depression. ⁓ I wasn’t lying to myself. Every single person went into recovery, not partial remission, not 50 % better, fully recovered by 10 months, every single one. And I was just blown away that, you know, I mean, I was blown away before, but then it was like, well, you’re not really lying to yourself. So that’s what I was doing until 2014 when I retired. I had actually an inaccurate diagnosis. I retired and… turned out it was incorrect. So it was actually really good to be retired, although I missed it terribly, really missed medicine terribly. But it gave me some time. And this is where this kind of starts to relate more to your audience. ⁓ I’m sitting on a hammock for six hours reading a book. Well, you can’t do that when you’re in practice. Bill Gasiamis (10:07) Good thing to do. Yeah. Photobiomodulation Stroke Recovery Applications Dr Bob Hedaya (10:13) That doesn’t happen. So but I was you know in retirement, so I’m reading this book and put two and two together over the course of time and I learned about laser which which they were using in Russia in 1980s and learned how the laser worked and And I was like whoa this could really help the brain and Then I was thinking now. I’m not in practice right, but I’m then I’m thinking but how would I know where to? point the laser in the brain for a patient. And then I keep reading in the book, and then they start talking about in the next chapter about quantitative EEG. And I’m like, oh, that’s how I would know. So I spent the next three years or so actually studying these methodologies. And then in 2017, I want to say, or 2018, I treated my first patient who had early dementia. published this case actually. I was treating her for early dementia. And I had treated her for six months with functional medicine, know, hormones and treating infections, et cetera, et cetera. And she really was much better. And then I was ready to do my first quantitative EEG. And she’s doing much better. She still has some symptoms. And I do the QEG. And actually, if I could share my I don’t know if I can, Okay, so basically what I just sent you is ⁓ how her brain looked after six months of functional medicine, right? So I was shocked because I thought her brain would look much better. And then I said, okay, let’s do the laser. So I knew where to point it because the QEG and this was the shocker. With the first laser, she had a problem. before the laser treatment of facial blindness. I don’t know if you know what that is. It’s people who can’t remember faces. They just met someone, they can’t remember the face. It’s called prosopagnosia. She had acquired it seven years earlier. Bill Gasiamis (12:11) I do. Yeah. Dr Bob Hedaya (12:21) After the first laser treatment, the problem was gone. Gone. She told me, she said, my God, I can remember the face of the person I worked with this morning and his wife and the dimple on the face. And I said, what are you talking about? She says, have prosopagnosia. I said, what? What is proto-diagnosia? I don’t know what that is. She says, can’t remember faces. I have to write down everything that I do and take pictures of everything and every person. I said, my God, it’s gone, gone. that’s when I went home that night and I was like, this doesn’t make any sense. How could this be? There’s nothing about a neurological condition being turned around in one minute. It makes no sense. But then I realized, I reasoned it out, realized, well, she had a population of neurons that were kind of alive, but they were not really functioning. And then I kind of jump started them with the laser and they went about their business and did their job. Bill Gasiamis (13:19) I love it. So, that’s a contrast on what you’re doing as in psychiatry, because psychiatry from, you know, my understanding is, you know, if you, if you speak to somebody who’s been through psychiatry and you ask them, how’s your condition or how is your situation or what has improved, very few people can say, ⁓ well, I’m, I’m better. I’ve overcome it. We’ve moved beyond the resolve that Dr Bob Hedaya (13:27) Yeah. Bill Gasiamis (13:47) Nobody really does that. They kind of just continue to go through the motions of another appointment, another medication, another adjustment in the amount of medication, et cetera. And what you said also seems a little bit ridiculous and kind of too quick. How do you get that kind of a solution that’s meant to take ages? You’re supposed to go through the typical times and it’s supposed to be costly and Dr Bob Hedaya (14:06) Too quick. Bill Gasiamis (14:16) unattainable and all these things. And it makes people feel sometimes I know stroke survivors who come across promises like that from other ⁓ people who talk about ⁓ perhaps ⁓ non-studied, ⁓ no scientific background kind of solutions to stroke and then kind of give everyone a blanket. If we do this, we’ll fix your stroke deficits, which is not true. ⁓ And then And then it leaves people feeling like they got ripped off. If they paid money, it leaves people lost for hope that there is no hope, cetera. And we kind of find ourselves in a, okay, desperate, what do we do now situation, right? And that’s kind of why I got excited when your patient’s husband reached out and said that we should chat. And I had a bit of a look into the kind of work that you do. ⁓ Functional medicine, I’ve heard about heaps. Dr Bob Hedaya (15:00) Hmm. Bill Gasiamis (15:14) And I love that it’s merged with psychiatry because when I started my journey in 2012, overcoming the first brain bladed and the second brain blade six weeks later, I went into functional medicine study to find out not formally, but I started doing what I didn’t know at the time was studying functional medicine and understanding like how I can decrease the inflammation in my brain. and provide the right environment for healing. And the first thing I came across was a book by somebody that you’re gonna know, Mark Hyman. And the book was, ⁓ the book was, ⁓ Eight Fat Get Thin. I read it, not wanting to get thin, I read it ⁓ because it ticked the boxes for the diet that I was gonna use to reduce inflammation in my brain. Dr Bob Hedaya (15:54) Okay. Bill Gasiamis (16:12) And the side effect was I thin. I wasn’t going for that because I was taking medication. was taking ⁓ dexamethasone, which made me put on weight and made these like all these types of ⁓ terrible side effects, but it was helping reduce the inflammation in my brain. So I, I was happy to have it, but I needed to achieve the same outcome as dexamethasone. Dr Bob Hedaya (16:13) I’m kidding. Bill Gasiamis (16:41) or a similar outcome as dexamethasone on a permanent basis without taking dexamethasone to improve the situation in my brain. And then I started to realize that I had a lot of power and I was ⁓ only not guided properly because my physicians, my doctors weren’t able to offer advice in that space. And had I not been the curious kind of guy that I was, I never would have come across Dr. Hyman and some other amazing guys who wrote books at around about that time that were similar in nature. so you’re, and then, and then a little while later, I found there was a Tasmanian, ⁓ psychiatrist, forget her name, but I have her book on my shelf upstairs who wrote a book about, ⁓ psychiatry and food and, the link between food and a good psychiatric outcome. Dr Bob Hedaya (17:15) huh. Bill Gasiamis (17:39) in the brain. And I just thought, okay, there’s much, much more that needs to happen here. Now, this the connections, there’s a lot of connections here. So recently on my YouTube channel, somebody left a comment I wanted to know about red light therapy, and will it help their brain? And I’m like, I have no idea. But let me do some research. I went on to PubMed, I found some articles and wouldn’t you believe it, there is a whole bunch of ⁓ proper data that Dr Bob Hedaya (17:40) You know what? Come on. Bill Gasiamis (18:08) suggests that there is a benefit. The only challenge that I always have with all of these potentially beneficial interventions is there’s no diagnosis done in the first place to determine whether somebody actually is eligible for a particular intervention. And what it sounds like you’re able to do is the diagnostics part and determine their eligibility. Tell me a little bit about why that is important. Dr Bob Hedaya (18:35) Right. Okay, so let me back, I wanna back up, because you said something very important, then I wanna reiterate it. I just gave you before a case of a woman who in five minutes, her problem was gone, right? Not, people should not think that’s the norm, okay? Not the norm. Occasionally it happens, I have a guy who had a head injury and had light sensitivity and confusion in certain situations with light, and one treatment, boom, gone. Understanding Laser Mechanisms People, you know, I have cases like that, but most of the time this is a gradual process. So people should not think it’s a cure-all for everybody. We do have to know who it’s good for. So what we do diagnostically before we do this is I will look at their brain, you know, obviously take some history and all of that business, but we do a quantitative neuroquant MRI. So we look at the different structures inside the brain. You know, we look at… Bill Gasiamis (19:32) Lovely. Dr Bob Hedaya (19:32) 30, 40 different structures. And then we also do a quantitative EEG, which is an electroencephalogram. We measure the electricity in the brain in 19 different places. And then there’s this really AI that takes all this data and it reverse engineers it. It’s called the inverse solution. And you can actually see the pathways, all of the pathways in the brain and the surface areas of the brain. And you can look at that, correlate that with the person’s symptoms. with the neuroquant MRI, it’s like a GPS, right? A triangulation of information and then assuming there’s not a mass or an aneurysm or some reason not to do the laser like an overactive brain or something like that, then we could consider using the laser. And then we also know where we want to do it based on the symptoms, based on the QEG, based on the neuroquant. We will decide what we’re going to target. And then we combine that, sometimes, not always. Bill Gasiamis (20:05) Hmm. Dr Bob Hedaya (20:31) with neurofeedback so we can exercise the areas that we want to exercise or calm down the areas that we want to calm down. And sometimes with hyperbaric oxygen, things like that. And hormones, using hormones or things like that. Bill Gasiamis (20:42) Yep. Hyperbaric oxygen has been a topic that I’ve discussed as well on the podcast and the people that I spoke to about hyperbaric oxygen and guys, I can’t remember right now, but I’ll put a link in the show notes for anyone listening so that you can go and find that episode and have a listen to it. Basically, what I loved about their approach was that they did a massive amount of diagnosis beforehand to determine where the penumbras were and then target those penumbras while the person was in the chamber. by getting them to do certain exercises that would activate those areas and therefore be targeted. So it sounds like the laser therapy is similar. Tell me about the laser. What kind of a laser is it? How does it get targeted to a specific spot? And what does it do when it goes there? I mean, I imagine it just doesn’t point there and go, I’ll illuminate that and it’ll be better. How does it actually work? Dr Bob Hedaya (21:18) Mm-hmm. Mm-hmm. Okay, so the laser, there are a bunch of different parameters that we have to adjust for each person. So it’s the frequency, how fast is the wavelength? What’s the wavelength? How many times per second is it pulsed? 10 times per second, 40 times per second, 50 times per second. Is it a 8, 10 nanometer wavelength or is it a 1064 wavelength? How many joules are we delivering? you know, where are we delivering it? So there are lots and lots of parameters to adjust, right? ⁓ What does it do? So simple, the first thing that it does, it does many, many things, right? But the very, very first thing it does is it actually releases ATP, the energy molecule, from your mitochondria. So it basically, the photon goes to the fourth channel, the fourth complex in the mitochondria, bumps off the nitric oxide, and that opens the flow of ATP. Well, if your brain, if your neurons have energy, they say, ⁓ energy, ⁓ well, we know what to do with energy. Let’s fix the puddles. Let’s build the roads. Let’s make the connections. Let’s do whatever we got to do. So now you’re getting energy flow. You also get synaptogenesis. You build new synapses. You get production of brain-derived neurotrophic factor. Bill Gasiamis (23:01) Wow. Dr Bob Hedaya (23:05) You get reduction of inflammation, get reduction of tau proteins and misfolded proteins. ⁓ You get, subjectively, get cognitive enhancement. aphasia, you know, people can start to speak. I mean, I can tell you one story. We used to shave people before doing the laser because I wanted to… Remember, you got a skull, you got the skin, you got all this stuff, right? How are you going to get the light into the brain, right? So we know that only about Bill Gasiamis (23:31) Mmm. Dr Bob Hedaya (23:35) 2.6 % of the light goes through the skull and the meninges and all the layers, right? So we used to shave people because I want to get the hair out of the way, right? At least get rid of some of it. So I had this woman who came to me, this is probably seven years ago, I guess. And at that time, I would not use the laser until I had done functional medicine on the patient. Because I figured, you know, let’s get the terrain straight. the nutrients, the hormones, get rid of the infections, get rid of the toxins, then we’ll apply the sunlight to the brain, to the plant, right? That was my logic. I thought that made perfect sense. So this woman came to me. She was 70 years old, obese. The husband wanted me to give her the laser. She wouldn’t change her diet, not an iota. High blood pressure, obesity. She could not speak. She would not take a medicine. She would not… Bill Gasiamis (24:04) Mm-hmm. Mm. Jumpstarting Healing with Laser Therapy Dr Bob Hedaya (24:33) Like, you name it, non-compliant all the way. Maybe you could say a word or two, that was it. Her husband begged me. I said, listen, it’s a waste, okay? It’s just a waste. I can’t ask her to shave her head. It’s not gonna work. I’m not doing it. He did not stop. So finally, I said, okay, fine, I’ll do it. So I was in my office and I’m making the laser plan. And I’m just writing, and something pops out of my mouth, God, I need a miracle. So I go into the laser room, and I start doing the laser. She starts talking. I have tears. He has tears. She starts talking. So by the end of like 20 sessions, I’m sitting with her having a 45-minute therapy session, because it turns out she was really severely abused when she was young. ⁓ She’s having a whole conversation with me. Turns out she’s psychotic also now. She’s also a psychotic and we didn’t know. So she needs to take some medicine for the psychosis because in the middle of the night, she’s going around with a baseball bat and she wants to like do, and she wouldn’t take medicines, I had to stop the laser. But that was an amazing thing because that was one, but with aphasia, typically it’s more gradual, much more gradual. But I have had a couple of patients where, and a woman came from Chicago and she just started talking also. So everyone’s different. You can’t necessarily come into this expecting that kind of thing is wonderful when it happens, but you Bill Gasiamis (26:14) Yeah. I love the fact that you can intervene with a laser, but also people can intervene with all the things that you said that that patient wasn’t doing beforehand. And that you that’s the top of the hierarchy of how you approach healing the brain is you do all those things. And then you supplement with ⁓ with a therapy like laser or whatever. And you kind of combine that and you make Dr Bob Hedaya (26:25) Yeah, yeah, you got it. Bill Gasiamis (26:42) like the, you make a soup of amazing things that all come together at the same time to support you together. And laser is just one of those things, but all the hierarchy like is so important because Dr Bob Hedaya (26:48) Yeah. It’s all important, all important. But I will tell you this. I have come to the point now where I believe that like people come to me and they don’t want to do anything and I’m like, okay, because I can jumpstart you, assuming you’re a good candidate. I can jumpstart you with the laser. I could just jumpstart you and then once I’ve jumpstarted you, say, ⁓ yeah, okay, I’ll do this. ⁓ okay, I’ll do a little of this. I’ll do a little. Because I’m bypassing everything and I’m giving you energy. Right? And so if you have energy, then, you know, there’s a lot that you can do that you couldn’t do before. So I kind of switched my model, really, only because of the accident of this guy who insisted I give his wife the laser, you know. Bill Gasiamis (27:30) Yeah. That’s not a way to go. mean, ⁓ there isn’t one way to solve a problem. there’s probably many iterations of, know, like how you can put that particular, like intervention together for a person that could specify for that individual, we’re going to go down this approach for you. You were going to go down this approach to get you going. Since you have all these, ⁓ challenges and energy is difficult. Maybe we’ll go directly with the laser and then Dr Bob Hedaya (27:46) Bye. Mm-hmm. Bill Gasiamis (28:09) We give you the skills, the energy, Dr Bob Hedaya (28:09) That’s right. That’s right. Bill Gasiamis (28:12) the training, the coaching, the support to implement the rest of the stuff that you need to implement to continue providing the right ⁓ space for your brain to heal in ongoing so you’re not just relying on laser. Dr Bob Hedaya (28:14) Yeah. ⁓ Yeah, yeah Yeah, if someone comes to me post stroke for example and the laser is appropriate I’m not gonna say well, we’ll get around to laser in six months. I’m not gonna do that They need relief they need help if it can help them Let’s do that. Let’s jump on that and you know, and then is the other stuff we need to do will do it And there’s usually stuff to do ⁓ But I want to get the healing remember the laser is healing It’s clearing out proteins, reducing inflammation, increasing blood flow, synaptogenesis, doing all these good things over the course of time. So you really want to get that process going, I feel, as soon as you can. then, okay, now you can work on the diet that’s going to take some time, check the hormones, make sure there’s no infections, toxic element, you know, all that functional medicine stuff. Maybe you need some medication for depression, you know, it’s having a… a phaser or a stroke or a head injury or some of things like this, they turn your life upside down better than I know. It’s ⁓ incomprehensible, really. Bill Gasiamis (29:26) Yeah, really. Yeah, really challenging. With a laser, how much laser for how long, how often? Understanding EEG vs. QEEG Dr Bob Hedaya (29:37) Great question. So let me say a couple of things. First of all, we have laser and then we have the LED helmets, right? You’ve read about and read the helmets, right? So there are a lot of studies on the helmets. There’s a question of whether they’re really having a direct effect because for a few reasons. Number one, it’s LED, it’s not a laser. Number two, the voltage is so low, if you’re only getting 2.6 % through and it’s so low to begin with, what do you think you’re actually delivering into the tissue? know, it’s hard to imagine that you’re delivering much. there, know, Henderson, I think, wrote an article where he showed there’s no penetration into the brain. But the studies do show cognitive benefit. So it could be an indirect effect or, you know, all the studies are done by the companies that make the… the helmet, there could be some bias. I don’t know the answer there. The laser ⁓ itself is more potent, so we’re doing, say, 30 watts. So the equivalent of a 30-watt light bulb, right? They might be doing half a watt, a very, very, very dim light bulb. We’re doing 30 watts. Now, we’re targeting the area or areas that we want to hit. Now, it goes through 2.6. Bill Gasiamis (30:34) devices. Dr Bob Hedaya (31:03) 5 % of it goes through. And then of course it’s going to be diffused, right? And it’s going to hit the surface tissues more. 1064 will penetrate deeper into the brain, but you don’t really have to go that deep because there’s downstream effects that happen, right? So we really, and then we adjust the parameters depending on how someone does. for example, you know, I had a woman who I was treating And actually it was the patient who her husband contacted you. I was treating her with a certain amount of energy and then after about five sessions I went up, I doubled the energy and boom, she had a response. But we have no way of knowing that’s what she needed. It’s all a calculation. But she, you know… Bill Gasiamis (31:39) Yes. Dr Bob Hedaya (32:00) Whatever it is, the thickness of the skull or the membranes or whatever it is, that’s what you needed and that’s what worked. Bill Gasiamis (32:06) Yeah. Tell me about ⁓ QEEG. So let’s dive deeper into it a little bit because we kind of glossed over it. I think it’s important to discuss how it’s different from EEG, ⁓ what EEG is and then what the Q adds to EEG. Dr Bob Hedaya (32:24) OK, so the EEG, imagine somebody, you put a cap on, and it has all these electrical wires that are measuring the electricity that comes, that’s on your scalp. It’s coming from your brain, but it’s measured at the scalp. And each one is measuring the energy from that spot, comparing it to other spots. And then you might, your viewers might remember. all those squiggly lines, you’ll see like 19 or 20 squiggly lines and you’re like, what is this spaghetti? I don’t know what this is. And I mean, even in medical school, we looked at it and our eyes would glaze over because who knows what it is. So the neurologists look at it and they’ll scroll through it and look for certain patterns to see is there a seizure or is there area of damage where there’s a lot of slowing like the frequency of the electricity slows down if there’s tissue damage, right? And they look visually to see what they can find. But we know with AI, you can get the patterns that you can determine. There’s no way the human mind, the human eye, a trained eye, I don’t care how long you’ve been looking at EEGs, there’s no way you can extract this data that we now extract. So the quantitative is actually looking at the quantity of this, what’s going on here versus the quantity of electricity that’s here versus what’s here versus what’s here. And then all of that is calculated and they say, ⁓ well, if this is high and this is here and this is low here and this is this, well, that means they’re coming from this deeper place here and that’s under functioning. And, you know, that’s done over thousands, thousands of points in a very short order, very short order. It’s amazing. I can’t imagine practicing without this. So now I can look at the thalamus. I can look at the putamen. Addressing Depression Post-Stroke Bill Gasiamis (34:07) Mm-hmm. Dr Bob Hedaya (34:17) In my office, I can do these tests in my office. If a patient is my patient, I can send the QEG to their home and do it in their home. And I get this imagery that’s immensely better than a spec scan. It’s not an MRI, an MRI structure. This is function. Okay, this is function. It tells us how different parts are functioning. Bill Gasiamis (34:40) What’s lighting up? What’s not lighting up? What could be lighting up better? What’s not going to light up anymore? Dr Bob Hedaya (34:45) What’s the information flow? How is the flow going from here to here? How about this network? Is this network working? Is this network overworking? Is it underworking? How about the neuron populations that are firing when I’m relaxed? How are they doing? How about the ones when I’m thinking? How about the ones when I’m thinking fast? How about the populations when I’m emotional? We can look at all those populations and see what’s going on with those populations. And then we can actually target them. train them, et cetera. And then we have that data that we treat, and then we measure and see is it getting better? Do we need to change the protocol? It’s not helping, it is helping, et cetera. Bill Gasiamis (35:29) Yeah. with stroke, so many things come from stroke that people are not equipped to handle. You know, firstly, all of the, ⁓ the parts relating to, ⁓ simply the person discovering them, they’re, they’re immortal after all, you know, you become a mere mortal immediately and you kind of work out the most terrible thing that could have happened to me happened. My brain is injured and all these things go away. Right. And then. Unfortunately, like I think it’s 30 % the studies of people who experienced stroke will then also experience depression. Like as if recovering from stroke isn’t enough and all the deficits that you also have to recover from depression. What’s it like? How can that be supported with this particular method, this approach that we’re discussing here today? Dr Bob Hedaya (36:28) So ⁓ kind of separate from stroke, ⁓ treat treatment resistant depression with laser all the time. With stroke, we use the laser, but you have to watch the QEG to make sure you’re not getting overstimulation, number one. Number two, I learned this with the patient that referred me to you, ⁓ that after, put us in touch, there was actually a central Bill Gasiamis (36:44) huh. for us in touch. Dr Bob Hedaya (36:58) hypothyroidism, meaning the low thyroid function, right? And we had to treat that, but the problem was as we treated that, there was a supersensitivity and because the tissues after stroke are more vulnerable to seizures, the patient actually had a seizure. She was actually having seizures we didn’t know, mild seizures. And then when we treated the thyroid, then we actually ended up having seizures. now we have to support, you need thyroid function to be good in order to not be depressed, right? If you have low thyroid, you’re much more likely to be depressed in the face of a stroke or other stresses. So we were kind of a little bit of a bind there because we went and treated, but it’s too sensitive. So anyway, we’re actually threading that needle nicely and we’re moving slowly and carefully and keeping, there’s no seizure activity now. But you have to treat the depression because of the depression itself. Bill Gasiamis (37:29) Yep. Dr Bob Hedaya (37:55) is a big problem because you know to recover from stroke, man, you gotta work hard. You gotta keep a good attitude. gotta have your eye on the ball. There’s no room for like… I’m going to give up. There’s no room for that. I mean, of course you feel it and I mean, it’s all natural feelings, but you have to really be determined and that’s essential. so with depression that is ⁓ really can get in the way. So we treat it. The laser can treat it. Sometimes pharmacology, sometimes therapy, sometimes yoga, know, hyperbaric, all these things that we do with the nutrition, making sure the hormones are right. All these things work together, you know. Bill Gasiamis (38:14) Yeah. I love all of those things that you mentioned. And then all of a sudden you just throw in yoga. mean, it just, it’s so counterintuitive, isn’t it? When you have a conversation about all these acronyms and all these tests and lasers and all that kind of stuff, and then you just throw in yoga casually like that. It’s, and we underplay it, but it’s such a massive thing in the picture of what creates the environment for a good recovery, but also I love that you mentioned the thyroid in that conversation as well about depression and what can also be a trigger to depression and people may have depression, never check their thyroid and not know that it’s a thing. Now I’ve had thyroid surgery, have ⁓ half of my thyroid removed because I had a massive ⁓ goiter on one side and that was such a difficult thing to discover and have to go through 16 months after brain surgery. but they only discovered it after my brain surgery when they did a chest x-ray, because I wasn’t recovering properly and they found that I had this goitre which would have been there for a long, long time impacting my health and all sorts of things. And I make that point because often people who have had a stroke and can’t speak, for example, have aphasia, ⁓ or their arm doesn’t work or the leg doesn’t work properly, will say, I just wanna fix this thing. If I could speak, Dr Bob Hedaya (39:40) No. Holistic Approaches to Recovery Bill Gasiamis (40:09) everything’s better, but they’ve never looked at the other things that may be contributing to keeping the speech at a level which is not good enough for them, for example, to be comfortable with. And it’s like this one track mind, I’ll just get my speech back, I’ll get my speech back, you what do I need to do? Or make it go, get back for me. There’s often no looking into the other things that might be causing depression, for example. Dr Bob Hedaya (40:31) Thank you. Bill Gasiamis (40:38) After stroke, know for a fact that the gut gets impacted ⁓ very dramatically from a stroke and the gut is highly linked to ⁓ mood and how you feel. And nutrition is what supports the gut to feel better and taking out things from the diet that are ⁓ making the gut sluggish and not work appropriately will ⁓ improve your mood and how you feel. It’ll make a difference and Dr Bob Hedaya (40:59) Okay. Yeah. Bill Gasiamis (41:08) and it’ll add to one of those little tools that supports depression and makes depression less impactful and you have less swings, et cetera. And that’s kind of the point that you’re making is that you don’t just turn up and do psychiatry. We’re gonna do psychiatry, treat you pharmacologically and then send you on your way and then see you in six, 12, eight months again or whatever and then just repeat the process again. It’s a whole, know, holistic is the word that you hear, but it is a broader conversation that people need to be having. And that sounds like what you guys do. It sounds like the conversation doesn’t encompass, it encompasses everything. It doesn’t just focus on one intervention. Dr Bob Hedaya (41:56) That’s why I call it whole psychiatry. But it really should be whole neuropsychiatry or whole brain or, you know, but it’s whole body, whatever you want to call it. It’s really more than the body because obviously the social connections play a big role as well, you know. So yeah, everything you’re saying is 100 % true and it’s all real. Everything you’re saying is real. Everything you do. mean, simple things going back to the B12. You you need B12 to… Bill Gasiamis (41:58) Yeah. Dr Bob Hedaya (42:26) remyelinate your neurons. need to keep the mercury, by the way, got to keep the mercury levels low. know, the mercury, if you’re eating tuna fish or swordfish and you have high mercury levels, know, the mercury will actually prevent you from making new branches. The mercury actually will bind on tubulin, which is like a brick that you need to build new roads. And it will prevent the tubulin from building new roads in your brain. So here you are working hard trying to… Bill Gasiamis (42:28) Mmm. Dr Bob Hedaya (42:54) do things and you’re a can of ⁓ whatever tuna fish with loads of mercury two, three, four times a week. Well, that’s not working, you know. So that’s why you really want to look at the whole thing. It’s a lot. It’s really a lot. You know, it’s a big program, but you you take, take steps. Everybody has different needs or not everybody has to do everything. Bill Gasiamis (43:04) Yeah. Yeah. Not everybody needs to do everything to achieve significant results, but it’d be amazing to be able to find the things and target those, the ones that you’re to get the most bang for buck on. So you’re to putting time and effort into things that are not getting results. For example, an led hat from, uh, Amazon for $9 that you put on your head. And it’s basically just a red light hat. It’s not really doing the thing, right? Dr Bob Hedaya (43:32) Hmm. Ha ha ha. Bill Gasiamis (43:49) And that’s kind of why I started to have that conversation and do a little bit of research in what they, know, what’s medically known as or scientifically known as photo bio modulation, you know, the idea is great, but then it came to me from somebody who I imagine was looking at a seven or eight or $9, $10 cap with red lights that put on the head and they Dr Bob Hedaya (44:00) Right. Bill Gasiamis (44:15) paid money for a cap and hoping for an outcome and they didn’t get an outcome and then they’re wondering why. I suggest when people are looking into those topics, is gonna go and have a look at the science, what it says about the nanometers of the type of light that you need to be experiencing, how, where, who, and always do these things with medical supervision. It really challenges me when I find out people do things like, know, methylene blue was a thing. Dr Bob Hedaya (44:44) Right. Bill Gasiamis (44:45) uh, very recently and people will just go get a bottle of Methylene blue from somewhere and just start taking it and have no idea what they’re doing and, and, and, know, what they could hope for. They could be making things worse than for themselves and actually making themselves, um, like make things a lot harder for themselves. So, uh, my point is this all needs to be done under medical supervision. Typically when you, somebody reaches out to you, how do you begin the conversation and then how does that person engage with you? And then what happens after they’re treated? Because often I know from my experience with all my neurologists, et cetera, very rarely do I see anybody a second time, six months, 12 months, 18 months, five years down the track. You usually go in, they patch you up, they send you home, you get back to your life and then maybe you do one MRI. Dr Bob Hedaya (45:36) Really? Bill Gasiamis (45:44) ⁓ for a few years after brain surgery just to make sure that everything’s stable. But that’s about it. Nobody follows up with you. Dr Bob Hedaya (45:52) No, it’s a whole different ball game with us. No. So what we do first is ⁓ if someone will contact us through the website, which is wholepsychiatry.com, they will actually fill out a form. And if we feel that it looks like we might be able to be helpful to them, then we will send them a welcome letter. And then they will have the opportunity to meet with our new patient coordinator at no charge. Patient-Centered Care and Follow-Up and she’ll talk with them for 15 to 30 minutes and kind of tell them what’s going on and see if they, you know, the fit is good, et cetera. And then they have an opportunity if they want to meet with me on Zoom for 15 to 30 minutes and ⁓ I’ll figure out, can I help them? Can I not help them? Is it a good fit, et cetera? And then if it looks like, you know, green light and they decide they want to move forward and it makes sense, then we’ll schedule an evaluation. The time duration of the evaluation depends on what kind of patient. It could be a couple of hours, could be four and a half hours. But usually for neurological patients, straightforward, it’s a shorter evaluation. And before the evaluation, we’ll collect the neuro-quant and the QEG and the old records, et cetera. And then I will go through all of that data plus lab data that we collect. And I will then have an idea. Okay, what’s going on here? Now there’s all these things. There’s digestion, there’s nutrition, there’s immune function, inflammation, toxins, hormones, all the hormones, structural issues, chiropractic issues, traumatic brain injury, cardiovascular issues, et cetera. We look at all of that and then to see what are the players here and spiritual, social resources, connectivity. We look at all of this. And then we have a whole picture of what’s going on. And then we can figure out, okay, how do we want to approach this? And sometimes we approach it very lightly. Say we just start with the laser, that’s it. Or sometimes somebody says, no, I want to really get in there and fix everything that’s wrong. Okay, well, we identified these five or six things that need correction. So let’s stage this in order. And that’s what we’ll do. And everyone’s different. And then we have follow-up depending on what we need in two weeks, in a month, six weeks, not usually six weeks. Once things are stable, it could be every two, three months or four months. But in the meantime, I’m in the boat rowing, paddling with them. That’s the way I do it. I treat people, really, I try to treat people just like I would want to be treated myself, like I would want my family to be treated. I do the very best. I love what I do, you know what I mean? I just love what I do and I try to do the best, highest quality. And it’s not that I’m perfect, not that I don’t make mistakes, ⁓ not that I know everything because that’s for sure that I don’t, but that’s my approach. So I try to be in the boat with the patient. As long as the patient’s paddling, I’m paddling just as hard, if not. Bill Gasiamis (49:02) Yeah, it sounds like at least if things, if you don’t make the right approach initially, there’s a whole bunch of tools and resources and things that you can kind of focus on. And one of the things you mentioned, again, you glossed over it, but I love that you do this is spiritual. Like it might be a spiritual journey that the person needs to take. And it’s so overlooked because people, you know, do have… Dr Bob Hedaya (49:22) yeah. yeah, yeah. Bill Gasiamis (49:30) existential crisis after a stroke. it’s like a spirituality helps somehow for a lot of people ease, heal that, ⁓ help people move through, you know, the weeds and come out into the opening and then kind of see the opportunities and where they need to go next. And people don’t need to engage with somebody like you to go on a spiritual journey. That might just be something they’ve ever looked and they can just go, you know what, I’m going to pick up the Bible or ⁓ I’m going to learn about this particular ⁓ spiritual journey or whatever and go through it and do whatever it is that they need to do to kind of start beginning the healing journey in their own special unique way. It’s really important that spirituality gets addressed and it’s not glossed over. And I’m not saying that you did or I did or we do, but in the back of the minds, stroke survivors may not consider that being important. The Role of Spirituality in Healing Dr Bob Hedaya (50:31) Yeah, first of all, I’m passionate about spirituality. I mean, passionate because the truth, in my opinion, is that consciousness, your level of awareness is really consciousness is the foundation, the substrate of everything that exists. The material is an outflow from consciousness. So I could talk about this forever. Not everyone is oriented this way. So, you know, I just saw a businessman, very successful businessman ⁓ last week. He doesn’t want to just, you know, get me back online. OK, I don’t want to hear this mumbo jumbo and I just can’t. I don’t want to delve into it. Just get me better. know. But other people are like, I want to find the meaning, you know, and it’s very important. to find the when I think generally for most people finding the meaning in it is critical. And I’ll say one thing, my mother, may she rest in peace, was in the emergency room, probably 25, 30 years ago, I don’t know, something was wrong, she was in the emergency room for seven, eight hours or whatever, and some guy comes by and says, ma’am, can I get you a sandwich? And she says, oh yeah, please, please get me a sandwich. He gets her a tuna fish sandwich, whatever it is, right? He leaves. She’s so grateful. She’s so grateful that she volunteers in the hospital for 20 years. Okay? This guy has no idea what he did and all the people that he helped through her, right? So you’re, you you and you’re not just you, but we, each of us in our small minds, we have no idea. the impact we have on other people. So if it’s important to a person to have a meaningful life, understand that you don’t have to be running a company. You can smile at a stranger, change their day. There are things that you can do and you have an impact. Now, that’s a small consolation when you’re dealing with a stroke, obviously, but that’s when you kind of want to work to a meaningful ⁓ attitude and a good attitude. So yes, the spirituality is… many people very important. Bill Gasiamis (52:54) David who brought us together ⁓ wanted me to meet you so I could interview you. that part of the role that he played in what happened to his wife ended becoming something that helped other people. Isn’t it interesting? The whole journey started on. Dr Bob Hedaya (53:15) Exactly. Bill Gasiamis (53:20) He contacted me because he wanted to make something good come of what happened to his wife, which I’m sure his wife was also interested in. And he said, you need to get Dr. Hedaya on because we need to share more information, make this stuff aware. so, and I’m like, well, that’s perfect. Of course I do. Whoever comes to me with that kind of information because they want to help other stroke survivors because he’s hoping that other caregivers that are in his shoes have a better outcome. They have more support. They have more information. They have more tools. Dr Bob Hedaya (53:27) Mm-hmm. Bill Gasiamis (53:50) That’s the spiritual journey. You don’t have to call it ⁓ Christianity, Judaism. You don’t have to call it something. You don’t have to label it, but that is what spirituality looks like in practice. Dr Bob Hedaya (53:56) Right. Right. That’s exactly it. That’s exactly it. And it gives me chills because, you know, I know his wife is suffering, you know, and ⁓ but she’s making really great headway, but it’s hard, you know. But look at look that he’s reaching out and he cares enough about other people and to and make her journey and what she’s gone through and what she’s learned be useful to other people. That’s it. That’s just beautiful. I mean, that that speaks volumes about him and her. Bill Gasiamis (54:32) It does absolutely and her and your work because your work is not unique. You’re not the only one doing this kind of work. I think there’s only kind of a small percentage of ⁓ medical professionals in the field that are practicing in this way. And hopefully that continues to grow. ⁓ If somebody wanted to, well, somebody lots of people are listening to this today. If anyone wanted to reach out ⁓ who thinks, you know, that they might be able to ⁓ benefit from or go down this kind of approach. How should they go about that? What questions should they be asking of you, et cetera? Like how do they begin? Because this is a different conversation than I have ⁓ neurological injury, have aphasia. It needs to be positioned differently, this conversation. Dr Bob Hedaya (55:29) Tell me what you mean. I’m not really clear what you’re saying. Bill Gasiamis (55:33) If somebody wants to find a clinician who practices the way that you practice, you guys, for example, you know, you know, who thinks about the brain in a different way. What, what should they be looking for and what. Dr Bob Hedaya (55:38) Aha, I see, I see. I would say that they should go to the website for the Institute for Functional Medicine. And there’s a tab. This is find the practitioner. And make sure you look for a practitioner that is certified, fully certified. And then investigate the practitioners who are in your area and see if they experience. in this area. there are not I’m not aware of, there’s a guy somewhere in the Midwest here who’s using a laser, I believe. And then maybe other people that I don’t know about using lasers, but I’m not aware of anybody that I could say, go see this person for this quantitative EEG guided transcranial photobiomodulation. I’m not saying that that is readily available. It’s not. But the whole functional medicine thing, there are a lot of practitioners. And I think that’s the way to go there. Just do your homework. Bill Gasiamis (56:48) Yeah. Yeah. Cool. Your organization is whole psychiatry and the brain recovery center. Is that right? Okay. So the psychiatry part of it, ⁓ people might be listening and going, well, that doesn’t apply to me, the specific word specifically doesn’t need to apply to an individual to engage with you because, we’re not just dealing with the psychiatry part of somebody’s recovery. Dr Bob Hedaya (56:56) Yeah. Right. Thank you. No, no, we’re dealing, we treat psychiatric, but we treat neurological. You know, I started as a psychiatrist. was, you know, certified by the American Board of Psychiatry and Neurology, but I was doing psychiatry. then, you know, just following, you know, learning and whatever, I ended up, you know, doing some neurology here. And so, but we didn’t change the name to the whole neuropsychiatry and brain recovery. Maybe we should, or maybe the whole brain recovery center or something like that. So, you we do both, no, and if, and if, I can’t be helpful, of course, I’m going to tell people this, we really don’t want to waste people’s time, energy, money, et cetera. ⁓ But it’s, it’s been, you know, I have to say an amazing journey. And I would say when you follow for me, this is me, my life, following my passion of learning about the brain and understanding the brain and Bill Gasiamis (57:45) Yeah. Dr Bob Hedaya (58:14) looking for the fundamentals of how do things work and just there’s a common sense in medicine. I looked at the laser when I was reading that book and I was like, wow, ATP in the brain, that could really help the brain. How would I

Krissy Dilger of SRNA hosted Dr. Benjamin Greenberg of UT Southwestern to share updates on the Q Study, a Phase 1 trial assessing the safety and feasibility of transplanting human glial restricted progenitor cells into the spinal cord of people who have been diagnosed with transverse myelitis (TM). Dr. Greenberg cautioned the audience against stem cell tourism [00:03:03]. He described the decades-long development of the cell line and safety monitoring for this study [00:01:35]. He reported no safety signals prompting a trial pause and noted the FDA-approved expansion of eligibility from non-ambulatory participants to those who can walk with assistance, while efficacy results were not yet being shared [00:08:31]. Finally, Dr. Greenberg outlined potential next steps, including Phase 2 studies and expanded populations (e.g., MOGAD and NMOSD diagnoses), as well as future targets [00:17:02].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 at Children's Medical Center [https://www.childrens.com/specialties-services/specialty-centers-and-programs/neurology/demyelinating-disease-program].Dr. Greenberg earned his medical degree at Baylor College of Medicine before completing an internal medicine internship at Chicago's Rush Presbyterian-St. Luke's Medical Center. He performed his neurology residency at the Johns Hopkins School of Medicine. He also holds an M.H.S. in molecular microbiology and immunology from the Bloomberg School of Public Health, as well as a bachelor's degree in the history of medicine – both from Johns Hopkins. Prior to his recruitment to UT Southwestern in 2009, Dr. Greenberg was on the faculty of the Johns Hopkins Division of Neuroimmunology, serving as the Director of the Encephalitis Center and Co-Director of the nation's first dedicated Transverse Myelitis Center.Dr. Greenberg splits his clinical time between adult and pediatric patients at William P. Clements Jr. and Zale Lipshy University Hospitals, Parkland, and Children's Medical Center. His research focuses on better diagnosing, prognosticating, and treating demyelinating diseases and nervous system infections. He also coordinates clinical trials to evaluate new treatments to prevent neurologic damage and restore function to affected patients.00:00 Welcome and Guest Intro01:35 Origins of Q Study02:46 Getting Cells Into Cord04:49 Phase One Trial Design06:31 Safety and Efficacy Measures08:31 Eligibility Expanded Criteria11:39 Screening and Selection14:05 Travel and Site Logistics15:15 Early Safety Findings17:02 Next Steps After Phase One19:01 Beyond Idiopathic Myelitis23:07 Damage Differences by Disease25:20 Optic Nerve and Brain Targets27:29 Expected Outcomes and Vision28:58 Final Thanks

Send us Fan MailWhat actually happens behind the scenes when someone is rushed to the hospital with a neurological emergency? And what decisions are doctors making so quickly?This week's episode features my conversation with Joshua Saunders, a neurology nurse practitioner.When someone you love is suddenly admitted to the hospital with a neurological issue, the experience can feel incredibly overwhelming. Between the imaging studies, neurological exams, constant monitoring, and transfers between hospital units, it can be difficult to understand what's happening and why certain decisions are being made so quickly.In this conversation, Josh helps break all of that down.We discuss what the typical hospital workflow looks like when a patient is admitted with a neurological condition, the kinds of neurological changes providers monitor closely for, and which symptoms raise immediate concern. He also shares how he approaches conversations with patients and families when explaining complex neurological diagnoses and treatment decisions.Josh also walks through a hypothetical stroke scenario from start to finish — from the moment a patient arrives at the hospital, to the imaging studies and tests that are ordered, the decisions providers are making in real time, and what recovery and follow-up can look like after discharge. Toward the end of the episode, he addresses two very common misconceptions patients and families have about neurological care in the hospital setting.Don't forget to rate and subscribe to The Neurological Disorder Podcast on Spotify, Apple Podcasts, or wherever you listen to your podcasts. Fill out this form in bio if you have questions, guest suggestions, or topics you would love to hear about!Feel free to contact me via:Email: neurologicaldisorderpodcast@gmail.com

A Lasting Legacy: How Brain Donation Is Advancing Autism Research While organ donation can help save a life, brain donation can help save thousands. Specifically for autism, brain donations are helping researchers uncover the biological causes of the disorder to improve the quality of life for future generations. Our experts highlight the critical need for donation awareness and participation. Guests:  Dr. David Amaral, scientific director, Autism BrainNet, Director of Research, UC Davis MIND Institute Kathy Stein, donor's loved one   Fighting The Status Quo: The Rebels Who Changed Public Health Forever Prevention is built into so many aspects of our lives, from coffee cup lids to seatbelts. However, many of these life-saving innovations were historically met with extreme public and professional resistance. Our expert explores "preventioneers" – the people who defied taboo and skepticism to transform how we protect ourselves from disease and disaster. Guest: Dr. Barry Davis, professor emeritus, University of Texas School of Public Health, author, The Preventioneers Facebook: ingoodhealthpodX: @ ingoodhealthpodIG: @ingoodhealthpodYouTube: @ingoodhealthpodSpotify Apple Podcast In Good Health PodcastSubscribed to the newsletterFull ArchiveContact UsBecome an Affiliate Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

A Lasting Legacy: How Brain Donation Is Advancing Autism Research While organ donation can help save a life, brain donation can help save thousands. Specifically for autism, brain donations are helping researchers uncover the biological causes of the disorder to improve the quality of life for future generations. Our experts highlight the critical need for donation awareness and participation. Guests: Dr. David Amaral, scientific director, Autism BrainNet, Director of Research, UC Davis MIND Institute Kathy Stein, donor's loved one Host and Producer: Kristen Farrah  Facebook: ingoodhealthpodX: @ ingoodhealthpodIG: @ingoodhealthpodYouTube: @ingoodhealthpodSpotify Apple Podcast In Good Health PodcastSubscribed to the newsletterFull ArchiveContact UsBecome an Affiliate Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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/Cash Apphttps://cash.app/$theoccultrejectsVenmo@TheOccultRejectsBuy Me A Coffeebuymeacoffee.com/TheOccultRejectsPatreonhttps://www.patreon.com/TheOccultRejectsFull show-notes bibliographyCore EEG and oscillationsAbubaker, M., & Dankaerts, W. (2021). Working memory and cross-frequency coupling of neuronal oscillations. *Frontiers in Psychology, 12*, 742860.Axmacher, N., Henseler, M. M., Jensen, O., Weinreich, I., Elger, C. E., & Fell, J. (2010). Cross-frequency coupling supports multi-item working memory in the human hippocampus. *Proceedings of the National Academy of Sciences, 107*(7), 3228–3233.Jensen, O., & Mazaheri, A. (2010). Shaping functional architecture by oscillatory alpha activity: Gating by inhibition. *Frontiers in Human Neuroscience, 4*, 186.Rayi, A., et al. (2022). Electroencephalogram. *StatPearls*. StatPearls Publishing.StatPearls / NCBI Bookshelf. (2024). Introduction to electroencephalography (EEG). *NCBI Bookshelf*.Theta, alpha, beta, gamma, and controlCavanagh, J. F., & Shackman, A. J. (2015). Frontal midline theta reflects anxiety and cognitive control: Meta-analytic evidence. *Journal of Physiology-Paris, 109*(1–3), 3–15.Eisma, J., et al. (2021). Frontal midline theta differentiates separate cognitive control strategies while still generalizing the need for cognitive control. *Scientific Reports, 11*, 14641.Jensen, O., Bonnefond, M., & VanRullen, R. (2012). An oscillatory mechanism for prioritizing salient unattended stimuli. *Trends in Cognitive Sciences, 16*(4), 200–206.Lundqvist, M., Herman, P., & Miller, E. K. (2018). Working memory: Delay activity, yes! Persistent activity? Maybe not. *Journal of Neuroscience, 38*(32), 7013–7019.Sleep architecture, spindles, and memoryCaporro, M., Haneef, Z., Yeh, H.-J., Mohamed, F. B., & Levin, H. S. (2012). Functional MRI of sleep spindles and K-complexes. *Clinical Neurophysiology, 123*(2), 303–309.Chen, P., Miao, X., Chen, J., et al. (2023). The devastating effects of sleep deprivation on memory: Lessons from rodent models, aging, and Alzheimer's disease. *Frontiers in Neuroscience, 17*, 1151639.Ng, T., et al. (2025). Bayesian meta-analysis reveals the mechanistic role of slow oscillation-spindle coupling in sleep-dependent memory consolidation. *eLife, 13*, RP101992.Patel, A. K., et al. (2024). Physiology, sleep stages. *StatPearls*. StatPearls Publishing.Páez, A., Gillman, S. O., Dogaheh, S. B., et al. (2025). Sleep spindles and slow oscillations predict cognition and biomarkers of neurodegeneration in mild to moderate Alzheimer's disease. *Alzheimer's & Dementia, 21*, e14424.Hypnagogia, N1, and dream incubationHorowitz, A. H., Esfahany, S., Boyle, M. R., et al. (2023). Targeted dream incubation at sleep onset increases post-sleep creative performance. *Scientific Reports, 13*, 5055.Lacaux, C., Andrillon, T., Bastoul, D., et al. (2021). Sleep onset is a creative sweet spot. *Science Advances, 7*(50), eabj5866.Meditation, prayer, chanting, and yoga nidraDatta, K., Mallick, H. N., Tripathi, M., Ahuja, G. K., & Deepak, K. K. (2022). Electrophysiological evidence of local sleep during yoga nidra practice in young male volunteers. *Frontiers in Neurology, 13*, 910794.Dobrakowski, P., Błaszkiewicz, M., & Skalski, S. (2020). Changes in the electrical activity of the brain in the alpha and theta bands during prayer and meditation. *International Journal of Environmental Research and Public Health, 17*(24), 9567.Gao, J., Leung, H. K., Wu, B. W. Y., Skouras, S., & Sik, H. H. (2019). The neurophysiological correlates of religious chanting. *Scientific Reports, 9*, 4262.Kaur, C., & Singh, P. (2015). EEG derived neuronal dynamics during meditation: Progress and challenges. *Advances in Preventive Medicine, 2015*, 614723.Lomas, T., Ivtzan, I., & Fu, C. H. Y. (2015). A systematic review of the neurophysiology of mindfulness on EEG oscillations. *Neuroscience & Biobehavioral Reviews, 57*, 401–410.Hypnosis and suggestionJensen, M. P., Adachi, T., & Hakimian, S. (2015). Brain oscillations, hypnosis, and hypnotizability. *American Journal of Clinical Hypnosis, 57*(3), 230–253.Kirenskaya, A. V., Novototsky-Vlasov, V. Y., Chistyakov, A. V., & Zvonikov, V. M. (2011). Waking EEG spectral power and coherence differences between highly hypnotizable and low hypnotizable subjects. *International Journal of Clinical and Experimental Hypnosis, 59*(2), 144–164.Mendoza, M. E., & Capafons, A. (2024). Neural correlates of hypnosis: A systematic narrative review. *Frontiers in Psychology, 15*, 1327738.Ritual rhythm, trance, and synchronyHuels, E. R., Kim, H. S., Lee, U., & Mollaahmetoglu, O. M. (2021). Neural correlates of the shamanic state of consciousness. *Frontiers in Human Neuroscience, 15*, 610466.Mogan, R., Fischer, R., & Bulbulia, J. A. (2017). To be in synchrony or not? A meta-analysis of synchrony's effects on behavior, perception, cognition and affect. *Journal of Experimental Social Psychology, 72*, 13–20.Tarr, B., Launay, J., & Dunbar, R. I. M. (2016). Silent disco: Dancing in synchrony leads to elevated pain thresholds and social closeness. *Evolution and Human Behavior, 37*(5), 343–349.Entrainment, binaural beats, fatigue, and overloadGoodman, S. P. J., et al. (2025). Approaches to inducing mental fatigue: A systematic review and meta-analysis of (neuro)physiologic indices. *Neuroscience & Biobehavioral Reviews, 170*, 105957.Ingendoh, R. M., Posny, E. S., & Heine, A. (2023). Binaural beats to entrain the brain? A systematic review of the effects of binaural beat stimulation on brain oscillatory activity, and the implications for psychological research and intervention. *PLOS ONE, 18*(5), e0286023.Snipes, S., et al. (2024). Extended wakefulness alters the relationship between EEG theta and alpha bursts and behavioural outcome. *European Journal of Neuroscience, 60*(8), 6268–6284.Xiang, C., et al. (2024). A resting-state EEG dataset for sleep deprivation. *Scientific Data, 11*, 406.Parkinson's disease and pathological betaAsadi, A., et al. (2022). The origin of abnormal beta oscillations in the parkinsonian corticobasal ganglia circuit. *Frontiers in Neuroscience, 16*, 823719.Paulo, D. L., et al. (2023). Corticostriatal beta oscillation changes associated with cognitive function in Parkinson's disease. *NPJ Parkinson's Disease, 9*, 202.Ancient sleep, dreams, and Asclepian healingAskitopoulou, H. (2015). Sleep and dreams: From myth to medicine in ancient Greece. *Journal of Anesthesia History, 1*(3), 70–75.Kapotsis, G., & Steiropoulos, P. (2025). Sleep incubation [enkoimesis] in medical practice at Asclepieia of Ancient Greece — the Ancient Greek sleep medicine. *Sleep Medicine, 130*, 85–89.Pavli, A. (2024). Asclepieia in ancient Greece: pilgrimage and healing. *Journal of Integrative Medicine and Research, 3*(2), 100119.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. A

This episode covers encephalitis.Notes: https://zerotofinals.com/paediatrics/infectiousdisease/encephalitis/Questions: https://members.zerotofinals.com/Books: https://zerotofinals.com/books/The audio in the episode was expertly edited by Harry Watchman.

ISRIB stands for “integrated stress response inhibitor).  As we discuss here, it is an oral medication that inhibits an intracellular pathway called the integrative stress response pathway.  It is not FDA approved for any condition but is available in Spain without a prescription.  There are theoretical ways that inhibiting this pathway could help a person with ALS, and there is promising data from preclinical ALS models.  However, it is not clear that ISRIB is soluble enough to get into motor neurons in the brain and spinal cord, and 2 of 3 trials of agents targeting the same pathway failed to show any benefits in people with ALS.  The risks of this product in ALS are not known.

Dr. Alex Menze and Dr. Kathryn C. Fitzgerald discuss using accelerometry to detect subtle, longitudinal changes in disability in people with multiple sclerosis and how these changes relate to brain atrophy and disability progression.  Show citation:  Fitzgerald KC, Sanjayan M, Dewey BE, et al. Association of Changes in Activity Patterns With Brain Atrophy and Disability Progression in People With Multiple Sclerosis. Neurology. 2026;106(7):e214678. doi:10.1212/WNL.0000000000214678  Show transcript:  Dr. Alexander Menze: Hi, this is Alexander Menze. I just finished interviewing Kate Fitzgerald for the Neurology Podcast. For today's Neurology Minute, Kate, I'm hoping you can tell us the main points of your paper. Dr. Kathryn C. Fitzgerald:  So we followed 238 people with MS who are 40 or older for over three years and they wore risk-worn accelerometers roughly every three months and had regular clinical assessments and brain MRI. And what we found was that changes in activity patterns over time at the individual level were associated with subsequent changes in disability worsening and brain volume loss, particularly in the deep gray matter and thalamus. Dr. Alexander Menze: Thank you very much. Be sure to download this week's podcast to hear our full interview.  

In this episode of the ADHD Parenting Podcast, hosts Mike and Ryan tackle a provocative but critical topic: why high expectations are the most loving thing you can do for a child with ADHD. They respond to a listener's experience in which an effective classroom point system—backed by decades of research—was canceled after other parents of children with ADHD complained. Mike and Ryan break down the difference between evidence-based structure and popular social media narratives, explaining why removing consequences and lowering the bar can lead to learned helplessness, prompt dependence, and failure to launch. They cite leading ADHD researchers like Dr. Russell Barkley, clarify what the science actually says about connection vs. consequence, and offer practical advice for IEP meetings, home life, and navigating parent group chats. Above all, Mike and Ryan argue that high expectations combined with high empathy aren't the opposite of love—they are love.Find Mike @ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.grownowadhd.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ & on ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠IG⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Find Ryan @ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.adhddude.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ & on ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Youtube⁠⁠⁠{{chapters}}[00:00:00] Start[00:05:29] Debunking the "connection, not consequence" myth[00:08:14] Dr. Russell Barkley: ADHD as a self-regulation problem[00:10:39] The cost of removing structure: Learned helplessness[00:14:05] "It's not fair": Neurology explains but does not exempt[00:15:30] Setting kids up for failure to launch[00:16:53] Research-backed classroom policies that work[00:21:26] What parents can do at home and in IEP meetings[00:25:05] Confidence is earned by meeting standards[00:25:44] Closing: High expectations + high empathy = loveCitations:Gaastra, G. F., Groen, Y., Tucha, L., & Tucha, O. (2016). The effects of classroom interventions on off-task and disruptive classroom behavior in children with symptoms of ADHD. Consequence-based approaches showed the largest positive effect.Barkley, R. A. (2015 / 2022). ADHD: A Handbook for Diagnosis and Treatment. Self-regulation model and "point of performance" principle.Power, T. J., Mautone, J. A., & Soffer, S. L. Family-School Success for Children with ADHD: A Guide for Intervention. Guilford Press. From the Center for Management of ADHD at Children's Hospital of Philadelphia — research-based home-school partnership intervention.Pelham, W. E., Fabiano, G. A., and colleagues. Daily Behavior Report Card evidence base.Rosenthal & Jacobson lineage. Pygmalion Effect / adult-expectation research in education.Milich and colleagues; 2024 review on learned helplessness in ADHD populations.

Advances in immunotherapies for multiple sclerosis and related disorders have increased the risk of infections and raised important questions about vaccination efficacy. This episode reviews infection risks across treatment classes, emphasizes the importance of monitoring and patient education, and discusses optimal vaccine timing to preserve protective immune responses. In this episode, Aaron L. Berkowitz, MD, PhD, FAAN, speaks with Avindra Nath, MBBS, FAAN, coauthor of the article "Infection Risk and Vaccine Considerations in Multiple Sclerosis and Related Disorders" in the Continuum® April 2026 Multiple Sclerosis and Related Disorders 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. Nath is the chief of the Section of Infections of the Nervous System at the National Institute of Neurological Disorders and Stroke, National Institutes of Health, in Bethesda, Maryland Additional Resources Read the article: Infection Risk and Vaccine Considerations in Multiple Sclerosis and Related Disorders Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @AaronLBerkowitz Full episode transcript available here Dr Berkowitz: Over the last decades, there has been a revolution in the treatment of multiple sclerosis, neuromyelitis optica spectrum disorder, and other immune-mediated neurologic conditions with countless new, highly effective medications. However, with every new treatment comes new risks; and in the case of immunomodulatory therapy, many of those risks relate to infection. Today, I have the privilege of talking with an expert on this topic, Dr Avindra Nath, about the infectious risks of treatments for multiple sclerosis and other immune-mediated neurologic disorders.  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, and today I'm interviewing Dr Avi Nath about his article on vaccine considerations and infection risk in multiple sclerosis and related disorders, which he coauthored with Dr Amit Bar-Or. This article appears in the April 2026 Continuum issue on multiple sclerosis. Welcome to the podcast, Dr Nath, and could you please introduce yourself to our audience?  Dr Nath: Thanks very much for inviting me to this podcast. I'm absolutely delighted to have the opportunity to discuss our areas of interest and expertise related to infections and vaccinations for MS patients. My area has been studying the infections of the nervous system since the beginning of the AIDS pandemic, and over the years and decades, we've developed expertise related to various types of CNS infections. That includes ones that are developing in individuals who have immune compromise due to a variety of different reasons. Dr Berkowitz: Fantastic. Well, glad to have the opportunity to speak with you today. When I was in medical school---and you were my attending, actually, we were just reminiscing, which we probably think was not that long ago, but is now over twenty years ago---there were just two medications for MS, right? Beta interferon and glatiramer acetate. And now we have over a dozen, and it's amazing to think of all the progress in these last two decades, as well as for related diseases like NMO. I don't think we even had the aquaporin-four biomarker, right, when I was working with you as a med student in the early 2000s. Dr Nath: And that certainly dates me a lot.  Dr Berkowitz: Both of us.  Dr Nath: Yeah.  Dr Berkowitz: Of course, with all these new treatments, these have been amazing advances for our patients, right? But these come with new treatment-related risks to monitor for with the immunomodulatory medications for MS and related disorders. And one of those most important risks is that of infection. So, your article reviews the potential infectious complications of medications used to treat MS, NMO, etc, and also covers considerations related to thinking about vaccines in this patient population. So, as the MS treatment landscape grows, I can say as a general neurologist, keeping up with all these medications and what to screen for and what to worry about and when to vaccinate just becomes more challenging every year. And your article has so many helpful tables, some organized by medicine, some organized by- sorry, medication, some organized by infection, some by vaccines. So, this is gonna be a great resource for our providers to print out and tape up in their clinic rooms. We won't be able to get into all the depth and detail that you have in this article today, but I do want to focus on some of the key points here related to the common medications we use for MS and which infections to think about and which vaccine considerations we might need to keep in mind for these medications. But before we delve into the drugs, I just wanna ask you more broadly, you talk in the article about the challenge of patients with immune-mediated diseases who are on immunomodulatory therapy being at risk for both flares of their disease and for infections; and these infections can present somewhat atypically, right, in immunomodulated hosts, to maybe coin a term you can correct me on, because they can't mount the full inflammatory response. So how do you approach new symptoms in patients on these immunomodulatory medicines as far as distinguishing disease flare from a treatment-related infection?  Dr Nath: So, I have to say that although a lot of new treatments have come along for MS, and they've really, you know, improved the outcome tremendously and there are so many different options, it has also kept people like me relevant because they cause a lot of various types of infections, and so keeps me in business all the same. But just as you mentioned, there's so many of them, even I have difficulty keeping track of what does what. So, you do need to be able to refer back to published literature, and the tables, I hope, will be quite useful in that regard. You're absolutely right, and you can get new infections, you can get reactivation of existing infections, and you can get atypical presentations of various types of infections that you may not normally think of. So that presents multiple challenges to the treating physician. The other interesting thing about MS is, just as you mentioned, that you already have CNS lesions to begin with. Now, on top of it, you have an infection, so now how to sort out what is the existing disease and what is the infection, it can again become challenging. But one thing is for sure: all these infections are caused by an organism. So, what you really need to do is, the underlying diagnostic is to demonstrate the presence of the organism. Whether you demonstrate it depending on the infection in the spinal fluid or in the brain or, you know, some peripheral organ system, that is going to be key to making the diagnosis. So, all your clinical acumen is good, but that alone may not be sufficient. Dr Berkowitz: Very good. So, when you see a, a patient now who has a new neurologic symptom in the context of an immune-mediated disease who's on immunomodulatory therapy, what goes through your mind? Are you thinking this disease and this drug, and sort of what are the infections, and does the syndrome match? Or are you thinking, you know, you can't always rely on the imaging to distinguish between, say, a flare of an MS and PML because white matter lesions could look similar? How do you sort of approach this scenario when it comes up?  Dr Nath: So, you're right. You have to keep an open mind so that even though you know some infections are more likely to occur with certain types of medications, that doesn't mean that others cannot occur. So, I think when you first see the patient, you should not jump to conclusions, but rather have an open mind. But yes, for example, your patient is on natalizumab, the chances of PML are going to be high. It's a very interesting drug. It does not cause immune compromise in the periphery, but what it's doing is preventing these cells from getting into the brain. So, because then it's acting at the blood-brain barrier. So that means that organisms that are already present in the brain have an opportunity to get reactivated. Turns out you don't have a lot of organisms in the brain, except JC virus seems to be one of them that does somehow, in some individuals, manage to reside out there. And so that can get reactivated. It can get reactivated in the periphery and then enter the brain, too. So, where the very specific mutations have to occur in that virus in order to take residence in the brain. That would be a suspicion that you might have, and MRI can be useful in, again, helping you think about that possibility. If you have typical lesions involving the U fibers, they're demyelinating, usually you do not have much edema around them because patient is immune compromised, but certainly within the brain in these individuals. And so, then you need to demonstrate the organism. The demonstration of the organism should be in the spinal fluid and not in the blood because in the virus, it can-- is reservoir in the kidneys and in the lymph nodes, and periodically it'll shed into the blood. Detection of the organism in the blood can be a false positive, but in the spinal fluid, it shouldn't be there unless you have an infection. Or if you cause a traumatic tap, I guess, if a patient is viremic, that's a possibility, but those are extremely rare. So at least for PML, that's the way that you would diagnose it. Now, you can develop, for example, if an individual is on fingolimod, you can get a wide variety of infections. Here it's a totally different type of mechanism of action. Here the cells are trapped within the lymph nodes, so that means now your entire periphery is immune compromised, right?  So here you can get viral infections, bacterial infections, fungal infections. So here, if a patient presents with new neurological symptoms, you have to have a really open mind for all these possibilities. Now, let's say a patient was on dimethyl fumarate, and dimethyl fumarate causes neutropenia early on. So here you have to worry about an individual developing bacterial infections, so latent tuberculosis or bacterial meningitis can occur in these individuals. That's something to keep in mind. It's not that other infections cannot occur with dimethyl fumarate, you can see PML and other things too, but the chances of bacterial infections are greater. So, you got to make sure that you draw all the cultures for that purpose. Similarly, if you're on a complement inhibitor, like a C5 inhibitor or the thing that I could use in NMO, there are the chances of meningococcal meningitis. So, these patients, you need to prevaccinate them before you start these kinds of treatments and look for that possibility. When you suspect bacterial infections, particularly acute bacterial meningitis, there time is of essence. Also, in some of the acute viral infections, for example---herpes encephalitis is another one---you have to be so careful, and if you suspect any of them, even if they're with possibly atypical manifestations, you treat first and then diagnose later, and draw all your cultures, whatever you need to, and just treat them. And these infections can also cause cerebral edema, so one has to be careful about doing spinal taps in these individuals. You want some kind of neuroimaging before you do them. In the days when we didn't have neuroimaging, we used to say, "Okay, if your patient has focal neurological signs or is comatose, you don't do it." But these days, you can get imaging very quickly and very easily. All the-- Because of our stroke management, we've learned how to do them so quickly. So, I think there's little excuse not to do imaging and prevent herniation from occurring.  Dr Berkowitz: That's very helpful. So, using the information we know about the drug, and we're going to rapid-fire review some of that in a bit to know what infections the patient is susceptible to, but acknowledging that any patient can get any infection, right? Whether they're on particular medications or not. And then if you're not sure, based on the neuroimaging, which as you said, is helpful, but not always helpful in distinguishing between infections and flares or, as you said, in the case of meningitis, encephalitis, early on at least, especially in immunocompromised or immunomodulated, quote unquote, patient might not see the typical imaging. So really, when safe, getting CSF or cultures, PCRs, and other infectious studies too is really gonna be the definitive diagnostic maneuver here. Is that fair summary across the board?  Dr Nath: I think you said that absolutely right. And you summarized that correctly. And, you know, thing about infection, a lot of neurological diseases are, you know, diagnosed by clinical acumen, like your Parkinson's and Alzheimer's and others. Think about infections is caused by an organism, demonstrate the organism, right? That should be your goal. It doesn't mean that clinical acumen is not important, but here you have an opportunity to demonstrate the organism, so you should depend upon that.  Dr Berkowitz: Okay. Well, you gave us a nice segue by talking about some of the infections to worry about with some of the medications. So what I'd like to do now for the sort of second half of our interview here is to go through some of the more common medications used for MS, and if we have time, for NMO, and just sort of go kind of rapid fire here, and for each medication, if you can tell us the kind of top infectious concerns and whether when to consider them or what screening needs to take place before or during administration of the medication, and then any vaccine considerations we should be aware of. Some of these will obviously be quite short depending on the medicine. So, going back to the two medications I alluded to earlier that were the only ones in play when you and I last saw each other on the wards when I was a medical student, beta interferon, glatiramer acetate, any infections or vaccine considerations with these medications?  Dr Nath: No, I think they're probably your safest medications now as far as immunomodulatory therapies are concerned. These two, and IVIG, if you ever use them, are probably the safest, do not require any vaccine considerations, per se. Dr Berkowitz: Perfect. Okay. So, moving on to fingolimod and others in the sphingosine-one phosphate receptor modulator family, what are the infectious considerations? Any prescreening or vaccination considerations?  Dr Nath: I think all your patients should be prescreened for antibodies to JC virus, because there is a risk for PML, and those who are positive should be closely monitored. So, it's not an absolute contraindication for using these medications, but they just require closer monitoring. With this class of drugs, PML is of consideration. Also, these varicella-zoster virus infection, yeah, with that you can develop zoster encephalitis or myelitis. It can present with motor symptoms as well, which can be atypical. You don't usually see them otherwise in immune-competent individuals. So, varicella-zoster, sometimes you can develop encephalitis, also vasculitis with varicella-zoster, so one has to be careful. So, getting the shingles vaccine can be actually very helpful to prevent these things. And then some patients can even develop herpes simplex encephalitis also, and that can be extremely atypical. So, they don't- they can involve the basal ganglia, can involve the brain stem and cerebellum. So again, your index of suspicion should be very high. Interestingly, although HSV encephalitis has been associated with NMDA receptor encephalitis, those reports of NMDA receptor encephalitis have not been published yet with NMS patients. Not sure why, maybe they just have been missed. But that doesn't seem to be a major concern. And then there are a whole host of other infections that can occur with this class of drugs, and that can include toxo; fungal infections, particularly crypto. There's a case report of histoplasmosis; hepatitis virus, particularly hepatitis C; and then the poxvirus is a good example. You can get molluscum contagiosum; warts with papillomavirus; you can get atypical mycobacteria; and even Kaposi sarcoma, which is HHV8. So, there's a huge variety of infections with the sphingosine one phosphate receptor modulators.  Dr Berkowitz: And any- aside from screening for JC virus before initiating these, any- and then continuing to monitor for JC antibody index, any other considerations as far as labs to send, monitoring before or on the drug or vaccine considerations for patients on fingolimod and the others in this category, siponimod, etcetera?  Dr Nath: Yeah, there are a lot of things to consider. All the details are really available in the chapter if you look at them. But briefly, all the things that one could potentially vaccinate patients for, all these infections I mentioned, one should do so. The timing is critical so that if you can do it before treatment, I think, before starting treatment, that is absolutely important. And you got to give them at least, you know, two to three weeks for these vaccines to take effect before starting your medication. If your patient already arrives on a medication, then you got to play this game of you know, before the next dose, give them again two to three weeks before the next dose and start vaccinating them and get all the vaccines in. Broadly, about the things to worry about the vaccines are you have live vaccines, and you've got the inactivated vaccines or the subunit vaccines. You have to be careful with live vaccines, because if your patient is immunocompromised, that virus can sometimes itself cause harm. For example, you know, yellow fever is one, and there you can develop encephalitis from it. Measles, mumps, rubella, these are all live vaccines. Now, the good thing is that a lot of us have been immunized very early in childhood, but that may not be the case any longer. And so, these things, one has to be very careful with when you're giving live vaccines, that we want to avoid them as much as possible, and individuals are gonna be immune-compromised. But all the others, meningococcus, for example, you should- the HPV vaccines, the varicella zoster vaccines, all these things, you've got to pre-vaccinate and make sure that they have an antibody response to them before starting immunocompromising therapy. Dr Berkowitz: Perfect. Okay, moving on to some of the other orals. What infectious and/or vaccine considerations do we have with teriflunomide?  Dr Nath: Okay, yeah. Teriflunomide is a very interesting drug. It's relatively safe. There is concern about the possibility of varicella zoster infection, people have reported that, and also tuberculosis. But PML is extremely rare, if not at all, and we haven't seen herpes encephalitis quite yet.  Dr Berkowitz: Got it. How about dimethyl fumarate? Dr Nath: Yeah. So dimethyl fumarate is... as I mentioned earlier, it's interesting because it causes this neutropenia. It's transient, but it occurs early on, and these patients can be at risk of PML, although small. They can develop varicella zoster virus infection, herpes encephalitis, and also fungal infections. For example, cryptococcal infection has been reported with dimethyl fumarate. Dr Berkowitz: Okay. We've spoken a bit about natalizumab and PML, and you have extensive information on this in your article, and I'll defer the reader to that. But for natalizumab, what are the key points every neurologist should know about natalizumab and PML as far as from the practical perspective, screening, frequency of screening, when to worry, when to not use natalizumab at all in the first place based on what you find in your screening for JC virus? What are the key points every neurologist should know?  Dr Nath: Uh, yes. You bring up an important point, and that is all patients should be monitored for JC virus. If they're JC virus-negative, so that's your most ideal patient to go on natalizumab, but that doesn't mean they cannot get infected with the virus. In fact, there's an interesting study claiming that, you know, patients, when they get these infusions, they're all sitting in the same room getting infused. Some have JC virus, some don't have JC virus, and so there's the potential that we may be aiding the transmission here in some way or another. The virus is an interesting one. It comes out in urine, and then it's spread through oral contamination, gets into the tonsils, and then spreads from there to your marrow and resides in the kidney and the marrow, as well as the lymph nodes, forever. So, you, you have to monitor these patients to see that during the course, even if they're negative, they could turn out positive. So, every six months or a year, an antibody test should be done on all patients irrespective. If a patient already has antibodies, that's not an absolute contraindication. It just means you've got to monitor them closely for development of new symptoms, and if, whenever there are new symptoms, don't just assume this is due to MS, but just make sure the MRI is done with and without contrast. The- and if there's still a suspicion, that you do a CSF evaluation for JC virus. Just detecting, looking for JC virus in the blood, a rising titer is another thing that can help you. And so, the titer is also important. And the reason you have rising titers is it means that there's an infection that's already occurred in the brain, and the immune system is reacting to that infection by increasing titers. But that alone is not sufficient to make the diagnosis. You still- that gives you an index of suspicion. You've got to then do the MRI and the spinal tap to, you know, be absolutely certain. So, each patient is a little bit different, so the way you monitor them is going to depend on where they are. You know, if they've had prior immunomodulatory therapy before starting natalizumab, or if they're on natalizumab for more than two years, then the chances of PML are much greater, so you may want to monitor them more closely. Uh, they never had any prior immunomodulatory therapy, you're just starting natalizumab, maybe once a year is sufficient. So, I think you've got to tailor it depending on what your risks are for each patient. Dr Berkowitz: Perfect. That's very helpful. And again, you write extensively about PML and natalizumab and PML considerations in your article. So, for a more detailed and in-depth discussion of what we just discussed, definitely hope readers will take a look at your article. Okay. Last but not least---certainly not least, 'cause we're using these probably, it seems, the most commonly in many places I've worked---rituximab, ocrelizumab are B-cell therapies for MS. What are some of the infectious and vaccine considerations related to these infusion medications?  Dr Nath: So, there's concern for PML with anti-B-cell therapies also, maybe not to the same degree as natalizumab, but the same principles should be applied. A lot of people think that these are relatively safe. I don't think so. I think we see enough number of patients on B-cell therapies with PML. So, I would use the same caution because these infections are... you know, can be fatal. So, one should be very careful, even with anti-B-cell therapies. And just with natalizumab, you also have the risk of VZV infection causing shingles. HSV1 has been reported, but there's another interesting complication that has been reported with anti-B-cell therapies, and that is severe West Nile encephalitis. And as mosquitoes-borne diseases are getting more and more prevalent, and we're seeing West Nile cases erupting every summer, I think one's got to be, you know, very cognizant of the fact that this can occur. These patients should take precautions to prevent mosquito bites from occurring and not expose themselves to areas where they could be at risk for it. Unfortunately, there is no vaccine for it and no specific treatment for West Nile. So, all one can do is use prevention strategies for mosquito bites.  Dr Berkowitz: Yeah, I'm glad you mentioned that. I think the only really truly severe neuroinvasive cases I've seen of West Nile virus have indeed been in patients who were being treated with B-cell therapy. Not, if I'm remembering correctly, for immune-mediated disease, but for a lymphoma, so probably other confounding factors there. But yeah, it's a disease we learn about and think about, but I've only seen the most severe cases in patients who had abnormal immune systems, so I'm glad you flagged that. This has been a very helpful discussion, and I've learned a lot from you. I learned a lot from your article, just as I did when you were my attending some 20-something years ago on the wards when I was a medical student. So, it's good to continue learning from you through your writing and research, and today from getting to talk to you again. I encourage our readers to read your article and to bookmark those tables for when these considerations come up for your patients on these immunomodulatory therapies and you're wondering which infections to worry about and how to manage vaccines in this patient population. So again, today I've been interviewing Dr. Avi Nath about his article on vaccine considerations and infection risk in multiple sclerosis and related disorders, which he wrote with Dr. Amit Bar-Or. This article appears in the April 2026 Continuum issue on multiple sclerosis. Be sure to check out Continuum Audio episodes from this and other issues, and thank you again to our listeners for joining today.  Dr Nath: Thank you so much, Aaron, for that wonderful interview, and I'm extremely proud of all your accomplishments over the last 20 years. You've done an amazing job, and it was such a pleasure to see you and to be able to do this interview with you. Thank you again.  Dr Berkowitz: Thanks. That means a lot. I never would have imagined- we won't say 20, how many, but 20-something years ago as the medical student looking up to you and all your expertise on these infections and all of your research that led to so much of our understanding on these, that I would find myself interviewing you two decades later. So, for all the students listening, you never know where you'll end up, but I appreciate your very kind words.  Dr Nath: That's what we hope for all our students. Thank you so much.  Dr Berkowitz: Thanks again.  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.

What is cultural distress? It is a negative response rooted in a cultural conflict where the patient lacks control over their situation. It results in more physiologic effects on the body resulting in allostatic overload. To prevent this, healthcare practitioners must use strategies such as cultural humility to help patients navigate healthcare. Come find the best ways to deliver culturally sensitive care in any setting.

Nadine Dijkstra is a Principal Investigator at the Institute of Neurology at UCL. Her research in Imaging Neuroscience explores how the brain generates mental images and differentiates them from actual perception. Utilizing neuroimaging, psychophysics, machine learning, and computational modeling, Dijkstra addresses fundamental questions about the overlap between perception and imagery.Recently, Dijkstra has been leading the Imagine Reality Lab at UCL's Department of Imaging Neuroscience, focusing on the intersection of imagination and reality. Dijkstra's 2023 paper in Nature Communications showed the brain evaluates images against a 'reality threshold' to distinguish between images and perception. Her work also investigates how changes in these neural processes could impact mental health.Check out our new series, Ideas for Our Time: https://youtu.be/nYS4FylZJ2QDon't hesitate to email us at podcast@iai.tv with your thoughts or questions on the episode!To witness such debates live buy tickets for our upcoming festival: https://howthelightgetsin.org/festivals/And visit our website for many more articles, videos, and podcasts like this one: https://iai.tv/You can find everything we referenced here: https://linktr.ee/philosophyforourtimesSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In the last episode of the series, Dr. Stacey Clardy and Drs. Deborah Hall and Deborah Setter discuss some practical changes that can immediately improve lactation support in neurology workplaces.  Show transcript: Dr. Stacey Clardy: This is the Neurology Minute. I'm Stacey Clardy from the Salt Lake City VA and the University of Utah. I've just had a fantastic in depth podcast discussion with Deborah Hall from Rush University and Deborah Setter from Olmsted Medical Center on their paper titled Workplace Lactation in Neurology: Barriers and Opportunities. You can find that in Neurology Clinical Practice. Deborah Hall, what are some practical changes that can immediately improve lactation support in neurology workplaces? Dr. Deborah Hall: One practical change that could be considered is to plan immediately when you know a provider will be going out on maternity leave. Prior to departure, you can plan what that schedule's going to look like when that provider returns. Ensure that they have those 30 minute breaks every two to three hours in their inpatient or outpatient schedule. Make sure that there's a space for them and have them go look at it that would be appropriate for their lactation breaks. You want to make sure they have that dedicated refrigerator for breast milk storage. And finally, make a plan for compensation. It's really important that they understand how their productivity targets and how compensation will be affected by the breaks that they will be taking. Dr. Stacey Clardy: Easy to make changes, right? And as we discuss in the full-length podcast, please everyone take a listen to this. This is something we can all improve on to support all of our colleagues in neurology. Please have a listen to the full-length podcast. We give you everything that you need to know to be a better support to your colleagues. Thanks so much, Deborah. 

Dr. Alex Menze talks with Dr. Kathryn C. Fitzgerald about using accelerometry to detect subtle, longitudinal changes in disability in people with multiple sclerosis and how these changes relate to brain atrophy and disability progression.  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/Cash Apphttps://cash.app/$theoccultrejectsVenmo@TheOccultRejectsBuy Me A Coffeebuymeacoffee.com/TheOccultRejectsPatreonhttps://www.patreon.com/TheOccultRejectsPrimary / traditional texts and core religious sourcesĀnāpānasati Sutta (MN 118), translated by Thanissaro Bhikkhu, Access to Insight. Best primary source for Buddhist mindfulness of breathing.“Ḏekr / Dhikr,” Encyclopaedia Iranica. Strong source for Sufi remembrance, rhythmic repetition, posture, and breathing-linked practice.“Hesychasm,” Encyclopaedia Britannica. Good general source for the Christian contemplative tradition of stillness, uninterrupted prayer, and the Jesus Prayer.“Saint Gregory Palamas,” Encyclopaedia Britannica. Useful for the role of bodily posture and controlled breathing in Hesychast prayer.Crowley, Aleister. Liber E vel Exercitiorum. Primary text for Crowley's explicit inclusion of “Pranayama – Regularisation of the Breathing” in occult training.Crowley, Aleister. Book Four, Part 1. Useful for Crowley's statement that pranayama is useful in “quieting the emotions and appetites.”Historical / religious context“Prana,” Encyclopaedia Britannica. Best short source for the deep Indian background: prāṇa, the five prāṇas, and breath as vital force.“Pranayama,” Encyclopaedia Britannica. Best short source for classical Yoga: pranayama as the fourth limb aimed toward samādhi.“Hatha Yoga,” Encyclopaedia Britannica. Useful for the force-oriented turn: bodily mastery, purification, and regulation of breathing.“Qi,” Encyclopaedia Britannica. Good for Daoist and Chinese background: qi as psychophysical energy and breath-linked vital force.“Qigong,” Encyclopaedia Britannica. Useful for qigong as a discipline combining movement, breathing, and mental concentration.“Are Kabbalistic Meditations all about Ecstasy?” in Hermes Explains (Cambridge). Strong academic source for Abraham Abulafia and ecstatic Kabbalah.“Classical Kabbalah, Its History and Symbolic Universe.” Useful academic source noting ecstatic Kabbalah's breathing exercises, postures, and developed techniques.Neuroscience / physiology / altered statesAshhad, Kam, Del Negro, and Feldman. “Breathing Rhythm and Pattern and Their Influence on Emotion.” Annual Review of Neuroscience (2022). One of the best overview papers for the whole episode.Yackle et al. “Breathing control center neurons that promote arousal in mice.” Science (2017). Key source for the preBötzinger complex / calm-vs-arousal section.Schottelkotte and Dutschmann. “Forebrain control of breathing: Anatomy and potential functions.” Frontiers in Neurology (2022). Best source for cortex, amygdala, hippocampus, hypothalamus, and thalamus in breathing control.Krohn et al. “The integrated brain network that controls respiration.” eLife (2023). Strong review for respiration as part of a larger integrated brain network.Heck et al. “Breathing as a fundamental rhythm of brain function.” Human MEG work on respiration-modulated brain oscillations across frequency bands and brain regions.(Note: the specific MEG paper surfaced in earlier research as the respiration-modulated oscillations study; the review sources above are the strongest anchors for that section.)Zelano et al. “Nasal Respiration Entrains Human Limbic Oscillations and Modulates Cognitive Function.” Journal of Neuroscience (2016). One of the most important human papers in the whole script.Schreiner et al. “Respiration modulates sleep oscillations and memory reactivation in humans.” Nature Communications (2023). Best source for the sleep-spindle / memory-reactivation section.Zaccaro et al. “How Breath-Control Can Change Your Life: A Systematic Review on Psychophysiological Correlates of Slow Breathing.” Frontiers in Human Neuroscience / PMC version (2018). Best broad source for slow breathing under 10 breaths per minute.Shao, Man, and Lee. “The Effect of Slow-Paced Breathing on Cardiovascular and Emotion Functions: A Meta-Analysis and Systematic Review.” Mindfulness (2024). Useful for the stabilizing-road section.Kozhevnikov et al. “Neurocognitive and Somatic Components of Temperature Increases during g-Tummo Meditation.” PLoS ONE (2013). Best source for vase breathing and inner-heat claims.Zhang et al. “Hyperventilation in neurological patients: from physiology to outcome evidence.” Useful source for hypocapnia, cerebral vasoconstriction, and reduced cerebral blood flow.Havenith et al. “Decreased CO2 saturation during circular breathwork supports emergence of altered states of consciousness.” Communications Psychology (2025). The key modern paper for circular breathwork and altered-state onset. 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. Now let me introduce the rest of the panel and guests.

Dr. Ashish Kabir is a board-certified neurologist at Hamilton Physician Group-Neurology in Dalton, Georgia.For more information about Hamilton Physician Group-Neurology, call 706-275-6121 or visit HamiltonHealth.com/neurology.This program in no way seeks to diagnose or treat illness or to replace professional medical care. Please see your healthcare provider if you have a health problem.

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/Cash Apphttps://cash.app/$theoccultrejectsVenmo@TheOccultRejectsBuy Me A Coffeebuymeacoffee.com/TheOccultRejectsPatreonhttps://www.patreon.com/TheOccultRejects1. Patel, A. K., et al. *Physiology, Sleep Stages*. StatPearls / NCBI Bookshelf, 2024.2. Jensen, O., & Mazaheri, A. “Shaping Functional Architecture by Oscillatory Alpha Activity: Gating by Inhibition.” *Frontiers in Human Neuroscience*, 2010.3. Cavanagh, J. F., & Shackman, A. J. “Frontal Midline Theta Reflects Anxiety and Cognitive Control: Meta-Analytic Evidence.” *Journal of Physiology-Paris*, 2015.4. Axmacher, N., et al. “Cross-Frequency Coupling Supports Multi-Item Working Memory in the Human Hippocampus.” *PNAS*, 2010.5. Lacaux, C., et al. “Sleep Onset Is a Creative Sweet Spot.” *Science Advances*, 2021.6. Horowitz, A. H., et al. “Targeted Dream Incubation at Sleep Onset Increases Post-Sleep Creative Performance.” *Scientific Reports*, 2023.7. Caporro, M., et al. “Functional MRI of Sleep Spindles and K-Complexes.” *Clinical Neurophysiology*, 2012.8. Ng, T., et al. “Bayesian Meta-Analysis Reveals the Mechanistic Role of Slow Oscillation-Spindle Coupling in Sleep-Dependent Memory Consolidation.” *eLife*, 2025.9. Datta, K., et al. “Electrophysiological Evidence of Local Sleep During Yoga Nidra Practice in Young Male Volunteers.” *Frontiers in Neurology*, 2022.10. Jensen, M. P., et al. “Brain Oscillations, Hypnosis, and Hypnotizability.” *American Journal of Clinical Hypnosis*, 2015.11. Huels, E. R., et al. “Neural Correlates of the Shamanic State of Consciousness.” *Frontiers in Human Neuroscience*, 2021.12. Ingendoh, R. M., et al. “Binaural Beats to Entrain the Brain? A Systematic Review...” *PLOS ONE*, 2023.13. Páez, A., et al. “Sleep Spindles and Slow Oscillations Predict Cognition and Biomarkers of Neurodegeneration in Mild to Moderate Alzheimer's Disease.” *Alzheimer's & Dementia*, 2025.14. Askitopoulou, H. “Sleep and Dreams: From Myth to Medicine in Ancient Greece.” *Journal of Anesthesia History*, 2015.15. Pavli, A. “Asclepieia in Ancient Greece: Pilgrimage and Healing.” *Journal of Integrative Medicine and Research*, 2024.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. Now let me introduce the rest of the panel and guests.

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Lee Neilson, Assistant Professor of Neurology at the University of Iowa and staff neurologist at the Iowa City VA specializing in movement disorders, to discuss his groundbreaking research examining whether obstructive sleep apnea represents a modifiable risk factor for Parkinson's disease. Dr. Neilson's ambitious study analyzed records from 13 million patients within the VA system to investigate whether OSA is associated with higher risk of neurodegenerative disorders and whether treating sleep apnea might help delay the onset of dementia. The conversation traces the research design from initial hypothesis through methodology, explaining how he narrowed this massive dataset and defined both OSA diagnosis and Parkinson's disease progression. Critical methodological details emerge: How was OSA diagnosed—through sleep testing, and using 4% or 3% hypopnea criteria? How did the study differentiate between mild and severe sleep apnea? How was Parkinson's disease identified—through clinical notes, medication records, or longitudinal follow-up? Dr. Neilson clarifies whether the analysis included only PD or extended to other neurodegenerative disorders like Alzheimer's disease. The core findings receive extensive examination: Did CPAP therapy have a modifying effect on PD risk? After adjusting for confounding factors including BMI, diabetes, depression, and hypersomnia, which variables mattered most? What was the number needed to treat to prevent one case of Parkinson's disease? Could hypoxic burden be examined as a potential mechanism? Intriguing tangential discussions explore whether idiopathic RBD can be distinguished from trauma-related RBD and whether these represent separate pathological processes. The conversation takes an unexpected turn into the neuroprotective effects of smoking in Parkinson's disease, with Dr. Neilson explaining proposed mechanisms and drawing parallels to ischemic preconditioning that might occur with OSA. The episode addresses severity gradients—did OSA severity correlate with PD risk? It also tackles a fundamental question: Does treating sleep apnea delay dementia onset or actually prevent it? Dr. Neilson discusses whether non-PAP therapies were examined and addresses a critical ethical concern in sleep apnea research: Is it irresponsible to withhold treatment from symptomatic patients, and did this study focus on non-sleepy individuals or include all OSA patients regardless of symptoms? This research has profound implications for how sleep medicine practitioners frame the importance of OSA treatment with patients and families. Beyond addressing immediate symptoms like sleepiness, treating sleep apnea may reduce long-term neurodegenerative risk—a compelling motivation for adherence that extends beyond quality of life to disease prevention. Whether you're counseling patients about the importance of OSA treatment, interested in the sleep-neurodegeneration connection, or seeking evidence-based approaches to discussing long-term benefits of therapy, this episode provides essential insights. Join us for this important conversation about how the work sleep medicine practitioners do every day may profoundly impact patients' neurological futures.

What happens when we slow down enough to really experience art? We visit a museum to discover how slow looking at art can cultivate awe, empathy, and a greater sense of connection in a distracted world.Summary: Art has the power to move us emotionally, physically, and socially—but only if we take the time to truly engage with it. As part of our Cities of Awe series, this episode of The Science of Happiness explores what happens when we slow down and really look at a piece of art. We visit the Nevada Museum of Art to look at the science and practice of slow looking—how it can deepen empathy, presence, and everyday meaning.How To Do This Practice: Choose One Piece and Commit to Staying With It: Pick a single artwork, photograph, object, or even a scene in nature. Set aside about 15 minutes and put away distractions—especially your phone. The goal is not to “figure it out,” but to stay present long enough for your experience to deepen. Spend Time Noticing the Form: For the first five minutes, focus only on what you see. Notice the shapes, textures, colors, lines, patterns, shadows, movement, or composition. Let your eyes wander slowly across the piece and observe details you might normally miss. Pay Attention to Your Emotional Response: For the next five minutes, shift inward. What feelings arise as you look? Curiosity, comfort, sadness, awe, tension, delight, nostalgia? Instead of labeling the experience as simply “I like it” or “I don't,” explore the full range of emotions and reactions that emerge. Let Your Mind Make Associations: For the last five minutes, allow the artwork to lead your thoughts elsewhere. What memories, people, places, or ideas come to mind? Does it remind you of something from your own life or spark questions about the world, history, or humanity? Follow the associations without judging them. Stay Open to Complexity and Discomfort: Some works may bring up conflicting or uncomfortable emotions. Rather than rushing past them, give yourself permission to sit with them.  Read the full study here.Scroll down for a transcription of this episode.Today's Guests: COLIN ROBERTSON is the Senior Vice President of Education and Research at the Nevada Museum of Art. Learn more about Colin Robertson here: https://www.linkedin.com/in/colinmrobertson/DR. ANJAN CHATTERJEE is a professor of Neurology, Psychology, and Architecture and the founding Director of the Penn Center for Neuroaesthetics. Learn more about Dr. Anjan Chatterjee here: https://tinyurl.com/yw2fs364Related Science of Happiness episodes:Cities of Awe Series: https://tinyurl.com/2vyhxvnyFollow us on Instagram: @ScienceOfHappinessPodWe'd love to hear about your experience with this practice! Share your thoughts at happinesspod@berkeley.edu or use the hashtag #happinesspod.Find us on Apple Podcasts: https://tinyurl.com/2p9h5aapHelp us share Happiness Break! Leave a 5-star review and share this link: https://tinyurl.com/2p9h5aapTranscription: https://tinyurl.com/5b5prh4t

What if loneliness isn't just an emotion… but one of the most dangerous biological threats to your health? In this deeply personal and scientifically explosive solo episode, Darin opens up about something he recently realized in his own life: despite being surrounded by people, he was lonely. But what began as an emotional realization quickly became a deep dive into some of the most shocking research he's ever uncovered, showing that chronic loneliness may increase the risk of heart disease, dementia, cancer, autoimmune dysfunction, accelerated aging, and early death. From inflammatory gene expression and cortisol dysregulation to oxytocin, vulnerability, and the collapse of real human connection in the digital age, this episode reveals why loneliness may be the most overlooked "fatal convenience" of modern life, and how vulnerability may be the medicine. What You'll Learn Why loneliness is a biological crisis, not just an emotional feeling The shocking link between loneliness and heart disease, dementia, and early death Why the quality of your relationships is the #1 predictor of long-term health How loneliness activates inflammatory genes inside your body The role of cortisol, sleep disruption, and chronic stress in social isolation Why social media and "surface-level connection" are replacing real intimacy The connection between loneliness and Alzheimer's disease How oxytocin and genuine connection reduce inflammation Why vulnerability is the gateway to meaningful relationships Practical ways to create deeper connection starting today Chapters 00:00:33 – Sponsor: the truth about the exploding NAD supplement market 00:01:04 – Why supplement verification and transparency matter 00:02:17 – Opening: Darin admits something deeply personal 00:02:30 – "I realized recently… I'm lonely" 00:02:37 – The difference between being surrounded by people vs being truly known 00:03:06 – Loneliness as a biological experience, not just an emotional one 00:03:27 – The hidden risks: heart disease, dementia, cancer, early death 00:03:45 – Why this is not fringe science 00:04:13 – The most important predictor of long-term health 00:04:34 – Why relationship QUALITY matters more than quantity 00:05:06 – The global loneliness epidemic 00:05:11 – U.S. Surgeon General advisory on loneliness 00:05:39 – Loneliness declared a public health crisis 00:06:02 – 50% of Americans report measurable loneliness 00:06:22 – "A generational collapse of connection" 00:06:30 – 29% of adults have no close friends 00:06:40 – Face-to-face interactions dramatically declining 00:07:01 – The UK, Japan, and Australia loneliness crisis initiatives 00:07:32 – The paradox: hyperconnected but deeply isolated 00:08:04 – Loneliness as a biological alarm signal 00:08:31 – What loneliness actually looks like in modern life 00:08:42 – The lonely CEO, the unseen mother, the isolated social media addict 00:09:31 – "Perceived social isolation" and why the brain can't tell the difference 00:10:21 – Meta-analysis of 3.4 million people 00:10:55 – Loneliness vs obesity and smoking risk comparisons 00:11:18 – The biology of loneliness begins 00:11:50 – NF-kB: inflammatory gene activation explained 00:12:33 – How loneliness changes gene expression 00:13:02 – Chronic inflammation and disease pathways 00:13:21 – Cortisol, sleep disruption, and immune dysfunction 00:14:00 – How loneliness affects brain repair and amyloid plaque clearing 00:14:21 – Sponsor: Fatty15 and cellular health 00:18:02 – The Alzheimer's and dementia connection 00:18:25 – Loneliness as a major modifiable dementia risk factor 00:18:57 – Cortisol, neuroinflammation, and brain degeneration 00:19:16 – The hippocampus physically shrinking in lonely people 00:19:27 – Social media as a "fatal convenience" 00:19:57 – The oxytocin economy: connection as medicine 00:20:15 – Oxytocin as one of the body's strongest anti-inflammatory molecules 00:20:30 – HeartMath research: emotional synchronization between people 00:20:48 – "You regulate each other's biology" 00:21:07 – The real barrier: vulnerability 00:21:32 – Darin's recent experiences with radical vulnerability 00:21:54 – Conversations with family, ex-partners, and loved ones 00:22:35 – Brené Brown's research on connection and worthiness 00:23:14 – The "depth audit" exercise 00:23:42 – Reaching out, expressing appreciation, and owning your emotions 00:24:01 – Sacred hours: spending time without phones 00:24:13 – Questions that create real intimacy 00:24:30 – Darin's emotional conversation with his brother 00:25:03 – Protecting yourself from social media disconnection 00:25:20 – Becoming a source of joy and connection in everyday life 00:25:25 – Darin reflects on seven years of subtle loneliness 00:25:48 – The shift from surface conversations to meaningful connection 00:26:01 – "If you want love, give love" 00:26:19 – Final message: generate the connection you want to receive 00:26:22 – Closing thoughts and outro Thank You to Our Sponsors Truniagen: Go to www.truniagen.com and use code DARIN20 at checkout for 20% off Fatty15: Get an additional 15% off their 90-day subscription Starter Kit by going to fatty15.com/DARIN and using code DARIN at checkout. Join the SuperLife Community Get Darin's deeper wellness breakdowns — beyond social media restrictions: Weekly voice notes Ingredient deep dives Wellness challenges Energy + consciousness tools Community accountability Extended episodes Join for $7.49/month → https://patreon.com/darinolien Connect with Darin Olien: Website: darinolien.com Instagram: @darinolien Book: Fatal Conveniences Platform & Products: superlife.com New Show: Roadmap to Happiness Key Takeaway "Loneliness isn't weakness. It isn't failure. It's a biological signal telling you that something essential is missing. And in a world addicted to surface-level connection, the real medicine may simply be this: vulnerability, presence, eye contact, honesty, and the courage to let yourself truly be seen." Bibliography/Sources The Loneliness Epidemic & Public Health Data Bureau of Labor Statistics. (2023). American time use survey. U.S. Department of Labor. https://www.bls.gov/tus/ Cigna. (2023). Cigna U.S. loneliness index. Evernorth Health Services. https://newsroom.cigna.com/loneliness-epidemic-continues-to-rise-cigna-study Murthy, V. H. (2023). Our epidemic of loneliness and isolation: The U.S. Surgeon General's advisory on the healing effects of social connection and community. U.S. Department of Health and Human Services. https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf Survey Center on American Life. (2021). The state of American friendship: Change, challenges, and loss. American Enterprise Institute. https://www.americansurveycenter.org/research/the-state-of-american-friendship-change-challenges-and-loss/ Mortality & Systemic Health Risk Cohen, S., Doyle, W. J., Skoner, D. P., Rabin, B. S., & Gwaltney, J. M. (1997). Social ties and susceptibility to the common cold. JAMA, 277(24), 1940–1944. https://pubmed.ncbi.nlm.nih.gov/9200634/ Hawkley, L. C., & Cacioppo, J. T. (2010). Loneliness matters: A theoretical and empirical review of consequences and mechanisms. Annals of Behavioral Medicine, 40(2), 218–227. https://pubmed.ncbi.nlm.nih.gov/20396846/ Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227–237. https://doi.org/10.1177/1745691614568352 Valtorta, N. K., Kanaan, M., Gilbody, S., Ronzi, S., & Hanratty, B. (2016). Loneliness and social isolation as risk factors for coronary heart disease and stroke. Heart, 102(13), 1009–1016. https://heart.bmj.com/content/102/13/1009 Genetics, Inflammation & The Immune System Cole, S. W. (2013). Social regulation of human gene expression: Mechanisms and implications for public health. American Journal of Public Health, 103(S1), S84–S92. https://pmc.ncbi.nlm.nih.gov/articles/PMC3786756/ Cole, S. W., Hawkley, L. C., Arevalo, J. M. G., Sung, C. Y., Rose, R. M., & Cacioppo, J. T. (2007). Social regulation of gene expression in human leukocytes. Genome Biology, 8(9), Article R189. https://pmc.ncbi.nlm.nih.gov/articles/PMC2375027/ Sleep & Cognitive Decline Cacioppo, J. T., Hawkley, L. C., Berntson, G. G., Ernst, J. M., Gibbs, A. C., Stickgold, R., & Hobson, J. A. (2002). Do lonely days invade the nights? Potential social modulation of sleep efficiency. Psychological Science, 13(4), 384–387. https://pubmed.ncbi.nlm.nih.gov/12137144/ Holwerda, T. J., Deeg, D. J. H., Beekman, A. T. F., et al. (2014). Feelings of loneliness, but not social isolation, predict dementia onset. Journal of Neurology, Neurosurgery & Psychiatry, 85(2), 135–142. https://jnnp.bmj.com/content/85/2/135 Oxytocin & The Biology of Connection Szeto, A., Sun-Suslow, N., Mendez, A. J., Hernandez, R. I., Wagner, K. V., & McCabe, P. M. (2017). Regulation of the macrophage oxytocin receptor in response to inflammation. American Journal of Physiology—Endocrinology and Metabolism, 312(2), E183–E189. https://journals.physiology.org/doi/full/10.1152/ajpendo.00424.2016 Uvnas-Moberg, K. (2003). The oxytocin factor: Tapping the hormone of calm, love, and healing. Da Capo Press. https://books.google.com/books?id=b-aKjQoB_nQC Psychology, Vulnerability & Relationship Science Aron, A., Melinat, E., Aron, E. N., Vallone, R. D., & Bator, R. J. (1997). The experimental generation of interpersonal closeness. Personality and Social Psychology Bulletin, 23(4), 363–377. https://doi.org/10.1177/0146167297234003 Brown, B. (2010). The gifts of imperfection: Let go of who you think you're supposed to be and embrace who you are. Hazelden Publishing. https://brenebrown.com/book/the-gifts-of-imperfection/ Cacioppo, J. T., & Patrick, W. (2008). Loneliness: Human nature and the need for social connection. W. W. Norton & Company. https://wwnorton.com/books/9780393335286 Dunbar, R. I. M. (2012). Bridging evolutionary approaches to the social brain and social bonding. In F. B. M. de Waal & P. F. Ferrari (Eds.), The primate mind. Harvard University Press. https://www.hup.harvard.edu/books/9780674063104 Dunbar, R. I. M. (2021). Friends: Understanding the power of our most important relationships. Little, Brown and Company. https://www.hachettebookgroup.com/titles/robin-dunbar/friends/9781408711736/ Waldinger, R., & Schulz, M. (2023). The good life: Lessons from the world's longest scientific study on happiness. Simon & Schuster. https://www.simonandschuster.com/books/The-Good-Life/Robert-Waldinger/9781982166694

Dr. Katie Krulisky talks with Dr. Cristina Domínguez-González about the complexities of mitochondrial disease, including diagnosis, biomarkers, and recent research on POLG-related disorders.  Read the related article in Neurology® Genetics.  Disclosures can be found at Neurology.org.

In the first episode of this series, Dr. Stacey Clardy, along with Drs. Deborah Hall and Deborah Setter, discusses the most overlooked barrier to effective lactation support in neurology today.  Show citation:  Hall D, Setter D, Ullrich N, et al. Clinical Workplace Lactation in Neurology: Barriers and Opportunities. Neurol Clin Pract. 2026;16 (3) e200611. Published 2026 Apr 17. doi:10.1212/CPJ.0000000000200611 Show transcript:  Dr. Stacey Clardy: This is the Neurology Minute. I'm Stacey Clardy from the Salt Lake City VA in the University of Utah. I've just had a great discussion with Deborah Hall and Deborah Setter about their paper, Workplace Lactation in Neurology: Barriers and Opportunities. Deborah Setter, my question for you for the minute is what is the most overlooked barrier or barriers to effective lactation support in neurology today? Dr. Deborah Setter: I think the biggest barrier is that lactation is a knowledge gap for neurologists. I was surprised to find out that a lactating person needs a 20 to 30-minute break every two to three hours to maintain their milk supply, prevent complications of insufficient milk expression, and to meet their personal lactation goals. Dr. Stacey Clardy: Awareness is key. I admit that I didn't even know the details surrounding the federal law in the United States regarding this as well. There is so much more in our full podcast discussion, so please take a listen. This is essential listening for all of us in neurology to help our field do better and to support our colleagues. Thanks so much, Deborah. 

Can a shingles vaccine cut your dementia risk by 20%? A series of landmark studies — published in Nature, Cell, and JAMA — say yes. In this episode, Tommy unpacks the research: how natural experiments in four countries produced one of the most compelling signals in dementia prevention, what might explain the effect beyond infection prevention, and what it means for your own vaccination decisions. In this episode: 00:00 — Introduction 00:52 — The new data on shingles vaccination and Alzheimer's risk 01:48 — The Stanford group and their regression discontinuity methodology 03:15 — How birthday-based eligibility creates a natural experiment (Wales, Canada, Australia) 05:28 — Results: a ~20% reduction in dementia diagnoses across all countries 06:52 — The Cell paper follow-up: benefits at every disease stage (unimpaired → MCI → dementia) 07:55 — Shingrix vs. Zostavax: the US natural experiment and a potentially larger effect 09:08 — Why does it work? Preventing illness, avoiding bed rest and disuse, immunomodulation 11:29 — Neuroinflammation and possible immune system "tuning" effects 12:27 — The sex difference: greater benefit in women in most (but not all) studies 15:52 — Summary of the evidence and what it means for dementia prevention strategy 17:36 — Josh's take: number needed to treat analysis 19:15 — Heterogeneous pathways to dementia and why vaccination fits the toolkit 21:13 — Practical advice: when to get vaccinated, repeat dosing, and personal risk assessment 25:36 — Wrap-up and how to submit questions Links & Resources: Shingles vaccine and dementia studies: Nature (Wales, 2025), Cell (Wales follow-up), JAMA/Lancet (Canada, Australia, US) Flu vaccine and dementia: Neurology (2026) Tommy's book: The Stimulated Mind To submit a question for us to answer on the podcast, go to brainjo.academy/question. To subscribe to the free Better Brain Fitness newsletter, join us when we record live, and get our Guide and Checklist to essential blood tests and nutrients, go to: betterbrain.fitness. To learn more about how you can boost brain fitness with neuroscience-based musical instruction, head to brainjo.academy.  Intro and Outro music composed and produced by Julienne Ellen.   

In this episode, editor in chief Joseph E. Safdieh, MD, FAAN, highlights articles about the increase in neurology residency matches this year, the risk of dementia in people with Type 1 diabetes, and the role of neurologists in the public health conversation.

In this episode, we review the high-yield topic of⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Glaucoma⁠ ⁠⁠from the Neurology section.Follow⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets

What actually makes you who you are? In this episode, we get into one of the biggest questions a person can ask, not in a vague or philosophical way, but through the lens of neuroscience. Our guest is Dr. Masud Husain, Professor of Neurology and Cognitive Neuroscience at Oxford, Editor-in-Chief of Brain, and the award-winning author of Our Brains, Our Selves, which won the Royal Society Trivedi Best Science Book Prize. Dr. Husain explains how your sense of self is built through memory, attention, motivation, perception, concepts, and relationships. In other words, who you are is not just something you have, it is something your brain is constantly creating. That is what makes this conversation so gripping. Because if the brain creates the self, then what happens when part of that system changes? We talk about real patients whose identities seemed to shift after changes in the brain, including one man who lost nearly all motivation after tiny strokes, and another who began losing not just words, but the concepts behind them. Their stories are fascinating, but they also raise a deeply personal question: how much of who you are depends on brain processes you rarely notice? We also get into why we become more risk-averse over time, why discomfort starts to feel less worth it, and whether changing how we think can actually change who we are. This episode will make you think differently about personality, memory, identity, and the story you tell yourself about yourself. Listen now, then subscribe and follow Smart People Podcast so you don't miss what's next. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Stacey Clardy talks with Drs. Deborah Hall and Deborah Setter about the current situation for lactating individuals in neurology and the opportunities for improvement in the workplace.  Read the related article in Neurology®.  Disclosures can be found at Neurology.org. 

For decades, an MS diagnosis came with outdated advice and significant uncertainty regarding starting a family. Today, the conversation has shifted from "Is it possible?" to "How do we optimize the journey?" This week, we're taking a deep dive into the essential considerations for family planning, managing MS during pregnancy, and the crucial postpartum period.  We're joined by Dr. Riley Bove, an Associate Professor of Neurology at UCSF and a leading expert in hormonal influences on MS. Dr. Bove brings her extensive research background and clinical expertise to help us understand how to navigate disease-modifying therapies while planning a family, the biological shifts that occur during pregnancy, and how to build a robust support system for the "fourth trimester." We're also sharing study results that provide some optimistic news for people experiencing MS-related depression. We'll tell you about a study that explains the actual changes in the immune system that occur when someone with MS exercises. If you get your health insurance on the Affordable Care Act online marketplace, we'll explain why health economists feel certain that your premiums will be going up again next year. And we're also sharing some sobering research that highlights systemic inequities that prevent people with MS who rely on Medicaid from accessing high-efficacy disease-modifying therapies. We have a lot to talk about! Are you ready for RealTalk MS??! This Week: MS and family planning, pregnancy, and postpartum  :22 STUDY: High-efficacy disease-modifying therapies are not available to all Medicaid recipients   1:08 Millions have failed to renew their ACA individual health insurance plans  5:05 STUDY: Cognitive-behavioral therapy improves MS-related depression  9:32 STUDY: Researchers identify the biological mechanisms that are impacted when people with MS exercise  11:29 Dr. Riley Bove discusses family planning, pregnancy, and postpartum issues that affect women with MS  14:48 Share this episode  35:31 Next week  35:50 SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/453 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 STUDY: Access to High-Efficacy Therapies for Multiple Sclerosis Under Medicaid: Variation in Coverage and Utilization Across States https://aan.com/msa/Public/Events/AbstractDetails/61520 STUDY: Effectiveness of Cognitive Behavioral Therapy for Depression in Patients with Multiple Sclerosis: A Systematic Review and Meta-Analysis https://journals.lww.com/md-journal/fulltext/2026/04170/effectivess_of_cognitive_behavioral_therapy_for.27.aspx STUDY: Physical Exercise Modulates T Cell Activity and Mitigates Synaptic Dysfunction in Multiple Sclerosis Through Vagus Nerve Engagement https://sciencedirect.com/science/article/abs/pii/S0889159126002710 UCSF Clinical Trials: Pregnancy Registry, Infants, Serum/Milk Analysis (PRISMA) https://clinicaltrials.ucsf.edu/trial/NCT06940323 AbleNOW https://ablenow.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 453 Guest: Dr. Riley Bove Privacy Policy

In this deeply moving episode of I Am Refocused, host Shemaiah Reed welcomes the dynamic husband-and-wife team Dr. Bob Cranston and Tammy Cranston. Dr. Bob Cranston is a neurologist with 35 years at Carle Health, a Fellow of the American Academy of Neurology, and Illinois Rural Physician of the Year 2024. He holds an MA in ethics, authored Bioethics and Today's Christian, and lectures widely on medical ethics while recently earning certification in Comprehensive Bereavement Skills. Tammy Cranston is an award-winning author, keynote speaker for women's retreats, and hospice volunteer. Her books include Why Not Me? and the critically acclaimed children's book Rooted: A Seedling's Journey (first in a five-book series). She too is certified in Comprehensive Bereavement Skills. Together, they co-authored The Blank Journal, write memoirs, and speak on grief companioning, advance directives, death, and finishing life well. Married since 2012 and living in Pensacola Beach, Florida, they also model a vibrant, adventurous life—skydiving, paragliding, white-water rafting, and more—while cherishing their four children and 13 grandchildren. If you've ever wondered how to navigate loss, make clear end-of-life decisions, or live with greater purpose and intention, this conversation will help you refocus and finish strong.https://tammycranston.com/

The May 2026 Recall highlights four in‑depth conversations focused on the clinical approach to monocular vision loss. The episode opens with Dr. Dan Ackerman leading a two-part series with Drs. Valérie Biousse and Nancy J. Newman on the challenges and opportunities in diagnosing CRAO and BRAO. The episode continues with a second, two‑part series in which Dr. Justin Abbatemarco speaks with Drs. Valérie Biousse and Nancy J. Newman about updates in non‑arteritic ischemic optic neuropathy. Podcast links: Challenges and Opportunities in Diagnosing CRAO/BRAO - Part 1 Challenges and Opportunities in Diagnosing CRAO/BRAO - Part 2 Updates in Non-Arteritic Ischemic Optic Neuropathy - Part 1  Updates in Non-Arteritic Ischemic Optic Neuropathy - Part 2  Related article: Eye Stroke Protocol in the Emergency Department  Disclosures can be found at Neurology.org.