Podcasts about ninds

In the final part of this three-part series, Dr. Jason Crowell delves into the third issue discussed at NOH, funding for NINDS and the BRAIN Initiative. Show reference: https://www.aan.com/advocacy/ 

Elevated GP - www.theelevatedgp.com Follow @dr.melissa_seibert on Instagram Connect with Melissa on Linkedin Dr. Peter Milgrom is Professor of Oral Health Sciences and Pediatric Dentistry in the School of Dentistry and adjunct Professor of Health Services in the School of Public Health at the University of Washington. He directs the Northwest Center to Reduce Oral Health Disparities. He holds academic appointments at Case Western University, University of Rochester, and University of California, San Francisco. He maintains a dental practice limited to the care of fearful patients and served as Director of the UW Dental Fears Research Clinic. Dr. Milgrom's work includes research on xylitol, the effectiveness of fluoride varnish and iodine in preschoolers, clinical efficacy and safety of diammine silver fluoride, motivational strategies to increase perinatal and well child dental visits in rural communities, and studies of cognitive interventions in pediatric and adult dental fear. The NIH, Maternal and Child Health Bureau, HRSA, and the Robert Wood Johnson Foundation support his work. Dr. Milgrom is author of 5 books and over 300 scientific articles. His latest book, Treating Fearful Dental Patients, was published in 2009.   Dr. Milgrom was Distinguished Dental Behavioral Scientist of the International Association for Dental Research for 1999. In 1999, and again in 2000, his work was recognized by the Giddon Award for research in the behavioral sciences in Dentistry. He received the Barrows Milk Award from IADR in 2000, recognizing his work for public health including the development of the Access to Baby and Child Dentistry (ABCD) program in Washington State. In 2003, Dr. Milgrom received a Special Commendation Award from the National Legal Aid and Defenders Association and the University of Washington Medical Center Martin Luther King, Jr. Community Service Award. In 2010, he received the Aubrey Sheiham Research Award for his work on xylitol. He serves on scientific review committees for the NIDCR, NIMHHD, NINDS, Center for Scientific Review at NIH and as a consultant to the FDA. In 2005, Dr. Milgrom was appointed the SAAD Visiting Professor of Pain and Anxiety Control at the King's College Dental Institute, University of London, UK for a six-year term. In 2008 he was awarded the degree of Doctor Honoris Causa from the University of Bergen, Norway in recognition of his work in social and behavioral dentistry. In 2012, he received the University of California, San Francisco Dental Alumni Gold Medal for his contributions to Dentistry. In 2012 he was also awarded the Norton Ross Award for Excellence in Clinical Research by the American Dental Association. In 2013, he was appointed to the Council of Scientific Affairs of the American Dental Association. In 2014, he received the Irwin M. Mandel Distinguished Mentor Award from the IADR. In 2015, he served as HMDP Expert in Dental Public Health for the Singapore Ministry of Health. Dr. Milgrom received his DDS from the University of California, San Francisco in 1972 and had a previous position at the National Academy of Sciences, Engineering, and Medicine. In the last few years, Dr. Milgrom has spoken to dental associations in Argentina, Colombia, Peru, Philippines, and USA and at major universities in USA and abroad.

Stiff Person Syndrome (SPS) is treatable if managed correctly from the outset. It is essential to distinguish SPS spectrum disorders from disease mimics to avoid both overdiagnoses and misdiagnoses. In this episode, Allison Weathers, MD, FAAN, speaks with Marinos C. Dalakas, MD, FAAN, author of the article “Stiff Person Syndrome and GAD Antibody–Spectrum Disorders,” in the Continuum® August 2024 Autoimmune Neurology issue. Dr. Weathers is a Continuum® Audio interviewer and associate chief medical information officer at the Cleveland Clinic in Cleveland, Ohio. Dr. Dalakas is a professor of neurology and director of the neuromuscular division at Thomas Jefferson University in Philadelphia, Pennsylvania; a professor of neurology and chief of the neuroimmunology unit and the National and Kapodistrian at the University of Athens in Athens, Greece. Additional Resources Read the article: Stiff Person Syndrome and GAD Antibody–Spectrum 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 @ContinuumAAN facebook.com/continuumcme Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology.  Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME.   Dr Weathers: This is Dr Allison Weathers. Today, I'm interviewing Dr Marinos Dalakas about his article on stiff-person syndrome and GAD antibody-spectrum disorders, which is part of the August 2024 Continuum issue on autoimmune neurology. Dr Dalakas is a world- renowned expert in neuromuscular diseases and, really, the first name any neurologist thinks of when they hear the diagnosis of stiff-person syndrome. Dr Dalakas, this is such an honor to be able to speak to you today. Welcome to the podcast, and would you please introduce yourself to our audience?   Dr Dalakas: Yes, thank you very much. I'm so happy to participate in this interview. I'm the Chief of the Neuromuscular Division at Thomas Jefferson University in Philadelphia, and I am interested in autoimmune neuromuscular diseases for many years and also on disease mechanisms and immunotherapy.   Dr Weathers: Thank you again for talking with me today. So, given how very rare stiff-person syndrome and the GAD antibody-spectrum disorders are, prior to December 2022, I would have started our time together by asking you to explain this collection of diagnoses to our listeners and by also talking about how often they occur. It feels like that's a bit unnecessary ever since Celine Dion went public with her diagnosis - that moment really changed the public awareness of what was previously outside of neurology and almost unheard-of disease. So, instead, I'll start with, what is the key message of your article? If our listeners are going to walk away remembering one thing from our discussion, what would you like it to be?   Dr Dalakas: Well, I think the publicity has been very good for the disease, this disease spectrum. On the other hand, there have been some misleading messages, like, it's extremely rare, it's untreatable, it's disabling – which, they are partially correct, so, my message is, first, to make sure the neurologists make the correct diagnosis, because there are a lot of diseases similar to stiff-person, but they are not stiff-person. So, to make sure the diagnosis is correct and to make the patients aware of what to expect when they have this disease and what therapies we have and what we may have in the future. So, the number one message is the correct diagnosis and then to avoid overdiagnosis or misdiagnosis, because now we see both - we see overdiagnosis and misdiagnosis.   Dr Weathers: I think that's such a critically important point, and one you really delve into really beautifully in the article, so I encourage our listeners who do have access to it to really read through it. As I said, you do a great job really explaining that - and, actually, to go into that further, could you explain how you approach the diagnosis of a patient with possible stiff-person syndrome or one of the other GAD antibody-spectrum disorders? And I know you probably get asked that on a daily basis. As I was telling you before we actually formally started recording, I remember back when I was a resident and saw my first case of a suspected patient with stiff-person syndrome, my mentor advised me to look up your case series, your articles at the time, and really use that to guide my diagnosis. What do you feel is the most challenging aspect of diagnosing a patient with one of these conditions?   Dr Dalakas: Well, the first is the clinical symptomatology. We say the patients present with spasms and stiffness, but also, there are phobias. They are very hyperexcitable to sudden stimulations, to sudden noises, to unexpected touches, and all of them can cause spasms, and then when you examine the patients, they have stiffness. Now, the stiffness (if there is a true stiffness) results in gait abnormalities (the patients are falling because they're so stiff), and also, the hyperexcitability causes a lot of anxiety and a lot of phobias (they're afraid to cross the street, they're afraid to make a destination promptly) – so, all these things are sort of suggestive of stiff-person. So, these are the symptoms that you hear, you listen, and you ask the patients, and then, when you examine the patient, you look for certain signs that there are, specifically, like stiffness of what we call agonist muscles and antagonist muscles, which means there is stiffness of the abdominal muscles and at the same time, stiffness of the back muscles - so, this concurrent stiffness of these opposing muscles is very specific, very characteristic of the stiff person, so if you see that, and then you listen to the history, you're very close to the diagnosis, and then you do the antibodies. And the antibodies (the specific antibodies, the GAD antibody), but it is specific as we say in the article, and we tried to make this very clear to the neurologists, that it's the high titers that matter, because low titers are not necessarily specific. So high titers of antibodies in the serum, above 10,000 by ELISA (or whatever method they use; but it has to be this many times above normal), and then if you have high serum titers and all the symptoms they mentioned, it is stiff-person. On the other hand, if the titers are low, then you may want to do a spinal tap to see if there is synthesis of antibodies in the spinal fluid. That helps you. Now if the GAD antibodies are negative, then you start wondering, is this seronegative SPS? And how do you confirm the seronegative SPS? You do electrophysiology, and the electrophysiology is, again, to see if there is activity (muscle activity) concurrently from the agonist and antagonist muscles - in other words, from the, let's say the tibialis anterior and the gastrocnemius (so, it's two opposing muscles, eg, biceps and triceps) - and if you see activity in both of these opposing muscle groups, and you see also hyperexcitability (you touch the patient, you stimulate just a little, and you see activity in other muscle groups). So, the electrophysiology is very important if the patient's antibody negative, but they have the other symptoms that I mentioned before.   Dr Weathers: I can imagine how challenging those must be (those seronegative cases) to try to really make sure you're identifying and carefully determining that you have the right disease as you alluded to at the beginning. I know how hard it must be for patients to want to at least have some answers to have a diagnosis.   Dr Dalakas: And this is the main thing today, because the publicity, as I mentioned, the beginning, increased the receipt of some information, so they overdiagnose it, like, “Oh, you have this and this and this, so it may be stiff-person”. And so, in fact, recently, we had a series of patients together with the Mayo Clinic Group of out of 173 patients referred to the Mayo Clinic for stiff-person – that's referred to them - only 28% had stiff-person. It's a low percentage, but it is an indication that the neurologists now refer patients to us for stiff-person, but we need to be very careful to correctly make a diagnosis.   Dr Weathers: On one hand, it's good that people are aware and considering the diagnosis, but it does highlight that risk of overdiagnosing.   Dr Dalakas: Yeah. It's the opposite of when I started this stiff-person syndrome (was close to 30 years ago at NIH) - at that time was underdiagnosed. This was the most rare disease, and I collected patients because at the NIH, I was also the Chief of the neuromuscular division there, and I was doing a study, so it was easy to collect patients (I collected more than 100 patients), but at that time, it was misdiagnosed. So, we had patients that I was seeing and they're really disabled, because they have been having the disease for many years, but they had been diagnosed either for Parkinson disease, for anxiety disorder, for psychiatric diseases, or for MS, or for myelopathies, or for myelitis - so many different things, and of course, they didn't have the correct diagnosis and they were disabled.   Dr Weathers: The side effect of having one of the most famous celebrities in the world having this rare disease - you know, the downside of the increased awareness, as we've said. So, moving on from the diagnosis to treatment - again, you do a, obviously, you know, an incredible job in the article, really going through the treatment options and your algorithms - what would you say is the most common misconception you've encountered in treating patients with this disease?   Dr Dalakas: The most common is now (with the publicity) is that it is a disabling disease. Well, it is disabling, but if you treat the disease correctly and early on, I'm not saying we're curing the disease - many diseases (autoimmune diseases), we help a lot, so there are some we make the patient feel normal, but the disease is there - so, if we start the correct therapy early, a good number of patients respond very well. But by the time the patients come to us, they are so stiff, they walk like a statue, or they come in a wheelchair - of course, it's difficult to reverse this, although we have been very happy to see patients with immunotherapies to get out of the wheelchair, to walk, to enjoy normal activities. So, we have made enough progress with the therapists to help a good number of patients. Now, what is the first therapy we do? Well, is what we call the antispasmodics - these are drugs that relax the stiffness that patients have, sort of a symptomatic therapy. It's not going to address the disease itself, but we address the symptoms. And of course, the symptomatic therapy in SPS is not just to relax the patients - it is related to the so-called GABAergic inhibition. So, the drugs that we use (like the benzodiazepines, or the baclofen, et cetera), these are the drugs that work on the GABAergic pathways. So, it is symptomatic therapy, but it works also on the mechanism, so it's not just a relaxing basis - but since the patients have a lot of phobias, the benzodiazepines also help the phobias. The anxiety and the phobias make the patients worse - they make them more stiff. And in the beginning, they go to psychiatrists because they are so phobic - they're phobic to walk. They hear something, they get so stiff. And I have patients coming at the National Airport in Washington to come to there needing aids in getting out of the plane - some of them get so stiff, they have to get an ambulance to come to the hospital because they're stiff everywhere. So, these phobias and anxiety have triggered a lot of my interest to the point of asking the investigators at the National Institute of Mental Health to see if there is any such thing like autoimmune phobias, because these patients have an autoimmune disease, so, well, maybe we can treat the phobias of immunology - well, we did not find anything, but I just sort of brought the idea maybe we have an autoimmune phobia. But on the other hand, when the patients get better, the phobias are reduced and they're more comfortable to walk. So, it's a very interesting complexity of the symptoms altogether.   Dr Weathers: That is – and, actually, that leads into my next question somewhat, that, as I mentioned in your introduction, you are the world expert in this rare disease. How did that happen? You talked about it a little bit just now. But how did you develop this particular interest and expertise? What drew you to this particular disease?   Dr Dalakas: Yes. It's interesting. I was interested in autoimmune neuromuscular diseases (many of them) and neuropathies and myopathies, and one day, I had a good friend of mine who was the clinical director of NINDS at that time, Dr Hallett. So, he saw patients in the movement disorder clinic and they had stiff-person (I don't know why they went to the movement disorder, but they went there), and Dr Hallett said, “Well, this is an autoimmune disease. You should work on this.” And then, I started seeing one or two patients, and I was very impressed. Really, the symptomatology is so interesting. The patients are suffering, and they sort of give the impression that they're neurotic. So, it's just a combination of when you listen to the symptoms, I was very impressed with the depth of the discomfort that they have and without seeing anything - but, when you examine the patient, you see the stiffness and nothing else. They're not weak, like, we see patients with MS, with myopathies, with neuropathies - they have weakness. They may use a cane, they may use two canes, they may use a walker, because they're stiff. So, it's a different disability than you see in patients who are weak. So, this really made me so interested to understand the mechanism - what's going on here - and that's the reason I started and I put the protocol. And then, we did a lot of immunological studies to understand the mechanism, electrophysiological studies to look at these agonist and antagonist muscles - and of course, we named it also. You know, in the beginning, the syndrome was described as stiff man (stiff-man syndrome), and they're all women. They are most of them, women. In fact, there is an article in a major journal, three women with stiff-man syndrome - and this was many years ago. So, stiff-person will be a more proper term. And then we're seeing a lot of patients or more women, but also we have enough men.   Dr Weathers: So, we've talked a lot about the change with this disease in public awareness. How has that changed your day-to-day life - has it (with the change in public awareness)? Are you bombarded with media requests?   Dr Dalakas: Well, it has stimulated me to write more about the disease and more articles, but also to highlight certain things that were not known before. For example, I had recently a paper on late-onset stiff-person. So, people, we see now patients who develop stiff-person at the age of seventy - they are above sixty or so, overall - and they have more severe disease. These patients also have not good tolerance to the medications we use - so, it's a more challenging group, so it is important to make the diagnosis even in patients with late-onset. These people do less well, because, first of all, they're all misdiagnosed, because if you're a little stiff at the age of sixty-five or seventy - well, you have a bad back, so you all have degenerative disc disease, so you don't think of stiff- person in that age. So, the stimulus was to identify some other issues with the stiff-person. The other is to think of new trials - and I have been working on two new trials. They're not out yet. I'm working to see how best to apply the new therapies. And also, it came up the idea of what are the best ways to assess, objectively, to assess the response, because this is an issue from the beginning. When I did controlled trials at the NIH, and we had established the so-called stiffness index to see how stiff they are measurably, but it is still subjective. It's not really objective, it's not (weakness to measure). So, we have gait analysis, we have the time to walk. So, I think establishing objective criterion to assess response to therapy, it's an important one - and so, I have been working on this how to make it more objective or as subjective as we can.   Dr Weathers: I think that's fantastic. And you actually, I think, have already answered my question - which is, what is the next breakthrough coming in the diagnosis and management of patients with stiff-person syndrome and the GAD antibody-spectrum disorders - and I think it's going to be the outcomes of these trials. Is there anything else that you're really excited about coming along in this field?   Dr Dalakas: Well, I think that the hope is, then, better immunotherapy, because the patients respond to IVIG based on the controlled study. We did one with anti-B-cell therapy - it was not statistically positive, but we had some placebo effects, because that second trial included some patients who did not have severe disease, so it was difficult to assess mild response. So, I'm interested in other similar immunotherapies, and we were approaching companies to see if they can sponsor such a trial. I think the publicity helps a lot, because if I was going to approach a company before the publicity, nobody would be interested in - there's no, you know - it's money-driven, so they will not do it. But at the NIH, I did it, because NIH had the grants there to sponsor the trials. So, I think the publicity will help us. And I know talking to companies, there are one or two companies that they have expressed a lot of interest, and, hopefully, we can do some new trials and go work on it, but I don't have any clear drug at the moment. I cannot discuss a real drug.   Dr Weathers: Of course, of course, more to come, but still very exciting. And so, still to learn more about you - again, you're so well known, obviously, for what you've done for the field of neurology. What do you like to do outside of seeing neuromuscular patients in your research career? What do you do for fun for your hobbies?   Dr Dalakas: Well, I have two hobbies. One is I'm an art collector of abstract expressionism. So, I go to a lot of auction houses, and I bid often for certain artists that I'm very interested, some French artists, some at the New York School of Modern Art. The eras of the forties and fifties of the abstract expressionism - so that's my collection and my interest in not missing auctions. And the other was I have a interest in wine collection – but, so, most of the time, I read art and I collect art.   Dr Weathers: That is a great answer. I appreciate art. I am not (fortunately) at the auction and collecting stage yet, but that I will have to learn from you. That's wonderful.   Dr Dalakas: Yeah. I'm originally from Greece, and I have also a professorship at the University of Athens, and also I go there. I also have some European artists in my collection.   Dr Weathers: That's wonderful. We have one more modern piece that we've been lucky enough to have.   Dr Dalakas: Yeah, I started with the impression impressionistic art, but I evolved into abstract.   Dr Weathers: Who is your favorite artist?   Dr Dalakas: Well, it's, you know, Rothko and Newman. So, these are very expensive artists, of course, so I can, but in that school, so these artists are not alive now, but people who are working with Rothko and Newman in the other group - so, there are four or five of them that I collect.   Dr Weathers: I feel like we need a whole separate interview just to talk about that.   Dr Dalakas: But, they are very stimulating, because the colors talk to you, and it's not like an impressionistic piece that, sort of, their flowers are nice, et cetera - so the colors talk to you differently.   Dr Weathers: They do. I love Rothko. Well, thank you, Dr Dalakas, for joining me on Continuum Audio. This has been a wonderful conversation. Again, today, I've been interviewing Dr Marinos Dalakas, whose article on stiff-person syndrome and GAD antibody-spectrum disorders appears in the most recent issue of Continuum on autoimmune neurology. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining us today.   Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at Continpub.com/AudioCME. Thank you for listening to Continuum Audio.

Fiona Smith, a PhD student at the Cizik School of Nursing at UTHealth Houston and Stroke Coordinator at Houston Methodist Sugar Land Hospital, recently joined the Institute for Stroke and Cerebrovascular Diseases Stroke Busters podcast to discuss her research on stroke awareness within the Spanish-speaking community. Smith's passion for improving stroke care and reducing disparities in healthcare access has driven her to focus on the cultural factors that influence care-seeking behavior among Spanish speakers. Smith highlighted the importance of the RAPIDO acronym, a Spanish-language tool designed to help individuals recognize the signs of stroke and take action. RAPIDO, which translates to "fast" in English, stands for: R: Rostro caído (fallen face) A: Afectación de equilibrio (balance impairment) P: Pérdida de fuerza en los brazos (weakness in the arms) I: Impedimento visual (visual impairment) D: Dificultad para hablar (difficulty speaking) O: Obtener ayuda (obtain help) Smith emphasized that while the RAPIDO acronym is an essential tool for stroke recognition, it is equally important to understand the cultural factors that may influence an individual's decision to seek care. Her current research focuses on identifying these variables and developing strategies to ensure that everyone seeks care as quickly as possible when experiencing stroke symptoms. Smith also stressed the importance of collaboration among healthcare professionals, including nurses, doctors, therapists, and technologists, in making significant changes to improve stroke care in the community. She encourages healthcare professionals and researchers passionate about addressing cultural barriers to find mentors and advisors who can provide guidance and support in pursuing their research goals. Fiona Smith's dedication to improving stroke awareness and care within the Spanish-speaking community serves as an inspiration to healthcare professionals and researchers alike. Her work highlights the importance of understanding and addressing cultural factors in healthcare delivery and the power of community engagement in promoting better health outcomes for all. Stroke Busters, a Podcast Presented by: The Institute for Stroke and Cerebrovascular Disease at the University of Texas Health Science Center at Houston (UTHealth) or “Stroke Institute Genre: Medicine About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news in stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many who are experts in their field, to discuss their practice, cutting-edge research and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at info.uthiscd@gmail.com

Young Stroke Survivor's Inspiring Journey Highlights the Power of Resilience, Support, and Research Katie was a healthy, active 27-year-old professional from Seattle starting her career, living life, and never expected it to be upended by a stroke. She woke up one morning and began her day like any other when suddenly her life changed forever. Katie traveled to Houston and dedicated herself to the rigorous 6-hour-a-day, 5-day-a-week program, working alongside her occupational therapist, Emily Stevens, MOT, OTR, CSRS. The results were remarkable; within just a few days, her father noticed significant improvements, and Katie herself began to recognize progress in her arm and leg function. In this episode of the Stroke Institute's podcast, Stroke Busters, she shared her daily struggles while also expressing her hopes to empower other survivors to find their voice and advocate for the support and resources they need to thrive. __________________ At the Stroke Busters Podcast, we're on a mission to decode the complexities of strokes, those unexpected disruptions in brain blood flow that can change lives in an instant. Our team of experts, affectionately known as the Stroke Busters, is committed to exploring new frontiers in stroke science, clinical excellence, and public awareness. Each episode will bring you captivating conversations with top physicians, researchers, and courageous survivors, offering valuable perspectives on cutting-edge research, transformative therapies, and inspiring tales of resilience in the face of adversity. Get ready to expand your knowledge and be inspired by the incredible work being done in the world of stroke care. This is the Stroke Busters Podcast, where we break barriers, ignite curiosity, and empower change. ____ StrokeBusters, a Podcast Presented by: The Institute for Stroke and Cerebrovascular Disease at the University of Texas Health Science Center at Houston (UTHealth) or “Stroke Institute Genre: Medicine uth.edu/stroke-institute About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news in stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many who are experts in their field, to discuss their practice, cutting-edge research and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs.

Welcome to the Stroke Busters Podcast! I'm your host, Amy Quinn, and I'm thrilled to take you on a journey into the fascinating world of stroke research and innovation. Join me as we delve into the latest breakthroughs and insights from the Institute for Stroke and Cerebrovascular Diseases at UTHealth Houston. At the Stroke Busters Podcast, we're on a mission to decode the complexities of strokes, those unexpected disruptions in brain blood flow that can change lives in an instant. Our team of experts, affectionately known as the Stroke Busters, is committed to exploring new frontiers in stroke science, clinical excellence, and public awareness. Each episode will bring you captivating conversations with top physicians, researchers, and courageous survivors, offering valuable perspectives on cutting-edge research, transformative therapies, and inspiring tales of resilience in the face of adversity. Get ready to expand your knowledge and be inspired by the incredible work being done in the world of stroke care. This is the Stroke Busters Podcast, where we break barriers, ignite curiosity, and empower change. Today, we are honored to have with us a distinguished guest who brings over 20 years of invaluable research experience to the field of stroke care. Starting her journey at MD Anderson Cancer Center and Baylor College of Medicine, she has made significant contributions to neurology and stroke research at Texas Oncology and currently at UT Health. A native Houstonian, she not only excels in her professional endeavors but also embraces an active lifestyle. She has conquered numerous marathons, 10k's, and 5k's, showing her determination and resilience. From MUD runs to step aerobics and trampoline classes, she embodies the importance of physical wellness. Beyond her professional and athletic achievements, our guest is deeply committed to community service. She actively participates in health fairs, community outreach programs, and prevention events, demonstrating her dedication to giving back and improving public health. Join me in welcoming our esteemed guest, a passionate researcher, an avid athlete, and a devoted community advocate. Welcome to the show! ____ StrokeBusters, a Podcast Presented by: The Institute for Stroke and Cerebrovascular Disease at the University of Texas Health Science Center at Houston (UTHealth) or “Stroke Institute Genre: Medicine About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news in stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many who are experts in their field, to discuss their practice, cutting-edge research and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs.

Welcome back to Stroke Busters where we bring you groundbreaking research and expert insights from the Institute for Stroke and Cerebrovascular Diseases at UTHealth Houston. Our team is committed to unraveling the mysteries surrounding strokes, those unexpected interruptions to the blood flow in the brain that can have life-altering consequences. Our team of experts, or as we like to call them Stroke Busters, is dedicated to pushing the boundaries of stroke research, clinical care, and public awareness. Each episode of the Stroke Busters Podcast will feature engaging conversations with leading physicians, researchers, and survivors, providing valuable insights into the latest advancements in stroke science, innovative treatments, and inspiring stories of triumph over adversity. Today, we were honored to chat with our special guest, a true luminary in the world of neurology and health disparities research. Dr. Lewis Morgenstern, a Professor of Neurology, Epidemiology, Emergency Medicine, and Neurosurgery at the University of Michigan Medical School and School of Public Health. Dr. Morgenstern has been at the forefront of groundbreaking research, serving as the Principal Investigator of the NIH-funded Brain Attack Surveillance in Corpus Christi (BASIC) project since 1999. With over 130 original, peer-reviewed manuscripts under his belt, his expertise spans health services clinical trials, stroke epidemiology, and clinical studies of intracerebral hemorrhage. We were able to ask Dr. Morgerstern a few more questions following his Grand Rounds presentation for medical students and faculty at the McGovern Medical School in Houston, TX,  with our host, Dr. Carlos De Garza. ______ StrokeBusters, a Podcast  Presented by: The Institute for Stroke and Cerebrovascular Disease at the University of Texas Health Science Center at Houston (UTHealth) or “Stroke Institute  Genre: Medicine    About  StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news in stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many who are experts in their field, to discuss their practice, cutting-edge research and medical care.  Who We Are  The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation.  Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs.  Our Podcast Audience  Our podcast content is targeted to stroke trainees (fellows, residents, medical students); however, we receive a wide range of listeners primarily in their 20's to 40's with moderate to advanced levels of education.  Contact  For more information or if you have any questions, please contact us at info.uthiscd@gmail.com 

This week, Dr. Victoria Sanchez of the University of South Florida, and Dr. Shannon Basham of Phonak, join host Amyn Amlani to discuss the ACHIEVE study, a multi-year randomized controlled trial examining the effects of best-practice hearing care interventions on cognitive decline in older adults. The study results found that for those at higher risk of cognitive decline, providing hearing aids and counseling slowed cognitive decline by 48% over 3 years compared to a control group. The hearing intervention utilized comprehensive audiological evaluations, evidence-based device fitting, and patient education and support. While additional analyses continue, these significant findings demonstrate the potential impact optimized hearing care can have on supporting long-term cognitive health. The panelists emphasize that complex research like ACHIEVE requires interdisciplinary expertise and collaboration. As the field increasingly focuses on the connections between hearing and cognition, audiologists will need to take a more holistic approach in managing patients while partnering closely with physicians, researchers and others. Resources like Phonak's upcoming ECHHO training program will help clinicians translate recent research on hearing and cognitive health into effective patient care and communication. With cognitive decline emerging as a major health issue, audiology has an opportunity to play a central role in providing interventions that support cognitive health in aging adults. More information about the ECHHO program can be found here: https://www.sonova.com/en/media/phonak-introduces-echho-program-enhance-understanding-link-between-hearing-loss-and-cognitive General acknowledgements and funding for ACHIEVE Parent Study: Members of the ACHIEVE Collaborative Research Group are listed at achievestudy.org. The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Study is supported by the National Institute on Aging (NIA) R01AG055426 and R01AG060502 with previous pilot study support from the NIA R34AG046548 and the Eleanor Schwartz Charitable Foundation, in collaboration with the Atherosclerosis Risk in Communities (ARIC) Study, supported by National Heart, Lung, and Blood Institute contracts (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I). Neurocognitive data are collected by 2U01HL096812, 2U01HL096814, 2U01HL096899, 2U01HL096902, 2U01HL096917 from the NIH (NHLBI, NINDS, NIA and NIDCD), and with previous brain MRI examinations funded by R01HL70825 from the NHLBI. The funder of the study had no role in study design, data collection, data analysis, data interpretation, writing of the report, or the decision to submit for publication.  The investigators thank the staff and participants of the ACHIEVE and ARIC studies for their important contributions and dedication to the study, Sonova / Phonak for in-kind donation of hearing technologies and training support of audiologists for the ACHIEVE study, and the members of the ACHIEVE DSMB (Doug Galasko, Julie Buring, Judy Dubno, Tom Greene, and Larry Lustig) for their guidance and insights during the course of the study. ACHIEVE Hearing Intervention Follow-up Study (ACHIEVE – HIFU) The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Hearing Intervention Follow-Up Study (ACHIEVE – HIFU) is supported by the National Institute on Deafness and Other Communication Disorders (NIDCD) R01DC019408. ACHIEVE Brain Health Follow-up Study (ACHIEVE – BHFU) The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Brain Health Follow-Up Study (ACHIEVE – BHFU) is supported by the National Institute on Aging (NIA) R01AG076518. The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Hearing Intervention Follow-Up Study (ACHIEVE – HIFU) is supported by the National Institute on Deafness and Other Communication Disorders (NIDCD) R01DC019408.

Listen in for the second of two special guest episodes of NIH's All About Grants podcast! In this episode, host Dr. David Kosub invites NINDS's Building Up the Nerve co-host,  Dr. Marguerite Matthews, and the Director of the Division of Biomedical Research Workforce at the NIH Office of Extramural Research, Dr. Ericka Boone, continues conversations unveiling the "hidden curriculum" of scientific training. They share experiences and perspectives on how personal growth and professional development intersect, setting a plan to identify your strengths, reiterate the importance of engaging your network, the power of communication, and much more.The first guest episode featured Building Up the Nerve's other co-host, Dr. Lauren Ullrich: https://www.buzzsprout.com/558574/13505607  ResourcesAll About GrantsInside Cancer CareersTranscript available at http://ninds.buzzsprout.com/.

Each month, our Carrier Connections program features a different X-linked condition with the goal to increase awareness and education of X-linked conditions and how they impact females. This month, we are featuring Kennedy's disease. Kennedy's disease is an X-linked disorder characterized by muscle weakness and wasting that typically manifests in adulthood. It is caused by a mutation in the AR gene, which is responsible for encoding a protein called an androgen receptor. Studies show that some female carriers may experience muscle weakness and neurodegeneration. Today, we are joined by Dr. Christopher Grunseich, M.D. Dr. Chris Grunseich is a Staff Clinician in the Neurogenetics Branch, NINDS. He completed his undergraduate studies at Brown University, and went on to receive his M.D. from SUNY Stony Brook School of Medicine in 2006. While at SUNY Stony Brook he completed an HHMI research fellowship year working in the laboratory of Dr. Gail Mandel. He then completed medical internship at St. Vincent's Hospital, and his residency training in neurology at Georgetown University. He joined Dr. Kenneth Fischbeck's research group as a neurogenetics fellow, and has been a Staff Clinician since 2016. He is board certified in Neurology. His research focuses on clinical studies of patients with motor neuron disease and using patient-derived cell models to better understand the biology of motor neuron diseases. Carrier Connections is sponsored by Horizon Therapeutics, Sanofi, and Ultragenyx Pharmaceutical. For more information about our organization, check out ⁠⁠⁠rememberthegirls.org⁠⁠⁠.

Meet Tess Zigo, CFP, CPA olsenna.com Olsen Facebook Olsen Instagram Olsen Linkedin Olsen Youtube https://www.oneplacecapital.com/ Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram Connect with Melissa on Linkedin Dr. Peter Milgrom is Professor of Oral Health Sciences and Pediatric Dentistry in the School of Dentistry and adjunct Professor of Health Services in the School of Public Health at the University of Washington. He directs the Northwest Center to Reduce Oral Health Disparities. He holds academic appointments at Case Western University, University of Rochester, and University of California, San Francisco. He maintains a dental practice limited to the care of fearful patients and served as Director of the UW Dental Fears Research Clinic. Dr. Milgrom's work includes research on xylitol, the effectiveness of fluoride varnish and iodine in preschoolers, clinical efficacy and safety of diammine silver fluoride, motivational strategies to increase perinatal and well child dental visits in rural communities, and studies of cognitive interventions in pediatric and adult dental fear. The NIH, Maternal and Child Health Bureau, HRSA, and the Robert Wood Johnson Foundation support his work. Dr. Milgrom is author of 5 books and over 300 scientific articles. His latest book, Treating Fearful Dental Patients, was published in 2009.   Dr. Milgrom was Distinguished Dental Behavioral Scientist of the International Association for Dental Research for 1999. In 1999, and again in 2000, his work was recognized by the Giddon Award for research in the behavioral sciences in Dentistry. He received the Barrows Milk Award from IADR in 2000, recognizing his work for public health including the development of the Access to Baby and Child Dentistry (ABCD) program in Washington State. In 2003, Dr. Milgrom received a Special Commendation Award from the National Legal Aid and Defenders Association and the University of Washington Medical Center Martin Luther King, Jr. Community Service Award. In 2010, he received the Aubrey Sheiham Research Award for his work on xylitol. He serves on scientific review committees for the NIDCR, NIMHHD, NINDS, Center for Scientific Review at NIH and as a consultant to the FDA. In 2005, Dr. Milgrom was appointed the SAAD Visiting Professor of Pain and Anxiety Control at the King's College Dental Institute, University of London, UK for a six-year term. In 2008 he was awarded the degree of Doctor Honoris Causa from the University of Bergen, Norway in recognition of his work in social and behavioral dentistry. In 2012, he received the University of California, San Francisco Dental Alumni Gold Medal for his contributions to Dentistry. In 2012 he was also awarded the Norton Ross Award for Excellence in Clinical Research by the American Dental Association. In 2013, he was appointed to the Council of Scientific Affairs of the American Dental Association. In 2014, he received the Irwin M. Mandel Distinguished Mentor Award from the IADR. In 2015, he served as HMDP Expert in Dental Public Health for the Singapore Ministry of Health. Dr. Milgrom received his DDS from the University of California, San Francisco in 1972 and had a previous position at the National Academy of Sciences, Engineering, and Medicine. In the last few years, Dr. Milgrom has spoken to dental associations in Argentina, Colombia, Peru, Philippines, and USA and at major universities in USA and abroad.

Dr. Richard Benson discusses the NINDS health equity efforts and the implications of the new strategic plan for research. Show references: https://n.neurology.org/content/101/7_Supplement_1

Dr. Farrah Mateen talks with Dr. Richard Benson about the NINDS health equity efforts and the implications of the new strategic plan for research. Read the related supplement in Neurology.  Visit NPUb.org/Podcast for associated article links.

DOT - Use the Code DENTALDIGEST for 10% off olsenna.com Olsen Facebook Olsen Instagram Olsen Linkedin Olsen Youtube https://www.oneplacecapital.com/ Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram Connect with Melissa on Linkedin Dr. Peter Milgrom is Professor of Oral Health Sciences and Pediatric Dentistry in the School of Dentistry and adjunct Professor of Health Services in the School of Public Health at the University of Washington. He directs the Northwest Center to Reduce Oral Health Disparities. He holds academic appointments at Case Western University, University of Rochester, and University of California, San Francisco. He maintains a dental practice limited to the care of fearful patients and served as Director of the UW Dental Fears Research Clinic. Dr. Milgrom's work includes research on xylitol, the effectiveness of fluoride varnish and iodine in preschoolers, clinical efficacy and safety of diammine silver fluoride, motivational strategies to increase perinatal and well child dental visits in rural communities, and studies of cognitive interventions in pediatric and adult dental fear. The NIH, Maternal and Child Health Bureau, HRSA, and the Robert Wood Johnson Foundation support his work. Dr. Milgrom is author of 5 books and over 300 scientific articles. His latest book, Treating Fearful Dental Patients, was published in 2009.   Dr. Milgrom was Distinguished Dental Behavioral Scientist of the International Association for Dental Research for 1999. In 1999, and again in 2000, his work was recognized by the Giddon Award for research in the behavioral sciences in Dentistry. He received the Barrows Milk Award from IADR in 2000, recognizing his work for public health including the development of the Access to Baby and Child Dentistry (ABCD) program in Washington State. In 2003, Dr. Milgrom received a Special Commendation Award from the National Legal Aid and Defenders Association and the University of Washington Medical Center Martin Luther King, Jr. Community Service Award. In 2010, he received the Aubrey Sheiham Research Award for his work on xylitol. He serves on scientific review committees for the NIDCR, NIMHHD, NINDS, Center for Scientific Review at NIH and as a consultant to the FDA. In 2005, Dr. Milgrom was appointed the SAAD Visiting Professor of Pain and Anxiety Control at the King's College Dental Institute, University of London, UK for a six-year term. In 2008 he was awarded the degree of Doctor Honoris Causa from the University of Bergen, Norway in recognition of his work in social and behavioral dentistry. In 2012, he received the University of California, San Francisco Dental Alumni Gold Medal for his contributions to Dentistry. In 2012 he was also awarded the Norton Ross Award for Excellence in Clinical Research by the American Dental Association. In 2013, he was appointed to the Council of Scientific Affairs of the American Dental Association. In 2014, he received the Irwin M. Mandel Distinguished Mentor Award from the IADR. In 2015, he served as HMDP Expert in Dental Public Health for the Singapore Ministry of Health. Dr. Milgrom received his DDS from the University of California, San Francisco in 1972 and had a previous position at the National Academy of Sciences, Engineering, and Medicine. In the last few years, Dr. Milgrom has spoken to dental associations in Argentina, Colombia, Peru, Philippines, and USA and at major universities in USA and abroad.

Listen in for the first of two special guest episodes of NIH's All About Grants podcast! In this episode, host Dr. David Kosub invites NINDS's Building Up the Nerve co-host,  Dr. Lauren Ullrich, and the host of National Cancer Institute's Inside Cancer Careers, Oliver Bogler, for a conversation on what they've learned from early career researchers through their podcasts.The next guest episode features Building Up the Nerve's other co-host, Dr. Marguerite Matthews!  ResourcesAll About GrantsInside Cancer CareersTranscript available at http://ninds.buzzsprout.com/.

DOT - Use the Code DENTALDIGEST for 10% off olsenna.com Olsen Facebook Olsen Instagram Olsen Linkedin Olsen Youtube https://www.oneplacecapital.com/ Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram Connect with Melissa on Linkedin Dr. Peter Milgrom is Professor of Oral Health Sciences and Pediatric Dentistry in the School of Dentistry and adjunct Professor of Health Services in the School of Public Health at the University of Washington. He directs the Northwest Center to Reduce Oral Health Disparities. He holds academic appointments at Case Western University, University of Rochester, and University of California, San Francisco. He maintains a dental practice limited to the care of fearful patients and served as Director of the UW Dental Fears Research Clinic. Dr. Milgrom's work includes research on xylitol, the effectiveness of fluoride varnish and iodine in preschoolers, clinical efficacy and safety of diammine silver fluoride, motivational strategies to increase perinatal and well child dental visits in rural communities, and studies of cognitive interventions in pediatric and adult dental fear. The NIH, Maternal and Child Health Bureau, HRSA, and the Robert Wood Johnson Foundation support his work. Dr. Milgrom is author of 5 books and over 300 scientific articles. His latest book, Treating Fearful Dental Patients, was published in 2009.   Dr. Milgrom was Distinguished Dental Behavioral Scientist of the International Association for Dental Research for 1999. In 1999, and again in 2000, his work was recognized by the Giddon Award for research in the behavioral sciences in Dentistry. He received the Barrows Milk Award from IADR in 2000, recognizing his work for public health including the development of the Access to Baby and Child Dentistry (ABCD) program in Washington State. In 2003, Dr. Milgrom received a Special Commendation Award from the National Legal Aid and Defenders Association and the University of Washington Medical Center Martin Luther King, Jr. Community Service Award. In 2010, he received the Aubrey Sheiham Research Award for his work on xylitol. He serves on scientific review committees for the NIDCR, NIMHHD, NINDS, Center for Scientific Review at NIH and as a consultant to the FDA. In 2005, Dr. Milgrom was appointed the SAAD Visiting Professor of Pain and Anxiety Control at the King's College Dental Institute, University of London, UK for a six-year term. In 2008 he was awarded the degree of Doctor Honoris Causa from the University of Bergen, Norway in recognition of his work in social and behavioral dentistry. In 2012, he received the University of California, San Francisco Dental Alumni Gold Medal for his contributions to Dentistry. In 2012 he was also awarded the Norton Ross Award for Excellence in Clinical Research by the American Dental Association. In 2013, he was appointed to the Council of Scientific Affairs of the American Dental Association. In 2014, he received the Irwin M. Mandel Distinguished Mentor Award from the IADR. In 2015, he served as HMDP Expert in Dental Public Health for the Singapore Ministry of Health. Dr. Milgrom received his DDS from the University of California, San Francisco in 1972 and had a previous position at the National Academy of Sciences, Engineering, and Medicine. In the last few years, Dr. Milgrom has spoken to dental associations in Argentina, Colombia, Peru, Philippines, and USA and at major universities in USA and abroad.

The September 2023 Neurology Recall showcases five dynamic interviews about ALS. The episode begins with a discussion about the strategic plan for ALS from the NINDS with Dr. Walter Korshetz. This episode features conversations with Drs. Ruben P.A. van Eijk-3 and Jordi van Unnik on simulation based interim analysis of ALS clinical trials followed by an interview with Dr. Emily Plowman on respiratory strength training (RST) programs in individuals with ALS. The episode continues with an interview with Dr. Suma Babu on the approved treatment for ALS associated with a mutation in the SOD1 gene. This month's Recall concludes with a conversation with Dr. Ajay Sampat on his story of being a neurologist diagnosed with ALS. Related Articles: Development and Evaluation of a Simulation-Based Algorithm to Optimize the Planning of Interim Analyses for Clinical Trials in ALS Respiratory Strength Training in Amyotrophic Lateral Sclerosis  FDA Approves Treatment of Amyotrophic Lateral Sclerosis Associated With a Mutation in the SOD1 Gene Related Podcast: The ALS Strategic Plan from NINDS Simulation-Based Planning of ALS Trials Respiratory Strength Training in ALS FDA Approved Therapy for SOD1 Associated ALS A Neurologist's Experience as a Patient with ALS Visit NPUb.org/Podcast for associated article links.

Welcome to an exciting episode of STroke Busters! Today, we're thrilled to introduce you to Dr. Wondwossen Tekle, who recently delivered a groundbreaking Vascular Neurology Grand Rounds presentation at McGovern Medical School. Dr. Tekle shares his incredible journey of pioneering Ethiopia's very first Stroke and Neurointerventional Program. Join our UTHealth Houston Vascular Neurology fellow, Carlos De La Garza, as he delves deep into Dr. Tekle's inspiring story. Learn how this innovative program is transforming healthcare in Ethiopia and making a global impact. If you're passionate about stroke care, neurointervention, or global healthcare initiatives, you won't want to miss this captivating conversation. Tune in now and be inspired by Dr. Tekle's extraordinary work! Don't forget to like, subscribe, and share this episode with your friends and colleagues. Together, let's spread awareness about this vital mission and advance stroke care worldwide. ____________________________________ Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke LinkedIn: linkedin.com/company/uthealth-stroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at ⁠info.uthiscd@gma⁠il.com

Today's guest is Dr. James Grotta, who after joining UT Houston faculty in 1979, he established the UT Houston Stroke Program and developed its NIH funded fellowship training program. He has been continuously funded to carry out translational research in acute stroke treatment, and played a leading role in many clinical research studies, including the NINDS TPA Stroke Study. In 2013, Dr. Grotta stepped down as department chair and moved his practice to Memorial Hermann Hospital to lead the Mobile Stroke Unit Consortium, the nation's first Mobile Stroke Unit to deliver TPA and other stroke therapies wherever the stroke occurs Dr. Grotta joined us for a Vascular Neurology Grand Rounds and stuck around to record this episode with one of our Vascular Neurology Fellows, Mohammad Rauf  to answer some more questions, so that we can share more of his insight and research.  ____________________________________ Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke LinkedIn: linkedin.com/company/uthealth-stroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at ⁠info.uthiscd@gma⁠il.com

Migraine affects about 11% children and adolescents, but it can look different from migraine in adults. Dr. Michael Oshinsky from the National Institute of Neurological Disorders and Stroke discusses the signs and symptoms of pediatric migraine as well as ways to support children at school and with their personal life. He also talks about treatment options and how the NINDS migraine trainer app can help manage migraine. *The contents of this podcast are intended for general informational purposes only and do not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The speaker does not recommend or endorse any specific course of treatment, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by this content is solely at your own risk.

Today's guest is Dr. Ameer Hassan, a triple board-certified neurologist who specializes in stroke, and is Head of the Neuroscience Department and a Professor of Neurology and Radiology at the University of TX Rio Grande Valley Dr. Hassan joined us for a Vascular Neurology Grand Rounds and stuck around to record this episode with one of our Vascular Neurology Fellows, Danish Kherani to answer some more questions so that we can share more of his insight and research.  ____________________________________ Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke LinkedIn: linkedin.com/company/uthealth-stroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at ⁠info.uthiscd@gma⁠il.com

TRANSCRIPTEric Topol (00:00):Hello, this is Eric Topol, and it's really a delight for me to welcome Hannah Davis who was the primary author of our recent review on Long Covid and is a co-founder of the Patient-Led Research Collaborative. And we're going to get into some really important topics about citizen science, Long Covid and related matters. So, Hannah, welcome.Hannah Davis (00:27):Thank you so much for having me.Eric Topol (00:29):Well, Hannah, before we get into it I thought because you had a very interesting background before you got into the patient led research collaborative organization with graphics and AI and data science. Maybe you could tell us a bit about that.Hannah Davis (00:45):Sure. Yeah. Before I got sick, I was working in machine learning with a particular focus on generative models for art and music. so I did some projects like translating data sets of landscapes into emotional landscapes. I did a project called The Laughing Room, where there was a room and you went in and the room would listen to you and laugh if it thought you said something funny, . and then I did a lot of generative music based on sentiment. So I, I did a big project where I was generating music from the sentiment of novels and a lot of kind of like critical projects, looking at biases in data sets, and also curating data sets to create desired outcomes in these generative models.Eric Topol (01:30):So, I mean, in a way again, you were ahead of your time because that was before ChatGPT in November last year, and you were ahead of the generative AI curve. And here again, you're way ahead in in the citizen science era as it particularly relates to the pandemic. So, I, I wonder if you could just tell us a bit I think it was back, we go back to March, 2020. Is that when you were hit with Covid?Hannah Davis (01:59):Yes.Eric Topol (02:00):And when did you realize that it wasn't just an acute phase illness?Hannah Davis (02:06): for me, honestly, I was not worried at all. I, my first symptom was that I couldn't parse a text message. I just couldn't read it, thought I was tired. an hour later, took my temperature, realized I had a fever, so that's when I kind of knew I was sick. but I really just truly believed the narrative I was going to get better. I was 32 at the time. I had no pre-existing conditions. I just was, you know, laying around doing music stuff, not concerned at all. And I put a calendar note to donate plasma two weeks out, and I was like, you know, I'm going to hit that mark. I'm going to donate plasma, contribute, it'll be fine. And that day came and went. I was still, you know, pretty sick with a mild case. You know, I didn't have to be hospitalized.(02:49):I didn't have severe respiratory symptoms. but my neurological symptoms were substantial and did increase kind of over time. And so I, I was getting concerned. Three weeks went by, still wasn't better. And then I read Fiona Lowenstein's op-ed in the New York Times. They were also very young. They were 26 at the time, they had been hospitalized, and they had this prolonged recovery, which we now know as Long Covid. and they started the Body Politic Support Group joined that saw thousands of people with the same kind of debilitating brain fog, the same complete executive functioning loss, inability to drive, forgetting your family members' names who were all extremely young, who all had mild cases. and that's kind of when I got concerned because I realized, you know, this was not just happening to me. This was happening to so many people, and no one understood what was happening.Eric Topol (03:49):Right. extraordinary. And, and was a precursor, foreshadowing of what was to come. Now, here it is, well over three years later. And you're still affected by all this, right?Hannah Davis (04:02):Yes. Pretty severely.Eric Topol (04:04):Yeah. And I learned about that when I had the chance to work with you on the review. You were the main driver of this review, and I remember asking you, because I, I didn't know anyone in the world that was tracking Long Covid like you and to be the primary author. And then you sent this outline, and I had never seen an outline in all my years in academic medicine. I never saw an outline like this of the review. I said, oh my God, this is incredible. So I know that during that time when we worked on the review together, along with Lisa McCorkell and Julia Moore Vogel, that, you know, there, there were times when you couldn't work on it right there, there were just absolutely, you would have some good days or bad days. And, and that's the kind of, is that kind of the way is, how it goes in any given unit time?Hannah Davis (04:55):I think generally, I, I communicated as like 40% of my function is gone. So, like, I used to be able to have very, very full days, 12 hour days would work, would socialize, would do music, whatever. you know, I, I have solidly four functional hours a day. on a good day, maybe that will be six. On a bad day, that's zero. And when I push myself by accident, I can get into a crash that can be three to seven days easily. Hmm. and then I'm, then I'm just not, you know, able to be present. I don't feel here. I don't feel cognitively able, I can't drive. And then I'm just completely out of the world for a bit of time.Eric Topol (05:35):Yeah. Wow. So back in the early days of when you were first got sick and realized that this was not going to just go away, you worked with others to form this Patient -Led Research Collaborative organization, and here you are, you didn't have a medical background. You certainly had a data science and computing backgrounds. But what were your thoughts? I mean, citizen science has taken on more of a life in recent years, certainly in the last decade. And here there's a group of you that are kind of been leading the charge. we'll get to, you know, working with RECOVER and NIH in just a moment. But what were your thoughts as to whether this could have an impact at working with these, the other co-founders?Hannah Davis (06:27):I think at first we really didn't realize how much of an impact we were going to have. The reason we started collecting data in the first place really was to get answers for ourselves as patients. You know, we saw all these kind of anecdotes happening in the support group. We wanted to get a sense of which were happening the most at what frequency, et cetera. and it really wasn't until after that when like the CDC and WHO started reaching out, asking for that data, which was gray literature at the time that we kind of realized we needed to formalize this and, and put out an official paper which was what ended up being the second paper. But the group that we formed really is magical, I think like, because the primary motivator to join the group was being sick and wanting to understand what was happening. And because everyone in the group only has the kind of shared experience of, of living with Long Covid, we ended up with a very, very diverse group. Many, many different and I think that really contributed to our success in both creating this data, but also communicating and, and doing actionable policy and advocacy work with it.Eric Topol (07:42):Did you know the folks before? Or did you all come together because of digital synapses?Hannah Davis (07:47):Digital synapses? I love that. Absolutely. No, we didn't know each other at all. they're now all, you know, they're my best friends by far. you know, we've been through this, this huge thing together. but no, we didn't meet in person until just last September, actually. And many of them we still haven't even met in person. which makes it even more magical to me.Eric Topol (08:13):Well, that's actually pretty extraordinary. So together you've built a formidable force to stand up for the millions and millions of people. As you wrote in the review, 65 million people around the world who are suffering in one way or another from Long Covid. So just to comment about the review --you know, I've been working in writing papers for too long, 35 years. I've never, in my entire career, over 1300 peer reviewed papers on varied topics, ever had one that's already had 900,000 downloads, is the fourth most cited paper and Altmetric since published the same timeframe in January of all 500,000 peer-reviewed papers. Did you ever think that the, the work that, that you did and our, you know, along with Lisa and doing, and I would ever have this type of level of interest?Hannah Davis (09:16):No, and honestly, it's so encouraging. Our, our second paper to me did very well. and, you know, was, was widely viewed and widely cited, and this one just surpassed that by miles. And I think that it's encouraging because it communicates that, that people are interested, right? People, even if they don't understand what long covid is, there is a huge desire to know. And I think that putting this out in this form, focusing on the biomedical side of things really gives people a, a tool to start to understand it. And from the patient side of things, more than any other paper I've heard we, we get so many comments that are like, oh, I brought this to my doctor and, you know, the course of my care change. Like he believed me and he started X treatment. and that, that's the kind of stuff that just makes us so, so meaningful. and I'm so, so grateful that, that we were able to do this.Eric Topol (10:16):Yeah. And as you aptly put it, you know, a work of love, and it was not easy because the reviewers were not not all of them were supportive about the real impact, the profound impact of long covid. So when you now every day you're keeping track of what's going on in this field, and there's something every single day. one of the things, of course is that we haven't really seen a validated treatment all this time, and you've put together a list of candidates, of course, it was in the review, and it constantly gets revised. What are some of the things that you think are alluring from preliminary data or mechanisms that might be the greatest unmet need right now of, of getting some relief, some remedy for this? What, what, what's your sense about that?Hannah Davis (11:13):I think the one I'm most excited about right now are JAK/STAT inhibitors. And this is because one of the leading researchers in viral onset illness Ron Davis and that group believe that basically they're, they have a shunt hypothesis, and that means they, they basically think there's a switch that happens in the body after you've, you've had a viral illness like this, and that that switch can actually be unswitched. And that, to me, as a patient, that's very exciting because, you know, that that's what I imagine a cure kind of looks like. and they did some computational modeling and, and identified JAK/STAT inhibitors as one of the promising candidates. so that's from like the, like hypothetical side that needs to be tested. And then from the patient community, from some things we're seeing I think really easily accessed ones include chromolyn sodium.(12:14):So these are prescription antihistamines. they're both systemic. So Coen has been seeming to work for patients with brain fog and sleep disorders. And chromolyn sodium particularly works in, in patients with gastrointestinal mast cell issues. People are going on to kind of address the micro clots. I, for me personally, has been one of the biggest changers game changers for my brain fog and kind of cognitive impairment type things. but there's so many others. I mean, I think we, we really wanna see trials of anticoagulants. I'm personally really excited to start on ivabradine which is next up in my queue. And, and seems to have been a, a game changer for a lot of patients too. I V I G has worked for patients who are, have been able to get it, I think for both I V I G and ivabradine. Those are medications that are challenging to get covered by insurance. And so we're seeing a lot of those difficulties in, in access with a couple of these meds. But yeah, just part of, part of the battle, I guess,Eric Topol (13:32):You know, one of the leading of many mechanisms that in this mosaic of long covid is the persistence of virus or virus components. And there have been at least some attempts to get some Paxlovid trials going. Do you see any hope for just dealing, trying to inactivate the virus as  a way forward?Hannah Davis (13:54):Absolutely. Definitely believe in the viral persistence theory. I think not only Paxlovid, but other a covid antivirals. I know that Steve deas and Michael Paluso at U C S F are starting a couple long covid trials with other covid antivirals that yeah, for sure. I think they all obviously need to be trialed A S A P. And then I also think on the viral persistence lens, ev like almost everyone I know has viral reactivation of some sort like EBV, CMV,  VZV, you know, we obviously see a lot of chickenpox or shingles reactivations and antivirals targeting those as well I think are really important.Eric Topol (14:41):Yeah. Well, and I also, just the way you're coming out with a lot of this, you know terminology and, you know science stuff like I V I G for intravenous immunoglobulin and for those who are not, you know, just remember, this is a non-life science expert who now has become one. And that goes back again to the review, which was this hybrid of people who had long covid with me who didn't to try to come up with the right kind of balance as to, you know, what synthesizing what, what we know. And I think this is something the medical profession has never truly understood, is getting people who are actually affected and, and becoming, you know, the real experts. I mean, I, I look to you as one of the world's leading authorities, and I learn from you all the time.(15:35):So that goes to RECOVER. So there was a long delay in the US to recognize the importance of long covid. Even the UK was talking to patients well before they ever had a meeting here in the us, but eventually, somehow or other they allocated a billion dollars towards long covid research at the NIH. And originally, you know, fortunately Francis Collins, when he was director, saw the importance, and he, I learned bequeathed that 2 of the NIH institutes, one of the directors, Gary Gibbons visited me recently because of a negative comment I made about RECOVER. But before I go over my comment, you've been as he said, you, and Lisa McCorkell ,among others from the Patient-led Collaborative have had a seat at the table. That's a quote from Gary. Can you tell us your impression about RECOVER you know, in terms of at least they are including Patient-Led research folks with long covid as to are they taking your input seriously? And what about the billion dollars ?Hannah Davis (16:46):Oh, boy. tricky question. I don't even know where to start. Well, I mean, so I think recover really messed up by not putting experts in the field in charge, right? Like we are, we have from the beginning have needed to do medical provider education at the same time that all these studies started getting underway. And that was just a massive amount of work to try to include the right test to convince medical professionals why they weren't necessary. all that could have been avoided by putting the right people in charge. And unfortunately, that didn't happen. unfortunately recovers our, our best hope still or at least the, the best funded hope. so I really want to see it succeed. I think that they, they have a long way to go in terms of, of really understanding why patient representation matters and, and patient engagement matters.(17:51):I, you know, it's been a couple years. It's, it's still very hard to do engagement with them. it's kind of a gamble when you get placed on a, a committee if they are going to respect you or not. And, and that's kind of hard as people Yeah. Who are experts now, you know, I've been in the field of Long Covid research more than anyone really I'm working with there. I, I really hope that they improve the research process, improve the publication process. the, a lot of the engagement right now is, is just tokenization. you know, they, they have patient reps that are kind of like just a couple of the patient reps are kind of yes men you know, they, they get put on higher kind of positions and things like that. but they're, I think there's 57 patient reps in total spread across committees. we don't have a good organizing structure. We don't know who each other are. We don't really talk to each other. there, there's room for a lot of improvement, I would say, well,Eric Topol (18:59):The way I would put it is, you know, you kind of remember it like when you have gatherings where there's an adult table, and then there's the kiddie's table. Absolutely. Folks are at the kiddy table. I mean, yeah. And it's really unfortunate. So they had their first kind of major publication last week, and it's led to all sorts of confusion. you wrote about it, what did we, what did we glean from that, from that paper that was reported as a 10% of people with covid go on to Long Covid, and there were clearly a risk with reinfections. Can you kind of review that and also what have we seen with respect to the different strains as we go on from, from the Wuhan ancestral all the way through to the  various lineages of omicron. Has that led to differences in what we've seen with Long Covid?Hannah Davis (19:56):Yeah, that's a great question and one that I think a lot of people ask just because it, you know, speaks to the impact of long covid on our future. I think not just this paper, but many other papers at this point, also, the, the ONS data have shown that that Long Covid after omicron is, is very common. I think the last ONS data that came out showed of everyone living with Long Covid in the UK. After Omicron, which was the highest group of all of them. we certainly saw that in the support groups also, just, just so many people. but people are still getting it. I think it's because it, most cases of Long Covid happen after a mild infection, 75 to 90%. And when you get covid, now, it is a mild infection, but whatever the pathophysiology is, it doesn't require severe infection.(20:50):And you know, where I think we hopefully have seen decreases in like the, the pulmonary and the cardiovascular like organ damage types we're not seeing real improvements at all in kind of the long term and the neurological and the ones that end up lasting, you know, for years. And that's really disappointing. in terms of the paper, you know, I think there were two parts of the paper. There were those, those items you mentioned, which I think are really meaningful, right? The, the fact that re infections have a higher rate of long covid is like ha needs to have a substantial impact on how we treat Covid going forward. that one in 10 people get it after Omicron is something we've been, you know, shouting for, for over a year now. and I think this is the first time that will be taken seriously.(21:42): but at the same time, the way RECOVER communicated about this paper and the way that you talked to the press about this paper shows how little they understand the post-viral history right, of, of like thinking about a definition.  Why wouldn't they know that would upset patients? You know, that and the fact that they, in my opinion you know, let patients take the brunt of that anger and upset you know, where they should have been at the forefront, they should have been engaging with the patient community on Twitter is really upsetting as well. Yeah.Eric Topol (22:20):Yeah. And you know, I, when I did sit down with Gary Gibbons recently, and he was in a way wanting to listen about how could recover fulfill its goals. And I said, well, firstly, you got to communicate and you got to take the people very seriously not just as I say, put 'em at the Kiddie table, but, you know, and then really importantly is why isn't there a clinical trial testing any treatment? Still today, not even a single trial has been mounted. There's been some that have been, you know, kind of in the design phase, but still not for the billion dollars. All that's been done is, is basically following people with symptoms as already had been done for years previously. So it's, it's just so vexing to see this waste and basically confusion that's been the main product of RECOVER to date and exemplified by this paper, which is apparently going to go through some correction phases and stuff. I mean, I don't know, but whether that's going to the two institutes that it's, it's N H L B I, the National heart, lung and Blood, and the Neurologic Institute, NINDS, that are the two now in charge of making sure that RECOVER recovers from where it's, it's at right now. And yeah, so lack of treatments, and then the first intervention study that was launched incredibly was exercise. Can you comment about that?Hannah Davis (23:56):It's unreal. You know, it's, it, it just speaks to the lack of understanding the existing research that's in this space. Exercise is not a treatment for people with hem. It has made people bedbound for life. The risks is are not, the risks are substantial. that there was no discussion about it, that there was no understanding about it. That, you know, even patients who don't have pem who wouldn't necessarily be harmed by this trial deserve better, right? They still deserve a trial on anticoagulants or literally anything else than exercise. And there's, it just, it, it's extremely frustrating to see it, it would have been so much better if it was led by people who already had the space, who didn't have to be educated in post exertional malaise and the, the underlying underpinnings of it. and just had a sense of, of how to continue forward and, you know, patients deserve better.(24:55):And I think we're, we're really struggling because yeah, there's, there's going to be five trials as I understand it, and that's not enough. And none of them should be behavioral or lifestyle interventions at all. you know, I think it also communicates just the, the not understanding how severe this is. And I get that it's hard. I get that when you see patients on the screen, you think that they're fine and that's just how they must look all the time. But recover doesn't understand that for every hour they're asking patients to engage in something that's an hour, they're in bed, you know, that, that they're, they take so much time away from patients without really understanding like the, the minimum they should be able to do is, is understand the scope and the severity of the condition, and that we need to be trialing substantially more serious me treatments than, than exercise. right,Eric Topol (25:54):Right, right. And also the recognition, of course, as you know very well about the subtypes of long covid. So, you know, for example, the postural orthostatic tachycardia syndrome pots and how, you know, there's a device, so you don't have to always think about drugs where you put it in the back of your ear and it's neuromodulator to turn down your vagus nerve and not have the dizziness and rapid heart rate when you stand and all the other symptoms. And, you know, it costs like a dollar to make this thing. And why don't you do a trial with that? I mean, that was one of the things, it doesn't have to always be drugs, and it doesn't have to, it certainly shouldn't be exercise. But you know, maybe at some point this will get on on track. Although I'm worried that so much of the billion dollars has already been spent and no less the loss of time here, I people are suffering. Now, that gets me to this lack of respect lack of every single day we are confronted with people who don't even believe there's such a thing as long covid after all this time, after all these people who've had their lives profoundly disrupted.(27:04):What, what can you say about this?Hannah Davis (27:07):It's just a staggering, staggering lack of empathy. And I think it's also fear and a defense mechanism, right? People want to believe that they have more control over their lives than they do, and they want to believe that, that it's not possible for them personally to get a virus and then never recover and have their life changed so substantially. I really genuinely believe the people who don't believe long covid is real at this point you know, have their own things going on. And just, yeah,Eric Topol (27:38):It's kinda like how Covid was a hoax, and now this is, I mean, the, you, you just, ofHannah Davis (27:44):Course, but it's true, like it's happened with, it happened with me, CF s it happened with HIV AIDS. Mm-hmm. someone just showed me a brochure of, of a 10 week lifestyle exercise intervention for aids, you know, saying that you could positively think your way out of it. All that is, is, is defense mechanism, just, yeah. You know, it's repeating the same history over and over.Eric Topol (28:07):Well, I think you nailed it. And of course, you know, it was perhaps easier with Myalgic encephalomyelitis when it weren't as many people affected as the tens of millions here, but to be in denial. the other thing is the young people perfectly healthy that are those who are the most commonly affected. a lot of the people who I know who have been hit are like you, you know, very young and, and you know like Julia in my group who, you know, was a big runner and, you know, can't even go blocks at times without being breathless. And this is the typical, I mean, I saw in clinic just yesterday, an older fellow who had been in the hospital for a few weeks and has terrible long covid. And yes, the severity of covid can correlate with the sequela, but because of just numbers, most people are more your phenotype. Right, Hannah.Hannah Davis (29:08):Right, exactly. It's a weird like math thing for people to wrap their head around. Like, yes, if you're hospitalized, the chance of getting long covid is much, much higher than if you were not hospitalized. But because the vast number of cases were not hospitalized, the vast number of long cases, long covid cases were not hospitalized. but I think like all of these things are interesting clues into the pathophysiology. You know, we also see people who were hospitalized who recover faster than some of these, the neurocognitive mild, my mild encephalomyelitis subtypes for sure. I think all of that is, is really interesting and can point to clues about kind of what is, what is happening at the core.Eric Topol (29:54):Yeah. And that I wanted to get into before I wrap up some of the things that are new or added since our review in published in January. so I just recently reviewed the brain in long covid with these two German studies, one of which showed the spike protein was lighting up in the reservoir, the kind of initial reservoir, the brain, the skull, and the meninges. the, the, basically the layers covering the brain, the, particularly the skull bone marrow. And that's where all these immune cells are in high density that are patrolling the brain. And so it really implicated spike protein per se, in people who've had covid. and then the other German study, which was so striking in mild covid, the majority of people where they had it 10 months later, all this signature by m r i, quantitative, m r i of major inflammation with free water and this so-called mean diffusivity, which is basically the leaking and you know, the inflammation of the brain.(31:01):And so, and that's as long as they follow the people, you know, if they followed 'em three years, they'd probably still see this. And so there's a lot of brain inflammation that is linked to the symptoms as you've described. You know, the brain fog, the memory executive function. But we have no remedy. We have no way, how can we stop the process? How can we turn it around like, as you mentioned, like a jak stat inhibitor in other ways that we desperately need to get into testing. so that was one thing I, I wonder, I mean, I think people who have had the symptoms of cognitive effects know there's something going wrong in their brain, but here is, you know, kind of living proof that what there's sensing is now you can see it. thoughts about that?Hannah Davis (31:52):I mean, I think the research is just staggering. It's so, so validating as someone, you know, who was living this and living the severity of it, you know, without research for years, it's, it's wonderful to finally see so many things come out. but it's overwhelming research. And I, I don't understand kind of the lack of urgency. Those are two huge, huge studies with huge implications. you know, that the, that the spike would still be in the skull like that in the, in the bone marrow like that. and the neuroinflammation I think, you know, feels very obvious in terms of what, like the symptoms end up presenting. why aren't we trialing things like the, the, this is just destroying people's lives. Even if you don't care about people's lives, like it will destroy the economy. Like people are still getting this, this is not decreasing. these are really, really substantial tangible injuries that are happening.Eric Topol (32:52):Yeah, I know. And, and there's not enough respect for preventing this. The only way we know to prevented it for sure is just not to get covid, of course. Right. And then, you know, things like vaccines help to some extent. The magnitude, we don't know for sure, you know, maybe metformin helps but, you know, prevention and everyone's guard, not everyone, but you know, vast majority, you know, really let down at this point when there's not as much circulating virus as there has been. Now, another area where it has really been lit up since our review was autoimmune diseases. So we know there's this common link in some people with long covid. There's lots of auto antibodies and self-destruction that's ongoing. The immune system has gone haywire. But now we've learned, you know, this much higher incidence of rheumatoid arthritis and lupus and across, you know, every one of the autoimmune diseases.(33:44):So the impact besides the brain autoimmune diseases and then the one that just blows me away at the beginning of the pandemic, even in the first year there were starting to see more people showing up with type two diabetes and say, ah, well it must be a coincidence. And now there are 12 large studies, every single one goes through of a significant increase in type two diabetes and, and possibly even autoimmune diabetes, which makes sense. So this is the thing I wanted to clarify cuz a lot of people get mixed up about this, Hannah, there's the symptoms of long covid, some of which we reviewed, many of the long lists we haven't. But then there's also the sequela to organ hits like the diabetes and immune system and the brain and you know, also obviously kidney and heart and on and on. Can you help differentiate? Cause a lot of people get mixed up by all this stuff.Hannah Davis (34:46):Yeah, I mean I think, you know, we started out with symptoms because that's what we knew, that's what we were talking about. but I do think it's helpful to start, and I, I do think it would be helpful to do a big review on conditions and that does include ME/CFS and Diso but also includes diabetes, includes heart attacks and strokes are includes dementia risks. and yeah, I think the, the difficulty with kind of figuring out what, what percent of long covid are each of these conditions is really biased by the fact that for that, doctors can't recognize me CFS and dysautonomia that it doesn't end up in the EHR data. And so we can't really do these large scale like figuring out the percentage of what is what. but I think like, I, I saw someone describe long covid recently as like a, a large scale neurocognitive impairment emergency, a a large scale cardiovascular event emergency. I think those are extremely accurate. the immune system dysfunction is really severe. I really would like to see the conversation start moving more toward the, the conditions and the pathophysiologies based on what we're finding yeah, more than, more than just the symptoms.Eric Topol (36:15):Right. And then, you know, there's this other aspect of the known unknown, so with two other viruses. So for example, back in 1918 with influenza, it, it took 15 years to see or more that this would lead to a significant increased risk of Parkinson's disease. And then with polio, the post-polio syndrome showed up up to 30 years later with profound progressive muscular atrophy and, you know, falls and all sorts of major neurologic hits that were due for from the original polio virus. And so, yeah, some of the things that we're learning here with long covid hopefully will spill over to all these other post-infectious processes. But I think what's emphasizing in our discussion is how much more we, we really do need to learn how we desperately need some treatments, how we desperately need to have the respect for this syndrome that it deserves which still isn't there, it's just, it's unfathomable to me that we still have people dissing it on a daily basis and, and not, you know, a small minority, but actually a pretty strident group that's, that's not so small.(37:35):Now, before you wrap up, what have I missed here? Hannah with you, because this is a rarefied opportunity to have a sit down with you about what's going on in long covid and also to emphasize citizen science here because this is, if there's anything I've ever seen in my career to show the importance of citizen science, it's been the long covid story. you as one of the leaders of it. So have I missed something?Hannah Davis (38:05):I feel like we actually covered a pretty good bit. I would say maybe just for people listening, emphasizing that long covid is still happening. I think, you know, so many people that we see recently got long covid after getting vaccinated or having a prior infection and just kind of relaxing all their precautions and they're, they're angry. You know, the, the newer group of long Covid folks are angry because they were lied to that they were safe, and that's completely reasonable. you know, that it's still happening in, in one in 10 vaccinated omicron infections is a huge deal. and, and I think yeah, just re-emphasizing that, but overall that, yeah, you know, this is very serious. I think there's my, my MO for Twitter, really, honestly, despite all the, the accusations of fear mon mongering, I really don't put extreme stuff online, but I really do believe that this is this is currently leading to, you know, higher rates of, of heart attacks.(39:08):I do believe that we will see a, a wave of early onset dementia that is honestly is happening already you know, happening in my friend group already. and like you said there, there's a lot of unknowns that can be speculated about the fact that we see E P V reactivation in so many people. Are we gonna see a lot of onset multiple sclerosis mm-hmm. you know, lymphomas other E B V sequelae, like the danger's not over the danger's actually, like pretty solidly. there's pretty solidly evidence for some, some pretty serious things to come and you know, I keep saying we gotta get on top of it now, butEric Topol (39:55):Well, I, I always the, unfortunately, some, some people don't realize it, but the eternal optimist that we will get there, it's taking too long, but we got to ratchet up the heat, get projects like RECOVER  and elsewhere in the world to go in high gear and, you know, really get to testing the promising candidates. You so have aptly outlined here and in your writings. you know, I think this has been an incredible relationship that I've been able to develop with you and your colleagues and I've learned so much from you and I will continue to be following you. I hope everyone listening that if they don't already follow you and, and others that are trying to keep us up to speed, which you know, just this week again, there was a Swiss study, two year follow up showing that the number of people that were still affected significantly with long covid symptoms at two years was 18%.(40:58):That's a lot of folks, and they were unvaccinated, but still, I mean, they, in order to have two year follow up, you're going to see a lot of people who before the advent of vaccines. So this, if you look at the data, the research carefully and it gets better quality as time goes on, because we have control groups, we have matched controls, we have, you know, hopefully the beginning of randomized trials of treatment. we'll hopefully get some light. And part of the reason we're going to get there is because of you and others, getting us fully aware, keeping track of things, getting the research committee to be accountable and not just pass off the same old stuff, which is not really understanding the condition. I mean, how can you start to really improve it if you don't even understand it? And who are you going turn to to understand it? you don't, you don't just look at, you know, MRI brain studies or immune lab studies. You got to talk to the folks who, who know it and know it so well.. All right, well this has been hopefully one of many more conversations we'll have in the future and at some point to celebrate some progress, which is what we so desperately need. Thank you so much, Hannah.Hannah Davis (42:19):Thank you so much. Absolute pleasure.LinksOur Long Covid review with Lisa McCorkell and Julia Moore-Vogelhttps://www.nature.com/articles/s41579-022-00846-2The Brain and Long Covidhttps://erictopol.substack.com/p/the-brain-and-long-covidHeightened Risk of Autoimmune Diseaseshttps://erictopol.substack.com/p/the-heightened-risk-of-autoimmuneCovid and the Risk of Type 2 Diabeteshttps://erictopol.substack.com/p/new-diabetes-post-acute-covid-pascThanks for listening and reading Ground Truths.Please share if you found this informative.Your free subscription denotes your support of this work. Should you decide to become a paid subscriber you should know that all proceeds go to support Scripps Research. That has already helped to bring on several of our summer high school and college interns. Get full access to Ground Truths at erictopol.substack.com/subscribe

Stroke Busters is a podcast presented by the Institute for Stroke and Cerebrovascular Disease at UTHealth Houston in Houston, TX. The purpose of this podcast is to bring you the latest news and discussion in stroke care, research, community, and academia. Today's guest is Dr. Patrick Key, a non-invasive board-certified clinical cardiologist with clinical interests in clinical lipidology, preventive cardiology and non-invasive cardiovascular imaging. His Ph.D. research focuses on the metabolism of high-density lipoproteins (aka good cholesterol). He has an active research program in molecular imaging of atherosclerosis and targeted drug delivery using novel nanoparticles and intravascular devices. He is a member of the National Lipid Association and is up to date with the contemporary management of various lipid disorders. He runs a Level 2 Lipid Clinic and Preventive Cardiology Clinic at the UT Professional Building.  Dr. Kee joined us for Stroke Grand Rounds and stuck around to record this episode with one of our Vascular Neurology Fellows, Jerome Jeevarajan to answer some more questions, so that we can share more of his insight and research. ____________________________________ Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke LinkedIn: linkedin.com/company/uthealth-stroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at info.uthiscd@gmail.com

4Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram Connect with Melissa on Linkedin Dr. Peter Milgrom is Professor of Oral Health Sciences and Pediatric Dentistry in the School of Dentistry and adjunct Professor of Health Services in the School of Public Health at the University of Washington. He directs the Northwest Center to Reduce Oral Health Disparities. He holds academic appointments at Case Western University, University of Rochester, and University of California, San Francisco. He maintains a dental practice limited to the care of fearful patients and served as Director of the UW Dental Fears Research Clinic. Dr. Milgrom's work includes research on xylitol, the effectiveness of fluoride varnish and iodine in preschoolers, clinical efficacy and safety of diammine silver fluoride, motivational strategies to increase perinatal and well child dental visits in rural communities, and studies of cognitive interventions in pediatric and adult dental fear. The NIH, Maternal and Child Health Bureau, HRSA, and the Robert Wood Johnson Foundation support his work. Dr. Milgrom is author of 5 books and over 300 scientific articles. His latest book, Treating Fearful Dental Patients, was published in 2009.   Dr. Milgrom was Distinguished Dental Behavioral Scientist of the International Association for Dental Research for 1999. In 1999, and again in 2000, his work was recognized by the Giddon Award for research in the behavioral sciences in Dentistry. He received the Barrows Milk Award from IADR in 2000, recognizing his work for public health including the development of the Access to Baby and Child Dentistry (ABCD) program in Washington State. In 2003, Dr. Milgrom received a Special Commendation Award from the National Legal Aid and Defenders Association and the University of Washington Medical Center Martin Luther King, Jr. Community Service Award. In 2010, he received the Aubrey Sheiham Research Award for his work on xylitol. He serves on scientific review committees for the NIDCR, NIMHHD, NINDS, Center for Scientific Review at NIH and as a consultant to the FDA. In 2005, Dr. Milgrom was appointed the SAAD Visiting Professor of Pain and Anxiety Control at the King's College Dental Institute, University of London, UK for a six-year term. In 2008 he was awarded the degree of Doctor Honoris Causa from the University of Bergen, Norway in recognition of his work in social and behavioral dentistry. In 2012, he received the University of California, San Francisco Dental Alumni Gold Medal for his contributions to Dentistry. In 2012 he was also awarded the Norton Ross Award for Excellence in Clinical Research by the American Dental Association. In 2013, he was appointed to the Council of Scientific Affairs of the American Dental Association. In 2014, he received the Irwin M. Mandel Distinguished Mentor Award from the IADR. In 2015, he served as HMDP Expert in Dental Public Health for the Singapore Ministry of Health. Dr. Milgrom received his DDS from the University of California, San Francisco in 1972 and had a previous position at the National Academy of Sciences, Engineering, and Medicine. In the last few years, Dr. Milgrom has spoken to dental associations in Argentina, Colombia, Peru, Philippines, and USA and at major universities in USA and abroad.

Dr. Sophie Cho, Program Director in the Division of Clinical Research at NINDS, discusses the state of Parkinson disease research.

Dr. Jason Crowell talks with Dr. Sophie Cho, Program Director in the Division of Clinical Research at NINDS, about the state of Parkinson disease research. For links to previous podcast episodes, please visit NPUb.org/Podcast.

Dr. Peter Milgrom is Professor of Oral Health Sciences and Pediatric Dentistry in the School of Dentistry and adjunct Professor of Health Services in the School of Public Health at the University of Washington. He directs the Northwest Center to Reduce Oral Health Disparities. He holds academic appointments at Case Western University, University of Rochester, and University of California, San Francisco. He maintains a dental practice limited to the care of fearful patients and served as Director of the UW Dental Fears Research Clinic. Dr. Milgrom's work includes research on xylitol, the effectiveness of fluoride varnish and iodine in preschoolers, clinical efficacy and safety of diammine silver fluoride, motivational strategies to increase perinatal and well child dental visits in rural communities, and studies of cognitive interventions in pediatric and adult dental fear. The NIH, Maternal and Child Health Bureau, HRSA, and the Robert Wood Johnson Foundation support his work. Dr. Milgrom is author of 5 books and over 300 scientific articles. His latest book, Treating Fearful Dental Patients, was published in 2009.   Dr. Milgrom was Distinguished Dental Behavioral Scientist of the International Association for Dental Research for 1999. In 1999, and again in 2000, his work was recognized by the Giddon Award for research in the behavioral sciences in Dentistry. He received the Barrows Milk Award from IADR in 2000, recognizing his work for public health including the development of the Access to Baby and Child Dentistry (ABCD) program in Washington State. In 2003, Dr. Milgrom received a Special Commendation Award from the National Legal Aid and Defenders Association and the University of Washington Medical Center Martin Luther King, Jr. Community Service Award. In 2010, he received the Aubrey Sheiham Research Award for his work on xylitol. He serves on scientific review committees for the NIDCR, NIMHHD, NINDS, Center for Scientific Review at NIH and as a consultant to the FDA. In 2005, Dr. Milgrom was appointed the SAAD Visiting Professor of Pain and Anxiety Control at the King's College Dental Institute, University of London, UK for a six-year term. In 2008 he was awarded the degree of Doctor Honoris Causa from the University of Bergen, Norway in recognition of his work in social and behavioral dentistry. In 2012, he received the University of California, San Francisco Dental Alumni Gold Medal for his contributions to Dentistry. In 2012 he was also awarded the Norton Ross Award for Excellence in Clinical Research by the American Dental Association. In 2013, he was appointed to the Council of Scientific Affairs of the American Dental Association. In 2014, he received the Irwin M. Mandel Distinguished Mentor Award from the IADR. In 2015, he served as HMDP Expert in Dental Public Health for the Singapore Ministry of Health. Dr. Milgrom received his DDS from the University of California, San Francisco in 1972 and had a previous position at the National Academy of Sciences, Engineering, and Medicine. In the last few years, Dr. Milgrom has spoken to dental associations in Argentina, Colombia, Peru, Philippines, and USA and at major universities in USA and abroad.

Episode 74 of the Long Covid Podcast is a chat with Dr Walter Koroshetz, Director of the National Institute of Neurological Disorders & Stroke, part of the National Institute of Health in the US. We chat through the RECOVER Initiative which is a huge study looking into all aspects of Long Covid, and also talk a little about ME/CFS research done by Dr Avindra Nath.Links:https://www.ninds.nih.gov/about-ninds/who-we-are/directors-cornerTranscript available under the "transcript" tab HERE-  Support the show~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~The Long Covid Podcast is self-produced & self funded. If you enjoy what you hear and are able to, please Buy me a coffee or purchase a mug to help cover costs.Share the podcast, website & blog: www.LongCovidPodcast.comFacebook @LongCovidPodcastInstagram & Twitter @LongCovidPodFacebook Support GroupSubscribe to mailing listPlease get in touch with feedback and suggestions or just how you're doing - I'd love to hear from you! You can get in touch via the social media links or at LongCovidPodcast@gmail.com

Bradyarrhythmia during AF screening, thrombolysis in stroke, NP vs MD care, and the most biased paper this year — on LAAO — are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Screening with ILR - Ade Adamson Tweet https://twitter.com/AdeAdamson/status/1625878856820482048?s=20 - The Rapid Rise in Cutaneous Melanoma Diagnoses https://www.nejm.org/doi/full/10.1056/NEJMsb2019760 - Loop Trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01698-6/fulltext - Prevalence and Prognostic Significance of Bradyarrhythmias in Patients Screened for Atrial Fibrillation vs Usual Care https://jamanetwork.com/journals/jamacardiology/fullarticle/2801362 II. Thrombolysis in Mild Stroke Thrombolysis Not Necessary in Mild Nondisabling Stroke: ARAMIS https://www.medscape.com/viewarticle/988381 - PRISMS Trial https://jamanetwork.com/journals/jama/fullarticle/2687354 - Risk of selection bias assessment in the NINDS rt-PA stroke study https://pubmed.ncbi.nlm.nih.gov/35705913/ - Tissue Plasminogen Activator for Acute Ischemic Stroke https://www.nejm.org/doi/full/10.1056/NEJM199512143332401 - Effects of alteplase for acute stroke; Hacke et al meta-analysis https://journals.sagepub.com/doi/10.1177/1747493017744464 - Methodological survey of missing outcome data in an alteplase for ischemic stroke meta-analysis https://onlinelibrary.wiley.com/doi/full/10.1111/ane.13656 - ECASS; Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke https://www.nejm.org/doi/full/10.1056/nejmoa0804656 - Thrombolysis with alteplase 3-4.5 hours after acute ischaemic stroke: trial reanalysis adjusted for baseline imbalances https://pubmed.ncbi.nlm.nih.gov/32430395/ III. NP vs MD Care This Doc Still Supports NP/PA Led Care ... With Caveats https://www.medscape.com/viewarticle/967073 - The Productivity of Professions: Evidence from the Emergency Department https://www.nber.org/papers/w30608 - Independent Nurse Practitioners and Physician Assistants: A Doc's View https://www.medscape.com/viewarticle/924047 IV. LAAO vs OAC - Comparative Effectiveness of Left Atrial Appendage Occlusio Versus Oral Anticoagulation by Sex https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.062765 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

FOURIER authors' response, a possible practice-changing paper in electrophysiology, and the ATLAS and CAPLA trials are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. FOURIER Authors Respond Recount of FOURIER Data Finds Higher Mortality With Evolocumab; Trialists Push Back https://www.medscape.com/viewarticle/986634 Restoring mortality data in the FOURIER cardiovascular outcomes trial of evolocumab in patients with cardiovascular disease: a reanalysis based on regulatory data https://bmjopen.bmj.com/content/12/12/e060172 Letter to the Editor RE: "Restoring mortality data in the FOURIER cardiovascular outcomes trial of evolocumab in patients with cardiovascular disease: a reanalysis based on regulatory data". BMJ Open https://bmjopen.bmj.com/content/12/12/e060172.responses#letter-to-the-editor-re-restoring-mortality-data-in-the-fourier-cardiovascular-outcomes-trial-of-evolocumab-in-patients-with-cardiovascular-disease-a-reanalysis-based-on-regulatory-data-bmj-open-2022123060172 Risk of selection bias assessment in the NINDS rt-PA stroke study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9202115/ Methodological survey of missing outcome data in an alteplase for ischemic stroke meta-analysis https://doi.org/10.1111/ane.13656 II. A Potential Practice-Changing Paper in Cardiac Pacing Novel 'Cure' May Avert Lead Extraction in CIED Pocket Infections https://www.medscape.com/viewarticle/986762 Regional Antibiotic Delivery for Implanted Cardiovascular Electronic Device Infections https://doi.org/10.1016/j.jacc.2022.10.022 Treatment of Localized Implantable Cardiac Device Pocket Infections https://doi.org/10.1016/j.jacc.2022.11.018 III. ATLAS Trial Perioperative Safety and Early Patient and Device Outcomes Among Subcutaneous Versus Transvenous Implantable Cardioverter Defibrillator Implantations https://doi.org/10.7326/M22-1566 Subcutaneous or Transvenous Defibrillator Therapy https://www.nejm.org/doi/full/10.1056/NEJMoa1915932 Subcutaneous or Transvenous Defibrillator Therapy https://www.nejm.org/doi/10.1056/NEJMc2034917 IV. CAPLA Published CAPLA Shows Limits of Further Ablation Post PVI in Persistent AF https://www.medscape.com/viewarticle/986901 Effect of Catheter Ablation Using Pulmonary Vein Isolation With vs Without Posterior Left Atrial Wall Isolation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation https://jamanetwork.com/journals/jama/fullarticle/2800186 Catheter Ablation for Persistent Atrial Fibrillation https://jamanetwork.com/journals/jama/fullarticle/2800200 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

We have another Grand Rounds follow up interview for you today, and a special one at that! Dr. Jared Chen has joined the Stroke Institute here at UTHealth Houston and we were so thankful not only for his time spent on his Grand Rounds presentation, but for sticking around for an in-depth look into his research and new faculty position. One of this year's Stroke Institute fellows, Mohammad Rauf, discussed Intracerebral Hemorrhage Therapies with Dr. Chen, past, present, and future, and we hope you enjoy, and share with colleagues. ____________________________________ Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at info.uthiscd@gmail.com

Though brain and cognitive changes are typically diagnosed as one form of dementia, recent studies have shown that mixed dementia is more common than previously thought. Mixed dementia, also known as Multiple-etiology dementia, is a condition where brain changes are caused by more than one neurological disease, such as Alzheimer's disease, Lewy body dementia (LBD), or frontotemporal dementia. Dr. Roderick Corriveau joins the podcast to discuss what is known about mixed dementia and how the field of studying neurological diseases is advancing to diagnose and treat this condition. Guest: Roderick Corriveau, PhD, program director, National Institute of Neurological Disorders and Stroke (NINDS), NIH Lead, Alzheimer's Disease-Related Dementias (ADRD) Summits Show Notes Read more about the National Institutes of Neurological Disorders and Stroke (NINDS) campaign, “Mind Your Risks,” at the Mind Your Risks website. Learn more about mixed dementia on the Alzheimer's Association website. Learn more about Dr. Corriveau at his bio on the National Institutes of Neurological Disorders and Stroke website. Learn more about NINDS on their website. Connect with us Find transcripts and more at our website. Email Dementia Matters: dementiamatters@medicine.wisc.edu Follow us on Facebook and Twitter. Subscribe to the Wisconsin Alzheimer's Disease Research Center's e-newsletter.

It's that time again for a Grand Rounds follow-up interview! Dr. Andrew Southerland, Associate Professor in the division of vascular neurology, departments of neurology and public health sciences at the University of Virginia Health. Our Stroke Fellow, Mohammad Rauf, interviewed Dr. Southerland following his Grand Rounds presentation, "Augmenting Clinical Diagnosis in Stroke" at McGovern Medical School to ask some more in-depth questions. __________ The Institute for Stroke and Cerebrovascular Disease (UTHealth Stroke Institute) http://www.utstrokeinstitute.com/ Host: Mohammad Rauf, Vascular Neurology Fellow, UTHealth Houston Stroke Institute Guest: Dr. Andrew Southerland | https://uvahealth.com/findadoctor/profile/andrew-m-southerland Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at info.uthiscd@gmail.com

We have an amazing Grand Rounds follow up interview for you today! Dr. Diogo Haussen, Director of Neuroendovascular Service at the Marcus Stroke & Neuroscience Center at Grady Memorial Hospital joined us for a Grand Rounds presentation with medical students and faculty at McGovern Medical School. His presentation was titled, Carotid Webs: Armed and Dangerous. Our Senior Neurology Resident, and future UT Stroke Fellow, Mohammad Ahmad, interviewed Dr. Haussen following his presentation to ask some more in depth questions. As with our previous Grand Rounds episode, we added the Q&A from the live Grand Rounds because it added so much value to this episode. __________ The Institute for Stroke and Cerebrovascular Disease (UTHealth Stroke Institute) http://www.utstrokeinstitute.com/ Host: Mohammad Ahmad, Neurology Resident, UTHealth Houston Guest: Dr. Diogo Haussen | https://www.gradyhealth.org/doctors/diogo-haussen Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at info.uthiscd@gma

A large majority of stroke awareness, stories and advocacy is centered around older or aging populations. When we think about stroke, we envision an adult or a person with high risk factors, adult risk factors, such as smoking, drinking, high blood pressure, etc…. Though more common in adults, stroke is among the top 10 causes of death in pediatric patients. Kyler's family have become advocates for pediatric stroke awareness. Telling and retelling their story through AVM Alliance, a Cure for Kyler and Friends, an organization they started to raise funds for AVM Foundation and the AVM Research Foundation in an effort to better the lives , support networks, and medical care of those affected by aneurysms and other types of vascular malformations of the brain. I spoke with Kyler's mom, Raylene, about a year ago to learn about Kyler's story and her presence, fierceness, and no-quit attitude has stuck with me ever since then. She is not only fighting for her own son, but so many more children , families, and caregivers living with the fallout of pediatric stroke. And she's built quite an amazing community around it all. Learn more about Kyler and his journey, the AVM Alliance, A Cure for Kyler and Friends, visit https://www.facebook.com/AVMAlliance go to cureforkyler.com, avmalliance.com or search the hashtag #ACureForKyler __________ The Institute for Stroke and Cerebrovascular Disease (UTHealth Stroke Institute) http://www.utstrokeinstitute.com/ Host: Amy Quinn, Communications Director for the Stroke Institute Guest: Kyler and Raylene Lewis Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at info.uthiscd@gmail.com

The September 2022 replay of past episodes showcases a selection of interviews about cognitive impairment from less common causes. This episode features dynamic conversations with Dr. Raquel Garnder on cognitive outcomes in TBI, transient global amnesia and TGA recurrence with Dr. Michaela Hernández, and a lesson on COVID Brain Fog and other cognitive syndromes with Dr. Avi Nath from NINDS. This month's Recall concludes with a conversation with Dr. Monica Shieu on PAP therapy and incidence of cognitive disorders in OSA.

In today's episode, Dr. Seema Aggarwal sat down with Dr. Yejin Kim to discuss Dr. Kim, along with many other UTHealth Houston and Stroke Institute researchers, an article from March 2022, a counterfactual analysis of differential comorbidity risk factors in Alzheimer's disease and related dementias. Their analysis discovered different comorbidities that predispose older African Americans to AD compared to Caucasian counterparts. The findings from their study, which used data collected from nationwide electronic health records will assist in developing a targeted treatment for AD. Their discussion also provided great insight into the processes Kim and her team went through to complete their study and their hopes for applications in the future. __________ The Institute for Stroke and Cerebrovascular Disease (UTHealth Stroke Institute) http://www.utstrokeinstitute.com/ Host: Seema Aggarwal, PhD, APRN, AGNP-C Guest: Yejin Kim, PhD Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at info.uthiscd@gmail.com

Date: July 1st, 2022 Guest Skeptic: Dr. Ravi Garg is a Neurologist in the Department of Neurology, Division of Neurocritical Care at Loyola University Chicago. Reference: Garg R, Mickenautsch S. Risk of selection bias assessment in the NINDS rt-PA stroke study. BMC Med Res Methodol. 2022 Jun 15;22(1):172. This is an SGEM Xtra episode. Dr. Garg […]

Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Each year we welcome a new class of fellows. This episode is a "wrap up" of their time with us this past year! Hosts: Amy Quinn, James Grotta, MD, Amanda Jagolino-Cole, MD Guests (Fellows): Drs. Stuart Fraser, Ivo Bach, Praveen Hariharan, Pamela Zelnik, Sishir Mannava StrokeBusters, a Podcast Presented by: The Institute for Stroke and Cerebrovascular Disease at the University of Texas Health Science Center at Houston (UTHealth) or “Stroke Institute" About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news in stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many who are experts in their field, to discuss their practice, cutting-edge research and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Contact Web: http://www.utstrokeinstitute.com Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke LinkedIn: @UTHealthStroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. For more information or if you have any questions, please contact us at info.uthiscd@gmail.com

Guest: Adam Oostema, MD MS FACEP (Associate Professor of EM, Michigan State University College of Human Medicine) Host: Jason Woods MD Select References: National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995 Dec 14;333(24):1581-7. doi: 10.1056/NEJM199512143332401. PMID: 7477192. Saver JL, Gornbein J, Starkman S. Graphic reanalysis of the two NINDS-tPA trials confirms substantial treatment benefit. Stroke. 2010 Oct;41(10):2381-90. doi: 10.1161/STROKEAHA.110.583807. Epub 2010 Sep 9. PMID: 20829518; PMCID: PMC2949055. Kwiatkowski TG et al. Effects of tissue plasminogen activator for acute ischemic stroke at one year. National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator Stroke Study Group. N Engl J Med. 1999 Jun 10;340(23):1781-7. doi: 10.1056/NEJM199906103402302. PMID: 10362821. Ingall TJ et al. Findings from the reanalysis of the NINDS tissue plasminogen activator for acute ischemic stroke treatment trial. Stroke. 2004 Oct;35(10):2418-24. doi: 10.1161/01.STR.0000140891.70547.56. Epub 2004 Sep 2. PMID: 15345796. Emberson J et al. Stroke Thrombolysis Trialists' Collaborative Group. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014 Nov 29;384(9958):1929-35. doi: 10.1016/S0140-6736(14)60584-5. Epub 2014 Aug 5. PMID: 25106063; PMCID: PMC4441266. Hacke W et al. ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008 Sep 25;359(13):1317-29. doi: 10.1056/NEJMoa0804656. PMID: 18815396. Alper BS et al. Thrombolysis with alteplase 3-4.5 hours after acute ischaemic stroke: trial reanalysis adjusted for baseline imbalances. BMJ Evid Based Med. 2020 Oct;25(5):168-171. doi: 10.1136/bmjebm-2020-111386. Epub 2020 May 19. PMID: 32430395; PMCID: PMC7548536. Powers WJ et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019 Dec;50(12):e344-e418. doi: 10.1161/STR.0000000000000211. Epub 2019 Oct 30. Erratum in: Stroke. 2019 Dec;50(12):e440-e441. PMID: 31662037.

On Episode 16 of the Stroke Alert Podcast, Dr. Negar Asdaghi highlights two articles from the May issue of Stroke: “Number of Affected Relatives, Age, Smoking, and Hypertension Prediction Score for Intracranial Aneurysms in Persons With a Family History for Subarachnoid Hemorrhage” and “Endovascular Treatment for Acute Ischemic Stroke With or Without General Anesthesia.” She also interviews Dr. Patrick Lyden on “The Stroke Preclinical Assessment Network: Rationale, Design, Feasibility, and Stage 1 Results.” Dr. Negar Asdaghi:         Let's start with some questions. 1) How is it that stroke can be cured in rodents but not in humans? 2) Are we wasting time or gaining time with general anesthesia before endovascular thrombectomy? 3) My father had an aneurysmal subarachnoid hemorrhage, Doctor. What is my risk of having an aneurysm, and how often should we check for one? We're back here with the Stroke Alert Podcast to tackle the toughest questions in the field because this is the best in Stroke. Stay with us. Dr. Negar Asdaghi:         Welcome back to the May 2022 issue of the Stroke Alert Podcast. My name is Negar Asdaghi. I'm an Associate Professor of Neurology at the University of Miami Miller School of Medicine and your host for the monthly Stroke Alert Podcast. For the May 2022 issue of Stroke, we have a number of papers that I'd like to highlight. We have seven articles as part of our Focused Update on the topic of neuroimmunology and stroke, organized by our own Stroke editors, Drs. Johannes Boltze and Miguel Perez-Pinzon. We also have an interesting study by Dr. David Saadoun and colleagues from Sorbonne University in Paris, where we learn that in patients with Takayasu disease, how the delay in diagnosis, as defined by the time from symptom onset to the diagnosis being over one year, was significantly associated with development of ischemic cerebrovascular events. In the Comments and Opinions section, we have an interesting study by Dr. Goldenberg and colleagues from University of Toronto on the benefits of GLP-1 receptor agonists for stroke reduction in type 2 diabetes and why should stroke neurologists be familiar with this new class of diabetic medication. Dr. Negar Asdaghi:         Later, in the interview section of the podcast, I have the great honor of interviewing Dr. Patrick Lyden, one of the founding fathers of thrombolytic therapy in stroke, as he walks us through the Stroke Preclinical Assessment Network and what his hopes are for the future of stroke therapy. I also ask him for some advice, and he did tell us about the view from the top, as he truly stands on the shoulder of giants. But first with these two articles. Dr. Negar Asdaghi:         In a landmark population-based study out of Sweden that was published in Brain in 2008, we learned that the odds of development of aneurysmal subarachnoid hemorrhage for individuals with one first-degree relative with a prior history of aneurysmal subarachnoid hemorrhage was 2.15. For individuals with two affected first-degree relatives, the odds ratio was 51. So, it's not surprising that a great deal of anxiety is caused within a family when a relative has an aneurysmal subarachnoid hemorrhage, especially if that family member was young or another member of the family had the same condition before. This scenario is commonly followed by a number of inevitable questions: Should all family members of the affected individual be screened for presence of an intracranial aneurysm? If yes, how often should vascular imaging be performed, and should other aneurysmal risk factors, such as age, sex, smoking, and hypertension, be also considered in the screening decision-making? In this issue of the journal, as part of a derivation-validation study, a group of investigators, led by Dr. Charlotte Zuurbier from University Medical Center at Utrecht Brain Center in the Netherlands, studied the ability of a simple scoring system that was developed in their derivation cohort to predict the presence of an intracranial aneurysm on vascular imaging. Dr. Negar Asdaghi:         They then tested the scoring model in their validation cohort. So, for their development cohort, they used data on 660 persons who were screened at the University Medical Center for presence of an intracranial aneurysm because they had two or more affected first-degree relatives with a prior history of aneurysmal subarachnoid hemorrhage. The median age of participants at the time of first screening was 40, and 59% were female. Dr. Negar Asdaghi:         So, in this cohort, the investigators simply looked at factors that were independently associated with finding an aneurysm on vascular screening by their multivariate analysis. And they identified the following factors; the first factor was the number of affected relatives. Now, a reminder that all of these people in the cohort had at least two first-degree relatives with an aneurysmal subarachnoid hemorrhage. And they found that amongst these people, those that had three or more family members with aneurysmal subarachnoid hemorrhage were significantly more likely to have a positive screening test for intracranial aneurysm. The next factor was older age — the older that relative, the more likely their screening imaging was positive for an aneurysm — and the other independent factors were smoking and hypertension. So they created the NASH acronym; N for number of relatives, A for age, S for smoking, and H for hypertension. When assigning points for each of these factors, the NASH scoring system had a C statistics of 0.68 in predicting whether or not someone would have a positive test, which is an intracranial aneurysm. Dr. Negar Asdaghi:         And now a reminder for our listeners that C statistics gives us the probability that a person with a certain condition, in this case, a certain NASH score, will have the outcome of interest, in this case, an aneurysm found by vascular imaging. In general, for C statistics, the closer we get to 1, the more robust is our predictive model. Values over 0.7 indicate that we have a good model, but values over 0.8 indicate a very strong model. So the NASH score, at 0.68, has a reasonably good capability in predicting who will or will not have an intracranial aneurysm if we complete the vascular imaging. But it's not a very strong model, and this should be kept in mind. Let's look at some of their numbers. In their development cohort, the probability of finding an intracranial aneurysm for a person who scored low on NASH, that is a young person who never smoked and is not hypertensive, was only 5%, whereas the probability of finding an intracranial aneurysm in a person who scored high on NASH, that is an older person in their 60s or 70s, with three or more affected relatives, who is hypertensive and a smoker, was 36%. Dr. Negar Asdaghi:         So, then they tested this NASH score in their external validation cohort and found that the likelihood of identifying an aneurysm increased as expected along the range of predicted probabilities of NASH. That is, the higher the score, the more likely to find an aneurysm on screening with vascular imaging. And the C statistics in the validation cohort was slightly lower than the C statistics in the derivation cohort. So, the important lesson we learned from this study is that the risk of having an intracranial aneurysm in a person who has a first-degree family member with a prior history of aneurysmal subarachnoid hemorrhage is substantially different depending on their NASH score, and this should be taken into consideration when deciding on screening and counseling various family members of the affected patient or prioritizing who should be screened first in routine practice. Dr. Negar Asdaghi:         The ideal anesthetic management during endovascular therapy is still unknown. A number of studies have compared the different anesthetic options available during thrombectomy, which include general anesthesia, or GA, conscious sedation, use of local anesthesia, and no sedation at all. The main argument for doing endovascular therapy under general anesthesia is that although this procedure will take some precious pre-thrombectomy time, it does result in strict immobility. And that is really ideal in the sense that it improves catheter navigation and interpretation of angiography, in addition to obviously providing a secure airway and, of course, avoiding the need to have to do an emergency intubation in case of procedural complications. The argument against general anesthesia is not only the issue of time but also the risk of hypotension and hemodynamic compromise, especially during induction, and the loss of very valuable neurological examination in a completely sedated patient during the procedure. Dr. Negar Asdaghi:         The question is, does general anesthesia improve or worsen neurological and functional outcomes post-thrombectomy? Several smaller randomized trials have looked at this very question, mainly comparing GA to all other forms of sedation during thrombectomy, but they have yielded inconsistent findings regarding the three-month functional outcome. Dr. Negar Asdaghi:         Some of them showed that patients under GA ended up doing better. Some showed no difference in the overall outcomes. But overall, their pooled analysis suggested that GA might be superior to the competing counterpart, which is the conscious sedation, and associated with better functional outcome. But these centers had highly specialized anesthesia teams, and it's possible that their findings may not be generalizable to routine practice. So, in this issue of the journal, using the Swiss Stroke Registry, Dr. Benjamin Wagner from the Department of Neurology at the University Hospital in Basel and colleagues report on the outcomes of endovascularly treated patients in the Swiss Stroke Registry receiving thrombectomy for an anterior circulation stroke with or without general anesthesia. The primary outcome was disability on the modified Rankin Scale after three months. For this study, they excluded one out of the nine centers in the registry that had lots of missing data on their three-month follow-up. Dr. Negar Asdaghi:         And so, from 2014 to 2017, 1,284 patients across eight stroke centers in the registry were included in this study. Sixty-six percent received thrombectomy under general anesthesia. On baseline comparison, the patients in the GA group were older, had a higher NIH Stroke Scale on admission, had worse preclinical functional status, and more likely to have presented with multi-territorial ischemic stroke. So, many reasons as to why people who underwent general anesthesia would have a worse clinical outcome in this study. So, now let's look at their primary outcome. In the unadjusted model, the three-month modified Rankin Scale was significantly worse in the GA group as compared to the non-GA group, which is obviously expected given the differences in their baseline characteristics. Dr. Negar Asdaghi:         But what was surprising was that the odds of having a higher mRS score was significantly greater still in the adjusted models. They also did propensity score matching analysis, and they found that the NIH Stroke Scale after 24 hours, and the odds of dependency and death and mortality were all higher in the adjusted model in the GA group. They also looked at a number of secondary outcomes and found that door-to-puncture time was longer in the GA group. Dr. Negar Asdaghi:         And also these patients were more likely to be transferred to ICU after treatment as compared to the non-GA treated counterparts. The authors point out that these real-world data are in keeping with the findings from the HERMES meta-analysis, which included over 1,700 endovascularly treated patients, and two previously published large registry data, one from Italy, which included over 4,000 endovascularly treated patients, and one from Germany, including 5,808 patients, all of them showing a worse functional outcome in endovascular therapy if the treatment was performed under general anesthesia, as compared to all other forms of sedation or no sedation at all. Again, these findings are in contrast with the reassuring results of the randomized trials on this topic, specifically in contrast to the AnStroke, SIESTA, and GOLIATH randomized trials, which compare GA to conscious sedation, showing either neutral or positive results in favor of general anesthesia pre-thrombectomy. Dr. Negar Asdaghi:         So, in summary, what we learned from this real-world, observational study is that general anesthesia was associated with worse functional outcome post-endovascular thrombectomy, independent of other confounders, which means that the jury is still out on the ideal form of anesthesia for an individual patient prior to endovascular therapy, and we definitely need larger, multicenter studies on this topic. Dr. Negar Asdaghi:         There are over a thousand experimental treatments that have shown benefit in prevention of neurological disability in animal models of ischemic stroke but have failed to show the same efficacy in human randomized trials. In fact, to date, reperfusion therapies, either in the form of intravenous lytic therapies or endovascular treatments, are the only successful treatments available to improve clinical outcomes in patients who suffer from ischemic stroke, and stroke remains a leading cause of death and disability worldwide. How come stroke can be cured in rodents but not in humans? Are neuroprotective therapies, or as more correctly referred to, the cerebroprotective therapies, the epitome of bench-to-bedside translational research failure? And if this is true, what are the key contributors to the scientific conundrum, and how can this be averted in the future? This is the question that a remarkable group of neuroscientists, led by Dr. Patrick Lyden from University of Southern California, are hoping to answer. Dr. Negar Asdaghi:         In this issue of the journal, these investigators describe the rationale, design, feasibility, and stage 1 results of their multicenter SPAN collaboration, which stands for the Stroke Preclinical Assessment Network. I'm joined today by Professor Lyden himself to discuss this collaboration. Now, Professor Lyden absolutely needs no introduction to our stroke community, but as always, introductions are nice. So, here we go. Dr. Lyden is a Professor of Physiology, Neuroscience, and Neurology at Zilkha Neurogenetic Institute, Keck School of Medicine, at USC. He has truly been a leader in the field of preclinical and clinical vascular research with over 30 years of experience in conducting studies and randomized trials, including conducting the pivotal NINDS clinical trial that led to the approval of the first treatment for acute ischemic stroke in 1996. Throughout his exemplary career, he has accumulated many accolades and is the recipient of multiple awards and honors, including the prestigious 2019 American Stroke Association William Feinberg Award for Excellence in Clinical Stroke. Good morning, Pat, it's truly an honor to welcome you to our podcast today. Dr. Patrick Lyden:            Thanks, I'm glad to be here. Dr. Negar Asdaghi:         Well, in the era of successful reperfusion therapies, it seems that the new generation of stroke neurologists and interventionalists have their eyes, so to speak, on the clock and are interested in opening the blood vessels and opening them fast. In the age of reperfusion treatments, why do we still need to talk about the role of cerebroprotective treatments? Dr. Patrick Lyden:            Well, not to sound too glib about it, but not everybody gets better after a thrombectomy. So, thrombectomy is good, it's more effective than anything else that we've tried before, but there are a remaining number of patients with a residual disability. Not only that, and from a more scientific standpoint, thrombectomy offers us the opportunity now to combine cerebroprotective therapy with known reperfusion. Remember, before, we didn't know when the artery had opened, but now we do an embolectomy, we know there's reperfusion. It gives us the opportunity to know that we're combining our treatment with reperfusion. Dr. Negar Asdaghi:         So, in the paper, you discussed how hundreds of treatments have been studied and shown efficacy in reducing neurological disability in animal models of stroke, and yet failed in human studies. In your opinion, what were the top two most disappointing studies in terms of clinical failure despite pre-clinical encouraging data? Dr. Patrick Lyden:            Well, the first one I mentioned was personal because it was the first one that I led, and it was a molecule called clomethiazole that I had helped establish the rationale for in my very first grant. So, it was the first trial I led, it was multinational, and, of course, I firmly believed we were going to hit a home run, and we failed. But to the field, the real watershed moment in neuroprotective therapy was the so-called SAINT II Trial. SAINT II was a study of a drug called NXY-059, and it was the first drug that purportedly had satisfied all of the so-called STAIR criteria. The STAIR criteria came out of a roundtable between academics and industry on how to best qualify drugs preclinically before going to human trials. And the idea was, if you were a 10 out of 10 on the STAIR criteria, then you should win when you come to human clinical trials. And the SAINT II Trial, which I was a co-leader, a co-investigator, on, also failed. Dr. Patrick Lyden:            And so many, many, many drugs had failed by that point. Tens of millions, if not a hundred million dollars, had been spent by industry, and SAINT II really caused the field to stop. Industry stopped investing in stroke; academic investment in stroke dried up. NIH funding became more difficult to get after SAINT II, and that really was sort of the really historical low moment in the development of treatment for stroke. Dr. Negar Asdaghi:         I was a resident when SAINT II came out, and I remember that somber feeling. Dr. Patrick Lyden:            It was a sad day. Dr. Negar Asdaghi:         Yeah. So, in the paper, you outline a number of potential causes as to why this translational failure may have occurred. But you highlighted the absence of preclinical scientific rigor as the most responsible source. And you already alluded to this a little bit. Can you please tell us a bit more? Dr. Patrick Lyden:            Absolutely. And first, of course, we have to say that the ideal clinical trial design is not available. We really don't know the absolute best way to test the drugs in human clinical trials. But leave that for another day. Dr. Patrick Lyden:            On the preclinical side, what can we say we're doing wrong? We're not sure, but one thing that has been highlighted over and over is that we don't approach preclinical characterization with as much rigor as we should. What do I mean by that? Animal models recapitulate for us some of the biology of a stroke, but not all. For example, many, many times we test a drug in a young model, an animal that's quite young, corresponding to a late teenager in human terms. Well, that's ridiculous. Stroke occurs in elderly people, and so on. So, the NIH called in a landmark conference for additional rigor, enhanced rigor. And I should mention the STAIR criteria were a first attempt at this. STAIR put out guidelines that said animals should be elderly, the animals should be randomized, et cetera, et cetera. And so that didn't happen. Although the STAIR criteria were out there, very few laboratories really committed to full rigor. And so the NIH funded the Stroke Preclinical Assessment Network, SPAN, to implement every aspect that we could think of that would add the best possible scientific design, the utmost rigor. So, we implemented true blinded assessment, true randomization, complete case ascertainment where we follow every single subject in the study and account for dropouts and subjects that don't complete the treatment, and, most importantly, a proper statistical design with adequate power and very large numbers. And the hypothesis that we're testing is that additional rigor in SPAN will lead to a better positive predictive value when we think about drugs that should go forward for testing in human stroke trials. Dr. Negar Asdaghi:         So, I think you already answered my next question, which was basically, why do you think SPAN is going to achieve what all others have failed to achieve? But I wanted to simplify and repeat what you mentioned. So, in simple terms, what SPAN is trying to do is to bring all preclinical research to a level of scientific rigor that was not necessarily present and make it a multicenter effort. And can you a little bit tell us about the different stages, again, of SPAN? Dr. Patrick Lyden:            Well, I'm not arguing that all preclinical research needs to be done following a SPAN type of model. Where SPAN fits in is at the end of a development project. So, if you want to characterize the cellular and molecular mechanisms, you don't need to do all of this rigor that we're doing. Just study the drug in the lab and do the mechanistic studies that need to be done. If you want to do dose finding, it doesn't need to be done this way. But at the end of that, OK, first we establish the mechanism, that's the first stage. Then we establish the toxicity. Then we establish target engagement. At the end, we are looking for some evidence that the drug will have a beneficial effect on outcomes. And in previous animal models, the only outcome, generally, the most common outcome that was studied, was size of the stroke. But in humans, the FDA does not recognize stroke size as a valid outcome. Dr. Patrick Lyden:            We look at function, most often measured with the Rankin score and the NIH Stroke Scale. So, we had to create a functional outcome, and then we had to study it at multiple laboratories to make sure we could replicate the effect across multiple sites. And we chose what's called a multi-arm, multi-stage (MAMS) statistical design. All the drugs start out in the experiment at the end of the first interim analysis, which is 25% of the sample size. We cull any compounds or treatments that appear futile are removed. Any that appear effective move on. At the end of the second stage, there's more culling. There's a total of four stages, and we're about to enter stage four, by the way. That's starting next week. And in stage four, there will be, at most, two, maybe only one treatment that has appeared non-futile and possibly effective for final characterization. Dr. Negar Asdaghi:         So, really interesting. I just want to highlight two important comments that you mentioned for our listeners again. So this is multi-layer, as you mentioned, multi-arm, multi-stages. It's sort of filter by filter, just ensuring that what we're seeing, the efficacy we're seeing in preclinical studies, will potentially be replicated in clinical studies. And what you mentioned that's very important is outcomes that classically is measured in animal models are infarct volume that are obviously very important but not necessarily may translate to exactly what we look at in clinical studies, which is functional outcomes, modified Rankin score and NIH Stroke Scale. So, with that, I want to then come back to the treatments that are actually being studied as part of SPAN. You have six very different agents as part of SPAN, from tocilizumab to uric acid. Why do you think these therapies will work? Dr. Patrick Lyden:            Well, my job as the PI of the coordinating center is to remain completely agnostic to the treatments. So, everybody's equal, and they all come in on an equal playing field. We actually have a mechanical treatment called remote ischemic conditioning, as well, and then five drugs. And these were selected through a peer review process at NIH. And then we were informed at the coordinating center what drugs we would be studying. Five drugs and one treatment. And then, of course, the challenge to us was to somehow create a blinded, randomized situation. Now, this turned out to be a fascinating, it's more mechanical, but how do you blind when some of the drugs are given orally, some are given intraperitoneally, some are given intravenously, some are given once, some are given multiple times? So, we had to work with the manufacturers and inventors of these drugs and figure out a way to package them, and in the paper, actually, there's a photograph in the appendix that shows we had to find these bottles that were amber-colored and how to load them and lyophilize the drug. Dr. Patrick Lyden:            And it's actually pretty fascinating how we were able to get all of these different, wildly different therapies, as you say, into a paradigm where they could be tested one against another in a truly blinded, truly randomized way. Dr. Negar Asdaghi:         Do you think you can go on record and say which one is your favorite? Dr. Patrick Lyden:            My favorite drug's not even in SPAN. I am truly agnostic because where my heart is, is with a drug that I've been studying in my laboratory completely separately and not part of SPAN. Dr. Negar Asdaghi:         All right, so we don't have a favorite. So, in a recent review article in Stroke, you commented on treatments used by ancient Persians, Greeks, and Romans to remedy the brain affected by stroke and how the future generation of physicians will look back at our current practices of stroke with the same, how you said, awe and bemusement we hold for Galen, Aristotle, and Avicenna. How do you think stroke will be treated in the year 2222? Dr. Patrick Lyden:            Well, first of all, and to be serious for just one moment, 200 years from now, I worry more about the climate than about medicine. And I really believe our biggest efforts need to be spent on saving the planet. But assuming we make it that long, obviously diagnostic methods will be completely different. Using ionizing radiation to scan the body will be laughed at by physicians in the future. There'll be detection technologies that aren't even on our radar yet today. And then treatments will be cellular focused and regionally focused. We give a drug through a vein and it circulates throughout the entire body, and I'm sure physicians in the future will find a way to somehow get treatment into the part of the body that's injured, not the whole body. And then, who knows? All we can say is they will laugh at us in the same way that we laugh at Theodoric the Barber of York. Dr. Negar Asdaghi:         Let's move on from the future to the past. You're arguably one of the founding fathers of reperfusion therapies. You were instrumental in getting intravenous lytic therapy approved in 1996. It literally took the field 20 years for the next treatment to be approved, that's endovascular treatment. If you could go back in time and give your young self an advice on the subject of research, of course, design and execution, what advice would you give yourself? Dr. Patrick Lyden:            Don't listen to old guys. We got a lot of advice from gray-bearded folks back when we were putting together the tPA trial, and fortunately we ignored some very bad advice and did what we imagined was the right thing to do as young, headstrong up-and-comers do. The other thing is, we really believed that by publishing our science very objectively, without editorial comment, we would be listened to. And that was dead wrong. So, the data was printed in the New England Journal in a very neutral tone, and we felt people would read that data and they would start using tPA the day after the publication. And, as you say, it took 20 years for tPA to really gain widespread acceptance, thrombolytic therapy. Today, people view it as standard, but it wasn't that way at the beginning. And I would say to myself and my colleagues at that time, "Don't be afraid to promote a positive result." Yes, it has to be done with the utmost rigor, but once you have a positive result, there will be plenty of people around pretending they know more than you and telling the world why you are wrong. And it's very important to stand up for your science and stand up for your results and say, no, no, no, no, that interpretation is wrong. The data says what we said it says, and this is an effective treatment and should be used, as an example. Dr. Negar Asdaghi:         What a great advice. Just be bold and say it loud and stand up for your science. Pat, it's been a pleasure interviewing you and having you on the podcast. We really look forward to watching your research. Bring, let me say it again, 2222 closer to now. Dr. Patrick Lyden:            Thank you. Glad to be here. Dr. Negar Asdaghi:         Thank you. Dr. Negar Asdaghi:         And this concludes our podcast for the May 2022 issue of Stroke. Please be sure to check out this month's table of contents for the full list of publications, including two articles on quality improvement in stroke and neurohospitalist—inpatient teleneurology, which comes as part of our Advances in Stroke series prepared by our section editors. And as we close our podcast today, let's take a moment and ask ourselves the same question that I asked Dr. Lyden earlier. What is the next frontier in stroke treatment? Past reperfusion therapies, we have to find ways to preserve the neurons and not just the neurons, all components of the brain. So, is the future of stroke therapy cerebroprotection? Ever since the dawn of history, humanity has lived alongside of death with the conscious apprehension that as we age, we lose the very gift of life. But unlike our ancestors, the search for immortality isn't the quest to find a fountain of youth anymore. We learned that death is inevitable, but with medicine, we can reduce illness and suffering to prolong a life worth living, one with a healthy brain. And today we're closer than ever to this modern immortality with cerebroprotection in stroke, as we stay alert with Stroke Alert. Dr. Negar Asdaghi:         This program is copyright of the American Heart Association, 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit AHAjournals.org.  

In this episode, we sat down with Dr. Suja Rajan following her groundbreaking presentation on the cost-effectiveness of mobile stroke units at the 2022 International Stroke Conference in New Orleans. Dr. Rajan and co-researchers aimed to prove “if outcome improvements associated with MSUs justify [an] increase in costs, thereby making MSUs cost effective, or if the outcome improvements lead to follow-up cost reductions thereby making MSUs cost-saving.” https://www.hmpgloballearningnetwork.com/site/neuro/conference-coverage/mobile-stroke-unit-utilization-cost-effective This was the first study that provided an economic evaluation using 1-year follow-up data on the cost-effectiveness of MSUs. Dr. Suja S. Rajan is a Health Economist and Econometrician, and is currently an Associate Professor at the School of Public Health, UT Health in Houston. Dr. Rajan's research interests include women's health, stroke and cancer health outcomes research, determining the effect of socio-economic determinants of health, identification and resolution of racial-ethnic, socio-economic and gender disparities, evaluating programs that address these disparities, and conducting cost-effectiveness and cost-benefit evaluations to establish the business case for medical interventions. Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at info.uthiscd@gmail.com

Dr. Nina Schor, deputy director of the NINDS, talks about her career, her research, her poetry and her current work in equity and diversity. https://journals.sagepub.com/doi/full/10.1177/0883073813483173

In this episode, Giovanni, Emily and David discuss grand funding from the NIH, the small business funding group she oversees, her background in the health tech space, why entrepreneurs might want to get non-dilutive NIH funding, the mechanics of how this non-dilutive funding works, the blueprint Medtech program, how they provide access to resources, and so much more. Emily Caporello LinkedIn David McMullen LinkedIn Giovanni Lauricella LinkedIn Project Medtech LinkedIn Project Medtech Website

Ischemic stroke is the leading cause of morbidity and mortality in the United States, taking the lives of 140,000 people each year.  Historically, the thrombolytic alteplase has been the mainstay of drug therapy, but now the FDA is looking at tenecteplase as a treatment option for ischemic strokes.   Guest speaker: Philippe Mentler, PharmD, BCPS Consulting Director, Pharmacy Vizient   Moderator: Gretchen Brummel, PharmD, BCPS Pharmacy Executive Director Vizient Center for Pharmacy Practice Excellence   Show Notes: [01:03] The treatment of ischemic strokes prior to alteplase [01:46] Controversies in the original clinical trials of alteplase, including the 1995 NINDS trial [02:45] The advances in imaging and patient care since the initial trials [03:58] The difficulties of administering alteplase – including estimating a patient's weight [04:50] The consequences of under-dosing [06:00] Tenecteplase: A potential alternative to alteplase [06:47] Variances of tenecteplase and alteplase in clinical trials [07:37] Determining the choice of one drug over the other [08:41] Clinical outcomes of tenecteplase vs. alteplase [10:37] Determining when to convert from alteplase to tenecteplase [12:17] Anticipating tenecteplase will eventually get FDA approval   Links | Resources: American Heart Association: Stroke, AHA/ASA Guideline, December 2019 Click here AHA Journals, Tenecteplase Thrombolysis for Acute Ischemic Stroke: Click here   Subscribe Today! Apple Podcasts Google Podcasts Spotify Stitcher Android RSS Feed  

The NINDS trial was the seminal study of IV-tPA in the treatment of acute stroke. Yet controversy still exists around the trial methodology and the interpretation of the data. Was anything missing from NINDS? Does it still resonate nearly 25 years later?