Podcasts about wnl

Vandaag gaat officieel het Europese Migratiepact in, met hoge verwachtingen vanuit Brussel én Den Haag. Eindigt vandaag dan de asielcrisis van de afgelopen tien jaar, of zijn er nog te veel losse eindjes? We spreken met Hans Leijtens, directeur van Frontex, de Europese grensbewaking, en Jeroen Lenaers, Nederlandse Europarlementariër en chief whip van de Christendemocraten in het Europees Parlement . Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

"Wet- en regelgeving zijn vandaag de dag vaak zeer complex." Met die woorden opent Kees van der Staaij, samen met vier andere preadviseurs, zijn boek over de uitvoerbaarheid van wet- en regelgeving. Straks vertelt hij bij Sven Kockelmann op welke oplossingen hij ziet. Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

Terwijl de VS en Iran elkaar opnieuw bestoken na het neerstorten van een Amerikaanse Apache-helikopter boven de Straat van Hormuz en het fragiele bestand op instorten staat, rammelt ook de militaire samenwerking in Europa. Wat betekent dat voor Nederland? Sven spreekt met oud-topambtenaar Ed Kronenberg. Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

Nog een paar dagen en dan treedt het Europese Migratiepact in werking. Volgens veel politici een belangrijke stap om de asielinstroom te beperken. Toch zitten er nog een hoop haken en ogen aan. Tweede Kamerlid en asielwoordvoerder van D66, Robert van Asten, schuift aan bij Sven. Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

Te gast bij Sven is staatssecretaris van Defensie Derk Boswijk. Op de ochtend waarop de NAVO boven Letland een drone uit de lucht moest schieten. Hij vertelt daarover en over zijn plannen rondom defensie-innovatie. Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

Minister van Werk en Participatie Thierry Aartsen wil statushouders en kansrijke asielzoekers sneller aan het werk helpen. Hij vertelt erover in Café Kockelmann. Verder te gast: de burgemeester van Arnhem Ahmed Marcouch over het omstreden optreden van rapper Ye (Kanye West), hoogleraar Wim Voermans over de parlementaire enquete en CDA-senator Madeleine van Toorenburg over haar ervaring met parlementaire enquetes. Café Kockelmann is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

ProRail-topman John Voppen vertrekt na 6,5 jaar leiding te hebben gegeven in een tijd dat er grote zorgen zijn over de kwetsbaarheid van onze infrastructuur en de cyberveiligheid van het spoor. Voelt het kabinet de urgentie? En wat is zijn laatste oproep aan de politiek? Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

Minister David van Weel (J&V) reist vandaag naar Zandvoort om bewoners te spreken over overlast door hangjongeren, al jaren een groeiende zorg. Samen met minister Heerma (BZK) stuurde hij gisteren een brief naar de Tweede Kamer over het demonstratierecht: burgemeesters moeten meer bevoegdheden krijgen om ordeverstorende demonstraties te verplaatsen, aldus de brief. Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

De Raad van State heeft besloten dat GroenLinks-PvdA de naam Progressief Nederland (PRO) mag gebruiken bij landelijke en Europese verkiezingen.
De uitspraak komt een dag voor het debat over de sociale zekerheid dat is aangevraagd door partijleider Jesse Klaver. Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

Breekt er een nieuwe fase aan in de oorlog in Oekraïne, waarin Europa een grotere rol speelt en mogelijk de overhand krijgt? Hoogleraar oorlogsstudies Frans Osinga duidt de veranderende verhoudingen aan het front. Zo meteen in gesprek met Sven Kockelmann. Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

De spanning tussen het kabinet en de vakbonden houdt aan. Hoe denkt CNV-voorzitter Hans van den Heuvel, een van de hoofdonderhandelaars namens de bonden, de impasse te doorbreken?  Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

Sven Kockelmann ontvangt minister van Financiën Eelco Heinen, minister van Onderwijs, Cultuur en Wetenschap Rianne Letschert en burgemeester van Leeuwarden Sybrand Buma. Café Kockelmann is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

Een zware kabinetsdelegatie spreekt vanochtend met sociale partners over de bezuinigingsplannen op sociale zekerheid. Sven bespreekt het met oud-topambtenaar Hans Borstlap, die pleit voor een totale verbouwing van het 'museale stelsel'. Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

Rob Jetten hield vandaag zijn eerste grote buitenlandtoespraak bij de eerste Next Gen Veiligheidsconferentie in Den Haag. Sven spreekt er met Jaap de Hoop Scheffer over de toekomst van de NAVO. Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

Angela de Jong is positief verrast door Johan Derksen, vertelt ze in de nieuwe AD Media Podcast. Hij trok het boetekleed aan na een foute opmerking over verkrachte vrouwen in de Engelse versie van Married at first sight. „Een groot compliment”, aldus de AD-columnist. Wie wordt de vervanger van Renze Klamer als hij met vakantie is? Het was deze week een komen en gaan van talkshowhosts op het kantoor van Endemol Shine. Vrijwel de hele presentatiestal van WNL kwam voorbij en ook Hila Noorzai zou vlak na haar zwangerschap al een pilot hebben gemaakt. Er is veel te doen rond het Eurovisie Songfestival. Omroep Max ziet het wel zitten om het liedjesfestijn over te nemen komend jaar. Ook haken diverse landen weer aan na de overwinning van Bulgarije en lijkt zelfs Canada interesse te hebben om mee te gaan doen. Qmusic had wéér een actieweek en daar worden vraagtekens bij gezet. De radiozender heeft wel erg veel acties. Ook wordt de nieuwe vrijdag-collega van Mattie Valk besproken. Daarnaast is er weer een bevolkingsgroep die mag daten op televisie.. Dit keer mannen die op Texel wonen. Ook komt natuurlijk de tv-clash tussen Harry Mens en Catherine Keyl voorbij. Er is een ergernis over Hunted VIPS en Angela de Jong zet een nieuwe Videoland-documentaire in haar etalage. Luisteren dus! Naar de wekelijkse AD Media Podcast, waarin columnist Angela de Jong en verslaggevers Gudo Tienhooven en Mark den Blanken alle hoofd-, rand-, en bijzaken bespreken op het gebied van media. De presentatie is in handen van Manuel Venderbos. Luister je liever via Spotify of Apple, of een andere podcastapp? Dat kan! Vind al onze podcasts op ad.nl/podcasts.Support the show: https://krant.nl/See omnystudio.com/listener for privacy information.

Gisteren liep de deadline van de vakbonden af. Als de AOW-verhoging en bezuinigingen op sociale zekerheid niet van tafel gaan, volgen acties. Leggen de bonden zaterdag het land plat? Sven vraag het aan FNV-voorzitter Hans Spekman. Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

Chaos in Europa en binnen de NAVO: is Europa wel voldoende voorbereid om het Europees Migratiepact uit te voeren? En hoe moet het verder met de NAVO nu de Verenigde Staten dreigen steeds meer troepen van ons continent terug te trekken? Zometeen te gast bij Sven Kockelmann: NAVO- en EU-correspondent voor de Telegraaf Alexander Bakker. Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

Afgelopen woensdag publiceerde de Algemene Rekenkamer een rapport met een harde conclusie: in 2025 zijn bijzonder weinig resultaten bereikt. Kortetermijndoelen zijn niet gehaald en langetermijndoelen raken verder uit zicht. Hoe nu verder? Pieter Duisenberg, president van de Algemene Rekenkamer, schuift aan bij Sven. Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

Te gast zijn CDA-leider Henri Bontenbal, premier van Aruba Mike Eman, staatssecretaris Eric van der Burg van Slagvaardige Overheid en de Iraans-Nederlandse Negin Nafissi. Café Kockelmann is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

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

Jaap Velema, burgemeester van Westerwolde (de gemeente waaronder Ter Apel valt), is te gast. Het lijkt daar namelijk weer mis te gaan: 51 mensen konden gisteravond niet overnachten in het aanmeldcentrum en moesten noodgedwongen overnachten in Stadskanaal. Volgens een NOS-verslaggever ter plekke hebben vier mensen wel de nacht buiten moeten doorbrengen. Wat wordt er vanavond en vooral vannacht verwacht?  Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

Het is vandaag Verantwoordingsdag, de dag dat het kabinet financiële verantwoording aflegt voor het uitgevoerde beleid. Zijn de belastingcenten wel rechtmatig en doelmatig besteed? Jeroen Dijsselbloem, oud-minister van Financiën en burgemeester van Eindhoven, schuift aan bij Sven. Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

Komt er voor de zomer een oplossing voor het stikstofprobleem zoals het kabinet graag wil, of niet? Het AD meldde dit weekend dat in kringen van het CDA te horen zou zijn dat er tóch meer tijd nodig is. Te gast bij Sven op 1 is Ger Koopmans, voorzitter van land- en tuinbouworganisatie LTO. Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

Biedt de ontmoeting tussen de Indiase premier Narendra Modi en Rob Jetten nieuwe hoop in de zaak-Insiya? Nadia Rashid, de moeder van Insiya, die bijna tien jaar geleden gewelddadig naar India werd ontvoerd, schuift aan bij Sven Kockelmann. Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

Te gast zijn: minister van Asiel en Migratie Bart van den Brink (CDA), VK-correspondent Lia van Bekhoven en natuurlijk politiek verslaggever Mats Akkerman. Café Kockelmann is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief

Tegen Gidi Markuszower wordt aangifte gedaan vanwege een vermeende oproep tot geweld tegen Palestijnse asielzoekers, gedaan in een interview met Left Laser. Hij bespreekt dit met Sven. Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

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

Het kan een gamechanger zijn in de energiewereld: de eerste gesmoltenzoutreactor. Het Nederlandse Thorizon is druk bezig deze kleine kerncentrale te ontwikkelen maar ook de Fransen zijn daar druk mee bezig. CEO Kiki Lauwers geeft tekst en uitleg over de voortgang en de uitdagingen.  Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

Het Internationaal Monetair Fonds heeft de prognose voor de Nederlandse economie naar beneden bijgesteld. Oorzaak: de oorlog in het Midden-Oosten. Ook levert de organisatie kritiek op de ‘vrijheidsbijdrage' en hamert zij op hervormingen van de Algemene Ouderdomswet. Om dit onderzoek verder te duiden, is Marnix van Rij te gast. Hij is plaatsvervangend bewindvoerder van het IMF en voormalig staatssecretaris Fiscaliteit en Belastingdienst. Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

Het voortdurende conflict in het Midden-Oosten en de blokkade van de Straat van Hormuz zorgen ervoor dat er inmiddels wordt gesproken over een mogelijke ‘stagflatie' van de economie. Voormalig president van De Nederlandsche Bank Nout Wellink schuift aan bij Sven. Sven op 1 is een programma van Omroep WNL. Meer van WNL vind je op onze website en sociale media: ► Website: https://www.wnl.tv  ► Facebook: https://www.facebook.com/omroepwnl  ► Instagram: https://www.instagram.com/omroepwnl ► Twitter: https://www.twitter.com/wnlvandaag ► Steun WNL, word lid: https://www.steunwnl.tv ► Gratis Nieuwsbrief: https://www.wnl.tv/nieuwsbrief 

One out of every two people with MS will experience clinical depression at some point in their MS journey, making depression one of the most significant yet under-discussed aspects of living with MS. While the physical symptoms of MS often take center stage, the neuropsychiatric challenges can be just as impactful on an individual's overall quality of life and long-term outcomes. Joining us to shed some light on this important topic is Dr. Anthony Feinstein, a world-renowned neuropsychiatrist and professor at the University of Toronto. Dr. Feinstein has spent decades researching the biological and psychological drivers of depression in MS. We're also sharing study results revealing that wait times to see a neurologist in the U.S. are way too long. We'll tell you about a pilot trial that's recruiting participants for an implantable device designed to promote remyelination. We're just two days away from the National MS Society's webcast on protecting federal funding for MS research, the NIH, CDC, and FDA. We're sharing all the details and info to register. And we'll tell you all about the MS Society's statement for the record at a congressional hearing, exposing how Pharmacy Benefit Managers often prioritize profits over patient welfare. We have a lot to talk about! Are you ready for RealTalk MS??! This Week: Managing MS-Related Depression  :22 Study results reveal wait times for an appointment with a neurologist in the U.S.    1:45 A pilot clinical trial for an implantable device designed to promote remyelination  4:38 A webcast to update you on the National MS Society's advocacy efforts to protect federal funding for MS research, the NIH, CDC, and FDA  7:05 The National MS Society has submitted a critical statement for the record at a congressional hearing, exposing how Pharmacy Benefit Managers often prioritize profits over patient welfare  8:39 Dr. Anthony Feinstein discusses the latest research and strategies for managing MS-related depression  11:00 Share this episode  29:37 Next week  28:56 SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/454 ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.com Phone: (310) 526-2283 And don't forget to join us in the RealTalk MS Facebook group! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes at www.RealTalkMS.com STUDY: Access to High-Efficacy Therapies for Multiple Sclerosis Under Medicaid: Variation in Coverage and Utilization Across States https://aan.com/msa/Public/Events/AbstractDetails/61520 STUDY RESULTS: Neurology Wait Times After Primary Care or Emergency Department Visits Among the Commercially Insured Population in the United States: 2019-2023 https://www.neurology.org/doi/10.1212/WNL.0000000000218008 CLINICAL TRIAL: The SetPoint System as a Pro-Remyelination Therapy for Relapsing-Remitting Multiple Sclerosis: A Pilot Study https://clinicaltrials.gov/study/NCT06796504 WEBCAST: Make It Count Now: Mobilizing for Federal Funding in a Changing Policy Landscape https://nmss.quorum.us/event/33151 READ: The National MS Society Statement for The Record: "Profits Over Patients: The PBM Business Model Under Scrutiny" https://cdn.sanity.io/files/y936aps5/production/0372d3964cc269a404c17dff8ca919b34d0c6603.pdf AbleNOW https://ablenow.com JOIN: The RealTalk MS Facebook Group https://facebook.com/groups/realtalkms REVIEW: Give RealTalk MS a rating and review http://www.realtalkms.com/review Follow RealTalk MS on X, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 454 Guest: Dr. Anthony Feinstein Privacy Policy

Are artificial sweeteners helping us age well—or quietly working against our brain health?In this episode of The Aging Well Podcast, Jeff and Corbin unpack new research linking popular sugar substitutes to accelerated cognitive decline. While artificial sweeteners are often marketed as healthier alternatives to sugar, emerging evidence suggests the story may be more complex—especially for midlife and older adults concerned about dementia risk.Together, they explore the science behind the study, the broader metabolic and neurological implications of artificial sweeteners, and whether “natural” alternatives like honey, maple syrup, or stevia truly offer an advantage. This episode offers a balanced, science-based discussion to help listeners make informed decisions about sweeteners and long-term brain health.Article links:https://scitechdaily.com/popular-sugar-substitutes-linked-to-faster-cognitive-decline/https://www.neurology.org/doi/10.1212/WNL.0000000000214023Please, support The Aging Well Podcast by hitting the ‘like' button, subscribing/following the podcast, sharing with a friend, and….Tip Jar! All donations support this podcast to keep it going. https://paypal.me/theagingwellpodcastBUY the products you need to… age well from our trusted affiliates and support the mission of The Aging Well Podcast*.The Aging Well Podcast merchandise | Show how you are aging well | Use the promo code AGING WELL for free shipping on orders over $75 | https://theagingwellpodcast-shop.fourthwall.com/promo/AGINGWELLAuro Wellness | Glutaryl—Antioxidant spray that delivers high doses of glutathione (“Master Antioxidant”) and the new Copper Tripeptide (GHK-Cu) | 10% off Code: AGINGWELL at https://aurowellness.com/agingwellpodcastNutritional Biochemical Inc. (NBI) | Trusted supplement. NBIstands 100% behind the quality of their formulations and the science on whichthey're based. | Click the following link and use the discount codeAGINGWELL for 10% off: https://shop.nbihealth.com/agingwellBerkeley Life | Optimize nitric oxide levels | Purchase your starter kit at a 15% discount | Use the promo code: AGINGWELL15 | https://berkeleylife.pxf.io/c/6475525/3226696/31118Oxford Healthspan | Primeadine®, a plant-derived spermidine supplement | 10% off code: AGINGWELL | https://oxford-healthspan.com/AgingWellJigsaw Health | Trusted supplements. “It's fun to feel good.” | Click the following link and use the discount code AGINGWELL for 10% off: https://www.jigsawhealth.com/?rfsn=8710089.1dddcf3&utm_source=refersion&utm_medium=affiliate&utm_campaign=8710089.1dddcf3KneeMo | A smart device programmed to reduce your knee pain and keep you moving. | Click the following link and use the discount code AGINGWELL15 for 15% off: https://thekneemo.com/ref/agingwellProlon | The Fasting Mimicking Diet (FMD) is a revolutionary five-day nutrition program scientifically formulated to mimic the effects of a prolonged water fast while still allowing nourishment - supporting the benefits of fasting without the challenges and risks that come from water-only fasts. | For the best available discount always use this link: https://prolonlife.com/theagingwellpodcastL-Nutra Health | The medical division of L-Nutra, focused on helping people manage and potentially reverse chronic health conditions, like type 2 diabetes, prediabetes, insulin resistance, and obesity, using personalized, lifestyle-based programs grounded in evidence, not prescriptions. | Use this link: https://l-nutrahealth.com/theagingwellpodcastDr Lewis Nutrition | Fight neurodegeneration and cognitive decline with Daily Brain Care by Dr Lewis Nutrition—a proven daily formula designed to protect and restore brain function. | 10% off code: AGINGWELL or use the link: https://drlewisnutrition.com/AGINGWEL*We receive commission on these purchases. Thank you.

Dr. Zohaib Siddiqi and Dr. Laurence Poirier discuss a complex stroke case associated with systemic vasculitis, highlighting diagnostic challenges and management strategies, including the role of endovascular therapy.  Show citation:  Poirier L, Brissette V, Shamy MCF, Maxwell JP, Drake B, Fahed R. Clinical Reasoning: A 70-Year-Old Man With Systemic Illness Related Strokes Refractory to Medical Treatment Managed With Intracranial Stent. Neurology. 2025;104(1):e210068. doi:10.1212/WNL.0000000000210068 

Dr. Andy Southerland and Dr. Layne Dylla discuss the trends in head CT use in US emergency departments from 2007 to 2022, highlighting disparities, regional variations, and the potential role of AI in optimizing imaging decisions.  Show citations:  Dylla L, Krothapalli N, Tu L, et al. Trends in Head CT Use in US Emergency Department Patients From 2007 to 2022: A Nationwide Analysis. Neurology. 2025;105(12):e214347. doi:10.1212/WNL.0000000000214347

Deze keer: de economische gevolgen van de oorlog in Iran. Terwijl Trump strooit met oorlogsretoriek en waarschuwt voor ‘het einde der tijden', gaan de energieprijzen wereldwijd door het dak. Hoe groot is de crisis? En zijn we hier in Europa wel op voorbereid? De Europese Commissie roept lidstaten nu al op om zuiniger om te gaan met energie. Komt de autoloze zondag terug? En hoe komen we in Europa af van onze enorme energie-afhankelijkheid? Onze kersverse presentator Hajar Yagkoubi en co-host Stefan de Vries bespreken het allemaal met schrijver, ondernemer en econoom Jona van Loenen. Jona ziet deze crisis ook als een enorme kans voor Europa. Hoe? Dat legt hij uit in deze aflevering. Oók checken we in bij Mariëlle Wijermars, hoofddocent Internet Government aan de Universiteit van Maastricht, voor onze nieuwe rubriek. Kan de EU straks sneller besluiten nemen als dwarsligger Victor Orbán de verkiezingen in Hongarije verliest? Tips en verwijzingen uit deze aflevering: - Hajar tipt ‘Het continent van kwaliteit' van Paul Schenderling https://www.botuitgevers.nl/pr... - Jona tipt ‘Antifragiel' van Nassim Nicholas Talebhttps://www.bol.com/nl/nl/f/an... Hajar Yagkoubi is presentator en spreker, o.a. bij NPO radio 1 en Eva Stefan de Vries is Europa-verslaggever voor o.a. Pauw & de Wit, BNR, Haagsch College en vaste duider voor Café Europa Jona van Loenen is schrijver, ondernemer en econoom, o.a. bij WNL en Pauw & de Wit Mariëlle Wijermars is hoofddocent Internet Government aan de Universiteit van Maastricht De podcast Café Europa is een initiatief van Haagsch College en Studio Europa Maastricht Deze podcast wordt mede mogelijk gemaakt door Nieuwspoort.

Dr. Derek Stitt and Dr. Page B. Pennell discuss antiseizure medication management during pregnancy and postpartum, based on the MONEAD study.  Show citation:  Pennell PB, Li D, Kerr WT, et al. Antiseizure Medication Dosing Strategy During Pregnancy and Early Postpartum in Women With Epilepsy in MONEAD. Neurology. 2026;106(2):e214483. doi:10.1212/WNL.0000000000214483 

In part two of this series, Dr. Tesha Monteith and Dr. Nimish A. Mohile discuss the motivation behind the development of this roadmap to neurological health equity.  Show citation:  Patel PB, Hamilton RH, Budhu JA, et al. A Roadmap to Neurologic Health Equity: An AAN Position Statement. Neurology. 2026;106(5):e214687. doi:10.1212/WNL.0000000000214687 

In the first part of this series, Dr. Tesha Monteith and Dr. Nimish A. Mohile discuss what the roadmap is and how it is intended to benefit practicing neurologists. Show citation:  Patel PB, Hamilton RH, Budhu JA, et al. A Roadmap to Neurologic Health Equity: An AAN Position Statement. Neurology. 2026;106(5):e214687. doi:10.1212/WNL.0000000000214687   

IN this episode Dr's J and Santhosh explore the history of common medical tools. ALong the way they cover common contents of the white coat, the oldest medical tool, doctor's bag, ancient egypt, medical totems, the origin story of the stethoscope, chest percussion and wine barrels, reflex hammers and targeted design, the reflector disc and it's true purpose, the laryngoscope, the greatest showman's songbird, tongue depressors and more! So sit back and relax as we investigate what we actually use to do our jobs!Further Readinghttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570491/#:~:text=Auscultation%3A%20Immediate%20versus%20Mediate,ear%20to%20the%20chest%20wall.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9482790/#:~:text=There%20are%20two%20versions%20of,Th%C3%A9ophile%20Hycanith%20Laennec.https://www.woodlibrarymuseum.org/museum/phonendoscope/https://www.entandaudiologynews.com/features/ent-features/post/manuel-patricio-rodriguez-garcia-1805-1906-the-inventor-of-the-laryngoscope-and-world-renowned-singing-teacherhttps://www.neurology.org/doi/pdf/10.1212/WNL.39.11.1542Support Us spiritually, emotionally or financially here! or on ACAST+travelmedicinepodcast.comBlueSky/Mastodon/X/Instagram: @doctorjcomedy @toshyfroTikotok: DrjtoksmedicineGmail: travelmedicinepodcast@gmail.comSpotify: https://open.spotify.com/show/28uQe3cYGrTLhP6X0zyEhTPatreon: https://www.patreon.com/travelmedicinepodcast Hosted on Acast. See acast.com/privacy for more information.

Dr. Greg Cooper and Dr. Sara Hassani discuss periprocedural brain health and call on neurologists to engage in multidisciplinary efforts to improve periprocedural outcomes. Show citation: Hassani S, Gorelick PB. Periprocedural Brain Health: The Scope of the Problem and the Neurologist's Role. Neurology. 2025;105(12):e214427. doi:10.1212/WNL.0000000000214427   Show transcript: Dr. Greg Cooper: Hi, this is Greg Cooper. I just finished interviewing Sara Hassani for this week's Neurology Podcast. For today's Neurology minutes, Sara, I'm hoping you can tell us the main points of your paper. Dr. Sara Hassani:  I would say that the central message of this paper is that paraprocedural neurologic complications, they're very common, and they may actually be as high as the third leading cause of mortality, and yet very few healthcare providers realize this. And furthermore, few healthcare providers are adequately prepared to discuss the risks of the various procedures with patients and/or their family members. Dr. Greg Cooper: Thank you for that summary and all your work on this topic. Please check out this week's podcast to hear the full interview, and read the full article published in Neurology, Paraprocedural Brain Health. Thank you. 

In this episode of Walk Don't Run to the Doctor, Miles Hassell MD breaks down one of the most debated topics in nutrition: saturated fat. For decades, saturated fat has been blamed as a major cause of heart disease—but what if the evidence isn't as clear as we've been told? This episode explores the history behind dietary guidelines, the evolving food pyramid, and why current research is challenging long-held beliefs about fat, cholesterol, and overall health. You'll learn how whole foods, processed foods, and the broader "food matrix" play a much bigger role than simply avoiding saturated fat. If you've ever been confused about what to eat—or felt like nutrition advice keeps changing—this conversation will help you think more critically about the science behind it all. Key Takeaways Saturated fat has been widely criticized since the 1950s, but much of the original evidence is weak or inconclusive Recent research shows little to no clear link between saturated fat and heart disease or mortality Not all saturated fats—or foods containing them—are the same (whole foods vs. processed foods matter) Dairy, red meat, and other whole-food sources of saturated fat may be neutral or even beneficial Ultra-processed foods, refined sugars, and white flour have far stronger evidence of harm Overall diet quality, lifestyle, and metabolic health matter far more than focusing on a single nutrient     [1] Talukdar, J. R., et al. (2023). Saturated fat, the estimated absolute risk and certainty of risk for mortality and major cancer and cardiometabolic outcomes: an overview of systematic reviews. Systematic reviews, 12(1), 179. https://doi.org/10.1186/s13643-023-02312-3 [2] Valk, R., et al. (2022). Saturated fat: villain and bogeyman in the development of cardiovascular disease? European journal of preventive cardiology, 29(18), 2312–2321. https://doi.org/10.1093/eurjpc/zwac194 [3] Krauss, R. M., et al. (2020). Public health guidelines should recommend reducing saturated fat consumption as much as possible: NO. The American journal of clinical nutrition, 112(1), 19–24. https://doi.org/10.1093/ajcn/nqaa111 [4] Dunne, S., et al. (2024). The effects of saturated fat intake from dairy on CVD markers: the role of food matrices. The Proceedings of the Nutrition Society, 83(4), 236–244. https://doi.org/10.1017/S0029665124000132 [5] Du, Y., et al. (2026). High- and Low-Fat Dairy Consumption and Long-Term Risk of Dementia: Evidence From a 25-Year Prospective Cohort Study. Neurology, 106(2), e214343. https://doi.org/10.1212/WNL.0000000000214343 [6] Yuan, M., et al. (2022). Saturated fat from dairy sources is associated with lower cardiometabolic risk in the Framingham Offspring Study. The American journal of clinical nutrition, 116(6), 1682–1692. https://doi.org/10.1093/ajcn/nqac224 [7] Dehghan, M., et al., … Prospective Urban Rural Epidemiology (PURE) study investigators (2017). Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet (London, England), 390(10107), 2050–2062. https://doi.org/10.1016/S0140-6736(17)32252-3 [8] Astrup, A., et al. (2020). Saturated Fats and Health: A Reassessment and Proposal for Food-Based Recommendations: JACC State-of-the-Art Review. Journal of the American College of Cardiology, 76(7), 844–857. https://doi.org/10.1016/j.jacc.2020.05.077

Dr. Paul Crane and Dr. Hanalise Huff discuss neurological and neurocognitive sequelae in pediatric survivors of the 2015 Ebola outbreak in Liberia.  Show citation:  Huff HV, Van Ryn C, Reilly C, et al. Neurologic Sequelae After Ebola Virus Disease in Children in Liberia: An Observational Study. Neurology. 2026;106(1):e214450. doi:10.1212/WNL.0000000000214450 

Dr. Greg Cooper and Dr. Kerry Sheets discuss how hearing aid use affects cognition and the risk of dementia in older adults with hearing impairment.  Show citations: Cribb L, Moreno-Betancur M, Pase MP, et al. Treating Hearing Loss With Hearing Aids for the Prevention of Cognitive Decline and Dementia. Neurology. 2026;106(3):e214572. doi:10.1212/WNL.0000000000214572  Show transcript: Dr. Greg Cooper: Hi, this is Greg Cooper. I just finished interviewing Kerry Sheets for this week's Neurology Podcast. For today's Neurology Minute, I'm hoping you can tell us the main points of your paper. Dr. Kerry Sheets: The central message of our paper is that hearing aid use in adults aged 70 years or older with hearing impairment may reduce dementia risk over 7 years. Results for the impact of hearing aid use on cognitive decline were less. Dr. Greg Cooper: Well, thank you for that summary and for all of your work on this topic. Please check out this week's podcast to hear the full interview and read the full article published in Neurology: Treating Hearing Loss with Hearing Aids for the Prevention of Cognitive Decline and Dementia. 

Dr. Halley Alexander and Dr. Abel Sandmann discuss seizure rates and risk factors in patients with cerebral cavernous malformations (CCMs) during long-term follow-up without CCM intervention.  Show citation:  Sandmann ACA, Vandertop WP, White PM, Verbaan D, Coutinho JM, Al-Shahi Salman R. Seizures and Epilepsy in Patients With Untreated Cerebral Cavernous Malformations: A Prospective, Population-Based Cohort Study. Neurology. 2025;105(11):e214387. doi:10.1212/WNL.0000000000214387  Show transcript:  Dr. Halley Alexander: Hi, this is Halley Alexander with today's Neurology Minute. I'm here with Abel Sandmann from Amsterdam University Medical Center, and we just finished recording a full-length podcast about some exciting findings related to cerebral cavernous malformations and the risk of seizures and epilepsy. Abel, can you give our listeners a rundown of the most exciting findings and how it can change practice? Dr. Abel Sandmann:  In our paper, we show that patients with a cerebral cavernous malformation who have a first unprovoked seizure should be diagnosed with epilepsy and considered for anti-seizure medication, as most of them achieve long-term seizure freedom with medical therapy alone. These findings are based on a prospective population-based cohort study in which we analyze long-term follow-up and assess the rates and risk factors for: one, a first-ever epileptic seizure; two, seizure recurrence to evaluate the updated ILAE definition of epilepsy; and three, seizure freedom over two years and five years among patients with epilepsy. We found that among patients who had never experienced a seizure before, the 10-year risk of a first-ever seizure was only 6%. This supports current recommendations against prophylactic anti-seizure medication in patients who are incidentally diagnosed with a cerebral cavernous malformation. However, following a first unprovoked seizure, the 10-year risk of recurrence was 80%, which exceeds the 60% threshold defined by the ILAE. This justifies diagnosing epilepsy after the first and provoked seizure in this population. Given that the risk of recurrence was lower in patients treated with anti-seizure medication after the first seizure, this supports early initiation of therapy, although these treatment analyses were non-randomized and should be interpreted cautiously. Most patients who met the definition of epilepsy became two year and five years seizure-free with medical management alone. But some patients with cerebral cavernous malformations develop medically intractable seizures and might benefit from surgical treatments. Dr. Halley Alexander: Excellent. Thank you so much, Abel. You can find the full-length podcast, which is available now on the Neurology Podcast, or you can also find the full article in Neurology at neurology.org, or in the December 2025 print issue. As always, thanks for tuning in for today's Neurology Minute.   

In part two of this series, Dr. Justin Abbatemarco, Dr. Marjo S. van der Knaap, and Romy J. van Voorst discuss the patient management card and how patients should use it.  Show citation: and Clinical Management of Vanishing White Matter. Neurology. 2025;105(11):e214320. doi:10.1212/WNL.0000000000214320  Show transcript:  Dr. Justin Abbatemarco: Hello and welcome back. This is Justin Abbatemarco here with Romy J. van Voorst and Dr. Marjo S. van der Knaap. After discussing her article, Published Neurology Consensus Base Expert Recommendation for Diagnosis and Clinical Management of Vanishing White Matter Disease. Romy, I really want to talk with you about the patient management card. What inspired you to create that in this publication, and how should patients use that? Romy J. van Voorst:  So what the main motivation was of the study was actually a previous study that we did before. And in this study, we looked at the impact of any short matter on unaffected family members. And we found out that actually many family members encountered clinicians that were unfamiliar with its disease or disease-specific management. And during interviews, we saw that there was an urgent need for moral harmonization of care and also symptom management because families felt like they are left alone with just their child and no guidance on how to go further. And we wrote these recommendations to help families better understand the diagnostic and care process so they can also participate in informed decision-making. So they can understand what kind of preventive measures they can take and whether or not this interferes, for example, with quality of life goals. So there are a lot of different recommendations families can take home with. Dr. Justin Abbatemarco:  Marjo, anything else you want to add there? Dr. Marjo S. van der Knaap:  Yeah, I think the management card also helps because they have a physical card when they go to consultation or to emergency room that they can hand over. It's an official publication. It's developed by the Finishing WebMetter Expert Consortium in combination with other experts in combination with patient advocates and representatives. And so it's really a sort of a guidance that cannot be denied. So it has some authority to it. Dr. Justin Abbatemarco:  But I think it's a theme that applies to many neurological diseases, and addressing that. You do it really practically. And I agree, giving something more tangible for patients to present, especially to non-neurologists to help them give some guidance. It's an idea that we need to think about in clinic all the time on how we're interacting and supporting caregivers and when they're interfacing with the medical community at large. So I love what you guys have done here and to make us think about this more broadly. Thanks again for all your time and your work on this topic. Dr. Marjo S. van der Knaap:  Thank you for having us. 

In this episode of PEM Currents: The Pediatric Emergency Medicine Podcast, we take a structured, evidence-based approach to the acute treatment of migraine in children and adolescents. From confirming the diagnosis and screening for concerning features to optimizing outpatient therapy and executing a protocolized emergency department strategy, this episode walks through what works. We review the role of NSAIDs and triptans, clarify how IV fluids and ketorolac fit into care, and provide a stepwise framework for dopamine antagonists, valproate bridge therapy, DHE protocols, steroids, discharge planning, and admission decisions. Practical dosing, reassessment timing, and family-centered communication strategies are emphasized throughout. Learning Objectives Recognize the clinical features of pediatric migraine and distinguish it from secondary causes of headache. Implement a stepwise, evidence-based emergency department approach to acute pediatric migraine, including appropriate medication selection and timing of reassessment. Develop safe discharge and follow-up plans by defining treatment endpoints, minimizing medication overuse, and identifying patients who require referral or inpatient management. References 1. Oskoui M, Pringsheim T, Holler-Managan Y, et al. Practice Guideline Update Summary: Acute Treatment of Migraine in Children and Adolescents: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2019;93(11):487-499. doi:10.1212/WNL.0000000000008095. 2. Patterson-Gentile C, Szperka CL. The Changing Landscape of Pediatric Migraine Therapy: A Review. JAMA Neurology. 2018;75(7):881-887. doi:10.1001/jamaneurol.2018.0046. 3. Bachur RG, Monuteaux MC, Neuman MI. A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department. Pediatrics. 2015;135(2):232-238. doi:10.1542/peds.2014-2432. 4. Ashina M. Migraine. The New England Journal of Medicine. 2020;383(19):1866-1876. doi:10.1056/NEJMra1915327. 5. Richer L, Billinghurst L, Linsdell MA, et al. Drugs for the Acute Treatment of Migraine in Children and Adolescents. The Cochrane Database of Systematic Reviews. 2016;4:CD005220. doi:10.1002/14651858.CD005220.pub2. Transcript This transcript was generated using Descript automated transcription software and has been reviewed and edited for accuracy by the episode's author. Edits were limited to correcting names, titles, medical terminology, and transcription errors. The content reflects the original spoken audio and was not substantively altered. And today we're gonna talk about the acute treatment of migraine headache in children and adolescents. This is bread and butter for the PED, requires precise diagnosis and evidence-based treatment. We're gonna talk about making that diagnosis, red flags, outpatient and ED treatment, as well as some second-line agents, admission decisions, and a whole lot more. So migraine in children is defined by three criteria, and at least five attacks lasting two to 72 hours. So you gotta have at least two of the following: pulsating or throbbing quality, moderate to severe intensity, aggravation by routine activity, and a unilateral location. Although in children, it's often bilateral, plus at least one of nausea or vomiting and photophobia and/or phonophobia. In children headaches are frequently bilateral, bifrontal, bitemporal. The duration might be shorter than adults, especially in kids under second or third grade. And you may have to infer whether or not they have photophobia from their behavior. Like does the child close their eyes or wanna go into a dark room? In the emergency department, we're often diagnosing based on pattern recognition plus exclusion of dangerous secondary causes. Or even more often than that, the patient comes in and says, I've got a migraine. Before I move on to treatments, let's talk about some red flags where you might wanna pause and not just jump to migraine therapy. And the mnemonic SNOOP can be helpful here. And it stands for S for systemic symptoms such as fevers, myalgia, weight loss, or another S, secondary risk factors such as an immune deficiency, cancer, pregnancy, N for neurologic signs, papilledema, focal deficit, confusion, seizures. O onset sudden, or thunderclap. Migraines are often a little more gradual than that. The other O is older age, or technically younger age too, younger than five years or older than 50. Hopefully those patients are not coming into the pediatric emergency department. And then pattern changes, these new symptoms in a previously stable pattern. Don't ignore that. And precipitants, you know, is it worse with Valsalva, position change, or under significant exertion? If these signs are present, you'll probably wanna take a pause and just not throw migraine treatment at the patient. If they're stable, MRI is the preferred imaging modality, but a very sick patient, it'd be okay to get a head CT. If you've got a normal neurologic exam, there's no red flags. Again, you don't need routine imaging for migraine headaches. So let's talk about treatment. So hopefully patients have actually started to treat their headache before they arrive in the emergency department. If they haven't, it's a good idea to have some triage protocols in place. So ibuprofen, 7.5 to 10 milligrams per kilogram, 10 milligrams per kilogram is superior to placebo and it's superior to acetaminophen at two hours. So that's what we would use. Early treatment's critical. So ideally within the first hour of onset. So that's why triage protocols help. We'll give kids 10 mg per kg of ibuprofen and like 30 ounces of Gatorade. Blue is often the first Gatorade choice, though that's not an evidence-based statement. You can also use naproxen, but most of the studies are on ibuprofen. If NSAIDs fail, many adolescents and some older children will be prescribed triptans. The best evidence currently supports sumatriptan plus naproxen or zolmitriptan nasal spray. Rizatriptan is FDA approved down to age six. Adolescents respond to these agents better than younger children, and the route matters. The nasal formulations help when nausea is prominent. Families should be counseled to treat early, use weight-appropriate dosing, and avoid using acute medications more than 10 days per month. Often patients will have already taken an NSAID and a triptan before they get to the ED, and that's where we get into the treatment of refractory migraine. Now this is most of the patients that I will see, and before we push medications, let's briefly review ED treatment goals. You either want the patient headache free. Back to their baseline or mild descending pain. So a pain score of one to three. If you don't reach one of those endpoints and it's not agreed upon with the patient and their family, you've not completed treatments. You should do a reassessment within one hour after each intervention. And let's face it, if you're not reassessing within an hour and defining treatment goals, you're not practicing protocolized migraine care. So in the emergency department, many of you may be familiar with the migraine cocktail. So what is that? In general, it's a dopaminergic agent such as prochlorperazine or metoclopramide plus ketorolac, plus IV fluids. Let's take a look at all three of those components and see if you can guess which one is actually the one that can abort the migraine. So fluids are commonly given in pediatric migraine, but they alone do not treat it. They're helpful. Many patients have been throwing up or a bit dehydrated, but there are small randomized trials that show essentially no meaningful pain reduction in patients that get IV fluids alone. Well, what about ketorolac? Toradol, like that's the first thing you give to a kid with a kidney stone, right? It does help, but it's really adjunctive. So the main first-line agents for refractory or status migrainosus in the emergency department are the dopamine antagonists, and the first-line treatment for most patients is prochlorperazine or Compazine. The dose is 0.15 milligram per kilogram IV. The max is 10 milligrams. This is the backbone of ED migraine care. And why do they work? Well, migraines aren't just some random vascular headache. This is an inherited disorder with central pain pathways gone awry. Dopamine plays a large role in that pain, nausea, hypersensitivity, amplification of symptoms and more that, frankly, I won't get into this podcast because molecules hurt my head. The dopamine antagonists treat the headache, they reduce the nausea, and they just tamp down this process. Overall, the response rates approach 85%. Some studies have suggested that the response rate is about 77% at an hour and 90% at three hours. If you add the ketorolac and IV fluids, you get your response rate up to about 93 to 94%. These agents really do work well together. There have been randomized trials comparing IV prochlorperazine versus ketorolac. 85% of prochlorperazine patients achieved headache relief versus only 55% of ketorolac patients. So ketorolac helps, but really it's the prochlorperazine. Metoclopramide, or Reglan, is used in a lot of centers as well. There are some smaller studies in children and adolescents that show that prochlorperazine is more effective, but if kids have an adverse reaction, more on that in a moment, or they prefer metoclopramide because they've responded to it in the past, it's okay to go with it as well. Right. So what does it actually look like when you give the migraine cocktail to a patient? I think it's important to explain to patients and families what to expect, and if this is a teenager, I'm talking to them directly. I mean, they're getting the medication first and foremost. I tell them that the most effective way to treat their headache is with an IV. This often causes lots of angst, even in older teenagers. The medication just does not get to the brain as effectively and fast enough if you take it by mouth. Many patients who get the dopaminergic agents, so prochlorperazine, will invariably feel jittery or anxious or like they gotta move or like they got ants in their pants. I tell them to expect this so they're not surprised and worried when it happens. I tell them that once they start feeling that way, it means the medicine is probably working. They need to hit the nurse button and we're gonna get them up and have them take a walk. This fixes it for the majority of patients just getting up and moving. In adult centers, even with the initial administration of the prochlorperazine or as sort of a reflexive response to any of those symptoms, they just give a slug of IV Benadryl. There's some studies in adolescents especially that this may decrease the effectiveness of the IV agents you're giving in the first place, and it may also increase return rates to the ED. So I will use IV diphenhydramine if getting up and moving around isn't working, or if the distress is significant, or if the patient clearly indicates they've needed it in the past. So if after the migraine cocktail, the patient has met their pain goals and the reassessment is favorable, they can go home to outpatient follow-up. How about if the headache got better, but not all the way? It's usually when the initial migraine cocktail didn't achieve the pain endpoints fully, like it helped partially. If the dopamine blockade didn't do anything, valproate is unlikely to rescue the case. And so valproate works on GABA and it stabilizes some of these pain processes, but the dopaminergic agent needs to have done something first for valproate to work. Per the most common protocol, you give an initial dose of IV valproate, then you discharge the patient home on Depakote ER. So oral valproic acid under 10 years old or under 50 kilograms, 250 milligrams PO twice a day for two weeks, or older than 10 or greater than 50 kilos, 500 milligrams twice a day for two weeks. This is the extended release and it's most helpful if you give the first oral dose in the emergency department. So that's why it's very important to build this protocol in advance. If you don't have IV valproate, then don't just give the patient oral valproate, and definitely don't prescribe an oral course for discharge. All right, well, what about DHE? Dihydroergotamine for refractory or status migrainosus? Generally, this is only given at pediatric centers where you have neurology coverage. It's contraindicated if you've had another dose of DHE within 14 days, or you've had any triptan of any sort within 24 hours, and you must obtain a pregnancy test in adolescent females before giving it. The dosing for less than 30 kilograms is 0.5 milligram. At least 30 kilograms is one milligram. You give 50% of the dose over three minutes, then the remaining 50% over 30 minutes. If this is gonna work, the patients are gonna start feeling wretched at first. They're gonna get very nauseous and they're gonna vomit. They're gonna have flushing, and you'll see transient hypertension. Most of that resolves within the hour in most centers. If you're committing to DHE, you're kind of bringing the patient into the hospital anyway, though some facilities will have DHE done in the emergency department with close outpatient follow-up. Either way, it's really best practice to involve child neurology if you're giving DHE. Alright, well what about steroids? They give those in grownups too, right? Steroids really only have a role for recurrence prevention in children. So for kids that have a history of returning within 72 hours for rebound headache, you can give dexamethasone 0.6 milligram per kilogram IV dose, the max of 10 milligrams. You do not discharge them home on a steroid prescription or a Medrol dose pack or something else, and this can cut the recurrence risk down a bit. There's other therapies out there like magnesium and ketamine. There's just not enough evidence there. And the purpose of this episode is to discuss the therapies that have good evidence behind them and should be part of protocols across the country. Some patients are unfortunately not responsive to emergency department therapy and need admission. The main inpatient therapy is the DHE protocol. If they're not DHE eligible, they haven't tolerated it well or it's unavailable, admission's unlikely to help them unless they just need some IV fluids to help them get back up on their feet. You should consult neurology if the headache goals are not met after maximizing ED therapy for advice. And we should definitely avoid opioids. They don't treat patients with migraines. They increase recurrence risk. They increase revisit rates. Again, the dopamine antagonist prochlorperazine, it's superior for sustained relief when families ask about them, and fortunately they're asking about opioids far less. We use medications that treat the migraine pain pathways and signaling. We don't just wanna mask the pain. All right, so that's all I've got on the acute management of migraine headaches, especially in the emergency department. Remember that migraine care in the ED should be protocolized and evidence-based. IV fluids are supportive. Prochlorperazine is the first line, or you can use metoclopramide as well. Ketorolac is an adjunctive therapy. Valproate is next line. If you've gotta escalate, and DHE is specialized therapy, you can start in the ED, but most of these patients are getting admitted. Dexamethasone or steroids in children can reduce recurrence risk, but they're not really part of the acute management. You should definitely define the endpoints and structurally and systematically reassess patients at an hour. The goal is to get them feeling better to a defined endpoint and to restore function. There is evidence-based pediatric emergency migraine care. You should understand that, plus how to explain why these agents are being given and some of the side effects to patients and families. I find that that approach increases your likelihood of buy-in and success. Alright, so that's it for this episode on the Acute Management of Migraine Headaches in Children and Adolescents. I hope you found it helpful and I can pretty much guarantee that you're gonna see a patient with a migraine on your next shift. If you've got any feedback or comments, send them my way. If you like this episode, leave a review on your favorite podcast site. It helps more people find the show. Or recommend it to a colleague. If there's other topics that you'd like to hear, send them my way for the Pediatric Emergency Medicine podcast. This has been Brad Sobolewski. See you next time.    

In part one of this two-part series, Dr. Justin Abbatemarco, Dr. Marjo S. van der Knaap, and Romy J. van Voorst discuss vanishing white matter disease, focusing on the clinical and MRI findings that would prompt the consideration of genetic testing.  Show citation: van Voorst RJ, Schoenmakers DH, Bonkowsky JL, et al. Consensus-Based Expert Recommendations for Diagnosis and Clinical Management of Vanishing White Matter. Neurology. 2025;105(11):e214320. doi:10.1212/WNL.0000000000214320  Show transcript:  Justin Abbatemarco: Hello and welcome. This is Justin Abbatemarco here with Romy J. van Voorst and Marjo S. van der Knaap. After discussing their article published in Neurology, Consensus-Based Expert Recommendation for Diagnosis and Clinical Management of Vanishing White Matter. They both work for Amsterdam University Medical Center in the Netherlands. And we're going to have a two-part episode dissecting maybe two elements of this paper. Marjo, maybe we could start here and just talking about what vanishing white matter disease is and what in the clinic and MRI findings would make us go towards a genetic testing. Dr. Marjo S. van der Knaap:  There are two things about vanishing white matter that matter most to families, and one is the stress sensitivity. So any type of physical stress, like fever, viral infection, anything may cause a rapid decline and you never know when it comes. And that brings me to the second item that's very difficult and painful for families. And that's the unpredictability. You never know when a disease is going to hit and then your child is going to go down. So you really need the support of neurologists who know about this disease and help you go through this situation. Dr. Justin Abbatemarco: Right. And this paper serves as a great resource for folks that if they have a patient in clinic like this, medications to avoid, how to manage those stress responses. And so it's a really helpful publication to have there. And then I think another message we talked a lot about on the podcast was the importance of genetic testing when patients aren't fitting a typical bucket and this specific disease has unique characteristics. I think the cystic appearance of the MRI, which you do a great job highlighting, would really lead us down that road. So I think it's all really helpful and it gives us some ways to start in clinic with patients and our caregivers. So thank you. Come back and join us for the second part of The Neurology Minute episode where we're going to talk about the patient management. 

Dr. Alex Menze and Dr. Divyanshu Dubey discuss the clinical insights into autoimmune nodopathies, particularly focusing on CASPR1 and CASPR1/CNTN1-complex-IgG.  Show citation:  Paramasivan NK, Basal E, LaFrance-Corey RG, et al. Clinical Insights Into CASPR1 and CASPR1/Contactin-1 Complex Autoimmune Nodopathies. Neurology. 2026;106(5):e214403. doi:10.1212/WNL.0000000000214403 Show transcript:  Dr. Alexander Menze: Hi, this is Alexander Menze. I just finished interviewing Divyanshu Dubey for the Neurology podcast. For today's Neurology Minute, I'm hoping you can tell us the main points of your paper. Dr. Divyanshu Dubey: Our paper talks about a rare form of autoimmune neuropathy associated with antibodies, CASPR1, as well as CASPR1/Contactin-1 complex IgG. These patients present with similar to CIDP, IDP, but tend to have more rapid progression, often a lot of sensory features preceding motor deficits including sensory ataxia in the contact and CASPR complex cases and presence of neuropathic pain in some of the CASPR1 cases. These patients, similar to other neuropathies are refractory to IVIg, but respond relatively well to rituximab.  Dr. Alexander Menze: Thank you. Be sure to download this week's podcast to hear our full interview.  

Dr. Halley Alexander and Dr. Alissa M. D'Gama discuss genetic testing for infantile epilepsies.  Show citation:  Nguyen JNH, Lachgar-Ruiz M, Higginbotham EJ, et al. Diagnostic Yield of Comprehensive Reanalysis After Nondiagnostic Short-Read Genome Sequencing in Infants With Unexplained Epilepsy. Neurology. 2026;106(6):e214645. doi:10.1212/WNL.0000000000214645  Show transcript:  Dr. Halley Alexander:  Hi, this is Halley Alexander with today's Neurology Minute, and I'm here with Dr. Alissa D'Gama from Boston Children's Hospital and Harvard Medical School, and we just finished recording a full-length podcast about some exciting new work in genetic testing for infantile onset epilepsies. Alissa, can you tell us what you found briefly and why it's important for neurology care? Dr. Alissa D'Gama:  Infantile epilepsies are relatively common, and they're associated with substantial burden of disease, and we know that identifying underlying genetic causes can impact clinical care. It's important for emerging precision therapies. But even after genome sequencing, which is the most comprehensive clinical genetic testing currently available, most infants remain genetically unsolved. And so what we did was take that genome sequencing data and reanalyze it for a cohort of infants who had unexplained non-acquired epilepsy and non-diagnostic genome sequencing, and in about 5% of cases, our reanalysis was able to identify a genetic diagnosis, and all of these diagnoses had impact on clinical care for their infants and their families. In some cases, we could incorporate new information, either new clinical information about the patient or new scientific methods or information about disease associations, and in other cases, we were able to incorporate new analysis methods to identify variants. And so our findings suggest that implementing reanalysis for infants or any individual with epilepsy within a year or two of non-diagnostic testing may be useful. Dr. Halley Alexander:  Thank you so much, and you can find a lot more details by listening to the full-length podcast, which is available now on the Neurology podcast, and you can find the full article in the March 10th issue of Neurology or online at neurology.org. As always, thanks for tuning in for today's Neurology Minute.