This week on the program, we have remastered one of our earliest (and most interesting!) episodes on Guillain-Barre syndrome. With an important announcement from Jim Siegler. Produced by James E. Siegler. Music courtesy of Lee Rosevere. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES  Dimachkie MM and Saperstein DS. Acquired immune demyelinating neuropathies. Continuum (Minneap Minn). 2014;20:1241-60. Osler W. The principles and practice of medicine. New York: Appleton; 1892. Gray H. History of lumbar puncture (rachicentesis): The operation and the idea. Arch Neurol Psych. 1921;6:61-69. Asbury AK. Guillain-Barre syndrome: historical aspects. Annals of neurology. 1990;27 Suppl:S2-6. Afifi AK. The landry-guillain-barre strohl syndrome 1859 to 1992 a historical perspective. J Family Community Med. 1994;1:30-4. Bril V and Katzberg HD. Acquired immune axonal neuropathies. Continuum (Minneap Minn). 2014;20:1261-73. Iodice V and Sandroni P. Autonomic neuropathies. Continuum (Minneap Minn). 2014;20:1373-97. Lehmann HC, Hartung HP, Kieseier BC and Hughes RA. Guillain-Barre syndrome after exposure to influenza virus. Lancet Infect Dis. 2010;10:643-51. Sivadon-Tardy V, Orlikowski D, Porcher R, Sharshar T, Durand MC, Enouf V, Rozenberg F, Caudie C, Annane D, van der Werf S, Lebon P, Raphael JC, Gaillard JL and Gault E. Guillain-Barre syndrome and influenza virus infection. Clin Infect Dis. 2009;48:48-56. Stowe J, Andrews N, Wise L and Miller E. Investigation of the temporal association of Guillain-Barre syndrome with influenza vaccine and influenzalike illness using the United Kingdom General Practice Research Database. American journal of epidemiology. 2009;169:382-8. Tam CC, O'Brien SJ, Petersen I, Islam A, Hayward A and Rodrigues LC. Guillain-Barre syndrome and preceding infection with campylobacter, influenza and Epstein-Barr virus in the general practice research database. PloS one. 2007;2:e344. Tam CC, O'Brien SJ and Rodrigues LC. Influenza, Campylobacter and Mycoplasma infections, and hospital admissions for Guillain-Barre syndrome, England. Emerg Infect Dis. 2006;12:1880-7. Dawood FS, Chaves SS, Perez A, Reingold A, Meek J, Farley MM, Ryan P, Lynfield R, Morin C, Baumbach J, Bennett NM, Zansky S, Thomas A, Lindegren ML, Schaffner W, Finelli L and Emerging Infections Program N. Complications and associated bacterial coinfections among children hospitalized with seasonal or pandemic influenza, United States, 2003-2010. The Journal of infectious diseases. 2014;209:686-94. McDermott M, Gelb DJ, Wilson K, Pawloski M, Burke JF, Shelgikar AV and London ZN. Sex Differences in Academic Rank and Publication Rate at Top-Ranked US Neurology Programs. JAMA Neurol. 2018;75:956-961. Keddie S, Pakpoor J, Mousele C, Pipis M, Machado PM, Foster M, Record CJ, Keh RYS, Fehmi J, Paterson RW, Bharambe V, Clayton LM, Allen C, Price O, Wall J, Kiss-Csenki A, Rathnasabapathi DP, Geraldes R, Yermakova T, King-Robson J, Zosmer M, Rajakulendran S, Sumaria S, Farmer SF, Nortley R, Marshall CR, Newman EJ, Nirmalananthan N, Kumar G, Pinto AA, Holt J, Lavin TM, Brennan KM, Zandi MS, Jayaseelan DL, Pritchard J, Hadden RDM, Manji H, Willison HJ, Rinaldi S, Carr AS and Lunn MP. Epidemiological and cohort study finds no association between COVID-19 and Guillain-Barre syndrome. Brain. 2021;144:682-693. Lunn MP, Cornblath DR, Jacobs BC, Querol L, van Doorn PA, Hughes RA and Willison HJ. COVID-19 vaccine and Guillain-Barre syndrome: let's not leap to associations. Brain. 2021;144:357-360. 

This week on the program, we have remastered one of our earliest (and most interesting!) episodes on Guillain-Barre syndrome. With an important announcement from Jim Siegler. Produced by James E. Siegler. Music courtesy of Lee Rosevere. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES <ol> <li>Dimachkie MM and Saperstein DS. Acquired immune demyelinating neuropathies. Continuum (Minneap Minn). 2014;20:1241-60.</li> <li>Osler W. The principles and practice of medicine. New York: Appleton; 1892.</li> <li>Gray H. History of lumbar puncture (rachicentesis): The operation and the idea. Arch Neurol Psych. 1921;6:61-69.</li> <li>Asbury AK. Guillain-Barre syndrome: historical aspects. Annals of neurology. 1990;27 Suppl:S2-6.</li> <li>Afifi AK. The landry-guillain-barre strohl syndrome 1859 to 1992 a historical perspective. J Family Community Med. 1994;1:30-4.</li> <li>Bril V and Katzberg HD. Acquired immune axonal neuropathies. Continuum (Minneap Minn). 2014;20:1261-73.</li> <li>Iodice V and Sandroni P. Autonomic neuropathies. Continuum (Minneap Minn). 2014;20:1373-97.</li> <li>Lehmann HC, Hartung HP, Kieseier BC and Hughes RA. Guillain-Barre syndrome after exposure to influenza virus. Lancet Infect Dis. 2010;10:643-51.</li> <li>Sivadon-Tardy V, Orlikowski D, Porcher R, Sharshar T, Durand MC, Enouf V, Rozenberg F, Caudie C, Annane D, van der Werf S, Lebon P, Raphael JC, Gaillard JL and Gault E. Guillain-Barre syndrome and influenza virus infection. Clin Infect Dis. 2009;48:48-56.</li> <li>Stowe J, Andrews N, Wise L and Miller E. Investigation of the temporal association of Guillain-Barre syndrome with influenza vaccine and influenzalike illness using the United Kingdom General Practice Research Database. American journal of epidemiology. 2009;169:382-8.</li> <li>Tam CC, O'Brien SJ, Petersen I, Islam A, Hayward A and Rodrigues LC. Guillain-Barre syndrome and preceding infection with campylobacter, influenza and Epstein-Barr virus in the general practice research database. PloS one. 2007;2:e344.</li> <li>Tam CC, O'Brien SJ and Rodrigues LC. Influenza, Campylobacter and Mycoplasma infections, and hospital admissions for Guillain-Barre syndrome, England. Emerg Infect Dis. 2006;12:1880-7.</li> <li>Dawood FS, Chaves SS, Perez A, Reingold A, Meek J, Farley MM, Ryan P, Lynfield R, Morin C, Baumbach J, Bennett NM, Zansky S, Thomas A, Lindegren ML, Schaffner W, Finelli L and Emerging Infections Program N. Complications and associated bacterial coinfections among children hospitalized with seasonal or pandemic influenza, United States, 2003-2010. The Journal of infectious diseases. 2014;209:686-94.</li> <li>McDermott M, Gelb DJ, Wilson K, Pawloski M, Burke JF, Shelgikar AV and London ZN. Sex Differences in Academic Rank and Publication Rate at Top-Ranked US Neurology Programs. JAMA Neurol. 2018;75:956-961.</li> <li>Keddie S, Pakpoor J, Mousele C, Pipis M, Machado PM, Foster M, Record CJ, Keh RYS, Fehmi J, Paterson RW, Bharambe V, Clayton LM, Allen C, Price O, Wall J, Kiss-Csenki A, Rathnasabapathi DP, Geraldes R, Yermakova T, King-Robson J, Zosmer M, Rajakulendran S, Sumaria S, Farmer SF, Nortley R, Marshall CR, Newman EJ, Nirmalananthan N, Kumar G, Pinto AA, Holt J, Lavin TM, Brennan KM, Zandi MS, Jayaseelan DL, Pritchard J, Hadden RDM, Manji H, Willison HJ, Rinaldi S, Carr AS and Lunn MP. Epidemiological and cohort study finds no association between COVID-19 and Guillain-Barre syndrome. Brain. 2021;144:682-693.</li> <li>Lunn MP, Cornblath DR, Jacobs BC, Querol L, van Doorn PA, Hughes RA and Willison HJ. COVID-19 vaccine and Guillain-Barre syndrome: let's not leap to associations. Brain. 2021;144:357-360.</li> </ol>

#30 GBS: 2021 Update

The field of neurocritical care and traumatic brain injury management is rapidly evolving. We are shifting from older (but not entirely outdated) monitoring techniques to novel diagnostic and therapeutic advances in critical care medicine. Managing intracranial pressure crises involves the careful tiptoeing of a line between maintaining brain circulation and yet reducing intracranial fluid volume. And many of our interventions rely on one simple mathematical construct: CPP = MAP - ICP [Cerebral perfusion pressure = Mean arterial pressure – Intracranial pressure] The importance of this formula cannot be understated. So we are spending 35 minutes today reviewing it, and discussing pearls and pitfalls of ICP monitoring and management. But believe me, it’s worth it. Produced by James E. Siegler and Jon Rosenberg. Music courtesy of Unheard Music Concepts, Rafael Archangel, Milton Arias, and Quincas Moreira. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES   Rosner MJ and Coley IB. Cerebral perfusion pressure, intracranial pressure, and head elevation. Journal of neurosurgery. 1986;65:636-41. Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, Petroni G, Lujan S, Pridgeon J, Barber J, Machamer J, Chaddock K, Celix JM, Cherner M, Hendrix T and Global Neurotrauma Research G. A trial of intracranial-pressure monitoring in traumatic brain injury. The New England journal of medicine. 2012;367:2471-81. Kristiansson H, Nissborg E, Bartek J, Jr., Andresen M, Reinstrup P and Romner B. Measuring elevated intracranial pressure through noninvasive methods: a review of the literature. J Neurosurg Anesthesiol. 2013;25:372-85. Armstead WM. Cerebral Blood Flow Autoregulation and Dysautoregulation. Anesthesiol Clin. 2016;34:465-77. Oddo M, Crippa IA, Mehta S, Menon D, Payen JF, Taccone FS and Citerio G. Optimizing sedation in patients with acute brain injury. Crit Care. 2016;20:128. Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW and Ghajar J. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2017;80:6-15. Okonkwo DO, Shutter LA, Moore C, Temkin NR, Puccio AM, Madden CJ, Andaluz N, Chesnut RM, Bullock MR, Grant GA, McGregor J, Weaver M, Jallo J, LeRoux PD, Moberg D, Barber J, Lazaridis C and Diaz-Arrastia RR. Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase-II: A Phase II Randomized Trial. Critical care medicine. 2017;45:1907-1914. Harary M, Dolmans RGF and Gormley WB. Intracranial Pressure Monitoring-Review and Avenues for Development. Sensors (Basel). 2018;18. Koenig MA. Cerebral Edema and Elevated Intracranial Pressure. Continuum (Minneap Minn). 2018;24:1588-1602. Jahns FP, Miroz JP, Messerer M, Daniel RT, Taccone FS, Eckert P and Oddo M. Quantitative pupillometry for the monitoring of intracranial hypertension in patients with severe traumatic brain injury. Crit Care. 2019;23:155. Cook AM, Morgan Jones G, Hawryluk GWJ, Mailloux P, McLaughlin D, Papangelou A, Samuel S, Tokumaru S, Venkatasubramanian C, Zacko C, Zimmermann LL, Hirsch K and Shutter L. Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients. Neurocritical care. 2020;32:647-666. Robba C, Pozzebon S, Moro B, Vincent JL, Creteur J and Taccone FS. Multimodal non-invasive assessment of intracranial hypertension: an observational study. Crit Care. 2020;24:379. 

The field of neurocritical care and traumatic brain injury management is rapidly evolving. We are shifting from older (but not entirely outdated) monitoring techniques to novel diagnostic and therapeutic advances in critical care medicine. Managing intracranial pressure crises involves the careful tiptoeing of a line between maintaining brain circulation and yet reducing intracranial fluid volume. And many of our interventions rely on one simple mathematical construct: CPP = MAP - ICP [Cerebral perfusion pressure = Mean arterial pressure – Intracranial pressure] The importance of this formula cannot be understated. So we are spending 35 minutes today reviewing it, and discussing pearls and pitfalls of ICP monitoring and management. But believe me, it’s worth it. Produced by James E. Siegler and Jon Rosenberg. Music courtesy of Unheard Music Concepts, Rafael Archangel, Milton Arias, and Quincas Moreira. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES  <ol> <li>Rosner MJ and Coley IB. Cerebral perfusion pressure, intracranial pressure, and head elevation. Journal of neurosurgery. 1986;65:636-41.</li> <li>Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, Petroni G, Lujan S, Pridgeon J, Barber J, Machamer J, Chaddock K, Celix JM, Cherner M, Hendrix T and Global Neurotrauma Research G. A trial of intracranial-pressure monitoring in traumatic brain injury. The New England journal of medicine. 2012;367:2471-81.</li> <li>Kristiansson H, Nissborg E, Bartek J, Jr., Andresen M, Reinstrup P and Romner B. Measuring elevated intracranial pressure through noninvasive methods: a review of the literature. J Neurosurg Anesthesiol. 2013;25:372-85.</li> <li>Armstead WM. Cerebral Blood Flow Autoregulation and Dysautoregulation. Anesthesiol Clin. 2016;34:465-77.</li> <li>Oddo M, Crippa IA, Mehta S, Menon D, Payen JF, Taccone FS and Citerio G. Optimizing sedation in patients with acute brain injury. Crit Care. 2016;20:128.</li> <li>Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW and Ghajar J. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2017;80:6-15.</li> <li>Okonkwo DO, Shutter LA, Moore C, Temkin NR, Puccio AM, Madden CJ, Andaluz N, Chesnut RM, Bullock MR, Grant GA, McGregor J, Weaver M, Jallo J, LeRoux PD, Moberg D, Barber J, Lazaridis C and Diaz-Arrastia RR. Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase-II: A Phase II Randomized Trial. Critical care medicine. 2017;45:1907-1914.</li> <li>Harary M, Dolmans RGF and Gormley WB. Intracranial Pressure Monitoring-Review and Avenues for Development. Sensors (Basel). 2018;18.</li> <li>Koenig MA. Cerebral Edema and Elevated Intracranial Pressure. Continuum (Minneap Minn). 2018;24:1588-1602.</li> <li>Jahns FP, Miroz JP, Messerer M, Daniel RT, Taccone FS, Eckert P and Oddo M. Quantitative pupillometry for the monitoring of intracranial hypertension in patients with severe traumatic brain injury. Crit Care. 2019;23:155.</li> <li>Cook AM, Morgan Jones G, Hawryluk GWJ, Mailloux P, McLaughlin D, Papangelou A, Samuel S, Tokumaru S, Venkatasubramanian C, Zacko C, Zimmermann LL, Hirsch K and Shutter L. Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients. Neurocritical care. 2020;32:647-666.</li> <li>Robba C, Pozzebon S, Moro B, Vincent JL, Creteur J and Taccone FS. Multimodal non-invasive assessment of intracranial hypertension: an observational study. Crit Care. 2020;24:379.</li> </ol>

#181 A primer on ICP management

What do hip weakness, headache, and neglect have in common? At minimum, they can all be approached with simple neurodiagnostic heuristics. But there's more to neurology and medicine than having an approach to "leg weakness" or an approach to "headache". You have to adapt to new information as it presents itself. You have to know when, and how, to pivot. Produced by James E. Siegler, Minal Patel, and Jesse Thon. Voiceovers by Taryn Hester and Terri Yeager. Music for our program today was courtesy of Lee Rosevere, Rafael Archangel, E’s Jammy Jams, Kai Engel, and Jon Watts under a Creative Commons license. Our theme song was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES  Rozen TD. Trigeminal neuralgia and glossopharyngeal neuralgia. Neurol Clin. 2004;22:185-206. Tarulli AW and Raynor EM. Lumbosacral radiculopathy. Neurol Clin. 2007;25:387-405. Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, Nurmikko T, Zakrzewska JM, American Academy of Neurology S and European Federation of Neurological S. AAN-EFNS guidelines on trigeminal neuralgia management. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2008;15:1013-28. Dyck PJ and Thaisetthawatkul P. Lumbosacral plexopathy. Continuum (Minneap Minn). 2014;20:1343-58. Beume LA, Hieber M, Kaller CP, Nitschke K, Bardutzky J, Urbach H, Weiller C and Rijntjes M. Large Vessel Occlusion in Acute Stroke. Stroke; a journal of cerebral circulation. 2018;49:2323-2329. Menon BK. Neuroimaging in Acute Stroke. Continuum (Minneap Minn). 2020;26:287-309. 

What do hip weakness, headache, and neglect have in common? At minimum, they can all be approached with simple neurodiagnostic heuristics. But there's more to neurology and medicine than having an approach to "leg weakness" or an approach to "headache". You have to adapt to new information as it presents itself. You have to know when, and how, to pivot. Produced by James E. Siegler, Minal Patel, and Jesse Thon. Voiceovers by Taryn Hester and Terri Yeager. Music for our program today was courtesy of Lee Rosevere, Rafael Archangel, E’s Jammy Jams, Kai Engel, and Jon Watts under a Creative Commons license. Our theme song was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES <ol> <li>Rozen TD. Trigeminal neuralgia and glossopharyngeal neuralgia. Neurol Clin. 2004;22:185-206.</li> <li>Tarulli AW and Raynor EM. Lumbosacral radiculopathy. Neurol Clin. 2007;25:387-405.</li> <li>Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, Nurmikko T, Zakrzewska JM, American Academy of Neurology S and European Federation of Neurological S. AAN-EFNS guidelines on trigeminal neuralgia management. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2008;15:1013-28.</li> <li>Dyck PJ and Thaisetthawatkul P. Lumbosacral plexopathy. Continuum (Minneap Minn). 2014;20:1343-58.</li> <li>Beume LA, Hieber M, Kaller CP, Nitschke K, Bardutzky J, Urbach H, Weiller C and Rijntjes M. Large Vessel Occlusion in Acute Stroke. Stroke; a journal of cerebral circulation. 2018;49:2323-2329.</li> <li>Menon BK. Neuroimaging in Acute Stroke. Continuum (Minneap Minn). 2020;26:287-309.</li> </ol>

#180 The art of the pivot

Who doesn’t enjoy their sleep? For most of us, it can be the most relaxing escape. And for others, a disturbance of sleep may be the first clue to a neurodenerative condition. Produced by James E. Siegler. Dr. Avidan reports that he receives royalties from Elsevier, is a consultant for Merck, and is a speaker for Eisai and Harmony. Music for our program today was by Andy Cohen, Purple Planet Music, Steve Combs, Yan Terrien, and Shane Ivers, whose music can be found at silvermansound.com. Our theme song was composed by Jimothy Dalton. Voiceover was courtesy of Taryn Hester. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES  Boeve BF, Silber MH, Ferman TJ, Lucas JA and Parisi JE. Association of REM sleep behavior disorder and neurodegenerative disease may reflect an underlying synucleinopathy. Mov Disord. 2001;16:622-30. Gilat M, Coeytaux Jackson A, Marshall NS, Hammond D, Mullins AE, Hall JM, Fang BAM, Yee BJ, Wong KKH, Grunstein RR and Lewis SJG. Melatonin for rapid eye movement sleep behavior disorder in Parkinson's disease: A randomised controlled trial. Mov Disord. 2020;35:344-349. Lloyd R, Tippmann-Peikert M, Slocumb N and Kotagal S. Characteristics of REM sleep behavior disorder in childhood. J Clin Sleep Med. 2012;8:127-31. Malhotra R and Avidan AY. Neurodegenerative Disease and REM Behavior Disorder. Current treatment options in neurology. 2012;14:474-92. McGrane IR, Leung JG, St Louis EK and Boeve BF. Melatonin therapy for REM sleep behavior disorder: a critical review of evidence. Sleep Med. 2015;16:19-26. Porter VR and Avidan AY. Clinical Overview of REM Sleep Behavior Disorder. Semin Neurol. 2017;37:461-470. Shin C, Park H, Lee WW, Kim HJ, Kim HJ and Jeon B. Clonazepam for probable REM sleep behavior disorder in Parkinson's disease: A randomized placebo-controlled trial. Journal of the neurological sciences. 2019;401:81-86. St Louis EK, Boeve AR and Boeve BF. REM Sleep Behavior Disorder in Parkinson's Disease and Other Synucleinopathies. Mov Disord. 2017;32:645-658. St Louis EK and Boeve BF. REM Sleep Behavior Disorder: Diagnosis, Clinical Implications, and Future Directions. Mayo Clinic proceedings. 2017;92:1723-1736. Teigen LN, Sharp RR, Hirsch JR, Campbell E, Timm PC, Sandness DJ, Feemster JC, Gossard TR, Faber SM, Steele TA, Rivera S, Junna MR, Lipford MC, Tippmann-Peikert M, Kotagal S, Ju YE, Howell M, Schenck CH, Videnovic A, Jennum P, Hogl B, Stefani A, Arnulf I, Heidbreder A, Lewis S, McCarter SJ, Boeve BF, Silber MH and St Louis EK. Specialist approaches to prognostic counseling in isolated REM sleep behavior disorder. Sleep Med. 2021;79:107-112. 

Who doesn’t enjoy their sleep? For most of us, it can be the most relaxing escape. And for others, a disturbance of sleep may be the first clue to a neurodenerative condition. Produced by James E. Siegler. Dr. Avidan reports that he receives royalties from Elsevier, is a consultant for Merck, and is a speaker for Eisai and Harmony. Music for our program today was by Andy Cohen, Purple Planet Music, Steve Combs, Yan Terrien, and Shane Ivers, whose music can be found at <a href="http://silvermansound.com" rel="nofollow" target="_blank">silvermansound.com</a>. Our theme song was composed by Jimothy Dalton. Voiceover was courtesy of Taryn Hester. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES <ol> <li>Boeve BF, Silber MH, Ferman TJ, Lucas JA and Parisi JE. Association of REM sleep behavior disorder and neurodegenerative disease may reflect an underlying synucleinopathy. Mov Disord. 2001;16:622-30.</li> <li>Gilat M, Coeytaux Jackson A, Marshall NS, Hammond D, Mullins AE, Hall JM, Fang BAM, Yee BJ, Wong KKH, Grunstein RR and Lewis SJG. Melatonin for rapid eye movement sleep behavior disorder in Parkinson's disease: A randomised controlled trial. Mov Disord. 2020;35:344-349.</li> <li>Lloyd R, Tippmann-Peikert M, Slocumb N and Kotagal S. Characteristics of REM sleep behavior disorder in childhood. J Clin Sleep Med. 2012;8:127-31.</li> <li>Malhotra R and Avidan AY. Neurodegenerative Disease and REM Behavior Disorder. Current treatment options in neurology. 2012;14:474-92.</li> <li>McGrane IR, Leung JG, St Louis EK and Boeve BF. Melatonin therapy for REM sleep behavior disorder: a critical review of evidence. Sleep Med. 2015;16:19-26.</li> <li>Porter VR and Avidan AY. Clinical Overview of REM Sleep Behavior Disorder. Semin Neurol. 2017;37:461-470.</li> <li>Shin C, Park H, Lee WW, Kim HJ, Kim HJ and Jeon B. Clonazepam for probable REM sleep behavior disorder in Parkinson's disease: A randomized placebo-controlled trial. Journal of the neurological sciences. 2019;401:81-86.</li> <li>St Louis EK, Boeve AR and Boeve BF. REM Sleep Behavior Disorder in Parkinson's Disease and Other Synucleinopathies. Mov Disord. 2017;32:645-658.</li> <li>St Louis EK and Boeve BF. REM Sleep Behavior Disorder: Diagnosis, Clinical Implications, and Future Directions. Mayo Clinic proceedings. 2017;92:1723-1736.</li> <li>Teigen LN, Sharp RR, Hirsch JR, Campbell E, Timm PC, Sandness DJ, Feemster JC, Gossard TR, Faber SM, Steele TA, Rivera S, Junna MR, Lipford MC, Tippmann-Peikert M, Kotagal S, Ju YE, Howell M, Schenck CH, Videnovic A, Jennum P, Hogl B, Stefani A, Arnulf I, Heidbreder A, Lewis S, McCarter SJ, Boeve BF, Silber MH and St Louis EK. Specialist approaches to prognostic counseling in isolated REM sleep behavior disorder. Sleep Med. 2021;79:107-112.</li> </ol>

#179 RBD and synucleinopathies 

As many as 1% of the world has epilepsy, but far more than will have a seizure in their lifetime. Not everyone needs a seizure medication, some people are even harmed by them. So who warrants treatment, and what do you start with. Consider today’s program an intro to AED decision making. For educational purposes only, of course. Not to guide any healthcare provider’s decision making. Produced by James E. Siegler. Music courtesy of Lee Rosevere, Cellophane Sam, Jon Watts, Josh Woodward, and Rafael Archangel. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES  Hauser WA, Rich SS, Annegers JF and Anderson VE. Seizure recurrence after a 1st unprovoked seizure: an extended follow-up. Neurology. 1990;40:1163-70. Randomized clinical trial on the efficacy of antiepileptic drugs in reducing the risk of relapse after a first unprovoked tonic-clonic seizure. First Seizure Trial Group (FIR.S.T. Group). Neurology. 1993;43:478-83. Hui AC, Tang A, Wong KS, Mok V and Kay R. Recurrence after a first untreated seizure in the Hong Kong Chinese population. Epilepsia. 2001;42:94-7. Koepp MJ and Woermann FG. Imaging structure and function in refractory focal epilepsy. The Lancet Neurology. 2005;4:42-53. Marson A, Jacoby A, Johnson A, Kim L, Gamble C, Chadwick D and Medical Research Council MSG. Immediate versus deferred antiepileptic drug treatment for early epilepsy and single seizures: a randomised controlled trial. Lancet. 2005;365:2007-13. Manjunath R, Davis KL, Candrilli SD and Ettinger AB. Association of antiepileptic drug nonadherence with risk of seizures in adults with epilepsy. Epilepsy Behav. 2009;14:372-8. Fountain NB. Choosing among antiepileptic drugs. Continuum (Minneap Minn). 2010;16:121-35. Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, Engel J, Jr., Forsgren L, French JA, Glynn M, Hesdorffer DC, Lee BI, Mathern GW, Moshe SL, Perucca E, Scheffer IE, Tomson T, Watanabe M and Wiebe S. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55:475-82. Krumholz A, Wiebe S, Gronseth GS, Gloss DS, Sanchez AM, Kabir AA, Liferidge AT, Martello JP, Kanner AM, Shinnar S, Hopp JL and French JA. Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2015;84:1705-13. Bouma HK, Labos C, Gore GC, Wolfson C and Keezer MR. The diagnostic accuracy of routine electroencephalography after a first unprovoked seizure. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2016;23:455-63. Leone MA, Giussani G, Nolan SJ, Marson AG and Beghi E. Immediate antiepileptic drug treatment, versus placebo, deferred, or no treatment for first unprovoked seizure. The Cochrane database of systematic reviews. 2016:CD007144. 

As many as 1% of the world has epilepsy, but far more than will have a seizure in their lifetime. Not everyone needs a seizure medication, some people are even harmed by them. So who warrants treatment, and what do you start with. Consider today’s program an intro to AED decision making. For educational purposes only, of course. Not to guide any healthcare provider’s decision making. Produced by James E. Siegler. Music courtesy of Lee Rosevere, Cellophane Sam, Jon Watts, Josh Woodward, and Rafael Archangel. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES <ol> <li>Hauser WA, Rich SS, Annegers JF and Anderson VE. Seizure recurrence after a 1st unprovoked seizure: an extended follow-up. Neurology. 1990;40:1163-70.</li> <li>Randomized clinical trial on the efficacy of antiepileptic drugs in reducing the risk of relapse after a first unprovoked tonic-clonic seizure. First Seizure Trial Group (FIR.S.T. Group). Neurology. 1993;43:478-83.</li> <li>Hui AC, Tang A, Wong KS, Mok V and Kay R. Recurrence after a first untreated seizure in the Hong Kong Chinese population. Epilepsia. 2001;42:94-7.</li> <li>Koepp MJ and Woermann FG. Imaging structure and function in refractory focal epilepsy. The Lancet Neurology. 2005;4:42-53.</li> <li>Marson A, Jacoby A, Johnson A, Kim L, Gamble C, Chadwick D and Medical Research Council MSG. Immediate versus deferred antiepileptic drug treatment for early epilepsy and single seizures: a randomised controlled trial. Lancet. 2005;365:2007-13.</li> <li>Manjunath R, Davis KL, Candrilli SD and Ettinger AB. Association of antiepileptic drug nonadherence with risk of seizures in adults with epilepsy. Epilepsy Behav. 2009;14:372-8.</li> <li>Fountain NB. Choosing among antiepileptic drugs. Continuum (Minneap Minn). 2010;16:121-35.</li> <li>Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, Engel J, Jr., Forsgren L, French JA, Glynn M, Hesdorffer DC, Lee BI, Mathern GW, Moshe SL, Perucca E, Scheffer IE, Tomson T, Watanabe M and Wiebe S. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55:475-82.</li> <li>Krumholz A, Wiebe S, Gronseth GS, Gloss DS, Sanchez AM, Kabir AA, Liferidge AT, Martello JP, Kanner AM, Shinnar S, Hopp JL and French JA. Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2015;84:1705-13.</li> <li>Bouma HK, Labos C, Gore GC, Wolfson C and Keezer MR. The diagnostic accuracy of routine electroencephalography after a first unprovoked seizure. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2016;23:455-63.</li> <li>Leone MA, Giussani G, Nolan SJ, Marson AG and Beghi E. Immediate antiepileptic drug treatment, versus placebo, deferred, or no treatment for first unprovoked seizure. The Cochrane database of systematic reviews. 2016:CD007144.</li> </ol>

#178 First seizure of life

To quote Donald Rumsfeld, “there are things we know we know…. we know there are some things we do not know... But there are also unknown unknowns—the ones we don't know we don't know…it is the latter category that tends to be the difficult ones.” In neurology, the agnosias are not that dissimilar from Rumsfeld’s 'unknown unknowns.' In this week’s program, we discuss the nosology and nomenclature for the agnosias, the localization, and the importance of recognizing one. Produced by James E. Siegler. Music courtesy of Dr. Turtle, Grossman, Ewell and Grainger, Marco Trovatelli, and Purple Planet Music. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES  Milner AD, Perrett DI, Johnston RS, Benson PJ, Jordan TR, Heeley DW, Bettucci D, Mortara F, Mutani R, Terazzi E and et al. Perception and action in 'visual form agnosia'. Brain. 1991;114 ( Pt 1B):405-28. Zeki S and Ffytche DH. The Riddoch syndrome: insights into the neurobiology of conscious vision. Brain. 1998;121 ( Pt 1):25-45. Biran I and Coslett HB. Visual agnosia. Current neurology and neuroscience reports. 2003;3:508-12. Coslett HB. Apraxia, Neglect, and Agnosia. Continuum (Minneap Minn). 2018;24:768-782. Dhont S, Derom E, Van Braeckel E, Depuydt P and Lambrecht BN. The pathophysiology of 'happy' hypoxemia in COVID-19. Respir Res. 2020;21:198. Li YC, Bai WZ and Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020;92:552-555. Matschke J, Lutgehetmann M, Hagel C, Sperhake JP, Schroder AS, Edler C, Mushumba H, Fitzek A, Allweiss L, Dandri M, Dottermusch M, Heinemann A, Pfefferle S, Schwabenland M, Sumner Magruder D, Bonn S, Prinz M, Gerloff C, Puschel K, Krasemann S, Aepfelbacher M and Glatzel M. Neuropathology of patients with COVID-19 in Germany: a post-mortem case series. The Lancet Neurology. 2020;19:919-929. 

To quote Donald Rumsfeld, “there are things we know we know…. we know there are some things we do not know... But there are also unknown unknowns—the ones we don't know we don't know…it is the latter category that tends to be the difficult ones.” In neurology, the agnosias are not that dissimilar from Rumsfeld’s 'unknown unknowns.' In this week’s program, we discuss the nosology and nomenclature for the agnosias, the localization, and the importance of recognizing one. Produced by James E. Siegler. Music courtesy of Dr. Turtle, Grossman, Ewell and Grainger, Marco Trovatelli, and Purple Planet Music. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES <ol> <li>Milner AD, Perrett DI, Johnston RS, Benson PJ, Jordan TR, Heeley DW, Bettucci D, Mortara F, Mutani R, Terazzi E and et al. Perception and action in 'visual form agnosia'. Brain. 1991;114 ( Pt 1B):405-28.</li> <li>Zeki S and Ffytche DH. The Riddoch syndrome: insights into the neurobiology of conscious vision. Brain. 1998;121 ( Pt 1):25-45.</li> <li>Biran I and Coslett HB. Visual agnosia. Current neurology and neuroscience reports. 2003;3:508-12.</li> <li>Coslett HB. Apraxia, Neglect, and Agnosia. Continuum (Minneap Minn). 2018;24:768-782.</li> <li>Dhont S, Derom E, Van Braeckel E, Depuydt P and Lambrecht BN. The pathophysiology of 'happy' hypoxemia in COVID-19. Respir Res. 2020;21:198.</li> <li>Li YC, Bai WZ and Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020;92:552-555.</li> <li>Matschke J, Lutgehetmann M, Hagel C, Sperhake JP, Schroder AS, Edler C, Mushumba H, Fitzek A, Allweiss L, Dandri M, Dottermusch M, Heinemann A, Pfefferle S, Schwabenland M, Sumner Magruder D, Bonn S, Prinz M, Gerloff C, Puschel K, Krasemann S, Aepfelbacher M and Glatzel M. Neuropathology of patients with COVID-19 in Germany: a post-mortem case series. The Lancet Neurology. 2020;19:919-929.</li> </ol>

#177 Agnosia

Almost 5 years ago, we published a show on chronic traumatic encephalopathy and its relationship to American football. But a lot has happened since 2016. New rules in the NFL. Emerging data on how the developing human brain of a child or adolescent is even more vulnerable to pathologic changes following mild head injury. And a heightened awareness of the disingenuous campaign against contact sports among one of the most outspoken whistleblowers in the medical field. This week on the program, we have remastered and updated the 2016 program. With some additional commentary on how parenthood may yield a new perspective on contact sports. Produced by James E. Siegler. Music courtesy of Chris Haugen, Kevin McLeod, and Meydan. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES  Montenigro PH, Corp DT, Stein TD, Cantu RC and Stern RA. Chronic traumatic encephalopathy: historical origins and current perspective. Annu Rev Clin Psychol. 2015;11:309-30. Giza CC, Kutcher JS, Ashwal S, Barth J, Getchius TS, Gioia GA, Gronseth GS, Guskiewicz K, Mandel S, Manley G, McKeag DB, Thurman DJ and Zafonte R. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;80:2250-7. Guskiewicz KM, Marshall SW, Bailes J, McCrea M, Cantu RC, Randolph C and Jordan BD. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery. 2005;57:719-26; discussion 719-26. Stamm JM, Bourlas AP, Baugh CM, Fritts NG, Daneshvar DH, Martin BM, McClean MD, Tripodis Y and Stern RA. Age of first exposure to football and later-life cognitive impairment in former NFL players. Neurology. 2015;84:1114-20. Ling H, Morris HR, Neal JW, Lees AJ, Hardy J, Holton JL, Revesz T and Williams DD. Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players. Acta Neuropathol. 2017;133:337-352. Alosco ML, Mez J, Tripodis Y, Kiernan PT, Abdolmohammadi B, Murphy L, Kowall NW, Stein TD, Huber BR, Goldstein LE, Cantu RC, Katz DI, Chaisson CE, Martin B, Solomon TM, McClean MD, Daneshvar DH, Nowinski CJ, Stern RA and McKee AC. Age of first exposure to tackle football and chronic traumatic encephalopathy. Annals of neurology. 2018;83:886-901. Hobson W. "From Scientist to Salesman". Available online at  https://www.washingtonpost.com/graphics/2020/sports/cte-bennet-omalu/. Accessed 31 December 2020. 

Almost 5 years ago, we published a show on chronic traumatic encephalopathy and its relationship to American football. But a lot has happened since 2016. New rules in the NFL. Emerging data on how the developing human brain of a child or adolescent is even more vulnerable to pathologic changes following mild head injury. And a heightened awareness of the disingenuous campaign against contact sports among one of the most outspoken whistleblowers in the medical field. This week on the program, we have remastered and updated the 2016 program. With some additional commentary on how parenthood may yield a new perspective on contact sports. Produced by James E. Siegler. Music courtesy of Chris Haugen, Kevin McLeod, and Meydan. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES <ol> <li>Montenigro PH, Corp DT, Stein TD, Cantu RC and Stern RA. Chronic traumatic encephalopathy: historical origins and current perspective. Annu Rev Clin Psychol. 2015;11:309-30.</li> <li>Giza CC, Kutcher JS, Ashwal S, Barth J, Getchius TS, Gioia GA, Gronseth GS, Guskiewicz K, Mandel S, Manley G, McKeag DB, Thurman DJ and Zafonte R. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;80:2250-7.</li> <li>Guskiewicz KM, Marshall SW, Bailes J, McCrea M, Cantu RC, Randolph C and Jordan BD. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery. 2005;57:719-26; discussion 719-26.</li> <li>Stamm JM, Bourlas AP, Baugh CM, Fritts NG, Daneshvar DH, Martin BM, McClean MD, Tripodis Y and Stern RA. Age of first exposure to football and later-life cognitive impairment in former NFL players. Neurology. 2015;84:1114-20.</li> <li>Ling H, Morris HR, Neal JW, Lees AJ, Hardy J, Holton JL, Revesz T and Williams DD. Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players. Acta Neuropathol. 2017;133:337-352.</li> <li>Alosco ML, Mez J, Tripodis Y, Kiernan PT, Abdolmohammadi B, Murphy L, Kowall NW, Stein TD, Huber BR, Goldstein LE, Cantu RC, Katz DI, Chaisson CE, Martin B, Solomon TM, McClean MD, Daneshvar DH, Nowinski CJ, Stern RA and McKee AC. Age of first exposure to tackle football and chronic traumatic encephalopathy. Annals of neurology. 2018;83:886-901.</li> <li>Hobson W. "From Scientist to Salesman". Available online at <a href="https://www.washingtonpost.com/graphics/2020/sports/cte-bennet-omalu/." rel="nofollow" target="_blank"> https://www.washingtonpost.com/graphics/2020/sports/cte-bennet-omalu/.</a> Accessed 31 December 2020.</li> </ol>

#33 Controversies in chronic traumatic encephalopathy

Happy New Year, and good riddance 2020! Hopefully there is more that you will take away from the past 12 months other than your personal experience with the coronavirus pandemic. Whether you lost a job, a loved one, or an invaluable life experience, I think we can all say BRING ON 2021! So let's welcome the new year with positive mental attitude, a bit more luck, and an unquenchable thirst for knowledge. Produced by James E. Siegler. Music courtesy of Jahzzar, Kevin McLeod, Patches, Montplaisir, Steve Combs, Lee Roosevere, Siddhartha, Soft and Furious, Magic in the Other, and Loyalty Freak Music. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES EEG  Wiebe S, Blume WT, Girvin JP, Eliasziw M, Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study G. A randomized, controlled trial of surgery for temporal-lobe epilepsy. The New England journal of medicine. 2001;345:311-8. Cascino GD. Clinical indications and diagnostic yield of video-electroencephalographic monitoring in patients with seizures and spells. Mayo Clinic proceedings. 2002;77:1111-20. Pillai J and Sperling MR. Interictal EEG and the diagnosis of epilepsy. Epilepsia. 2006;47 Suppl 1:14-22. Bouma HK, Labos C, Gore GC, Wolfson C and Keezer MR. The diagnostic accuracy of routine electroencephalography after a first unprovoked seizure. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2016;23:455-63. Debicki DB. Electroencephalography after a single unprovoked seizure. Seizure. 2017;49:69-73.  DYSFERLINOPATHY  Suresh E and Wimalaratna S. Proximal myopathy: diagnostic approach and initial management. Postgraduate medical journal. 2013;89:470-7. Walter MC, Reilich P, Thiele S, Schessl J, Schreiber H, Reiners K, Kress W, Muller-Reible C, Vorgerd M, Urban P, Schrank B, Deschauer M, Schlotter-Weigel B, Kohnen R and Lochmuller H. Treatment of dysferlinopathy with deflazacort: a double-blind, placebo-controlled clinical trial. Orphanet J Rare Dis. 2013;8:26. Fayssoil A, Ogna A, Chaffaut C, Chevret S, Guimaraes-Costa R, Leturcq F, Wahbi K, Prigent H, Lofaso F, Nardi O, Clair B, Behin A, Stojkovic T, Laforet P, Orlikowski D and Annane D. Natural History of Cardiac and Respiratory Involvement, Prognosis and Predictive Factors for Long-Term Survival in Adult Patients with Limb Girdle Muscular Dystrophies Type 2C and 2D. PloS one. 2016;11:e0153095. Harris E, Bladen CL, Mayhew A, James M, Bettinson K, Moore U, Smith FE, Rufibach L, Cnaan A, Bharucha-Goebel DX, Blamire AM, Bravver E, Carlier PG, Day JW, Diaz-Manera J, Eagle M, Grieben U, Harms M, Jones KJ, Lochmuller H, Mendell JR, Mori-Yoshimura M, Paradas C, Pegoraro E, Pestronk A, Salort-Campana E, Schreiber-Katz O, Semplicini C, Spuler S, Stojkovic T, Straub V, Takeda S, Rocha CT, Walter MC, Bushby K and Jain COSC. The Clinical Outcome Study for dysferlinopathy: An international multicenter study. Neurol Genet. 2016;2:e89. Clark KEN and Isenberg DA. A review of inflammatory idiopathic myopathy focusing on polymyositis. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2018;25:13-23. Wicklund MP. The Limb-Girdle Muscular Dystrophies. Continuum (Minneap Minn). 2019;25:1599-1618. Preston DC and Shapiro BE. Electromyography and neuromuscular disorders: clinical-electrophysiologic correlations. 3rd ed. London; New York: Elsevier Saunders; 2013. “rAAVrh74.MHCK7.DYSF.DV for Treatment of Dysferlinopathies.” Clinicaltrials.gov. Retrieved from  https://clinicaltrials.gov/ct2/show/NCT02710500?cond=dysferlinopathy&amp;draw=2&amp;rank=1 on 22 December 2019.  SPINAL DURAL AV FISTULA  Jellema K, Tijssen CC, van Rooij WJ, Sluzewski M, Koudstaal PJ, Algra A and van Gijn J. Spinal dural arteriovenous fistulas: long-term follow-up of 44 treated patients. Neurology. 2004;62:1839-41. Mull M, Nijenhuis RJ, Backes WH, Krings T, Wilmink JT and Thron A. Value and limitations of contrast-enhanced MR angiography in spinal arteriovenous malformations and dural arteriovenous fistulas. AJNR American journal of neuroradiology. 2007;28:1249-58. Krings T and Geibprasert S. Spinal dural arteriovenous fistulas. AJNR American journal of neuroradiology. 2009;30:639-48. Alexander MD, Oliff MC, Olorunsola OG, Brus-Ramer M, Nickoloff EL and Meyers PM. Patient radiation exposure during diagnostic and therapeutic interventional neuroradiology procedures. J Neurointerv Surg. 2010;2:6-10. Cifarelli CP, Kaptain G, Yen CP, Schlesinger D and Sheehan JP. Gamma knife radiosurgery for dural arteriovenous fistulas. Neurosurgery. 2010;67:1230-5; discussion 1235. Kim DJ, Willinsky R, Geibprasert S, Krings T, Wallace C, Gentili F and Terbrugge K. Angiographic characteristics and treatment of cervical spinal dural arteriovenous shunts. AJNR American journal of neuroradiology. 2010;31:1512-5. Chen J and Gailloud P. Safety of spinal angiography: complication rate analysis in 302 diagnostic angiograms. Neurology. 2011;77:1235-40. Manninen AL, Isokangas JM, Karttunen A, Siniluoto T and Nieminen MT. A comparison of radiation exposure between diagnostic CTA and DSA examinations of cerebral and cervicocerebral vessels. AJNR American journal of neuroradiology. 2012;33:2038-42. 

Happy New Year, and good riddance 2020! Hopefully there is more that you will take away from the past 12 months other than your personal experience with the coronavirus pandemic. Whether you lost a job, a loved one, or an invaluable life experience, I think we can all say BRING ON 2021! So let's welcome the new year with positive mental attitude, a bit more luck, and an unquenchable thirst for knowledge. Produced by James E. Siegler. Music courtesy of Jahzzar, Kevin McLeod, Patches, Montplaisir, Steve Combs, Lee Roosevere, Siddhartha, Soft and Furious, Magic in the Other, and Loyalty Freak Music. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES EEG <ol> <li>Wiebe S, Blume WT, Girvin JP, Eliasziw M, Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study G. A randomized, controlled trial of surgery for temporal-lobe epilepsy. The New England journal of medicine. 2001;345:311-8.</li> <li>Cascino GD. Clinical indications and diagnostic yield of video-electroencephalographic monitoring in patients with seizures and spells. Mayo Clinic proceedings. 2002;77:1111-20.</li> <li>Pillai J and Sperling MR. Interictal EEG and the diagnosis of epilepsy. Epilepsia. 2006;47 Suppl 1:14-22.</li> <li>Bouma HK, Labos C, Gore GC, Wolfson C and Keezer MR. The diagnostic accuracy of routine electroencephalography after a first unprovoked seizure. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2016;23:455-63.</li> <li>Debicki DB. Electroencephalography after a single unprovoked seizure. Seizure. 2017;49:69-73.</li> </ol> DYSFERLINOPATHY <ol> <li>Suresh E and Wimalaratna S. Proximal myopathy: diagnostic approach and initial management. Postgraduate medical journal. 2013;89:470-7.</li> <li>Walter MC, Reilich P, Thiele S, Schessl J, Schreiber H, Reiners K, Kress W, Muller-Reible C, Vorgerd M, Urban P, Schrank B, Deschauer M, Schlotter-Weigel B, Kohnen R and Lochmuller H. Treatment of dysferlinopathy with deflazacort: a double-blind, placebo-controlled clinical trial. Orphanet J Rare Dis. 2013;8:26.</li> <li>Fayssoil A, Ogna A, Chaffaut C, Chevret S, Guimaraes-Costa R, Leturcq F, Wahbi K, Prigent H, Lofaso F, Nardi O, Clair B, Behin A, Stojkovic T, Laforet P, Orlikowski D and Annane D. Natural History of Cardiac and Respiratory Involvement, Prognosis and Predictive Factors for Long-Term Survival in Adult Patients with Limb Girdle Muscular Dystrophies Type 2C and 2D. PloS one. 2016;11:e0153095.</li> <li>Harris E, Bladen CL, Mayhew A, James M, Bettinson K, Moore U, Smith FE, Rufibach L, Cnaan A, Bharucha-Goebel DX, Blamire AM, Bravver E, Carlier PG, Day JW, Diaz-Manera J, Eagle M, Grieben U, Harms M, Jones KJ, Lochmuller H, Mendell JR, Mori-Yoshimura M, Paradas C, Pegoraro E, Pestronk A, Salort-Campana E, Schreiber-Katz O, Semplicini C, Spuler S, Stojkovic T, Straub V, Takeda S, Rocha CT, Walter MC, Bushby K and Jain COSC. The Clinical Outcome Study for dysferlinopathy: An international multicenter study. Neurol Genet. 2016;2:e89.</li> <li>Clark KEN and Isenberg DA. A review of inflammatory idiopathic myopathy focusing on polymyositis. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2018;25:13-23.</li> <li>Wicklund MP. The Limb-Girdle Muscular Dystrophies. Continuum (Minneap Minn). 2019;25:1599-1618.</li> <li>Preston DC and Shapiro BE. Electromyography and neuromuscular disorders: clinical-electrophysiologic correlations. 3rd ed. London; New York: Elsevier Saunders; 2013.</li> <li>“rAAVrh74.MHCK7.DYSF.DV for Treatment of Dysferlinopathies.” <a href="http://Clinicaltrials.gov" rel="nofollow" target="_blank">Clinicaltrials.gov</a>. Retrieved from <a href="https://clinicaltrials.gov/ct2/show/NCT02710500?cond=dysferlinopathy&amp;draw=2&amp;rank=1" rel="nofollow" target="_blank"> https://clinicaltrials.gov/ct2/show/NCT02710500?cond=dysferlinopathy&amp;draw=2&amp;rank=1</a> on 22 December 2019.</li> </ol> SPINAL DURAL AV FISTULA <ol> <li>Jellema K, Tijssen CC, van Rooij WJ, Sluzewski M, Koudstaal PJ, Algra A and van Gijn J. Spinal dural arteriovenous fistulas: long-term follow-up of 44 treated patients. Neurology. 2004;62:1839-41.</li> <li>Mull M, Nijenhuis RJ, Backes WH, Krings T, Wilmink JT and Thron A. Value and limitations of contrast-enhanced MR angiography in spinal arteriovenous malformations and dural arteriovenous fistulas. AJNR American journal of neuroradiology. 2007;28:1249-58.</li> <li>Krings T and Geibprasert S. Spinal dural arteriovenous fistulas. AJNR American journal of neuroradiology. 2009;30:639-48.</li> <li>Alexander MD, Oliff MC, Olorunsola OG, Brus-Ramer M, Nickoloff EL and Meyers PM. Patient radiation exposure during diagnostic and therapeutic interventional neuroradiology procedures. J Neurointerv Surg. 2010;2:6-10.</li> <li>Cifarelli CP, Kaptain G, Yen CP, Schlesinger D and Sheehan JP. Gamma knife radiosurgery for dural arteriovenous fistulas. Neurosurgery. 2010;67:1230-5; discussion 1235.</li> <li>Kim DJ, Willinsky R, Geibprasert S, Krings T, Wallace C, Gentili F and Terbrugge K. Angiographic characteristics and treatment of cervical spinal dural arteriovenous shunts. AJNR American journal of neuroradiology. 2010;31:1512-5.</li> <li>Chen J and Gailloud P. Safety of spinal angiography: complication rate analysis in 302 diagnostic angiograms. Neurology. 2011;77:1235-40.</li> <li>Manninen AL, Isokangas JM, Karttunen A, Siniluoto T and Nieminen MT. A comparison of radiation exposure between diagnostic CTA and DSA examinations of cerebral and cervicocerebral vessels. AJNR American journal of neuroradiology. 2012;33:2038-42.</li> </ol>

Best of BrainWaves 2020

I shouldn’t have to tell you that traumatic brain injury is a major cause of morbidity and mortality. I shouldn’t have to. But I will. And it is. In severe cases of head injury, there can be delayed and irreversible deterioration in the nervous system for which there is no treatment and the prognosis is grim. This week on the program, Dr. Monisha Kumar (University of Pennsylvania) discusses the worst of the worst of these scenarios, what to look out for, and expert recommendations on what to do when it happens. Produced by James E. Siegler and Monisha Kumar. Music courtesy of Rui, Swelling, Unheard Music Concepts, Jahzzar, Ian Southerland, and TRG Banks. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES  Strich SJ. Diffuse degeneration of the cerebral white matter in severe dementia following head injury. Journal of neurology, neurosurgery, and psychiatry. 1956;19:163-85. Adams JH, Graham DI, Murray LS and Scott G. Diffuse axonal injury due to nonmissile head injury in humans: an analysis of 45 cases. Annals of neurology. 1982;12:557-63. Povlishock JT, Becker DP, Cheng CL and Vaughan GW. Axonal change in minor head injury. J Neuropathol Exp Neurol. 1983;42:225-42. Gentry LR. Imaging of closed head injury. Radiology. 1994;191:1-17. Meythaler JM, Peduzzi JD, Eleftheriou E and Novack TA. Current concepts: diffuse axonal injury-associated traumatic brain injury. Arch Phys Med Rehabil. 2001;82:1461-71. Arfanakis K, Haughton VM, Carew JD, Rogers BP, Dempsey RJ and Meyerand ME. Diffusion tensor MR imaging in diffuse axonal injury. AJNR American journal of neuroradiology. 2002;23:794-802. Scheid R, Preul C, Gruber O, Wiggins C and von Cramon DY. Diffuse axonal injury associated with chronic traumatic brain injury: evidence from T2*-weighted gradient-echo imaging at 3 T. AJNR American journal of neuroradiology. 2003;24:1049-56. DeKosky ST, Ikonomovic MD and Gandy S. Traumatic brain injury--football, warfare, and long-term effects. The New England journal of medicine. 2010;363:1293-6. Johnson VE, Stewart W and Smith DH. Widespread tau and amyloid-beta pathology many years after a single traumatic brain injury in humans. Brain Pathol. 2012;22:142-9. Schrag M and Greer DM. Clinical associations of cerebral microbleeds on magnetic resonance neuroimaging. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2014;23:2489-2497. Haghbayan H, Boutin A, Laflamme M, Lauzier F, Shemilt M, Moore L, Zarychanski R, Douville V, Fergusson D and Turgeon AF. The Prognostic Value of MRI in Moderate and Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Critical care medicine. 2017;45:e1280-e1288. Izzy S, Mazwi NL, Martinez S, Spencer CA, Klein JP, Parikh G, Glenn MB, Greenberg SM, Greer DM, Wu O and Edlow BL. Revisiting Grade 3 Diffuse Axonal Injury: Not All Brainstem Microbleeds are Prognostically Equal. Neurocritical care. 2017;27:199-207. van Eijck MM, Schoonman GG, van der Naalt J, de Vries J and Roks G. Diffuse axonal injury after traumatic brain injury is a prognostic factor for functional outcome: a systematic review and meta-analysis. Brain Inj. 2018;32:395-402. 

I shouldn’t have to tell you that traumatic brain injury is a major cause of morbidity and mortality. I shouldn’t have to. But I will. And it is. In severe cases of head injury, there can be delayed and irreversible deterioration in the nervous system for which there is no treatment and the prognosis is grim. This week on the program, Dr. Monisha Kumar (University of Pennsylvania) discusses the worst of the worst of these scenarios, what to look out for, and expert recommendations on what to do when it happens. Produced by James E. Siegler and Monisha Kumar. Music courtesy of Rui, Swelling, Unheard Music Concepts, Jahzzar, Ian Southerland, and TRG Banks. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES <ol> <li>Strich SJ. Diffuse degeneration of the cerebral white matter in severe dementia following head injury. Journal of neurology, neurosurgery, and psychiatry. 1956;19:163-85.</li> <li>Adams JH, Graham DI, Murray LS and Scott G. Diffuse axonal injury due to nonmissile head injury in humans: an analysis of 45 cases. Annals of neurology. 1982;12:557-63.</li> <li>Povlishock JT, Becker DP, Cheng CL and Vaughan GW. Axonal change in minor head injury. J Neuropathol Exp Neurol. 1983;42:225-42.</li> <li>Gentry LR. Imaging of closed head injury. Radiology. 1994;191:1-17.</li> <li>Meythaler JM, Peduzzi JD, Eleftheriou E and Novack TA. Current concepts: diffuse axonal injury-associated traumatic brain injury. Arch Phys Med Rehabil. 2001;82:1461-71.</li> <li>Arfanakis K, Haughton VM, Carew JD, Rogers BP, Dempsey RJ and Meyerand ME. Diffusion tensor MR imaging in diffuse axonal injury. AJNR American journal of neuroradiology. 2002;23:794-802.</li> <li>Scheid R, Preul C, Gruber O, Wiggins C and von Cramon DY. Diffuse axonal injury associated with chronic traumatic brain injury: evidence from T2*-weighted gradient-echo imaging at 3 T. AJNR American journal of neuroradiology. 2003;24:1049-56.</li> <li>DeKosky ST, Ikonomovic MD and Gandy S. Traumatic brain injury--football, warfare, and long-term effects. The New England journal of medicine. 2010;363:1293-6.</li> <li>Johnson VE, Stewart W and Smith DH. Widespread tau and amyloid-beta pathology many years after a single traumatic brain injury in humans. Brain Pathol. 2012;22:142-9.</li> <li>Schrag M and Greer DM. Clinical associations of cerebral microbleeds on magnetic resonance neuroimaging. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2014;23:2489-2497.</li> <li>Haghbayan H, Boutin A, Laflamme M, Lauzier F, Shemilt M, Moore L, Zarychanski R, Douville V, Fergusson D and Turgeon AF. The Prognostic Value of MRI in Moderate and Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Critical care medicine. 2017;45:e1280-e1288.</li> <li>Izzy S, Mazwi NL, Martinez S, Spencer CA, Klein JP, Parikh G, Glenn MB, Greenberg SM, Greer DM, Wu O and Edlow BL. Revisiting Grade 3 Diffuse Axonal Injury: Not All Brainstem Microbleeds are Prognostically Equal. Neurocritical care. 2017;27:199-207.</li> <li>van Eijck MM, Schoonman GG, van der Naalt J, de Vries J and Roks G. Diffuse axonal injury after traumatic brain injury is a prognostic factor for functional outcome: a systematic review and meta-analysis. Brain Inj. 2018;32:395-402.</li> </ol>

#176 Mind blown

COVID-19 is more than just a threat to your physical health. Even if you are never infected, you may not be free of it. In today's program, we take lessons from prior pandemics and consider the sociocultural effects of a global infectious disease. Be advised, this one is of the "sentimental" variety. Produced by James E. Siegler. Music courtesy of Purple Planet Music, Meydn, Kevin MacLeod and Shane Ivers, which you can find at Silvermansound.com. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES  Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095-128. Fineberg HV. Pandemic preparedness and response--lessons from the H1N1 influenza of 2009. The New England journal of medicine. 2014;370:1335-42. Shanks GD. Insights from unusual aspects of the 1918 influenza pandemic. Travel Med Infect Dis. 2015;13:217-22. Armitage R and Nellums LB. COVID-19 and the consequences of isolating the elderly. Lancet Public Health. 2020;5:e256. Bonaccorsi G, Pierri F, Cinelli M, Flori A, Galeazzi A, Porcelli F, Schmidt AL, Valensise CM, Scala A, Quattrociocchi W and Pammolli F. Economic and social consequences of human mobility restrictions under COVID-19. Proc Natl Acad Sci U S A. 2020;117:15530-15535. Dinmohamed AG, Visser O, Verhoeven RHA, Louwman MWJ, van Nederveen FH, Willems SM, Merkx MAW, Lemmens V, Nagtegaal ID and Siesling S. Fewer cancer diagnoses during the COVID-19 epidemic in the Netherlands. Lancet Oncol. 2020;21:750-751. Jeffery MM, D'Onofrio G, Paek H, Platts-Mills TF, Soares WE, 3rd, Hoppe JA, Genes N, Nath B and Melnick ER. Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US. JAMA internal medicine. 2020;180:1328-1333. Rabinovitz B, Jaywant A and Fridman CB. Neuropsychological functioning in severe acute respiratory disorders caused by the coronavirus: implications for the current COVID-19 pandemic. Clin Neuropsychol. 2020:1-27. Santini ZI, Jose PE, York Cornwell E, Koyanagi A, Nielsen L, Hinrichsen C, Meilstrup C, Madsen KR and Koushede V. Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis. Lancet Public Health. 2020;5:e62-e70. Wong LE, et al. Where are all the patients? New Eng J Med (2020): Published online 14 May 2020. Available at https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0193. 

COVID-19 is more than just a threat to your physical health. Even if you are never infected, you may not be free of it. In today's program, we take lessons from prior pandemics and consider the sociocultural effects of a global infectious disease. Be advised, this one is of the "sentimental" variety. Produced by James E. Siegler. Music courtesy of Purple Planet Music, Meydn, Kevin MacLeod and Shane Ivers, which you can find at <a href="http://Silvermansound.com" rel="nofollow" target="_blank">Silvermansound.com</a>. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES <ol> <li>Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095-128.</li> <li>Fineberg HV. Pandemic preparedness and response--lessons from the H1N1 influenza of 2009. The New England journal of medicine. 2014;370:1335-42.</li> <li>Shanks GD. Insights from unusual aspects of the 1918 influenza pandemic. Travel Med Infect Dis. 2015;13:217-22.</li> <li>Armitage R and Nellums LB. COVID-19 and the consequences of isolating the elderly. Lancet Public Health. 2020;5:e256.</li> <li>Bonaccorsi G, Pierri F, Cinelli M, Flori A, Galeazzi A, Porcelli F, Schmidt AL, Valensise CM, Scala A, Quattrociocchi W and Pammolli F. Economic and social consequences of human mobility restrictions under COVID-19. Proc Natl Acad Sci U S A. 2020;117:15530-15535.</li> <li>Dinmohamed AG, Visser O, Verhoeven RHA, Louwman MWJ, van Nederveen FH, Willems SM, Merkx MAW, Lemmens V, Nagtegaal ID and Siesling S. Fewer cancer diagnoses during the COVID-19 epidemic in the Netherlands. Lancet Oncol. 2020;21:750-751.</li> <li>Jeffery MM, D'Onofrio G, Paek H, Platts-Mills TF, Soares WE, 3rd, Hoppe JA, Genes N, Nath B and Melnick ER. Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US. JAMA internal medicine. 2020;180:1328-1333.</li> <li>Rabinovitz B, Jaywant A and Fridman CB. Neuropsychological functioning in severe acute respiratory disorders caused by the coronavirus: implications for the current COVID-19 pandemic. Clin Neuropsychol. 2020:1-27.</li> <li>Santini ZI, Jose PE, York Cornwell E, Koyanagi A, Nielsen L, Hinrichsen C, Meilstrup C, Madsen KR and Koushede V. Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis. Lancet Public Health. 2020;5:e62-e70.</li> <li>Wong LE, et al. Where are all the patients? New Eng J Med (2020): Published online 14 May 2020. Available at <a href="https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0193" rel="nofollow" target="_blank">https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0193</a>.</li> </ol>

#175 Call your Mom

BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology and medicine. Follow us on Twitter @brainwavesaudio, or just tune in every Thursday for the latest shows! NOT FOR CLINICAL DECISION MAKING

A great podcast for all neurologists! Concise and relevant. Keep up the good work :)

Awesome podcast

Just the kind of neurology podcast I’ve been looking for. Entertaining and educational. Great job!

Great for neurologists at any point in their career

BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology and medicine. Follow us on Twitter @brainwavesaudio, or just tune in every Thursday for the latest shows! NOT FOR CLINICAL DECISION MAKING

BrainWaves: A Neurology Podcast

The first wave of the opioid crisis began in 1991 when physicians began to overprescribe narcotic analgesics for pain. Eventually, addiction led to abuse and the fatality rates began to climb. In response, the US government cracked down on narcotic prescriptions--leading a surge in the price of medical grade opioids. By 2010, the cost of pharmacologic opiates was unaffordable, and users reverted back to the (now cheaper) alternative, heroin. 2013 marked the third wave of the opioid crisis, whereby synthetic, high-potency opiates like fentanyl and carfentanyl were being infused into other opiate products. With each wave, the world witnessed a spike in the number of opioid-related deaths, and thus far, our solutions have only led to new problems. But there is more to the opioid crisis than the effect of opioids on the voluntary user. In 2017, we released a show highlighting the clinical consequences and management of opioid dependence on infants born to mothers who had used opioids during their pregnancy. This week, we have remastered the 2017 program and included an update at the end. Produced by James E. Siegler. Music courtesy of Little Glass Men, Jason Shaw, and Chris Zabriskie. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES  McQueen K and Murphy-Oikonen J. Neonatal Abstinence Syndrome. The New England journal of medicine. 2016;375:2468-2479. Vlahov D, Des Jarlais DC, Goosby E, Hollinger PC, Lurie PG, Shriver MD and Strathdee SA. Needle exchange programs for the prevention of human immunodeficiency virus infection: epidemiology and policy. American journal of epidemiology. 2001;154:S70-7. Kocherlakota P. Neonatal abstinence syndrome. Pediatrics. 2014;134:e547-61. Hagan H, McGough JP, Thiede H, Weiss NS, Hopkins S and Alexander ER. Syringe exchange and risk of infection with hepatitis B and C viruses. American journal of epidemiology. 1999;149:203-13. Wodak A and Cooney A. Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. Subst Use Misuse. 2006;41:777-813. Jarlenski M, Barry CL, Gollust S, Graves AJ, Kennedy-Hendricks A and Kozhimannil K. Polysubstance Use Among US Women of Reproductive Age Who Use Opioids for Nonmedical Reasons. Am J Public Health. 2017;107:1308-1310. Hudak ML, Tan RC, Committee On D, Committee On F, Newborn and American Academy of P. Neonatal drug withdrawal. Pediatrics. 2012;129:e540-60. Winkelman TNA, Villapiano N, Kozhimannil KB, Davis MM and Patrick SW. Incidence and Costs of Neonatal Abstinence Syndrome Among Infants With Medicaid: 2004-2014. Pediatrics. 2018;141. MacMillan KDL, Rendon CP, Verma K, Riblet N, Washer DB and Volpe Holmes A. Association of Rooming-in With Outcomes for Neonatal Abstinence Syndrome: A Systematic Review and Meta-analysis. JAMA Pediatr. 2018;172:345-351. Gomez-Pomar E and Finnegan LP. The Epidemic of Neonatal Abstinence Syndrome, Historical References of Its' Origins, Assessment, and Management. Front Pediatr. 2018;6:33. 

The first wave of the opioid crisis began in 1991 when physicians began to overprescribe narcotic analgesics for pain. Eventually, addiction led to abuse and the fatality rates began to climb. In response, the US government cracked down on narcotic prescriptions--leading a surge in the price of medical grade opioids. By 2010, the cost of pharmacologic opiates was unaffordable, and users reverted back to the (now cheaper) alternative, heroin. 2013 marked the third wave of the opioid crisis, whereby synthetic, high-potency opiates like fentanyl and carfentanyl were being infused into other opiate products. With each wave, the world witnessed a spike in the number of opioid-related deaths, and thus far, our solutions have only led to new problems. But there is more to the opioid crisis than the effect of opioids on the voluntary user. In 2017, we released a show highlighting the clinical consequences and management of opioid dependence on infants born to mothers who had used opioids during their pregnancy. This week, we have remastered the 2017 program and included an update at the end. Produced by James E. Siegler. Music courtesy of Little Glass Men, Jason Shaw, and Chris Zabriskie. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES <ol> <li>McQueen K and Murphy-Oikonen J. Neonatal Abstinence Syndrome. The New England journal of medicine. 2016;375:2468-2479.</li> <li>Vlahov D, Des Jarlais DC, Goosby E, Hollinger PC, Lurie PG, Shriver MD and Strathdee SA. Needle exchange programs for the prevention of human immunodeficiency virus infection: epidemiology and policy. American journal of epidemiology. 2001;154:S70-7.</li> <li>Kocherlakota P. Neonatal abstinence syndrome. Pediatrics. 2014;134:e547-61.</li> <li>Hagan H, McGough JP, Thiede H, Weiss NS, Hopkins S and Alexander ER. Syringe exchange and risk of infection with hepatitis B and C viruses. American journal of epidemiology. 1999;149:203-13.</li> <li>Wodak A and Cooney A. Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. Subst Use Misuse. 2006;41:777-813.</li> <li>Jarlenski M, Barry CL, Gollust S, Graves AJ, Kennedy-Hendricks A and Kozhimannil K. Polysubstance Use Among US Women of Reproductive Age Who Use Opioids for Nonmedical Reasons. Am J Public Health. 2017;107:1308-1310.</li> <li>Hudak ML, Tan RC, Committee On D, Committee On F, Newborn and American Academy of P. Neonatal drug withdrawal. Pediatrics. 2012;129:e540-60.</li> <li>Winkelman TNA, Villapiano N, Kozhimannil KB, Davis MM and Patrick SW. Incidence and Costs of Neonatal Abstinence Syndrome Among Infants With Medicaid: 2004-2014. Pediatrics. 2018;141.</li> <li>MacMillan KDL, Rendon CP, Verma K, Riblet N, Washer DB and Volpe Holmes A. Association of Rooming-in With Outcomes for Neonatal Abstinence Syndrome: A Systematic Review and Meta-analysis. JAMA Pediatr. 2018;172:345-351.</li> <li>Gomez-Pomar E and Finnegan LP. The Epidemic of Neonatal Abstinence Syndrome, Historical References of Its' Origins, Assessment, and Management. Front Pediatr. 2018;6:33.</li> </ol>

#84 Neonatal abstinence syndrome

The common teaching is that restricted diffusion on MRI indicates stroke—acute cerebral infarction. When, more specifically, the changes on DWI and ADC indicate impairment in the random movement of water molecules in a given tissue. With slower movement, as in energy-depleted tissues with failing ATP-dependent sodium/potassium channels, high cellularity, or a highly viscous extra-cellular space, there is restricted diffusion (of water) and a corresponding bright signal on DWI. These and other considerations are the focus of this week's episode of BrainWaves. Produced by James E. Siegler. Music courtesy of Uncanny and Kevin McLeod. Sound effects by Mike Koenig. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES  Filippi M, Iannucci G, Cercignani M, Assunta Rocca M, Pratesi A and Comi G. A quantitative study of water diffusion in multiple sclerosis lesions and normal-appearing white matter using echo-planar imaging. Archives of neurology. 2000;57:1017-21. Meyer JR, Gutierrez A, Mock B, Hebron D, Prager JM, Gorey MT and Homer D. High-b-value diffusion-weighted MR imaging of suspected brain infarction. AJNR American journal of neuroradiology. 2000;21:1821-9. Roberts TP and Rowley HA. Diffusion weighted magnetic resonance imaging in stroke. Eur J Radiol. 2003;45:185-94. McKinney AM, Short J, Truwit CL, McKinney ZJ, Kozak OS, SantaCruz KS and Teksam M. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol. 2007;189:904-12. Maier SE, Sun Y and Mulkern RV. Diffusion imaging of brain tumors. NMR Biomed. 2010;23:849-64. Steiner I, Budka H, Chaudhuri A, Koskiniemi M, Sainio K, Salonen O and Kennedy PG. Viral meningoencephalitis: a review of diagnostic methods and guidelines for management. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2010;17:999-e57. Hegde AN, Mohan S, Lath N and Lim CC. Differential diagnosis for bilateral abnormalities of the basal ganglia and thalamus. Radiographics. 2011;31:5-30. Aliaga ES and Barkhof F. MRI mimics of multiple sclerosis. Handbook of clinical neurology. 2014;122:291-316. Starkey J, Kobayashi N, Numaguchi Y and Moritani T. Cytotoxic Lesions of the Corpus Callosum That Show Restricted Diffusion: Mechanisms, Causes, and Manifestations. Radiographics. 2017;37:562-576. 

The common teaching is that restricted diffusion on MRI indicates stroke—acute cerebral infarction. When, more specifically, the changes on DWI and ADC indicate impairment in the random movement of water molecules in a given tissue. With slower movement, as in energy-depleted tissues with failing ATP-dependent sodium/potassium channels, high cellularity, or a highly viscous extra-cellular space, there is restricted diffusion (of water) and a corresponding bright signal on DWI. These and other considerations are the focus of this week's episode of BrainWaves. Produced by James E. Siegler. Music courtesy of Uncanny and Kevin McLeod. Sound effects by Mike Koenig. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES <ol> <li>Filippi M, Iannucci G, Cercignani M, Assunta Rocca M, Pratesi A and Comi G. A quantitative study of water diffusion in multiple sclerosis lesions and normal-appearing white matter using echo-planar imaging. Archives of neurology. 2000;57:1017-21.</li> <li>Meyer JR, Gutierrez A, Mock B, Hebron D, Prager JM, Gorey MT and Homer D. High-b-value diffusion-weighted MR imaging of suspected brain infarction. AJNR American journal of neuroradiology. 2000;21:1821-9.</li> <li>Roberts TP and Rowley HA. Diffusion weighted magnetic resonance imaging in stroke. Eur J Radiol. 2003;45:185-94.</li> <li>McKinney AM, Short J, Truwit CL, McKinney ZJ, Kozak OS, SantaCruz KS and Teksam M. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol. 2007;189:904-12.</li> <li>Maier SE, Sun Y and Mulkern RV. Diffusion imaging of brain tumors. NMR Biomed. 2010;23:849-64.</li> <li>Steiner I, Budka H, Chaudhuri A, Koskiniemi M, Sainio K, Salonen O and Kennedy PG. Viral meningoencephalitis: a review of diagnostic methods and guidelines for management. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2010;17:999-e57.</li> <li>Hegde AN, Mohan S, Lath N and Lim CC. Differential diagnosis for bilateral abnormalities of the basal ganglia and thalamus. Radiographics. 2011;31:5-30.</li> <li>Aliaga ES and Barkhof F. MRI mimics of multiple sclerosis. Handbook of clinical neurology. 2014;122:291-316.</li> <li>Starkey J, Kobayashi N, Numaguchi Y and Moritani T. Cytotoxic Lesions of the Corpus Callosum That Show Restricted Diffusion: Mechanisms, Causes, and Manifestations. Radiographics. 2017;37:562-576.</li> </ol>

#154 All that restricts does not infarct

Quick tutorial to help you navigate through the causes of foot drop. Check it out! BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. REFERENCES Preston DC &amp; Shapiro BE. Electromyography and neuromuscular disorders, 3rd ed. Saunders (2013).

Quick tutorial to help you navigate through the causes of foot drop. Check it out! BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. REFERENCES Preston DC &amp; Shapiro BE. Electromyography and neuromuscular disorders, 3rd ed. Saunders (2013).

#3 Foot Drop

The most common primary brain tumor that occurs in adults, glioblastoma multiforme comes with a life expectancy shorter than practically every other form of cancer. But thanks to novel treatment strategies, advanced neuroimaging, and biomarker research, we are learning more and more how to improve the survival and the quality of life with patients who suffer from this terrible illness. Produced by James E. Siegler and Neena Cherayil. Music by Axle, Coldnoise, Josh Woodward, and Kelly Latimer. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES  Grady, D “Glioblastoma, John Mccain’s Form of Brain Cancer, Carries Troubling Prognosis” The New York Times  Scutti, S “Sen John McCain has aggressive brain tumor, surgically removed” CNN  Gately L, et al. Life beyond a diagnosis of glioblastoma: a systematic review of the literature. J Cancer Surviv (2017). Thakkar JP, et al. Epidemiologic and Molecular Prognostic Review of Glioblastoma. Cancer epidemiology, biomarkers &amp; prevention (2014). Louis DN, et al. “The 2016 World Health Organization Classification of Tumors of the Central Nervous System: A Summary” Acta Neuropathologica (2016) 6: 803-820. Stupp R, et al. MGMT Gene Silencing and Benefit from Temozolomide in Glioblastoma. N Engl J Med (2005). Stupp R, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. The Lancet Oncology (2009). Weller M and Wick W. Neuro-oncology in 2013: improving outcome in newly diagnosed malignant glioma. Nature reviews Neurology. 2014;10:68-70. 

The most common primary brain tumor that occurs in adults, glioblastoma multiforme comes with a life expectancy shorter than practically every other form of cancer. But thanks to novel treatment strategies, advanced neuroimaging, and biomarker research, we are learning more and more how to improve the survival and the quality of life with patients who suffer from this terrible illness. Produced by James E. Siegler and Neena Cherayil. Music by Axle, Coldnoise, Josh Woodward, and Kelly Latimer. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES <ol> <li>Grady, D “Glioblastoma, John Mccain’s Form of Brain Cancer, Carries Troubling Prognosis” The New York Times <a href="https://www.nytimes.com/2017/07/20/health/john-mccain-brain-cancer.html" rel="nofollow" target="_blank"></a></li><a href="https://www.nytimes.com/2017/07/20/health/john-mccain-brain-cancer.html" rel="nofollow" target="_blank"> <li>Scutti, S “Sen John McCain has aggressive brain tumor, surgically removed” CNN </li> <li>Gately L, et al. Life beyond a diagnosis of glioblastoma: a systematic review of the literature. J Cancer Surviv (2017).</li> <li>Thakkar JP, et al. Epidemiologic and Molecular Prognostic Review of Glioblastoma. Cancer epidemiology, biomarkers &amp; prevention (2014).</li> <li>Louis DN, et al. “The 2016 World Health Organization Classification of Tumors of the Central Nervous System: A Summary” Acta Neuropathologica (2016) 6: 803-820.</li> <li>Stupp R, et al. MGMT Gene Silencing and Benefit from Temozolomide in Glioblastoma. N Engl J Med (2005).</li> <li>Stupp R, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. The Lancet Oncology (2009).</li> <li>Weller M and Wick W. Neuro-oncology in 2013: improving outcome in newly diagnosed malignant glioma. Nature reviews Neurology. 2014;10:68-70.</li> </a></ol>

#75 Glioblastoma

Not all that shakes are seizures. Last week, we talked about what it's like to have epilepsy. This week, I am joined by Dr. Taneeta "Mindy" Ganguly to discuss what it's like NOT to have epilepsy--meaning to have non-epileptic seizures. But sometimes, you can have both. And this is where it gets tricky for the neurologist. Produced by James E. Siegler. Music by Aitua and Kai Engel. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES 1. Reuber M and Elger CE. Psychogenic nonepileptic seizures: review and update. Epilepsy Behav. 2003;4:205-16.

Not all that shakes are seizures. Last week, we talked about what it's like to have epilepsy. This week, I am joined by Dr. Taneeta "Mindy" Ganguly to discuss what it's like NOT to have epilepsy--meaning to have non-epileptic seizures. But sometimes, you can have both. And this is where it gets tricky for the neurologist. Produced by James E. Siegler. Music by Aitua and Kai Engel. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES 1. Reuber M and Elger CE. Psychogenic nonepileptic seizures: review and update. Epilepsy Behav. 2003;4:205-16.

#66 Psychogenic non-epileptic events (or are they seizures?)

2019 was a big year. The year of the Mueller report. The American college admissions scandals. Brexit. But it was also the year the US Women's team won the World Cup, and lobbied for the equal pay of women and men in sports. It was the year of NMO, in which several pivotal trials showed benefit of disease modulating therapy in this condition. The year Will Smith played Genie in Aladdin. 2019 was a great year. And as we wrap up 2019, this week's episode includes some of the highlights. Enjoy! Produced by James E. Siegler with support from Erika Mejia, Rajat Dhar, and the entire Siegler family. Music courtesy of Axletree, Chris Zabriskie, John Paston, Kevin Mcleod, Josh Woodward, Steve Combs, Lee Rosevere, Scott Holmes, Advent Chamber Orchestra, Coldnoise, and Pachyderm. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES [BRAIN FOOD]  Kennedy DO, Wightman EL, Reay JL, Lietz G, Okello EJ, Wilde A and Haskell CF. Effects of resveratrol on cerebral blood flow variables and cognitive performance in humans: a double-blind, placebo-controlled, crossover investigation. Am J Clin Nutr. 2010;91:1590-7. Devore EE, Kang JH, Breteler MM and Grodstein F. Dietary intakes of berries and flavonoids in relation to cognitive decline. Annals of neurology. 2012;72:135-43. Norton S, Matthews FE, Barnes DE, Yaffe K and Brayne C. Potential for primary prevention of Alzheimer's disease: an analysis of population-based data. The Lancet Neurology. 2014;13:788-94. Morris MC, Tangney CC, Wang Y, Sacks FM, Barnes LL, Bennett DA and Aggarwal NT. MIND diet slows cognitive decline with aging. Alzheimers Dement. 2015;11:1015-22. Valls-Pedret C, Sala-Vila A, Serra-Mir M, Corella D, de la Torre R, Martinez-Gonzalez MA, Martinez-Lapiscina EH, Fito M, Perez-Heras A, Salas-Salvado J, Estruch R and Ros E. Mediterranean Diet and Age-Related Cognitive Decline: A Randomized Clinical Trial. JAMA internal medicine. 2015;175:1094-1103. Newman JC, Covarrubias AJ, Zhao M, Yu X, Gut P, Ng CP, Huang Y, Haldar S and Verdin E. Ketogenic Diet Reduces Midlife Mortality and Improves Memory in Aging Mice. Cell Metab. 2017;26:547-557 e8. Miller MG, Hamilton DA, Joseph JA and Shukitt-Hale B. Dietary blueberry improves cognition among older adults in a randomized, double-blind, placebo-controlled trial. Eur J Nutr. 2018;57:1169-1180. Okkersen K, Jimenez-Moreno C, Wenninger S, Daidj F, Glennon J, Cumming S, Littleford R, Monckton DG, Lochmuller H, Catt M, Faber CG, Hapca A, Donnan PT, Gorman G, Bassez G, Schoser B, Knoop H, Treweek S, van Engelen BGM and consortium O. Cognitive behavioural therapy with optional graded exercise therapy in patients with severe fatigue with myotonic dystrophy type 1: a multicentre, single-blind, randomised trial. The Lancet Neurology. 2018;17:671-680. Radd-Vagenas S, Duffy SL, Naismith SL, Brew BJ, Flood VM and Fiatarone Singh MA. Effect of the Mediterranean diet on cognition and brain morphology and function: a systematic review of randomized controlled trials. Am J Clin Nutr. 2018;107:389-404. Xu W, Wang H, Wan Y, Tan C, Li J, Tan L and Yu JT. Alcohol consumption and dementia risk: a dose-response meta-analysis of prospective studies. Eur J Epidemiol. 2017;32:31-42. Lefevre-Arbogast S, Gaudout D, Bensalem J, Letenneur L, Dartigues JF, Hejblum BP, Feart C, Delcourt C and Samieri C. Pattern of polyphenol intake and the long-term risk of dementia in older persons. Neurology. 2018;90:e1979-e1988. Liu QP, Wu YF, Cheng HY, Xia T, Ding H, Wang H, Wang ZM and Xu Y. Habitual coffee consumption and risk of cognitive decline/dementia: A systematic review and meta-analysis of prospective cohort studies. Nutrition. 2016;32:628-36.  [OF MEASLES AND MEN]  Murch SH, Anthony A, Casson DH, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Valentine A, Davies SE and Walker-Smith JA. Retraction of an interpretation. Lancet. 2004;363:750. Perry RT and Halsey NA. The clinical significance of measles: a review. The Journal of infectious diseases. 2004;189 Suppl 1:S4-16. Campbell H, Andrews N, Brown KE and Miller E. Review of the effect of measles vaccination on the epidemiology of SSPE. Int J Epidemiol. 2007;36:1334-48. Poland GA and Jacobson RM. The age-old struggle against the antivaccinationists. The New England journal of medicine. 2011;364:97-9. Maglione MA, Das L, Raaen L, Smith A, Chari R, Newberry S, Shanman R, Perry T, Goetz MB and Gidengil C. Safety of vaccines used for routine immunization of U.S. children: a systematic review. Pediatrics. 2014;134:325-37. Bester JC. Measles and Measles Vaccination: A Review. JAMA Pediatr. 2016;170:1209-1215. Bester JC. Not a matter of parental choice but of social justice obligation: Children are owed measles vaccination. Bioethics. 2018;32:611-619. Fournet N, Mollema L, Ruijs WL, Harmsen IA, Keck F, Durand JY, Cunha MP, Wamsiedel M, Reis R, French J, Smit EG, Kitching A and van Steenbergen JE. Under-vaccinated groups in Europe and their beliefs, attitudes and reasons for non-vaccination; two systematic reviews. BMC Public Health. 2018;18:196.   Trump’s tweet: https://twitter.com/realdonaldtrump/status/449525268529815552?lang=en [NON-INFECTIOUS NEUROLOGIC COMPLICATIONS OF ORGAN TRANSPLANT]  Senzolo M, Ferronato C and Burra P. Neurologic complications after solid organ transplantation. Transpl Int. 2009;22:269-78. Dhar R. Neurologic complications of transplantation. Handbook of clinical neurology. 2017;141:545-572. Mateen FJ, Dierkhising RA, Rabinstein AA, van de Beek D and Wijdicks EF. Neurological complications following adult lung transplantation. Am J Transplant. 2010;10:908-14. Munoz P, Valerio M, Palomo J, Fernandez-Yanez J, Fernandez-Cruz A, Guinea J and Bouza E. Infectious and non-infectious neurologic complications in heart transplant recipients. Medicine (Baltimore). 2010;89:166-75. Wu Q, Marescaux C, Wolff V, Jeung MY, Kessler R, Lauer V and Chen Y. Tacrolimus-associated posterior reversible encephalopathy syndrome after solid organ transplantation. Eur Neurol. 2010;64:169-77. Dhar R, Young GB and Marotta P. Perioperative neurological complications after liver transplantation are best predicted by pre-transplant hepatic encephalopathy. Neurocritical care. 2008;8:253-8. 

2019 was a big year. The year of the Mueller report. The American college admissions scandals. Brexit. But it was also the year the US Women's team won the World Cup, and lobbied for the equal pay of women and men in sports. It was the year of NMO, in which several pivotal trials showed benefit of disease modulating therapy in this condition. The year Will Smith played Genie in Aladdin. 2019 was a great year. And as we wrap up 2019, this week's episode includes some of the highlights. Enjoy! Produced by James E. Siegler with support from Erika Mejia, Rajat Dhar, and the entire Siegler family. Music courtesy of Axletree, Chris Zabriskie, John Paston, Kevin Mcleod, Josh Woodward, Steve Combs, Lee Rosevere, Scott Holmes, Advent Chamber Orchestra, Coldnoise, and Pachyderm. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES [BRAIN FOOD] <ol> <li>Kennedy DO, Wightman EL, Reay JL, Lietz G, Okello EJ, Wilde A and Haskell CF. Effects of resveratrol on cerebral blood flow variables and cognitive performance in humans: a double-blind, placebo-controlled, crossover investigation. Am J Clin Nutr. 2010;91:1590-7.</li> <li>Devore EE, Kang JH, Breteler MM and Grodstein F. Dietary intakes of berries and flavonoids in relation to cognitive decline. Annals of neurology. 2012;72:135-43.</li> <li>Norton S, Matthews FE, Barnes DE, Yaffe K and Brayne C. Potential for primary prevention of Alzheimer's disease: an analysis of population-based data. The Lancet Neurology. 2014;13:788-94.</li> <li>Morris MC, Tangney CC, Wang Y, Sacks FM, Barnes LL, Bennett DA and Aggarwal NT. MIND diet slows cognitive decline with aging. Alzheimers Dement. 2015;11:1015-22.</li> <li>Valls-Pedret C, Sala-Vila A, Serra-Mir M, Corella D, de la Torre R, Martinez-Gonzalez MA, Martinez-Lapiscina EH, Fito M, Perez-Heras A, Salas-Salvado J, Estruch R and Ros E. Mediterranean Diet and Age-Related Cognitive Decline: A Randomized Clinical Trial. JAMA internal medicine. 2015;175:1094-1103.</li> <li>Newman JC, Covarrubias AJ, Zhao M, Yu X, Gut P, Ng CP, Huang Y, Haldar S and Verdin E. Ketogenic Diet Reduces Midlife Mortality and Improves Memory in Aging Mice. Cell Metab. 2017;26:547-557 e8.</li> <li>Miller MG, Hamilton DA, Joseph JA and Shukitt-Hale B. Dietary blueberry improves cognition among older adults in a randomized, double-blind, placebo-controlled trial. Eur J Nutr. 2018;57:1169-1180.</li> <li>Okkersen K, Jimenez-Moreno C, Wenninger S, Daidj F, Glennon J, Cumming S, Littleford R, Monckton DG, Lochmuller H, Catt M, Faber CG, Hapca A, Donnan PT, Gorman G, Bassez G, Schoser B, Knoop H, Treweek S, van Engelen BGM and consortium O. Cognitive behavioural therapy with optional graded exercise therapy in patients with severe fatigue with myotonic dystrophy type 1: a multicentre, single-blind, randomised trial. The Lancet Neurology. 2018;17:671-680.</li> <li>Radd-Vagenas S, Duffy SL, Naismith SL, Brew BJ, Flood VM and Fiatarone Singh MA. Effect of the Mediterranean diet on cognition and brain morphology and function: a systematic review of randomized controlled trials. Am J Clin Nutr. 2018;107:389-404.</li> <li>Xu W, Wang H, Wan Y, Tan C, Li J, Tan L and Yu JT. Alcohol consumption and dementia risk: a dose-response meta-analysis of prospective studies. Eur J Epidemiol. 2017;32:31-42.</li> <li>Lefevre-Arbogast S, Gaudout D, Bensalem J, Letenneur L, Dartigues JF, Hejblum BP, Feart C, Delcourt C and Samieri C. Pattern of polyphenol intake and the long-term risk of dementia in older persons. Neurology. 2018;90:e1979-e1988.</li> <li>Liu QP, Wu YF, Cheng HY, Xia T, Ding H, Wang H, Wang ZM and Xu Y. Habitual coffee consumption and risk of cognitive decline/dementia: A systematic review and meta-analysis of prospective cohort studies. Nutrition. 2016;32:628-36.</li> </ol> [OF MEASLES AND MEN] <ol> <li>Murch SH, Anthony A, Casson DH, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Valentine A, Davies SE and Walker-Smith JA. Retraction of an interpretation. Lancet. 2004;363:750.</li> <li>Perry RT and Halsey NA. The clinical significance of measles: a review. The Journal of infectious diseases. 2004;189 Suppl 1:S4-16.</li> <li>Campbell H, Andrews N, Brown KE and Miller E. Review of the effect of measles vaccination on the epidemiology of SSPE. Int J Epidemiol. 2007;36:1334-48.</li> <li>Poland GA and Jacobson RM. The age-old struggle against the antivaccinationists. The New England journal of medicine. 2011;364:97-9.</li> <li>Maglione MA, Das L, Raaen L, Smith A, Chari R, Newberry S, Shanman R, Perry T, Goetz MB and Gidengil C. Safety of vaccines used for routine immunization of U.S. children: a systematic review. Pediatrics. 2014;134:325-37.</li> <li>Bester JC. Measles and Measles Vaccination: A Review. JAMA Pediatr. 2016;170:1209-1215.</li> <li>Bester JC. Not a matter of parental choice but of social justice obligation: Children are owed measles vaccination. Bioethics. 2018;32:611-619.</li> <li>Fournet N, Mollema L, Ruijs WL, Harmsen IA, Keck F, Durand JY, Cunha MP, Wamsiedel M, Reis R, French J, Smit EG, Kitching A and van Steenbergen JE. Under-vaccinated groups in Europe and their beliefs, attitudes and reasons for non-vaccination; two systematic reviews. BMC Public Health. 2018;18:196.</li> </ol>  Trump’s tweet: <a href="https://twitter.com/realdonaldtrump/status/449525268529815552?lang=en" rel="nofollow" target="_blank">https://twitter.com/realdonaldtrump/status/449525268529815552?lang=en</a> [NON-INFECTIOUS NEUROLOGIC COMPLICATIONS OF ORGAN TRANSPLANT] <ol> <li>Senzolo M, Ferronato C and Burra P. Neurologic complications after solid organ transplantation. Transpl Int. 2009;22:269-78.</li> <li>Dhar R. Neurologic complications of transplantation. Handbook of clinical neurology. 2017;141:545-572.</li> <li>Mateen FJ, Dierkhising RA, Rabinstein AA, van de Beek D and Wijdicks EF. Neurological complications following adult lung transplantation. Am J Transplant. 2010;10:908-14.</li> <li>Munoz P, Valerio M, Palomo J, Fernandez-Yanez J, Fernandez-Cruz A, Guinea J and Bouza E. Infectious and non-infectious neurologic complications in heart transplant recipients. Medicine (Baltimore). 2010;89:166-75.</li> <li>Wu Q, Marescaux C, Wolff V, Jeung MY, Kessler R, Lauer V and Chen Y. Tacrolimus-associated posterior reversible encephalopathy syndrome after solid organ transplantation. Eur Neurol. 2010;64:169-77.</li> <li>Dhar R, Young GB and Marotta P. Perioperative neurological complications after liver transplantation are best predicted by pre-transplant hepatic encephalopathy. Neurocritical care. 2008;8:253-8.</li> </ol>

Best of BrainWaves 2019

There is nothing mysterious about the chemistry of the cerebrospinal fluid. Cells. Protein. Glucose. But the interplay of these unique components can give you incredible insight into the state of the central nervous system. This week, we revisit a prior episode where Dr. Mike Rubenstein reviews his approach to interpreting CSF results. And then we have an update at the end regarding recent advances in CSF analysis. Produced by James E. Siegler and Michael Rubenstein. Music by Steve Combs. Sound effects by Mike Koenig, Daniel Simion. Voiceover by Patrick Green (German). BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. If you like what you hear, let us know and rate the show! REFERENCES 1. Frederiks JA and Koehler PJ. The first lumbar puncture. J Hist Neurosci. 1997;6:147-53. 2. Seehusen DA, Reeves MM and Fomin DA. Cerebrospinal fluid analysis. Am Fam Physician. 2003;68:1103-8. 3. Shah KH and Edlow JA. Distinguishing traumatic lumbar puncture from true subarachnoid hemorrhage. J Emerg Med. 2002;23:67-74. 4. Deisenhammer F, Bartos A, Egg R, Gilhus NE, Giovannoni G, Rauer S, Sellebjerg F and Force ET. Guidelines on routine cerebrospinal fluid analysis. Report from an EFNS task force. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2006;13:913-22. 5. Nagel MA, Cohrs RJ, Mahalingam R, Wellish MC, Forghani B, Schiller A, Safdieh JE, Kamenkovich E, Ostrow LW, Levy M, Greenberg B, Russman AN, Katzan I, Gardner CJ, Hausler M, Nau R, Saraya T, Wada H, Goto H, de Martino M, Ueno M, Brown WD, Terborg C and Gilden DH. The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features. Neurology. 2008;70:853-60. 6. Messacar K, Schreiner TL, Van Haren K, Yang M, Glaser CA, Tyler KL and Dominguez SR. Acute flaccid myelitis: A clinical review of US cases 2012-2015. Annals of neurology. 2016;80:326-38.

There is nothing mysterious about the chemistry of the cerebrospinal fluid. Cells. Protein. Glucose. But the interplay of these unique components can give you incredible insight into the state of the central nervous system. This week, we revisit a prior episode where Dr. Mike Rubenstein reviews his approach to interpreting CSF results. And then we have an update at the end regarding recent advances in CSF analysis. Produced by James E. Siegler and Michael Rubenstein. Music by Steve Combs. Sound effects by Mike Koenig, Daniel Simion. Voiceover by Patrick Green (German). BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. If you like what you hear, let us know and rate the show! REFERENCES 1. Frederiks JA and Koehler PJ. The first lumbar puncture. J Hist Neurosci. 1997;6:147-53. 2. Seehusen DA, Reeves MM and Fomin DA. Cerebrospinal fluid analysis. Am Fam Physician. 2003;68:1103-8. 3. Shah KH and Edlow JA. Distinguishing traumatic lumbar puncture from true subarachnoid hemorrhage. J Emerg Med. 2002;23:67-74. 4. Deisenhammer F, Bartos A, Egg R, Gilhus NE, Giovannoni G, Rauer S, Sellebjerg F and Force ET. Guidelines on routine cerebrospinal fluid analysis. Report from an EFNS task force. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2006;13:913-22. 5. Nagel MA, Cohrs RJ, Mahalingam R, Wellish MC, Forghani B, Schiller A, Safdieh JE, Kamenkovich E, Ostrow LW, Levy M, Greenberg B, Russman AN, Katzan I, Gardner CJ, Hausler M, Nau R, Saraya T, Wada H, Goto H, de Martino M, Ueno M, Brown WD, Terborg C and Gilden DH. The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features. Neurology. 2008;70:853-60. 6. Messacar K, Schreiner TL, Van Haren K, Yang M, Glaser CA, Tyler KL and Dominguez SR. Acute flaccid myelitis: A clinical review of US cases 2012-2015. Annals of neurology. 2016;80:326-38.

#49 Intro to CSF analysis

It seems like a new antibody in autoimmune central nervous system disorders is being discovered every day. Well, maybe not that frequently. But autoimmune encephalitis may now be as common as infectious encephalitis. In this week's program, we revisit an episode from 2016 where Dr. Ramani Balu (neurocritical care) shares his experience in evaluating and managing patients with these conditions. Produced by James E. Siegler. Music by Three Chain Links, Lee Rosevere, and Kevin McLeod. Sound effects by Mike Koenig. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES 1. Anderson NE and Barber PA. Limbic encephalitis - a review. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2008;15:961-71. 2. Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J and Friedman D. Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology. 2012;79:1094-100. 3. Lancaster E, Martinez-Hernandez E and Dalmau J. Encephalitis and antibodies to synaptic and neuronal cell surface proteins. Neurology. 2011;77:179-89. 4. Rosenfeld MR and Dalmau JO. Paraneoplastic disorders of the CNS and autoimmune synaptic encephalitis. Continuum (Minneap Minn). 2012;18:366-83. 5. Titulaer MJ, McCracken L, Gabilondo I, Armangue T, Glaser C, Iizuka T, Honig LS, Benseler SM, Kawachi I, Martinez-Hernandez E, Aguilar E, Gresa-Arribas N, Ryan-Florance N, Torrents A, Saiz A, Rosenfeld MR, Balice-Gordon R, Graus F and Dalmau J. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. The Lancet Neurology. 2013;12:157-65. 6. Irani SR, Michell AW, Lang B, Pettingill P, Waters P, Johnson MR, Schott JM, Armstrong RJ, A SZ, Bleasel A, Somerville ER, Smith SM and Vincent A. Faciobrachial dystonic seizures precede Lgi1 antibody limbic encephalitis. Annals of neurology. 2011;69:892-900. 7. Dubey D, Pittock SJ, Kelly CR, McKeon A, Lopez-Chiriboga AS, Lennon VA, Gadoth A, Smith CY, Bryant SC, Klein CJ, Aksamit AJ, Toledano M, Boeve BF, Tillema JM and Flanagan EP. Autoimmune encephalitis epidemiology and a comparison to infectious encephalitis. Annals of neurology. 2018;83:166-177.

It seems like a new antibody in autoimmune central nervous system disorders is being discovered every day. Well, maybe not that frequently. But autoimmune encephalitis may now be as common as infectious encephalitis. In this week's program, we revisit an episode from 2016 where Dr. Ramani Balu (neurocritical care) shares his experience in evaluating and managing patients with these conditions. Produced by James E. Siegler. Music by Three Chain Links, Lee Rosevere, and Kevin McLeod. Sound effects by Mike Koenig. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES 1. Anderson NE and Barber PA. Limbic encephalitis - a review. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2008;15:961-71. 2. Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J and Friedman D. Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology. 2012;79:1094-100. 3. Lancaster E, Martinez-Hernandez E and Dalmau J. Encephalitis and antibodies to synaptic and neuronal cell surface proteins. Neurology. 2011;77:179-89. 4. Rosenfeld MR and Dalmau JO. Paraneoplastic disorders of the CNS and autoimmune synaptic encephalitis. Continuum (Minneap Minn). 2012;18:366-83. 5. Titulaer MJ, McCracken L, Gabilondo I, Armangue T, Glaser C, Iizuka T, Honig LS, Benseler SM, Kawachi I, Martinez-Hernandez E, Aguilar E, Gresa-Arribas N, Ryan-Florance N, Torrents A, Saiz A, Rosenfeld MR, Balice-Gordon R, Graus F and Dalmau J. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. The Lancet Neurology. 2013;12:157-65. 6. Irani SR, Michell AW, Lang B, Pettingill P, Waters P, Johnson MR, Schott JM, Armstrong RJ, A SZ, Bleasel A, Somerville ER, Smith SM and Vincent A. Faciobrachial dystonic seizures precede Lgi1 antibody limbic encephalitis. Annals of neurology. 2011;69:892-900. 7. Dubey D, Pittock SJ, Kelly CR, McKeon A, Lopez-Chiriboga AS, Lennon VA, Gadoth A, Smith CY, Bryant SC, Klein CJ, Aksamit AJ, Toledano M, Boeve BF, Tillema JM and Flanagan EP. Autoimmune encephalitis epidemiology and a comparison to infectious encephalitis. Annals of neurology. 2018;83:166-177.

#23 Autoimmune and paraneoplastic limbic encephalitis

Lesion localization is a critical skill for any neurologist. The so-called "cortical signs" are symptoms or exam findings which are often associated with cortical neuron injury--aphasia, neglect, gaze preference. But they are also seen after injury to subcortical structures, including white matter tracts, the thalamus, and basal ganglia. In this week's installment of the BrainWaves podcast, we'll attempt to localize subcortical lesions based on these major cortical signs. Produced by James E. Siegler. Music by Aussenseiter, Gnagno, Yshwa, and Kevin McLeod. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES  Maeshima S and Osawa A. Thalamic Lesions and Aphasia or Neglect. Current neurology and neuroscience reports. 2018;18:39. Bogousslavsky J, Regli F and Uske A. Thalamic infarcts: clinical syndromes, etiology, and prognosis. Neurology. 1988;38:837-48. Karnath HO, Himmelbach M and Rorden C. The subcortical anatomy of human spatial neglect: putamen, caudate nucleus and pulvinar. Brain. 2002;125:350-60. Lam YW and Sherman SM. Functional organization of the thalamic input to the thalamic reticular nucleus. J Neurosci. 2011;31:6791-9. Tijssen CC. Contralateral conjugate eye deviation in acute supratentorial lesions. Stroke; a journal of cerebral circulation. 1994;25:1516-9. Fridriksson J, den Ouden DB, Hillis AE, Hickok G, Rorden C, Basilakos A, Yourganov G and Bonilha L. Anatomy of aphasia revisited. Brain. 2018. Epub ahead of print. Nadeau SE and Crosson B. Subcortical aphasia. Brain Lang. 1997;58:355-402; discussion 418-23. 

Lesion localization is a critical skill for any neurologist. The so-called "cortical signs" are symptoms or exam findings which are often associated with cortical neuron injury--aphasia, neglect, gaze preference. But they are also seen after injury to subcortical structures, including white matter tracts, the thalamus, and basal ganglia. In this week's installment of the BrainWaves podcast, we'll attempt to localize subcortical lesions based on these major cortical signs. Produced by James E. Siegler. Music by Aussenseiter, Gnagno, Yshwa, and Kevin McLeod. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES <ol> <li>Maeshima S and Osawa A. Thalamic Lesions and Aphasia or Neglect. Current neurology and neuroscience reports. 2018;18:39.</li> <li>Bogousslavsky J, Regli F and Uske A. Thalamic infarcts: clinical syndromes, etiology, and prognosis. Neurology. 1988;38:837-48.</li> <li>Karnath HO, Himmelbach M and Rorden C. The subcortical anatomy of human spatial neglect: putamen, caudate nucleus and pulvinar. Brain. 2002;125:350-60.</li> <li>Lam YW and Sherman SM. Functional organization of the thalamic input to the thalamic reticular nucleus. J Neurosci. 2011;31:6791-9.</li> <li>Tijssen CC. Contralateral conjugate eye deviation in acute supratentorial lesions. Stroke; a journal of cerebral circulation. 1994;25:1516-9.</li> <li>Fridriksson J, den Ouden DB, Hillis AE, Hickok G, Rorden C, Basilakos A, Yourganov G and Bonilha L. Anatomy of aphasia revisited. Brain. 2018. Epub ahead of print.</li> <li>Nadeau SE and Crosson B. Subcortical aphasia. Brain Lang. 1997;58:355-402; discussion 418-23.</li> </ol>

#118 Subcortical kinds of cortical signs

In 2016, Dr. Ali Hamedani summarized the basic principles underlying a neurologic evaluation for acute dizziness--the acute vestibular syndrome. We've remastered the prior show, and added in a few new factoids for ya in this 2019 remake. Enjoy! Produced by James E. Siegler. Music courtesy of John Bartman and Kevin McLeod. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES 1. Kerber KA. Acute constant dizziness. Continuum (Minneap Minn). 2012;18:1041-59. 2. Lempert T. Vestibular migraine. Semin Neurol. 2013;33:212-8. 3. Kim JS and Zee DS. Clinical practice. Benign paroxysmal positional vertigo. The New England journal of medicine. 2014;370:1138-47. 4. Kattah JC, Talkad AV, Wang DZ, Hsieh YH and Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke; a journal of cerebral circulation. 2009;40:3504-10.

In 2016, Dr. Ali Hamedani summarized the basic principles underlying a neurologic evaluation for acute dizziness--the acute vestibular syndrome. We've remastered the prior show, and added in a few new factoids for ya in this 2019 remake. Enjoy! Produced by James E. Siegler. Music courtesy of John Bartman and Kevin McLeod. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES 1. Kerber KA. Acute constant dizziness. Continuum (Minneap Minn). 2012;18:1041-59. 2. Lempert T. Vestibular migraine. Semin Neurol. 2013;33:212-8. 3. Kim JS and Zee DS. Clinical practice. Benign paroxysmal positional vertigo. The New England journal of medicine. 2014;370:1138-47. 4. Kattah JC, Talkad AV, Wang DZ, Hsieh YH and Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke; a journal of cerebral circulation. 2009;40:3504-10.

#36 Teaching through clinical cases: Acute vestibular syndrome

Unfortunately, many patients with epilepsy fail their first trial of an anti-seizure medication. A large proportion of these patients are put on a second agent...or a third. But is more necessarily better? Produced by James E. Siegler. Music by Justin Warren and Lee Rosevere. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES  Perucca E. Clinically relevant drug interactions with antiepileptic drugs. Br J Clin Pharmacol. 2006;61:246-255 Pennell PB, Newport DJ, Stowe ZN, Helmers SL, Montgomery JQ, Henry TR. The impact of pregnancy and childbirth on the metabolism of lamotrigine. Neurology. 2004;62:292-295 Petrenaite V, Sabers A, Hansen-Schwartz J. Individual changes in lamotrigine plasma concentrations during pregnancy. Epilepsy Res. 2005;65:185-188 Pennell PB, Peng L, Newport DJ, Ritchie JC, Koganti A, Holley DK, et al. Lamotrigine in pregnancy: Clearance, therapeutic drug monitoring, and seizure frequency. Neurology. 2008;70:2130-2136 

Unfortunately, many patients with epilepsy fail their first trial of an anti-seizure medication. A large proportion of these patients are put on a second agent...or a third. But is more necessarily better? Produced by James E. Siegler. Music by Justin Warren and Lee Rosevere. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES <ol> <li>Perucca E. Clinically relevant drug interactions with antiepileptic drugs. Br J Clin Pharmacol. 2006;61:246-255</li> <li>Pennell PB, Newport DJ, Stowe ZN, Helmers SL, Montgomery JQ, Henry TR. The impact of pregnancy and childbirth on the metabolism of lamotrigine. Neurology. 2004;62:292-295</li> <li>Petrenaite V, Sabers A, Hansen-Schwartz J. Individual changes in lamotrigine plasma concentrations during pregnancy. Epilepsy Res. 2005;65:185-188</li> <li>Pennell PB, Peng L, Newport DJ, Ritchie JC, Koganti A, Holley DK, et al. Lamotrigine in pregnancy: Clearance, therapeutic drug monitoring, and seizure frequency. Neurology. 2008;70:2130-2136</li> </ol>

#14 Anti-epileptic drug-drug interactions

Nobody is getting any younger. Which is too bad. Muscle cramping...fatigue...stiffness... you'll be dealing with it more and more. 'It's probably nothing,' you tell yourself. But what if it's not? Every once in a while, you might come across a case of myotonia. And you won't want to miss it. This week on BrainWaves, Dr. Noah Levinson provides a brief overview to myotonia and the conditions that are associated with it. IF YOU'RE TAKING YOUR NEUROLOGY BOARDS, and not sure how to prepare, check out the 2019 Penn Neurology Board Review Course here [or here: https://upenn.cloud-cme.com/default.aspx?P=5&amp;EID=54399]. BrainWaves' listeners get $150 off their enrollment fee using the promo code 'WAVES2019'. Produced by James E. Siegler. Music courtesy of Yshwa, Steve Combs, MMFFF, and Scott Holmes. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES  Miller TM. Differential diagnosis of myotonic disorders. Muscle Nerve. 2008;37:293-9. Sansone VA. The Dystrophic and Nondystrophic Myotonias. Continuum (Minneap Minn). 2016;22:1889-1915. Okkersen K, Jimenez-Moreno C, Wenninger S, Daidj F, Glennon J, Cumming S, Littleford R, Monckton DG, Lochmuller H, Catt M, Faber CG, Hapca A, Donnan PT, Gorman G, Bassez G, Schoser B, Knoop H, Treweek S, van Engelen BGM and consortium O. Cognitive behavioural therapy with optional graded exercise therapy in patients with severe fatigue with myotonic dystrophy type 1: a multicentre, single-blind, randomised trial. The Lancet Neurology. 2018;17:671-680. Thornton CA, Wang E and Carrell EM. Myotonic dystrophy: approach to therapy. Curr Opin Genet Dev. 2017;44:135-140. 

Nobody is getting any younger. Which is too bad. Muscle cramping...fatigue...stiffness... you'll be dealing with it more and more. 'It's probably nothing,' you tell yourself. But what if it's not? Every once in a while, you might come across a case of myotonia. And you won't want to miss it. This week on BrainWaves, Dr. Noah Levinson provides a brief overview to myotonia and the conditions that are associated with it. IF YOU'RE TAKING YOUR NEUROLOGY BOARDS, and not sure how to prepare, check out the 2019 Penn Neurology Board Review Course <a href="https://upenn.cloud-cme.com/default.aspx?P=5&amp;EID=54399" rel="nofollow" target="_blank">here</a> [or here: <a href="https://upenn.cloud-cme.com/default.aspx?P=5&amp;EID=54399" rel="nofollow" target="_blank">https://upenn.cloud-cme.com/default.aspx?P=5&amp;EID=54399</a>]. BrainWaves' listeners get $150 off their enrollment fee using the promo code 'WAVES2019'. Produced by James E. Siegler. Music courtesy of Yshwa, Steve Combs, MMFFF, and Scott Holmes. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES <ol> <li>Miller TM. Differential diagnosis of myotonic disorders. Muscle Nerve. 2008;37:293-9.</li> <li>Sansone VA. The Dystrophic and Nondystrophic Myotonias. Continuum (Minneap Minn). 2016;22:1889-1915.</li> <li>Okkersen K, Jimenez-Moreno C, Wenninger S, Daidj F, Glennon J, Cumming S, Littleford R, Monckton DG, Lochmuller H, Catt M, Faber CG, Hapca A, Donnan PT, Gorman G, Bassez G, Schoser B, Knoop H, Treweek S, van Engelen BGM and consortium O. Cognitive behavioural therapy with optional graded exercise therapy in patients with severe fatigue with myotonic dystrophy type 1: a multicentre, single-blind, randomised trial. The Lancet Neurology. 2018;17:671-680.</li> <li>Thornton CA, Wang E and Carrell EM. Myotonic dystrophy: approach to therapy. Curr Opin Genet Dev. 2017;44:135-140.</li> </ol>

#134 Myotonia

Yes! Finally an episode dedicated entirely to caffeine! And just how wonderful it is. ...and how wonderful it may not be. In this installment of BrainWaves, you'll hear about how fantastic and how frightful this chemical can be. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Yes, caffeine can be toxic. But so is water. Be smart, do your homework, and remember this is just a podcast--not a guideline for pharmacological management. REFERENCES 1. Nawrot P, Jordan S, Eastwood J, Rotstein J, Hugenholtz A, Feeley M. Effects of caffeine on human health. Food Addit Contam. 2003;20:1-30 2. Ferre S. An update on the mechanisms of the psychostimulant effects of caffeine. J Neurochem. 2008;105:1067-1079 3. Park CA, Kang CK, Son YD, Choi EJ, Kim SH, Oh ST, et al. The effects of caffeine ingestion on cortical areas: Functional imaging study. Magn Reson Imaging. 2014;32:366-371 4. Martin ED, Buno W. Caffeine-mediated presynaptic long-term potentiation in hippocampal ca1 pyramidal neurons. J Neurophysiol. 2003;89:3029-3038 5. Ribeiro JA, Sebastiao AM. Caffeine and adenosine. J Alzheimers Dis. 2010;20 Suppl 1:S3-15 6. Pelchovitz DJ, Goldberger JJ. Caffeine and cardiac arrhythmias: A review of the evidence. The American journal of medicine. 2011;124:284-289

Yes! Finally an episode dedicated entirely to caffeine! And just how wonderful it is. ...and how wonderful it may not be. In this installment of BrainWaves, you'll hear about how fantastic and how frightful this chemical can be. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Yes, caffeine can be toxic. But so is water. Be smart, do your homework, and remember this is just a podcast--not a guideline for pharmacological management. REFERENCES 1. Nawrot P, Jordan S, Eastwood J, Rotstein J, Hugenholtz A, Feeley M. Effects of caffeine on human health. Food Addit Contam. 2003;20:1-30 2. Ferre S. An update on the mechanisms of the psychostimulant effects of caffeine. J Neurochem. 2008;105:1067-1079 3. Park CA, Kang CK, Son YD, Choi EJ, Kim SH, Oh ST, et al. The effects of caffeine ingestion on cortical areas: Functional imaging study. Magn Reson Imaging. 2014;32:366-371 4. Martin ED, Buno W. Caffeine-mediated presynaptic long-term potentiation in hippocampal ca1 pyramidal neurons. J Neurophysiol. 2003;89:3029-3038 5. Ribeiro JA, Sebastiao AM. Caffeine and adenosine. J Alzheimers Dis. 2010;20 Suppl 1:S3-15 6. Pelchovitz DJ, Goldberger JJ. Caffeine and cardiac arrhythmias: A review of the evidence. The American journal of medicine. 2011;124:284-289

#57 Neurostimulants part 1: CAFFEINE!

Cerebral vein and dural sinus thrombosis comprises only 0.5% of all strokes, but is one of the most litigated medical diagnoses due to the high rate of underdiagnosis and high probability of neurologic decline without early and aggressive intervention. In this week's installment, Ali Hamedani puts Jim Siegler in the hot seat to go over the clinical and radiographic manifestations of this condition, treatment, and prognosis. Produced by Ali Hamedani and James E. Siegler. Music by Andy Cohen, MMFFF, Loyalty Freak Music, Steve Combs, Josh Woodward. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision making. REFERENCES  Stam J. Thrombosis of the cerebral veins and sinuses. The New England journal of medicine. 2005;352:1791-8. Khandelwal N, Agarwal A, Kochhar R, Bapuraj JR, Singh P, Prabhakar S and Suri S. Comparison of CT venography with MR venography in cerebral sinovenous thrombosis. AJR Am J Roentgenol. 2006;187:1637-43. Ferro JM, Canhao P, Bousser MG, Stam J, Barinagarrementeria F and Investigators I. Early seizures in cerebral vein and dural sinus thrombosis: risk factors and role of antiepileptics. Stroke; a journal of cerebral circulation. 2008;39:1152-8. Saposnik G, Barinagarrementeria F, Brown RD, Jr., Bushnell CD, Cucchiara B, Cushman M, deVeber G, Ferro JM, Tsai FY, American Heart Association Stroke C, the Council on E and Prevention. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke; a journal of cerebral circulation. 2011;42:1158-92. 

Cerebral vein and dural sinus thrombosis comprises only 0.5% of all strokes, but is one of the most litigated medical diagnoses due to the high rate of underdiagnosis and high probability of neurologic decline without early and aggressive intervention. In this week's installment, Ali Hamedani puts Jim Siegler in the hot seat to go over the clinical and radiographic manifestations of this condition, treatment, and prognosis. Produced by Ali Hamedani and James E. Siegler. Music by Andy Cohen, MMFFF, Loyalty Freak Music, Steve Combs, Josh Woodward. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision making. REFERENCES <ol> <li>Stam J. Thrombosis of the cerebral veins and sinuses. The New England journal of medicine. 2005;352:1791-8.</li> <li>Khandelwal N, Agarwal A, Kochhar R, Bapuraj JR, Singh P, Prabhakar S and Suri S. Comparison of CT venography with MR venography in cerebral sinovenous thrombosis. AJR Am J Roentgenol. 2006;187:1637-43.</li> <li>Ferro JM, Canhao P, Bousser MG, Stam J, Barinagarrementeria F and Investigators I. Early seizures in cerebral vein and dural sinus thrombosis: risk factors and role of antiepileptics. Stroke; a journal of cerebral circulation. 2008;39:1152-8.</li> <li>Saposnik G, Barinagarrementeria F, Brown RD, Jr., Bushnell CD, Cucchiara B, Cushman M, deVeber G, Ferro JM, Tsai FY, American Heart Association Stroke C, the Council on E and Prevention. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke; a journal of cerebral circulation. 2011;42:1158-92.</li> </ol>

#89 Cerebral venous sinus thrombosis

The request for a consult is like calling in a favor. You shouldn't actually expect the consultant to do it, you should be polite and helpful in all the ways your grandmother expects you to behave. At least that's the courtesy I've seen from really spectacular providers. In this week's episode, we not only review the proper etiquette for calling a consult, but you'll also hear some pearls on the workup for altered mental status. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. REFERENCES None this week. (Sorry!)

#46 The neuro consult for altered mental status

This week on the BrainWaves podcast, finally...a REAL show about BRAINWAVES! Dr. Carolina Maciel, of the University of Florida, schools Jim Siegler on how to read EEG and interpret abnormal patterns across the ictal-interictal continuum. Produced by James E. Siegler and Carolina Maciel. Music courtesy of Chris Zabriskie, Montplaisir, Rafael Archangel, Steve Combs, Unheard Music Concepts, and Siddhartha. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES  Chong DJ and Hirsch LJ. Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society. 2005;22:79-91. Benbadis SR, LaFrance WC, Jr., Papandonatos GD, Korabathina K, Lin K, Kraemer HC and Workshop NEST. Interrater reliability of EEG-video monitoring. Neurology. 2009;73:843-6. Hirsch LJ, LaRoche SM, Gaspard N, Gerard E, Svoronos A, Herman ST, Mani R, Arif H, Jette N, Minazad Y, Kerrigan JF, Vespa P, Hantus S, Claassen J, Young GB, So E, Kaplan PW, Nuwer MR, Fountain NB and Drislane FW. American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2012 version. Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society. 2013;30:1-27. Gaspard N, Hirsch LJ, LaRoche SM, Hahn CD, Westover MB and Critical Care EEGMRC. Interrater agreement for Critical Care EEG Terminology. Epilepsia. 2014;55:1366-73. Newey CR, Sahota P and Hantus S. Electrographic Features of Lateralized Periodic Discharges Stratify Risk in the Interictal-Ictal Continuum. Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society. 2017;34:365-369. Rubinos C, Reynolds AS and Claassen J. The Ictal-Interictal Continuum: To Treat or Not to Treat (and How)? Neurocritical care. 2018;29:3-8. Gerber PA, Chapman KE, Chung SS, Drees C, Maganti RK, Ng YT, Treiman DM, Little AS and Kerrigan JF. Interobserver agreement in the interpretation of EEG patterns in critically ill adults. Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society. 2008;25:241-9. Beniczky S, Hirsch LJ, Kaplan PW, Pressler R, Bauer G, Aurlien H, Brogger JC and Trinka E. Unified EEG terminology and criteria for nonconvulsive status epilepticus. Epilepsia. 2013;54 Suppl 6:28-9. Claassen J. How I treat patients with EEG patterns on the ictal-interictal continuum in the neuro ICU. Neurocritical care. 2009;11:437-44. 

This week on the BrainWaves podcast, finally...a REAL show about BRAINWAVES! Dr. Carolina Maciel, of the University of Florida, schools Jim Siegler on how to read EEG and interpret abnormal patterns across the ictal-interictal continuum. Produced by James E. Siegler and Carolina Maciel. Music courtesy of Chris Zabriskie, Montplaisir, Rafael Archangel, Steve Combs, Unheard Music Concepts, and Siddhartha. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES <ol> <li>Chong DJ and Hirsch LJ. Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society. 2005;22:79-91.</li> <li>Benbadis SR, LaFrance WC, Jr., Papandonatos GD, Korabathina K, Lin K, Kraemer HC and Workshop NEST. Interrater reliability of EEG-video monitoring. Neurology. 2009;73:843-6.</li> <li>Hirsch LJ, LaRoche SM, Gaspard N, Gerard E, Svoronos A, Herman ST, Mani R, Arif H, Jette N, Minazad Y, Kerrigan JF, Vespa P, Hantus S, Claassen J, Young GB, So E, Kaplan PW, Nuwer MR, Fountain NB and Drislane FW. American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2012 version. Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society. 2013;30:1-27.</li> <li>Gaspard N, Hirsch LJ, LaRoche SM, Hahn CD, Westover MB and Critical Care EEGMRC. Interrater agreement for Critical Care EEG Terminology. Epilepsia. 2014;55:1366-73.</li> <li>Newey CR, Sahota P and Hantus S. Electrographic Features of Lateralized Periodic Discharges Stratify Risk in the Interictal-Ictal Continuum. Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society. 2017;34:365-369.</li> <li>Rubinos C, Reynolds AS and Claassen J. The Ictal-Interictal Continuum: To Treat or Not to Treat (and How)? Neurocritical care. 2018;29:3-8.</li> <li>Gerber PA, Chapman KE, Chung SS, Drees C, Maganti RK, Ng YT, Treiman DM, Little AS and Kerrigan JF. Interobserver agreement in the interpretation of EEG patterns in critically ill adults. Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society. 2008;25:241-9.</li> <li>Beniczky S, Hirsch LJ, Kaplan PW, Pressler R, Bauer G, Aurlien H, Brogger JC and Trinka E. Unified EEG terminology and criteria for nonconvulsive status epilepticus. Epilepsia. 2013;54 Suppl 6:28-9.</li> <li>Claassen J. How I treat patients with EEG patterns on the ictal-interictal continuum in the neuro ICU. Neurocritical care. 2009;11:437-44.</li> </ol>

#146 Tangled up in squiggles: EEG 101 and the ictal inter-ictal continuum

Distinguishing aphasia from delirium can be INCREDIBLY difficult in the hospital setting, and a missed diagnosis of aphasia can prove disastrous for patients. In this episode, I get a little help from Johnny Depp (yes, that Johnny Depp) in order to illustrate the major differences between these two disease states.   BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice.

Distinguishing aphasia from delirium can be INCREDIBLY difficult in the hospital setting, and a missed diagnosis of aphasia can prove disastrous for patients. In this episode, I get a little help from Johnny Depp (yes, that Johnny Depp) in order to illustrate the major differences between these two disease states. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice.

#59 Speak of the devil: Aphasia vs. delirium

Seeing is believing. Or so I'm told. But this isn't a hard and fast rule in neurology. Cognitive neuroscientist and neurologist, Dr. Geoffrey Aguirre, joins me in this brief episode to discuss the neuroanatomy of higher order visual processing. Produced by James E. Siegler &amp; Erika Mejia. Music by Ars Sonor and Nuno Adelaida. Voiceover by Erika Mejia &amp; Jennifer Aniston. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES  Barton JJ. Disorders of higher visual processing. Handbook of clinical neurology. 2011;102:223-61. Meadows JC and Munro SS. Palinopsia. Journal of neurology, neurosurgery, and psychiatry. 1977;40:5-8. Radoeva PD, Prasad S, Brainard DH and Aguirre GK. Neural activity within area V1 reflects unconscious visual performance in a case of blindsight. J Cogn Neurosci. 2008;20:1927-39. 

Seeing is believing. Or so I'm told. But this isn't a hard and fast rule in neurology. Cognitive neuroscientist and neurologist, Dr. Geoffrey Aguirre, joins me in this brief episode to discuss the neuroanatomy of higher order visual processing. Produced by James E. Siegler &amp; Erika Mejia. Music by Ars Sonor and Nuno Adelaida. Voiceover by Erika Mejia &amp; Jennifer Aniston. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES <ol> <li>Barton JJ. Disorders of higher visual processing. Handbook of clinical neurology. 2011;102:223-61.</li> <li>Meadows JC and Munro SS. Palinopsia. Journal of neurology, neurosurgery, and psychiatry. 1977;40:5-8.</li> <li>Radoeva PD, Prasad S, Brainard DH and Aguirre GK. Neural activity within area V1 reflects unconscious visual performance in a case of blindsight. J Cogn Neurosci. 2008;20:1927-39.</li> </ol>

Quanta: Agnosia

What do gardeners and snow skiers have in common? Well, besides the fact that both tend to enjoy the outdoors, it turns out they are also at an increased risk of peripheral nerve injury. This week on the podcast, we review the anatomy and pathophysiology of several of the most common sites of nerve damage in the lower extremity. Produced by James E. Siegler. Music by Lee Rosevere. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES  Stewart JD. Foot drop: where, why and what to do? Pract Neurol. 2008;8:158-69. Baima J and Krivickas L. Evaluation and treatment of peroneal neuropathy. Curr Rev Musculoskelet Med. 2008;1:147-53. Marciniak C. Fibular (peroneal) neuropathy: electrodiagnostic features and clinical correlates. Phys Med Rehabil Clin N Am. 2013;24:121-37. 

What do gardeners and snow skiers have in common? Well, besides the fact that both tend to enjoy the outdoors, it turns out they are also at an increased risk of peripheral nerve injury. This week on the podcast, we review the anatomy and pathophysiology of several of the most common sites of nerve damage in the lower extremity. Produced by James E. Siegler. Music by Lee Rosevere. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES <ol> <li>Stewart JD. Foot drop: where, why and what to do? Pract Neurol. 2008;8:158-69.</li> <li>Baima J and Krivickas L. Evaluation and treatment of peroneal neuropathy. Curr Rev Musculoskelet Med. 2008;1:147-53.</li> <li>Marciniak C. Fibular (peroneal) neuropathy: electrodiagnostic features and clinical correlates. Phys Med Rehabil Clin N Am. 2013;24:121-37.</li> </ol>

Quanta: Foot drop

Of the "reversible" causes of dementia, normal pressure hydrocephalus (NPH) may be the most controversial. But there is something to be said about how surgical intervention alters the physiology of patients who present with gait impairment, ventriculomegaly, and normal CSF pressure. This week on the show, we discuss the clinical features and the controversy behind this diagnosis. Produced by James E. Siegler. Music by Ghost, Jon Watts, Julie Maxwell, Komiku, and Kevin McLeod. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES  Relkin N, Marmarou A, Klinge P, Bergsneider M and Black PM. Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery. 2005;57:S4-16; discussion ii-v. Gallia GL, Rigamonti D and Williams MA. The diagnosis and treatment of idiopathic normal pressure hydrocephalus. Nat Clin Pract Neurol. 2006;2:375-81. Klassen BT and Ahlskog JE. Normal pressure hydrocephalus: how often does the diagnosis hold water? Neurology. 2011;77:1119-25. Williams MA and Relkin NR. Diagnosis and management of idiopathic normal-pressure hydrocephalus. Neurol Clin Pract. 2013;3:375-385. Kazui H, Miyajima M, Mori E, Ishikawa M and Investigators S-. Lumboperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (SINPHONI-2): an open-label randomised trial. The Lancet Neurology. 2015;14:585-94. 

Of the "reversible" causes of dementia, normal pressure hydrocephalus (NPH) may be the most controversial. But there is something to be said about how surgical intervention alters the physiology of patients who present with gait impairment, ventriculomegaly, and normal CSF pressure. This week on the show, we discuss the clinical features and the controversy behind this diagnosis. Produced by James E. Siegler. Music by Ghost, Jon Watts, Julie Maxwell, Komiku, and Kevin McLeod. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES <ol> <li>Relkin N, Marmarou A, Klinge P, Bergsneider M and Black PM. Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery. 2005;57:S4-16; discussion ii-v.</li> <li>Gallia GL, Rigamonti D and Williams MA. The diagnosis and treatment of idiopathic normal pressure hydrocephalus. Nat Clin Pract Neurol. 2006;2:375-81.</li> <li>Klassen BT and Ahlskog JE. Normal pressure hydrocephalus: how often does the diagnosis hold water? Neurology. 2011;77:1119-25.</li> <li>Williams MA and Relkin NR. Diagnosis and management of idiopathic normal-pressure hydrocephalus. Neurol Clin Pract. 2013;3:375-385.</li> <li>Kazui H, Miyajima M, Mori E, Ishikawa M and Investigators S-. Lumboperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (SINPHONI-2): an open-label randomised trial. The Lancet Neurology. 2015;14:585-94.</li> </ol>

#125 No pressure

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