BrainWaves: A Neurology Podcast

Latest Episodes:

#116 Pain in the neck Jul 19, 2018

Show notes

Some have estimated the annual cost of chronic back or neck pain in the US to exceed $200 billion per year. And the economic burden is almost as unbearable as the pain faced by patients. This week on the program, we discuss the clinical and radiographic aspects of structural spine disease--or spondylosis--and expert recommendations on how to manage it.

Produced by James E. Siegler. Music by Steve Combs and Scott Holmes. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making, especially not for back surgery.

REFERENCES

Baron EM and Young WF. Cervical spondylotic myelopathy: a brief review of its pathophysiology, clinical course, and diagnosis. Neurosurgery. 2007;60:S35-41.
Stino AM and LoRusso SJ. Myelopathies Due to Structural Cervical and Thoracic Disease. Continuum (Minneap Minn). 2018;24:567-583.
Rindler RS, Chokshi FH, Malcolm JG, Eshraghi SR, Mossa-Basha M, Chu JK, Kurpad SN and Ahmad FU. Spinal Diffusion Tensor Imaging in Evaluation of Preoperative and Postoperative Severity of Cervical Spondylotic Myelopathy: Systematic Review of Literature. World Neurosurg. 2017;99:150-158.
Witiw CD, Tetreault LA, Smieliauskas F, Kopjar B, Massicotte EM and Fehlings MG. Surgery for degenerative cervical myelopathy: a patient-centered quality of life and health economic evaluation. Spine J. 2017;17:15-25.
Farrokhi MR, Ghaffarpasand F, Khani M and Gholami M. An Evidence-Based Stepwise Surgical Approach to Cervical Spondylotic Myelopathy: A Narrative Review of the Current Literature. World Neurosurg. 2016;94:97-110.

#23 Autoimmune and paraneoplastic limbic encephalitis Jul 12, 2018

Show notes

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.

#115 Novel immunotherapies in demyelinating disease Jul 05, 2018

Show notes

In 2017, neuroimmunology experts revised the criteria with which we diagnose multiple sclerosis, they encouraged more aggressive treatment, and now they have introduced novel therapeutic agents into our pharmacologic armamentarium. Dr. Christopher Perrone explains how these newer agents work and how effective they are in patients with demyelinating disease.

Produced by James E. Siegler. Music by Steve Combs, Pachyderm, and Lee Rosevere. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Hauser SL, Bar-Or A, Comi G, Giovannoni G, Hartung HP, Hemmer B, Lublin F, Montalban X, Rammohan KW, Selmaj K, Traboulsee A, Wolinsky JS, Arnold DL, Klingelschmitt G, Masterman D, Fontoura P, Belachew S, Chin P, Mairon N, Garren H, Kappos L, Opera I and Investigators OIC. Ocrelizumab versus Interferon Beta-1a in Relapsing Multiple Sclerosis. The New England journal of medicine. 2017;376:221-234.
Hauser SL, Waubant E, Arnold DL, Vollmer T, Antel J, Fox RJ, Bar-Or A, Panzara M, Sarkar N, Agarwal S, Langer-Gould A, Smith CH and Group HT. B-cell depletion with rituximab in relapsing-remitting multiple sclerosis. The New England journal of medicine. 2008;358:676-88.
Hemmer B, Nessler S, Zhou D, Kieseier B and Hartung HP. Immunopathogenesis and immunotherapy of multiple sclerosis. Nat Clin Pract Neurol. 2006;2:201-11.
Montalban X, Hauser SL, Kappos L, Arnold DL, Bar-Or A, Comi G, de Seze J, Giovannoni G, Hartung HP, Hemmer B, Lublin F, Rammohan KW, Selmaj K, Traboulsee A, Sauter A, Masterman D, Fontoura P, Belachew S, Garren H, Mairon N, Chin P, Wolinsky JS and Investigators OC. Ocrelizumab versus Placebo in Primary Progressive Multiple Sclerosis. The New England journal of medicine. 2017;376:209-220.
Selter RC and Hemmer B. Update on immunopathogenesis and immunotherapy in multiple sclerosis. Immunotargets Ther. 2013;2:21-30.
Maloney DG, Grillo-Lopez AJ, White CA, Bodkin D, Schilder RJ, Neidhart JA, Janakiraman N, Foon KA, Liles TM, Dallaire BK, Wey K, Royston I, Davis T and Levy R. IDEC-C2B8 (Rituximab) anti-CD20 monoclonal antibody therapy in patients with relapsed low-grade non-Hodgkin's lymphoma. Blood. 1997;90:2188-95.

#114 Madness Jun 28, 2018

Show notes

That's what the Greeks called it. Madness. In Sanskrit, the term was rabhas, which meant "to do violence". Later, Latin and English translations would give us the present day term for it.

Rabies.

Dr. Krista Rieckert (veterinary medicine) comments on this example of a neurotropic virus that infects humans and animals alike.

Produced by James E. Siegler. Music by Ars Sonor, Cold Noise, Damiano Baldoni, Kevin MacLeod, US Army Old Guard and Drum Corps, and Ghost. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. If you're bitten by a wild animal (or a domestic one), talk to your doctor.

REFERENCES

Baer GM. Rabies--an historical perspective. Infect Agents Dis. 1994;3:168-80.
Co SJ, Mackenzie IR and Shewchuk JR. Rabies encephalitis. Radiographics. 2015;35:235-8.
Hemachudha T, Ugolini G, Wacharapluesadee S, Sungkarat W, Shuangshoti S and Laothamatas J. Human rabies: neuropathogenesis, diagnosis, and management. The Lancet Neurology. 2013;12:498-513.
Anderson LJ, Nicholson KG, Tauxe RV and Winkler WG. Human rabies in the United States, 1960 to 1979: epidemiology, diagnosis, and prevention. Annals of internal medicine. 1984;100:728-35.

#113 Teaching through clinical cases: Hypoactive delirium & antipsychotics Jun 21, 2018

Show notes

This week's clinical case features a complex course of hospital-acquired delirium with an in-depth discussion on antipsychotics. Dr. Ayyappan Venkatraman reviews the pertinent psychopharmacology in dopaminergic and non-dopaminergic signaling.

Produced by James E. Siegler. Music by Unheard Music Concepts, Kevin McLeod, Lee Rosevere, and Steve Combs. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. For more information, check out http://brainwaves.me/.

REFERENCES

O'Keeffe ST and Lavan JN. Clinical significance of delirium subtypes in older people. Age and ageing. 1999;28:115-9.
Lacasse H, Perreault MM and Williamson DR. Systematic review of antipsychotics for the treatment of hospital-associated delirium in medically or surgically ill patients. Ann Pharmacother. 2006;40:1966-73.
Jeste DV and Caligiuri MP. Tardive dyskinesia. Schizophr Bull. 1993;19:303-15.

#112 Optic neuritis Jun 14, 2018

Show notes

As a pupil of neurology and medicine, I feel like it is my responsibility to cover this topic at least once on the podcast. This topic came to me in a vision. But not one of phosphenes or impaired stereopsis--both of which we'll cover today. This week, we're discussing inflammation of the optic nerve, from the historical aspects to current concepts. And while you're listening, there's no need to lash out at my puns. You can stop rolling your eyes now.

Produced by James E. Siegler. Music by Lee Rosevere, Kevin McLeod, Steve Combs, and Unheard Music Concepts. 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

Balcer LJ. Clinical practice. Optic neuritis. The New England journal of medicine. 2006;354:1273-80.
Volpe NJ. Optic neuritis: historical aspects. J Neuroophthalmol. 2001;21:302-9.
Hickman SJ, Dalton CM, Miller DH and Plant GT. Management of acute optic neuritis. Lancet. 2002;360:1953-62.
O'Doherty M and Flitcroft DI. An unusual presentation of optic neuritis and the Pulfrich phenomenon. Journal of neurology, neurosurgery, and psychiatry. 2007;78:906-7.
Liu GT, Volpe NJ and Galetta SL. Neuro-Ophthalmology: Diagnosis and Management, 2nd Ed.: Elsevier; 2010.
Beck RW, Cleary PA, Anderson MM, Jr., Keltner JL, Shults WT, Kaufman DI, Buckley EG, Corbett JJ, Kupersmith MJ, Miller NR and et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group. The New England journal of medicine. 1992;326:581-8.
Toosy AT, Mason DF and Miller DH. Optic neuritis. The Lancet Neurology. 2014;13:83-99.

#111 Depression and dementia…and everything in-between Jun 07, 2018

Show notes

Depression and dementia are unfortunately two very common disorders in mental health. But the fact that they occur together is not explained by their overall prevalence. The relationship is a bit more complicated. Joan Dietz joins Jim Siegler in a discussion on how she counters these common conditions.

Produced by James E. Siegler. Music by Lee Rosevere, Jason Shaw, Chris Zabriskie, Kai Engel, and Scott Holmes. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Byers AL and Yaffe K. Depression and risk of developing dementia. Nature reviews Neurology. 2011;7:323-31.
Korczyn AD and Halperin I. Depression and dementia. Journal of the neurological sciences. 2009;283:139-42.
Alexopoulos GS, Murphy CF, Gunning-Dixon FM, Latoussakis V, Kanellopoulos D, Klimstra S, Lim KO and Hoptman MJ. Microstructural white matter abnormalities and remission of geriatric depression. Am J Psychiatry. 2008;165:238-44.
Dotson VM, Beydoun MA and Zonderman AB. Recurrent depressive symptoms and the incidence of dementia and mild cognitive impairment. Neurology. 2010;75:27-34.
Saczynski JS, Beiser A, Seshadri S, Auerbach S, Wolf PA and Au R. Depressive symptoms and risk of dementia: the Framingham Heart Study. Neurology. 2010;75:35-41.
Lee CW, Lin CL, Sung FC, Liang JA and Kao CH. Antidepressant treatment and risk of dementia: a population-based, retrospective case-control study. J Clin Psychiatry. 2016;77:117-22; quiz 122.
Sachdev PS, Smith JS, Angus-Lepan H and Rodriguez P. Pseudodementia twelve years on. Journal of neurology, neurosurgery, and psychiatry. 1990;53:254-9.

#110 Teaching through clinical cases: Hemorrhagic infarction May 31, 2018

Show notes

Unfortunately, stroke is all too common. Nearly 1 million new strokes are diagnosed in the US each year. And this means that complications of stroke--even if rare--may also be common. One such complication is hemorrhagic transformation. This week, Dr. Ava Liberman reviews a clinical case of hemorrhage following ischemic stroke.

Produced by James E. Siegler. Music by Ghost, Kevin McLeod, and Scott Holmes. Voiceover by David Manly. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jimenez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P, American Heart Association Council on E, Prevention Statistics C and Stroke Statistics S. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation. 2018;137:e67-e492.
Frontera JA, Lewin JJ, 3rd, Rabinstein AA, Aisiku IP, Alexandrov AW, Cook AM, del Zoppo GJ, Kumar MA, Peerschke EI, Stiefel MF, Teitelbaum JS, Wartenberg KE and Zerfoss CL. Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine. Neurocritical care. 2016;24:6-46.
Prabhakaran S, Gupta R, Ouyang B, John S, Temes RE, Mohammad Y, Lee VH and Bleck TP. Acute brain infarcts after spontaneous intracerebral hemorrhage: a diffusion-weighted imaging study. Stroke; a journal of cerebral circulation. 2010;41:89-94.

#14 Anti-epileptic drug-drug interactions May 24, 2018

Show notes

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

Quanta: TNK-ing to the next level May 20, 2018

Show notes

It's the age of thrombectomy. The DAWN of a new era. But should we give up on intravenous thrombolysis for acute ischemic stroke? In this installment of the Quanta series (typically shorter episodes, this one happens to be 19 min...), we review the latest data on fibrinolytic agents and anticipate the upcoming paradigm shift in the management of patients with cerebral infarction.

Produced by James E. Siegler. Music by Hyson and Jon Watts. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Assessment of the S, Efficacy of a New Thrombolytic I, Van De Werf F, Adgey J, Ardissino D, Armstrong PW, Aylward P, Barbash G, Betriu A, Binbrek AS, Califf R, Diaz R, Fanebust R, Fox K, Granger C, Heikkila J, Husted S, Jansky P, Langer A, Lupi E, Maseri A, Meyer J, Mlczoch J, Mocceti D, Myburgh D, Oto A, Paolasso E, Pehrsson K, Seabra-Gomes R, Soares-Piegas L, Sugrue D, Tendera M, Topol E, Toutouzas P, Vahanian A, Verheugt F, Wallentin L and White H. Single-bolus tenecteplase compared with front-loaded alteplase in acute myocardial infarction: the ASSENT-2 double-blind randomised trial. Lancet. 1999;354:716-22.
Campbell BCV, Mitchell PJ, Churilov L, Yassi N, Kleinig TJ, Dowling RJ, Yan B, Bush SJ, Dewey HM, Thijs V, Scroop R, Simpson M, Brooks M, Asadi H, Wu TY, Shah DG, Wijeratne T, Ang T, Miteff F, Levi CR, Rodrigues E, Zhao H, Salvaris P, Garcia-Esperon C, Bailey P, Rice H, de Villiers L, Brown H, Redmond K, Leggett D, Fink JN, Collecutt W, Wong AA, Muller C, Coulthard A, Mitchell K, Clouston J, Mahady K, Field D, Ma H, Phan TG, Chong W, Chandra RV, Slater LA, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Bladin CF, Sharma G, Desmond PM, Parsons MW, Donnan GA, Davis SM and Investigators E-IT. Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke. The New England journal of medicine. 2018;378:1573-1582.
Huang X, Cheripelli BK, Lloyd SM, Kalladka D, Moreton FC, Siddiqui A, Ford I and Muir KW. Alteplase versus tenecteplase for thrombolysis after ischaemic stroke (ATTEST): a phase 2, randomised, open-label, blinded endpoint study. The Lancet Neurology. 2015;14:368-76.
Logallo N, Novotny V, Assmus J, Kvistad CE, Alteheld L, Ronning OM, Thommessen B, Amthor KF, Ihle-Hansen H, Kurz M, Tobro H, Kaur K, Stankiewicz M, Carlsson M, Morsund A, Idicula T, Aamodt AH, Lund C, Naess H, Waje-Andreassen U and Thomassen L. Tenecteplase versus alteplase for management of acute ischaemic stroke (NOR-TEST): a phase 3, randomised, open-label, blinded endpoint trial. The Lancet Neurology. 2017;16:781-788.
Parsons M, Spratt N, Bivard A, Campbell B, Chung K, Miteff F, O'Brien B, Bladin C, McElduff P, Allen C, Bateman G, Donnan G, Davis S and Levi C. A randomized trial of tenecteplase versus alteplase for acute ischemic stroke. The New England journal of medicine. 2012;366:1099-107.
Haley EC, Jr., Lyden PD, Johnston KC, Hemmen TM and Investigators TNKiS. A pilot dose-escalation safety study of tenecteplase in acute ischemic stroke. Stroke; a journal of cerebral circulation. 2005;36:607-12.
Haley EC, Jr., Thompson JL, Grotta JC, Lyden PD, Hemmen TG, Brown DL, Fanale C, Libman R, Kwiatkowski TG, Llinas RH, Levine SR, Johnston KC, Buchsbaum R, Levy G, Levin B and Tenecteplase in Stroke I. Phase IIB/III trial of tenecteplase in acute ischemic stroke: results of a prematurely terminated randomized clinical trial. Stroke; a journal of cerebral circulation. 2010;41:707-11.

Our TOPPODCAST Picks

Follow Us

Stay Connected

BrainWaves: A Neurology Podcast

Related Podcasts

Links

Stay Connected