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    Education

    BrainWaves: A Neurology Podcast

    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**

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    Copyright: © All rights reserved

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    Latest Episodes:
    #174 The mental status Nov 19, 2020
    Show notes

    The mental status exam is a keystone of the neurologic assessment. Dr. Andrea Casher (Cooper University Hospital) builds upon this metaphor in our program this week. Making a special appearance is US President Donald Trump, who underwent a mental status exam and recounts his experience.

    Produced by James E. Siegler and Andrea Casher. Music courtesy of Unheard Music Concepts, Purple Planet Music, Lee Rosevere, and Scott Holmes. 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

    1. Tombaugh TN and McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992;40:922-35.
    2. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL and Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695-9.
    3. Dong Y, Sharma VK, Chan BP, Venketasubramanian N, Teoh HL, Seet RC, Tanicala S, Chan YH and Chen C. The Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute stroke. Journal of the neurological sciences. 2010;299:15-8.
    4. Gorno-Tempini ML, Hillis AE, Weintraub S, Kertesz A, Mendez M, Cappa SF, Ogar JM, Rohrer JD, Black S, Boeve BF, Manes F, Dronkers NF, Vandenberghe R, Rascovsky K, Patterson K, Miller BL, Knopman DS, Hodges JR, Mesulam MM and Grossman M. Classification of primary progressive aphasia and its variants. Neurology. 2011;76:1006-14.
    5. Ng KP, Chiew HJ, Lim L, Rosa-Neto P, Kandiah N and Gauthier S. The influence of language and culture on cognitive assessment tools in the diagnosis of early cognitive impairment and dementia. Expert review of neurotherapeutics. 2018;18:859-869.
    6. 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.
    #93 Aspirin vs. Plavix: The showdown Oct 29, 2020
    Show notes

    October 29 is World Stroke Day! Might as well know how it is best treated.

    This week, Jim Siegler revisits a 2017 episode on the differences between two of the most commonly prescribed post-stroke treatments, with some key updates, recent trial results, and practice-changing paradigms.

    Produced by James E. Siegler. Music courtesy of William Ross Chernoff's Nomads, Steve Combs, Rui, Little Glass Men, and Peter Rudenko. 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

    1. Jauch EC, Saver JL, Adams HP, Jr., Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW, Jr., Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H, American Heart Association Stroke C, Council on Cardiovascular N, Council on Peripheral Vascular D and Council on Clinical C. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke; a journal of cerebral circulation. 2013;44:870-947.
    2. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group. Lancet. 1997;349:1569-81.
    3. CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. CAST (Chinese Acute Stroke Trial) Collaborative Group. Lancet. 1997;349:1641-9.
    4. Kennedy J, Hill MD, Ryckborst KJ, Eliasziw M, Demchuk AM, Buchan AM and Investigators F. Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial. The Lancet Neurology. 2007;6:961-9.
    5. Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C, Wang C, Li H, Meng X, Cui L, Jia J, Dong Q, Xu A, Zeng J, Li Y, Wang Z, Xia H, Johnston SC and Investigators C. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. The New England journal of medicine. 2013;369:11-9.
    6. Hong KS, Lee SH, Kim EG, Cho KH, Chang DI, Rha JH, Bae HJ, Lee KB, Kim DE, Park JM, Kim HY, Cha JK, Yu KH, Lee YS, Lee SJ, Choi JC, Cho YJ, Kwon SU, Kim GM, Sohn SI, Park KY, Kang DW, Sohn CH, Lee J, Yoon BW and Investigators C. Recurrent Ischemic Lesions After Acute Atherothrombotic Stroke: Clopidogrel Plus Aspirin Versus Aspirin Alone. Stroke; a journal of cerebral circulation. 2016;47:2323-30.
    7. Liu L, Wong KS, Leng X, Pu Y, Wang Y, Jing J, Zou X, Pan Y, Wang A, Meng X, Wang C, Zhao X, Soo Y, Johnston SC, Wang Y and Investigators C. Dual antiplatelet therapy in stroke and ICAS: Subgroup analysis of CHANCE. Neurology. 2015;85:1154-62.
    8. Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration. Bmj. 1994;308:81-106.
    9. Antithrombotic Trialists C. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Bmj. 2002;324:71-86.
    10. Committee CS. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet. 1996;348:1329-39.
    11. Ringleb PA, Bhatt DL, Hirsch AT, Topol EJ, Hacke W and Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events I. Benefit of clopidogrel over aspirin is amplified in patients with a history of ischemic events. Stroke; a journal of cerebral circulation. 2004;35:528-32.
    12. Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, Leys D, Matias-Guiu J, Rupprecht HJ and investigators M. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364:331-7.
    13. Bhatt DL, Fox KA, Hacke W, Berger PB, Black HR, Boden WE, Cacoub P, Cohen EA, Creager MA, Easton JD, Flather MD, Haffner SM, Hamm CW, Hankey GJ, Johnston SC, Mak KH, Mas JL, Montalescot G, Pearson TA, Steg PG, Steinhubl SR, Weber MA, Brennan DM, Fabry-Ribaudo L, Booth J, Topol EJ and Investigators C. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. The New England journal of medicine. 2006;354:1706-17.
    14. Rothwell PM, Price JF, Fowkes FG, Zanchetti A, Roncaglioni MC, Tognoni G, Lee R, Belch JF, Wilson M, Mehta Z and Meade TW. Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials. Lancet. 2012;379:1602-12.
    15. Sahlen A, Varenhorst C, Lagerqvist B, Renlund H, Omerovic E, Erlinge D, Wallentin L, James SK and Jernberg T. Outcomes in patients treated with ticagrelor or clopidogrel after acute myocardial infarction: experiences from SWEDEHEART registry. European heart journal. 2016;37:3335-3342.
    16. Bath PM, Woodhouse LJ, Appleton JP, Beridze M, Christensen H, Dineen RA, Duley L, England TJ, Flaherty K, Havard D, Heptinstall S, James M, Krishnan K, Markus HS, Montgomery AA, Pocock SJ, Randall M, Ranta A, Robinson TG, Scutt P, Venables GS, Sprigg N and Investigators T. Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial. Lancet. 2018;391:850-859.
    17. Lopes RD, Heizer G, Aronson R, Vora AN, Massaro T, Mehran R, Goodman SG, Windecker S, Darius H, Li J, Averkov O, Bahit MC, Berwanger O, Budaj A, Hijazi Z, Parkhomenko A, Sinnaeve P, Storey RF, Thiele H, Vinereanu D, Granger CB, Alexander JH and Investigators A. Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation. The New England journal of medicine. 2019;380:1509-1524.
    18. Wang Y, Chen W, Lin Y, Meng X, Chen G, Wang Z, Wu J, Wang D, Li J, Cao Y, Xu Y, Zhang G, Li X, Pan Y, Li H, Zhao X, Liu L, Lin J, Dong K, Jing J, Johnston SC, Wang D, Wang Y and Group PPS. Ticagrelor plus aspirin versus clopidogrel plus aspirin for platelet reactivity in patients with minor stroke or transient ischaemic attack: open label, blinded endpoint, randomised controlled phase II trial. Bmj. 2019;365:l2211.
    #173 Matching during the COVID-19 pandemic Oct 22, 2020
    Show notes

    This week on the program, we bring to you a special episode on the impact of the COVID-19 pandemic on the neurology 2021 match--and potentially MANY subsequent matches. Jim Siegler is joined by the Assistant Program Director of the Cooper Neurology Residency Program, Olga Thon, and the creators of the @NMatch2021 Twitter account (who you should DEFINITELY follow after listening to our episode). If you are an applicant for the 2021 cycle, this show is MANDATORY.

    (only kidding, this is just a podcast)

    Produced by James E. Siegler, with assistance by Olga Thon, Adriana Romirez, Dylan Del Papa, Justine Ker, and Alvin Singh. Music courtesy of Akash Gandi, Little Glass Men, Kevin MacLeod, Josh Woodward, Julie Maxwell, and Kai Engel. 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.

    #83 Halloween Special: Zombies in neurology Oct 15, 2020
    Show notes

    Halloween is one of the most exciting and festive holidays, but this year I imagine many of us are going to spend it indoors. To help pass the time, enjoy this seasonal special about the neurologic manifestations of zombie-ism. Today's program is a re-run from 2017, featuring Dr. Brian Hanrahan, and has been remastered and updated with some recent additions in light of the coronavirus pandemic.

    Produced by James E. Siegler. Music courtesy of Andrew Sacco, Ars Sonor, Yan Terrien, and Unheard Music Concepts. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig, with some original recordings out of Studio 3. 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

    1. Smith TC. Zombie infections: Epidemiology, treatment, and prevention. Bmj. 2015;351:h6423
    2. Adams AJ, Banister SD, Irizarry L, Trecki J, Schwartz M, Gerona R. "Zombie" outbreak caused by the synthetic cannabinoid amb-fubinaca in new york. The New England journal of medicine. 2017;376:235-242
    3. Rabinovitz B, Jaywant A, 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
    4. Gilmour SJ, Saito E, Yoneoka D. Importance of survival strategies after a zombie pandemic. Bmj. 2016;532:i259
    5. Hughes DP, Andersen SB, Hywel-Jones NL, Himaman W, Billen J, Boomsma JJ. Behavioral mechanisms and morphological symptoms of zombie ants dying from fungal infection. BMC Ecol. 2011;11:13
    #172 Cavernoma Oct 01, 2020
    Show notes

    As the second most common vascular malformation in the central nervous system, cerebral cavernomas are often incidental radiographic findings. Also incidental is Jim's interest in mediocre sci-fi television shows, such as Netflix's recent series, Away—which incidentally includes one character with a symptomatic cerebral cavernoma. This week on the podcast, Dr. Siegler discusses with Dr. Dena Little (Cooper University Hospital) the epidemiology, clinical course, and management (including counseling) of patients with this vascular malformation.

    Plus, a critical appraisal of Away's medical consultant. 0_o

    Produced by James E. Siegler and Dena Little. Music courtesy of Ars Sonor, Andrew Sacco, Chris Zabriskie, 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

    1. Pozzati E, Acciarri N, Tognetti F, Marliani F and Giangaspero F. Growth, subsequent bleeding, and de novo appearance of cerebral cavernous angiomas. Neurosurgery. 1996;38:662-9; discussion 669-70.
    2. Batra S, Lin D, Recinos PF, Zhang J and Rigamonti D. Cavernous malformations: natural history, diagnosis and treatment. Nature reviews Neurology. 2009;5:659-70.
    3. Gross BA, Lin N, Du R and Day AL. The natural history of intracranial cavernous malformations. Neurosurgical focus. 2011;30:E24.
    4. Horne MA, Flemming KD, Su IC, Stapf C, Jeon JP, Li D, Maxwell SS, White P, Christianson TJ, Agid R, Cho WS, Oh CW, Wu Z, Zhang JT, Kim JE, Ter Brugge K, Willinsky R, Brown RD, Jr., Murray GD, Al-Shahi Salman R and Cerebral Cavernous Malformations Individual Patient Data Meta-analysis C. Clinical course of untreated cerebral cavernous malformations: a meta-analysis of individual patient data. The Lancet Neurology. 2016;15:166-173.
    5. Zafar A, Quadri SA, Farooqui M, Ikram A, Robinson M, Hart BL, Mabray MC, Vigil C, Tang AT, Kahn ML, Yonas H, Lawton MT, Kim H and Morrison L. Familial Cerebral Cavernous Malformations. Stroke; a journal of cerebral circulation. 2019;50:1294-1301.
    6. Zuurbier SM, Hickman CR, Tolias CS, Rinkel LA, Leyrer R, Flemming KD, Bervini D, Lanzino G, Wityk RJ, Schneble HM, Sure U, Al-Shahi Salman R and Scottish Audit of Intracranial Vascular Malformations Steering C. Long-term antithrombotic therapy and risk of intracranial haemorrhage from cerebral cavernous malformations: a population-based cohort study, systematic review, and meta-analysis. The Lancet Neurology. 2019;18:935-941.
    #171 High-convexity tight sulci Sep 17, 2020
    Show notes

    You know the triad for normal pressure hydrocephalus (NPH). Wet, wobbly, and wacky. And you have probably heard of the Evan's index—the relative proportion of the lateral ventricles in reference to the inner table of the skull. But you might not have heard of high-convexity tight sulci.

    Now you have.

    Produced by James E. Siegler. Music courtesy of Jason Shaw, Javolenus, and Lee Rosevere, under a Creative Commons License. The opening theme was composed by Jimothy Dalton. 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. Kitagaki H, Mori E, Ishii K, Yamaji S, Hirono N and Imamura T. CSF spaces in idiopathic normal pressure hydrocephalus: morphology and volumetry. AJNR American journal of neuroradiology. 1998;19:1277-84.
    2. Sasaki M, Honda S, Yuasa T, Iwamura A, Shibata E and Ohba H. Narrow CSF space at high convexity and high midline areas in idiopathic normal pressure hydrocephalus detected by axial and coronal MRI. Neuroradiology. 2008;50:117-22.
    3. Allali G, Laidet M, Armand S, Momjian S, Marques B, Saj A and Assal F. A combined cognitive and gait quantification to identify normal pressure hydrocephalus from its mimics: The Geneva's protocol. Clinical neurology and neurosurgery. 2017;160:5-11.
    4. Graff-Radford J, Gunter JL, Jones DT, Przybelski SA, Schwarz CG, Huston J, 3rd, Lowe V, Elder BD, Machulda MM, Gunter NB, Petersen RC, Kantarci K, Vemuri P, Mielke MM, Knopman DS, Graff-Radford NR and Jack CR, Jr. Cerebrospinal fluid dynamics disorders: Relationship to Alzheimer biomarkers and cognition. Neurology. 2019;93:e2237-e2246.
    #170 Myoclonus and neurodegenerative diseases Sep 03, 2020
    Show notes

    Myoclonus is the most etiologically non-specific motor manifestation of neurologic and systemic disease. It's like slurred speech or altered mental status. But in the appropriate context, it can become a useful clue in your differential diagnosis. Dr. John Caviness of the Mayo Clinic joins Jim Siegler this week for a discussion on this abnormal movement and what it may indicate.

    Produced by James E. Siegler and John Caviness. Music courtesy of Kevin McLeod and E's Jammy Jams. "Endings" and "What's the Angle" were produced by Shane Ivers (https://www.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

    1. Caviness JN. Myoclonus and neurodegenerative disease--what's in a name? Parkinsonism Relat Disord. 2003;9:185-92.
    2. Caviness JN. Parkinsonism & related disorders. Myoclonus. Parkinsonism Relat Disord. 2007;13 Suppl 3:S375-84.
    3. Caviness JN. Pathophysiology and treatment of myoclonus. Neurol Clin. 2009;27:757-77, vii.
    4. Zutt R, van Egmond ME, Elting JW, van Laar PJ, Brouwer OF, Sival DA, Kremer HP, de Koning TJ and Tijssen MA. A novel diagnostic approach to patients with myoclonus. Nature reviews Neurology. 2015;11:687-97.
    5. Levy A and Chen R. Myoclonus: Pathophysiology and Treatment Options. Current treatment options in neurology. 2016;18:21.
    6. Caviness JN. Myoclonus. Continuum (Minneap Minn). 2019;25:1055-1080.
    #109 Misnomers in medicine: Low grade glioma Aug 20, 2020
    Show notes

    A lot can happen in two years. You might have matched into residency, graduated from fellowship, had a kid... Or several phase II trials in low grade glioma research could have been published.

    Since the original airing of this episode in May 2018, there have been a few updates in neuro-oncology. We'll cover some of the major ones this week in the BrainWaves podcast.

    Produced by James E. Siegler, Brian Nahed and Jorg Dietrich. Music courtesy of Ian Sutherland, Lovira, and Lee Roosevere. 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

    1. McGirt MJ, Chaichana KL, Attenello FJ, Weingart JD, Than K, Burger PC, Olivi A, Brem H and Quinones-Hinojosa A. Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas. Neurosurgery. 2008;63:700-7; author reply 707-8.
    2. Shaw EG, Wang M, Coons SW, Brachman DG, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR and Mehta MP. Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2012;30:3065-70.
    3. Schiff D. Low-grade Gliomas. Continuum (Minneap Minn). 2017;23:1564-1579.
    4. Wen PY and Huse JT. 2016 World Health Organization Classification of Central Nervous System Tumors. Continuum (Minneap Minn). 2017;23:1531-1547.
    5. Bell EH, Zhang P, Fisher BJ, Macdonald DR, McElroy JP, Lesser GJ, Fleming J, Chakraborty AR, Liu Z, Becker AP, Fabian D, Aldape KD, Ashby LS, Werner-Wasik M, Walker EM, Bahary JP, Kwok Y, Yu HM, Laack NN, Schultz CJ, Gray HJ, Robins HI, Mehta MP and Chakravarti A. Association of MGMT Promoter Methylation Status With Survival Outcomes in Patients With High-Risk Glioma Treated With Radiotherapy and Temozolomide: An Analysis From the NRG Oncology/RTOG 0424 Trial. JAMA Oncol. 2018;4:1405-1409.
    6. van den Bent MJ, Klein M, Smits M, Reijneveld JC, French PJ, Clement P, de Vos FYF, Wick A, Mulholland PJ, Taphoorn MJB, Lewis J, Weller M, Chinot OL, Kros JM, de Heer I, Verschuere T, Coens C, Golfinopoulos V, Gorlia T and Idbaih A. Bevacizumab and temozolomide in patients with first recurrence of WHO grade II and III glioma, without 1p/19q co-deletion (TAVAREC): a randomised controlled phase 2 EORTC trial. Lancet Oncol. 2018;19:1170-1179.
    7. Fangusaro J, Onar-Thomas A, Young Poussaint T, Wu S, Ligon AH, Lindeman N, Banerjee A, Packer RJ, Kilburn LB, Goldman S, Pollack IF, Qaddoumi I, Jakacki RI, Fisher PG, Dhall G, Baxter P, Kreissman SG, Stewart CF, Jones DTW, Pfister SM, Vezina G, Stern JS, Panigrahy A, Patay Z, Tamrazi B, Jones JY, Haque SS, Enterline DS, Cha S, Fisher MJ, Doyle LA, Smith M, Dunkel IJ and Fouladi M. Selumetinib in paediatric patients with BRAF-aberrant or neurofibromatosis type 1-associated recurrent, refractory, or progressive low-grade glioma: a multicentre, phase 2 trial. Lancet Oncol. 2019;20:1011-1022.
    8. Bell EH, Zhang P, Shaw EG, Buckner JC, Barger GR, Bullard DE, Mehta MP, Gilbert MR, Brown PD, Stelzer KJ, McElroy JP, Fleming JL, Timmers CD, Becker AP, Salavaggione AL, Liu Z, Aldape K, Brachman DG, Gertler SZ, Murtha AD, Schultz CJ, Johnson D, Laack NN, Hunter GK, Crocker IR, Won M and Chakravarti A. Comprehensive Genomic Analysis in NRG Oncology/RTOG 9802: A Phase III Trial of Radiation Versus Radiation Plus Procarbazine, Lomustine (CCNU), and Vincristine in High-Risk Low-Grade Glioma. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2020:JCO1902983.
    9. Breen WG, Anderson SK, Carrero XW, Brown PD, Ballman KV, O'Neill BP, Curran WJ, Abrams RA, Laack NN, Levitt R, Galanis E, Buckner JC and Shaw EG. Final report from Intergroup NCCTG 86-72-51 (Alliance): a phase III randomized clinical trial of high-dose versus low-dose radiation for adult low-grade glioma. Neuro Oncol. 2020;22:830-837.
    10. Ullrich NJ, Prabhu SP, Reddy AT, Fisher MJ, Packer R, Goldman S, Robison NJ, Gutmann DH, Viskochil DH, Allen JC, Korf B, Cantor A, Cutter G, Thomas C, Perentesis JP, Mizuno T, Vinks AA, Manley PE, Chi SN, Kieran MW and Consortium NFCT. A Phase II Study of Continuous Oral mTOR Inhibitor Everolimus for Recurrent, Radiographic-Progressive Neurofibromatosis Type 1-Associated Pediatric Low-Grade Glioma: A Neurofibromatosis Clinical Trials Consortium Study. Neuro Oncol. 2020.
    #169 The interictal EEG Aug 06, 2020
    Show notes

    The electroencephalogram is a nearly 100-year old neurodiagnostic instrument. And yet, we learn new things from it every day. This week on the BrainWaves podcast, Dr. Tracey Milligan (Mass General Brigham) reviews the indications and utilization of a routine scalp EEG. Also discussed:

    • Limitations of scalp EEG
    • Brain surgery
    • Non-epileptic events
    • Why YOU should consider becoming an epileptologist

    Produced by James E. Siegler and Tracey Milligan. Music courtesy of Steve Combs, Lee Roosevere, Siddhartha, Soft and Furious, Patches, and Magic in the Other. 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. James Siegler reports having received consulting fees from Ceribell, which produces a bedside scalp EEG with automated seizure detection. However, there is no specific reference to this device or company, nor was this episode sponsored by Ceribell. 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. 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.
    2. Cascino GD. Clinical indications and diagnostic yield of video-electroencephalographic monitoring in patients with seizures and spells. Mayo Clinic proceedings. 2002;77:1111-20.
    3. Pillai J and Sperling MR. Interictal EEG and the diagnosis of epilepsy. Epilepsia. 2006;47 Suppl 1:14-22.
    4. 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.
    5. Debicki DB. Electroencephalography after a single unprovoked seizure. Seizure. 2017;49:69-73.
    #168 (Mis)understanding the locked-in state Jul 23, 2020
    Show notes

    The locked-in syndrome is a rare clinical consequence following many types of neurologic injury. In general, the locked-in patient is fully paralyzed, with perhaps minimal function of the fingers, the eyes, or the mouth. What's more, the gross motor dysfunction is enormously disproportional to the cognitive function of the individual. The locked-in patient is conscious and completely aware of their surroundings. They can often hear, see, smell, and feel just as any other person would. But because of their profound physical disability, they have a very limited means of communicating even the simplest thoughts. "I feel hot." "My head hurts." "My cheek itches."

    It may surprise you that the patient's perspective of their condition is wholly different from how the healthcare provider or caregiver imagines it to be. This week on the program, Dr. Lauren Elman (Pennsylvania Medical Center ALS Multi-disiplinary Clinic) reviews this discrepancy. Dr. Elman also shares her experience managing this inevitable consequence of ALS when all life-sustaining measures are desired.

    REFERENCES

    1. Patterson JR and Grabois M. Locked-in syndrome: a review of 139 cases. Stroke; a journal of cerebral circulation. 1986;17:758-64.
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    4. Kuzma-Kozakiewicz M, Andersen PM, Ciecwierska K, Vazquez C, Helczyk O, Loose M, Uttner I, Ludolph AC and Lule D. An observational study on quality of life and preferences to sustain life in locked-in state. Neurology. 2019;93:e938-e945.
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