Brainwaves

The FDA label for ACTEMRA (tocilizumab)--the first medication approved for use in giant cell arteritis in 2017--is 40 pages long. Of the information provided in this document, which includes important dosing information, dose adjustments based on leukocyte count, clinical trial and epidemiologic data, there is a box of text on the first page of the insert. "WARNING: RISK OF SERIOUS INFECTIONS" it reads. What do you make of this warning? And with such a clear and broad-sweeping statement stamped on the medication, how do you mitigate the medico-legal risk for using this drug? This week on the program we launch into a 2-part series focused on some of the events which follow major clinical trials. In part 1, we cover the 3 major classifications of FDA alerts for medical treatments using 2 examples from the neurologic pharmacopoeia. In part 2, we emphasize the importance of post-publication peer review. And both are equally instrumental in our medical decision making. Produced by James E. Siegler with the support

This year, Halloween falls on a Thursday. So we've put together a special episode to celebrate it! But first...a question: What do Frankenstein's monster, Spock, and Rick Deckard all have in common? Find out in this week's episode of BrainWaves. Produced by James E. Siegler. Special guest, Scott Kasner (Hospital of the University of Pennsylvania) with fair use of material from Young Frankenstein (1974), Star Trek: The Original Series (1966-1969), and Blade Runner (1982). Music courtesy of Grossman, Ewell and Grainger, Heftone Banjo Orchestra, Sergey Chereminisov, and Ondrosik under a Creative Commons License. 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 Labbe R, Firl A, Jr., Mufson EJ and Stein DG. Fetal brain transplant: reduction of cognitive deficits in rats with frontal cortex lesions. Scien

College is a tough time for any kid. But it should also be exciting. Then to experience the freedoms of young adulthood, only later to face the horrifying reality of a progressive neurodegenerative condition...it's not something anyone should experience. In this week's continuation of the patient narrative series, Dr. Paul McIntosh (Duke) shares his life-changing story, and his optimism, about surviving a chronic neurological illness. Produced by James E. Siegler with the help of Paul McIntosh. For more information about Pompe Disease, check out the resources provided by the United Pompe Foundation at unitedpompe.com. Music for our program this week was courtesy of Ars Sonor, Franz Danzi, Lee Rosevere, 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 Kishnani PS a

Sara Henya would have you recognize her for her music, not her malady. While she may have Tourette Syndrome, she refuses to let it define her. In this week's episode of BrainWaves, we're launching a two part series featuring people who are living with a chronic neurologic illness--how they were diagnosed, how they cope with it, and of course, the neurobiology that underlies it. Produced by James E. Siegler with Dr. Michael Rubenstein and Sara Henya. Music courtesy of Sara Henya (find her music at www.sarahenya.com), Lee Rosevere, Loyalty Freak Music, Marco Trovatello, and Steve Combs. 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 Pringsheim T, Holler-Managan Y, Okun MS, Jankovic J, Piacentini J, Cavanna AE, Martino D, Muller-Vahl K, Woods DW, Robinson M, Jarvie E, Roessner V and

This week on the program, our earlier episode on the multidisciplinary care of ALS patients gets a face lift. Since it originally aired in 2016, there have been several important advances in the treatment of these patients--including the first FDA approved therapy for this condition in more than 2 decades. But many of the core management strategies remain the same. Dr. Lauren Elman, Associate Professor of Neurology, Director of Research Operations and Associate Director of clinical care at the Penn Comprehensive ALS Center, shares her experience in this 2019 update. Produced by James E. Siegler. Music courtesy of Chris Zabriskie, Nuno Adelaida, and Meydan. 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 de Carvalho M, Dengler R, Eisen A, England JD, Kaji R, Kimura J, Mills K, Mits

In this week's clinical case, Dr. Mike Bradshaw (Chicago Medical School and Billings Clinic) walks us through the case of a young woman with HSV encephalitis. With a twist. SPOILER ALERT: If you don't want to know the answer, DON'T LOOK AT THE SHOWNOTES! Produced by James E. Siegler and Mike Bradshaw. Music courtesy of Yan Terrien, Unheard Music Concepts, Steve Combs, and Montplaisir. 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 Bacon TH, Boon RJ, Schultz M and Hodges-Savola C. Surveillance for antiviral-agent-resistant herpes simplex virus in the general population with recurrent herpes labialis. Antimicrob Agents Chemother. 2002;46:3042-4. Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D, Cunningham R, Zuckerman M, Mutton KJ, Solomon T, Ward KN, Lunn MP, Iran

We just used clinical trial data regarding eculizumab in myasthenia gravis as an example of how to critically appraise the literature, and in this week's program...MORE data on the efficacy of eculizumab in another neurological condition. This week on BrainWaves, the exciting results of the PREVENT trial and the future treatment of NMO spectrum disorder! Produced by James E. Siegler. Special thanks to Dr. Olga Rosenveld Thon. Music courtesy of Unheard Music Concepts, TRG Banks, and Aitua. Sound effects by Mike Koenig and baby Sofia Joan Siegler. 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  Pittock SJ, Lennon VA, McKeon A, Mandrekar J, Weinshenker BG, Lucchinetti CF, O'Toole O and Wingerchuk DM. Eculizumab in AQP4-IgG-positive relapsing neuromyelitis optica spectrum disorders: an open-label pilot study. The Lancet Neurology.

One study shows that 30 minutes of exercise 5 times a week can reduce your risk of squamous cell carcinoma of the skin, p=0.001. (Let's pretend this is true). What does this mean? Well, let's start by asking the question, how IMPORTANT is it that you reduce your risk of SCC of the skin, and how MUCH does exercise reduce that risk? If the effect of exercise is associated with a relative risk reduction of 1% in your lifetime risk of SCC, is that enough to get you to spend 1 week of your life each year on a treadmill? In this week's "I wonder" series, Dr. Ali Hamedani joins Jim Siegler to discuss the difference between statistical significance and clinical importance, how to interpret p-values, and exactly what kinds of conclusions you should draw from clinical studies. Produced by James E. Siegler and Ali Hamedani. Music courtesy of Jahzzar, Kevin McLeod, Sergey Cheremisinov, and the trio Grossman, Ewell and Grainger. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are in

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., Pap

Clean up on aisle 4! Or should it be IL-4? In this week's installment of the BrainWaves Podcast, we submerge ourselves into the microscopic environment of Alzheimer's pathology. It's interesting, it's messy, and whoever made this mess is also responsible for the clean up. Produced by James E. Siegler. Music courtesy of Andy Cohen, Brendan Kinsella, Cuicuitte, Damiano Baldoni, Kai Engel, Nctrnm. Sound effects by Mike Koenig, Blastfx.com, Caroline Ford, Robertv, 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 Arranz AM and De Strooper B. The role of astroglia in Alzheimer's disease: pathophysiology and clinical implications. The Lancet Neurology. 2019;18:406-414. Maragakis NJ and Rothstein JD. Mechanisms of Disease: astrocytes in neurodegenerative disease. Nat Clin Pract Neurol. 2006;2:679-89. Wisniewski T and

In one of our previous Teaching through Clinical Cases, Dr. Sneha Mantri (formerly a movement disorders fellow at the Philadelphia VA, now an Assistant Professor of Neurology at Duke) took us through the case of a gentleman with gait instability and falls. We are re-releasing this show with an update on the 2017 revised diagnostic criteria for the neurologic condition experienced by this patient. Produced by James E. Siegler. Music courtesy of Julie Maxwell, Yan Terrien, Josh Woodward, Quantum Jazz, 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 Hess CW and Okun MS. Diagnosing Parkinson Disease. Continuum (Minneap Minn). 2016;22:1047-63. Garbutt S, Riley DE, Kumar AN, Han Y, Harwood MR and Leigh RJ. Abnormalities of optokinetic nystagmus in progressive supranuclear

A 50-year-old gentleman presents with severe headaches and speech disturbance. The MRI shows acute strokes and multifocal vascular irregularities. Is it reversible cerebral vasoconstriction syndrome or primary angiitis of the central nervous system? Or is it something else entirely? RCVS and PACNS almost always pose a challenge--even to the most astute neurologist. But, because they are treated entirely differently and their clinical trajectories depend on these treatments, it is worth knowing how experts distinguish the two. This week on the BrainWaves podcast, Dr. Jesse Thon joins Jim Siegler in a discussion about the clinical and radiographic features of these two conditions, and shares his experience in managing these patients. Produced by James E. Siegler and Jesse Thon. Music courtesy of Nuno Adelaida, Peter Rudenko on the piano, Squire Tuck on the guitar, Swelling, and Uncanny. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education onl

In this week's Teaching through Clinical Cases, Dr. Olga Rosenveld Thon (Drexel) walks us through the challenging management decisions that emerge in the care of women with demyelinating disease. Why are women prone to multiple sclerosis? How do pregnancy, breastfeeding, and menopause influence the disease course--and should these events alter the course of their therapy? Produced by James E. Siegler and Olga Thon. Music courtesy of Cellophane Sam, Chris Zabriskie, Jon Watts, Kai Engel, and 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. DISCLOSURES Dr. Rosenveld Thon reports relevant financial interests in Ocrevus, as a consultant. REFERENCES Michel L, Foucher Y, Vukusic S, Confavreux C, de Seze J, Brassat D, Clanet M, Clavelou P, Ouallet JC, Brochet B, Pelletier J, Labauge P,

In episode 142, Jim Siegler is joined by Dr. Deena Kuruvilla (Yale University School of Medicine) to discuss the 5 trigeminal autonomic cephalalgias--what we know about the pathophysiology, the diagnostic criteria, and current and future management strategies. Produced by James E. Siegler and Deena Kuruvilla. Music courtesy of Ars Sonor, Axletree, Kevin McLeod, Lee Rosevere, and Steve Combs. 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 Goadsby PJ. Trigeminal autonomic cephalalgias. Continuum (Minneap Minn). 2012;18:883-895 Lambru G, Matharu MS. Sunct, suna and trigeminal neuralgia: Different disorders or variants of the same disorder? Curr Opin Neurol. 2014;27:325-331 Akram H, Miller S, Lagrata S, Hyam J, Jahanshahi M, Hariz M, et al. Ventral tegmental area deep brain stimulati

You might think George Clooney gets his devilishly handsome smile from well polished genes or a long history of acting lessons. As it turns out, he has mild residual weakness from a remote Bell's Palsy. In this week's installment of the BrainWaves podcast, we've got even more factoids about the facial nerve as we revisit a prior show that originally aired in January 2017. We've touched up the audio a bit, so get comfortable and grab a pen, you may want to take notes on this one. Produced by James E. Siegler. Music courtesy of Marcos H. Bolanos, Jon Watts & 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 1. Gilden DH. Clinical practice. Bell's Palsy. The New England journal of medicine. 2004;351:1323-31. 2. Sweeney CJ and Gilden DH. Ramsay Hunt syndrome. Journal of

Things are heating up for BrainWaves this week as we explore an exciting new topic in our digital curriculum: Heat-related illness. From the causes to the manifestation of the various causes of hyperthermia which can ultimately lead to circulatory collapse. But don’t panic. It’s just a podcast. Produced by James E. Siegler. Music courtesy of Ghost, John Bartmann, Kai Engel, and Marco Trovatello. 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. **7 July 2019 update** Much appreciated feedback from passionate listener Phoebe Duke (Spokane Falls Community College)! Whenever possible, submersion in cold water remains the most effective way to cool the body during heatstroke. Recommended by the AHA and other professional societies. Thanks for the input Phoebe! My REFERENCES Casa DJ, Armstrong LE,

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

Since January 1, 2019, there have been nearly 900 confirmed US cases of measles across 24 states. This is 10 times greater than the number of cases in the US 3 years ago, and it is the largest outbreak the US has seen since 1994. The month of May also marks the first reported case of measles in the state of Pennsylvania, where BrainWaves is produced. So this week on the program, Jim Siegler speaks with Dr. Erika Mejia (pediatrician) about the medical and sociopolitical triggers for this outbreak, the misconceptions of the measles-mumps-rubella vaccine, and finally, what you can do to keep measles from "going viral"*. Produced by James E. Siegler and Erika Mejia. Music courtesy of Advent Chamber Orchestra, Coldnoise, Josh Woodward, Kevin McLeod, and Lee Roosevere. 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 updat

It would be an understatement to say that endovascular thrombectomy has revolutionized acute stroke management. As of 2018, the American Heart Association recommends treatment up to 24 hours after time last seen normal for select patients. This week on the BrainWaves podcast, Dr. Tudor Jovin--PI for the DAWN and REVASCAT clinical trials--summarizes the history of thrombectomy trials, and what it is about our current strategies that have breathed new life into a technique that has historically fizzled. 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&EID=54399]. BrainWaves' listeners get $150 off their enrollment fee using the promo code 'WAVES2019'. Produced by James E. Siegler and Jesse Thon. Music courtesy of Cuicuitte, Coldnoise, Medyn, Jon Watts, Lee Rosevere, and Mystery Mammal. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are

Although he may never have attended university, Leonardo da Vinci (1452-1519) was a true scholar of the Renaissance. His contributions to civil and mechanical engineering, the creative arts, and natural philosophy are nothing short of extraordinary. Less well popularized--although of equal importance--were his accomplishments in the field of anatomy. This week on the BrainWaves Podcast, we delve into his discoveries, his methodology, his handedness, and the message he has left us with. IF YOU'RE TAKING YOUR NEUROLOGY BOARDS, and not sure how to prepare, check out the 2019 Penn Neurology Board Review Course here [https://upenn.cloud-cme.com/default.aspx?P=5&EID=54399]. If Leonardo da Vinci had gone to school, he would have liked this course. BrainWaves' listeners get $150 off their enrollment fee using the promo code 'WAVES2019'. Produced by James E. Siegler. Music courtesy of Sergey Chereminisov, Peter Rudenko, Fatal Injection, Andrew Sacco, Alavedra Montserrat, William McColl, and Joseph Levine. Sound ef