215 episodes

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 Jim Siegler, MD | Neurologist | Father | Friend of dogs

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    • 5.0 • 3 Ratings

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**

    #33 Controversies in chronic traumatic encephalopathy

    #33 Controversies in chronic traumatic encephalopathy

    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.

    • 18 min
    Best of BrainWaves 2020

    Best of BrainWaves 2020

    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.” Clinica

    • 1 hr 7 min
    #176 Mind blown

    #176 Mind blown

    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.

    • 30 min
    #175 Call your Mom

    #175 Call your Mom

    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.

    • 20 min
    #174 The mental status

    #174 The mental status

    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
    Tombaugh TN and McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992;40:922-35. 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. 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. 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. 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. 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.

    • 29 min
    #93 Aspirin vs. Plavix: The showdown

    #93 Aspirin vs. Plavix: The showdown

    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
    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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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

    • 20 min

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