Enjoy this Valentine’s Day edition of Lessons From the Lab! Drs. Rubin and Levin work through a case with some twists and turns and a variety of teaching points – it’s just like not knowing what you are going to get when you open a box of Valentine’s Day chocolates!

Grab your hot chocolate and cozy up to your fireplace as you warm up with an educational discussion about a patient who lost his voice. Drs. Rubin and Munin will help teach you how to help patients find their voice (or at least find some muscles contributing to their voice with needle EMG) as they figure out the best way to approach this patient.

In this AANEM podcast, Dr. Stino interviews Dr. Allen on the groundbreaking ADHERE study, published in Lancet Neurology in 2024, which investigated efgartigimod for treating chronic inflammatory demyelinating polyneuropathy (CIDP). As the largest CIDP trial to date with 322 patients across 146 sites, it marked the first major study of a targeted biologic therapy in CIDP. The trial featured a unique two-stage design: An open-label response phase followed by a randomized controlled phase for responders. Dr. Allen explains the rationale behind targeting IgG in CIDP, despite its less clear antibody-mediated mechanism compared to myasthenia gravis. The study demonstrated a 66-70% response rate in the open-label phase, with significantly lower relapse rates compared to placebo in the randomized phase. This research represents a significant advancement in CIDP treatment options, offering a weekly subcutaneous administration that could reduce treatment burden compared to traditional therapies.

In this AANEM podcast, Dr. Andrés De León interviews neuromuscular pathology experts Dr. Aziz Shaibani and Dr. Marcus Pinto about the current state and value of muscle and nerve biopsies in clinical practice. The discussion covers essential topics including proper indications for biopsies, technical considerations in choosing biopsy sites, staining techniques, and the impact of advancing genetic testing on diagnostic approaches. Dr. Shaibani emphasizes that while genetic testing has reduced some muscle biopsy indications, biopsies remain crucial for certain conditions like inflammatory myopathies and mitochondrial disorders. Dr. Pinto details specific scenarios where nerve biopsies are invaluable, particularly in diagnosing vasculitic neuropathy and amyloidosis. Both experts share insights on the complementary role of muscle and nerve biopsies in conditions like systemic vasculitis and discuss how modern diagnostic tools like myositis antibody testing and genetic panels are changing but not eliminating the need for tissue diagnosis.

In this AANEM podcast, Carrie Ford, a CNCT and R.NCS.T. from the University of Utah's Jack Petajan EMG Lab, interviews Dr. Kyle Mahoney, an associate professor at the University of Utah, who provides a comprehensive explanation of neuromuscular junction transmission and the critical concept of the "safety factor." He breaks down complex neurophysiological concepts using accessible analogies, explaining how the safety factor serves as a built-in buffer that ensures reliable nerve-to-muscle signal transmission. The discussion covers normal neuromuscular junction function, the impact of various pathological conditions such as Lambert-Eaton Myasthenic Syndrome, myasthenia gravis, and ALS on neuromuscular transmission, and the clinical significance of repetitive nerve stimulation testing. Dr. Mahoney's clear explanations make these technically challenging concepts more approachable for healthcare professionals, particularly EMG technicians who may be less familiar with the underlying mechanisms of neuromuscular transmission.

In this AANEM podcast, Dr. Kelly Gwathmey interviews Dr. Aziz Shaibani and Dr. Yessar Hussain, two experienced neuromuscular specialists who run successful private practice clinical research programs in Texas. They discuss the motivations for conducting clinical trials, including expanding treatment options for patients and contributing to medical advancement. The experts share valuable insights about building research infrastructure, recruiting patients, managing competing trials, and balancing clinical duties with research responsibilities. They emphasize the importance of having well-trained research coordinators, efficient databases, and proper facility space. Both physicians stress the need for more clinical trial training in medical education and encourage young physicians to enter the field, noting that while only 5% of physicians participate in clinical trials, there are over 200,000 trials currently listed in the USA, presenting significant opportunities for new researchers.

In this comprehensive discussion, four prominent neuromuscular experts—Drs. Bhaskar Roy, Jeff Allen, Diana Castro, and Luis Querol—explore recent developments in Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). The conversation centers on the new European Academy of Neurology and Peripheral Nerve Society guidelines, highlighting significant changes in diagnostic criteria and disease classification. The experts discuss the challenges of diagnosing CIDP, particularly in pediatric cases and variant forms, while emphasizing the importance of proper electrodiagnostic testing and the role of supportive criteria like CSF studies and MRI. They delve into the emerging field of autoimmune neuropathies and the significance of specific antibody testing. The podcast concludes with a discussion of treatment options, including traditional approaches (IVIG, corticosteroids, plasmapheresis) and newer therapies such as FcRn inhibitors and complement-targeting drugs, while also addressing the controversial role of rituximab in CIDP treatment. Throughout the discussion, the experts stress the importance of regular diagnostic reassessment and the need for more personalized treatment approaches based on patient profiles.

This podcast discusses paraproteinemic neuropathies,