Today we’ll focus on a major shift in the treatment of myasthenia gravis -- as a wave of new therapies is changing how we treat this disease. Who should be considered for these new treatments? And what else is in the pipeline?

Our guest today is Dr.  Gil Wolfe, a neuromuscular neurologist at the University of Buffalo State University of New York, Jacob School of Medicine and Biomedical Sciences. Dr. Wolfe was interviewed by Dr. Ioannis Karakis, adjunct professor of neurology at Emory University School of Medicine.

References:

• https://www.nature.com/articles/s41598-024-79918-7

Disclosures: Dr. Wolfe discloses: Consultant for: Alexion, Argenx, BPL, Cartesian, Canopy, Grifols, Johnson & Johnson, Takeda, UCB; Speaker Bureau for: Grifols, Alexion, UCB; Grant/Research support from: ArgenX, Ra/UCB, Immunovant, Roche, Alexion, Sanofi

Climate change is no longer a distant worry—it’s showing up in neurology clinics across the US, from Lyme meningitis in the Midwest to worsening migraines during heat waves, climate-linked and vector-borne neurological conditions are entering the differential.

Our guests today are two experts on climate change and neurological health: Dr. Beth Malow, Professor of Neurology and Pediatrics at Vanderbilt University Medical Center, and Dr. Monica Diaz, Assistant Professor of Neurology at the University of North Carolina at Chapel Hill. They’ll explore the clinical impact of climate change on neurology, and how neurologists can adapt through patient care, advocacy, and research.

Drs. Malow and Diaz were interviewed by Dr. Sara Stern-Nezer, Associate Professor of Neurology at the University of California, Irvine.

• Interviewer: Dr. Sara Stern-Nezer, Associate Professor of Neurology at the University of California, Irvine
• Guests: Dr. Beth Ann Malow, Professor of Neurology and Pediatrics at Vanderbilt University Medical Center, and Dr. Monica Diaz, Assistant Professor of Neurology at the University of North Carolina at Chapel Hill
• Disclosure: Dr. Malow serves as a consultant for Neurim Pharmaceuticals.
• Resources: Neurologists Interested in Climate and Health (NICHE)
  • Climate Change and Brain Health: What Do We Know and What Can We Do? http://nichebrainhealth.com/what-we-can-do/

Restless leg syndrome is a common movement and sleep disorder affecting 2-3% of the population. Certain neurologic disorders are associated with a higher incidence, and neuropsychiatric medications prescribed by neurologists and psychiatrists often exacerbate these symptoms. In January, the American Academy of Sleep Medicine published updated guidelines for the evaluation and treatment of RLS. The recommendations shifted from recommending the use of dopamine agonists, to prioritizing iron evaluation and supplementation, alpha-2-delta ligands (gabapentin, gabapentin enacarbil, pregabalin), and recommending against the long-term use of dopamine agonists. The guidelines also recommend opiates for moderate-severe medication refractory RLS. Dr. Winkleman is a Professor of Psychiatry at Harvard Medical School and chief of the Sleep Disorders Clinical Research Program in the Department of Psychiatry at Massachusetts General Hospital. He is the first-author on the new guidelines, and is here to discuss these changes and what is needed to effectively change practice. He is interviewed by Dr. Kara Wyant, Clinical Assistant Professor of Neurology, University of Michigan Medical School. RLS Curbside

Look around you right now and think for a minute about all of the things you’re exposed to: the coffee you’re drinking, the mug holding the coffee you’re drinking, the soap that mug was washed in, the sleep you got last night -- or didn’t get. All of this is part of what we now call your exposome. And as we’re learning, the neural exposome influences our risk of developing a range of neurologic diseases.

Our guest today is Dr. Eva Feldman, the  James W Albers Distinguished University Professor and the Russell N. De Young professor of neurology and neurosurgery at the University of Michigan. She’ll talk to us about research on the neural exposome in neurodegenerative disease -- and what we should be telling patients and policymakers about this research. Dr. Feldman was interviewed by Dr. Vinita Acharya, Professor of Neurology and Distinguished Educator at Penn State College of Medicine.

• Guest: Dr. Eva Feldman, the  James W Albers Distinguished University Professor and the Russell N. De Young professor of neurology and neurosurgery at the University of Michigan - https://medicine.umich.edu/dept/mni/eva-feldman-md-phd 
• Interviewer: Dr. Vinita Acharya, Professor of Neurology and Distinguished Educator at Penn State College of Medicine
• Disclosures: None

Neurologists bring an important perspective to health policy. But few have formal training in how to advocate for patients at a state or national level. Our guest today, Dr. Kara Stavros, is an associate professor of neurology at The Warren Alpert Medical School of Brown University and the President of the Rhode Island Medical Society. She’s also a self-described advocate, who’s found a number of ways to speak up for her patients and influence health policy. Dr. Stavros spoke about her path to advocacy with Dr. Sarah Nelson, Assistant Professor of Neurology at Tufts Medical Center.

• Guest: Dr. Kara Stavros, associate professor of neurology at The Warren Alpert Medical School of Brown University and the President of the Rhode Island Medical Society
• Interviewer: Dr. Sarah Nelson, Assistant Professor of Neurology at Tufts Medical Center
• Disclosures: None

Parkinson’s Disease has long been a clinical diagnosis. But recently, there have been proposals to redefine the disease based on biomarkers of alpha-synucleinopathy and dopaminergic dysfunction. A similar shift has already occurred in Alzheimer disease, with the “amyloid, tau, and neurodegeneration,” or ATN, classification system. 

Our guest today, Michael Okun, is is Professor of Neurology and Director of the Norman Fixel Institute for Neurological Diseases at the University of Florida and medical advisor for the Parkinson's Foundation. He co-authored an op-ed in JAMA last summer in JAMA arguing that there would be benefits to a biological definition of Parkinson’s - but there would also be risks. He’ll unpack both sides of this debate today with Dr. Christine Doss Esper, Associate Professor of Neurology at Emory University. Series 6, Episode  5

Featuring:

• Guest: Dr. Michael Okun, is Professor of Neurology and Director of the Norman Fixel Institute for Neurological Diseases at the University of Florida and medical advisor for the Parkinson's Foundation
• Interviewer: Dr. Christine Doss Esper, Associate Professor of Neurology at Emory University
• Disclosures: None

We all know that atrial fibrillation is associated with increased risk of stroke. But new research suggests that how we define afib -- and the timing and duration of the arrhythmia -- may be important for how we manage it in stroke patients. Luciano Sposato is a Professor of Neurology and Head of the Stroke Program at Western University in Ontario. He’ll talk to Christoph Stretz, vascular neurologist at Brown University, about the latest research into afib and aflutter after stroke -- and how this research might impact current clinical practice. Series 6, Episode 4

Featuring: Guest: Dr. Luciano Sposato, Professor of Neurology and Head of the Stroke Program at Western University in Ontario & Interviewer: Christoph Stretz, vascular neurologist at Brown University

Disclosures: Dr. Sposato disclosed consulting fees and honoraria from Bayer, Boehringer Ingelheim, Pfizer, Gore, Astrazeneca, and Simcere.

Dementia is a global issue, with two-thirds of people with dementia living in low- and middle- income countries. Despite this, dementia research continues to focus on patients in high-income countries. Our guest on this episode, Dr. Riadh Gouider, is working to correct this imbalance. Dr. Gouider is the Head of the Department of Neurology and the Alzheimer Center at Razi Hospital in Tunisia and an advisor on the latest WHO Global Action Plan on the public health response to dementia. He spoke with Dr. Jayant Acharya, Professor and Chair of Neurology at Southern Illinois University School of Medicine -- about challenges, and opportunities, for dementia research across the globe. Series 6, Episode 3

Featuring: Dr. Riadh Gouider, Head of the Department of Neurology and the Alzheimer Center at Razi Hospital in Tunisia & Dr. Jayant Acharya, Professor and Chair of Neurology at Southern Illinois University School of Medicine.

• Disclosures: None

Below are the links to the publications discussed during this episode.

• Lancet Commission on Dementia: https://www.thelancet.com/commissions/dementia-prevention-intervention-care
• WHO Global Action Plan on Dementia: https://www.who.int/publications/i/item/global-action-plan-on-the-public-health-response-to-dementia-2017---2025

It used to be that surgery for medically refractory epilepsy was big, open and invasive, a treatment of last resort. The landscape has changed in recent decades, with more and more minimally invasive surgical approaches being developed. So what does this mean for the average patient with medically refractory epilepsy? Our guest today is Dr. Jon Willie, Associate Professor, Department of Neurological Surgery, Washington University School of Medicine in St. Louis. He speaks with Dr. Ionnis Karakis, Epileptologist and Adjunct Professor of Neurology at Emory University, about the new landscape of epilepsy surgery. Series 6, Episode 2

Featuring:

• Guest: Jon T. Willie, MD, PhD, FAANS, Associate Professor, Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
• Interviewer: Ioannis Karakis, MD, PhD, MSc., Epileptologist and Adjunct Professor of Neurology at Emory University

Disclosures: Dr. Karakis disclosed that he is a consultant for USB, GSK, Ceribell, and Epitel. Dr. Willie disclosed Consulting for Clearpoint, Inc, AiM Medical Robotics, Inc., and Fortec Medical, Inc.; Contracted Research with Abbott, Inc., Neurona, Inc., and Neuropace, Inc.; and Honoraria from Medtronic, Inc. 

Until recently, the Glymphatic System was a neglected corner of neuroscience. Now it’s increasingly clear that the brain’s system for the flow of fluid, nutrients, and waste plays an important role in sleep and brain disease. With glymphatics in the spotlight, researchers are coming up with innovative ways to study this slow, constant flow of cerebrospinal fluid throughout the brain. Dr. Daniel Claassen is a Professor of Neurology and Chief of the Behavioral and Cognitive Neurology Division at Vanderbilt University, who researches the glymphatic system in humans. He’ll talk about new directions in glymphatics research with Dr. Cheran Elangovan, a Vascular Neurologist at the University of Tennessee Health Science Center. Series 6, Episode 1

Featuring:

• Guest: Dr. Daniel Claassen is a Professor of Neurology and Chief of the Behavioral and Cognitive Neurology Division at Vanderbilt University
• Interviewer: Dr. Cheran Elangovan, a Vascular Neurologist at the University of Tennessee Health Science Center
• Disclosures: No relationships