Patients with refractory or high-risk myasthenia gravis (MG) respond poorly to conventional immunosuppressive therapy, requiring rescue therapies and often experiencing treatment toxicity. The study discussed in this podcast suggests that lower doses of cyclophosphamide can be effective and safe in people with MG, including older age. JNNP's podcast editor, Saima Chaudhry, is joined by Professor Carolina Barnett-Tapia, University of Toronto, University Health Network, who authors the editorial comment 'Cyclophosphamide for myasthenia gravis: a comeback?'(https://jnnp.bmj.com/content/95/12/1095).

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The effectiveness of endovascular treatment (EVT) in cases of acute ischaemic stroke caused by distal medium vessel occlusion (DMVO) is still unclear. A study in the JNNP assessed the safety and effectiveness of EVT in comparison to the best medical management for DMVO. Podcast host Dr. Saima Chaudhry¹ spoke to some of the paper's authors, Dr. Adam Dmytriw², Dr. Vivek Yedavalli³ and Dr. Hamza Salim³.

Read the paper: Endovascular therapy versus best medical management in distal medium middle cerebral artery acute ischaemic stroke: a multinational multicentre propensity score-matched study

1. Warren Alpert Medical School, Brown University, Rhode Island, USA

2. Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA

3. Radiology, Johns Hopkins Medicine, Baltimore, Maryland, USA

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Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) can be difficult to distinguish from autoimmune nodopathy. In this podcast, Dr. Saima Chaudhry (1) is joined from the Netherlands by Dr. Ruth Huizinga (2) and Dr. Maarten Titulaer (3), to discuss their article, "Clinical relevance of distinguishing autoimmune nodopathies from CIDP: longitudinal assessment in a large cohort". They start with explaining what an autoimmune nodopathy really is, patient features to look out for, and the typical testing process for identifying CIDP.

(1) Warren Alpert Medical School, Brown University, Rhode Island, USA

(2) Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands

(3) Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands

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The cause of a nutritional neuropathy may not always be obvious when first examining a patient. Restrictive diets with roots in religious practices or personal preferences will be less familiar to neurologists than issues involving bariatric surgery or diseases of malabsorption, and can present as being not overtly malnourished. A recent review in JNNP details links between B-vitamin deficiencies and peripheral neuropathy, and discusses historical trends in the occurrence of nutritional neuropathies. The review's last author, Dr. Alexander Rossor (1), joins host Dr. Saima Chaudhry (2) to talk through how to approach this diagnosis.

Read the paper here: "Nutritional peripheral neuropathies"

(1) UCL Queen Square Institute of Neurology, London, UK

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How often do movement disorder specialists agree when classifying tics? A recent study published in JNNP explores this question with a two-stage approach, seeking a diagnosis from experts first based on video evidence alone and then following the provision of additional clinical data. The study's last author, Dr. Christos Ganos (1), joins host Dr. Saima Chaudhry (2) to discuss the results.

Read the paper here: "Distinguishing functional from primary tics: a study of expert video assessments" 

Related links:

European Society for the Study of Tourette Syndrome 2022 criteria for clinical diagnosis of functional tic-like behaviours: International consensus from experts in tic disorders

Tics and functional tic-like movements: can we tell them apart?

(1) Department of Neurology (C.G.), Charité University Medicine Berlin, Germany

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With the UK government announcing plans to make recreational use of nitrous oxide illegal, JNNP podcast host Dr. Saima Chaudhry (1) is joined by London-based neurologist Dr. Alastair Noyce (2)(3) to examine the findings of his group's recently published research paper, "Nitrous oxide-induced myeloneuropathy: a case series". Read the paper here: https://jnnp.bmj.com/content/94/9/681

Related links:

https://www.gov.uk/government/news/nitrous-oxide-to-be-illegal-by-end-of-the-year

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Social media platforms and clinical patient encounters are abundant in references to brain fog, but how much is it really understood? In this episode, JNNP's podcast host, Dr. Saima Chaudhry (1), speaks with Dr. Laura McWhirter (2) about her recently published article, "What is Brain Fog?"and how further understanding of this can help to better treat patients. 

(2) Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK

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In this episode, JNNP's new podcast host Dr. Saima Chaudhry (1) speaks with Dr. Michael Benatar (2) about his recently published article, "A roadmap to ALS prevention: strategies and priorities". This explores a new approach to Amyotrophic lateral sclerosis, with an emphasis on earlier treatment before significant damage has occurred. This is important due to the limited capacity of the central nervous system to repair itself. The researchers involved sought to understand contributing factors for ALS risk, and to identify high-risk groups for further study.

Note: The genetic therapy referred to as Tofersen, under review at the time of recording, has been approved by the FDA: https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-treatment-amyotrophic-lateral-sclerosis-associated-mutation-sod1-gene 

(2) Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA

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In this episode, JNNP's new podcast host Dr. Saima Chaudhry (1) speaks with Dr. Matteo Gastaldi (2) about Myelin oligodendrocyte glycoprotein antibody-associated disease, or MOGAD for short. A multi-centre retrospective study, "Prognostic relevance of quantitative and longitudinal MOG antibody testing in patients with MOGAD", was recently published in JNNP, and Dr. Gastaldi is its first author. Listen to this podcast to learn what MOGAD is, its differential diagnosis and the potential pathogenesis. Plus some discussion of the use of MOG titres in predicting relapse of the disease. You can read the paper at the following link: https://jnnp.bmj.com/content/94/3/201

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Related article: https://jnnp.bmj.com/content/92/12/1325