The Neurology Lounge

In this short podcast, I highlight 10 major neurological disorders that can afflict pregnant women.

Linda Gask joins me in this episode to explore her dual perspectives of depression as a sufferer, and as a psychiatrist. Emerita Professor of Primary Care Psychiatry, Linda chronicles her history of depression which first reared its head when she was in medical school, and dogged her career as a junior doctor and then as a consultant.

Linda described the manifestations of her depression, from low mood and poor motivation to physical pain and suicidality. She also highlighted her co-morbid performance anxiety, obsessiveness, and ruminative thoughts. We also explored her biopsychosocial vulnerabilities to depression, such as a strong family history of mental illness, and the life events that trigger her breakdowns.

The podcast also discussed Linda's double-edged experience of antidepressants, and of psychological therapies. She also highlighted the importance of having healthy relationships and being open about the disorder. Other themes of the conversation are the vulnerability of doctors, especially psychiatrists, to depression and suicide; the practical approaches to managing depression; and the inadequacies of current anti-depressant therapies.

Linda has worked as an advisor to WHO and has been on the Board of the World Psychiatric Association. She co-founded the STORM suicide prevention training organisation, and she now serves as Vice-Chair of the Blide Trust, a mental health voluntary organisation. Her latest book is ‘Out of Her Mind: How We are Failing Women’s Mental Health and What Must Change’.

In this episode I take an exhaustive look at the diverse perspectives of depression, that pervasive mood disorder that afflicts far too many people. I explore its gradual onset and chronic, often life-long course, and highlight the overwhelming features of depression, from low mood and poor appetite to poor sleep and loss of interest in pleasurable activities. I also explore the less appreciated dimension of the pain of depression.

I illustrate the lived experience of depression with such fascinating patient accounts as that of Sally Brampton titled Shoot the Damned Dog, of Lewis Wolpert titled Malignant Sadness, of Andrew Solomon titled The Noonday Demon, and of William Styron titled Darkness Visible. Significantly, the memoirs stress the difficulty people have in recognising that their low mood has crossed the threshold into depression.

The interplay of familial and environmental risk factors of depression is also a major theme of the podcast which emphasised such critical provoking life events as divorce and loss of income. I also discussed the risk of suicide that may complicate depression, a theme that I explored by relying on the book When It is Darkest by psychologist and suicide expert Rory O’Connor.

I also discuss the different treatment modalities of depression, from antidepressants and psychotherapy to somatic therapy, the long road to recovery, and the ever-present risk of treatment resistance and relapse. Other themes the podcast covers are the shame and stigma that accompany depression.

The historical themes of the podcast highlight the insights of Abu Zayd Al Balkhi in depression and cognitive behaviour therapy, that roles played by Sigmund Freud and Joseph Breuer in establishing psychoanalysis, and that of Nathan Kline in the development of the first antidepressant.

This brief podcast reviews the top ten causes of persistent impairment of consciousness.

I am joined in this podcast by Joanne Hedger to discuss her lifelong experience of aphantasia, something she has written about in her memoir titled Aphantasia: Journeying Through Mind Blindness and Embracing Our Unique Neurodiversity with Passion and Purpose. Our conversation delved into how she discovered she had aphantasia when she alone was unable to understand a joke with friends in a camp site. We also explored the emotions this discovery evoked in her, from loneliness and regret to relief and understanding.

Beyond her inability to imagine visually, Joanne also reflected on other lifelong characteristics, such as with dreaming and memory. Other themes we covered in the conversation are the history of our understanding of aphantasia, its acquired and familial causes, its impact on her perception of herself and on her relationships, and the advantages of having aphantasia.

We also explored the strategies she has adopted to compensate, even before she knew she had aphantasia, from relying on lists and spreadsheets to taking a lot of photographs and notes. Joanne also highlighted practical recommendations for parents, teachers and students which included identifying aphantasia early, using memory aids, accepting it as a feature of normal neurodiversity, and making educational adaptations to accommodate it.

Joanne spent her early years growing up on a dairy farm in south-east England where her fascination with nature began. After a corporate career in software consultancy, which spanned 25 years, several continents, and numerous bouts of stress and exhaustion, Joanne quit the rat race in 2017 to follow her passions for wildlife and photography. Despite being mind-blind and left-handed, Joane stressed that she is hugely creative and sees her own level of aphantasia as a quirky fascination, not a hindrance or a disability.

Following graduation, she worked as a guide and later became the manager of a luxury bush camp in the Kafue National Park, Zambia, where she still freelances for a few months each year. She lives in the UK and, when she's not writing, she spends her time rewilding a small piece of ancient woodland, making handmade nature-inspired jewellery and taking photographs. You can find her on Facebook or visit her website, www.elementalretail.com

In this episode, I explore the fascinating phenomenon of aphantasia, the inability to imagine. I discuss the manifestations of the condition which primarily affects visual imagination, but which also affects the ability to imagine sounds, smells, tastes, touch, and even feelings. The podcast also illustrates how aphantasia influences recollection of memories, and how it impacts of education and career.

I illustrate aphantasia with such fascinating memoirs as that of Charlotte Langlais, titled 'Aphantasia Club', and of Alan Kendle titled 'Discover the Fascinating World of Aphantasia'. These show the different ways by which people with aphantasia discover that they have the condition, and the emotions that accompany this knowledge.

Importantly, the podcast also highlights how people with the condition adapt by using alternative strategies, and how they have found such advantages of aphantasia, from the better ability to remember facts and meditate to the lesser risk of reliving painful memories.

The podcast also traces the history of our understanding of aphantasia, starting with Francis Galton who first described, to Adam Zeman who resuscitated its study. This theme also narrated how Zeman came to coin the name aphantasia. Also covered in the podcast is the epidemiology of the condition, its familial and acquired causes, and its associated features, from impaired facial recognition to difficulty recollecting dreams.

In this episode, I explore 10 disorders that manifest during sleep, or are considered sleep disorders. These range from the more familiar REM sleep behaviour disorder, to the lesser-known exploding head syndrome.

I am joined in this podcast by Holly Frances to discuss her experience of Guillain Barre syndrome as she narrated in her illness memoir titled Life Support: Surviving Guillain-Barre Syndrome. Holly is a mother in a blended family of five, and the face behind Holly After GBS on social media, where her recovery videos have inspired millions of people around the world.

Our conversation traced Holly’s illness from onset with mild sensory symptoms through to complete paralysis within a short time. Importantly, she highlighted less appreciated symptoms of the disease that she experienced, particularly neck pain, a major early symptom that initially indicated a different diagnosis, and which exacerbated and spread as her illness progressed.

Holly chronicled how her weakness progressed rather rapidly to complete paralysis and requirement for ventilation on the intensive care unit. We also discussed the spinal fluid analysis and electromyogram tests she had to confirm the clinical diagnosis of GBS, and the various treatments she received. Our conversation also detailed her long rehabilitation course, interspersed by relapses, and her long and slow journey to complete recovery.

Significantly, Holly also explored the emotional and psychological burden that the illness placed on her, ranging from fear and anxiety to resentment and depression, and the uncertainty that plagued her mind regarding outcome. We also covered how her life and relationships changed on account of her experience of GBS, what the illness has taught her, and the advocacy work that is now the focus of her work.

In this episode, I delve into Guillain Barre syndrome, a relatively common neurological disorder. I discuss the clinical manifestations of the disease which range from fairly rapid weakness and sensory impairment to pain and breathing difficulty. I also detail the long road to recovery from the disease. The podcast also discusses the almost limitless triggers for GBS, from infections and vaccinations to trauma and childbirth.

I also review the pathology of the disease, explaining how a wide range of antibodies target the fatty myelin covering of the nerves to reduce the efficiency of electrical nerve transmission. The podcast also highlights the investigations of GBS, particularly spinal fluid analysis and nerve conduction studies, and the treatment of the disease, which canter around immune modulating agents.

I also chronicle the history of the terminology of GBS, following the work of the three French physicians, Georges Guillain, Jean Alexandre Barré, and André Strohl. I refer in this theme to the book 'Guillain-Barre Syndrome: From Diagnosis to Recovery', by Gareth Parry and Joel Steinberg.

I illustrate the clinical aspects of GBS with such graphic patient memoirs as those of Carole Williams, titled 'Chaos in Body and Mind', of Meg Lumsden, titled 'Unknown', of Wenesday Ketron titled 'Geeyahn What?', of Scott Earle titled 'The Wave of Guillain Barre Syndrome', and of Robin Sheppard titled 'A Solitary Confinement'.

In this episode, Amanda Ellison joins me to explore the intersection of brain science and clinical practice as it relates to cluster headache. Amanda is a neuroscientist and physiologist, professor in the Psychology Department in Durham University and former Director of the Wolfson Research Institute for Health and Wellbeing, and she is interested in understanding how different brain regions communicate to create our behaviour and experience of the world around us.

Our conversation on the history of the understanding of cluster headache used the monickers that have been applied over time as fulcrum, and these included migrainous neuralgia as proposed by Wilfred Harris, and Horton’s cephalalgia. We also explored the emergence of the name cluster headache, and how this coincided with the establishment of the International Headache Society.

The podcast also exhaustively reviewed the biological mechanisms driving cluster headache with references to the emerging role of the hypocretin system in generating the disease, as well as its tendency to manifest in men and in smokers. We also delved into the clinical manifestations of the disease, with Amanda noting both the classical and the non-classical presentations. She also explored the circadian periodicity of the disease in the context of the role played by the suprachiasmatic nucleus and serotonin-melatonin pathway.

The discussion also covered the acute treatment of alcohol especially with triptans and alcohol, a theme that reviewed the scientific contributions of Lisa Kudrow, the star of the television show Friends, and her father – both neuroscientists. We also looked at the history of the use of verapamil and lithium, the main prophylactic drugs of cluster headache. Amanda also explored the how coffee, chocolates and sex are biologically able to mitigate the severity of headaches, and the research into the place of deep brain stimulation of in the treatment of the disorder.