VJNeurology Podcast

In this podcast episode, leading experts Kara Melmed (NYU Langone Health, New York City, NY) and Chitra Venkatasubramanian (Stanford University, Stanford, CA) debate blood pressure targets in ICH, focusing on the key question: how low should we go? They discuss the pathophysiological background for lowering blood pressure in ICH, key trial evidence, selecting between agents, and give advice for practicing clinicians.

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Welcome to today’s podcast, which focuses on the understanding and management of rare brain disorders. This episode, in honor of Rare Disease Day, delves into a variety of rare conditions, including adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP), phenylketonuria (PKU), cerebral autosomal dominant arteriopathy with subcortical infarct (CADASIL), succinic semialdehyde dehydrogenase deficiency (SSADHD), and rare epilepsies.

This podcast features Zbigniew Wszolek, MD, Mayo Clinic, Jacksonville, FL, Bernadette Sheehan Gilroy, PhD candidate and rare disease advocate, Munster Technological University, Kerry, Ireland, Elisa Ferrante, PhD, National Institutes of Health, Bethesda, MD, Christian Brandt, MD, Bielefeld University Medical School, Bielefeld, Germany, Simona Balestrini, MD, PhD, University College London, London, UK, and Henry Lee, PhD, Boston Children’s Hospital, Boston, MA.

The post Advancing the awareness and management of rare neurological disorders: ALSP, PKU, CADASIL, SSADHD, & rare epilepsies appeared first on VJNeurology.

The 2024 revision of the McDonald diagnostic criteria for multiple sclerosis (MS) was recently presented at the 40th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS 2024). Key updates include the recognition of optic nerve lesions, the incorporation of cerebrospinal fluid (CSF) kappa-free light chains as a diagnostic biomarker, and the addition of central vein sign (CVS) and paramagnetic rim lesions (PRLs) as imaging markers.

This podcast features experts Marcello Moccia, MD, PhD, University of Naples Federico II, Naples, Italy, Serena Borrelli, MD, Université catholique de Louvain & Hôpital Erasme, Université Libre de Brussels, Brussels, Belgium, Celia Oreja-Guevara, MD, PhD, University Hospital San Carlos, Madrid, Spain, and Giancarlo Comi, MD, Vita-Salute San Raffaele University, Milan, Italy, who discuss the updates. They delve into the diagnostic value of CVS, PRLs, and optic nerve lesions, and speak about the implementation of these new guidelines into clinical practice.

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Dopaminergic medications have been widely used in the treatment of restless legs syndrome (RLS), where they are effective at reducing symptoms in the short term. However, long-term use of these agents has been associated with augmentation, a worsening of symptoms over time or earlier in the day. This phenomenon has led to a shift in treatment recommendations, favoring non-dopaminergic options as first-line therapies.

This podcast brings you updates on managing augmentation in RLS from Sleep Europe 2024, which took place in Seville, Spain. You will hear from experts Celia Garcia-Malo, MD, PhD, Centro Integral de Sueño y Neurociencias CISNe, Madrid, Spain, Diego Garcia-Borreguero, MD, PhD, Sleep Research Institute, Madrid, Spain, and Ambra Stefani, MD, PhD, Medical University of Innsbruck, Innsbruck, Austria. They delve into the role of dopaminergic agonists in the treatment of RLS and how augmentation can develop. They suggest various alternative therapies, give advice for terminating dopaminergic agents, and provide updates on guidelines regarding the use of dopaminergic therapies. 

The post Updates on managing augmentation in RLS from Sleep Europe 2024 appeared first on VJNeurology.

In recent years, genetic therapies have garnered much attention for their potential to modify the underlying pathological processes in neurological diseases. By correcting, replacing, or removing aberrant genetic material, gene therapies could revolutionize the treatment of many diseases, where symptomatic management is the only available option.

Examples of gene therapy methods include the use of CRISPR/Cas9 technologies to directly edit genetic mutations, vector-based gene therapy to deliver new genetic material, and antisense oligonucleotides (ASOs) to modulate gene expression.

The success of gene therapy in treating diseases like spinal muscular atrophy (SMA) has paved the way for similar approaches in amyotrophic lateral sclerosis (ALS), with several groundbreaking clinical trials taking place in recent years. 

In this podcast, we are joined by leading neurologist Prof. Dame Pamela Shaw who will share her insights into the progress in genetic therapies for ALS and explain the challenges being faced, offering a glimpse into the future ALS therapy landscape.

With Prof. Dame Pamela Shaw, DBE, MBBS, MD, FRCP, FMedSci, FAAN, FANA, FAAAS, University of Sheffield, Sheffield, UK.

The post ALS Gene Therapy Insights with Prof. Dame Pamela Shaw appeared first on VJNeurology.

In this episode, we delve into the complexities of managing status epilepticus, particularly the refractory stages that resist initial treatments. Status epilepticus is a neurological emergency that requires prompt medical intervention to prevent significant morbidity and mortality. Despite aggressive treatment, some cases do not respond to initial lines of therapy. Refractory and super refractory status epilepticus pose significant treatment challenges and carry high risks, including neuronal injury, long-term neurological deficits, and increased mortality. 

Tune in to learn more about the approaches to refractory and super refractory status epilepticus management, novel strategies that are gaining traction, unique considerations in the pediatric population, and new research looking at biomarkers in new-onset refractory status epilepticus (NORSE) to predict short- and long-term outcomes.

With Clio Rubinos, MD, University of North Carolina at Chapel Hill, Chapel Hill, NC; Maria Roberta Cilio, MD, PhD, Université Catholique de Louvain, Brussels, Belgium; and Aurelie Hanin, PharmD, PhD, Yale University, New Haven, CT.

The post Navigating Status Epilepticus: Breakthroughs in Management appeared first on VJNeurology.

Medication-overuse headache (MOH) is a neurological disorder, affecting 1% of the general population. It plays a huge role in transforming headache disorders from episodic to chronic, and has a significant impact on the patients’ quality of life.

MOH is classified as a chronic headache disorder secondary to a pre-existing headache syndrome, in which headache occurs on ≥15 days per month in a patient with regular medication overuse for ≥3 months. Several different approaches are used to treat MOH, with a lack of clear evidence as to which method is optimal. The need for detoxification, and how quickly to detoxify, as well as the best timing for the introduction of preventive medication is the subject of ongoing debate.

In this episode, we are joined by neurology experts who will provide valuable insights into the diagnosis and treatment of MOH. They will explore important topics including how to manage MOH, predictors of relapse, and the follow-up care required for successful treatment.

With Sait Ashina, MD, Harvard Medical School, Boston, MA; Morris Levin, MD, University of California San Francisco, San Francisco, CA; Alan Rapoport, MD, University of California, Los Angeles, CA; and Licia Grazzi, MD, Fondazione IRRCS Istituto Neurologico Carlo Besta, Milan, Italy.

The post Breaking the Cycle: Debating Management Approaches in Medication Overuse Headache appeared first on VJNeurology.

The latest guidelines recommend endovascular thrombectomy (EVT) as the gold standard treatment approach for eligible patients with an acute ischemic stroke due to large vessel occlusion, but there is currently no robust randomized control data supporting its routine use in medium vessel occlusion (MeVO) strokes.  

In this podcast, stroke experts delve into current uncertainties surrounding the management of small- and medium-vessel strokes, namely optimal detection and treatment strategies. They discuss current guidelines, key debates, and ongoing randomized clinical trials assessing the efficacy of EVT in MeVO stroke.

With Johanna Ospel, MD, University of Calgary, Alberta, Canada; Nishita Singh, MD, University of Calgary, Alberta, Canada; and Jan Gralla, MD, Inselspital, University Hospital Bern, Bern, Switzerland.

The post Examining evidence for EVT in MeVO stroke appeared first on VJNeurology.

Over the past decade, a genomic revolution has unfolded in medicine, and the epilepsy space is no exception. The intricacies presented by the diverse array of epilepsy syndromes and the highly variable inter-individual responses to therapies create considerable challenges in disease management.

With advancements in DNA sequencing revealing a genetic component in over 30% of epilepsy syndromes, genetic testing now plays a crucial role in confirming clinical diagnoses, predicting disease prognosis, and guiding treatment decisions. Tailoring medication choice to an individual’s genetic makeup aims to not only lessen seizure burden, but also improve the patient’s comorbidities and quality of life. Ongoing research is dedicated to developing therapies that directly address and correct the genetic variants responsible for the disease, while simultaneously unraveling the underlying mechanisms and pharmacogenomics of individual epilepsies.

In this podcast, join us as Guido Rubboli, MD; Simona Balestrini, MD, PhD; Reetta Kälviäinen, MD, PhD; and Kristen Park, MD, share their invaluable perspectives on the cutting-edge advancements in precision medicine for epilepsy. Together, they unravel key advances, including the use of pharmacogenomics for decision making, the development of gene therapies, and the role of gene modifiers in phenotypic expression.

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Cluster headache, a rare and severe form of headache disorder, represents the most common trigeminal autonomic cephalalgia. Due to its rarity and often refractory nature, management can be challenging. Treatment accessibility is also inadequate, with certain options such as triptans, oxygen, and neuromodulation being inaccessible or costly. While acute management often utilizes therapies effective in various other headache conditions, there remains a significant unmet need for more specific, efficacious, and tolerable treatments, especially for prevention.

In this podcast, leading experts delve into the current and emerging therapies for cluster headache. Elizabeth Leroux, MD, FRCP, from the University of Calgary, outlines the current strategies for episodic and chronic cluster headache management based on recently published guidelines. Dr. Leroux also explores emerging strategies including psilocybin and SPG stimulation. Rigmor Hojland Jensen, MD, from the University of Copenhagen, delves into the role of CGRP in cluster headache pathophysiology and treatment and addresses limitations in current treatment strategies.

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