ANA Investigates

Recently on the podcast we’ve been talking about neurotechnology -- devices that interface with the brain to treat disease, for example by restoring speech function in people with locked-in syndrome, or motor function in people with paralyzed limbs. But listen to the media, and you’ll also hear buzz about neurotechnology for healthy people... Series 4, Episode 7

• Guest: Philip Sabes, PhD, UCSF
• Interviewer/Producer: Rohini Samudralwar, MD, University of Pennsylvania

This episode is non-CME.

Among several highlights of the recent International Stroke Conference was new evidence supporting endovascular thrombectomy for patients with so-called “large core” ischemic strokes. In current practice, thrombectomy is considered for patients with occlusions of the internal carotid or middle cerebral artery who are less than 24 hours since the last known well and have a small “core” of ischemia on non-contrast head CT or CT or MR perfusion imaging -- in other words, there’s radiographic evidence that only a small core of the brain has suffered permanent injury and a larger penumbra of tissue can be saved. SELECT-2 is a multicenter randomized controlled trial that examined whether patients with LARGE cores of ischemic tissue could ALSO benefit from thrombectomy. On our show today we have SELECT-2 principal investigator Dr. AM-rou sou-RAJ, who is also Professor of Neurology at Case Western Reserve University School of Medicine. He was interviewed by Dr. Michelle Johansen, vascular neurologist at Johns Hopkins University, about what the study results might mean for stroke care -- and stroke imaging -- going forward.

• Guest: Dr. Amrou Sarraj, Professor of Neurology, Case Western Reserve University School of Medicine, George M. Humphrey II Endowed Chair, University Hospitals Neurological Institute, Director, Comprehensive Stroke Center and Stroke Systems, University Hospitals
• Interviewer/Producer: Dr. Michelle Johansen, Johns Hopkins Medicine
• Interviewer/Producer: Dr. Joseph Carrera, University of Michigan

Dr. Sarraj discloses the following relationships: SELECT2 principal investigator - funded by Stryker Neurovascular with research grant to University Hospitals Cleveland Medical Center and UT McGovern Medical School SELECT principal investigator - funded by Stryker Neurovascular with research grant to UT McGovern Medical School Member, Speaker bureau and advisory board - Stryker Neurovascular Provided advisory services to AstraZeneca, Genentech and Lumosa Theraputics

Concussion, or mild acute traumatic brain injury, is incredibly common -- 1 in 5 of adolescents report having suffered a concussion at some point in their lifetime (JAMA. 2021;325(17):1789-1791)... and an estimated 1 in 5 players of contact sports suffer a concussion each season. Sports neurologists are rare enough that most people suffering concussions are never seen by one. And general neurologists aren’t always well-trained to treat this condition, especially as the science of concussion is advancing. Our guest today, Dr. Jose Posas is a sports neurologist and residency program director at Ochsner Medical Center in New Orleans and he spoke to ANA producer Dr. Mandy Jagolino-Cole of The University of Texas Health Science Center at Houston about recent findings in concussion research and how we can apply that research at the bedside. Series 4, Episode 5.

Publication mentioned in the episode: McAllister TW, Broglio SP, Katz BP, Perkins SM, LaPradd M, Zhou W, McCrea MA; Concussion Assessment, Research and Education (CARE) Consortium. Characteristics and Outcomes of Athletes With Slow Recovery From Sport-Related Concussion: A CARE Consortium Study. Neurology. 2023 Jan 18:10.1212/WNL.0000000000206853. doi: 10.1212/WNL.0000000000206853. Epub ahead of print. PMID: 36653178. https://pubmed.ncbi.nlm.nih.gov/36653178/

• Guest: Dr. Jose Posas, Ochsner Medical Center
• Interviewer/Producer: Dr. Amanda Jagolino-Cole, The University of Texas Health Science Center at Houston

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On our December show, we talked about ethical issues surrounding brain-computer interfaces. We’ll pick up the topic again this month with a discussion about one type of brain-computer interface: neuroprosthetics. Our guest is Dr. Edward Chang, Professor and Chair of Neurological Surgery at the University of California San Francisco. Dr. Chang is an expert in brain mapping during neurosurgery, with the aim of preserving the brain areas responsible for language, speech, movement and emotion. His research focuses on neuro-prosthetics that can restore movement in people who are paralyzed and speech in people with speech disorders. As we’ll talk about today, this research raises interesting ideas about the neural representation of speech and language and the ethics surrounding brain-computer interfaces. Dr. Chang was interviewed by ANA Producer Dr. Amanda Jagolino-Cole of The University of Texas Health Science Center at Houston. Series 4, Episode 4. 

• Interviewer/Producer: Dr. Amanda Jagolino-Cole, The University of Texas Health Science Center at Houston, McGovern Medical School
• Guest: Dr. Edward Chang, UCSF Weill Institute for Neurosciences, School of Medicine

Dr. Chang and UCSF have intellectual property related to algorithms for BCI, Dr. Chang is a consultant for Synchron

Football audiences were shaken on January 2nd when Buffalo Bills safety Damar Hamlin suffered a cardiac arrest after a tackle during a Monday Night Football game. He was resuscitated on the field and then transferred to the University of Cincinnati Medical Center in critical condition. Thus began a waiting period, all too familiar to neurologists, while the world wondered to what extent Mr. Hamlin’s brain would recover. But remarkably, just 4 days later, Mr. Hamlin was able to communicate in writing. He was extubated the following day and discharged home on January 11th. Our guest on today’s podcast, ANA Vice President and Johns Hopkins University neurointensivist Dr. Romer Geocadin, says that Mr. Hamlin’s story should inspire hope... not only for families of survivors of cardiac arrest but also for researchers and physicians. Romer was interviewed by ANA Education Innovation committee Chair and UCSF Neurohospitalist Dr. Megan Richie for this special episode of ANA Investigates.... on cardiac arrest and paths to recovery. Series 4, Episode 3.

• Interviewer/Producer: Dr. Megan Richie, UCSF
• Guest: Dr. Romer Geocadin, Johns Hopkins

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The emergence of the syndrome known as long COVID has brought new attention to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). On this episode we explore the advances in science that may soon lead to answers.

• Interviewer/Producer: Dr. Megan Richie, UCSF
• Guest: Dr. Sonya Marshall-Gradisnik, National Centre for Neuroimmunology and Emerging Diseases (NCNED), Griffith University, Queensland, Australia
• Guest: Dr. Kiran Thapaliya, National Centre for Neuroimmunology and Emerging Diseases (NCNED), Griffith University, Queensland, Australia

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Neurotechnology like DBS or transcranial magnetic stimulation have clear benefits in diagnosis and therapy and are largely embraced by the medical community. But what about recent accelerated development from tech entrepreneurs to harness cognitive pathways for everyday tasks? This is referred to as brain computer interface technology or BCI. Commercial products such as Neuralink, attempt to implant chips promising to link brain activity with tasks such as accessing phones or cars. This brings up real questions on autonomy, privacy, and medical implications, but is there more to these technological advancements that could provide medical benefit for our patients? We discuss the commercial and medical aspects surrounding BCI technology and the physician and scientist’s role in this rapidly evolving field with Dr. Karen Rommelfanger, the founder and director of the Neuroethics Program at Emory University and now the founder of the world’s first think and DO tank dedicated wholly to neuroethics called the Institute of Neuroethics. She also serves as a member of the BRAIN Initiative’s Neuroethics Working Group and was on the advisory council to the director of the National Institutes of Health (NIH) for BRAIN 2025. Series 4, Episode 1.

• Interviewer/Producer: Dr. Rohini Samudralwar, University of Pennsylvania
• Guest: Dr. Karen Rommelfanger, Emory University & Institute of Neuroethics

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The role of genetics in both pediatric and adult epilepsies is expanding. Now, making a genetic diagnosis in epilepsy isn’t just important for family planning and prognostication - these diagnoses can also improve patients’ care starting at the moment of diagnosis. Our guest today, Ingrid Scheffer, is a leader in gene discovery in epilepsy. Dr. Scheffer is a Laureate Professor of Pediatric Neurology at the University of Melbourne, and she directs the Children's Epilepsy Research Center at Austin Health. She says while there’s still a long way to go before precision medicine is available for the hundreds of known genetic epilepsies, her patients are already benefiting from genetic testing, in many ways. Dr. Scheffer was interviewed by ANA Investigates Producer and epileptologist Dr. Rohit Das of UT Southwestern Medical Center. Series 3, Episode 12.

• Guest: Ingrid Scheffer, AO FRS FAA FAHMS, University of Melbourne
• Interviewer/Producer: Rohit Das, MD, UT Southwestern

In the past 24 months, Ingrid Scheffer has consulted for Atheneum Partners, Biohaven Pharmaceuticals Inc, Care Beyond Diagnosis, Epilepsy Consortium and Zynerba Pharmaceuticals, has served as an investigator for Anavex Life Sciences, Cerebral Therapeutics, Cerecin Inc, Cereval Therapeutics, Eisai, Encoded Therapeutics, EpiMinder Inc, Epygenyx, ES-Therapeutics, GW Pharma, Marinus, Neurocrine BioSciences, Ovid Therapeutics, Takeda Pharmaceuticals, UCB, Ultragenyx, Xenon Pharmaceutical, Zogenix and Zynerba; received speaker honoraria from Biocodex, BioMarin, Chiesi, Liva Nova and UCB; received funding for travel from Biomarin, Eisai and UCB; and served on scientific advisory boards for Bellberry Ltd, BioMarin, Chiesi, Eisai, Encoded Therapeutics, Knopp Biosciences, Rogcon, Takeda Pharmaceuticals and UCB. Ingrid Scheffer may accrue future revenue on pending patent WO2009/086591: Diagnostic And Therapeutic Methods For EFMR (Epilepsy And Mental Retardation Limited To Females); has a patent for SCN1A testing held by Bionomics Inc and licensed to various diagnostic companies (WO/2006/133508); she has a patent for a molecular diagnostic/therapeutic target for benign familial infantile epilepsy (BFIE) [PRRT2] WO/2013/059884 with royalties paid.

Equitable tele-neurologic care starts with first identifying disparities, then identifying how to overcome them – learn about both with Dr. Lee Schwamm on the latest ANA Investigates. Series 3, Episode 11.

• Guest: Dr. Lee Schwamm, C Miller Fisher Endowed Chair in Vascular Neurology and the Director of the Center for TeleHealth at Massachusetts General Hospital, Professor of Neurology at Harvard Medical School and Vice President for Digital Patient Experience at the Mass General Bri
• Interviewer/Producer: Dr. Amanda Jagolino-Cole, Director of the UT Teleneurology Division at McGovern Medical School at the University of Texas Health Science Center in Houston

• Disclosures: None

Late last month, the journal Science published an investigative report that accused a much-cited publication in Alzheimer’s disease... of fabricating scientific images. The study under scrutiny was published in Nature in 2006 by Sylvain Lesné and colleagues. It claimed that an amyloid oligomer called Aβ*56 impaired memory in mice. The recent Science report found potential fabrication in the images used in that paper... and concluded that this potential fabrication threatens the amyloid hypothesis in Alzheimer’s disease. Here at ANA Investigates, we decided we needed to ask the experts about that. Their conversation will help us understand the impact of the recent investigative report on the field of Alzheimer’s research. Series 3, Episode 10.

• Guest: Dr. Richard O’Brien, Alzheimer’s researcher, Chair of the Department of Neurology at Duke University
• Interviewer/Producer: Dr. Erik Roberson, Alzheimer’s researcher, endowed Professor of Neurology, and Director of the Alzheimer’s Disease Center at the University of Alabama at Birmingham

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Last month on the podcast, we talked about updates in the diagnosis of autoimmune encephalitis. This month we turn to advances in the treatment of autoimmune encephalitis. Treating these conditions has traditionally been practitioner-dependent, and currently no FDA-approved therapies exist. But that’s beginning to change. Series 3, Episode 9.

• Guest: Dr. Maarten Titulaer, Erasmus MC University Medical Center
• Interviewer/Producer: Dr. Rohini Samudralwar, University of Pennsylvania

Dr. Titulaer disclosed that his institution receives consulting funds form UCB, Viela Bio (Horizon), and CSL Behring, he is the co-investigator on the ExTinguish trial funded in part by Horizon, and a PI IVIG trial funded by CSL Behring.

On today's episode, Dr. Adeline Goss interviews Dr. Andrew McKeon on updates on diagnostics for part one of a two-part series on autoimmune encephalitis. Series 3, Episode 8.

• Guest: Andrew McKeon,, M.B., B.Ch., M.D., Mayo Clinic College of Medicine and Science
• Interviewer/Producer: Adeline Goss, MD, Highland Hospital

Dr. McKeon disclosed that he is a consultant for Johnson & Roche Genentech; and receives royalties from Euroimmun

On today's episode, we discuss the term "TIA" and the current debate as it pertains to advances in stroke diagnostics that have led some to propose that we retire the term. Series 3, Episode 7.

• Guest: Clay, Johnston, MD, PhD, The University of Texas at Austin
• Interviewer/Producer: Megan Richie, MD, UCSF

Dr. Johnston disclosed research  support from AstraZeneca for the THALES trial.

Burnt out by talking about burnout? Please join us for a podcast with Dr. Amy Arnsten, Professor of Neuroscience and Psychology at Yale University, to investigate what goes on in the brain that leads to burnout and how this can direct our efforts to reduce burnout. Series 3, Episode 6.

• Guest: Dr. Amy Arnsten, Professor of Neuroscience and Psychology at Yale University
• Interviewer/Producer: Dr. Amanda Jagolino-Cole, McGovern Medical at the University of Texas Health Science Center in Houston

On today’s show, we’ll focus on the future of biomarkers in Alzheimer’s disease. We know that amyloid beta and tau protein deposit long before patients with Alzheimer’s develop symptoms. If we could use biomarkers to detect this pathology early, and treat patients early, could we prevent the progression to dementia? Our guests today are leaders in the development of biomarkers for Alzheimer’s disease - Dr. Suzanne Schindler, Associate Professor of Neurology at Washington University in St. Louis and Dr. Gil Rabinovici, Professor of Neurology and Radiology at the University of California San Francisco. They’ll talk with Dr. Doug Ney of UC Denver about the expanding role of biomarkers in Alzheimer’s prevention and treatment. Series 3, Episode 5.

• Guest: Dr. Suzanne Schindler, Associate Professor of Neurology at Washington University in St. Louis
• Guest: Dr. Gil Rabinovici, Professor of Neurology and Radiology at the University of California San Francisco
• Interviewer/Producer: Dr. Doug Ney, UC Denver

Disclosures: Dr. Schindler disclosed that C2N Diagnostics provided data free of cost for her team to analyze. Dr. Rabinovici disclosed that he leads the New IDEAS study and has received research funding from Avid Radiopharmaceuticals, GE Healthcare, Life Molecular Imaging, Genentech; and is on scientific advisory boards for Eisai, J&J, Genentech, Eli Lilly, and Roche.

Can coma be “cured”? On this podcast, we talk to Dr. Claude Hemphill and Dr. Romer Geocadin of the Curing Coma Campaign. Series 3, Episode 4 https://www.curingcoma.org/events2/world-coma-day

Below are articles the guests of this podcast wished to share with the listeners:

• Early Thalamocortical Reperfusion Leads to Neurologic Recovery in a Rodent Cardiac Arrest Model: https://doi.org/10.1007/s12028-021-01432-9
• Proceedings of the First Curing Coma Campaign NIH Symposium: Challenging the Future of Research for Coma and Disorders of Consciousness: https://doi.org/10.1007/s12028-021-01260-x 
• AHA SCIENTIFIC STATEMENT: Standards for Studies of Neurological Prognostication in Comatose Survivors of Cardiac Arrest: Circulation. 2019;140:e517–e542. DOI: 10.1161/CIR.0000000000000702 - https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000702
• Detection of Brain Activation in Unresponsive Patients with Acute Brain Injury; n engl j med 380;26 nejm.org June 27, 2019
• Therapies to Restore Consciousness in Patients with Severe Brain Injuries: A Gap Analysis and Future Directions; Neurocrit Care (2021) 35:68–85; https://doi.org/10.1007/s12028-021-01227-y
• Mechanisms Underlying Disorders of Consciousness: Bridging Gaps to Move Toward an Integrated Translational Science; Neurocrit Care (2021) 35:37–54; https://doi.org/10.1007/s12028-021-01281-6

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• Guest: Romer Geocadin, MD, Johns Hopkins University
• Guest: Claude Hemphill, MD, University of California San Francisco
• Interviewer/Producer: Dr. Adeline Goss, Highland Hospital

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Treatment of stroke has changed dramatically in the past decade, with the advent of perfusion imaging and an expanded time window for mechanical thrombectomy. Thrombectomy is now standard of care for eligible patients. But while data clearly supports the use of thrombectomy for certain patients with anterior circulation strokes, the benefit of thrombectomy for patients with basilar artery occlusions remains unproven. Today we’ll talk to a vascular neurologist and a neurointerventional surgeon who are trying to better define which patients with basilar artery occlusion may benefit from thrombectomy -- and which patients may not. Series 3, Episode 3. 

• Guest: Dr. Carlo Cereda, vascular neurologist, head of the EOC Comprehensive Stroke Center at the Neurocenter of Southern Switzerland and Faculty of Biomedical Sciences, Università della Svizzera Italiana in Lugano
• Guest: Dr. Jeremy Heit, Assistant Professor of Radiology and of Neurosurgery and the interim Chief of Neuroradiology at Stanford University
• Interviewer/Producer: Dr. Michelle Johansen, Assistant Professor of Neurology, Johns Hopkins Medicine

Disclosures: Dr. Heit disclosed that he consults for Medtronic and MicroVention, and consults and is a member of medical and scientific advisory board for iSchemaView, Inc., and Dr. Cereda disclosed that he is a advisory board for iSchemaView, Inc.

On today’s show we’ll focus on functional neurological disorder, or FND -- a wide range of conditions including non-epileptic seizures and functional weakness, dystonia and tremor. These conditions are common and can cause serious disability. But what are these conditions, exactly? What have functional neuroimaging and other tools taught us about their pathophysiology, diagnosis, and treatment? Series 3, Episode 2.

• Guest: Dr. Sara Finkelstein, neurologist and specialist in functional neurological disorder at Massachusetts General Hospital
• Interviewer/Producer: Dr. Adeline Goss, Highland Hospital

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Some patients with medically refractory epilepsy are offered surgeries to implant devices that electrically stimulate the nervous system and actually modulate neural networks over time. On this episode of ANA Investigates, Dr. Vikram Rao of the UCSF Weill Institute for Neurosciences discusses how these neurostimulation devices can reduce seizure burden, along with a range of other potential benefits.‌ Series 3, Episode 1.

• Guest: Dr. Vikram Rao, epileptologist and Associate Professor of Neurology at the UCSF Weill Institute for Neurosciences
• Interviewer/Producer: Dr. Rohit Das, epileptologist at UT Southwestern Medical Center‌‌

Dr. Rao disclosed the following relevant relationships for CME purposes: NeuroPace-Consultant; LivaNova-Scientific Advisory Board