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Physician Podcasts

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Sensory Neuronopathies

    9/19/2016
Dr. Justin Willer interviews Dr. Kelly Gwathmey about her article, Sensory Neuronopathies. The sensory neuronopathies (or ganglionopathies) are a small subcategory of neuropathies characterized by primary degeneration of the dorsal root ganglia and trigeminal ganglion sensory neurons, resulting in a distinctive clinical presentation. Patients typically have subacute onset of asymmetric, non–length-dependent sensory impairment and early ataxia. The etiologies of acquired sensory neuronopathies are rather limited. Early identification is imperative, as they may herald an underlying malignancy or an autoimmune condition such as Sjögren syndrome. This podcast reviews the Muscle and Nerve article on this subject. Muscle Nerve 53: 8–19, 2016

Critically re-evaluating a common technique: Accuracy, reliability, and confirmation bias of EMG

    3/25/2016
Dr. Stephen Goutman interviews Drs. Pushpa Narayanaswami and Seward Rutkove about their article Critically re-evaluating a common technique: Accuracy, reliability, and confirmation bias of EMG. This study supports that in evaluations of radiculopathy (1) serial EMG studies should be performed by the same electromyographer since intrarater reliability is better than interrater reliability; (2) knowledge of clinical information does not bias EMG interpretation substantially; (3) EMG has moderate diagnostic accuracy for radiculopathy with modest specificity and electromyographers should exercise caution interpreting mild abnormalities. Neurology. 2016 Jan 19;86(3):218-23. doi: 10.1212/WNL.0000000000002292. Epub 2015 Dec 23.

Can Mycophenolate Mofetil be Tapered Safely in MG? A Retrospective, Multicenter Analysis

    2/19/2016
Dr. Justin Willer interviews Dr. Lisa Hobson-Webb about her Muscle & Nerve article on safely tapering mycophenolate mofetil (MMF) in myasthenia gravis (MG) patients. MMF is frequently used to treat patients with MG but there is little information to guide clinicians on the safety of reducing the dose in well-controlled patients. Discussion includes standard dosages, determining clinical response to MMF and suggested goals in tapering MMF. Muscle Nerve. 2015 Aug;52(2):211-5. doi: 10.1002/mus.24694. Epub 2015 Jun 18.

Paraproteinemic Neuropathies

    2/8/2016
Dr. Justin Willer interviews Dr. Divisha Raheja about her Muscle & Nerve article on paraproteinemic neuropathies. When the neuropathy is the presenting feature, neuromuscular specialists can play a particularly important role, possibly uncovering clinical, laboratory, radiologic, electrodiagnostic, or biopsy findings that lead to identification of the underlying paraproteinemia. Dr. Raheja offers suggestions on when testing should be done, elaborating on the various types of testing as well as treatments. Muscle Nerve. 2015 Jan;51(1):1-13. doi: 10.1002/mus.24471.

Inherited Etiologies of Rhabdomyolysis

    10/21/2015
In this second part of the Clinical Presentation and Acquired Causes of Rhabdomyolysis podcast, Dr. Ted Burns interviews Drs. Jessica Nance and Andrew Mammen about their paper Diagnostic evaluation of rhabdomyolysis from the June 2015 issue of Muscle and Nerve. Rhabdomyolysis is characterized by severe acute muscle injury resulting in muscle pain, weakness, and/or swelling with release of myofiber contents into the bloodstream. Symptoms develop over hours to days after an inciting factor and may be associated with dark pigmentation of the urine. This podcast focuses on the inherited etiologies. For the article in Muscle and Nerve refer to Muscle Nerve 51: 793-810, 2015.

Pharmacotherapy for Neuropathic Pain in Adults: A Systematic Review and Meta-Analysis

    9/22/2015
Dr. Stephen Goutman interviews Dr. Nadine Attal about the article she coauthored in Lancet Neurology on pharmacotherapy for neuropathic pain in adults. Drs. Goutman and Attal discuss the evidence and limitations supporting each class of medication aimed at the treatment of neuropathic pain and how these recommendations can be incorporated into clinical practice. Lancet Neurol. 2015 Feb;14:162-173.

Clinical Presentation and Acquired Causes of Rhabdomyolysis

    9/8/2015
Dr. Ted Burns interviews Drs. Jessica Nance and Andrew Mammen about their paper Diagnostic evaluation of rhabdomyolysis from the June 2015 issue of Muscle and Nerve. Rhabdomyolysis is characterized by severe acute muscle injury resulting in muscle pain, weakness, and/or swelling with release of myofiber contents into the bloodstream. Symptoms develop over hours to days after an inciting factor and may be associated with dark pigmentation of the urine. This podcast focuses on the clinical presentation and acquired causes which can include substance abuse, medication or toxic exposures, electrolyte abnormalities, endocrine disturbances, and autoimmune myopathies. For the article in Muscle and Nerve refer to Muscle Nerve 51: 793-810, 2015.

Patterns of Clinical and EDX Abnormalities in early ALS

    8/11/2015
Noah Kolb, MD, interviews Neil Simon, MBBS, BSc, FRACP, about his article on patterns of clinical and electrodiagnostic abnormalities in early ALS, published in Muscle and Nerve with Drs. Lomen-Hoerth and Kiernan. Drs. Kolb and Simon discuss the distribution of clinical and neurophysiological abnormalities in patients with early ALS. Clinical and electrodiagnostic data were collected from 150 ALS patients and analyzed based on the clinical region of onset. Findings suggest a pattern of disease spread in ALS. This study may serve to guide ongoing development of disease quantitation biomarkers and the targeting of future neuroprotective strategies. Muscle Nerve 50: 894–899, 2014

NCS Technique for Ulnar Neuropathy

    6/17/2015
An interview about ulnar neuropathy with the neurologist who invented ulnar inching, William W. Campbell, MD, and Mary Franklin, REEGT, CNCT. Have you ever wondered when to test the FDI with an ulnar nerve entrapment? Have you ever asked yourself what is ulnar mapping and when should I do this? Maybe you’ve wondered about the “10 centimeter” theory in measuring the ulnar nerve around the elbow or about the degree at which the elbow should be flexed and when to inch? If so, then this podcast is for you! It’s an excellent educational resource for technologists and physicians alike!

Neuralgic Amyotrophy (Parsonage-Turner): Etiology, Treatment, Natural History by Nens Van Alfen

    5/12/2015
Neuralgic amyotrophy--also known as Parsonage-Turner syndrome or brachial plexus neuritis--is a distinct and painful peripheral neuropathy that causes episodes of multifocal paresis and sensory loss in a brachial plexus distribution with concomitant involvement of other PNS structures (such as the lumbosacral plexus or phrenic nerve) in a large number of patients. The phenotype can be limited or extensive and the amount of disability experienced also varies between patients, but many are left with residual disabilities that affect their ability to work and their everyday life. Both idiopathic and hereditary forms exist. This podcast discusses etiology, treatment, and natural history.

Neuralgic Amyotrophy (Parsonage-Turner): presentation and diagnosis. Interview with Nens Van Alfen

    5/1/2015
Neuralgic amyotrophy--also known as Parsonage-Turner syndrome or brachial plexus neuritis--is a distinct and painful peripheral neuropathy that causes episodes of multifocal paresis and sensory loss in a brachial plexus distribution with concomitant involvement of other PNS structures (such as the lumbosacral plexus or phrenic nerve) in a large number of patients. The phenotype can be limited or extensive and the amount of disability experienced also varies between patients, but many are left with residual disabilities that affect their ability to work and their everyday life. Both idiopathic and hereditary forms exist.

Whole Exome Sequencing by Dr. Daniel MacArthur

    4/16/2015
Whole Exome Sequencing and the Clinical Impact of Sequencing Techniques by Dr. Daniel MacArthur, interviewed by Dr. Ted Burns.

Next Generation Sequencing and its Impact on Neuromuscular Medicine by Dr. Daniel MacArthur

    4/13/2015
Next Generation Sequencing and its Impact on Neuromuscular Medicine by Dr. Daniel MacArthur interviewed by Dr. Ted Burns.

ALS Onset is Influenced by the Burden of Rare Variants in Known ALS Genes by Drs. Baloh and Harms

    3/27/2015
ALS Onset is Influenced by the Burden of Rare Variants in Known ALS Genes by Drs. Robert Baloh and Matthew Harms, interviewed by Dr. Ted Burns. Amyotrophic lateral sclerosis onset is influenced by the burden of rare variants in known amyotrophic lateral sclerosis genes.Ann Neurol. 2015 Jan;77(1):100-13. doi: 10.1002/ana.24306. Epub 2014 Nov 27.

Muscle intrusion as a potential cause of carpal tunnel syndrome by Dr. Michael Cartwright

    1/21/2015
Muscle intrusion as a potential cause of carpal tunnel syndrome by Dr. Michael Cartwright interviewed by Dr. Justin Willer. Muscle Nerve. 2014 Oct;50(4):517-22. doi: 10.1002/mus.24183. Epub 2014 Jun 16.

Dermatomyositis and Autoantibodies by Dr. Andrew L. Mammen

    12/18/2014
Dermatomyositis and Autoantibodies by Dr. Andrew L. Mammen. This is part three of a three part series on immune-mediated myopathies and autoantibodies.

Necrotizing Myopathies by Dr. Andrew L. Mammen

    12/11/2014
Necrotizing Myopathies by Dr. Andrew L. Mammen. This is part two of a three part series on immune-mediated myopathies and autoantibodies.

Antisynthetase syndrome and myositis by Dr. Andrew L. Mammen

    12/4/2014
Antisynthetase syndrome and myositis by Dr. Andrew L. Mammen. This is part one of a three part series on immune-mediated myopathies and autoantibodies.

Pathokinesiology of Duchenne Muscular Dystrophy

    11/25/2014
Ernest W. Johnson, MD discusses pathokinesiology of Duchenne muscular dystrophy: implications for management in Arch Phys Med Rehabil 1977;58:1-4. Interviewed by Ted Burns, MD and Gregory Carter, MD, MS.

Clinical Value of Motor Nerve Conduction Velocity Determination by Ernest W. Johnson, MD

    11/21/2014
An Interview with Ernest W. Johnson, MD, author of "Clinical Value of Motor Nerve Conduction Velocity Determination," an article appearing in JAMA 1960;172:2030-2035. Interviewed by Lawrence H. Phillips, II, MD and Gary Goldberg, MD. An introduction honoring the late Dr. Ernie Johnson is included.

Evidence-based Guideline Summary: Diagnosis and Treatment of Limb-Girdle and Distal Dystrophies

    11/13/2014
This podcast is an interview by Dr. Ted Burns with Drs. Anthony Amato and Pushpa Narayanaswami about the article: Evidence-based Guideline Summary: Diagnosis and Treatment of Limb-Girdle and Distal Dystrophies. A Report of the Guideline Development Subcommittee of the American Academy of Neurology and the Practice Issues Review Panel of the American Association of Neuromuscular and Electrodiagnostic Medicine.

Electrodiagnosis of Ulnar Neuropathy at the Elbow (Une): a Bayesian Approach.

    11/12/2014
This podcast, Electrodiagnosis of ulnar neuropathy at the elbow (Une): a Bayesian approach, is based on an article in Muscle Nerve. 2014 Mar;49(3):337-44. doi: 10.1002/mus.23913.

Myotonic Dystrophy Health Index: Initial Evaluation of a Disease-Specific Outcome Measure

    8/29/2014
Myotonic Dystrophy Health Index: Initial Evaluation of a Disease-Specific Outcome Measure by Dr. Chad Heatwole and interviewed by Dr. Nicholas Silvestri. From the Muscle and Nerve article: INTRODUCTION: In preparation for clinical trials we examine the validity, reliability, and patient understanding of the Myotonic Dystrophy Health Index (MDHI). METHODS: Initially we partnered with 278 myotonic dystrophy type-1 (DM1) patients and identified the most relevant questions for the MDHI. Next, we used factor analysis, patient interviews, and test-retest reliability assessments to refine and evaluate the instrument. Lastly, we determined the capability of the MDHI to differentiate between known groups of DM1 participants. RESULTS: Questions in the final MDHI represent 17 areas of DM1 health. The internal consistency was acceptable in all subscales. The MDHI had a high test-retest reliability (ICC = 0.95) and differentiated between DM1 patient groups with different disease severities. CONCLUSIONS: Initial evaluation of the MDHI provides evidence that it is valid and reliable as an outcome measure for assessing patient-reported health. These results suggest that important aspects of DM1 health may be measured effectively using the MDHI. Muscle Nerve. 2014 Jun;49(6):906-14. doi: 10.1002/mus.24097.

Vasculitic Neuropathies by Drs. Kelly Gwathmey and P. James B. Dyck interviewed by Dr. Ted Burns

    7/30/2014
This podcast discusses information from the article "Vasculitic Neuropathies" in Lancet Neurology. The vasculitic neuropathies are a diverse group of disorders characterised by the acute-to-subacute onset of painful sensory and motor deficits that result from inflammatory destruction of nerve blood vessels and subsequent ischaemic injury. They are common in patients with primary systemic vasculitis and are seen in vasculitis secondary to disorders such as rheumatoid arthritis, viral infections, and diabetic inflammatory neuropathies. It is imperative that neurologists recognise these disorders to initiate treatment promptly and thereby prevent morbidity and mortality. Lancet Neurol. 2014 Jan;13(1):67-82. doi: 10.1016/S1474-4422(13)70236-9.

Improving Referring Physicians' Understanding of EMG Reports When Qualifying Radiculopathies

    4/10/2014
Electromyographic (EMG) reporting of radiculopathies is not standardized, and the terminology used in reports can be misinterpreted by referring physicians. Physicians who refer patients for EMG studies at the Mayo Clinic were surveyed about their understanding of 6 different EMG interpretations of an S1 radiculopathy. Of 45 responders, the terms “acute, active,” “chronic, inactive,” and “old” were interpreted consistently by 95%, 98%, and 84% of responders, respectively. Physicians had the most difficulty understanding the meaning of “chronic” in isolation, “chronic, active,” or “old with uncompensated denervation.” These findings suggest a need to educate referring physicians on the meaning of the terms used in EMG reports and to develop standard guidelines for qualifying radiculopathies. Based on our observations, guidelines for the reporting of radiculopathies have been adopted in the Mayo Clinic Florida EMG laboratory. Muscle Nerve 49: 129–130, 2014
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