An international approach to the use of immunoglobulin

In the latest bonus podcast, the practical use of intravenous immunoglobulin is discussed with perspectives from three continents. Participants: Professor Alasdair Coles is Head of Department for Clinical Neuroscience and also Co-Director of the Cambridge Centre for Myelin Repair, UK. Dr. Lynette Kiers is a Clinical Associate Professor at The University of Melbourne, and Director of Clinical Neurophysiology at the Royal Melbourne Hospital, Australia. Dr. Christopher Hahn is an Associate Clinical Professor of Neurology at the University of Calgary's Cumming School of Medicine, and the Medical Director of the Calgary Electromyography Lab, Canada. Read the paper (https://pn.bmj.com/content/25/3/228) which is part of the June issue of the Practical Neurology journal.   Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Letícia Amorim. Thank you for listening. 

Gastric sleeve surgery is the key feature of a pair of recent cases from the journal, which start this episode (1:17). Both cases feature 25-yo women with presentations in common: paraesthesia and limb weakness, along with disordered eye movement. Their symptoms arose soon after the gastrectomy operation.  https://pn.bmj.com/content/25/3/268  The second report is a "true grey case" (22:14), with a myriad of presenting symptoms in a 27-yo man: fevers, weight loss, lethargy, light sensitivity, and skin plaques around the nose and mouth. Steroid treatment was started with a suspicion of a  connective tissue disease, but was halted when his condition soon worsened. Some feathered friends of the podcast shine a light on the diagnosis. https://pn.bmj.com/content/25/3/253  The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Babak Soleimani³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the June 2025 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Research Fellow, Oxford Laboratory for Neuroimmunology and Immunopsychiatry, Nuffield Department of Medicine, University of Oxford Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production by Amy Ross Russell and Brian O'Toole, editing by Brian O'Toole. Thank you for listening.

A neuroinflammatory disorder with the potential to affect virtually any organ in the body, IgG4-related disease is a challenge on many fronts. The latest Editors' Choice paper in the June 2025 issue takes on this systemic disease, presenting a treatment algorithm for its management. This episode, PN's podcast editor Dr. Amy Ross Russell speaks with author Dr. Claire Rice. Hear an overview on the disease background, the signs in presentation, what to look for in the histology, and steroid treatment strategy.    Read the paper: IgG4-related disease in the nervous system    Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production by Amy Ross Russell and Brian O'Toole. Editing by Brian O'Toole. Thank you for listening. 

This episode’s theme is new diseases, whether they are newly described, or old diseases back in a new form. We start off with IgG4-related disease, a chronic multisystem disorder that is still being understood. Then there is a genetics paper on repeat expansion disorders, a group of conditions often thought as disparate but with quite a few commonalities. Next along is a fascinating case following gastric sleeve bariatric surgery, highlighting the dangers of travelling for unsupervised surgeries, and raising the question, “Are you getting enough soil in your diet?” There’s also a discussion of what else Hoover’s sign might represent, and the evolution of immunoglobulin use. Closing the episode is a paper offering a masterclass on the assessment of best interests in  prolonged disorder of consciousness.   Read the issue: https://pn.bmj.com/content/25/3/199   Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Brian O'Toole. Thank you for listening. 

Two wide open cases from the latest issue of the journal. Starting with a case from Italy (1:18), of a 63-yo man having a history of behavioural and cognitive problems since retiring. His many changes included low mood, significant weight loss, and problems with sleep and temperature regulation. He had a background of type 2 diabetes. Initial treatment was on a suspicion of Alzheimer's, but there was no clinical improvement. https://pn.bmj.com/content/25/2/159  A case from the United States is next (17:36), featuring a 66-yo lady experiencing 10 days of generalised weakness, with episodes of forgetfulness and a series of falls. She had previously been treated for left-sided ophthalmic herpes zoster. Neurological examination showed mild right arm and leg weakness. https://pn.bmj.com/content/25/2/164    The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Babak Soleimani³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the February 2025 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Research Fellow, Oxford Laboratory for Neuroimmunology and Immunopsychiatry, Nuffield Department of Medicine, University of Oxford Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Brian O'Toole. Thank you for listening. 

Immune checkpoint inhibitors can significantly improve cancer survival rates. But resulting immune-related toxicities are common, requiring multidisciplinary cooperation between oncology and neurology.  This episode, PN's podcast editor Dr. Amy Ross Russell speaks with a panel of experts on the balancing act required when treating cancer patients with these new drugs. Oncologist Dr. Heather Shaw is alongside neurologists Dr. Aisling Carr and Dr. Mark Willis, and they are amongst the authors of the editors' choice paper for the latest issue of Practical Neurology. Read the paper: Neurological complications of immune checkpoint inhibitors: a practical guide  Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production by Letícia Amorim, Brian Kennedy, Amy Ross Russell and Brian O'Toole. Editing by Brian O'Toole. Thank you for listening. 

The latest guidelines on disease-modifying treatment in multiple sclerosis (MS) from the Association of British Neurologists is discussed in this intercontinental podcast with perspectives from the UK, the USA, and Australia.   Participants: Professor Alasdair Coles is Head of Department for Clinical Neuroscience and also Co-Director of the Cambridge Centre for Myelin Repair, UK. Dr. Tamara Kaplan is Assistant Professor of Neurology at Harvard Medical School, and is also affiliated with the Brigham and Women's Hospital, Boston, USA. Professor Michael Barnett is a consultant neurologist at Royal Prince Alfred Hospital Sydney, Central Clinical School, and Director of the RPAH MS Clinic and the MS Clinical Trials Unit at the Brain and Mind Centre, University of Sydney, Australia. Read the paper (https://pn.bmj.com/content/25/1/18) which is part of the February issue of the Practical Neurology journal.   Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Letícia Amorim. Thank you for listening.     

It's a podcast of pairs this time, for the latest issue of the journal. There's two hosts, two halves of the brain, two sides to a clinical debate, and two themes to the episode itself. Leading off is a discussion on peripheral neurology, taking a look at the editors' choice paper on immune checkpoint inhibitors. That's followed by a paper on  secondary hypertension, and another on small fibre neuropathies. The second half covers elements of cognitive neurology, including a topic with increasing awareness - that of brain fog. There's the dramatically named STOP-BANG questionnaire, a notable appearance from a monkey, and a reflection on modern practices for cognitive assessment. Read the issue: https://pn.bmj.com/content/25/2/101 Listen to Dr. Laura McWhirter on the JNNP podcast: Brain fog demystified Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production by Letícia Amorim and Brian O'Toole. Editing by Brian O'Toole. Thank you for listening. 

A puzzling pair of Case Reports from the most recent issue of the journal. First up (1:35) is a man in his mid-fifties, presenting with lumbar spine fractures, which then developed into confusion, vomiting, and abdominal pain. An x-ray showed  dilated intestinal loops and his blood sodium levels were low. https://pn.bmj.com/content/25/1/87 The second case (23:06) involves a 21-yo woman, who presented  at 18 weeks pregnant with  multiple episodes of right upper limb tonic extension, and subsequently developed new-onset refractory status epilepticus (NORSE). https://pn.bmj.com/content/25/1/56    The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Xin You Tai³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the February 2025 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital.  Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Letícia Amorim and Brian O'Toole. Thank you for listening. 

Intermittent painful spasms, stiffness and rigidity of the proximal and truncal muscles are only a few symptoms of the relatively uncommon Stiff-person syndrome (SPS). In this podcast, we delve into the characteristics and diagnosis of this complex autoimmune condition. PN's podcast editor Dr. Amy Ross Russell interviews Professor Saiju Jacob (University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK). The paper is the Editor's Choice paper of the February issue of Practical Neurology. The episode is released to coincide with world Encephalitis day. For more information about World encephalitis day, or encephalitis international please follow this link: https://www.encephalitis.info/world-encephalitis-day/  Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production by Letícia Amorim and Brian O'Toole. Editing by Brian O'Toole. Thank you for listening.