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Neurology Minute

Neurology Minute

De: American Academy of Neurology
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The Neurology Minute podcast delivers a brief daily summary of what you need to know in the field of neurology, the latest science focused on the brain, and timely topics explored by leading neurologists and neuroscientists. From the American Academy of Neurology and hosted by Stacey Clardy, MD, Ph.D., FAAN, with contributions by experts from the Neurology journals, Neurology Today, Continuum, and more.2024 Enfermedades Físicas Higiene y Vida Saludable Psicología Psicología y Salud Mental
Episodios
  • Headache Medicine and Women's Health Series: Overview of Menstrual Migraine

    Headache Medicine and Women's Health Series: Overview of Menstrual Migraine
    Jan 13 2026

    Dr. Tesha Monteith discusses the different forms of menstrual migraines.

    Show transcript:

    Dr. Tesha Monteith:

    Hi, this is Tesha Monteith with the Neurology Minute. Welcome to our series on headache medicine and women's health. I want to start off this series with a discussion on menstrual migraine. Menstrual migraine is considered more frequent, more severe, and is associated with most migraine-associated symptoms with the exception of aura. The pathophysiology is linked to the effects of estrogen withdrawal and the impacts on the trigeminal vascular system. Do check out a recent paper by Pan and colleagues published just in neurology in November showing a robust hypothalamic activation prior to the headache phase in patients with menstrual migraine compared to controls.

    Now, there are two forms of menstrual migraine recognized in the International Classification of Headache Disorders III. First is menstrually related migraine which consists of attacks that occurred during the perimenstrual window. That's day one of menses plus or minus two days and at least two of three menstrual cycles and during additional times outside of the window. Perimenstrual migraine attacks occur exclusively during the perimenstrual window and is much less common than menstrually related migraine.

    A key point is that there's a predictable timing with each cycle, yet the condition is still very much underdiagnosed. Advise your patients to use an e-diary to improve the diagnosis and hopefully reduce disability. This is Tesha Monteith. Thank you for listening to the Neurology Minute.
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    2 m
  • Levetiracetam - Part 2

    Levetiracetam - Part 2
    Jan 12 2026
    In the second part of this series, Dr. Neishay Ayub discusses levetiracetam and one of its most common side effects, irritability. Show citations: Abou-Khalil B. Levetiracetam in the treatment of epilepsy. Neuropsychiatr Dis Treat. 2008;4(3):507-523. doi:10.2147/ndt.s2937 Löscher W, Gillard M, Sands ZA, Kaminski RM, Klitgaard H. Synaptic Vesicle Glycoprotein 2A Ligands in the Treatment of Epilepsy and Beyond. CNS Drugs. 2016;30(11):1055-1077. doi:10.1007/s40263-016-0384-x Rogawski MA. Brivaracetam: a rational drug discovery success story. Br J Pharmacol. 2008;154(8):1555-1557. doi:10.1038/bjp.2008.221 Ulloa CM, Towfigh A, Safdieh J. Review of levetiracetam, with a focus on the extended release formulation, as adjuvant therapy in controlling partial-onset seizures. Neuropsychiatr Dis Treat. 2009;5:467-476. doi:10.2147/ndt.s4844 Wu PP, Cao BR, Tian FY, Gao ZB. Development of SV2A Ligands for Epilepsy Treatment: A Review of Levetiracetam, Brivaracetam, and Padsevonil. Neurosci Bull. 2024;40(5):594-608. doi:10.1007/s12264-023-01138-2 Mahmoud A, Tabassum S, Al Enazi S, et al. Amelioration of Levetiracetam-Induced Behavioral Side Effects by Pyridoxine. A Randomized Double Blind Controlled Study. Pediatr Neurol. 2021;119:15-21. doi:10.1016/j.pediatrneurol.2021.02.010 Major P, Greenberg E, Khan A, Thiele EA. Pyridoxine supplementation for the treatment of levetiracetam-induced behavior side effects in children: preliminary results. Epilepsy Behav. 2008;13(3):557-559. doi:10.1016/j.yebeh.2008.07.004 Romoli M, Perucca E, Sen A. Pyridoxine supplementation for levetiracetam-related neuropsychiatric adverse events: A systematic review. Epilepsy Behav. 2020;103(Pt A):106861. doi:10.1016/j.yebeh.2019.106861 Show transcript: Dr. Neishay Ayub: Hello, my name is Neishay Ayub, and today we will be discussing levetiracetam and one of its most common side effects, irritability. While levetiracetam can be remarkably helpful for patients, behavioral adverse effects were noted in post-marketing analysis and open-label studies in adult and pediatric patients. For this, physicians started using vitamin B6 supplementation, particularly in the pediatric populations. Why would physicians use B6? Well, low vitamin B6 has been associated with neuropsychiatric disorders, which could be related to the fact that vitamin B6 is an essential co-factor for several neurotransmitters that affect mood and behavior, such as serotonin, dopamine, and GABA. There is an epilepsy syndrome associated with vitamin B6 deficiency. And vitamin B6 deficiency is seen with enzyme-inducing anti-seizure medications, although levetiracetam is not an enzyme-inducing seizure medication. These are some of the possibilities as to why vitamin B6 supplementation was initially explored. Some initial anecdotal evidence and case reports were suggested that it was helpful in reducing behavioral side effects and the need to discontinue levetiracetam. There was a meta-analysis reviewing pyridoxine use, which included 11 case reports and retrospective studies, as well as one prospective study, case-control study, which was not placebo controlled. While evidence was suggestive of a benefit, the quality of the evidence was poor due to selection, reporting, and assessment biases. Overall, the authors recommended a larger randomized, controlled, double-blind trial with adequate statistical power, well-defined eligibility criteria and standardized assessment tools to evaluate B6 efficacy in treating levetiracetam-induced irritability. Since then, there was one small randomized, controlled, double-blind study involving 105 children for whom neuropsychiatric adverse effects were noted after levetiracetam was introduced. Children were randomized to receive a therapeutic dose of pyridoxine, which was 10 to 15 milligrams per kilogram per day, up to 200 milligrams, or a homeopathic dose of 0.5 milligrams per kilogram per day. They were scored on a behavioral checklist and monitored for up to six months. While there was a reduction in behavioral symptoms reported in the therapeutic pyridoxine group, there was no validated assessment tools used, and there was an absence of a true placebo group. Lastly, there are a few studies reporting on adverse effects of B6 toxicity, which is possible, but it's typically seen at higher daily doses, although something to keep in mind if considering B6 supplementation. In summary, while there has been a clinical practice of prescribing pyridoxine at 50 to 100 milligrams as a low-cost, well-tolerated adjunctive supplement, there may be a modest benefit for some patients, but the overall efficacy for the treatment of neuropsychiatric side effects for levetiracetam remain unclear, and more evidence is needed.
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    3 m
  • Monogenic Mimics of Neuroinflammatory Phenotypes in Children and Young Adults - Part 1

    Monogenic Mimics of Neuroinflammatory Phenotypes in Children and Young Adults - Part 1
    Jan 9 2026

    In part one of this two-part series, Dr. Stacey Clardy and Drs. Ayush Gupta and Kuntal Sen discuss the key clinical features that should shift suspicion from autoimmune encephalitis or demyelinating disease to monogenic mimics.

    Show citation:

    Gupta A, Sahjwani D, Kahn I, Gombolay GY, Sen K. Monogenic Mimics of Neuroinflammatory Phenotypes in Children and Young Adults: An Evolving Landscape. Neurol Genet. 2025;11(6):e200326. Published 2025 Nov 25. doi:10.1212/NXG.0000000000200326

    Show transcript:

    Dr. Stacey Clardy:

    Hi, this is Stacey Clardy from the Salt Lake City VA in the University of Utah.

    For a two-part podcast series, I've been speaking with Ayush Gupta from the University of Nebraska Medical Center and Kuntal Sen from Children's National Hospital in Washington DC about the monogenic disorders that mimic neuroinflammatory disease that are lurking in all of our clinics just waiting to be diagnosed.

    Ayush, for the minute, when you're seeing a patient with a presumed autoimmune encephalitis or demyelinating disease, what single cluster of features should instead most strongly push us to think of monogenic mimics at the top of our differential?

    Dr. Ayush Gupta:

    So when you are seeing a patient with presumed autoimmune encephalitis or a demyelinating disorder, cluster of features such as earlier onset in terms of age, developmental delays, CSF or imaging finding that's non-concordant with the diagnosis such as a non-inflammatory CSF, a symmetric white matter or deep gray matter involvement and relentless progression despite immunotherapy, these are the red flags where you should stop, seriously consider the possibility of a monogenic disorder and reach out to help from colleagues.

    Dr. Stacey Clardy:

    That's a great list, and we get into far more detail in the two-part podcast series. So please listen to both of those and take a read of the neurology genetics review titled Monogenic Mimics of Neuroinflammatory Phenotypes in Children and Young Adults: An Evolving Landscape.
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    2 m
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