In view of a recent TikTok fiasco (which I was too busy to address at the time), I thought I would set out a little #Tweetorial on Psychogenic Non-Epileptic Seizures (PNES), a topic that seems to generate both considerable interest and misunderstanding. /1 PNES are events that superficially resemble epileptic seizures, but without any rhythmic electrical discharge in the brain to account for them.

Like epileptic seizures, they are sudden and time-limited, and may involve staring, shaking, or other abnormal movements. /2

Police vs. Physicians: a thread

If I wanna do a research study, I have to make a submission to the Institutional Review Board.

There's a big packet of forms with dozens and dozens of questions. Takes HOURS AND HOURS to fill out.

It's a titanic pain in the butt. /1

https://twitter.com/AugustTakala/status/1270399690912272384

And that doesn't include the consent form I have to create and show to them, which itself takes HOURS AND HOURS to write.

After I do that, I have to wait WEEKS while the board reviews it to decide if it's ethical and if I did everything possible to protect the study subjects. /2

This is among the stranger pieces I have seen in @washingtonpost.

I have some comments & concerns.

1. I was taught about "dementia pugilistica" as a Neurology resident. It was then thought of as something that happened to boxers.

washingtonpost.com/graphics/2020/… 2. If Mike Webster had "buckets of tau" in his brain at age 50, then given his history, he almost certainly had CTE.

If he didn't, they wouldn't have found all these subsequent cases. Omalu may not be the foremost authority, but he clearly wasn't wrong about this.

OK, a number of folks have tweeted to say that they were taught the Review of Systems in med school in the 80s (and perhaps earlier?). So, maybe there was some variability in its presence.

But HCFA (which is what CMS used to be called) surely blew up its use in 1995./1 And in recounting that story, we get into the origins of our current billing and training climate, which has only been in place for 24 years.

It goes like this... /2

thestar.com/calgary/2019/0…

I don’t have medical facts, but it points up the confusion many people (even in healthcare) have about different kinds of CNS infections.

So, a brief #tweetorial on meningitis and the like. /1 There are two main types of nervous system infections: meningitis and encephalitis.

ENCEPHALITIS is infection of the brain substance. It presents with marked alteration of mental status, along with fever & elevated white blood cell count. Other symptoms are variable. /2

I’ve been too busy in the hospital lately to circle back to the CBD article in the NYT Magazine Health Issue whose cover I posted, but I’ve been meaning to, because whoo, what a doozy.

So, a mini-rant on cannabidiol, belief, evidence, & journalism. /1

nyti.ms/2Q3AsSh When I read the piece, I was hoping for a balanced look at the CBD craze, the evidence thereof, and perhaps a critical look at the social phenomenon.

Instead we got mainly a potpourri of anecdotes, hopes, planned studies without results, and sundry speculation. /2

I saw this news the other day, courtesy of @MDaware, and it has not received nearly as much attention as it deserves — for a few reasons.

So, a thread on the important and overlooked topic of medicinal “supplements”. 1/16

nbcnews.com/health/health-… CVS announced that it will obtain independent testing of all vitamins & supplements it sells to ensure that they actually comply with their labels.

This is huge news, & I applaud the company for doing so.

But let’s take a step back & consider why this is needed at all. 2/16

Many people seem unaware of the impact of depression on cognitive function (i.e. thinking abilities).

I discovered this when a few small replies I made recently on someone’s thread garnered a total of a few thousand likes (and still counting).

So, a brief Tweetorial. /1 Impairment of cognition — meaning, impaired ability to think, remember, solve problems, etc. — is quite common in depression, and is a very common cause of cognitive complaints in medical practice overall.

There are two major reasons depression causes cognitive problems. /2