American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM)

In a patient with progressive hand weakness, is a good, careful clinical examination enough to make a diagnosis? Should we forget about EMG, ultrasound, and other testing? Maybe, maybe not. Tune in to this episode to hear an expert neuromuscular specialist perspective.

Hebatallah R. Rashed, MD, PhD interviews Milone, Margherita, MD, PhD on multisystem proteinopathies. They will discuss variable phenotypes associated with this rare genetically determined disorder. How it presents and how it evolves, risk of mortality, and underlying pathogenesis. We will also share an approach for diagnosis and management.

Do you think that patients with fasciculations should always be evaluated with an EMG? Tune in to this episode to see how to approach an unusual patient with fasciculations.

In this podcast, we will unpack the neuroprotective role of sex hormones and the profound hormonal changes that happen during perimenopause and after menopause. With our experts Ileana Howard, MD, Rebecca O'Bryan, MD, Seneca Storm, MD, and Amanda Wise DO, we will delve into common musculoskeletal symptoms associated with this transformative stage of women's life and how to reach a diagnosis and deliver optimum care.AANEM podcasts are intended for educational purposes only. The views expressed are those of the speakers and do not necessarily reflect the views or policies of AANEM. Podcast content should not be interpreted as clinical, legal, or reimbursement advice. Contact ⁠[email protected] ⁠with any questions or concerns.

In this podcast, we will unpack the neuroprotective role of sex hormones and the profound hormonal changes that happen during perimenopause and after menopause. With our experts Ileana Howard, MD, Rebecca O'Bryan, MD, Seneca Storm, MD, and Amanda Wise DO, we will delve into common musculoskeletal symptoms associated with this transformative stage of women's life and how to reach a diagnosis and deliver optimum care.AANEM podcasts are intended for educational purposes only. The views expressed are those of the speakers and do not necessarily reflect the views or policies of AANEM. Podcast content should not be interpreted as clinical, legal, or reimbursement advice. Contact ⁠[email protected] ⁠with any questions or concerns.

In this podcast, Heba Rashed, MD, PhD will engage in a discussion with our expert Teerin Liewluck, MD on rare, yet treatable myopathies which are associated with monoclonal gammopathies. Together, we will navigate different types, presentations, histopathological features, and therapeutic options. AANEM podcasts are intended for educational purposes only. The views expressed are those of the speakers and do not necessarily reflect the views or policies of AANEM. Podcast content should not be interpreted as clinical, legal, or reimbursement advice. Contact ⁠[email protected] ⁠with any questions or concerns.

Shawn Jorgenson, MD facilitates a debate between Dave Preston, MD and Richard Lewis, MD: Should Neuromuscular Ultrasound be Routinely Used in the Diagnosis of CIDP?AANEM podcasts are intended for educational purposes only. The views expressed are those of the speakers and do not necessarily reflect the views or policies of AANEM. Podcast content should not be interpreted as clinical, legal, or reimbursement advice. Contact [email protected] with any questions or concerns.

Tune in to this episode to learn important pearls about performing pediatric EMG as Drs. Rubin and Jarrar talk through an interesting case of a young patient with progressive weakness.

Kelly Gwathmey, MD facilitates a debate between Christina Fournier, MD and Shafeeq Ladha, MD: Should Serum Neurofilament Light Chain or NfL be Incorporated into Routine ALS Clinical Practice?AANEM podcasts are intended for educational purposes only. The views expressed are those of the speakers and do not necessarily reflect the views or policies of AANEM. Podcast content should not be interpreted as clinical, legal, or reimbursement advice. Contact ⁠[email protected] ⁠with any questions or concerns.

Shawn Jorgenson, MD facilitates a debate between Larry Robinson, MD and Jeff Strakowski, MD: Should a Combined Sensory Index be Used in Every Case of Suspected Carpal Tunnel Syndrome?AANEM podcasts are intended for educational purposes only. The views expressed are those of the speakers and do not necessarily reflect the views or policies of AANEM. Podcast content should not be interpreted as clinical, legal, or reimbursement advice. Contact ⁠[email protected] ⁠with any questions or concerns.

What are you most thankful for this year? Is it listening to these educational Lessons from the Lab?  If so, you are in luck – enjoy this Thanksgiving edition of Lessons from the Lab as Drs. Rubin and Del Toro talk turkey, stuffing, and nerves!

Carrie Ford, CNCT specialist II facilitates a debate between Michael Andary, MD and Nassim Rad, MD on the balance between diagnostic testing and clinical care — when it’s appropriate to add an Evaluation and Management component to the EMG, and when it’s more appropriate to keep the study purely diagnostic.AANEM podcasts are intended for educational purposes only. The views expressed are those of the speakers and do not necessarily reflect the views or policies of AANEM. Podcast content should not be interpreted as clinical, legal, or reimbursement advice. Contact ⁠[email protected] ⁠with any questions or concerns.

If you missed this engaging, Lessons at the AANEM in San Francisco, you are in luck . . . join this “replay” of the lively panel and audience discussion about a woman with sudden painless hand weakness. Does this woman’s clinical presentation, EDX findings, and image make sense? Should you always perform Babinski testing on ever patient in the EMG laboratory? Enjoy this educational discussion and debate.

Do you think that patients that complain of shoulder pain should always be evaluated with an EMG?  Perhaps not, but not all shoulder pain is orthopedic in nature. Tune in to this episode to see how EMG can help when the cause of shoulder pain may not be obvious?

Chilvana Patel, MD interviews Devon Rubin, MD on "Lessons Learned in the EMG Lab: Elevating EMG Practice Through International Exchange." Dr. Rubin will be sharing his extensive experience in EMG education and collaborative practice across the countries. That effort is the exchange of best practices and the development of collaborations that ultimately improve patient care and promote health equity worldwide.

Do you have questions about neuralgic amyotrophy? In this episode, Shawn Jorgensen, MD will check in with Joelle Gabet, MD, the lead author of the recent review of neuralgic amyotrophy in Muscle and Nerve. She will review recent updates in the clinical presentation, electrodiagnosis, imaging, and treatment of this disorder with a focus on evolving aspects, including imaging findings and surgical and non-surgical implications.

Carrie Ford, CNCT interviews Clark Moser, MD, ABEM, ABPN on "Electromyography Referrals: Principles and Practices for Optimizing EMG Orders ". This podcast is for neurologists, PMRs, orthopedists, PCPs, NPs, PAs, and residents who refer patients for EMG and NCS. It also helps NCS technologists understand the clinical intent behind each referral—guided by the EMGer’s diagnostic focus. This episode offers practical strategies for improving the quality of the EMG referrals by treating each order as a focused clinical study. We review what the EMG evaluates—nerve and muscle function—and how to understand results in terms of localization and severity. Listeners will learn to move beyond vague referral terms like “weakness,” “pain,” or “paresthesia” and instead indicate in the EMG order what specific neuromuscular or electrodiagnostic question they want answered.

In this AANEM session, Chilvana Patel, MD moderates a discussion with Pushpa Narayanswami, MD, Nicholas Silvestri, MD, and Kelly Gwathmey, MD on the evolving treatment landscape in myasthenia gravis (MG). The panel reviews the use of targeted therapies in women of childbearing age with myasthenia gravis, alongside guidance for perioperative care before elective surgery. Through illustrative patient cases, the experts provide insight into practical challenges and emerging opportunities in tailoring advanced immunotherapies to individual patient needs.

Chilvana Patel, MD is hosting a case-based panel discussion titled "Evolving Therapeutic Horizons in Myasthenia Gravis: Expert Perspectives on Targeted Therapies - Part 1." She will engage with renowned neuromuscular specialists—Pushpa Narayanaswami, MD, Nicholas Silvestri, MD, and Kelly Gwathmey, MD—to explore real-world cases and discuss the latest advances in targeted treatment options for Myasthenia Gravis.

Have you ever experienced tingling after running a marathon? Is marathon running good for your nerves? Tune in to this episode and listen to Drs. Rubin and Shahrizaila discuss an unusual case to help you decide whether or not to take up running.

In this episode, Dr. Nadia Khalil interviews Dr. Nathaniel Robbins, the Director of the Autonomic and Small Fiber Neuropathy program at Mass General Brigham, on POTS. In this episode, they review the diagnostic criteria, clinical presentation, differential diagnosis, adjunctive testing, and management.

Do you know what neuromuscular condition Spock from Star Trek may have had? Tune in to this Lessons from the Lab to learn!

In this AANEM podcast, Chilvana Patel, MD, interviews Devin Rubin, MD, and Nortina Shahrizaila, PhD, about global disparities in EMG and nerve conduction study training. They discuss challenges such as inconsistent educational program standards, limited resources, and lack of mentorship, especially in developing countries. This podcast covers the current efforts to improve access to hands-on training and standardized education.

Dr. Kelly Gwathmey interviews Dr. Corey Bacher from the University of Toronto, Dr. Charles Kassardjian from the University of Toronto, both in Toronto, Ontario, Canada. We also have Dr. Ruple Laughlin from the Mayo Clinic in Rochester, Minnesota, and Dr. Puspha Narayanswami from Beth Israel Deaconess Medical Center in Boston, Massachusetts. They will all be discussing recommendations for monitoring and managing glucocorticoid related systemic complications from the recently published: “International Consensus Guidance for the Management of Glucocorticoid Related Complications in Neuromuscular Disease."

This AANEM podcast features Dr. Joome Suh, a neurologist and neuromuscular specialist at Brigham and Women's Hospital, interviewed by neuromuscular fellow Dr. Nadia Khalil. They discuss HMG-CoA reductase immune-mediated necrotizing myopathy (HMGCR IMNM), a rare autoimmune muscle disease often associated with statin use. The discussion covers clinical presentation, epidemiologic considerations, histopathologic findings, and treatment approaches, with special focus on Dr. Suh’s recent research published in Muscle and Nerve with co-author Dr. Anthony Amato. Their study found that patients receiving maintenance IVIG as part of their regimen were more likely to have a normal CK at 6 months and the daily prednisone-equivalent was lower. A sub-group analysis suggested IVIG as monotherapy is effective.

How did you fare on your March Madness brackets? Did you win your EMG lab pool? Did you pick any upsets? Tune in and you will be sure to win this Lessons from the Lab March Madness bracket. It’s full of surprises and successes, and you won’t be “upset".

In this podcast, host Carrie Ford, CNCT, R.NCS.T., interviews 4 nerve conduction technologists: Candy Dolan, CNCT, R.NCS.T, R.EEGT, Pati Ramsey, CNCT, R.NCS.T, Nicole Wiley, CNCT, and Nathaniel Dickey, CNCT.They discuss how AANEM transformed their field by establishing the Certified Nerve Conduction Technologist (CNCT) credential in 2011. The technologists share insights about AANEM membership benefits, certification challenges, employer support and offer advice to newcomers on mentorship and continuous learning. All emphasize the importance of certification and community involvement in maintaining professional standards.

The podcast explores the AANEM Training Program Partnership (TPP), an educational resource designed for neurology and PM&R training programs. The discussion features current neuromuscular fellows, Sukhraj Gill & Praveen Attele, along with hosts Bhaskar Roy (an associate professor at Yale) and Carrie Ford (a technologist at University of Utah).

Enjoy this Valentine’s Day edition of Lessons From the Lab! Drs. Rubin and Levin work through a case with some twists and turns and a variety of teaching points – it’s just like not knowing what you are going to get when you open a box of Valentine’s Day chocolates!

Grab your hot chocolate and cozy up to your fireplace as you warm up with an educational discussion about a patient who lost his voice. Drs. Rubin and Munin will help teach you how to help patients find their voice (or at least find some muscles contributing to their voice with needle EMG) as they figure out the best way to approach this patient.

In this AANEM podcast, Dr. Stino interviews Dr. Allen on the groundbreaking ADHERE study, published in Lancet Neurology in 2024, which investigated efgartigimod for treating chronic inflammatory demyelinating polyneuropathy (CIDP). As the largest CIDP trial to date with 322 patients across 146 sites, it marked the first major study of a targeted biologic therapy in CIDP. The trial featured a unique two-stage design: An open-label response phase followed by a randomized controlled phase for responders. Dr. Allen explains the rationale behind targeting IgG in CIDP, despite its less clear antibody-mediated mechanism compared to myasthenia gravis. The study demonstrated a 66-70% response rate in the open-label phase, with significantly lower relapse rates compared to placebo in the randomized phase. This research represents a significant advancement in CIDP treatment options, offering a weekly subcutaneous administration that could reduce treatment burden compared to traditional therapies.

In this AANEM podcast, Dr. Andrés De León interviews neuromuscular pathology experts Dr. Aziz Shaibani and Dr. Marcus Pinto about the current state and value of muscle and nerve biopsies in clinical practice. The discussion covers essential topics including proper indications for biopsies, technical considerations in choosing biopsy sites, staining techniques, and the impact of advancing genetic testing on diagnostic approaches. Dr. Shaibani emphasizes that while genetic testing has reduced some muscle biopsy indications, biopsies remain crucial for certain conditions like inflammatory myopathies and mitochondrial disorders. Dr. Pinto details specific scenarios where nerve biopsies are invaluable, particularly in diagnosing vasculitic neuropathy and amyloidosis. Both experts share insights on the complementary role of muscle and nerve biopsies in conditions like systemic vasculitis and discuss how modern diagnostic tools like myositis antibody testing and genetic panels are changing but not eliminating the need for tissue diagnosis.

In this AANEM podcast, Carrie Ford, a CNCT and R.NCS.T. from the University of Utah's Jack Petajan EMG Lab, interviews Dr. Kyle Mahoney, an associate professor at the University of Utah, who provides a comprehensive explanation of neuromuscular junction transmission and the critical concept of the "safety factor." He breaks down complex neurophysiological concepts using accessible analogies, explaining how the safety factor serves as a built-in buffer that ensures reliable nerve-to-muscle signal transmission. The discussion covers normal neuromuscular junction function, the impact of various pathological conditions such as Lambert-Eaton Myasthenic Syndrome, myasthenia gravis, and ALS on neuromuscular transmission, and the clinical significance of repetitive nerve stimulation testing. Dr. Mahoney's clear explanations make these technically challenging concepts more approachable for healthcare professionals, particularly EMG technicians who may be less familiar with the underlying mechanisms of neuromuscular transmission.

Sit back and reminisce about the old oral EMG board examination as two former examiners discuss their thought process on an interesting case. See if Dr. Chiodo passes his Lessons From the Lab examination (he does with flying colors!). You are sure to learn good, practical knowledge when you listen to this episode.

In this AANEM podcast, Dr. Kelly Gwathmey interviews Dr. Aziz Shaibani and Dr. Yessar Hussain, two experienced neuromuscular specialists who run successful private practice clinical research programs in Texas. They discuss the motivations for conducting clinical trials, including expanding treatment options for patients and contributing to medical advancement. The experts share valuable insights about building research infrastructure, recruiting patients, managing competing trials, and balancing clinical duties with research responsibilities. They emphasize the importance of having well-trained research coordinators, efficient databases, and proper facility space. Both physicians stress the need for more clinical trial training in medical education and encourage young physicians to enter the field, noting that while only 5% of physicians participate in clinical trials, there are over 200,000 trials currently listed in the USA, presenting significant opportunities for new researchers.

Join in to this episode of Lessons From the Lab as Drs. Rubin and Hobson-Webb discuss a challenging case filled with many things to ponder. Is the arm finding related to the neuropathy? Are the findings indicative of demyelination? Is there conduction block? Is Dr. Rubin good at ultrasound scanning? You will be sure to learn quite a bit during this discussion!

In this comprehensive discussion, four prominent neuromuscular experts—Drs. Bhaskar Roy, Jeff Allen, Diana Castro, and Luis Querol—explore recent developments in Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). The conversation centers on the new European Academy of Neurology and Peripheral Nerve Society guidelines, highlighting significant changes in diagnostic criteria and disease classification. The experts discuss the challenges of diagnosing CIDP, particularly in pediatric cases and variant forms, while emphasizing the importance of proper electrodiagnostic testing and the role of supportive criteria like CSF studies and MRI. They delve into the emerging field of autoimmune neuropathies and the significance of specific antibody testing. The podcast concludes with a discussion of treatment options, including traditional approaches (IVIG, corticosteroids, plasmapheresis) and newer therapies such as FcRn inhibitors and complement-targeting drugs, while also addressing the controversial role of rituximab in CIDP treatment. Throughout the discussion, the experts stress the importance of regular diagnostic reassessment and the need for more personalized treatment approaches based on patient profiles.

This podcast discusses paraproteinemic neuropathies, featuring experts Dr. Michelle Maruman and Dr. Eli Naddaf. They explore the definition and clinical significance of monoclonal proteins, the necessary tests for diagnosing these conditions, and the various types of paraproteinemic neuropathies. The discussion covers IgM-associated neuropathies, including DADS, CANOMAD, and Waldenstrom's acroglobulinemia-associated neuropathies, as well as non-IgM neuropathies such as POEMS syndrome and light chain amyloidosis. The experts detail the clinical features, diagnostic criteria, and management approaches for these conditions, emphasizing the importance of accurate diagnosis and appropriate treatment. They conclude by reminding clinicians that the co-occurrence of peripheral neuropathy and monoclonal gammopathy in aging populations is often coincidental, and a careful evaluation is necessary to establish a causal relationship.

Despite its recognition for nearly 40 years, anti-MAG neuropathy continues to have limited therapeutic options. The emergence of bruton tyrosine kinase inhibition as a new therapeutic pathway appears promising. In this interview, Dr. Amro Stino interviews Dr. Chiara Briani on her 2023 paper exploring the prevalence of the MYD 88 mutation among patients with anti-MAG neuropathy. This is discussed within the broader context of disease presentation, current treatment landscape, and future drug development.

Dr. Andrés De León interviews Drs. Simon Podnar and Gregor Omejec about their research on recovery of ulnar nerve conduction block at the elbow. 

Dr. Chilvana Patel interviews Dr. Khadilkar on the article titled "Acquired Hyperexcitable Peripheral Nerve Disorders: Clinical and Laboratory Features, Therapeutic Responses, and Long-Term Follow-Up." This study examines the clinical and laboratory characteristics of acquired hyperexcitable peripheral nerve disorders, evaluates therapeutic responses, and provides insights from long-term follow-up observations.

Did you miss Lessons From the Lab LIVE 2? Watch the recording now and see the fun you missed as Drs. Devon Rubin and Christopher Lamb present and discuss a unique case of a young rock climber with arm weakness.

Carrie Ford, CNCT, RNSCT, REPT (Emeritus) interviews Peter Grant, MD who is a fraud and abuse expert for the FBI Office of Inspector General, US Attorney’s Office, private insurers, and state medical boards. During this podcast, Peter discusses AANEM lab accreditation—how and when it got started. Dr. Grant explains how to apply for lab accreditation, the benefits of being an accredited lab, exemplary accreditation status vs regular accreditation, and how the HB2639 will affect lab accreditation.

Carrie Ford, CNCT, RNSCT, REPT (Emeritus) interviews Peter Grant, MD who is a fraud and abuse expert for the FBI, Office of Inspector General, US Attorney’s Office, private insurers, and state medical boards. In this podcast Dr. Grant discusses promoting quality electrodiagnostic medicine through legislation—HB2639 explaining the history and need for this legislation, as well as explaining EDX “fraudsters,” and roadblocks that have occurred with this legislation. Dr. Grant also discusses the AANEM’s state liaisons, lobbying in Washington, DC, and meetings with congressman Pete Sessions for support of HB2639.

Join this Lessons From the Lab as Dr. Devon Rubin picks the amazing brains of Drs. Donald Sanders and Janice Massey on the approach to a patient with weakness. Learn what it means when a patient walks into the office sucking on hard candy as well as what tools should be used to think about and assess for an uncommon neuromuscular disorder.

Carrie Ford, CNCT, RNSCT, REPT (Emeritus), interviews Peter Grant, MD, for a podcast on electrodiagnostic (EDX) fraud and abuse. Dr. Grant is a fraud and abuse expert for the FBI, Office of Inspector General, US Attorney’s Office, private insurers, and state medical boards. In this podcast, Dr. Grant explains EDX fraud and how it adversely affects PM&R and neurology, which includes hand-held devices, billing unnecessary repeat studies, billing unnecessary multiple nerves with EMG, and mobile diagnostic labs.

Dr. Nadia Khalil interviews Dr. Collin Grant on his experience in private practice. He shares his take on the highlights, challenges, and keys for success.

Have you ever encountered a patient with progressive patchy weakness in various muscles throughout the body? Have you ever performed an EMG in which the findings don’t always fit perfectly into what you were expecting?  Have you ever wondered whether you even need to perform an EMG in a patient with weakness? Have you ever wondered how much fun it would be to listen to a new episode of Lessons From the Lab? Well, you have come to the right place to find some answers to these questions! Join Drs. Rubin and Narayanaswami as they ponder and discuss many clinical, electrodiagnostic, and practical approaches to an interesting patient with progressive weakness.

Dr. Nadia Khalil interviews Dr. Ileana Howard and Dr. Kelly Gwathmey on their careers in neuromuscular medicine. They define a neuromuscular practice and highlight how meaningful, challenging, and exciting this field of medicine is.

Dr. Nadia Khalil interviews Dr. Nicholas Johnson on a career in research. He describes what research in practice looks like, his inspiration, and pearls for success.