The diagnosis and management of idiopathic normal pressure hydrocephalus (NPH) is evolving. However, skepticism about this diagnosis persists among neurologists based upon lack of disease specific pathology, overlap with other neurodegenerative processes, and a lack of uniform diagnostic criteria. Also, prior reports of minimal or transient improvement after treatment with an invasive procedure and lack of high-quality studies has concerned some neurologists. We are joined by 2 experts in the field of movement disorders and CSF flow – Dr. Alberto Espay and Dr. Michael Williams – to discuss advances in our understanding of idiopathic NPH, the PENS trial, and evidence still needed to convince neurologists that NPH is clinical syndrome that warrants timely evaluation and treatment.

• Guest(s): Dr. Alberto Espay, Professor of Neurology at the University of Cincinnati; Dr. Michael Williams, Professor Neurology and Neurological Surgery at the University of Washington
• Interviewer: Dr. Kara Wyant, Clinical Associate Professor of Neurology at the University of Michigan
• Disclosures:
  • Dr. Espay: Consultancies & Scientific Advisory Boards Mitsubishi Tanabe Pharma America (formerly, Neuroderm), Amneal, Acorda, Abbvie, Bial, Supernus (formerly, USWorldMeds), NeuroDiagnostics, Inc (SYNAPS Dx), Intrance Medical Systems, Inc., Merz, Praxis Precision Medicines, Citrus Health, and Herantis Pharma.
  • Dr. Williams: I am a paid consultant to Aesculap regarding devices to treat hydrocephalus
  • Dr. Wyant: Biovie - consulting, (NEW 8/2025) ongoing, UCB Pharma - research support, ended 6/2025, PhotoPharmics - research support, ongoing

 Last year, the FDA approved adaptive deep brain stimulation for the treatment of people with Parkinson's disease. This is a major step forward in neurology. It allows personalized therapy by adjusting deep brain stimulation settings in real-time based on an individual's brain signals.

Our guest on this episode is Dr. Helen Bronte-Stewart, the John E. Cahill Family Professor of Neurology and Director of the Human Motor Control and Neuromodulation Lab at Stanford University. Dr. Bronte-Stewart was interviewed by Dr. Karlo Lizarraga, Associate Professor of Neurology and Director of the Motor Physiology and Neuromodulation program at the University of Rochester.

Disclosures: Dr. Bronte-Stewart disclosed equity in QDG Health. Dr. Lizarraga disclosed FHC: Consulting (Course Instructor), BlueRock: Research support.

 In this episode, we'll focus on new onset refractory status epilepticus or NORSE, and its closely related presentation, febrile and infection related epilepsy syndrome, known as FIRES. NORSE and FIRES are clinical presentations where the evidence is limited, stakes are high, and treatment often has to begin before the diagnosis is clear. They also raise broader questions about how neurology can respond to rare but catastrophic illness, including how patients, families and researchers can work together to move the field forward. For an update on NORSE and FIRES, we spoke with Dr. Howard Goodkin and Dr. Larry Hirsch. Dr. Goodkin is the Shure professor of neurology and pediatrics at University of Virginia. Dr. Larry Hirsch is a professor of neurology at Yale University. They were interviewed by Dr. Ifrah Zawar, assistant professor of neurology at the University of Virginia.

Disclosures: Dr. Hirsch has received consultation fees for advising from Ceribell, Natus, & UCB and honoraria for speaking/training from Neuropace & Natus.