Teerin Liewluck, MD, FAAN, FANA

Professor of Neurology, Myologist, Myopathologist & Electromyographer at Mayo Clinic; Tweets limited to Medicine, Travel & Food.

[Teerin Liewluck, MD, FAAN, FANA @TLiewluck]

@wisit661 @MayoClinicNeph @MayoClinic Congratulations!!!!!

[Teerin Liewluck, MD, FAAN, FANA @TLiewluck]

📢 Applications open for the 2027 Muscle Disorders Fellowship at @MayoClinic!

Advanced training in muscle diseases for neurology residents, #neuromuscular fellows & eligible IMGs (USMLE + ECFMG).

Learn more: https://t.co/F9degMFuNb

[Marcus Pinto, MD, MS @MarcusVPinto]

I am excited to share my review article, “Amyloid Neuropathies,” published in @ContinuumAAN. My journey caring for patients with amyloid neuropathies began 14 years ago at the Brazilian Amyloidosis Referral Center at my alma mater, @ufrj. Since moving to @MayoClinic, I’ve continued my clinical work and research in amyloidosis, which has given me a unique perspective on patient care across two very different settings. I’ve aimed to simplify this complex topic, including many clinical pearls and a diagnostic flow chart highlighting key red flags.

I’m also proud to share that @LyellJ selected this article as one of the editor’s picks, making it freely available for the next three months. Don’t miss out—download it now! 😊

https://t.co/PA4ewUKMx6

Lastly, I want to say it's such an honor to write for @ContinuumAAN, which was the most important neurology journal throughout my (long) neurology training journey. The opportunity to give back through this review was very meaningful to me.

I hope you all enjoy it!

[Teerin Liewluck, MD, FAAN, FANA @TLiewluck]

An elegant talk by @elkeschipani on #pregnancy in hereditary muscle diseases!!! We are proud of you 👍.
#Myopathy
#MuscularDystrophy
#MyotonicDystrophy
@MayoNeuroFellow
@MayoClinicNeuro

[Teerin Liewluck, MD, FAAN, FANA @TLiewluck]

Hot 🔥 off the press: TUBA4A-opathy as a new member of genetic myopathy-myasthenic overlap syndrome!!! We cannot treat the #myopathy part, but we can help with the #myasthenia.
https://t.co/kaLcshUFPc

[Teerin Liewluck, MD, FAAN, FANA @TLiewluck]

What you need to know about disorders of muscle lipid metabolism in adult patients! We highlight an acquired form of lipid storage #myopathy (#sertraline associated MADD-like disorder).
https://t.co/ROvTG6lP3v
#MetabolicMyopathy
#Neurology
#Psychiatry

[Elke Schipani, MD @elkeschipani]

🤔 Are all patients with severe ICI toxicity truly demonstrating “triple M” physiology? Check out our video interview with @MayoProceedings https://t.co/r4YHvk9WZW and our published article at https://t.co/i5BQ5ituPY, now available online! @TLiewluck @EWijdicks

[Marcus Pinto, MD, MS @MarcusVPinto]

A three-step method to evaluate a patient presenting with a wrist drop:

1. Arm position. Before assessing strength, place the patient's forearm and hand on their lap or another surface. The dropped wrist position (wrist hyperflexion) creates a biomechanical disadvantage for the forearm flexors and intrinsic hand muscles, often leading to an exaggerated perception of muscle weakness.

2. Identify which muscles are weak. In a central wrist drop, both the forearm flexors and intrinsic hand muscles are also weak. In a peripheral wrist drop, muscle strength of these muscles is usually normal, as radial mononeuropathy is the most common cause.

3. Make a fist. With the wrist dropping, instruct the patient to make a fist. If the wrist extends during this movement, it confirms a central lesion. In peripheral wrist drop, wrist extension either worsens or remains unchanged; it never extends. Wrist extension occurring with finger flexion is a synkinesia and hallmark of central wrist drop (video).

https://t.co/Vpu43hfcnT

[Teerin Liewluck, MD, FAAN, FANA @TLiewluck]

It was a pleasure to virtually take part in the National Congress of the Chilean Society of Medical #Oncology yesterday morning, speaking on myotoxicity associated with #cancer therapies. 🇨🇱

[Marcus Pinto, MD, MS @MarcusVPinto]

One of my missions is to make Peripheral Neuropathies more understandable for non-experts. Recognizing that physicians often find PNs challenging, especially in the hospital setting, I collaborated with @MayoClinicNeuro Neuromuscular hospitalists, @ReeceHass and @SantilliAshley, and my former NM co-fellow #JMartinezThompson to develop an engaging infographic that simplifies how to approach neuropathies leading to hospitalization. The incredible artistic skills and creativity of @ReeceHass truly brought this project to life, exceeding all expectations. We hope you find this helpful. https://t.co/HjEJbfOkqh

[Marcus Pinto, MD, MS @MarcusVPinto]

It is July, I’m staffing the PN clinic and once again, it is essential to emphasize to the new PN/NM fellows the critical role of the clinical phenotype in diagnosing peripheral neuropathies.

NCS/EMG are valuable, but the neurological exam is the most important (as it should be in neurology but many have forgotten).

This is the neuropathy clinical phenotype classification I find the most helpful:

1-Isolated small fiber neuropathy
2-Length-dependent peripheral neuropathy (or distal symmetric polyneuropathy)
3-Multiple mononeuropathies
4-Mononeuropathy
5-Asymmetric neuropathy
6-Polyradiculoneuropathy
7-Plexopathy (brachial or lumbosacral, many times a radiculoplexus neuropathy)
8-Sensory neuronopathy
9-Motor neuronopathy

I always tell my trainees they don’t have to memorize the causes of each phenotype. If you define the syndrome correctly, you can ask a Chatbot what are the most likely causes. If you add the time course (tempo), presence of autonomic dysfunction, presence of systemic features (weight loss, rashes, fever, night sweats, or anasarca), comordities and response to immunotherapy, the chatbot will provide you an expert level discussion and differential.

1- Isolated Small Fiber Neuropathy

-Pure small fiber neuropathy.
-Only temperature and pinprick dysfunction on exam.
-Ankle reflexes must be normal in patients < 60 yo.
-NCS must be normal for age.

2- Length-dependent peripheral neuropathy (or distal symmetric polyneuropathy)

-Sensory predominant neuropathy, can also have motor involvement, distal predominant, worsens in an ascending length-dependent fashion: foot->leg-> hands/knee->elbow/anterior abdomen.

3- Multiple Mononeuropathies

Involvement of two or more non-contiguous (separate) motor, sensory or sensorimotor peripheral nerves.

4- Mononeuropathy

Involvement of a single sensory, motor or sensorimotor peripheral nerve.

5-Asymmetric neuropathy
It’s the pattern of overlapping multiple mononeuropathies.

Length-dependent polyneuropathy (distal predominant) involving bilateral extremities in an asymmetric fashion demonstrated by at least one grade of motor power difference by the Medical Research Council strength scale, more than 50% difference in sensory testing and involved individual nerves could not be identified separately.

6-Polyradiculoneuropathy

Proximal and distal weakness and sensory loss in the four limbs.
Can be distal>proximal; distal=proximal or distal<proximal.

7- Plexopathy

-Proximal and distal weakness in a single limb with decreased/absent reflexes and sensation loss (can be only proximal or only distal in brachial plexopathies; and of course can be bilateral).
- On exam can look like a radiculopathy or multiple radiculopathies.

-Plexopathies usually have more dense sensation loss than radiculopathies and may cause alodynea (pain caused by non-painful stimulus) which is rarer in radiculopathies.

8- Sensory Neuronopathy or Ganglionopathy

-The cell body of the sensory neurons are affected, usually asymmetric and affecting distal and proximal limbs, patchy, can affect the face or whole body, must have sensory ataxia and preserved strength.
- Can be accompanied by pseudoathetosis.

9- Motor neuronopathy

-Pure motor syndromes.
-The body of the motor neurons are affected.
-Usually asymmetric and distal predominant, accompanied by atrophy, fasciculations, decreased/absent reflexes (can also have upper motor neuron signs) and normal sensory exam.

[Iago Pinal-Fernandez @DrIagoPinal]

Excited to share our latest @ARD_BMJ study! We reveal the mechanism by which autoantibodies enter cells, disrupt their target autoantigens, and drive tissue injury and inflammation in myositis and other autoimmune diseases. 🧬

https://t.co/nbX62hRSb6

[Marcus Pinto, MD, MS @MarcusVPinto]

The recommendation to perform serum SPEP with immunofixation in every case of distal symmetric polyneuropathy has caused unnecessary harm to patients. This advice has been repeated so often that many regard it as an absolute truth. However, Dr. Go and colleagues from @MayoClinic Hematology demonstrate the very low clinical utility of monoclonal gammopathy testing in patients with peripheral neuropathy. https://t.co/dNpWGKskCR

[Elke Schipani, MD @elkeschipani]

❗️HOT OFF THE PRESS❗️

https://t.co/k4m0KP1u8k

Can plasma Neurofilament light chain (pNfL) help clarify whether a you are dealing with a clinically stable or active neuropathy?

We looked at pNfL across neuromuscular patients at Mayo Clinic. 🧵 @GreenJournal

[Elke Schipani, MD @elkeschipani]

Is the “MG” in ICI-associated “Triple M syndrome” actually myasthenia gravis? In 27 patients, we found no decrement on RNS, no pyridostigmine response, and SFEMG abnormalities alongside severe myopathy. Time to rethink the label. 🧵@TLiewluck https://t.co/xz3pMkEfrw

[Teerin Liewluck, MD, FAAN, FANA @TLiewluck]

All you need to know about Myasthenia Gravis (#MG) and #Thymoma! AChR antibodies can be positive without myasthenia gravis in 1/3 of patients with thymoma.
https://t.co/9KJRyDo1ev

[Divyanshu Dubey @Div_Dubey]

In this @JAMANeuro Viewpoint, we discuss why continued autoantibody discovery matters. Today's seronegative patient may become tomorrow's newly recognized disease. Discovery advances diagnosis, reveals disease mechanisms &amp; guides targeted therapies.

https://t.co/bc9qHwcyCo

[Mayo Clinic Neurology Fellowships @MayoNeuroFellow]

Dr. Tony Zhang (CNP-EMG Fellow), Dr. Grace Dominguez (CNP-EMG Fellow), and Dr. Ikreet Cheema (Neuromuscular Fellow) celebrate the end of their fellowship year in the Mayo EMG Lab with their consultants&amp;mentors.
The Minion’s happy and fellows have thrived!

#MayoNeuroFellowships

[Teerin Liewluck, MD, FAAN, FANA @TLiewluck]

Updating my talk for new fellows reminded me of @AANEMorg
monograph I wrote in 2021:
Guidelines for genetic testing of muscle and neuromuscular junction disorders. Although it has been 5 years since its publication, the core concept is still relevant.
https://t.co/Cqa3mWEu8Y

[Teerin Liewluck, MD, FAAN, FANA @TLiewluck]

@MarcusVPinto @aszelikovich @MayoClinic Congratulations, Marcus!!!