Simon Rowe

@GrokCertified @mufaddal_vohra Australia only bowled 67.3 overs in Perth in both innings combined. I think they'll be fine...

- No Pat Cummins. - No Josh Hazlewood. AUSTRALIA ANNOUNCE AN UNCHANGED SQUAD FOR THE 2ND ASHES TEST.

@kookcove I don't know if it works across the board, but for me when I was a super fussy tween and for my eldest two (now 15 and 12), the game changer was letting the kids cook for themselves. Fussiness is often a wish for control and cooking for yourself gives that back.

I love my children dearly. Recently, my coworkers have been talking to me about processesd foods and preservatives. They've lots of opinions. I felt guilt that sometimes I take the easy way out with my kids. This was dinner tonight.They ate almost none of it. What do you do next?

@aditya_gan3500 /... Midline shift. Decompressed. Returned to us a week later. Mood, appetite, participation all much improved. Suddenly making progress. SDH can be very sneaky, and older people can cope with quite a lot of misplaced blood in their heads... Until they can't.

@aditya_gan3500 I still recall from my first term: 70M, Hx of CIDP, inpatient rehab after an admission for worsening mobility. Hx of a fall, 2 months before. Now languishing, depressed, getting worse despite rehab, ready to give up. Then, new left arm weakness. CTB showed acute on chronic SDH/

I will focus on my area of expertise. The CT scan. Its not wrong to obtain a CT head even in trivial trauma and for elderly patients. Many subdural hematomas are very sneaky. We obtain such scans for nearly all falls in older patients. Guidelines are not necessarily accurate all the time and missing an SDH can be catastrophic. Plus 'self fall' here is likely an unwitnessed fall. It could be a seizure or syncope or trauma or whatever. Neuroimaging is important here. Let us not sacrifice being careful at the altar of rational medical practice. #MedTwitter #NeuroTwitter

Today, NeuRA proudly hosted the Parkinson's Disease Open Day a special event bringing together science, support, and community. Welcomed by the Park and Sing choir, the event gave visitors the opportunity to learn about the services NeuRA offers for people living with Parkinson’s Disease and hear the latest research updates and clinical trial developments. NeuRA's Dr Michael Li shared insights on the connection between genetics and Parkinson’s Disease. @DrSimonRowe discussed the effects of diet, nutrition, and the microbiome, and Dr @gautamwali presented the latest research in Parkinson’s Disease. Attendees also had the opportunity to connect with NeuRA researchers and explore current studies, as well as meet our fantastic event partners: Parkinson's NSW, Shake It Up Australia, and Preview Health. #NeuRA #Parkinsons #ParkinsonsDisease @OkuboYoshiro

@JaneKin54322448 @EricaCampbell48 I wonder if unwanted pregnancies might have any negative effects on young women's mental health outcomes 🤔 Oh wait, silly me. No pregnancy is unwanted by these good people. As long as the government doesn't have to help the parents, were5all good.

Was this just a bad day? I thought they said he debated intelligently and in good faith.

@AndrewHayen There has been a concerted push this year at the top levels to hollow out academic life in Australia in the name of 'efficiency'. It's so coordinated as to clearly suggest a deliberate strategy to break the remaining resistance to casualisation in academia.

For those who know me... This no longer brings me joy. Just dread and sadness

@NeuroJediMaster Great case and excellent discussion points. Thank you!

Learning points Of course we do test the panel of antibodies when we have a suspected autoimmune encephalitis. But the clinical phenotype should fit, or we should be able to proof without a doubt that the unusual phenotype is really due to the antibody detected. All the differentials given by @Neuroptimist23 @aditya_gan3500 were correct but can we fine tune our ability to predict? What to take away from the case: Hyponatremia It is seen in VGKC related disorder and is more common on LGI1 , but can be seen in the other two as well. It is important to know this and not attribute seizures, altered sensorium to just hyponatremia. Evaluate deeper for hyponatremia, these encephalitis can be missed if not kept in mind in the right clinical context. Two plausible explaination- 1. VGKC channels are expressed in renal tubules. 2. Direct effect on ADH-secreting hypothalamic neurons LGI1? Dysautonomia and insomnia can be there. Although hyponatremia is more common, cerebellar ataxia is not.( there are case reports though) Onset is usually acute, with Limbic encephalitis presentation. IgLON5? They can present with ataxia but sleep disorders associated are usually parasomnia. Insomnia if present is usually mild. They can have bulbar syndrome, PSP,MSA like phenotype, neuromuscular phenotype. Homer-3? Has MSA phenotype. So cerebellar ataxia and autonomic dysfunction yes. But again parasomnia rather than insomnia. Hyponatremia not reported( as far as I’ve reviewed) CASPR? Significant Insomnia Can have both episodic/ progressive cerebellar ataxia. Hyponatremia is less common compare to LGI1. Dysautonomia is seen. This is a case related to autoimmunity against VGKC channel. VGKC spectrum can be - 1. Anti- LGI1 encephalitis 2. Anti-CASPR2 encephalitis 3. Morvan syndrome. This patient had strong positive CASPR2. So Hyponatremia can be seen in VGKC related autoimmune disorder. But ataxia was the clue that could narrow down to CASPR. Insomnia is very significant. ( less in IGLON5) So watch out , Hyponatremia should not mislead you ,but rather guide you to the diagnosis The below table is from the book Autoimmune encephalitis and related disorders of nervous system by Joseph Dalmau and Francesc Graus. Fantastic book I do believe it may need some changes as dysautonomia in CASPR2 and ataxia in LGI1 have been reported. #MedTwitter #NeuroTwitter #Autoimmune #Ataxia #Insomnia

@JaneKin54322448 @davebeerflog No, no you're doing it wrong. You have to take full credit due to your [retro conditioning move/niche nutraceutical/one weird trick] that [big pharma/the government/leftist] don't want us to know! Then we [subscribe to your substack/buy your ebook/join your bunker cult]. Rules.

@Natasha57932694 @SteveBigpond @drkeithsiau @erdocAA @ranjitrao1 Plus some frusemide for the low urine output and an ACE inhibitor for their uncharacteristic hypertension right?

@SteveBigpond @drkeithsiau @erdocAA @DrSimonRowe @ranjitrao1 Not a NSAID!!!! Unless you are trying to get them to us 😂😂😂

@drkeithsiau @Natasha57932694 @erdocAA @DrSimonRowe @ranjitrao1 Physiology for orthopods 1. The function of the heart is to transport cefazolin to the bone 2. The function of the kidneys is to remove cefazolin from the blood after the bone no longer needs it That’s all folks

Alzheimer's disease is too important, and its latest 'treatments' are too fraught with harms, for the current pharma-led wishful thinking and you-can-see-it-if-you-squint analyses. Neurodegeneration is more than any single molecule, and reductionist paradigms do not suffice.

@AlbertoEspay @alzforum Thank you for this excellent analysis. As I see patients asking for, and paying large amounts for, such therapies more and more, this data absolutely deserves more scrutiny.

In #Alzheimers news: “4 years on #lecanemab, the benefit tripled” … “3 years on #donanemab, the benefit doubled”, as summed by @Alzforum from #AAIC25 reported data. How the graphical illusion hides the acceleration of cognitive decline (9-part thread). alzforum.org/news/conferenc…

@m_as_in_mancy @taipan168 The problem with your argument is that eradication (i.e. extinction) of a virus requires reducing r0 to <1 globally for a prolonged period. Any reservoir will allow resurgence due to waning immunity in more suppressed areas and a return to square one. This is just not feasible.

@taipan168 First, you don’t know that. Second I didn’t claim that only masks could be attributed to the eradication of a flu strain. The point is that by reducing r0 enough, you can eliminate a virus. Masks significantly reduce the effective r0.

Imagine still believing in almost September 2025 that: a) this dystopian fantasy was even remotely realistic; and b) it would have achieved that result.

@taipan168 @JamesGWood_UNSW @missrobinson @Ben_Richards99 @kookcove Yes, I agree. Free markets are a convenient fantasy when it comes to healthcare since the 'consumer' [🤮] does not and never can have 'free choice'. They are a captive market, and the only semblance of freedom belongs to the providers.

@DrSimonRowe @JamesGWood_UNSW @missrobinson @Ben_Richards99 @kookcove As somebody who is very much in favour of free markets, I have somewhat reluctantly come to the conclusion that you may well be right. Similar principle applies to investment funds like Brookfield owning private hospitals.

Last post on this topic lest I get diagnosed with ASD myself. Patrick McGorry is a psychiatrist known for his development of the early intervention services for emerging mental disorders in young people, so you think he'd know what he was talking about. smh.com.au/national/nsw/y…

@JamesGWood_UNSW @missrobinson @taipan168 @Ben_Richards99 @kookcove Major equity issues. A heat map of NDIS uptake vs median household income would have a very clear correlation. This is a major issue with the whole NDIS system which applies market principles to healthcare, a strategy known to drastically inflate cost and reduce value.

@DrSimonRowe @missrobinson @taipan168 @Ben_Richards99 @kookcove It is extremely expensive, which of course creates major equity problems re access to diagnosis (and till now resulting NDIS funding). Very tricky area that I doubt government is ready to tackle in full.

@missrobinson @taipan168 @Ben_Richards99 @kookcove I think it also needs to be said: simplistically describing the NDIS inclusion of autism as 'incentivising' diagnosis neglects the main dynamic that used to prevail, namely: Without access to funding, what use is a diagnosis that actually costs thousands of dollars to obtain?

@taipan168 @Ben_Richards99 @kookcove The problem is, the 'point' has been delivered by you and others with a quite a nasty tone when most parents on the scheme just want help for their kids that are struggling. Families aren't making money out of it, or getting much more than therapy. It is a complicated issue.

@disco___cat Yeah I recall when moving to northern Germany for a while that the total rainfall in Sydney was much higher, but the total rainy days in Hamburg were close to double. Plus here, the rain mostly falls when then days are longest (this month is exceptional, obvs).

The issue with the weather in London isn’t the rain - rains far more in Sydney - but the lack of sunshine hours over the year. It’s overcast, a lot.

@JaneKin54322448 I honestly think that the Venn diagram of those who deride the autism diagnosis as a whole and dispute its inclusion in the NDIS, and those who used to bully such kids into a life of isolation and misery is a perfect circle.

@ajmnsaus The real question is why didn't they let it carry ferries across the harbour. Would've cut that route down by 90%, wharf to wharf.

Clinton gets it. Sydney Metro is useless.

@drvyom Any pressured speech, flight of ideas, grandiosity?😆

I might've been a tad theatrical at work today. A patient literally applauded when I concluded the consultation.