Dr. Matthew Goldfinger, DO: Pediatric Neurologist, Functional Neurological Disorder Specialist

Join me and Matthew Goldfinger, DO, in talking about his journey into pediatric neurology and his current sub-specializations in Functional Neurological Disorders (FNDs) as well as Behavioral Pediatric Neurology. Matt is incredibly passionate about the current innovations of functional neurology and his work with children, too. We talk about the growth of the field of neurology over the recent years, figuring out where and how to do medical & specialty training, and exploring your passions and niche interests. 

Transcript

SPEAKER_00 0:02

All right, everyone. Welcome back to another episode of In Practice. I have another wonderful guest with me today. We actually have another pediatric neurologist on. Um, Matthew, if you want to introduce yourself, I'm excited to talk to you and hear about your work.

SPEAKER_01 0:17

Yeah, thank you. So I'm Matt Goldfinger. I work at Mass General, and my specialty within pediatric neurology is actually behavioral neurology. And I see people who are in the pediatric cohort, and then I actually see up to 30-year-olds, so some adult time as well, in that kind of transitional age where people are kind of figuring out what they're doing with their life.

SPEAKER_00 0:40

Nice, very cool. How did you decide to get into this specialty? And then I want to talk more about your subspecialty because that is super cool.

SPEAKER_01 0:48

Yeah. Um, so I think when you talk to pediatric neurologists, you get the people who always knew neurology, and then they found that the population of pediatrics was really what called to them. And then you get the people who are clearly, I've always wanted to work with kids, and then neurology was a fascinating part of the body. Um, and they kind of specialize in that way. And across the country, it's kind of split. Sometimes pediatrics is the overarching department that actually houses neurology, and then sometimes neurology houses pediatric neurology. Um, I think the latter is more common, but um I kind of always knew neuro. Uh I was a weird kid who subscribed to Journal of Neuroscience at a really young age, didn't understand any of it. Um, and the reason that I landed there was because I asked a lot of questions and I said, Well, how does that work? How does that work? How does that work? And my very, very smart mom, who I will loop back to why ended up doing behavioral neurology because she's very smart, but my very smart mom would answer all of my questions, but ultimately the answer to, I don't know, why is this kid not able to talk? Um, would be you might want to ask their neurologist. And um I thought that it was like the final frontier of understanding, well, sometimes it controls what the heart does, sometimes it controls what the gut does, sometimes it controls what every part of the body does. Endocrine, controlled by brain, heart rate controlled by the nervous system. And so they're all integrated and they're all essential, but I almost see it as like the final frontier or the final boss of um kind of medicine to just understand the regulation, the allostasis, and the homeostasis that's controlled via the nervous system. So that's why neuro. And then pediatrics, um, I just really love working with kids because of the infinite potential, I think. Uh, you know, every type of physician is necessary and makes a huge difference. And my adult neurology colleagues who I adore make a huge difference for those patients. But I kind of am in love with the fairy tale idea that if I make a difference in someone whose brain is young, it's still plastic, it can change, and I can get like another 80 to 100 years out of the improvement versus starting a little later, things are a little bit more entrenched, the brain's a little bit more solidified, and then sure you get really nice um outcomes, but the delta is maybe not as significant. Yeah.

SPEAKER_00 3:29

I uh I work with a lot of kids in tutoring and such. And I also feel that way a lot of the time that the younger they are, you just feel like you can really make more of an impact, which I think can also be a little stressful because you can make a really big impact.

SPEAKER_01 3:43

Yeah, the wins are amazing, and then uh the trouble is is definitely more devastating. But um, I I love it, and and I think um I don't want to take away from any other field working with any other population, but that's kind of the thing that gets me going, is just like knowing how much change is possible because there's a condition called Rust Musins where you may actually have to take out an entire hemisphere of the brain, and those kids do amazing if you do it early enough. And so um I've seen kids with a ribbon cortex where they just have like a literally a ribbon. I've seen incredible things that those people grow up to do stuff that even like knowledgeable doctors and neurologists said might not be possible. And uh the kids, as they would say, say bet, you know, they like willing to just say, like, no, I'm gonna do amazing things. So um, that's why I love what I do.

SPEAKER_00 4:41

And then I'd love to hear. So actually, I'm gonna ask you first, did you know going into med school that you wanted to do neurology, or were you wondering still?

SPEAKER_01 4:51

So a lot of people go into med school with a neuroscience degree uh way, way, way, way more than go into neurology. And I've actually done a little bit of med-ed work in trying to understand why that happens and like what are we doing wrong in teaching neuroscience in med school that scares away the people who studied it in undergrad. Uh, I happen to have come in loving it, um, and it stayed something I loved, but that's definitely not everyone's story, and I don't want any of your listeners to fear that they don't know what they're doing going into med school or being afraid to change or anything like that. I happened to know that that was what I wanted to do. But um, even once I'm in neurology, there was a lot of decision making about what that would look like. And so I kind of didn't feel limited. Uh, it wasn't a scary decision because I knew that the types of careers that I could build were quite varied.

SPEAKER_00 5:48

Yeah. And so yeah, I wanted to hear more about your behavioral subspecialty and what that sort of is and and why you how you got there.

SPEAKER_01 5:58

Yeah. So I think that uh behavioral neurology is a really broad term itself and can contain working on like cognitive things with people with like memory issues or personality changes or um you know problems with performance in the work setting or in the school setting, or um personality uh things are kind of central to what I was curious about. Um, because my other really, really um potentially insulting to other fields perspective on neurology is if you're little Billy with a heart problem, you're still little Billy. Um if you're little Billy with a stomach problem, you're still little Billy. And of course, those things can impact you greatly. But if something happens to your brain, the thing that makes you you might not be working. And so uh you might not be little Billy anymore.

SPEAKER_00 6:52

Yeah.

SPEAKER_01 6:53

And the brain is just so central to who we are as people. And so uh I told you I would loop back to my mom is smarter than I am, and she thought I was gonna do psychiatry. Um, and I love the field of psychiatry, but I was just really curious about uh some of the underlying neuroscience, and now the fields are coming back together. They've been separate and they're they've fused and then separated a couple times throughout history, and it's one board. The question bank for the licensing exam is the same question bank, it's just percentage of the questions that you end up doing to get licensed, and so it's a false dichotomy, it's a weird philosophical quirk that we've separated them at times. Um, but she's right because I looped back to the kind of psychiatry-adjacent work with my behavioral neurology. And so um my sub-sub-sub specialty within behavioral neurology is functional neurologic disorders, where people have seizures or weakness or sensory changes or vision changes that aren't because of a stroke, they're not because of epilepsy. And they used to be called psychogenic, but we're actually learning now that there are actually abnormal connections in the brain. And so functional neurologic disorder kind of tells that it's a neurologic disorder. That's why we put the term back in there, but it's also related to the network connectivity, so it's that things that shouldn't be connected got connected, or things that should be talking to each other got disconnected. And so uh, for example, I have a you know, patient where every time her cheek gets touched, her hand starts jerking and moving in a reliable way. And that's an odd thing. There shouldn't be a relationship between cheek touch and hand movement. So um it's something that big psychological events or pressures or stress can influence, but uh more generally that can happen post-surgery, post-anesthesia, post-injury, if you have chronic pain, if you have problems where your brain is always trying to keep you regulated and some external force, be it life event or biologic process otherwise elsewhere in your body, is causing it hard to be hard for your brain to maintain regulation. One of the ways that the dysregulation of the brain's kind of concept of self can happen, one of the failure points is FND. And so functional neurologic disorders is a really interesting and kind of newly developing part of neurogy. Uh, and it gets at who we are as people. What does it mean to be conscious? What does it mean to interact with each other? And how do brain states change that? And so uh it's kind of a thing that we're starting to learn that a large percentage of people with epilepsy also have depression. And the question is, is it just saddening to have a chronic illness? Or is there something about the brain networks that are seizing that also causes depression? And I would argue it's definitively the latter.

SPEAKER_00 10:10

Interesting, very interesting. Do you do any research now as part of your like normal, you know, routine and daily work?

SPEAKER_01 10:17

Yeah. Um, so I have a background a little bit in kind of brain mapping lab and stuff, but more so now I'm doing uh a little bit of clinical research, and then a lot more I'm getting involved in kind of setting standards. And so some of my publications are like how to talk to a school age kid, a teenager, a parent, a school, a therapist, an OT or a PT, like how to talk to different people about your needs and explain the condition at different levels of development or different relationships to the patient. Um, so kind of more of the um advocacy education side of things is more of my academic output at this point.

SPEAKER_00 11:00

Which is super important, I think, for kids, especially. Um, and I know that you or I noted actually in your email signature that you went to an osteopathic medical school. I'm curious if that was like a desire, or rather it just sort of happened, and then how that's kind of shaped what you feel like you're doing now.

SPEAKER_01 11:20

Um full transparency. Uh, I kind of knew very little about it uh at first. And then as I was kind of building my list of places to go, someone said, Oh, you should consider DO. And then I learned about it and got excited about it. And so uh it was something that spoke to me in terms of philosophy, and ultimately the education ends up being basically the same thing. Um, and you can do anything with an osteopathic degree, be a surgeon, be, you know, head of a hospital, whatever. Like it doesn't matter. Um, but the on-paper philosophy really mattered to me. And I think the person that likes the fact that I'm a DO the most is uh any of my friends or family who get benefit of manipulation and massage. Uh, so it's nice to be able to actually do a little bit of hands-on diagnosis and get those kind of 400 hours of hands-on and and touch and kind of feeling like where muscles are um in terms of their like set point of how tight they are versus how loose they are. And it has served me as a neurologist to be a little bit more comfortable with that kind of tactile thing, but you develop that in residency either way. Yeah. Um, but yeah, I can I can kind of use some of the hands-on techniques I learned in DO school to help aid in my diagnostics to understand, like, hey, uh, you say that this muscle is spasmed, but interestingly, it feels very similar to this other one. So, could it be your impression of how tight the muscle is rather than the actual tonic state of the muscle? And so it's been really helpful to me. I I love my osteopathic degree. I I think it really helped. And I I think I have enough reasons that I don't think this is just like a buyer's remorse confirmation bias sort of thing. I I think it's genuinely like something that has served me well. Uh, but those skills are absolutely attainable through the MD degree as well. So I I think it's something that ended up being a blessing for me, but uh it doesn't really matter. Go to whatever school will allow you to have a lifestyle that you really like with people you like near support that you, you know, have cultivated in your life, be it family, other friends, um, you know, whatever you like to do. If you're a concert person, go to a bigger city with concerts. If you're a person who likes to go hiking, go to somewhere with nice hiking. That's way more important than which school.

SPEAKER_00 13:49

Yeah, I think a lot of people, you know, for college admissions, everyone thinks about location because it's like, oh, well, you're going to college. Think about like where you want to live for four years. But I feel like for medical school, we've really lost that idea. And it's always just about like, well, how good of a school can you get into or what's the best here or whatever. But those kinds of things really matter. You're going to spend another four years of your life somewhere. You want to like where you are.

SPEAKER_01 14:12

And I would add that yes, there are there are still regions of the country and still uh institutions that care about that stuff. Um, and and especially within some of the other like more quote unquote competitive residencies. So if you want to do some of the things where they look at that, I can't tell you not to. But I would say that med school is tough, but it's also extremely rewarding. And so choosing a place that looks good on paper but is damaging to your well-being will not turn out a good doctor, will not turn out a compassionate doctor, will turn out a jaded person. Um, and some people are resilient to it no matter what, and you know yourself, but I think on average, the people who had a better med school experience have turned out as more well-adjusted doctors and more compassionate and don't hate medicine and don't hate their life and don't hate their patients, versus if you kind of hated your med school, that's the foundation of your identity as a physician. And how are you going to possibly turn into somebody who cares about your patients as much if you don't care about medicine because it hurt you? Yeah. So that's my perspective on that.

SPEAKER_00 15:35

But that makes a lot of sense. No, no, I I agree. Um, as I'm building my own list of where to apply, I'm trying to be broad because it's hard to get in, but I'm not going so broad that I'm applying to places I don't actually want to live in or places I don't actually want to go because why would I, you know, why would I do that?

SPEAKER_01 15:54

Yeah. And to kind of flip things a little bit on that, um, there was a stage in my career where I went to a smaller town that I had never heard of for some of my training. Um, now look at me. I I don't say this for the cred. I don't say this for gloating. I'm I went to the best child neurology program in the country at Boston Children's at one of the best children's hospitals in the country. I am currently working at one of the greatest hospitals in the country, and I only bring that up because I went to a deal school. So for anyone who's afraid of that, remember that. And I went to a smaller town for part of my training. Look at me now. I am now participating on an international stage in my field. And uh I think the reason to kind of look at my career for this purpose is to not be afraid to look elsewhere and to not be convinced that your life is over because any particular step didn't look like what you thought it was going to. So I had a great training experience in a smaller hospital, and actually I think there were benefits to it. I actually got more independence, um, I was able to kind of make uh more decisions, and then I had a little bit of a culture shock coming to a bigger hospital like Boston Children's during my training, because I tried to do something and they said, Well, you should ask nephrology about that. And I said, Well, no, that's the purview of me having finished pediatrics. Yeah, I can do that. And they said, Not here, you don't. Um, and and I don't want to besmirch them either, because it's incredible for the patient to have a lot of those like small electrolyte decisions made by a professional nephrologist. Um, but from a training perspective, having the bandwidth to do that is extremely helpful and makes you, I think, a more comfortable, confident physician, should you ever be in a spot where you don't have access to those resources. So pluses and minuses to everything. I think the most important thing are the people rather than the place. And when I the and the place matters for can you find the things that give you joy. Right. I if you're a forest and mountain person, I wouldn't go to a desert or prairie. But I think um as long as you're comfortable, you feel like you know, you can walk outside and take a deep breath and feel good about your life, that's what matters.

SPEAKER_00 18:29

Yeah. Wow, that's a great, that's a great way to say that and great advice, I think, for how to pick where you're going, but also how to feel about because you know, in in um the medical journey, there's a lot of times where you try all you can to make a choice, but sometimes the decision sort of gets made for you. You can't always go to your number one or number two or even number three place. So I think it's good perspective that things things will work the way sort of they're supposed to, and you just do the best you can to to find the right people in the right situation for yourself, and it'll it'll come come to what it's supposed to be.

SPEAKER_01 19:02

Yeah. Um, and an interesting quirk of the fact that I was a neuro-interested person in a gen pediatric program that wasn't turning out a lot of neurologists, was that they just gave me all the neurocases, and I learned a ton of neuro during my PEAD's time uh by virtue of, okay, well, I have to figure this out. I will consult with the neurologists to, you know, help me. But our program was just light on the field that I was interested in, and I thought that was going to be an issue, and it actually ended up being super helpful because I gained independent identity working in the field of my choice, so that when I hit residency, I was like, yeah, I've already managed these few bread and butter things of neurology. Of course, we sent the complicated stuff out, but then I also found ways to do rotations in the kind of big hospitals during my pediatric training. So those opportunities are there if you're driven. If you have any idea what you want to do, those cases will find you. So during my med school time, any opportunity where there were kids and my peers didn't really want to see kids. Hey Matt, do you want to see this person? Yes, sure. I'll go see the younger end of the spectrum on my internal medicine rotation. Oh, I'm on my PEDS rotation. All right, go see the neuro kid. I know you want to do that. Cool. During pediatric training, all of neurology flowed through me for my program just to you know allow me to come see, even when I wasn't on and I loved it. And then during neuro, hey, you like the kind of behavioral, kind of difficult social situation kids, right? Yeah, sure, go go deal with that. And so by the end of my neuro training, a lot of my clinic was already behavioral and FND. And I had mentors who were in that field who were the ones who helped cultivate my comfort and skill in there. So that when I went to go then do this as a profession and kind of build myself a little bit of a fellowship model, uh, I'd already been doing it. So if you know what you want to do or you have something that you're passionate about, uh it'll find you and you don't have to worry about where you are.

SPEAKER_00 21:23

That's super cool. That's awesome. Um I wanted to ask just a more tactical question because you just mentioned something about a fellowship. So you did, I know that pediatric neurology typically is you do a pediatrics residency and then you'll do like neurology, but almost as a subspecialty, or how how how is your path?

SPEAKER_01 21:42

So actually the most common version of it, like far and away the most common version of it, is it's actually one residency, child neurology. Okay, which as part of that residency, you do two years of pediatrics, unlike uh doctor. Neuro where they do one year of internal medicine, you do two years of pediatrics, and then you do three of neurology, and it's all baked into one. Um, where you do that pediatrics, still, it's one application can vary. So, uh, for example, you know, Boston Children's, I can tell you a little bit more about. You can do it at Boston Children's, but then there are pathways in from other centers, Western Mass. Uh, you can go do your PEDs there and then come in if you want more of that community-oriented thing. Now we have relationships, uh, they have relationships with somewhere, I believe, in New York. Um, and so you can do those pediatric things, those two years, and then come in. Less common, and what I did was finish pediatrics, and then during your second year of three of pediatrics, you apply to join a class who's done it through one application. So the terms, just so that I'm using the right terms, is categorical, which is all five years baked into one, you do one application. Then there is advanced, which means find your own two-year pediatrics or three-year pediatrics, but you apply when you're leaving med school and the position will wait for you. You'll join a class who's just done it there. And then the last form is reserved. Reserved is where you didn't apply when you're done with med school for neuro. You actually apply when you're in pediatrics and say, hey, I want to subspecialize in neuro. That will get you the three years of neurotraining, either after two of pediatrics or after three of pediatrics. And a big change that's happened recently is there's less requirement that you actually be a board-eligible pediatrician before you do your neurotraining. So it used to be very rigid that you had to fulfill all of the requirements of a pediatric board eligible person in order to train in child neuro. That's not true anymore. Um, now you can have a normal two years and then go on to do your neurotraining, whereas previously you had to shove all of the requirements into two years to be board eligible pediatrics and then do your three. So it's lightened a little bit, and people have different opinions on whether that's a good idea or a bad idea. Um, but I think uh I think now it's a little bit easier, and and there will be more walks of life of people who were like, yeah, I'm full of pediatrician. I want to do my reserve position. Hey, I know I want to do three years of pediatrics and then do my stuff. I'm gonna apply for that cycle of advanced position. Or hey, I know I want to do it right out of the gate. I'm gonna apply for a five-year single institution or multi-institution program for five years uh right out of med school. So there's different approaches, and then you can choose whether to condense your schedule into two to be board eligible or just ride it out like a normal PEEDS program would, where they're counting on you having a third to be board eligible, so you don't actually meet criteria to take the PEEDS boards, which is okay if that's not your preference.

SPEAKER_00 25:19

Well, that sounds like it's allowing for more like options and choice and less it's nice that it's less rigid. It also sounds like you could go into pediatric surgency and correct me if I'm wrong, not necessarily knowing if you're going to do PEEDS neuro and then decide a little bit later on.

SPEAKER_01 25:36

Yeah. One of the admittedly irritations from my perspective is that neuro isn't viewed as a fellowship. It's weird because cardio is viewed as a fellowship.

SPEAKER_00 25:47

Right.

SPEAKER_01 25:47

Um, but if you do three of pediatrics, you sit for the PEADS boards, and then you do three years of Neuro, I'm not clear why it's not a fellowship. And that has ramifications for whether it's counted as employment, whether it's got a higher salary, whether it's there are a lot of um things. And in fact, when you apply for jobs, they ask, have you done a fellowship? And the answer is no, even though you've just done five to six years of training and it's not a surgical specialty. So it is a little weird.

SPEAKER_00 26:22

But uh I'm sure though, if things are already changing in terms of applications and rigidity, I'm sure there will also be other shifts later on, or I hope rather that's I would hope so.

SPEAKER_01 26:33

Then the problem, sorry, I didn't mean to cut you off. No, I I just I I would hope that's true. Um I think that then the adult neuro people will say, well, does adult neuro count? Because you do three years of neuro after one year of internal medicine. Is that going to be a fellowship? And I think the problem is that we're viewing child neuro as very similar to adult neuro. And so why would one be a residency, one be a fellowship? And I think the reason that they went in the direction of saying you don't have to be a board eligible pediatrician is to more comfortably match what adult neuro is doing. Uh, so it's moving away from fellowship rather than towards, and I I don't know that that's a service or I it might be a disservice to the providers. I think that there should be more pathways for adult neurologists to be incredible internal medicine physicians who know every body system and then go on to do adult neurology. I I I think that after internal medicine and nephro, the next group that's managing blood pressures is neuro because of strokes. And so there's a lot of internal medicine dealing with the electrolyte shifts and the blood pressure. And then I don't know why it's not more common to just say you're a subspecialist. And it matters for billing because some hospitals can't bill when uh you know neuro comes uh as they they say it's a you know a separate field, but then a neurosubspecialist comes, epilepsy comes to see them, stroke comes to see them, and they don't see it as like a totally separate field. It's it's got a lot of um financial ramifications, is my point. And and I think it is a little odd, but I I think that's gonna change, like you said.

SPEAKER_00 28:23

Yeah. So that's actually a very interesting. I I'd never really thought about that or had anyone talk about that. So I'm I'm glad you bring it up. It's an interesting, you know, the these shifts that are getting made and why and and what influences how things are viewed and how how you can apply and and all that kind of stuff. It's all very tricky, but I'm glad to hear that you are so interested and passionate about what you're doing now. Um yeah.

SPEAKER_01 28:49

Yeah, I really, really do love it. I think uh I get to go to work and play with kids and call it a neuro exam. I get to uh talk to them, to their families, I get to talk to the people who care about them for a large percentage of the day, which is the schools or the daycares. And I it's a really a team sport because I really do support the it takes a village model of taking care of kids. And I think uh as the neurologist, I get to kind of be partly the team leader for that because um another really important decision for people who are really interested in the fact that the brain changes a lot very quickly, and that as a child neurologist, you're treating a little baby who has very different brain than a slightly older child, and you know, it kind of changes quite a lot. Um you can approach that same question from developmental pediatrics or from neurology, from child neurology. Um, and so I like the kind of understanding very deeply what is the brain doing during those phases, and then what are the failure types that can happen from deeply understanding the brain? I can kind of derive, hey, you have this early life insult, what is that going to look like for your development? Um, and understanding and more comfort with the MRIs and things like that. So that's an approach to the same question that very um skilled developmental pediatricians are also very knowledgeable about that stuff too, but they just don't have the broader foundation in kind of understanding it. Um, but I will acknowledge that neuro isn't for everyone just because we know so little about the brain compared to uh you know uh what hopefully we will eventually learn, and there are things we may never learn, and it definitely is a weird thing for the brain to study itself. And uh I had a mentor who said that the brain always pays a price for studying itself, that you know you need one part that doesn't work as well to be the outside observer to study the rest of it, and so um for me it's visual spatial. I can get lost going down the block. Um, and I think everybody in Nero kind of uh jokes about the fact that it is somehow damaging to have the brain study itself um, you know, playfully. So I think it's not for everyone, is my point.

SPEAKER_00 31:10

Yeah, sure. And some people really like going into something knowing that we know all about the system, and some people, like you, I'm sure, really enjoy sort of this this interesting like meta aspect, and also that there's so much more to learn.

SPEAKER_01 31:24

Yeah, I actually that cues up a really important thing. There's this idea that uh in Neuro it's like you debate about the question, and then you come up to a solution after solving this complex problem of where in the brain is this, and then there's nothing to do. Um, but the truth is now there's a lot more to do in the last like 10 years. So, first of all, um we now have drugs that are helping with cognitive decline and dementias. Um, but within child neuro, we have solved some really serious diseases. So, within some of the muscular dystrophies, where you're missing a gene that helps to make some of the proteins that actually like allow you to move your muscles, we have gene skipping technology that can get rid of something that's creating a protein that doesn't work and allow it to actually make something that works, maybe not as well, but it works. And so people with dystrophies are now allowing them to actually survive and thrive that they couldn't before. There's another condition that was potentially a death sentence, uh, spinal muscular atrophy, which in the last again, like a lot of the development in the last 10 years and really proliferation the last five years, has been initially a very expensive, very frequent spinal infusion. Then it went down to a one-time infusion, then it went down to an oral pill. And you still use all of these to different degrees, but we've solved it and we have people surviving and thriving. And there's a, I think he's collegiate at this point, soccer player who is potentially going to be a professional soccer player, um, topical for the World Cup going on right now. And he had a form of SMA that would have potentially been lethal to him as a child. And so we are in a really different place now. We are solving things. There are new anti-seizure medications all the time, there are new surgeries for anti-seizure medications, and then within my field of behavioral neurology, we're starting to understand these things. And so I don't know that we're that far away from a transcranial magnetic stimulation target to break up the network that's causing functional seizures or restore function of an arm. As a great example of something I just saw at a conference I went to, uh, there are people who have functional vision loss. They like can't see, but their brain's actually getting the information. They just can't consciously experience it. So they do a transcranial magnetic stimulation of the occipital lobe to make their occipital lobe see something, and then their brain goes, Oh, I can see, and it goes back. And so we've been able to one session cure people with like seven years of functional blindness. Uh, it doesn't work for everyone, but that's a really, really cool thing that we now can go, this is the network that's not working. Let's make it work. Um, some people who have functional weakness, this is a little less common, but like making their arm twitch with uh electrical stimulation either at the brain level or kind of locally, sometimes that helps. So we're solving some of these things that we used to just say, oh, you're hysterical, you're this is psychogenic, this is conversion of your feelings. No, we understand these are brain networks. We can actually uh scan the brains with fMRI and say, hey, that's what's not working. And now we have options that are developing to actually fix those networks. It's a really exciting time for neurology. I think we're not as helpless as we used to be. Um, and it's definitely a stereotype about the field that's gonna have to change. So um I think there is less of that like armchair philosopher of like nothing to do, but fascinating, isn't it? And now it's lots to do, fascinating still.

SPEAKER_00 35:15

Yeah, that's incredible. Well, thank you so much. Um, it's so wonderful how excited you are about all of this. Um, and thank you for sharing all sorts of things about what you've done and all these innovations that we can get excited about.

SPEAKER_01 35:30

Yes, thank you so much.