iiinova — where your digital self keeps evolving

Braydon Dymm, MD @befast.bsky.social · 25/08/2026

These are promising data, but there are reasons to remain skeptical. First, the detailed arm movement & dexterity exam results (FMA-UE & BBT) fell flat. For the miracle headline to be true, there must be a difference in participants' functional ability invisible to these exams.

Table showing detailed arm-function secondary outcomes. Arm motor status change on FMA-UE score, entry to weeks 8-12, mean (SD): Active 22.2 (±11.1) vs Sham 21.8 (±12.1); Risk ratio 1.09 (-3.22 to 5.41); standardized effect size 0.03 (0.0 to 0.41); P values 1.00 and 0.87. Arm function change on BBT, entry to weeks 8-12, mean (SD): Active 20.0 (±13.3) vs Sham 17.6 (±14.7); Risk ratio 3.02 (-2.45 to 8.48); standardized effect size 0.17 (0.0 to 0.55); P values 0.30 and 0.21. Neither measure shows a statistically significant difference between groups.

120

Braydon Dymm, MD @befast.bsky.social · 25/08/2026

So, when you pool these groups together—and pick the best secondary end point as your new primary end point—you get a significant result! Goodbye stroke disability 👋 But not just that, global mRS shift turned positive too. Awesome!

Stacked bar chart titled "mRS Distribution (BL to 8-12 Weeks; Pooled cohort)," combining data from both BrainQ3 and EMAGINE. Study entry Active: 12% mRS1, 88% mRS4. 8-12 Weeks Active: 3% mRS0, 34% mRS1, 48% mRS2, 10% mRS3, 5% mRS4. 8-12 Weeks Sham: 13% mRS1, 59% mRS2, 24% mRS3, 4% mRS4. Study entry Sham: 2% mRS0, 10% mRS1, 88% mRS4. The pooled Active group shows a dramatic shift from mRS4 at study entry to mostly mRS1-mRS2 by 8-12 weeks, a larger shift than seen in the Sham group.

Table 2, "Primary and Secondary Efficacy Outcomes," pooled analysis. Freedom-from-disability (mRS score 0-1) at weeks 8-12, n (%): Active ENTF stimulation 22 (37.3%) vs Sham stimulation 7 (13.0%); measure of effect Risk ratio 2.87 (95% CI 1.34 to 6.19); standardized difference for effect size 0.58 (0.21 to 0.95); P value adjusted for trial 0.006; P value adjusted also for outcome-related covariates 0.004. Disability level change on mRS score, entry to weeks 8-12, mean (SD): Active -2.1 (±0.8) vs Sham -1.7 (±0.7); t test, difference -0.40 (-0.69 to -0.11); standardized effect size 0.52 (0.14 to 0.89); P values 0.006 and 0.003. Ordinal level of disability (mRS score 0-1/2/3-6) at weeks 8-12, n (%): NA vs NA; Common odds ratio 2.95 (1.40 to 6.21); standardized effect size 2.95 (1.40 to 6.20); P values 0.006 and 0.01.

110

Braydon Dymm, MD @befast.bsky.social · 25/08/2026

The pilot led to the larger ElectroMagnetic Field Ischemic Stroke–Novel Subacute Treatment (EMAGINE) trial. Its chosen primary endpoint—global mRS shift—did not reach significance... but freedom-from-disability was borderline significant.

Table 2, "Primary and Secondary Efficacy Outcomes," from the EMAGINE trial, showing Mean (SD) for Active ENTF stimulation group (n=46) vs Sham ENTF stimulation group (n=46), with P values adjusted for prespecified covariates and adjusted for outcome-related covariates. Disability-level change on mRS, baseline to day 90: Active -1.96 (0.12) vs Sham -1.72 (0.12), P=.07 and .05. Freedom from disability at day 90 (mRS score 0-1), %: Active 12 (26%) vs Sham 5 (11%), P=.05 and .03. Functional independence at day 90 (mRS score 0-2), %: Active 38 (83%) vs Sham 34 (74%), P=.29 and .33.

Stacked bar chart from the EMAGINE trial showing distribution of modified Rankin Scale (mRS) levels 1-4, as percent, across four groups. Active ENTF stimulation group at baseline: 6% mRS1, 94% mRS4. Active ENTF stimulation group at day 90: 26% mRS1, 57% mRS2, 11% mRS3, 7% mRS4. Sham ENTF stimulation group at day 90: 11% mRS1, 63% mRS2, 22% mRS3, 4% mRS4. Sham ENTF stimulation group at baseline: 6% mRS1, 94% mRS4. The active group shows a much larger shift toward lower (better) mRS scores by day 90 than the sham group.

110

Braydon Dymm, MD @befast.bsky.social · 25/08/2026

BrainQ3 ended early due to disruption from the COVID pandemic, but it showed really promising results. With data from the 21 participants who completed it, there was a dramatic shift towards the mRS 1 category (stroke symptoms but no disability).

Table 2 from the BrainQ3 pilot study comparing Sham group (n=8) to ENTF group (n=13). Primary outcome measures: FMA-UE Week 4, Sham 9.6±9.0 vs ENTF 23.2±14.1, significance 0.007; FMA-UE Week 8, Sham 23.1±14.1 vs ENTF 31.5±10.7, significance 0.06. Secondary outcome measures: mRS Week 8, Sham -1.3±0.5 vs ENTF -2.5±0.7, significance 0.0005.

Two-panel figure from the BrainQ3 pilot study. Panel A: a slope/spaghetti plot tracking each patient's modified Rankin Scale (mRS) score, 0 to 5, from baseline to Week 8, with ENTF patients' lines trending toward lower (better) scores than Sham patients' lines. Panel B: stacked bar chart of mRS distribution at Week 8 — Sham group is 25% mRS0, 38% mRS1, 38% mRS2; ENTF group is 15% mRS0, 62% mRS1, 15% mRS2, 8% mRS3.

110

Braydon Dymm, MD @befast.bsky.social · 25/08/2026

This was a striking statement, so I dug into it. Saver et al pooled indv patient-level data from 2 double-blind, randomized, sham-controlled studies: BrainQ3 Trial (n=24) & EMAGINE 1 (n=100). One positive pilot & one larger study that failed to meet its primary end point.

Journal article title page from Frontiers in Neurology, 13 November 2022, Stroke section, Volume 13, 2022. Title: "Frequency-tuned electromagnetic field therapy improves post-stroke motor function: A pilot randomized controlled trial." Authors listed include Batsheva Weisinger, Dharam P. Pandey, and Jeffrey L. Saver.

Journal article title page from JAMA Network Open, Vol. 8, No. 10. Section: Original Investigation, Neurology. Title: "Electromagnetic Stimulation to Reduce Disability After Ischemic Stroke: The EMAGINE Randomized Clinical Trial." Authors listed include Jeffrey L. Saver, MD, Pamela W. Duncan, PhD, and Joel Stein, MD.

110

Braydon Dymm, MD @befast.bsky.social · 25/08/2026

The idea behind electromagnetic network-targeted field (ENTF) brain stimulation is to stimulate post-stroke brains with oscillating fields similar to those of a healthy brain. One such device is manufactured by BRAIN.Q which funded the study.

110

Braydon Dymm, MD @befast.bsky.social · 25/08/2026

The latest Stroke journal has a meta-analysis that boasts an amazing conclusion. Tripled freedom-from-disability! What is this miracle therapy? Is noninvasive brain stimulation for stroke rehab finally for real? 🧵

Graphic titled "ENTF Therapy Triples Freedom-From-Disability After Stroke." Study cohort: n=124 patients (65 ENTF, 59 sham), 4-21 days post-ischemic stroke. Diagram of the ENTF device, a helmet-like coil frame around a head. Bar chart of mRS distribution (baseline to day 90, pooled cohort) showing four groups: Baseline Active, D90 Active, D90 Sham, and Baseline Sham, each split into mRS0-mRS4 categories. The D90 Active group shows much larger green/light-green (low disability) segments than D90 Sham. Caption: intervention was 40-45 ENTF neuromodulation sessions delivered concurrently with rehabilitation therapy; outcome at 90 days showed about 3x higher recovery, NNT = 4.6.

140

Braydon Dymm, MD @befast.bsky.social · 20/08/2026

January 1st, 2026? Sure, why not

Price performance of computation, 1939–2023

000

Braydon Dymm, MD @befast.bsky.social · 08/08/2026

Bots are a majority of internet traffic and soon they’ll outnumber humans 1000:1. So I looked around for efforts to make a human-only internet. And I found this…. and it’s the most Claude thing ever.

020

Braydon Dymm, MD @befast.bsky.social · 02/08/2026

It uses thinking to pre-process an answer. It can functionally think ahead and give hints.

110

Braydon Dymm, MD @befast.bsky.social · 10/07/2026

Looks like the Wikipedia page will need updating

020

Braydon Dymm, MD @befast.bsky.social · 30/06/2026

Strongly dislike health clinics hosting AI slop anatomy references. No, this is not the vagus nerve. And no, the stomach is not the liver.

Healthpoint Osteopathic Clinic - AI-generated false depiction of anatomy.

140

Braydon Dymm, MD @befast.bsky.social · 22/05/2026

There are 3 metaphors floating around to describe negative relationship dynamics with AI. - Cyranoid (from the classic play Cyrano de Bergerac) - Cordyceps (a genus of parasitic fungi) - The Borg (Star Trek baddie) So of course I used AI to make an infographic.

Infographic of 3 bad relationship dynamics with AI: Cyranoid, Cordyceps, & The Borg

000

Braydon Dymm, MD @befast.bsky.social · 17/05/2026

Apparently there’s disagreement about whether zero WBCs are required as well

120

Braydon Dymm, MD @befast.bsky.social · 17/05/2026

The APGAR score is not named for the mnemonic’s components, but for Dr. Virginia Apgar who created it.

010

Braydon Dymm, MD @befast.bsky.social · 11/05/2026

I just ordered @tyrangiel.bsky.social‘s book, AI for Good. Like any technology, AI is a double edged sword. I’m most interested in amplifying the good stuff.

0136

Braydon Dymm, MD @befast.bsky.social · 21/04/2026

8) Asundexian for Secondary Stroke Prevention (phase 3 OCEANIC-STROKE trial) - asundexian at a daily dose of 50 mg resulted in lower risks of ischemic stroke and major cardiovascular events than placebo, without a higher risk of major bleeding

100

Braydon Dymm, MD @befast.bsky.social · 21/04/2026

7) ICECAP: In comatose survivors of out-of-hospital cardiac arrest, longer cooling duration did not improve outcomes, arguing against simply extending hypothermia time and toward better patient selection instead. Very interesting adaptive design!

100

Braydon Dymm, MD @befast.bsky.social · 21/04/2026

6) METEOROID: Satralizumab cut relapse risk by 68% in relapsing MOGAD versus placebo, with benefit emerging by week 8, significant gains on key secondary endpoints, and a safety profile comparable to placebo.

100

Braydon Dymm, MD @befast.bsky.social · 21/04/2026

5) ACUITY: In acute optic neuritis, privosegtor improved low-contrast visual acuity, preserved retinal structure, lowered neurofilament light, and was well tolerated, suggesting a neuroprotective effect beyond symptom recovery.

110

Braydon Dymm, MD @befast.bsky.social · 21/04/2026

4) Ecopipam: In pediatric Tourette syndrome, ecopipam reduced relapse risk by 50% versus placebo in this withdrawal trial, supporting more durable maintenance of benefit.

110

Braydon Dymm, MD @befast.bsky.social · 21/04/2026

3) Zilganersen: In Alexander disease, the first potential disease-modifying therapy showed statistically significant and clinically meaningful stabilization of gait speed, with secondary endpoints and broader symptom measures also generally favoring treatment.

110

Braydon Dymm, MD @befast.bsky.social · 21/04/2026

2) NIMBLE: Cemdisiran given subcutaneously every 3 months met the primary and key secondary endpoints in generalized myasthenia gravis, with rapid, sustained, clinically meaningful improvement, no waning through the dosing interval, and no added benefit from combination therapy.

110

Braydon Dymm, MD @befast.bsky.social · 21/04/2026

1) Essential3: Ulixacaltamide became the first positive phase 3 program in essential tremor, showing clinically meaningful, durable benefit across studies and subgroups, was generally well tolerated, and now has FDA Breakthrough Therapy designation.

110

Braydon Dymm, MD @befast.bsky.social · 21/04/2026

Big news from the AAN 2026 Clinical Trials Plenary: breakthrough treatments & several other major trial readouts that could shape neurology practice 👇

161

Braydon Dymm, MD @befast.bsky.social · 18/04/2026

Personally, I am hopeful. Especially for stroke prevention. LAMP is a trial that deserves a confirmatory follow-up.

010

Braydon Dymm, MD @befast.bsky.social · 18/04/2026

The AAN highlights a study on GLP-1s on migraine. It's an observational study, but the results are promising to reduce migraine attacks and visits to the emergency room.

110

Braydon Dymm, MD @befast.bsky.social · 18/04/2026

I'm at the first plenary session of #AANAM - Controversies in Neurology. Question 3 - Are GLP1s More Hype Than Hope?

120

Braydon Dymm, MD @befast.bsky.social · 18/04/2026

Also worth flagging: APOE ε4 carriers may represent a particularly responsive subgroup

000

Braydon Dymm, MD @befast.bsky.social · 18/04/2026

The audience poll was split, slightly leaning yes. The AAN has highlighted a trial that shows a positive link, but that does not prove that hormone therapy causes changes in memory

100

Braydon Dymm, MD @befast.bsky.social · 18/04/2026

And what really counts as a "Medium Vessel" anyway? Is a proximal/dominant M2 really "medium"? Or should we consider it "large"?

110

Braydon Dymm, MD @befast.bsky.social · 18/04/2026

Despite disappointing results from the MeVO trials, the majority of the audience voted yes. To be fair, the answers yes/no don't capture the nuance, and the better answer is closer to "it depends..."

110

Braydon Dymm, MD @befast.bsky.social · 09/04/2026

Cygnus X-1, the first discovered black hole, is now cemented into popular culture. Rush wrote a two-part prog rock epic about it in 1977. A season 7 Futurama episode opens with a tagline about it. And NASA published this awesome fake movie poster!

NASA's "Galaxy of Horrors" poster for Cygnus X-1

110

Braydon Dymm, MD @befast.bsky.social · 09/04/2026

The supergiant loses about one solar mass every 400,000 years to stellar wind. The black hole warps that wind, pulling material into an accretion disk heated to millions of degrees. That's where the X-rays come from.

X-ray image of Cygnus X-1 taken by a balloon-borne telescope, the High-Energy Replicated Optics (HERO) project

100

Braydon Dymm, MD @befast.bsky.social · 09/04/2026

How do you confirm a black hole? The companion star's spectrum showed Doppler shifts from a 5.6-day orbit. The math gave a companion mass too heavy to be a neutron star. And Uhuru satellite data showed X-ray flickering on millisecond timescales -- the source had to be tiny.

A blue-band light curve for Cygnus X-1, adapted from Kemp et al. (1987)

100

Braydon Dymm, MD @befast.bsky.social · 09/04/2026

Stephen Hawking bet Kip Thorne that Cygnus X-1, the source of the X-rays, was NOT a black hole. He called it an "insurance policy" -- if black holes didn't exist, at least he'd win a subscription to Private Eye magazine.

100

Braydon Dymm, MD @befast.bsky.social · 09/04/2026

The system was found in 1964 by Geiger counters on a rocket launched from White Sands Missile Range. The rocket spun as it flew, sweeping the counters across the sky to find new sources of cosmic X-rays. That's how we found the first black hole.

100

Braydon Dymm, MD @befast.bsky.social · 09/04/2026

The black hole's event horizon is about 44 km across: smaller than a mid-sized city. It orbits a blue supergiant star 20+ times wider than the Sun. Most art makes the black hole huge. Beautiful, dramatic... and wrong. In reality you'd barely see it next to its companion.

Stylized not-to-scale space illustration of the Cygnus X-1 system. On the right, a huge blue-white companion star fills much of the frame and blows a bright stream of gas toward a black hole on the left. The black hole is surrounded by a large glowing orange-red accretion disk with a dark center. A narrow blue-white jet shoots vertically above and below the disk. The background is black and filled with stars.

100

Braydon Dymm, MD @befast.bsky.social · 09/04/2026

Cygnus X-1 was the first black hole ever discovered. I commissioned what I think is the first actually to-scale artistic depiction of it. This matters because Cygnus X-1 is wildly interesting once you understand what you’re actually looking at. 🧵

A labeled space illustration of the Cygnus X-1 system. On the left, a huge glowing blue supergiant star fills most of the frame, with only part of its curved edge visible. On the right, the black hole companion is shown at the correct scale as an almost invisible point, highlighted by a magnified inset circle labeled “Accretion disc diameter ~15000 km.” The inset shows the tiny bright accretion disk around the black hole. White measurement lines label the star’s radius as 0.1 astronomical units and the distance from the star’s surface toward the black hole as 15 million km, also marked as 0.1 AU. The caption “Cygnus X-1” appears at the bottom. Commissioned artwork.

2111

Braydon Dymm, MD @befast.bsky.social · 05/02/2026

The main event concluded with Tirofiban for Branch Atheromatous Disease-Related Stroke (aka STRATEGY): This trial was unable to show a significant effect. Compare to last year’s trial with argatroban (PubMed: 40242875).

000

Braydon Dymm, MD @befast.bsky.social · 05/02/2026

Following up on the MMA embolization trials that dominated ISC in 2024, EMBOLISE found a 2-fold reduction in the composite primary outcome.

100

Braydon Dymm, MD @befast.bsky.social · 05/02/2026

TNK-PLUS examined TNK for late-presenting ischemic stroke patients, but unlike OPTION, they included thrombectomy patients. This design mirrors TIMELESS. And just like TIMELESS, they did not see functional improvement when TNK was combined with thrombectomy.

100

Braydon Dymm, MD @befast.bsky.social · 05/02/2026

This was immediately followed by similar study focusing on late-presenting posterior circulation strokes who get thrombectomy: ATTENTION LATE In contrast, there was no significant difference in outcomes.

100

Braydon Dymm, MD @befast.bsky.social · 05/02/2026

Next up: “Tenecteplase for acute non-large vessel occlusion at 4.5-24 hours” aka OPTION Results support treatment for a higher likelihood of an excellent functional outcome than standard medical care, although an increased risk of symptomatic intracranial hemorrhage.

100