Neurology requires some detective work at times, and identifying the patterns of symptoms associated with drug misuse can be a tricky mystery indeed. For this episode, we're receiving a masterclass from Dr. Robin Howard¹ on the wide variety of drugs that bring patients into hospital, as well as the mechanisms they act on. His paper "Neurological aspects of drug misuse" is the Editors' Choice for the October 2025 issue, and he joins PN podcast editor Dr. Amy Ross Russell in the studio. From the new dangers of synthetic psychoactives to the profound consequences of chronic use, the discussion unveils critical clinical presentations every neurologist should recognize. We delve into fascinating phenomena including "punding," compulsive repetitive behaviors seen with stimulant abuse, and the rare but striking CHANTER syndrome, with its signs of disturbed consciousness and extensive cerebellar involvement. Hear too about the distinctive spongiform leukoencephalopathy associated with "chasing the dragon," a dangerous method of heroin inhalation, but which can also be caused by cocaine usage. Read the paper: https://pn.bmj.com/content/25/5/411 (1) Guy's and St. Thomas’ NHS Foundation Trust, London, UK Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production by Amy Ross Russell and Brian O'Toole and editing by Brian O'Toole. Thank you for listening.

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