Neurology

Neuromuscular

Questions discussed in this category

What treatment do you recommend for patients with meralgia paresthetica?

Can Guillain-Barre syndrome present with intact reflexes?

Do you typically recommend a wash-out period when switching patients with myasthenia gravis from Soliris to Vyzvart?

Do you switch MG patients from Soliris to Vyzvart due to cost, and with switching do you have a recommended wash out period?

1 Answer available

Do you typically see peripheral neuropathy in patients with castleman syndrome?

2 Answers available

Would the concerns about respiratory side effects from sodium phenylbutyrate and taurusodiol change your management of patients with predominantly bulbar ALS?

3 Answers available

Do you ever refer patients for surgery with significant peripheral neuropathy and lumbosacral radiculopathy?

Is there any role for a surgical intervention in patients with distal weakness, who has marked peripheral neuropathy but also lumbosacral radiculopath...

1 Answer available

How do you manage myasthenia gravis in patients over the age of 90?

What is the best way to treat late onset myasthenia gravis (in this case, age >90)? Would the newer complement inhibitors be safe? Steroids in this...

2 Answers available

How do you account for a normal EMG/NCS in the setting of prolonged clinical symptoms suggestive of a radiculopathy?

How do you account for a normal EMG/NCS in the setting of prolonged clinical symptoms suggestive of a radiculopathy? How do you explain this to patien...

3 Answers available

Do you use isosorbide dinitrate spray for the treatment of neuropathic pain?

1 Answer available

When do you recommend genetic testing in patients with neuropathy?

1 Answer available

Do you screen for any environmental exposures in patients with newly diagnosed ALS?

Are there any environmental exposures you ask about for newly diagnosed ALS patients?

1 Answer available

Do you typically encounter phrenic involvement in patients with CIDP?

Do you see improvement with treatment such as IVIG?

1 Answer available

When is a paraneoplastic panel indicated when working up patients with neuromuscular conditions?

1 Answer available

How do you approach malignant plexopathy?

In patients with hx of metastatic cancer, presenting with unilateral proximal arm weakness. No checkpoint inhibitors use. Which CSF lab...

1 Answer available

How do you counsel patients on the side effects of sodium phenylbutyrate and taurursodiol?

3 Answers available

Do you typically assess plasma levels of the phosphorylated axonal neurofilament H subunit (pNF-H) in patients with ALS?

3 Answers available

How clinically meaningful are the differences in primary outcome between treatment and placebo groups in the CENTAUR trial?

Will these results change your practice?

3 Answers available

Based on its mechanism of action, do you think sodium phenylbutyrate and taurursodiol could have benefit in other neurodegenerative disorders?

3 Answers available

How do you approach pain management in patients with idiopathic polyneuropathy?

3 Answers available

For patients with refractory seropositive myasthenia gravis who have failed other oral and infusion meds and are dependent on frequent IVIG could efgartigimod be an option to wean off/replace IVIG?

1 Answer available

What would be the differential and initial work-up for tongue fasciculation?

3 Answers available

What is the significance of isolated increase of Asialo-GM1 antibodies with nerve conduction suggestive of sensory motor axonal polyneuropathy?

1 Answer available

When would you add acyclovir for treatment of Bell's Palsy in addition to steroids and symptomatic care?

1 Answer available

What is your preferred medical treatment of carpal tunnel syndrome that recurs after carpal tunnel release?

1 Answer available

When treating sialorrhea in ALS patients, what treatment schedule do you use?

Assouline et al., PMID 24411632 recommend delivering 500cGy x 4 fractions = 2000cGy on days 1, 3, 8, 10. Do you follow this schedule, treat every othe...

4 Answers available

How do you manage patients with a diagnosis of AIDP who do not respond to initial IVIg?

2 Answers available

What is your approach to treatment of benign fasciculation syndrome?

1 Answer available

How do you manage a diabetic patient with generalized myasthenia gravis post thymectomy previously treated with Imuran?

1 Answer available

Do you screen for paraneoplastic antibodies in patients with suspected ALS?

2 Answers available

How does failure to recover clinically after >2 years in a patient with suspected diabetic amytrophy shift diagnostic and therpeutic approach?

1 Answer available

Do you typically pursue EMG/nerve conduction study in patients who already have a clinical diagnosis of myasthenia gravis?

1 Answer available

When do you redose IVIG in GBS patients who were under-treated and are worsening?

Is there any data supporting this?

2 Answers available

Does use of imaging influence diagnostic accuracy and patient outcome in patients with suspected CIDP?

In patients with suspected CIDP, does the use of imaging—MRI (thickening or abnormal enhancement of cervical/lumbar nerve roots or brachial/lumb...

2 Answers available

When do you typically check vitamin B5 levels in patients with peripheral neuropathy?

B5 deficiency can be seen in patients with burning feet syndrome, do you typically screen for this when assessing for neuropathy?

1 Answer available

When do you consider immunosuppression in patients with Sjogren's neuropathy?

3 Answers available

How would you treat a patient with small fiber neuropathy and elevated FGFR3 titers of 6000?

1 Answer available

Which is the preferred infusion therapy (Efgartigimod alfa, eculizumab or ravulizumab) for patients not responding to oral treatment with Seropositive Generalized Myasthenia?

1 Answer available

Why do we not typically see features of rhabdomyolysis or acute kidney injury with idiopathic inflammatory myopathies?

1 Answer available

How do you approach the workup for patients with hyperCKemia and positive NXP2 with no clinical symptoms?

1 Answer available

How long do you hold pyridostigmine prior to EMG / nerve conduction study in patients with suspected myasthenia?

1 Answer available

When do you trial pyridostigmine in a patient with suspected myasthenia gravis?

Is there a role for using a trial of pyridostigmine as a diagnostic aid in a patient with suspected (but not confirmed) myasthenia gravis?

1 Answer available

Do you treat patients with riluzole who have ALS and a valosin-containing protein mutation?

Does your management change in any way?

1 Answer available

How do you decide on initiation of treatment with steroids or immunomodulatory therapy in patients with statin-induced myopathy versus statin-induced autoimmune necrotizing myopathy?

In patients presenting with likely statin-induced myopathy versus statin-induced autoimmune necrotizing myopathy - how do you approach the decision re...

3 Answers available

How do you counsel young adults with antibody-negative necrotizing myopathy on prognosis and long-term monitoring/treatment?

How do you counsel young adults with antibody-negative necrotizing myopathy on prognosis, risk of recurrence, and long-term monitoring/treatment?

1 Answer available

Do you ever use IVIG in patients with parsonage-turner syndrome?

1 Answer available

What workup do you do for patients who have PL-7 elevation when screening for myopathy?

2 Answers available

How do you work up patients who present with elevated myoglobin in the setting of normal creatinine kinase and exercise intolerance?

For patients who present with elevated myoglobin in the setting of normal creatinine kinase and exercise intolerance, what work up process do you typi...

1 Answer available

How do you interpret a mildly positive NT5C1A lab test in patients with hyperCKemia?

1 Answer available

What workup do you recommend for patients with low back pain and imaging concerning for spina bifida occulta?

What referrals do you recommend/imaging orders?

1 Answer available

At what point do you recommend muscle biopsy in the workup for myositis?

1 Answer available

When do you send AChR+ ocular myasthenia gravis patients for thymectomy?

How do you decide if and when to send patients with AChR+ ocular myasthenia gravis for thymectomy?

1 Answer available

When do you use plasmapheresis after IVIG in patients with Guillain-Barre Syndrome?

4 Answers available

When would you suspect metabolic myopathy and what is your approach to initial workup?

2 Answers available

What is the role of x-ray of the cervical or lumbar spine in patients presenting with radicular symptoms?

I teach my students/residents that they should hardly ever get routine X-rays in patients presenting with radicular symptoms. MRI far better for seein...

4 Answers available

How do you treat anti-HMGCoA myopathy?

3 Answers available

What is the first line therapy for demyelinating neuropathy with positive NF-155 antibodies?

1 Answer available

At what stage of the neuropathy workup do you screen for B6 toxicity?

2 Answers available

How do you treat lupus-associated small fiber neuropathy?

1 Answer available

How would you approach evaluation and treatment of a patient on pembrolizumab therapy who presents with symmetric, proximal, upper extremity and lower extremity painful weakness without an elevated CK?

1 Answer available

Have you seen patients who develop neuromuscular disorders following COVID-19 vaccination?

1 Answer available

Do you recommend EMG/NCS in all patients with clinical findings of carpal tunnel syndrome?

4 Answers available

At what point is a skin biopsy indicated in patients with neuropathy?

1 Answer available

How do you manage a patient with inclusion body myositis?

Is there a role for immunomodulatory therapy?

2 Answers available

What is the importance of finding a positive titer for FGFR3 and what treatment would be advised for these patients?

1 Answer available

When do you initiate immunosuppressant drugs for patients with a diagnosis of myasthenia gravis?

1 Answer available

What workup do you start in patients with evidence of demyelination on EMG/NCS?

At what point do you consider genetic testing?

1 Answer available

Do you start Riluzole on all patients diagnosed with ALS?

Are there any reasons you avoid therapy?

2 Answers available

When would you consider treatment with steroids in patients with diabetic radiculoplexus neuropathy?

Are there any alternative treatments?

1 Answer available

At what timepoint do you do an EMG/NCS in patients with suspected GBS?

How long do you wait (from onset of symptoms) to do a EMG/NCS in a patient with GBS?

1 Answer available

How do you differentiate motor neuron disease from limb girdle muscular dystrophy on electrodiagnostic testing?

What other workup/clinical examination findings do you look for?

1 Answer available

In a patient with suspected Miller Fisher syndrome, would you wait until antibody testing results to start IVIG or treat empirically?

Is there is a particular pattern of extraocular motility restriction in Miller Fisher syndrome?

1 Answer available

In patients with Duchenne Muscular Dystrophy who have an exon 51 mutation, do you treat with both prednisone and Eteplirsen?

What are common side effects to look out for with Eteplirsen?

1 Answer available

In patients with clinically probable ALS, what other mimicking pathology do you rule out before establishing the diagnosis?

Ie through electrodiagnostic, imaging, and otherwise?

2 Answers available

Is an EMG/NCS required to clinically diagnose Guillain barre syndrome?

1 Answer available

How do you approach the use of biologics in patients with a history of Guillain-Barre syndrome?

1 Answer available

How do you monitor response to treatment in patients with mononeuritis multiplex secondary to vasculitis?

Given the slow recovery of nerve damage, what would you expect to see on a repeat EMG after treatment? Continued denervation or just sequelae of past ...

1 Answer available